Uterine Pathology Flashcards
Cause of Acute Endometritis
- Staphylococci and Streptococci (after delivery or miscarriage)
- Neisseria gonorrhoeae, Chlamydia trachomatis
- Retained products of conception
What type of Endometritis shows plasma cells (lympho-plasmacytic infiltrates) on histology?
Chronic Endometritis
Acute -> Neutophilic infiltrates
Histology of Acute vs Chronic Endometritis
Chronic –> Plasma cells
Acute –> Neutophilic infiltrates
Causes of Chronic Endometritis
- Chlamydia trachomatis, Mycobacterium tuberculosis → Granulomatous Endometritis + Salpingitis + Peritonitis
- Retained gestational tissue (post-partum or post
abortion patients) - Intra-uterine contraceptive device (IUD)
Clinical presentations of Endometritis
Fever, abdominal pain, and menstrual abnormalities
Complications of Endometritis
Increased risk of infertility and ectopic pregnancy
(consequence of scarring of the fallopian tubes)
———-: Growth of the basal layer of the endometrium down into the myometrium
Adenomyosis
Macroscopic features:
– Enlarged globular uterus
– Thickened uterine wall
Microscopic findings:
– Nests of endometrial stroma, glands, or both, deep in the myometrium interposed between the muscle bundles
– Reactive hypertrophy of the myometrium
features of?
Adenomyosis
Clinical presentation of Adenomyosis
1) AUB/HMB (abnormal uterine bleeding/ heavy menstural bleeding)
2) pelvic pain and Dymernorrhea (pain ass. w/ mensturation)
———— : Presence of endometrial glands and stroma
in a location outside the endo-myometrium
Endometriosis
Endometriosis is commonly found in?
ovaries (frequently bilateral), pelvis, peritoneum, recto-vaginal septum, tubes, uterine ligaments
(can spread to distant sites such as the lymphs, heart and lungs)
Cause of Endometriosis
May be due:
1) Retrograde (backflow) menstrual flow
2) Metaplastic transformation; Endometrail diffrentiation of coleomic epithelium
3) transportation of endometrial tissue via lymphatic system
What udergoes cycling bleeding, Endometriosis or Adenomyosis?
Endometriosis
Clinical presentation of Endometriosis
1) Cyclic pelvic pain and Dysmenorrhoea
2) Pain on defecation (Dyschezia)
3) Dyspareunia (painful intercourse)
4) Dysuria
5) Infertility
Microscopic findings:
1. Endometrial glands
2. Endometrial stroma
3. Haemosiderin pigment
4. blood filled, Chocolate cysts
features of?
Endometriosis
The 3 Types of Abnormal uterine bleeding
1. Menorrhagia: Profuse or prolonged bleeding at the time of the period
2. Metrorrhagia: Irregular bleeding between the periods
3. Post-menopausal bleeding
Causes of Abnormal Uterine Bleeding
(4 groups)
1. Failure of Ovulation
2. Inadequate Luteal Phase
3. Contraceptive-induced Bleeding
4. Endo-Myometrial Disorders
What group of AUB is caused by failure of the corpus luteum to mature normally or regresses prematurely → relative lack of progesterone?
Inadequate Luteal Phase
Patho of Ovulatory faliure
excess of oestrogen relative to progesterone; Thus, the endometrium goes through a proliferative phase that is not followed by the normal secretory phase –> breakdown and abnormal bleeding
Microscopic findings:
– Disordered or mild dilated endometrial glands
– Scarce endometrial stroma (due to lack of
progesterone)
features of?
Abnoraml Uterine Bleeding caused by Ovulatory failure
patho of AUB caused by Contraceptive-induced bleeding
The use of Older oral contraceptives –> induces a variety of endometrial responses, resulting in abnormal bleeding
State 3 Endo-Myometrial Disorders
✓Endometritis
✓Endometrial Polyps
✓Submucosal Leiomyomas
Proliferative lesions/Neoplasms of the Endometrium
- Endometrial Hyperplasia
- Endometrial Carcinomas
- Endometrial Polyps
- Endometrial Stromal Sarcoma
Proliferative lesions/Neoplasms of the Myometrium
- Leiomyomas
- Leiomyosarcomas, de novo
Epi of Endometrial Hyperplasia
Excess of oestrogen relative to progesterone
Causes of Endometrial Hyperplasia
Failure of ovulation, oestrogen producing ovarian
lesions (polycystic ovary disease), obesity
Clinical presentation of Endometrial Hyperplasia
Abnormal uterine bleeding
Endometrial Hyperplasia is asso. w?
