pathology of the uterus Flashcards
ovarian cycle
-follicular phase
-ovulation
-luteal phase
uterine cycle
-menstrual phase
-proliferative phase
-secretory phase
what hormone for proliferative phase
oestrogen
what hormone for secretory phase
progesterone
what effect for menstrual phase
necrosis
indications for endometrial sampling
-Abnormal uterine bleeding
-Investigation for infertility
-Spontaneous and therapeutic abortion
-Assessment of response to hormonal therapy
-Endometrial ablation
-Work up prior to hysterectomy for benign indications
-Incidental finding of thickened endometrium on scan
-Endometrial cancer screening in high risk patients
what is menorrhagia
prolonged and increased menstrual flow
what is metorrhagia
regular intermenstrual bleeding
polymenorrhoea
menses occurring at <21 day interval
what is polymenorrhagia
increased bleeding and frequent cycle
what is menometrorrhagia
prolonged menses and intermenstrual bleeding
what is amenorrhoea
absence of menstruation > 6 months
what is oligomenorrhoea
menses at intervals of > 35 days
causes of abnormal uterine bleeding in adolescence/early reproductive life
-usually due to anovulatory cycles
-pregnancy/miscarriage
-endometritis
-bleeding disorders
causes of AUB in reproductive/perimenopause life
-Pregnancy/miscarriage
-DUB: anovulatory cycles, luteal phase defects,
-Endometritis
-Endometrial/endocervical polyp
-Leiomyoma
-Adenomyosis
-Exogenous hormone effects
-Bleeding disorders
-Hyperplasia
-Neoplasia: cervical, endometrial
causes of AUB post menopause
-Atrophy
-Endometrial polyp
-Exogenous hormones: HRT, tamoxifen
-Endometritis
-Bleeding disorders
how thick does endometrium need to be to indicate a biopsy
over 4mm in post menopausal
16mm in premenopausal
histological assessment of endometrial samples for AUB
-Is the sample adequate/representative for the given clinical scenario
-Is there evidence of fresh/old breakdown/haemorrhage
-Is there an organic benign abnormality? (polyp, endometritis, miscarriage)
-Is there evidence for dysfunctional bleeding?
-Is there hyperplasia (atypical/non atypical) or malignancy?
what is DUB
irregular uterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining
cause of DUB
mostly due to anovulatory cycles
-commonest at either end of reproductive life
-corpus luteum does not form
-continued growth of functionalis layer
what is luteal phase deficiency
-insufficient progesterone or poor response by the endometrium to progesterone
-abnormal follicular development (inadequuate FSH/LH)
-poor corpus luteum
organic causes of AUB in the endometrium
-endometritis
-polyp
-miscarriage
organic causes of AUB in the myometrium
-adenomyosis
-meiomyoma
-leiomyoma
how is endometritis diagnosed histologically
by recognising an abnormal pattern of inflammatory cells
what protects the endometrium from infection
cervical mucous plug and cyclical shedding of the endometrium
micro-organisms that can cause endometritis
Neisseria
Chlamydia
TB
CMV
Actinomyces
HSV
other causes of endometritis
-intra-uterine contraceptive device
-post partum
-postabortal
-post curettage
-chronic endometritis NOS
-granulomatous
-associated with leiomyomata or polyps
endometrial polyps
-Common
-Usually asymptomatic but may present with bleeding or discharge
-Often occur around and after the menopause
-Almost always benign
-BUT endometrial carcinoma can present as a polyp
what is a molar pregnancy
-abnormal form of pregnancy in which non-viable fertilized egg implants in the uterus
-a form os gestational trohpblastic disease which grows as a mass characterised by swollen chorionic villi
-moles can be partial or complete
what causes complete moles
caused by a single or two sperm combining with an egg which has lost its DNA
-only parental DNA is present in a complete mole
what causes partial moles
when the egg is fertilised by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY
-partial moles gave both maternal and paternal DNA
what is adenomyosis
endometrial glands and stroma within the myometrium
what is a leiomyoma
benign tumour of smooth muscle, may be found in locations other than the uterus
-growth is oestrogen dependent
