Pathology of the uterus Flashcards
Describe the part of the ovarian cycle, the time in the cycle, the hormones assoc. and the effect on the uterus of: -Menstrual phase -proliferative phase -secretory phase -fertilisation -post menopausal phases of uterine cycle
menstrual phase:
- Ovarian cycle = follicular
- D1-3
- Hormones = withdrawal of hormones
- effect = necrosis and shedding
Proliferative phase:
- ovarian cycle = follicular
- D1-14
- Hormones = oestrogen
- effect = growth
Secretory phase:
- ovarian cycle = luteal phase
- D16-28
- hormones = progesterone from corpus luteum (switches off estrogen)
- effect = secretion
Fertilisation:
- time is secretory onwards
- hormones progesterone and HCG
- effects = hypersecretion and decidualisation
Post-menopausal:
- non cycling
- inactive/atrophic
What are the 8 indications for endometrial sampling?
¥ Abnormal uterine bleeding
¥ Investigation for infertility
¥ Spontaneous and therapeutic abortion
¥ Assessment of response to hormonal therapy: Sometimes with pts who have endometrial cancer and can’t tolerate surgery they are treated with hormones (merina coil) – the progesterone dampens down the proliferation of cancer
¥ Endometrial ablation: Sample for biopsy before abalation
¥ Work up prior to hysterectomy for benign indications: Hysterectomy can be done laparoscopically where the uterus is ‘chewed up’ therefore can’t do this if there’s cancer cells.
¥ Incidental finding of thickened endometrium on scan
¥ Endometrial cancer screening in high risk patients: Lynch syndrome
What are the caues of AUB in adolescence/early productive life?
¥ DUB usually due to anovulatory cycles
¥ Pregnancy/miscarriage
¥ Endometritis
¥ Bleeding disorders
What are the causes of AUB in reproductive/premenopausal life?
¥ Pregnancy/miscarriage ¥ DUB: anovulatory cycles, luteal phase defects, ¥ Endometritis ¥ Endometrial/endocervical polyp ¥ Leiomyoma ¥ Smooth muscle tumour ¥ Adenomyosis ¥ This is endometriosis in the smooth muscle ¥ Exogenous hormone effects ¥ Bleeding disorders
Causes of AUB post menopause?
¥ Atrophy ¥ Endometrial polyp ¥ Exogenous hormones: HRT, tamoxifen ¥ Endometritis ¥ Bleeding disorders ¥ Hyperplasia ¥ Endometrial carcinoma ¥ Sarcoma
What features are needed from the history if a endometrial sample is taken for the pathologist?
¥ Age ¥ Date of LMP and length of cycle ¥ Pattern of bleeding ¥ Hormones ¥ Recent pregnancy ¥ Do not need to know number of pregnancies, drugs without hormonal influences etc.
What is looked for in the histological assessment of endometrial samples?
¥ 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 endometritis? what are the natural barriers to this?
¥ Histologically endometritis is diagnosed by recognising an abnormal pattern of inflammatory cells – if you can see plasma cells = endometritis
¥ Cervical mucous plug protects the endometrium from ascending infection
¥ Cyclical shedding of the endometrium also makes it relatively resistant
What micro-organisms can cause endometritis?
¥ Neisseria ¥ Chlamydia ¥ TB ¥ CMV ¥ Actinomyces – more common with IUD ¥ HSV
What causes can result in an endometritis without specific organisms?
¥ Intra-uterine contraceptive device ¥ Postpartum ¥ Postabortal ¥ Post curettage ¥ Chronic endometritis NOS ¥ Granulomatous (sarcoid, foreign body post ablation) ¥ Associated with leiomyomata or polyps
Endometrial polyp:
- is this common?
- what is the presentation?
- when do these occur?
- how are these managed?
¥ 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 therefore remove all
Leiomyoma:
- what is this?
- what can this present as?
- what is the growth dependant on?
- what is seen microscopically?
Benign tumour of smooth muscle, may be found in locations other than the uterus
Present:
- menorrhagia
- infertility
- mass effect
- pain
- single/multiple may distort uterine cavity
Growth:
-estrogen dependant
Microscopic:
-interlacing smooth muscle cells
