Pathology of the Uterus

Question 1

What are the phases of the Ovarian cycle?

Answer 1

Follicular phase
Ovulation
Luteal phase

Question 2

What are the phases of the Uterine cycle?

Answer 2

Menstrual phase
Proliferative phase
Secretory phase

Question 3

What is present in a Graafian follicle?

Answer 3

Oocyte

Granulosa cell

Question 4

What are causes of abnormal uterine bleeding post menopause?

Answer 4

Atrophy
Endometrial polyp
Exogenous hormones, HRT, tamoxifen
Endometritis
Bleeding disorders
Hyperplasia
Endometrial carcinoma
Sarcoma

Question 5

How thick is the endometrium?

Answer 5

> 4mm post menopausal

16mm in premenopausal

Question 6

What is used to assess the endometrium?

Answer 6

Hysteroscopy

Question 7

How big is an endometrial pipelle?

Answer 7

3.1 diameter

Question 8

What information is needed in the history?

Answer 8

Age
Date of LMP and cycle length
Patterns of bleeding
Hormones
Recent pregnancy

Question 9

What is DUB?

Answer 9

Irregular uterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining
No organic cause for bleeding

Question 10

What is the most common cause of DUB?

Answer 10

Anovulatory cycles

Question 11

Does the corpus luteum form in DUB?

Answer 11

No

Question 12

What happens to the functionalis layer?

Answer 12

Continues to grow

Question 13

What is luteal phase deficiency?

Answer 13

Insufficient progesterone or poor response by the endometrium to progesterone. Abnormal follicular development (inadequate FSH/LH) - poor corpus luteum

Question 14

What can happen in a disordered proliferation?

Answer 14

Even when LMP was 8 weeks prior, the glands and stroma continue to grow

Question 15

What are organic causes of AUB?

Answer 15

Endometritis
Polyp
Miscarriage
Adenomyosis
Leiomyoma

Question 16

What is endometritis?

Answer 16

Diagnosed by abnormal pattern of inflammatory cells
Cervical mucous plug protects the endometrium from ascending infection
Cyclical shedding of the endometrium also makes it relatively resistant

Question 17

What organisms can cause endometritis?

Answer 17

Neisseria
Chlamydia
TB
CMV
Actinomyces
HSV

Question 18

Describe chronic plasmocytic endometritis?

Answer 18

Infectious until proven otherwise

Associated with PID (Neiserria, chlamydia, enteric organisms)

Question 19

Describe endometrial polyps?

Answer 19

Usually asymptomatic but may present with bleeding/discharge
Often around/after menopause
Usually benign
Endometrial carcinoma can present as a polyp

Question 20

What are the Myometrium causes of AUB?

Answer 20

Adenomyosis
Endometrial glands and storma within the myometrium
Leiomyoma - benign tumour of smooth muscle, may be found in locations other than the uterus

Question 21

Describe Leiomyoma?

Answer 21

may be menorrhagia/infertility/mass effect, pain
Single or multiple, may be distort uterine cavity
Growth is oestrogen dependant
Microscopic - interlacing smooth muscle cells

Question 22

How common is a Leiomyosarcoma?

Answer 22

rare

Question 23

What is a molar pregnancy?

Answer 23

Abnormal form of pregnancy in which a non-viable fertilised egg implants in the uterus (or tube)

Question 24

What is a gestational trophoblastic disease?

Answer 24

Grows as a mass characterised by swollen chorionic villi

Can be partial or complete moles

Question 25

How do partial moles occur?

Answer 25

One egg fertilised by 2 sperm or by one sperm with 2 dna sets. making foetus triploid

Question 26

What is a complete mole?

Answer 26

When the egg loses its DNA and the sperm becomes diploid meaning all the DNA of the foetus is from the father