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Reproductive & Sexual Health > Pathology of the uterus > Flashcards

Pathology of the uterus Flashcards

1
Q

What are the three stages in the ovarian cycle?

A

Follicular phase Ovulation Luteal phase

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2
Q

What are the three stages in the uterine cycle?

A

Menstrual phase proliferative phase secretory phase

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3
Q

When does the proliferative phase of the uterine cycle occur? What hormone influences it? What effect does it have?

A

D1 -14 Oestrogen Growth

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4
Q

When does the secretory phase of the uterine cycle occur? What hormone influences it? What effect does it have?

A

D16-28 Progesterone Secretion

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5
Q

When does the menstrual phase of the uterine cycle occur? What hormone influences it? What effect does it have?

A

D1-3 Withdrawal Necrosis

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6
Q

What phase does the endometrium enter if there has been implantation? What hormone influences it and what is the effect?

A

Fertilised Progesterone & HCG Hypersecretion Decidualisation

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7
Q
A
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8
Q

What stage in the endometrial cycle is shown?

A

Proliferative phase

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9
Q

Which phase in the menstrual cycle is shown and how can you tell?

A

Secretory phase

Increasing tortuosity

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10
Q

Why is the endometrial biopsy difficult to interpret?

A

Constant physiological changes before, during and after reproductive life

Changes due to hormone therapy

Lack of clinical data

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11
Q

List the indications for endometrial sampling?

A
  1. Abnormal uterine bleeding
  2. Investigation for infertility
  3. Spontaenous and therapeutic abortion
  4. Assessment of response to hormonal therapy
  5. Endometrial ablation
  6. Work up prior to hysterectomy for benign indications
  7. Incidental finding of thickened endometrium on scan
  8. Endometrial cancer screening in high risk patients
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12
Q

What does menorrhagia mean?

A

Prolonged and increased menstrual flow

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13
Q

What does metrorrhagia mean?

A

Regular intermenstrual bleeding

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14
Q

What does polymenorrhoea mean?

A

Menses ocurring at <21 day interval

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15
Q

What does polymenorrhagia mean?

A

Increased bleeding and frequent cycle

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16
Q

What does menometorrhagia mean?

A

Prolonged menses and intermenstrual bleeding

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17
Q

What does amenorrhoea mean?

A

Absence of menstruation > 6 months

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18
Q

What does oligomenorrhoea mean?

A

Menses at intervals of >35 days

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19
Q

What is dysfunctional uterine bleeding

A

Abnormal uterine bleeding with no organic cause

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20
Q

Define post-menopausal bleeding

A

Abnormal uterine bleeding >1 year after cessation of menstruation

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21
Q

What are the common causes of abnormal uterine bleeding in adolescence/early reproductive life?

A
  • anovulatory cycles
  • pregnancy/miscarriage
  • endometritis
  • bleeding disorders
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22
Q

What are the causes of abnormal uterine bleeding during reproductive life/perimenopause?

A
  • pregnancy/miscarriage
  • DUB: anovulatory cycles, luteal phase defects
  • Endometritis
  • Endometrial/endocervical polyp
  • Leiomyoma
  • Adenomyosis
  • exogenous hormone effects
  • bleeding disorders
  • hyperplasia
  • neoplasia: cervical, endometrial
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23
Q

What are the causes of abnormal uterine bleeding post-menopause?

A
  • atrophy
  • endometrial polyp
  • exogenous hormones: HRT, tamoxifen
  • endometritis
  • bleeding disorders
  • > hyperplasia*
  • > endometrial carcinoma*
  • > sarcoma*
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24
Q

Endometrial thickness of ____ in postmenopausal women (____ in premenopausal) is generally taken as an indication for biopsy

A

Endometrial thickness of >4mm in postmenopausal women (16mm in premenopausal) is generally taken as an indication for biopsy

25
Q

How can the endometrium be sampled?

