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Gynaecology > Pathology - Uterus > Flashcards

Pathology - Uterus Flashcards

1
Q

3 phases of the ovarian cycle

A

follicular

ovulation

luteal

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2
Q

3 phases of uterine cycle

A

menstrual phase

proliferative phase

secretory phase

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3
Q

Time, Hormone, effect of each uterine cycle phase

A

Proliferative - D 1-14 , Oestrogen, Growth

Secretory - D16-28, Progesterone, Secretion

Menstrual- D1-3, Withdrawal, Necrosis

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4
Q

effect of fertilisation on endometrium (+ responsible hormones)

A

progesterone - hypersecretion

HCG - decidualisation

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5
Q

Post-menopausal effect on endometrium

A

atrophy, inactivity

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6
Q

histological features of secretory phase

A

increasing tortuosity and lumenal secretions

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7
Q

3 limitations in interpreting endometrial biopsies

A

Constant physiological changes before, during and after reproductive life

Changes due to hormone therapy

Lack of clinical data

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8
Q

8 indications for endometrial sampling

A

Abnormal uterine bleeding

Investigation for infertility

Spontaneous and therapeutic abortion

Assessment of response to hormonal therapy

Endometrial ablation

Work up prior to hysterectomy for benign indications

Incidental finding of thickened endometrium on scan

Endometrial cancer screening in high risk patients

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9
Q

Menorrhagia

A

prolonged and increased menstrual flow

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10
Q

Metrorrhagia

A

regular IMB

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11
Q

Polymenorrhea

A

Menses occurring

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12
Q

Polymenorrhagia

A

increased bleeding and frequent cycle

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13
Q

Menometrorrhagia

A

Prolonged/heavy menses and IMB

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14
Q

Amenorrhoea

A

absence of menses >6m

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15
Q

Oligomenorrhoea

A

Menses at intervals >35 days

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16
Q

DUB

A

AUB with no organic cause

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17
Q

PMB

A

AUB > 1 year after cessation of menstruation

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18
Q

Painful bleeds (term)

A

Dysmenorrheoa

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19
Q

Causes of AUB in adolescence/early reproductive life (4)

A

DUB due to anovulatory cycles

Pregnancy/miscarriage

Endometritis

Bleeding disorders

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20
Q

Causes of AUB: Reproductive life/perimenopause (10)

A

pregnancy/miscarriage

endometritis

DUB: anovulatory/luteal phase defects

Endocervical/endometrial polyps

leiomyoma

adenomyosis

exogenous hormone effects

bleeding disorders

hyperplasia

neoplasia: cervical, endometrial

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21
Q

Causes of post menopausal AUB (8)

A

endometrial polyps

atrophy

endometritis

bleeding disorders

exogenous hormones: HRT, tamoxifen

hyperplasia

neoplasia: endometrial

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22
Q

Methods of assessing the endometrium

A

TVUS

Hysteroscopy

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23
Q

What endometrial thickness on TVUS is an indication for biopsy? (postmenopausal and premenopausal)

A

Endometrial thickness of:

> 4mm in Postmenopausal

> 16mm in Premenopausal

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24
Q

2 ways of sampling the endometrium

A
  1. Endometrial pipelle

2. Dilatation and Curretage

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25
Q

Which endometrial sampling method is the most thorough?

A

D & C

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26
Q

Endometrial pipelle pros (4)

A

no anaesthesia
outpatient procedure
very safe
3.1mm diameter no dilatation needed

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27
Q

Endometrial pipelle cons

A

Limited sample

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28
Q

What is the most common operation performed on women

A

D&C

29
Q

Pros of D&C (1)

A

most thorough sampling method

30
Q

Cons of D&C (1)

A

Can miss 5% hyperplasia/cancers

31
Q

Required History for endometrial biopsy (5)

A 
Age
Date of LMP and length of cycle
Pattern of bleeding
Hormones
Recent pregnancy
32
Q

What information do pathologists NOT need to know with endometrial biopsy

A

drugs WITHOUT hormonal influences

Number of pregnancies

33
Q

Questions to ask yourself in the histological assessment of endometrial samples for AUB (5)

A

is the sample adequate/representative for the given clinical scenario?

Is there evidence of fresh/old breakdown/haemorhage?

