Pathology of the Uterine Body and Endometrium Flashcards
What is the term for the existence of endometrial tissue within the myometrium?
Adenoymosis
Give examples of common sites of endometriosis
Ovaries Peritoneal surfaces (uterine ligaments, rectovaginal septum) Large and small bowel Appendix Vagina Mucosa of cervix
Describe the metastatic theory of the pathophysiology of endometriosis
Retrograde mentsruation or surgical produces introduce endometrium to sites outwith the uterine cavity
Describe the metaplastic theory of the pathophysiology of endometriosis
Endometrium arises directly from the coelomic epithelium of the pelvis as this is where endometrium originates from during embryological development
What is endometriosis?
The presence of endometrial tissue outside of the uterus
What are the clinical symptoms of endometriosis?
Dysmenorrhoea, pelvic pain and infertility
Endometrial polyps can be associated with which anti-cancer drug?
Tamoxifen
What are endometrial polyps?
Exophytic masses of variable size which project into the endometrial cavity
How are endometrial polyps treated?
Hysteroscopy
Describe the microscopic appearance of endometrial polyps
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
It is possible for frank adenocarcinoma to be found in endometrial polyps. T/F?
True
Endometrial hyperplasia and adenocarcinoma are associated with prolonged oestrogen stimulation. Give examples of causes of this
Anovulatory cycles
Endogenous sources of oestrogen (obesity, PCOS, oestrogen secreting ovarian tumours)
Exogenous sources of oestrogen (oestrogen only HRT)
What are the histological characteristics of endometrial hyperplasia?
Increase in gland to stroma ratio
With or without cytological atypia
Atypical endometrial hyperplasia is a precursor of endometriosis adenocarcinoma. T/F?
True
How can endometrial hyperplasia be managed?
Progesterone therapy such as Mirena, IUS or hysterectomy
How is endometrial adenocarcinoma treated?
Hysterectomy possibly with further oncological treatment
What is the name for a benign smooth muscle tumour fo the myometrium?
Leiomyoma
In women of what age are leiomyomas most commonly found?
Reproductive age
Smaller leiomyomas are often asymptomatic. If leiomyomas of the myometrium are large, what symptoms can this produce?
Abnormal bleeding
Urinary frequency
Impaired fertility
Describe the appearance of leiomyomas.
Sharply demarcated round grey-white tumours with a whorled cut surface
Microscopically they resemble normal smooth muscle
What is the possible medical management of leiomyomas?
Progesterone secreting IUS, hormonal therapies, tranexamic acid and GnRH agonists
What is the possible surgical management of leiomyomas?
Uterine artery embolisation
Myomectomy
Hysterectomy
What is the name for malignant smooth muscle tumours of the myometrium?
Leimyosarcoma
In women of what age are leiomyosarcomas most commonly found?
Between age 40 and 60
Describe the macroscopic appearance of leiomyosarcomas of the myometrium
Necrosis, haemorrhage, variable cut surface
Describe the microscopic appearance of leiomyosarcomas of the myometrium
Overt cytological atypia
Necrosis
Mitotic activity
Infiltrative margins
Where do leiomyosarcomas fo the myometrium commonly spread to?
Lungs, liver, brain
Leiomyosarcomasof the myometrium initially have no symptoms. Laters, what symptoms can these tumours produce?
Bleeding and pain
Endometrial stromal sarcomas are usually low grade tumours. T/F?
True
How would you describe the macroscopic growth pattern fo an endometrial stromal sarcoma?
Worm like
If products of conception are to to the pathology laboratory to confirm an intrauterine pregnancy. What structures would a pathologist look for?
Chorionic villi
Implantation site
Gestational trophoblastic disease is an umbrella term for conditions such as…?
hydatidiform moles and frankly malignant tumours including chorionocarinoma
Hydatidiform moles are present with spontaneous miscarriage. T/F?
True
What is the cause of a partial hydatidiform mole?
Fertilisation of one egg by two sperm which results in a triploid karyotype
What is the cause of a complete hydatidiform mole?
Fertilisation of an egg with no genetic material, usually by one sperm which duplicates its chromosomal material or by two sperm
Microscopically, what features would you seen on a partial hydatidiform mole?
Oedematous villi
Subtle trophoblast proliferation
Microscopically, what features would you seen on a complete hydatidiform mole?
Markedly enlarged oedematous villi with central cisterns and circumferential trophoblast proliferation
Hydatidiform moles can become invasive. What complication can result form this?
Uterus rupture
What type of cancer can result from a complete hydatidiform mole?
Choriocarcinoma
