Pathology of the Uterine Body & Endometrium Flashcards
Describe the normal development from the coelomic lining [7]
- 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
- fused portion of the mullerian ducts → uterus
- unfused portion of the mullerian ducts → fallopian tubes
- structures derived from coelomic lining:
- endometrial cavity
- linings of fallopian tubes
- peritoneal coverings of all gynae organs
What are the 5 types of developmental abnormalities of the uterus? [5]
- septate uterus
- dysmorphic uterus
- bicorporeal uterus
- hemi-uterus
- aplastic uterus
What generally causes developmental abnormalities of the uterus? [1]
abnormalities in the fusion of the mullerian ducts
What is the endometrium? [2]
inner lining of the uterus that consists of glands and stroma
What is the myometrium? [1]
smooth muscle comprising most of the uterus
Describe the normal menstrual cycle [10]
- ovarian cycle:
- primary follicle
- secondary follicle
- tertiary follicle
- ovulation
- corpus luteum
- regression
- corpus albicans
- uterine cycle:
- menstrual phase
- proliferative phase
- secretory phase
What is endometriosis? [1]
the presence of endometrial tissue outside the uterus
Name 6 possible sites of endometriosis [6]
- ovaries
- peritoneal surfaces
- (incl. uterine ligaments + rectovaginal septum)
- small and large bowel
- appendix
- mucosa of cervix, vagina + fallopian tubes
- lapartomy scars
What is adenomyosis? [1]
the presence of endometrial tissue within the myometrium
What is dysmenorrhoea? [1]
menstruation associated with cramping low abdominal pain radiating into the lower back and thighs
What are the signs and symptoms of endometriosis/adenomyosis? [3]
- dysmenorrhoea
- pelvic pain
- infertility
Describe the 2 theories associated with the pathogenesis of endometriosis/adenomyosis? [4]
- the metastatic theory:
- retrograde menstruation or surgical procedures introduce endometrium to sites outwith the uterine cavity
- the metaplastic theory:
- endometrium arises directly from the coelomic epithelium (i.e. peritoneum) of the pelvis
Endometrial Polyps
- Definition? [1]
- What does exophytic mean? [1]
- Presentation? [1]
- What drug can endometrial polyps be associated with in some cases? [1]
- Describe the microscopic features [5]
- exophytic masses of variable size which project into the endometrial cavity
- exophytic = growth outwards from an epithelial surface
- presents with abnormal bleeding
- associated with tamoxifen
- 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
Endometrial Hyperplasia & Adenocarcinoma
- Who gets it? [1]
- Presentation? [1]
- What is the main pathological cause and what can that be caused from? [7]
- Histological Features of Endometrial Hyperplasia [2]
- Management of Endometrial Hyperplasia [4]
- post-menopausal women
- post-menopausal bleeding
- 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)
- histological features:
- increase in gland-to-stroma ratio
- +/- cytological atypia
- progesterone therapy
- Mirena
- IUS
- hysterectomy
Atypical endometrial hyperplasia is a known precursor of endometrial adenocarcinoma.
Describe the management of endometrial adenocarcinoma [2]
- hysterectomy (surgical removal of uterus)
- subsequent management depending on tumour grade/stage
Leiomyoma
- Definition? [1]
- Who gets it? [1]
- Signs & Symptoms? [4]
- Macroscopic features [3]
- Microscopic features [1]
- Medical management? [4]
- Surgical management? [3]
- benign smooth muscle tumour of the myometrium
- mostly women of reproductive age
- signs & symptoms:
- asymptomatic
- abnormal bleeding
- if large, can get urinary frequency
- impaired fertility
- macroscopic features
- sharply demarcated round grey-white tumours with whorled cut surface
- very variable in size
- resembles normal smooth muscle microscopically
- medical management:
- progesterone secreting IUS (intrauterine system)
- hormonal therapies
- tranexamic acid
- GnRH agonists
- surgical management:
- uterine artery embolisation
- myomectomy
- hysterectomy
Leiomyosarcoma
- Definition? [1]
- Who gets it? [2]
- Symptoms? [2]
- Macroscopic features? [5]
- Microscopic features? [4]
- uncommon malignant smooth muscle tumour of the myometrium
- women aged 40-60yrs
- initially no symptoms then bleeding and pain
- macroscopic features:
- bulky invasive masses
- polypoid
- necrosis
- haemorrhage
- variable cut surface
- microscopic features:
- cytological atypia
- necrosis
- mitotic activity
- infiltrative margin
Endometrial Stroma Sarcoma (ESS)
- What is it? [1]
- Macroscopic features? [1]
- Microscopic features? [1]
- group of tumours of the endometrial stroma
- diffusively infiltrative “worm-like” growth pattern
- low-grade tumour cells resemble cells of proliferativing endometrial stoma, with mitoses
Describe the histological features during normal conception [3]
- normal chorionic villi with central stroma
- surrounded by inner cytotrophoblast and outer layer of syncytiotrophoblast
- there is some extravillous trophoblast
- chorionic villi have small blood vessels containing fetal red blood cells
Define gestational trophoblastic disease [1]
- umbrella term for several conditions:
- hydatidiform moles (partial + complete)
- malignant tumours → choriocarcinoma
Describe the typical presentation of hydatidiform moles [2]
- spontaneous miscarriage
- abnormalities on ultrasound
Partial Hydatidiform Mole
- Cause? [1]
- Microscopic features? [2]
- There is a risk of an invasive mole with a partial mole. What is an invasive mole? [1]
- fertilisation of one egg by 2 sperm, resulting in a triploid karyotype
- microscopic features:
- oedematous villi
- subtle trophoblast profile
- invasive mole invades and destroys the uterus
Complete Hydatidiform Mole
- Causes? [1]
- Microscopic features? [2]
- fertilisation of an egg with no genetic material, usually by 1 sperm, which duplicates its chromosomal material
- microscopic features:
- markedly enlarged oedematous villi with central cisterns
- circumferential trophoblast proliferation
Choriocarcinoma
- Features? [5]
- Treatment? [1]
- features:
- malignant
- rapidly invasive
- metastasises widely
- can occur following normal pregnancy or an abortion of non-molar pregnancies
- treated with chemotherapy