Is there an organic benign abnormality? (polyp, endometritis, miscarriage)

Is there evidence for dysfunctional bleeding?

Is there hyperplasia (atypical/non-atypical) or malignancy?

34
Q

During what phase is the endometrial biopsy least informative?

A

Menstrual

35
Q

What is the definition of DUB

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 bleeding)

36
Q

What % of DUB are due to anovulatory cycles?

A

85%

37
Q

When is anovulatory DUB most common?

A

either ends of reproductive life

38
Q

What happens in anovulatory DUB?

A

Corpus luteum does not form

continued growth of the functionalis layer

39
Q

Other causes of anovulation? (4)

A

PCOS

Hypothalamic dysfunction

Thyroid disorders

Hyperprolactinaemia

40
Q

What happens in luteal phase deficiency?

A

insufficient progesterone or poor response by the endometrium to progesterone.

Abnormal follicular development - inadequate FSH/LH

Poor corpus Luteum

41
Q

Histological features of anovulatory cycle

A

disordered proliferation

eg. LMP 8 weeks previously yet glands and stroma continue to grow

42
Q

Organic ENDOMETRIAL causes of AUB (3)

A

endometritis
polyps
miscarriage

43
Q

organic MYOMETRIAL causes of AUB (2)

A

Leiomyoma

Adenomyosis

44
Q

Endometritis histological diagnosis

A

abnormal pattern of inflammatory cells

45
Q

What are the endometrial defences to ascending infection? (2)

A

cervical mucus plug

cyclical shedding

46
Q

Mico-organism causes of endometritis? (6)

A 
CMV
HSV
Actinomyces
TB
Gonorrhea 
Chlamydia
47
Q

non-specific inflammatory causes of endometritis? (7)

A 
post partum 
post curettage
post abortion 
Granulomatous - sarcoid/FB post-ablative 
IUD
associated with leiomyomata or polyps
48
Q

What is chronic plasmacytic endometritis and what is it associated with?

A

infectious until proven otherwise

associated with PID (gonorrhea, chlamydia, enteric organisms)

49
Q

Are endometrial polyps rare?

A

nope, they are common

50
Q

How do endometrial polyps present?

A

asymptomatic, but may present with bleeding or discharge

51
Q

When do endometrial polyps occur?

A

around and after the menopause (40-60s) or pregnancy

52
Q

Are endometrial polyps benign?

A

almost always

53
Q

What may be mimicked by endometrial polyp?

A

Endometrial carcinoma

54
Q

How are endometrial polyps diagnosed?

A

TVUS

55
Q

Miscarriage histology - what will be seen

A

products of conception (fetal RBC and chorionic villi)

56
Q

Molar pregnancy histological features

A

abnormally proliferating trophoblasts

57
Q

Genetics of a complete mole

A

Complete mole is caused by a single (incidence is about 90%) or two (incidence is about 10%) sperm combining with an egg which has lost its DNA (the sperm then reduplicates forming a “complete” 46 chromosome set.

Only paternal DNA is present in a complete mole.

58
Q

Genetics of partial mole

A

Partial mole occurs when egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid).

Partial moles have both maternal and paternal DNA

59
Q

Complete v partial moles - which have a higher risk developing into choriocarcinoma

A

Complete hydatidiform moles have a higher risk of developing into choriocarcinoma (a malignant tumour of trophoblast) than partial moles.

60
Q

What will MRI of complete mole show?

A

enlarged uterus

61
Q

Adenomyosis

A

aka fibroid
Endometrial glands and stroma within the myometrium

Causes menorrhagia/dysmenorrhoea

62
Q

Leiomyoma

A

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

menorrhagia / dysmenorrhoea

63
Q

Microscopic leiomyoma

A

interlacing smooth muscle cells

64
Q

Presentation of leiomyoma

A

menorrhagia
infertility
mass effect
pain

65
Q

Do leiomyomas occur as single or multiple and what are its complications

A

Single or multiple, may disort uterine cavity

66
Q

what is fibroid growth dependent on?

A

oestrogen

67
Q

what is the cancerous version of leiomyoma

A

leiomyosarcoma

68
Q

Management of fibroids

A

myomectomy

Gynaecology (7 decks)

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