Pathology of the Uterine Body and Endometrium

Question 1

What is the term for the existence of endometrial tissue within the myometrium?

Answer 1

Adenoymosis

Question 2

Give examples of common sites of endometriosis

Answer 2

Ovaries
Peritoneal surfaces (uterine ligaments, rectovaginal septum)
Large and small bowel
Appendix
Vagina
Mucosa of cervix

Question 3

Describe the metastatic theory of the pathophysiology of endometriosis

Answer 3

Retrograde mentsruation or surgical produces introduce endometrium to sites outwith the uterine cavity

Question 4

Describe the metaplastic theory of the pathophysiology of endometriosis

Answer 4

Endometrium arises directly from the coelomic epithelium of the pelvis as this is where endometrium originates from during embryological development

Question 5

What is endometriosis?

Answer 5

The presence of endometrial tissue outside of the uterus

Question 6

What are the clinical symptoms of endometriosis?

Answer 6

Dysmenorrhoea, pelvic pain and infertility

Question 7

Endometrial polyps can be associated with which anti-cancer drug?

Answer 7

Tamoxifen

Question 8

What are endometrial polyps?

Answer 8

Exophytic masses of variable size which project into the endometrial cavity

Question 9

How are endometrial polyps treated?

Answer 9

Hysteroscopy

Question 10

Describe the microscopic appearance of endometrial polyps

Answer 10

Haphazardly arranged glands with preservation of a low gland to stroma ratio
Thick walled blood vessels and fibrous stroma
Glands are usually inactive but can show ploiferation, secretory changes or metaplasia

Question 11

It is possible for frank adenocarcinoma to be found in endometrial polyps. T/F?

Answer 11

True

Question 12

Endometrial hyperplasia and adenocarcinoma are associated with prolonged oestrogen stimulation. Give examples of causes of this

Answer 12

Anovulatory cycles
Endogenous sources of oestrogen (obesity, PCOS, oestrogen secreting ovarian tumours)
Exogenous sources of oestrogen (oestrogen only HRT)

Question 13

What are the histological characteristics of endometrial hyperplasia?

Answer 13

Increase in gland to stroma ratio

With or without cytological atypia

Question 14

Atypical endometrial hyperplasia is a precursor of endometriosis adenocarcinoma. T/F?

Answer 14

True

Question 15

How can endometrial hyperplasia be managed?

Answer 15

Progesterone therapy such as Mirena, IUS or hysterectomy

Question 16

How is endometrial adenocarcinoma treated?

Answer 16

Hysterectomy possibly with further oncological treatment

Question 17

What is the name for a benign smooth muscle tumour fo the myometrium?

Answer 17

Leiomyoma

Question 18

In women of what age are leiomyomas most commonly found?

Answer 18

Reproductive age

Question 19

Smaller leiomyomas are often asymptomatic. If leiomyomas of the myometrium are large, what symptoms can this produce?

Answer 19

Abnormal bleeding
Urinary frequency
Impaired fertility

Question 20

Describe the appearance of leiomyomas.

Answer 20

Sharply demarcated round grey-white tumours with a whorled cut surface
Microscopically they resemble normal smooth muscle

Question 21

What is the possible medical management of leiomyomas?

Answer 21

Progesterone secreting IUS, hormonal therapies, tranexamic acid and GnRH agonists

Question 22

What is the possible surgical management of leiomyomas?

Answer 22

Uterine artery embolisation
Myomectomy
Hysterectomy

Question 23

What is the name for malignant smooth muscle tumours of the myometrium?

Answer 23

Leimyosarcoma

Question 24

In women of what age are leiomyosarcomas most commonly found?

Answer 24

Between age 40 and 60

Question 25

Describe the macroscopic appearance of leiomyosarcomas of the myometrium

Answer 25

Necrosis, haemorrhage, variable cut surface

Question 26

Describe the microscopic appearance of leiomyosarcomas of the myometrium

Answer 26

Overt cytological atypia
Necrosis
Mitotic activity
Infiltrative margins

Question 27

Where do leiomyosarcomas fo the myometrium commonly spread to?

Answer 27

Lungs, liver, brain

Question 28

Leiomyosarcomasof the myometrium initially have no symptoms. Laters, what symptoms can these tumours produce?

Answer 28

Bleeding and pain

Question 29

Endometrial stromal sarcomas are usually low grade tumours. T/F?

Answer 29

True

Question 30

How would you describe the macroscopic growth pattern fo an endometrial stromal sarcoma?

Answer 30

Worm like

Question 31

If products of conception are to to the pathology laboratory to confirm an intrauterine pregnancy. What structures would a pathologist look for?

Answer 31

Chorionic villi

Implantation site

Question 32

Gestational trophoblastic disease is an umbrella term for conditions such as…?

Answer 32

hydatidiform moles and frankly malignant tumours including chorionocarinoma

Question 33

Hydatidiform moles are present with spontaneous miscarriage. T/F?

Answer 33

True

Question 34

What is the cause of a partial hydatidiform mole?

Answer 34

Fertilisation of one egg by two sperm which results in a triploid karyotype

Question 35

What is the cause of a complete hydatidiform mole?

Answer 35

Fertilisation of an egg with no genetic material, usually by one sperm which duplicates its chromosomal material or by two sperm

Question 36

Microscopically, what features would you seen on a partial hydatidiform mole?

Answer 36

Oedematous villi

Subtle trophoblast proliferation

Question 37

Microscopically, what features would you seen on a complete hydatidiform mole?

Answer 37

Markedly enlarged oedematous villi with central cisterns and circumferential trophoblast proliferation

Question 38

Hydatidiform moles can become invasive. What complication can result form this?

Answer 38

Uterus rupture

Question 39

What type of cancer can result from a complete hydatidiform mole?

Answer 39

Choriocarcinoma