Pathology Flashcards
phases of the ovarian cycle
follicular
ovulation
luteal
phases of the uterine cycle
menstrual
proliferative
secretory
when does proliferative phase of uterine cycle occur
day 1-14
what hormone is mainly present in the proliferative phase
oestrogen
when does the secretory phase of uterine cycle occur
day 16-28
what hormone is mainly present in the secretory phase
progesterone
what day of the uterine cycle is menstruation
day 1-3
causes of abnormal uterine bleeding in young women
DUB- usually anovulatory
Pregnancy/miscarriage
Endometritis
Bleeding disorders
causes of abnormal uterine bleeding in peri-menopausal women
polyp leiomyoma adenomyosis neoplasia hormone defects DUB
causes of abnormal uterine bleeding in post-menopausal women
atrophy endometrial polyp carcinoma/sarcoma HRT Endometritis
what endometrial thickness in post menopausal women indicates a biopsy
> 4mm
what endometrial thickness in pre-menopausal women indicates a biopsy
> 16 mm
history needed before endometrial biopsy
Age Date of last period + length of cycle pattern of bleeding hormones recent pregnancies
definition of dysfunctional uterine bleeding (DUB)
irregular uterine bleeding that reflects a disruption In the normal cyclic pattern of ovulatory hormonal stimulation to endometrial lining
what are most cases of DUB caused by
anovulatory cycles
what happens in anovulatory cycles
corpus luteum does not form - continued growth of functionalis layer
causes of an anovulatory cycle
PCOS Hypothalamic dysfunction thyroid disorders hyperprolactinaemia luteal phase deficiency
what happens in luteal phase deficiency
insufficient progesterone/ poor response of endometrium to progesterone
abnormal follicular development (inadequate FSH/LH)
poor corpus luteum formation
pathological causes of abnormal uterine bleeding
endometritis polyp adenomyosis leiomyoma miscarriage
causes of endometritis
Neisseria, chlamydia, TB, HSV
IUCD
post-partum granulomatous
what is endometritis associated with
leoimyoma
polyps
what indicates chronic endometritis
plasma cells in the stroma of the endometrium
ie. chronic plasmacytic endometritis
what is chronic endometritis associated with
pelvic inflammatory disease
features of a polyp
common, usually asymptomatic
benign
may cause bleeding/discharge
treatment of endometritis
ampicillin + gentamicin + metronidazole
what age do polyps present
around/after menopause
what is a molar pregnancy
non-viable fertilised egg implants in the uterus
what type of disease is molar pregnancy
gestational trophoblastic disease
what is a complete mole
egg has lost its DNA.
Fertilised- only paternal DNA is present
what is a partial mole
haploid egg
fertilised + reduplicates/fertilised by 2 sperm- Triploidy
which mole has higher risk of choriocarcinoma
complete
what is adenomyosis
endometrial glands + stroma within the myometrium
symptoms of adenomyosis
menorrhagia
dysmenorrhoea
what is a leiomyoma
fibroid- Benign tumour of smooth muscle
symptoms of leiomyoma
menorrhagia
pain
infertility
what is growth of leiomyoma dependent on
oestrogen
what is the transitional zone of the cervix
junction between squamous cells on the outer cervix and columnar cells on the inner cervix
what can alter the position of the transitional zone
menarche
pregnancy
menopause
what is cervical erosion
exposure of endocervical epithelium to the acid environment of the vagina
what does cervical erosion lead to
squamous metaplasia
what are nabothian cysts
mucus filled cyst on the surface of the cervix
what causes nabothian cysts
squamous epithelium grows over the glands and block them
symptoms of cervicitis
often asymptomatic
vaginal discharge
dysuria
intermenstrual/post coital bleeding
what can cause cervicitis
chlamydia
HSV
gonorrhoea
follicular cervicitis
what is follicular cervicitis
inflammation of the sub epithelial reactive lymphoid follicles in the cervix
what is follicular cervicitis also known as
chronic lymphofollicular cervicitis
what HPV are associated with cervical cancer
16 + 18
what is cervical intra-epithelial neoplasia (CIN)
Pre-invasive stage of cervical cancer
where doe CIN occur
at transformation zone
symptoms of CIN
asymptomatic
what causes CIN
dysplasia of squamous cells
what is koilocytosis
squamous epithelial cell that has undergone a number of structural changes due to HPV infection
stages of CIN
- Normal squamous epithelium
- Koilocytosis
- CIN 1
- CIN 2
- CIN 3
Histological changes seen in CIN
Hyperchromasia
Pleomorphism
Excess mitotic activity
More immature basal cells
what is hyperchromasia
dark staining nuclei due to increased DNA content
most common cervical tumour
invasive squamous carcinoma
why is invasive squamous carcinoma preventable
develops from CIN- can be picked up by screening
symptoms of cervical cancer
abnormal bleeding- post coital/post menopausal
pelvic pain
haematuria
ureteric obstruction
what lymph nodes does cervical cancer spread to
para-aortic
what is cervical glandular intra-epithelial neoplasia (CGIN)
pre-invasive phase of endocervical adenocarcinoma
where does CGIN originate from
endocervical epithelium
prognosis of endocervical adenocarcinoma
worse than squamous
who gets vulvar invasive squamous carcinoma
elderly women
what lymph nodes does vulvar invasive squamous carcinoma spread to
inguinal
how does vulvar pagets disease present
crusting rash
what do tumour cells in vulvar pagets disease contain
mucin
where does the tumour arise from in vulvar pagets disease
sweat glands in the skin