A

Endometrial pipelle

Dilatation and curettage

26
Q

Describe an endometrial pipelle

A
  • 3.1mm diameter, no dilatation needed
  • no anaesthesia
  • outpatient procedure
  • very safe
  • limited sample
27
Q

Describe dilatation and curettage

A
  • most common operation performed on women
  • most thorough sampling method
  • can miss 5% hyperplasias/cancers
28
Q

What history is required for interpreting an endometrial sample

A
  • age
  • date of LMP and length of cycle
  • pattern of bleeding
  • hormones
  • recent pregnancy
  • do not need to know number of pregnancies, drugs withough hormonal influences*
29
Q

What is considered in histological assessment of endometrial samples for abnormal uterine bleeding

A
  • 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?
30
Q

In which phase of the menstrual cycle is the endometrial sample the least informative?

A

Menstrual phase

31
Q

Define dysfunctional uterine bleeding

A

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

32
Q

What is dysfunctional uterine bleeding normally caused by?

A

Anovulatory cycles

33
Q

Describe an anovulatory cycle

A

Commonest at either end of reproductive life

Corpus luteum does not form

Continuous growth of functionalis layer

34
Q

What can cause anovulatory cycles?

A

PCOS

hypothalamic dysfunction

thyroid disorders

hyperprolactinaemia

35
Q

What is luteal phase deficiency

A

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

36
Q

What organic causes from the endometrium can cause abnormal uterine bleeding?

A

Endometritis

Polyp

Miscarriage

37
Q

What organic pathologies in the myometrium can result in AUB?

A

Adenomyosis

Leiomyoma

38
Q

How is endometritis diagnosed histologically?

A

By recognising an abnormal pattern of inflammatory cells

39
Q

What is the role of the cervical mucous plug in protecting the endometrium?

A

Protects from ascending infection

40
Q

What makes the endometrium relatively resistant to infection?

A

Cyclical shedding

41
Q

Which micro-organisms can cause endometritis?

A

Neisseria

Chlamydia

TB
CMV
Actinomyces

HSV

42
Q

What can cause endometritis without specific organisms?

A

IUCD

Postpartum

Postabortal

Post curettage

Chronic endometritis- NOS

Granulomatous (sarcoid, foreign body post ablation)

Associated with leiomyomata or polyps

43
Q

What is chronic plasmacytic endometritis?

A

Infectious unless proven otherwise

Associated with PID (neisseria gonorrhoea, chlamydia, enteric organisms)

44
Q

How may endometrial polyps present?

A

Usually asymptomatic but may present with bleeding or discharge

45
Q

When do endometrial polyps occur?

A

Often occur around and after the menopause

46
Q

What is the prognosis of endometrial polyps

A

Almost always benign

BUT endometrial carcinoma can present as a polyp

47
Q

What may be seen on a miscarriage specimen

A

Products of conception

  • chorionic villi
  • foetal RBCs
48
Q

What is a molar pregnancy?

A

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

49
Q

Molar pregnancy is a gestational _____________ disease which grows as a mass characterised by swollen _______ _____. Categorised as ______ ______ or _______ _____.

A

Molar pregnancy is a gestational trophoblastic disease which grows as a mass characterised by swollen chorionic villi. Categorised as partial moles or complete moles.

50
Q

What causes a complete mole?

A

Caused by one or two sperm combining with an egg that has lost its DNA.

51
Q

How does a complete mole form?

A

The sperm reduplicates forming a complete 46 chromosome set but only paternal DNA is present

52
Q

When does a partial mole occur?

A

When an egg is fertilised by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69 XXY (triploid)

53
Q

Which type of molar pregnancy has the greatest potential to become choriocarcinoma?

A

Complete hydatidiform moles

54
Q
A
55
Q

What is adenomyosis?

A

Endometrial glands and stroma within the myometrium

56
Q

How does adenomyosis present?

A

Causes menorrhagia/dysmenorrhoea

57
Q

What is a leiomyoma

A

Benign tumour of smooth muscle, may be found in locations other than the uterus

58
Q

How may a leiomyoma present?

A

Menorrhagia/infertility/mass effect, pain

Single or multiple, may distort uterine cavity

59
Q

What is the growth of leiomyomas dependent upon?

A

Oestrogen

Reproductive & Sexual Health (54 decks)

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