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Week 3 - Female GU Pathology > Pathology of the Uterine Body & Endometrium > Flashcards

Pathology of the Uterine Body & Endometrium Flashcards

1
Q

Describe the normal development from the coelomic lining [7]

A
  1. at around 6 weeks, the coelomic lining epithelium forms the lateral mullerian ducts, which grows downwards into the pelvis and fuse with the urogenital sinus
  2. fused portion of the mullerian ducts → uterus
  3. unfused portion of the mullerian ducts → fallopian tubes
  4. structures derived from coelomic lining:
    • endometrial cavity
    • linings of fallopian tubes
    • peritoneal coverings of all gynae organs
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2
Q

What are the 5 types of developmental abnormalities of the uterus? [5]

A
  1. septate uterus
  2. dysmorphic uterus
  3. bicorporeal uterus
  4. hemi-uterus
  5. aplastic uterus
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3
Q

What generally causes developmental abnormalities of the uterus? [1]

A

abnormalities in the fusion of the mullerian ducts

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4
Q

What is the endometrium? [2]

A

inner lining of the uterus that consists of glands and stroma

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5
Q

What is the myometrium? [1]

A

smooth muscle comprising most of the uterus

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6
Q

Describe the normal menstrual cycle [10]

A
  • ovarian cycle:
    1. primary follicle
    2. secondary follicle
    3. tertiary follicle
    4. ovulation
    5. corpus luteum
    6. regression
    7. corpus albicans
  • uterine cycle:
    1. menstrual phase
    2. proliferative phase
    3. secretory phase
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7
Q

What is endometriosis? [1]

A

the presence of endometrial tissue outside the uterus

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8
Q

Name 6 possible sites of endometriosis [6]

A
  1. ovaries
  2. peritoneal surfaces
    • (incl. uterine ligaments + rectovaginal septum)
  3. small and large bowel
  4. appendix
  5. mucosa of cervix, vagina + fallopian tubes
  6. lapartomy scars
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9
Q

What is adenomyosis? [1]

A

the presence of endometrial tissue within the myometrium

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10
Q

What is dysmenorrhoea? [1]

A

menstruation associated with cramping low abdominal pain radiating into the lower back and thighs

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11
Q

What are the signs and symptoms of endometriosis/adenomyosis? [3]

A
  1. dysmenorrhoea
  2. pelvic pain
  3. infertility
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12
Q

Describe the 2 theories associated with the pathogenesis of endometriosis/adenomyosis? [4]

A
  1. the metastatic theory:
    • retrograde menstruation or surgical procedures introduce endometrium to sites outwith the uterine cavity
  2. the metaplastic theory:
    • endometrium arises directly from the coelomic epithelium (i.e. peritoneum) of the pelvis
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13
Q

Endometrial Polyps

  1. Definition? [1]
  2. What does exophytic mean? [1]
  3. Presentation? [1]
  4. What drug can endometrial polyps be associated with in some cases? [1]
  5. Describe the microscopic features [5]
A
  1. exophytic masses of variable size which project into the endometrial cavity
  2. exophytic = growth outwards from an epithelial surface
  3. presents with abnormal bleeding
  4. associated with tamoxifen
  5. microscopic features:
    • glands are haphazardly arranged but overall low gland-to-stroma ratio is preserved
    • thick walled blood vessels + fibrous stroma
    • gland epithelium is bland + resembles inactive or proliferative endometrium
    • occasionally cytological atypia or frank adenocarcinoma can be found in polyps
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14
Q

Endometrial Hyperplasia & Adenocarcinoma

  1. Who gets it? [1]
  2. Presentation? [1]
  3. What is the main pathological cause and what can that be caused from? [7]
  4. Histological Features of Endometrial Hyperplasia [2]
  5. Management of Endometrial Hyperplasia [4]
A
  1. post-menopausal women
  2. post-menopausal bleeding
  3. prolonged oestrogenic stimulation of endometrium, which can be caused by:
    • anovulatory cycles
    • endogenous oestrogen
      • polycystic ovarian syndrome
      • obesity
      • oestrogen-secreting ovarian tumours
    • exogenous oestrogen
      • oestrogen-only hormone replacement therapy (HRT)
  4. histological features:
    • increase in gland-to-stroma ratio
    • +/- cytological atypia
  5. progesterone therapy
    • Mirena
    • IUS
    • hysterectomy
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15
Q

Atypical endometrial hyperplasia is a known precursor of endometrial adenocarcinoma.

