Pathology of Uterus Flashcards
What can be used to investigate the uterus?
What is considered abnormal in women?
TV-USS or a hysteroscope
> 4mm in post-menopausal and >16mm in pre-menopausal is generally indication for a biopsy
What is the most common cause for DUB?
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
What are some causes of anovulation?
PCOS, hyperprolactinaemia, pituitary failure, hypothalmic dysfunction, thyroid disorders
What is endometritis?
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
What protective mechanisms prevent infection in the endometrium?
Cervical mucous plug protects from ascending infection
Cyclical shedding
What is chronic plasmocytic endometritis associated with?
PID - infectious until proven otherwise
How will endometrial polyps present?
Usually asymptomatic (found incidentally) but can present with bleeding
most commonly found on peri- or post-menopausal women
almost always benign
What can present as endometrial polyps?
Endometrial cancer
What is a molar pregnancy?
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
What is molar pregnancy characterised by?
swollen chorionic villi
What is the definition of a ‘complete’ molar pregnancy?
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
What is the definition of a ‘partial’ molar pregnancy?
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
What can develop from a molar pregnancy?
Choriocarcinoma (malignant tumour of trophoblasts) - complete has a greater risk than partial of developing into this
What will a molar pregnancy look like on USS?
Snow storm appearance
What is adenomyosis?
This is the growth of enometrium (glands and stroma) through the myometrium
What is a leiomyoma?
benign tumour of the smooth muscle (can occur in any location of smooth muscle)
What hormone is a leiomyoma dependent on?
Oestrogen dependent for growth
What is the difference between endometrial polyp and a fibroid?
Polyp = overgrowth of the endometrial layer Fibroid = overgrowth of the myometrium
What are the characteristics of an adenomyosis?
35-40, menorrhagia, dysmenorrhoea, dyspareunia, reduced fertility
How is adenomyosis treated?
Progesterone
What are the characteristics of a leiomyoma?
Also called fibroids
very common in women over 40
Present with pelvic mass, menorrhagia, infertility, compression on the uterine cavity
What is ‘red degradation’?
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
How will a leiomyoma (fibroid) look on USS?
smooth echogenic mass, usually multiple
What cells are present on a histology slide of a fibroid?
Smooth muscle cells interlacing
Why may an MRI be used in fibroids?
For localisation
What is a polyp?
This is an inflammatory outgrowth of the endometrium
What is the presentation of a polyp?
Asymptomatic but may have inter-menstrual bleeding or post-menstrual bleeding as well as a change to discharge
How is a polyp investigated?
hysteroscopy or TVUS
How is a polyp managed?
watch and wait but may require diathermal removal
How are fibroids managed?
Watch and wait but may require surgery (embolisation, myomectomy, hysteroscopic resection)
What is endometrial hyperplasia?
This is the overgrowth of endometrial tissue generally due to unopposed oestrogen levels
What are some causes of unopposed oestrogen?
HRT (oestrogen only), PCOS (menstrual irregularity), menopause, obesity (external conversion of androgens by aromatase in fat)
How will endometrial hyperplasia present?
DUB or PMB
What are the different types of endometrial hyperplasia?
Simple - generalised stroma and glands
Complex - focal glands but normal cytology
Atypical - focal gland and abnormal cytology, can become malignant
Describe the hormone axis involved in endometrial hyperplasia
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
What are the two types of endometrial cancer?
Endometriod (mucinous) carcinoma and Serous (clear cell) carcinoma
Describe the precusors for endometroid carcinoma
atypical hyperplasia associated with unopposed oestrogen and lynch syndrome
What is lynch syndrome?
this is a condition that predisposes an individual to cancers e.g. colon, endometrial, breast, ovarian, stomach
What is lynch syndrome characterised by?
microsatelite instability - causes defective mismatch repair
What is the precusor for serious endometrial carcinoma?
serous intraepithelial carcinoma - associated with TP53
What is the general presentation of endometrial cancer?
older women 50-60s, will present with post-menopausal bleeding then a pelvic mass and large uterus
What is the best investigation for endometrial carcinoma?
TVUS + biopsy
Why would MRI/CT be used in endometrial carcinoma?
MRI - to determine the layer of infiltration of carcinoma
CT - to determine the nodal and pulmonary infiltrate
What might immunohistochemistry show for endometrial carcinoma and why?
Microsatellite instability - lynch syndrome
How is a low risk endometrial carcinoma treated?
usually surgery +/- brachytherapy/pelvic radiotherapy
If a person wants to maintain their fertility then can give a progestin hormonal therapy (Megestrol) with regular monitoring
How is moderate endometrial carcinoma treated?
Surgery + radiotherapy + chemo
How is high risk endometrial carcinoma treated?
Radiotherapy +/- surgery
What is palliative treatment for an ER positive tumour?
Tamoxifen + aromatase inhibitor (chemo combo)
What is palliative treatment for an ER negative tumour?
carboplatin and paclitaxel (chemo combo)
Give some example of rarer endometrial cancers
Carcinosarcoma (associated with a rhabdomyosarcoma)
Leiomyosarcoma (malignant fibroid)
How are endometroid cancers graded?
mainly by their architecture
grade 1 = 5% or less solid growth
grade 2 = 6-50% solid growth
grade 3 = >50% solid growth
