Uterine Pathology Flashcards
describe the endometrium histology during the proliferative phase?
there is a glandular monolayer with stroll cells in between, higher mitotic figures tell you the cell is proliferating and dividing
describe the endometrium histology during the secretory phase?
glands more torturous
many nuclei and a vacuole seen
indications for endometrial sampling?
Abnormal uterine bleeding
Investigation for infertility
Spontaneous and therapeutic abortion (are there trophoblastic nuclei & villi)
Assessment of response to hormonal therapy
Endometrial ablation
Work up prior to hysterectomy for benign indications
Incidental finding of thickened endometrium on scan (lynch syndrome)
Endometrial cancer screening in high risk patients
state the definitions of the words below
- Menorrhagia
- Metrorrhagia
- Polymenorrhoea
- Polymenorrhagia
- Menometrorrhagia
- Amenorrhoea
- Oligomenorrhoea
- prolonged and increased menstrual flow
- regular intermenstrual bleeding
- menses occurring at < 21 day interval
- increased bleeding and frequent cycle
- prolonged menses and intermenstrual bleeding
- absence of menstruation > 6 months
- Menses at intervals of > 35 days
name the causes of abnormal uterine bleeding (AUB) in early reproductive life? (4)
anovulatory cycles
Preg/miscarriage
Endometritis
Bleeding disorders
causes of AUB perimenopause? (10)
pregnancy/miscarriage DUB:anovulatory cycles, luteal phase defects endometritis endometrial/endocervical polyp Leiomyoma (smooth muscle tumour) Adenomyosis (endometrium enters the myometrium) Exogenous hormone effects Bleeding disorders Hyperplasia Neoplasia:cervical/endometrial
causes of AUB post menopause? (8)
Atrophy Endometrial polyp Exogenous hormones: HRT, tamoxifen Endometritis Bleeding disorders
hyperplasia
endometrial carcinoma
sarcoma
how do you asses the endometrium on investigation?
- imaging?
- sampling?
Trans vaginal US & hystroscopy
Endometrial thickness of > 4mm in postmenopausal women (16mm in premenopausal) is an indication for biopsy
-endometrial pipelle
3.1mm diameter, no dilatation needed
no anaesthesia necessary
Outpatient procedure
very safe
limited sample
dilatation & curetage
more thorough sampling method but can miss 5% hyperplasias
Histological assessment of endometrial samples in AUB: what is required? (4)
Is the sample adequate/representative for the given clinical scenario
Is there evidence of fresh/old breakdown/haemorrhage
Is there an organic benign abnormality? (polyp, endometritis, miscarriage)
Is there evidence for dysfunctional bleeding?
Is there hyperplasia (atypical/non atypical) or malignancy?
what is dysfunctional uterine bleeding?
-cause for most cases?
irregular uterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation (no organic cause for bleeding)
-annovulatory cycles
in PCOS, hypothalamic dysfunction, thyroid disorders , hyperprolactinaemia
OR
luteal phase deficiency- insufficient progesterone or poor response by the endometrium to progesterone , gives abnormal follicular development and poor corpus luteum
Appearance of the endometrium after an anovulatory cycle
see disordered proliferation
large cystic glands and no secretory development in the glands at all
Endometritis
- histological Dx?
- endometrial protective mechanisms?
- causative organisms?
- inflammation without organisms?
- marker for chronic plasmacytic endometritis
- abnormal pattern of inflammatory cells
- cervical mucous plug and cyclical shedding of the endometrium also helps
- Neisseria/Chlamydia/TB/CMV/Actinomyces/HSV
- IUD, postpartum, Postabortal, post curettage, Chronic endometritis, granulomatous, assoc with leiomyomata or polyps
- can see plasma cells, infectious unless proved otherwise, Assoc with PID
Endometrial polyps
- presentation?
- occur when?
- malignant status?
- usually asymptomatic but may present with bleeding or discharge
- Often occur around and after the menopause
- almost always benign but endometrial carcinoma can present as a polyp
what is seen on histology after miscarriage in the products of conception?
trophoblastic cells that the chorionic villi & earliest placenta are made up of
+foetal RBC have nuclei
Molar pregnancy
- what is a molar pregnancy?
- catagories of mole?
- complication of molar preg?
- investigations?
-an abnormal form of pregnancy in which a non viable fertilised egg implants in the uterus
basically a form of gestational trophoblastic disease which grows as a mass characterised by swollen chorionic villi
-complete mole and partial mole
Complete: caused by a single or two sperm combined with an egg which has lost it’s DNA (the sperm then reduplicates forming a complete 46 chromosome set. only paternal DNA is present in a complete mole
Partial: when an egg is fertilised by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid). Partial moles have both maternal and paternal DNA
- cmoplete hydatidiform moles have a higher risk of developing into choriocarcinoma (malignant tumour of trophoblasts) the tend to be chemosensitive
- very high Beta HCG & enlarged Uterus on CT
