12 Endometriosis Endometrial foci outside the uterus Results in dysmenorrhea, infertilityCommon in pelvis, ovary, tube, ligaments, or any other sitesTheoryRegurgitation theoryMetaplastic theoryVascular and lymphatic dissemination theory
17 Adenomyosis Endometrial foci within the myometrium Usually of the basal layer endometriumUsually non-functioningFindings:Thick uterine wall with small cystic areasEndometrial tissue in the myometriumSymptoms: pain, menorrhagia, dysmenorrhea
35 Tumors of the endometrium Endometrial carcinomaSurvival: 5-year survivalStage I (limited to uterine cavity): 90%Stage II (extend to cervix): 50%Stage III (outside the uterus): 20%
36 Tumors of the Myometrium LeiomyomaLeiomyosarcoma
37 Tumors of the Myometrium LeiomyomaMost common benign tumor in female30-50% of women at reproductive ageBlack>White?Estrogen relatedShrink postmenopausalClinically: asymptomatic, mass lesion, menorrhagia
38 Tumors of the Myometrium LeiomyomaFindings:Sharply circumscribed , firm, white gray, whorled cut surfaceIntramural, submucosal, subsersalSmooth muscle bundlesSecondary changes: cystic change, hemorrhage, degeneration
43 Tumors of the Myometrium Leiomyosarcoma:MalignantDe novo (rarely arise in leiomyoma)Large mass, infiltrating the wall, or polypoid, sometime similar to leiomyomaSmooth muscle bundles: Mitosis, atypia, necrosisOverall 5-year survival: 40%
45 A massively obese (5'3", 275 pounds), 55-year-old, sexually active woman, nulligravida (no pregnancies), presented to her gynecologist because of vaginal spotting for 1 year. Her medical history included non-insulin-dependent diabetes mellitus and medically controlled hypertension, both diagnosed at age 43. Her gynecologic history included: menarche, age 11; coitarche, age 20; lifetime sexual partners, 2; 6 menses/year until age 51 when she became menopausal and her menstrual periods stopped.
48 Following the biopsy, the patient was lost to follow-up for 8 years Following the biopsy, the patient was lost to follow-up for 8 years. She is now brought to the ER after fainting at home. Her hemoglobin is 5 g/dL. Endometrial biopsy is repeated, followed by a simple hysterectomy with bilateral salpingo-oophorectomy.