Pathology of the Uterus and Endometrium Flashcards
how are the uterus and fallopian tubes formed embryologically?
From the coelomic lining epithelium which forms the lateral mullerian ducts. The ducts fuse with the urogenital sinus to form the uterus, and the unfused part becomes the fallopian tubes.
What is the endometrial cavity and peritoneal lining formed from embryologically?
Coelomic lining epithelium.
An issue in what causes abnormalities of the uterus?
Mullerian duct fusion.
What are the 2 most common uterine abnormalities?
Septate uterus
Bicornuate uterus.
Define endometriosis?
Presence of endometrial tissue outside the uterus.
Define adenomyosis?
Presence of endometrial tissue in the myometrium.
List some common sites of endometriosis?
Bowel Peritoneum Ovaries Mucosa of cervix, vagina, fallopian tubes Laparotomy scars
Describe the pathogenesis of endometriosis?
2 theories
- Metastatic theory: Retrograde menstruation through fallopian tubes or surgical procedure introduces endometrial tissue to a new site.
- Metaplastic theory: Endometrial tissue arises from coelomic epithelium (aka peritoneum).
What is an endometrial polyp?
An exophytic lesion of variable size projecting into the endometrial cavity.
What are the symptoms of endometriosis?
Pelvic pain
Infertility
Dysmennorhoea
How are endometrial polyps treated?
With a hysteroscope in an outpatient clinic.
What does microscopy of an endometrial polyp show?
Haphazardly arranged glands with preservation of glands:stroma ratio.
Thick walled vessels.
Fibrous stroma.
Occasionally can see cytological atypia or adenocarcinoma.
What can cause endometrial hyperplasia and adenocarcinioma?
Prolonged oestrogen stimulation of the endometrium.
May be due to
- anovulatory changes
- endogenous oestrogen e.g. PCOS, obesity, ovarian tumour
- Exogenous oestrogen e.g. HRT
What is endometrial hyperplasia?
Categorised by an increase in the gland:stroma ratio.
Can be with or without cytological atypia.
What kind of endometrial hyperplasia is a precursor of endometrioid carcinoma?
Atypical endometrial hyperplasia.
How is endometrial hyperplasia mangaged?
Progesteron therapy such as mirena IUD or hysterectomy.
How is endometrioid adenocarcinoma managed?
Hysterectomy with subsequent management based on stage.
What is a leiomyoma?
A benign smooth muscle tumour of the myometrium.
What are the symptoms of leiomyoma?
Asymptomatic
Abnormal bleeding
Urinary frequency (if large and presses bladder)
Impaired fertility
Describe the appearance of leiomyomas?
Well demarkated with no necrosis or haemorrhagic areas. White tumours with whorled cut surface.
Microscopically resembles normal smooth muscle.
What is the medical management of leiomyomas?
Progesterone secreting IUS
Hormonal therapies
Transexamic acid
GnRH agonists.
What is the surgical management of leiomyomas?
Uterine artery embolisation (blocks the artery that feeds it)
Myomectomy
Hysterectomy
What is a Leiomyosarcoma?
An uncommon malignant tumour of the myometrium
What is the peak incidence of leiomyosarcoma?
40-60
What are the symptoms of leiomyosarcoma?
Initially none, then bleeding and pain.
Describe the pathology of a leiomyosarcoma?
Can be a bulky invasive mass or a polypoid mass with necrosis, haemorrhagic areas.
Microscopically has cytological atypia, necrosis, mitotic activity, infiltrative margin.
Where does leiomyosarcoma commonly metastasise to?
Liver lungs and brain.
What is an Endometrial Stromal Sarcoma (ESS)?
A group of tumours in the endometrial stroma. Very rare, can be low grade or high grade.
Describe the pathology of ESS?
Both have diffuse infiltrative worm like growths. Many mitoses.
What is gestational trophoblasstic disease?
An umberela term for several conditions including hydatidiform moles (partial and complete), and malignant tuours such as choriocarcinoma.
How do hydatidiform moles presents?
Either as spontaneous miscarriage or abnormalities detected on ultrasound.
What is a partial hydatidiform mole?
What does microscopy show?
One egg fertilised by 2 sperm, resulting in a triploid karyotype.
Microscopy shows oedematous villi and trophoblast proliferation. There is a risk of the mole invading and destroying the uterus.
What is a complete hydatidiform mole?
What does microscopy show?
One egg with no genetic material being fertilised by one sperm that duplicates its genetic material, OR 2 sperm.
Diploid karyotype usually 46XX.
Microscopy: Large oedematous villi with central cisterns and circumferential trophoblast proliferation.
Risk of invasive mole or choriocarcinoma.
How do we diagnose moles and choriocarcinoma?
Send products of conception to pathology. They can confirm placentally derived chorionic villi or an implantation site.
