abnormal vaginal bleeding - kusm-w wesley …...abnormal vaginal bleeding a 35-year old patient...

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)