••• Chapter 51^ Gynecologic Pathology^507
❍ In an endometrial biopsy, you see pronounced stromal edema, moderate glandular secretions, an absence of
stromal/glandular mitoses, markedly tortuous glands, and no significant decidual change. Approximately
what day of the 28-day cycle is the biopsy obtained from?
Approximately day 22. Day 22 is when stromal edema is maximal and glandular secretions are just beyond their
peak (day 20 or 21) and predecidual change has not become evident yet.
❍ What is the most common site of endometriosis?
The ovary.
❍ What is the name of the phenomenon that tends to occur in pregnancy and is characterized by a focus of
tightly clustered endometrial glands that appear hypertrophic and demonstrate nuclear pleomorphism and
cytoplasmic vacuolization?
Arias-Stella reaction (which can be confused with clear cell and adenocarcinoma in situ of the cervix.
❍ What substances are produced by the corpus luteum and are important in regulating the secretory phase of
the endometrium?
Estradiol and progesterone.
❍ What is the basic mechanism by which clomiphene citrate is useful as a fertility drug?
Clomiphene citrate decreases endogenous estrogen thus resulting in secretion of gonadotropin-releasing
hormone and then follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This, hopefully, results
in ovulation.
❍ What is the most common cause of dysfunctional uterine bleeding in reproductive age women?
Anovulatory cycles.
❍ What is the most common cause of postmenopausal endometrial bleeding?
Endometrial atrophy (60%). Remember, endometrial carcinoma must be considered but is the cause in only 10%
of the time.
❍ What is the most common etiology of chronic endometritis?
It is most commonly an ascending infection by way of the cervix following such things as abortion or
instrumentation.
❍ What are the most common etiologic agents of chronic endometritis?
Chlamydia trachomatis and Neisseria gonorrhoeae.
❍ What is the name of the endometrial polypoid lesion that has abundant smooth muscle, tends to occur in
the lower uterine segment, and occurs in women of reproductive age?
Atypical polypoid adenomyoma.