Increased risk for Endometrial Carcinoma,
(esp. w/ cytologic atypia)
what type of Endometrial Hyperplasia is this?
Simple Hyperplasia
without Atypia
what type of Endometrial Hyperplasia is this?
Complex Hyperplasia
with Atypia
what type of Endometrial Hyperplasia is this?
Complex Hyperplasia
without Atypia
Epi of Endometrial CA
- Most frequent cancer in the female genital tract
- btw 55-65 yrs
The 2 distinct types of Endometrial CA?
- Endometrioid Carcinoma (80% of cases)
- Serous Carcinoma (15% of cases)
Endometrioid CA is ass. w?
Association with Oestrogen excess and Endometrial Hyperplasia in peri-menopausal women
Risk factors of Endometrioid CA
- Obesity
- Diabetes mellitus
- Hypertension
- Infertility
- Exposure to unopposed Oestrogen
Endomterioid CA are caused by what type of mutations?
mismatch repair genes and the tumour
suppressor gene PTEN
Serous type CA are caused by what type of mutations?
Mutations in TP53 gene
Microscopic findings:
– Similarity to normal endometrial glands
– Various histologic types: i. Mucinous, ii. Tubal, &
iii. Squamous differentiation
- Tall columnar cells w/ bland nuclei
features of?
Endometrioid type Carcinoma
what Grade of Endometrioid Adeno-Ca is this?
Grade 1 Endometrioid Adeno-Ca
(myo-invasion)
what Grade of Endometrioid Adeno-Ca is this?
Endometrioid type Ca (Grade 3)
what Grade of Endometrioid Adeno-Ca is this?
Endometrioid type Ca (Grade 2)
Prognosis of serous Type CA
Aggressive behaviour; By definition high-grade
Microscopic findings:
– Small tufts and papillae (chracteristic)
– High degree of cytologic atypia
- Immunohistochemistry: Marked positivity for TP53
features of ?
Serous type Carcinoma
Clinical presentation of Endometrial CA?
1) Leukorrhoea and irregular bleeding (post-menopausal women)
2) Uterus enlargement
Complications of Endometerial CA
Dissemination to regional lymph nodes and distant sites
———— : Polypoid projection of the endometrial mucosa into the uterine cavity
Endometrial Polyps
Epi of Endometrial Polyps
At any age, but most frequently around the time of menopause
Clinical presentation of Endometrial Polyps
Abnormal uterine bleeding
Microscopic findings:
– Endometrium resembling stratum basalis
– Frequently, Presence of small muscular arteries (thick-walled)
– Most commonly, cystically dilated glands
Features of?
Endometrial Polyps
———–: Benign tumours that arise from the smooth muscle cells in the myometrium
Leiomyomas
Epi of Leiomyomas
-
The most common benign tumour in females
– increased incidence in Black pateints
patho of Leiomymoas
Oestrogen sensitive–> Oestrogens stimulate the growth of Leiomyomas
Clinical presentation of leiomyomas
1) Abnormal uterine bleeding
2) Large leiomyomas –> Palpable lesions
3) Dragging sensation
Macroscopic features:
– More often multiple discrete tumours [D]
– Sharply circumscribed
– Firm gray-white mass
– Characteristic whorled pattern of smooth muscle bundles w/ well-demarcated borders
– Localisation: intramural, submucosal, subserosal
Features of?
Leiomyomas
Malignant tumours that arise, de novo from
the mesenchymal cells of the myometrium . W/ soft, haemorrhagic, necrotic masses microscopically.
Leiomyosarcomas
Diagnostic features of malignancy
- Necrosis
- Cytologic atypia
- Mitotic activity
Microscopic features:
* Cytologic atypia with hyperchromatic pleomorphic nuclei
* Prominent cellular pleomorphism
* spindle-shapped smooth muscle cells with varying degree of Atypia and mitotic figures
* Round or polygonal cells with eosinophilic to clear cytoplasm
* widely variable histologic appearance; ranging from tumours closely resembling Leiomyomas to wildly anaplastic neoplasms
features of?
Leiomyosarcomas
Epi of Leiomyosarcomas
Post-menopausal women