Describe the management of endometrial adenocarcinoma [2]

A
  1. hysterectomy (surgical removal of uterus)
  2. subsequent management depending on tumour grade/stage
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16
Q

Leiomyoma

  1. Definition? [1]
  2. Who gets it? [1]
  3. Signs & Symptoms? [4]
  4. Macroscopic features [3]
  5. Microscopic features [1]
  6. Medical management? [4]
  7. Surgical management? [3]
A
  1. benign smooth muscle tumour of the myometrium
  2. mostly women of reproductive age
  3. signs & symptoms:
    • asymptomatic
    • abnormal bleeding
    • if large, can get urinary frequency
    • impaired fertility
  4. macroscopic features
    • sharply demarcated round grey-white tumours with whorled cut surface
    • very variable in size
  5. resembles normal smooth muscle microscopically
  6. medical management:
    • progesterone secreting IUS (intrauterine system)
    • hormonal therapies
    • tranexamic acid
    • GnRH agonists
  7. surgical management:
    • uterine artery embolisation
    • myomectomy
    • hysterectomy
17
Q

Leiomyosarcoma

  1. Definition? [1]
  2. Who gets it? [2]
  3. Symptoms? [2]
  4. Macroscopic features? [5]
  5. Microscopic features? [4]
A
  1. uncommon malignant smooth muscle tumour of the myometrium
  2. women aged 40-60yrs
  3. initially no symptoms then bleeding and pain
  4. macroscopic features:
    • bulky invasive masses
    • polypoid
    • necrosis
    • haemorrhage
    • variable cut surface
  5. microscopic features:
    • cytological atypia
    • necrosis
    • mitotic activity
    • infiltrative margin
18
Q

Endometrial Stroma Sarcoma (ESS)

  1. What is it? [1]
  2. Macroscopic features? [1]
  3. Microscopic features? [1]
A
  1. group of tumours of the endometrial stroma
  2. diffusively infiltrative “worm-like” growth pattern
  3. low-grade tumour cells resemble cells of proliferativing endometrial stoma, with mitoses
19
Q

Describe the histological features during normal conception [3]

A
  1. normal chorionic villi with central stroma
  2. surrounded by inner cytotrophoblast and outer layer of syncytiotrophoblast
    • there is some extravillous trophoblast
  3. chorionic villi have small blood vessels containing fetal red blood cells
20
Q

Define gestational trophoblastic disease [1]

A
  • umbrella term for several conditions:
    • hydatidiform moles (partial + complete)
    • malignant tumours → choriocarcinoma
21
Q

Describe the typical presentation of hydatidiform moles [2]

A
  1. spontaneous miscarriage
  2. abnormalities on ultrasound
22
Q

Partial Hydatidiform Mole

  1. Cause? [1]
  2. Microscopic features? [2]
  3. There is a risk of an invasive mole with a partial mole. What is an invasive mole? [1]
A
  1. fertilisation of one egg by 2 sperm, resulting in a triploid karyotype
  2. microscopic features:
    • oedematous villi
    • subtle trophoblast profile
  3. invasive mole invades and destroys the uterus
23
Q

Complete Hydatidiform Mole

  1. Causes? [1]
  2. Microscopic features? [2]
A
  1. fertilisation of an egg with no genetic material, usually by 1 sperm, which duplicates its chromosomal material
  2. microscopic features:
    • markedly enlarged oedematous villi with central cisterns
    • circumferential trophoblast proliferation
24
Q

Choriocarcinoma

  1. Features? [5]
  2. Treatment? [1]
A
  1. features:
    • malignant
    • rapidly invasive
    • metastasises widely
    • can occur following normal pregnancy or an abortion of non-molar pregnancies
  2. treated with chemotherapy

Week 3 - Female GU Pathology (7 decks)

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