abnormal vaginal bleeding - kusm-w wesley …...abnormal vaginal bleeding a 35-year old patient...
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ABNORMAL VAGINAL BLEEDINGA 35-year old patient visit the gynecologist’s office complaining of 6 month of menometrorrhagia. The patient state that she started having menstruation at age 13 and that she has had regular menses until
the past six months. A BHC-G test is performed and is normal. A pelvic exam is normal and a pap smear is normal. The gynecologist begins to worry
about anatomic lesions though the pelvic examshowed no vaginal lacerations or lesions and the
cervical exam and pap smear showed no evidence of a polyps/tumors or cervicitis. A pelvic exam,
ultrasound, a hysteroscopy and endometrial sampling is performed.
Proliferative
Secretory pattern endometrium
FOCAL DOLPHINS
Persistent proliferative phase/Disordered proliferative endometrium
• Focal glandular disorganization anddilatation most likely related to chronic
anovulation, interspersed within normalglands
Proliferative with glandular andstromal breakdown.
Endometrial polyp
1 to 1
SIMPLE HYPERPLASIA
3:1
Complex hyperplasia without atypia
Complex hyperplasia with atypia
ENDOMETRIOID FIGO GRADE 1
FIGO GRADE 2 ENDOMETRIOID
FIGO Grade 3
MMT
SKINNY ELDERLY, ATROPHIC , p53 POSITIVE, ER NEGATIVE
Serous carcinoma
CLEAR Cell carcinoma
Leiomyoma
leiomyosarcoma
ER negative p16 positive CEA and HPV positive
PROGESTIN EFFECT vs HYPERSECRETORY/GESTATIONAL
Endometrial curettings with atrophic endometrial surface epithelium with no good gland formation.
Chronic endometritis
Sarcoma botyroides (embryonal rhabdomyosarcoma)