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Reproductive and Sexual Health > Pathology of Uterus > Flashcards

Pathology of Uterus Flashcards

1
Q

What can be used to investigate the uterus?

What is considered abnormal in women?

A

TV-USS or a hysteroscope

> 4mm in post-menopausal and >16mm in pre-menopausal is generally indication for a biopsy

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2
Q

What is the most common cause for DUB?

A

anovulatory cycle - this is the lack of development of a leading follicle and corpus luteum. SO there is no lutinising phase and continued oestrogen release - results in continued growth of endometrium

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3
Q

What are some causes of anovulation?

A

PCOS, hyperprolactinaemia, pituitary failure, hypothalmic dysfunction, thyroid disorders

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4
Q

What is endometritis?

A

This is inflammation of the endometrium caused by:

  • organsims (neisseria, chlamydia, TB, CMV, HSV…)
  • IUD
  • Post partum/ post abortion/ post currettage
  • chronic
  • associated with leimyomata or polyps
  • granulomatous disease
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5
Q

What protective mechanisms prevent infection in the endometrium?

A

Cervical mucous plug protects from ascending infection

Cyclical shedding

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6
Q

What is chronic plasmocytic endometritis associated with?

A

PID - infectious until proven otherwise

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7
Q

How will endometrial polyps present?

A

Usually asymptomatic (found incidentally) but can present with bleeding
most commonly found on peri- or post-menopausal women
almost always benign

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8
Q

What can present as endometrial polyps?

A

Endometrial cancer

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9
Q

What is a molar pregnancy?

A

this is an abnormal fertilised egg that implants into the uterus or tubes
it can be either partial or complete
it is a form of gestational trophoblastic disease

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10
Q

What is molar pregnancy characterised by?

A

swollen chorionic villi

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11
Q

What is the definition of a ‘complete’ molar pregnancy?

A

This is when a haploid sperm will fertilise an egg that has lost its DNA. This will then divide to have 46 chromosomes but the DNA will only be paternal

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12
Q

What is the definition of a ‘partial’ molar pregnancy?

A

This is when 2 sperm or 1 sperm that duplicates will fertilise an egg to give 69XXY (triploidy). both maternal and paternal DNA is pregnant

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13
Q

What can develop from a molar pregnancy?

A

Choriocarcinoma (malignant tumour of trophoblasts) - complete has a greater risk than partial of developing into this

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14
Q

What will a molar pregnancy look like on USS?

A

Snow storm appearance

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15
Q

What is adenomyosis?

A

This is the growth of enometrium (glands and stroma) through the myometrium

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16
Q

What is a leiomyoma?

A

benign tumour of the smooth muscle (can occur in any location of smooth muscle)

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17
Q

What hormone is a leiomyoma dependent on?

A

Oestrogen dependent for growth

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18
Q

What is the difference between endometrial polyp and a fibroid?

A 
Polyp = overgrowth of the endometrial layer
Fibroid = overgrowth of the myometrium
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19
Q

What are the characteristics of an adenomyosis?

A

35-40, menorrhagia, dysmenorrhoea, dyspareunia, reduced fertility

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20
Q

How is adenomyosis treated?

A

Progesterone

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21
Q

What are the characteristics of a leiomyoma?

A

Also called fibroids
very common in women over 40
Present with pelvic mass, menorrhagia, infertility, compression on the uterine cavity

22
Q

What is ‘red degradation’?

A

this is the acute disproportionate pain associated with the newly compromised blood supply to a fibroid. This is most commonly occurring in pregnancy or perimenopause

23
Q

How will a leiomyoma (fibroid) look on USS?

A

smooth echogenic mass, usually multiple

24
Q

What cells are present on a histology slide of a fibroid?

A

Smooth muscle cells interlacing

25
Q

Why may an MRI be used in fibroids?

A

For localisation

26
Q

What is a polyp?

A

This is an inflammatory outgrowth of the endometrium

27
Q

What is the presentation of a polyp?

A

Asymptomatic but may have inter-menstrual bleeding or post-menstrual bleeding as well as a change to discharge

28
Q

How is a polyp investigated?

A

hysteroscopy or TVUS

29
Q

How is a polyp managed?

A

watch and wait but may require diathermal removal

30
Q

How are fibroids managed?

A

Watch and wait but may require surgery (embolisation, myomectomy, hysteroscopic resection)

31
Q

What is endometrial hyperplasia?

A

This is the overgrowth of endometrial tissue generally due to unopposed oestrogen levels

32
Q

What are some causes of unopposed oestrogen?

A

HRT (oestrogen only), PCOS (menstrual irregularity), menopause, obesity (external conversion of androgens by aromatase in fat)

33
Q

How will endometrial hyperplasia present?

A

DUB or PMB

34
Q

What are the different types of endometrial hyperplasia?

A

Simple - generalised stroma and glands
Complex - focal glands but normal cytology
Atypical - focal gland and abnormal cytology, can become malignant

35
Q

Describe the hormone axis involved in endometrial hyperplasia

A

oestrogen will increase the growth of the endometrium. In a normal person the release of an ovum would cause development of the corpus luteum (produces progesterone). If fertilisation did not occur then there will be a drop in progesterone and eostrogen levels to signal the start of menstruation. In endometrial hyperplasia there is no release of ovum, production of progesterone so menstruation is not initiated - results in overgrowth of the endometrium

36
Q

What are the two types of endometrial cancer?

A

Endometriod (mucinous) carcinoma and Serous (clear cell) carcinoma

37
Q

Describe the precusors for endometroid carcinoma

A

atypical hyperplasia associated with unopposed oestrogen and lynch syndrome

38
Q

What is lynch syndrome?

A

this is a condition that predisposes an individual to cancers e.g. colon, endometrial, breast, ovarian, stomach

39
Q

What is lynch syndrome characterised by?

A

microsatelite instability - causes defective mismatch repair

40
Q

What is the precusor for serious endometrial carcinoma?

A

serous intraepithelial carcinoma - associated with TP53

41
Q

What is the general presentation of endometrial cancer?

A

older women 50-60s, will present with post-menopausal bleeding then a pelvic mass and large uterus

42
Q

What is the best investigation for endometrial carcinoma?

A

TVUS + biopsy

43
Q

Why would MRI/CT be used in endometrial carcinoma?

A

MRI - to determine the layer of infiltration of carcinoma

CT - to determine the nodal and pulmonary infiltrate

44
Q

What might immunohistochemistry show for endometrial carcinoma and why?

A

Microsatellite instability - lynch syndrome

45
Q

How is a low risk endometrial carcinoma treated?

A

usually surgery +/- brachytherapy/pelvic radiotherapy
If a person wants to maintain their fertility then can give a progestin hormonal therapy (Megestrol) with regular monitoring

46
Q

How is moderate endometrial carcinoma treated?

A

Surgery + radiotherapy + chemo

47
Q

How is high risk endometrial carcinoma treated?

A

Radiotherapy +/- surgery

48
Q

What is palliative treatment for an ER positive tumour?

A

Tamoxifen + aromatase inhibitor (chemo combo)

49
Q

What is palliative treatment for an ER negative tumour?

A

carboplatin and paclitaxel (chemo combo)

50
Q

Give some example of rarer endometrial cancers

A

Carcinosarcoma (associated with a rhabdomyosarcoma)

Leiomyosarcoma (malignant fibroid)

51
Q

How are endometroid cancers graded?

A

mainly by their architecture
grade 1 = 5% or less solid growth
grade 2 = 6-50% solid growth
grade 3 = >50% solid growth

Reproductive and Sexual Health (27 decks)

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