Uterine pathology

Question 1

the three stages of the ovarian cycle

Answer 1

follicular phase
ovulation
luteal phase

Question 2

the three stages of the uterine cycle

Answer 2

menstrual phase
proliferative phase
secretory phase

Question 3

what happens to the cells in the secretory phase

and when does this happen

Answer 3

they become increasingly torturous and luminal secretions

day 16 of the 18 day cycle

Question 4

why is an endometrial biopsy one of the most difficult things to interpret

Answer 4

constant physiological changed before, during and after repro life
changes due to hormonal therapy
lack of clinical data

Question 5

what are the indications for endometrial sampling

Answer 5

abnormal uterine bleeding
ix for infertility
spontaneous and therapeutic abortion
assessment of response to hormonal therapy
endometrial ablation
work prior to hysterectomy for benign indications
incidental finding of thickened endometrium on scan
endometrial cancer screening in high risk patients

Question 6

menorrhagia 
metrohhagia 
polymenorrhoea
polymenorrhagia
menemetrorrhagia
amen
oligo

Answer 6

prolonged and increased flow
regular intermenstrual bleeding
menses at <21 day intervals
increased bleeding and frequent cycle
prolonged menses and intermensual bleeding
absence of menstruation >6months
menses intervals of >35 days

Question 7

when does post menopausal bleeding occur

Answer 7

> 1 year after cessation of menstruation

Question 8

causes of abnormal uterine bleeding in adolescence/repro life

Answer 8

DUB usually due to anovulatory cycles
preg/misc
endometritis
bleeding disorders

Question 9

what does dub mean

Answer 9

dysfunctional uterine bleeding - AUB with no cause

Question 10

causes of AUB: repro life/perimenopause

Answer 10

preg/misc
DUB: anovultaroy cycles, luteal phase defects
endometritis
endometrial/endocervical polio
leiomyoma
adenomyosis
exogenous hormonal effects
bleeding disorders
hyperplasia
neoplasia: cervical, endometrial

Question 11

causes of AUB: post menopausal

Answer 11

atrophy
endometrial polyp
exogenous hormone: HRT, tamoxifen
endometritis
bleeding disorders

hyperplasia
endometrial carcinoma
sarcoma

Question 12

assessing endometrium TVUS

when would a biopsy be taken depending on the US

Answer 12

transvaginal US

endometrial thickness of >4mm in post menopausal woman and 16mm in premeno is taken as indication for biopsy

Question 13

what is another method of assessing the endometrium and what can be done with that

Answer 13

hysteropscopy
endometrial pipelle - 3.1mm dm, no dilatation needed, no anaesthesia, out[atient procedure, safe

dilatation and curettage - most common operation performed on women, can miss 5% hyperplasias/cancers

Question 14

what is the required history

Answer 14

age
date of LMP and length of cycle 
pattern of bleeding 
hormones
recent preg

Question 15

histological assessment of endometrial sample for AUB

Answer 15

is the sample adequate/representaive for the given clinical scenario
evidence of fresh/old breakdown heam
organic benign abnormality (polyp, endometritis, misc)
dysfunctional bleeding?
hyperplasia, malig?

Question 16

definition of DUB

Answer 16

irregular uterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining - no organic cause for the bleeding

Question 17

what is DUB most commonly due to
when is it the commonest
what happens (2) and why

Answer 17

anovulatory cycles
either end of repro life

CL does not form and continued growth of functionalis layer (PCOS, hypothalamic dysfunction, thyroid disorders, hyperprolacinoma)

luteal phase deficiency - insuffienient prog or poor response by the endometrium to prog - abnormal follicular development (inadequate FSH/LH) - poor CL

Question 18

histology of DUB

Answer 18

disordered prolif

Question 19

organic causes of AUB

Answer 19

endo: endometritis, polyp, misc
myo: adenomyosis, leiomyoma

Question 20

endometritis
dx
2

Answer 20

histologically dx - abnormal pattern of inflam cells
cervical mucous plug prevents the endometrium from ascending infection
cyclical shedding of the endometrium also makes it relatively resistant

Question 21

causes of endometritis

Answer 21

neiseeria, chalmydia, TB, CMV, actinomycetes, HSV

without specific organisms:
IUD, post partum, post abortal, post curratege, chronic endometritis, granulomatous, assoc with leiomyomata or polyps

Question 22

chronic plasmacytic endometritis

Answer 22

infectious unless proven otherwise

assoc with PID (gonorrhoea, chlamydia, enteric organisms)

Question 23

endometrial polyps
symp
when
risk

Answer 23

common
asymp - can present with bleeding/discharge
around and after meno
almost always benign BUT endometrial carcinoma can present as a polyp

Question 24

molar preg is what
types
risk

Answer 24

abnormal form of preg where non viable fertilised egg implants - form of gestational trophoblastic disease

complete - single/two sperm combining with an egg that has lost its DNA only Y/YY
partial - egg fertilised by 2 or 1 sperm which replicates itself XXY instead of XY

complete hydatidiform moles have a higher risk of developing into a choriocarcinoma than partial moles

Question 25

adenomyosis

Answer 25

endometrial glands and stroma within the myometrium causes menorrhagia/dysmenohhoea

Question 26

leiomyoma
symp
types
growth
microscopic 
leiomyosarcoma

Answer 26

benign tumour os smooth muscle, may be found in locations other than the uterus

menorrhagia/infertility/mass effect/pain

single or multiple, may distort uterine cavity

oestrogen dependant

interlacing smooth muscle cells

rare