Uterine Pathology Flashcards
What phases make up the ovarian cycle?
Follicular phase
Ovulation (Day 14)
Luteal phase
What phases make up the uterine cycle?
Menstrual phase (day 1)
Proliferative phase
Secretory phase
Describe the proliferative phase of the endometrium:
Time
Hormone involved
Effect
Day 1 - 14
Oestrogen
Growth
Describe the secretory phase of the endometrium:
Time
Hormone involved
Effect
Day 16 - 28
Progesterone
Secretion
Describe the menstrual phase of the endometrium:
Time
Hormone involved
Effect
Day 1 - 3
Withdrawal of hormones
Necrosis
Describe the fertilised phase of the endometrium:
Time
Hormone involved
Effect
From secretory phase onwards (day 16)
Progesterone and HCG
Hypersecretion and decidualisation
What are indications for endometrial sampling?
Abnormal uterine bleeding
Investigations for infertility
Spontaneous and therapeutic abortion
Assessment of response to hormonal therapy
Prior to ablation to check that tissue is benign
Prior to hysterectomy
Endometrial cancer screening in high risk patients e.g. Lynch syndrome
Define menorrhagia
Prolonged and increased menstrual flow
Define metrorrhagia
Regular intermenstrual bleeding
Define polymenorrhoea
Menses occuring at <21 day interval
Define polymenorrhagia
Increased bleeding and frequent cycle
Define menometorrhagia
Prolonged menses and intermenstrual bleeding
Define amenorrhoea
Absence of menstruation >6 months
Define oligomenorrhoea
Menses at intervals >35 days
What is dysfunctional uterine bleeding?
Abnormal uterine bleeding without an organic cause
What is peri-menopausal bleeding?
Abnormal uterine bleeding (AUB) more than 1 year after cessation of menstruation
What is the most common cause of AUB in adolescence?
Anovulatory cycles - if the woman doesn’t ovulate then the endometrium keeps growing until it outgrows its blood supply and dies
What is the most common cause of AUB in reproductive life?
Pregnancy/ miscarriage
What is the most common cause of AUB in post-menopausal women?
Atrophy
How can the breast cancer drug Tamoxifen cause uterine bleeding?
Anti-oestrogenic drug but paradoxical stimulation of oestrogen in endometrium
What does sarcoma in uterus affect?
Stromal cells of endometrium
Smooth muscle cells of myometrium
How can the endometrium be assessed?
Transvaginal ultrasound
Hysteroscopy - endometrial pipelle or dilatation and curettage
What are the indications for a biopsy after transvaginal ultrasound?
If the endometrial thickness is:
>4mm in postmenopausal
>16mm in premenopausal
What are organic causes of AUB in the endometrium?
Endometriosis
Polyps
Miscarriage
What are organic causes of AUB in myometrium?
Adenomyosis
Leiomyoma
What are causes of endometriosis?
Infection - neisseria, chlamydia, TB, CMB, acinomyces, HSV IUD Post-partum Post-curattage Granulomatous (sarcoid etc) Associated with leiomyomata or polyps
What is chronic plasmacytic endometritis?
Infectious - associated with PID
Plasma cells in endometrium
What is granulomatous endometritis?
Collection of epithelial macrophages
Granular disease - sarcoid, TB
What are the clinical signs and symptoms of endometrial polyps?
Usually asymptomatic
Sometimes bleeding or discharge
Are endometrial polyps benign or malignant?
Almost always benign
Can occur due to endometrial carcinoma
What is a molar pregnancy?
Non-viable fertilised egg implants in uterus
A form of gestational trophoblastic disease characterised by swollen chorionic villi
What are the types of molar pregnancies?
Complete mole
Partial mole
How is a complete mole formed?
One or two sperm combine with egg that has no DNA (i.e. only paternal DNA)
How is a partial mole formed?
When an egg is fertilised by 2 sperm or by 1 sperm which reduplicates
i.e. 69XXY
What is a potential malignancy risk of complete moles?
Risk of developing into choriocarcinoma (malignant tumour of trophoblast)
What is adenomyosis?
Endometrial glands and stroma within the myometrium
What is leiomyoma?
Benign tumour of the smooth muscle
