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Repro > Uterine Pathology > Flashcards

Uterine Pathology Flashcards

1
Q

List 9 indications for endometrial sampling.

A

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

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2
Q

What is menorrhagia? (Type of Abnormal uterine bleeding (AUB))

A

Prolonged and increased menstrual flow - very common cause for biopsy

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3
Q

What is metrorrhagia? (AUB)

A

Regular intermenstrual bleeding

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4
Q

What is polymenorrhoea? (AUB)

A

Periods occurring at <21 day interval

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5
Q

What is polymenorrhagia? (AUB)

A

Increased bleeding and frequent cycle

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6
Q

What is menometrorrhagia? (AUB)

A

Prolonged periods and intermenstrual bleeding

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7
Q

What is amenhorrhoea? (AUB)

A

Absence of menstruation >6months

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8
Q

What is oligomenorrhoea? (AUB)

A

Periods at intervals of >35 days

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9
Q

What is the difference between abnormal uterine bleeding (AUB) and disordered uterine bleeding (DUB)?

A

DUB is AUB with no organic cause

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10
Q

What is post-menopausal bleeding (PMB)?

A

AUB >1year after cessation of menstruation

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11
Q

List causes of AUB in the perimenopausal stage?(10)

A 
Pregnancy/miscarriage, 
DUB,
endometriosis, 
endometrial/endocervical polyp, 
leiomyoma, 
adenomyosis, 
exogenous hormone effects, 
bleeding disorders, 
hyperplasia, 
neoplasia (cervical/endometrial)
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12
Q

DUB usually occurs at the start or end of perimenopause (reproductive life). What are 2 causes of DUB and which is most common?

A

Anovulatory cycles most common,

luteal phase defects

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13
Q

List 8 causes of AUB in post-menopausal state.

A 
Atrophy,
endometrial polyp, 
exogenous hormones (e.g. HRT, tamoxifen),
endometritis (usually bacterial), 
bleeding disorders, 
hyperplasia, 
endometrial carcinoma, 
sarcoma
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14
Q

What endometrial thickness is expected in postmenopausal women and what thickness in premenopausal women?

A

> 4mm in postmenopausal

>16mm in premenopausal

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15
Q

How can endometrium be assessed and how biopsied?

A

Assessed: USS & Hysteroscopy
Biopsied: endometrial pipelle or dilatation and curretage

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16
Q

Which method of sampling the endometrium is best for getting bigger sample and which is most common?

A

Dilatation and curretage

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17
Q

What is important to include in the notes with an endometrial biopsy?

A
  • age
  • date of last menstrual period and length of cycle
  • pattern of bleeding
  • hormones
  • recent pregnancy
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18
Q

Corpus luteum forms but does not function properly in DUB caused by anovulatory cycles. True/false

A

False- corpus luteum does not form at all

19
Q

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?

A

PCOS,
hypothalamic dysfunction,
thyroid disorders,
hyperprolactinaemiac

20
Q

What is luteal phase deficiency?

A

Insufficient progesterone or poor response by endometrium to progesterone. There is abnormal follicular development and so poor corpus luteum

21
Q

How do glands appear on pathology section of endometrium with anovulatory cycle?

A

Disorder proliferation with dilated and irregular glands and mitotic figures

22
Q

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?

A

Plasma cells - shouldn’t normally be in endometrial stroma

23
Q

Endometritis is infection of the endometrial tissue. Why is endometritis not very common?

A

Cervical mucous plug protects the endometrium from ascending infection and also routine shedding of endometrium

24
Q

List 6 micro-organisms that can cause endometritis.

A

Neisseria, chlamydia, TB, CMV, actinomyces, HSC

25
Q

List 7 causes of inflammation of endometritis that isn’t caused by infection.

A

Coil, postpartum, postabortal, post curettage, chronic endometritis NOS, granulomatous, associated with leiomyomata or polyps

26
Q

Chronic plasmacytic endometritis must be assumed infectious unless proven otherwise. This is because of its association with a specific disease, what disease is this?

A

Associated with PID

27
Q

What are 2 causes of granulomatous endometritis?

A

Sarcoidosis or foreign body post ablation

28
Q

What is a granuloma?

A

Collection of epithelioid macrophages

29
Q

How and in who do endometrial polyps normally present?

A

Usually asymptomatic but may present with bleeding/discharge. Often around/after the menopause

30
Q

Endometrial polyps are almost always benign but endometrial carcinoma can present as a polyp. True/false?

A

True

31
Q

What is present on histological slide in miscarriage and give one example?

A

Products of conception - e.g. chorionic villi

32
Q

Why might a sample of miscarriage be sent for analysis by pathology?

A

To differentiate it from a molar pathology

33
Q

What is a molar pregnancy?

A

Abnormal pregnancy in which a non-viable fertilised egg implants in the uterus

34
Q

Molar pregnancy is the most common form of gestational trophoblastic disease. How is it characterised histologically?

A

By swollen chorionic villi

35
Q

What is a complete mole in a molar pregnancy and does it contain maternal/paternal/both DNA?

A

1 or 2 sperm combining with an egg which has lost its DNA. Sperm reduplicated so complete mole contains only paternal DNA

36
Q

What is a partial mole in molar pregnancy and does it have maternal/paternal/both DNA?

A

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

37
Q

Why is it important to differentiate complete moles?

A

Complete moles have a higher risk of developing into choriocarcinoma than partial moles

38
Q

What marker is used for monitoring complete mole to see if it has degraded or not?

A

Beta HCG cos it produces beta HCG

39
Q

What is adenomyosis and what 2 main symptoms does it cause?

A

Presence of endometrial glands and stroma within the myometrium. Causes menorrhagia/dysmenorrhoea

40
Q

What is leiomyoma? What is another clinical term for this?

A

Common benign tumour of smooth muscle. Fibroid

41
Q

How may leiomyoma present?

A

Menorrhagia
infertility
mass effect
pain

42
Q

The growth of leiomyomas depend on what hormone?

A

Oestrogen

43
Q

Leiomyosarcomas are common. True/false?

A

False - they are rare

44
Q

How do leiomyomas present histologically?

A

Interlacing smooth muscle cells

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