Uterine Pathology Flashcards
List 9 indications for endometrial sampling.
Main: exclude malignancy ,
Abnormal uterine bleeding,
infertility,
spontaneous and therapeutic abortion,
Assessment of response to hormonal therapy e.g. cancers treated by progesterone therapy,
Endometrial ablation,
prior to hysterectomy for benign indications,
Incidental finding of thickened endometrium on scan,
Endometrial cancer screening in high risk patients e.g. Lynch syndrome
What is menorrhagia? (Type of Abnormal uterine bleeding (AUB))
Prolonged and increased menstrual flow - very common cause for biopsy
What is metrorrhagia? (AUB)
Regular intermenstrual bleeding
What is polymenorrhoea? (AUB)
Periods occurring at <21 day interval
What is polymenorrhagia? (AUB)
Increased bleeding and frequent cycle
What is menometrorrhagia? (AUB)
Prolonged periods and intermenstrual bleeding
What is amenhorrhoea? (AUB)
Absence of menstruation >6months
What is oligomenorrhoea? (AUB)
Periods at intervals of >35 days
What is the difference between abnormal uterine bleeding (AUB) and disordered uterine bleeding (DUB)?
DUB is AUB with no organic cause
What is post-menopausal bleeding (PMB)?
AUB >1year after cessation of menstruation
List causes of AUB in the perimenopausal stage?(10)
Pregnancy/miscarriage, DUB, endometriosis, endometrial/endocervical polyp, leiomyoma, adenomyosis, exogenous hormone effects, bleeding disorders, hyperplasia, neoplasia (cervical/endometrial)
DUB usually occurs at the start or end of perimenopause (reproductive life). What are 2 causes of DUB and which is most common?
Anovulatory cycles most common,
luteal phase defects
List 8 causes of AUB in post-menopausal state.
Atrophy, endometrial polyp, exogenous hormones (e.g. HRT, tamoxifen), endometritis (usually bacterial), bleeding disorders, hyperplasia, endometrial carcinoma, sarcoma
What endometrial thickness is expected in postmenopausal women and what thickness in premenopausal women?
> 4mm in postmenopausal
>16mm in premenopausal
How can endometrium be assessed and how biopsied?
Assessed: USS & Hysteroscopy
Biopsied: endometrial pipelle or dilatation and curretage
Which method of sampling the endometrium is best for getting bigger sample and which is most common?
Dilatation and curretage
What is important to include in the notes with an endometrial biopsy?
- age
- date of last menstrual period and length of cycle
- pattern of bleeding
- hormones
- recent pregnancy
Corpus luteum forms but does not function properly in DUB caused by anovulatory cycles. True/false
False- corpus luteum does not form at all
Without corpus luteum in anovulatory cycles there is continued growth of functionalis layer without going into secretory phase and can cause DUB. What are 4 examples of causes of this?
PCOS,
hypothalamic dysfunction,
thyroid disorders,
hyperprolactinaemiac
What is luteal phase deficiency?
Insufficient progesterone or poor response by endometrium to progesterone. There is abnormal follicular development and so poor corpus luteum
How do glands appear on pathology section of endometrium with anovulatory cycle?
Disorder proliferation with dilated and irregular glands and mitotic figures
Endometritis can be diagnosed histologically by looking for inflammatory cells that shouldn’t be in the endometrial stroma. Which cells in particular does this refer to?
Plasma cells - shouldn’t normally be in endometrial stroma
Endometritis is infection of the endometrial tissue. Why is endometritis not very common?
Cervical mucous plug protects the endometrium from ascending infection and also routine shedding of endometrium
List 6 micro-organisms that can cause endometritis.
Neisseria, chlamydia, TB, CMV, actinomyces, HSC
