Gynecologic Path 1 Flashcards
What are the indications for endometrial biopsy?
- Determine cause of abnormal uterine bleeding
- Eval endo in infertile pts
- Evacuation
- Assess the response of endometrium to hormone therapy
What is the first histologic evidence of ovulation?
Abundant subnuclear vacuoles in epithelial cells
What is the interval phase?
There are 36-48 hours between ovulation and the first histologic changes of the endometrium
What are the histologic dating pts to look at?
- Glandular changes
- Stromal changes
What histologic features are present at day 17?
Uniform subnuclear vacuoles, single row of nuclei
What histologic features are present at day 20-21?
Intraluminal secretions, mared stromal edema “naked nuclei”
What histologic features are present at day 23-24?
Prominent spiral arteries, predecidual change around spiral arteries
What histologic features are present at day 26-27?
Confluent sheets of predecidua, lymphocytes
What is menorrhagia?
Excessive bleeding in both amt and duration of flow occurring at regular intervals
What is metrorrhagia?
Bleeding, not usually heavy, occurring at irregular intervals
What is menometrorrhagia?
Excessive bleeding with prolonged pd of flow occurring at freq and irregular intervals
What is dysmenorrhea?
Painful menses
What is postmenopausal bleeding?
Abnormal bleeding at least 1 year after menopause
What is dysfunctional uterine bleeding (DUB)?
Alteration of the normal cyclical hormonal stimulation of the endometrium. There is no underlying organic disorder and it usually indicates ovulatory dysfunction. It excludes postmenopausal bleeding and presence of pathological processes.
What is a common histologic finding in DUB?
Stromal and glandular breakdown with no secretory endometrium. Collapse of stroma into “stromal blue balls” and evidence of bleeding.
Describe the process of glandular and stromal breakdown
When there is no progesterone, but normal estrogen ovulation doesn’t occur. However, estrogen causes the endometrial lining to continue to grow. The glands become enlarged, irregular and disordered. Once it gets too big for the blood supply, it breaks down and bleeding occurs.
There is a non-secretory background, collapse of stroma into aggregates (stromal balls), nuclear debris and reparative epithelial changes and evidence of bleeding
What is endometrial atrophy?
Common cause of bleeding in postmenopausal women. Due to lack of estrogen stimulation
What is the histology with endometrial atrophy?
Dilation of cystic glands with no mitosis (may result in thickened endometrial stripe) . Less cellular, fibrotic stroma with few glands and evidence of bleeding
What are endometrial polyps?
Localized hyperplasia of the basal endometrium. Do not respond to cycling hormones in a normal manner. They can break down and bleed irregularly. They have no malignant potential, but there can exist a carcinoma within them.
What do endometrial polyps look like grossly?
Vary in size, can be sessile (flat) or pedunculated (floppy)
What is the histology of endometrial polyps?
Larger tissue fragments with dense, fibrotic stroma and thick-walled arteries. Irregular glands that may be dilated or focally crowded. Separate fragments of normal endometrium (background).
What is a Leiomyoma?
Benign smooth muscle tumor that can happen anywhere but usually occurs in the corpus/body of the uterus
What demographic is Leiomyoma most common in?
African Americans get them at a younger age, more commonly symptomatic and larger
What is the etiology of a leiomyoma?
Caused by some hormonal event because they occur during reproductive age and regress after menopause and they have a high sensitivity to estrogen.
