Endometrial hyperplasia and cancer: Clinical

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Endometrial hyperplasia and cancer: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 58-year-old woman comes to the office because of vaginal bleeding. She experienced an episode of bleeding two months ago for the first time since menopause five years ago. The episode lasted for two days and was lighter in flow than her previously normal menses. She experienced another episode of bleeding this week that lasted three days that was similar in flow to her normal menstrual cycles. Other than some minimal cramping, she denies pain with these episodes. In the past she had normal menstrual cycles and gave birth to one full-term boy via spontaneous vaginal delivery at 32 years old. She went through menopause at the age of 54 and was treated with hormonal replacement therapy for nine months due to severe hot flashes. Her past medical history is otherwise noncontributory. Her BMI is 35 kg/m2. Which of the following is the most likely diagnosis?


Content Reviewers

Endometrial cancer or endometrial carcinoma is when cancer cells arise in the glands within the lining of the uterus.

Initially the abnormal growth is called endometrial hyperplasia, a precancerous lesion that can eventually progress to endometrial cancer.

Now, the main cause of endometrial hyperplasia and cancer is excess estrogen - either endogenous or exogenous.

In fact, estrogen has a cumulative effect throughout a female’s lifetime - so risk factors include early menarche or late menopause, both of which increase the number of ovulatory cycles, each of which contributes to a spike in estrogen.

Females who have never been pregnant are also at risk - because they don’t have a pause in their menstrual cycles.

Additionally, obese females are also at risk, because excess adipose tissue converts adrenal androgens to estrogen.

Another risk factor is chronic anovulation, like with polycystic ovarian syndrome. That’s because the ovarian follicles keep secreting estrogen, and there’s no luteal phase progesterone to counteract its effects on the endometrium.

Iatrogenic causes include hormone replacement therapy with estrogen, as well as tamoxifen, a breast cancer medication that blocks the estrogen receptor in the breast, but stimulates the estrogen receptor in the uterus.


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