Pathology of the uterine body and endometrium Flashcards
What are developmental abnormalities of the uterus due to?
Fusion of the mullerian ducts
What is the basic histology of the endometrium
Consists of glands and stroma and has a variety of normal appearances depending on the phase of the menstrual cycle, menopausal status etc.
Describe the basic histology of the myometrium
Smooth muscle comprising much of the uterus
Which hormone results in the thickening of the endometrial lining?
Oestrogen
Describe the endometrium during the proliferative phase
- Gland to stroma ratio is low
- Glands have a tubular appearance
- Cells within glands are cuboidal and have ovoid nuclei
- Presence of mitotic
Describe the endometrium during the secretory phase
- Glands have a coiled appearance
- No mitotic activity
- Gland to stroma ratio is low
- Nuclei are close to the basement membrane but small gap in which there are vacuoles (which disappear as move through phase)
Describe the endometrium in the menstrual phase
- Lots of blood
- Fragmentation of the endometrium, condensed stroma
- Presence of apoptosis
Describe the endometrium in menopause
- Cystic atrophy
- More thin
- Still low gland to stroma ratio
- Low cytoplasm
What is endometriosis?
The presence of endometrial tissue outside of the uterus
What is adenomyosis?
The presence of endometrial tissue within the myometrium
What are the clinical symptoms of endometriosis?
- Dysmenorrhoea
- Pelvic pain
- Infertility
What is the metastatic theory of endometriosis?
Retrograde menstruation or surgical procedures introduce endometrium to sites outwit the uterine cavity
What is the metaplastic theory of endometriosis?
Endometrium arises directly from the coelomic epithelium (i.e. peritoneum) of the pelvis as this is where the endometrium originates from during embryological development
Describe endometrial polyps
Exophytic masses of variable size which project into the endometrial cavity
What drug are endometrial polyps associated with?
Tamoxifen
How can endometrial polyps present?
Abnormal bleeding
How are endometrial polyps treated?
Hysteroscope in the outpatient clinic
Describe the histology of endometrial polyps
- Haphazardly arranged glands with preservation of a low gland to stroma ratio
- Often thick walled blood vessels and fibrous stroma
- Glands are usually inactive but can show proliferation, secretory changes or metaplasia
- Occasionally cytological atypia or frank adenocarcinoma
What is the relationship between endometrial hyperplasia and adenocarcinoma?
They are on the same spectrum, hyperplasia is often first and then can transform into adenocarcinoma
What are endometrial hyperplasia and adenoma associated with?
Prolonged oestrogen stimulation of the endometrium
What are the possible underlying causes of endometrial hyperplasia and adenocarcinoma?
- Anovulatory cycle
- Endogenous sources of oestrogen - obesity, PCOS, oestrogen secreting ovarian tumours
- Exogenous sources of oestrogen such as oestrogen only HRT (not really given now)
What are the symptoms of endometrial hyperplasia and adenocarcinoma?
Usually postmenopausal bleeding or in premenopausal women irregular/continuous/heavy bleeding
What is the histological characteristic of endometrial hyperplasia and adenocarcinoma?
There is an increase in the gland to stroma ratio
What is the management of endometrial hyperplasia?
- Progesterone therapy e.g. mirena IUS
* Hysterectomy
