Uterine Pathology Flashcards by Elyaa Saleh

Cause of Acute Endometritis

Staphylococci and Streptococci (after delivery or miscarriage)
Neisseria gonorrhoeae, Chlamydia trachomatis
Retained products of conception

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What type of Endometritis shows plasma cells (lympho-plasmacytic infiltrates) on histology?

Chronic Endometritis

Acute -> Neutophilic infiltrates

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Histology of Acute vs Chronic Endometritis

Chronic –> Plasma cells
Acute –> Neutophilic infiltrates

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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)

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Clinical presentations of Endometritis

Fever, abdominal pain, and menstrual abnormalities

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Complications of Endometritis

Increased risk of infertility and ectopic pregnancy
(consequence of scarring of the fallopian tubes)

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———-: Growth of the basal layer of the endometrium down into the myometrium

Adenomyosis

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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

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Clinical presentation of Adenomyosis

1) AUB/HMB (abnormal uterine bleeding/ heavy menstural bleeding)
2) pelvic pain and Dymernorrhea (pain ass. w/ mensturation)

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———— : Presence of endometrial glands and stroma
in a location outside the endo-myometrium

Endometriosis

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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)

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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

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What udergoes cycling bleeding, Endometriosis or Adenomyosis?

Endometriosis

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Clinical presentation of Endometriosis

1) Cyclic pelvic pain and Dysmenorrhoea
2) Pain on defecation (Dyschezia)
3) Dyspareunia (painful intercourse)
4) Dysuria
5) Infertility

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Microscopic findings:
1. Endometrial glands
2. Endometrial stroma
3. Haemosiderin pigment
4. blood filled, Chocolate cysts

features of?

Endometriosis

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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

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Causes of Abnormal Uterine Bleeding
(4 groups)

1. Failure of Ovulation
2. Inadequate Luteal Phase
3. Contraceptive-induced Bleeding
4. Endo-Myometrial Disorders

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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

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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

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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

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patho of AUB caused by Contraceptive-induced bleeding

The use of Older oral contraceptives –> induces a variety of endometrial responses, resulting in abnormal bleeding

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State 3 Endo-Myometrial Disorders

✓Endometritis
✓Endometrial Polyps
✓Submucosal Leiomyomas

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Proliferative lesions/Neoplasms of the Endometrium

Endometrial Hyperplasia
Endometrial Carcinomas
Endometrial Polyps
Endometrial Stromal Sarcoma

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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?

1. Endometrioid Carcinoma (80% of cases) 2. 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

1. **Obesity** 2. Diabetes mellitus 3. Hypertension 4. Infertility 5. **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

1. Necrosis 2. Cytologic atypia 3. 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