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
List 7 causes of inflammation of endometritis that isn’t caused by infection.
Coil, postpartum, postabortal, post curettage, chronic endometritis NOS, granulomatous, associated with leiomyomata or polyps
Chronic plasmacytic endometritis must be assumed infectious unless proven otherwise. This is because of its association with a specific disease, what disease is this?
Associated with PID
What are 2 causes of granulomatous endometritis?
Sarcoidosis or foreign body post ablation
What is a granuloma?
Collection of epithelioid macrophages
How and in who do endometrial polyps normally present?
Usually asymptomatic but may present with bleeding/discharge. Often around/after the menopause
Endometrial polyps are almost always benign but endometrial carcinoma can present as a polyp. True/false?
True
What is present on histological slide in miscarriage and give one example?
Products of conception - e.g. chorionic villi
Why might a sample of miscarriage be sent for analysis by pathology?
To differentiate it from a molar pathology
What is a molar pregnancy?
Abnormal pregnancy in which a non-viable fertilised egg implants in the uterus
Molar pregnancy is the most common form of gestational trophoblastic disease. How is it characterised histologically?
By swollen chorionic villi
What is a complete mole in a molar pregnancy and does it contain maternal/paternal/both DNA?
1 or 2 sperm combining with an egg which has lost its DNA. Sperm reduplicated so complete mole contains only paternal DNA
What is a partial mole in molar pregnancy and does it have maternal/paternal/both DNA?
When egg is fertilised by 2 sperm or by one sperm which reduplicates itself so there 69, XXY/XXX. Partial moles have maternal and paternal DNA
Why is it important to differentiate complete moles?
Complete moles have a higher risk of developing into choriocarcinoma than partial moles
What marker is used for monitoring complete mole to see if it has degraded or not?
Beta HCG cos it produces beta HCG
What is adenomyosis and what 2 main symptoms does it cause?
Presence of endometrial glands and stroma within the myometrium. Causes menorrhagia/dysmenorrhoea
What is leiomyoma? What is another clinical term for this?
Common benign tumour of smooth muscle. Fibroid
How may leiomyoma present?
Menorrhagia
infertility
mass effect
pain
The growth of leiomyomas depend on what hormone?
Oestrogen
Leiomyosarcomas are common. True/false?
False - they are rare
How do leiomyomas present histologically?
Interlacing smooth muscle cells
