9: Pathology of the uterus Flashcards
Which hormone causes the endometrium to proliferate?
Oestrogen
Which hormone maintains the endometrium during the luteal phase and encourages uterine secretions?
Progesterone
What term is used to describe the appearance of the endometrium when the egg cell is fertilised?
Decidualised
Which hormones are involved in the uterine cycle if the egg is cell is actually fertilised?
hCG
Progesterone
if not, corpus luteum degenerates and these aren’t produced
What are the elements of the proliferative endometrium which you can see on histology?
Columnar epithelium
Stromal cells
Glands
In the proliferative phase of the uterine cycle, which aspects of the endometrium grow?
Stroma
Glands
What is the corpus luteum?
Remnant of leading follicle left when egg is released
Produces progesterone to maintain endometrium
In the event of no fertilisation, what does the corpus luteum degenerate to form?
Corpus albicans
What phase of the uterine cycle starts when ovulation occurs?
Secretory phase
because progesterone is being produced
How does the endometrium change in the secretory phase?
Glands become torturous - wiggly
Glands fill with secretions
If no fertilisation occurs, what happens to the endometrium?
Loss of blood supply
Sloughing > Menstruation
What is a genetically inherited syndrome which causes GI polyposis and increases a woman’s chances of developing endometrial cancer?
Lynch syndrome / HNPCC
What is the difference between abnormal and dysfunctional uterine bleeding?
Abnormal bleeding - organic cause: infection, tumour, miscarriage, ectopic/molar pregnancy
Dysfunctional bleeding - no abnormal cause: pathology is hormonal or idiopathic
What is the most common cause of dysfunctional uterine bleeding?
Anovulation
common at extremes of age
How does anovulation cause dysfunctional uterine bleeding?
No ovulation > no corpus luteum to produce progesterone
Prolonged oestrogen production > Prolonged proliferation of endometrium
Eventually sloughs due to loss of blood supply > Heavy bleeding
Which tumours can cause abnormal uterine bleeding?
Endometrial polyps
Leiomyomas (fibroids)
What are endometriosis and adenomyosis?
Growth of endometrium / glands outwith the uterus
Grow in response to oestrogen
Cause pain
What inflammatory condition causes abnormal uterine bleeding?
Endometritis
What drugs used to control menopausal symptoms can cause abnormal uterine bleeding?
HRT
Tamoxifen
An endometrial thickness of over ___ mm is an indication for biopsy.
4 mm
What investigation is used to assess endometrial thickness?
Transvaginal ultrasound
Which investigation is used to view the endometrium?
Hysteroscopy
What are two methods of taking an endometrial biopsy?
Pipelle biopsy
Dilatation and curettage
What is a disadvantage of using a pipelle over D&C for taking an endometrial biopsy?
You can’t see the endometrium while taking the sample
Between pipelle biopsy and D&C, what is the preferred method for taking endometrial samples?
D&C
Because you can see the endometrium while you’re doing it
During which phase of the uterine cycle are endometrial biopsies not particularly useful?
Menstrual phase
because glands and stroma are falling apart
If endometrial glands grow for months e.g anovulation, what can they form?
Cysts
Despite being in the muscle layer, how do leiomyomas cause abnormal uterine bleeding?
Contraction stretches blood vessels, stroma and glands
Endometritis is inflammation of the endometrium which can be either infectious or non-infectious.
What symptom can it cause?
How do you recognise it on histology?
Abnormal uterine bleeding
Inflammatory cells (shouldn’t be there; chronic - plasma cells, acute - neutrophils & macrophages)
What type of endometritis does tuberculosis cause?
Granulomatous endometritis
big closed off rings of inflammatory cells
Endometrial polyps are usually (benign / malignant).
benign
Some endometrial polyps progress to form ___.
carcinomas
When do women tend to develop endometrial polyps?
Menopause
What structures, belonging to the foetus, are seen on histology of a miscarriage sample?
Chorionic villi
Foetal red blood cells
How can you tell foetal RBCs apart from maternal RBCs on histology?
Foetal RBCs are nucleated
Maternal RBCs aren’t
