Pathology of Uterus Flashcards
What is the effect of oestrogen in the proliferative phase of the menstrual cycle?
Growth
What is the effect of progesterone in the secretory phase of the menstrual cycle?
Secretion
What will the endometrium be like post-menopausal?
Inactive
Atrophic
What is the graafian follicle?
The dominant follicle that is selected to become the corpus luteum
What type of epithelium lines the endometrium?
Glandular (columnar) epithelium
What is a mitotic figure?
Cell actively growing
What is the corpus albicans?
As the corpus luteum is being broken down by macrophages, fibroblasts lay down type I collagen, forming the corpus albicans
How will the histological slides change as the endometrium progresses from follicular to secretory?
Increased tortuosity and luminal secretions
What are the indications for endometrial sampling?
Abnormal uterine bleeding
Ix for infertility
Spontaneous and therapeutic abortion
Assessment of response to hormonal therapy
Endometrial ablation; indication for abnormal bleeding
Work up prior to hysterectomy for benign indications
Incidental finding of thickened endometrium on scan
Endometrial cancer screening; lynch syndrome
Why should you sample spontaneous and therapeutic abortions?
Exclude a molar pregnancy
What is menorrhagia?
Prolonged and increased menstrual flow
What is metorrhagia?
Regular intermenstrual bleeding
What is polymenorrhoea?
Menses occuring at <21 days interval
What is polymenorrhagia?
Increased bleedig and frequent cycle
What is menometorrhagia?
Prolonged menses and intermenstrual bleeding
What is amenorrhoea?
Absence of menstruation > 6 months
What is oligoamenorrhoea?
Menses at intervals of > 35 days
What is the definition of post menopausal bleeding?
Abnormal uterine bleeding > 1 year after cessation of menstruation
What are causes of AUB in adolescence or early reproductive life?
DUB due to anovulatory cycles
Pregnancy/ miscarriage
Endometritis
Bleeding disorders; protein S or protein C deficiency
What are causes of AUB in reproductive life/ perimenopause?
Pregnancy/ miscarriage DUB; anovulatory cycles, luteal phase defects Endometritis Endometrial/ endocervical polyp Leiomyoma = FIBROID Adenomyosis Exogenous hormone effects Bleeding disorders Hyperplasia Neoplasia; cervical, endometrial
What is adenomyosis?
Endometrial glands and stroma in the myometrium; causes painful menstruatio n
What is dysmenorrhea?
Painful menses
What is endometriosis?
Endometrial glands and stroma outwith the endometrial cavity
What causes AUB postmenopausally?
Endometrial carcinoma Sarcoma Atrophy Endometrial polyp Exogenous hormones; HRT, tamoxifen Endometritis Bleeding disorders
What is the gold standard for assessing the endometrium?
Transvaginal US
In postmenopausal women what endometrial thickness is an indication for taking a biopsy?
More than 4mm
16mm in premenopausal
What are the 2 methods to sample the endometrium?
Endometrial pipelle
Dilation and curretage
What is the difference between an endometrial pipelle and dilatation and curettage?
Pipelle; no anaesthesia, outpatient procedure, very safe BUT limited sample
Dilatation and curretage; most common op performed in women, most common sampling method, BUT can miss5% of hyperplasias/ cancers
What is a required history in gynae?
Age Date of LMP and length of cycle Pattern of bleeding Hormones Recent pregnancy
Should you take a pipelle when the women is menstruating?
No
What is DUB?
Irregular uterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining (no organic cause for bleeding)
What is the most common cause of DUB?
Anovulatory cycles; PCOS, hypothalamic dysfunction, thyroid disorders, hyperprolactinaemia
When is DUB most common?
At either end of reproductive life
Describe the pathogenesis of DUB?
Corpus luteum does not form
Continued growth of functionalis layer
What is luteal phase deficiency?
Insufficient progesterone or poor response by endometrium to progesterone
Abnormal follicular development (inadequate FSH/LH)
Poor corpus luteum
What is the pathology of organic causes of AUB?
Endometrium; endometritis, polyp, miscarriage
Myometrium; adenomyosis, leiomyoma
How is endometritis pathologically diagnosed?
Recognition of abnormal pattern of inflammatory cells
What is the role of the cervical plug?
Protects the endometrium from ascending infection
What micro-organisms commonly cause endometritis?
N. gonorrhea Chlamydia TB CMV Actinomyces (fungal assoc with IUCD) HSV
What can cause inflammation of the endometrium without a specific organism?
IUCD; copper coil Post-partum Postabortal Post-curretage Chronic endometritis Granulomatous (sarcoid, foreign body post ablation) Assoc with leiomyomata or polyps
What is chronic plasmacytic endometritis assoc with?
PID; N. gonorrhoeae, chlamydia, enteric organisms)
Will endometrial polyps be symptomatic?
Tend to be asymptomatic but may present with bleeding or discharge
Is an endometrial polyp always benign?
No; endometrial cancer can present as a polyp
When will polyps become painful?
They can tort and infarct
Can ulcerate
What are the subunits of the placenta?
Chorionic villi; contains all the DNA of the foetus
At what age will a foetus have nucleated blood vessels?
Below 12 weeks
What is a molar pregnancy?
Abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus
It’s a form of gestational trophoblastic disease which grows as a mass characterized by swollen chorionic villi
Partial or complete moles
What is a trophoblast?
Cells that form the outer layer of a blastocyst, which provide nutrients to the embryo and develop into a large part of the placenta
Which type of hydatidiform mole has a higher risk of malignant transformation to a choriocarcinoma (tumour of placenta)?
Complete rather than partial
What is a complete molar pregnancy?
Only paternal DNA present
Sperm fertilises with an egg that has lost its DNA
What is a partial molar pregnancy?
2 sperm fertilize one egg and therefore you will get 69 XXY (triploid)
So will have both maternal and paternal DNA
What is leiomyoma?
Benign tumour of smooth muscle, may be found in locations other that the uterus
How can a leiomyoma present?
Menorrhagia
Infertility
Mass effect
Pain
How will a leiomyoma look microscopically?
Interlacing smooth muscle cells
Can a leiomyoma transform malignant?
Yes; leiomyosarcoma
