uterine pathology Flashcards
causes of abnormal uterine bleed in adolescence/early reproductive life
dysfunctional uterine bleeding
pregnancy/miscarriage
endometritis
bleeding disorders
what endometrial thickness on TVUS indicates need for biopsy
> 4mm postmenopausal
>16mm pre-menopausal
what is dysfunctional uterine bleeding
bleeding disrupting normal cycle
common cause of dysfunctional uterine bleeding
anovulatory cycles (start/end reproductive life)
corpus luteum does/doesn’t form in dysfunctional uterine bleeding
doesn’t
what layer of uterus has overgrown in dysfunctional uterine bleeding
functionalis
diagnosis of dysfunctional uterine bleeding
diagnosis of exclusion
rule out other things - FBC, cervical smear, thyroid, renal and LFTs, endometrial sampling
management of dysfunctional uterine bleeding
progesterone/COCP GnRH analogues NSAIDs anti-fibrinolytics mirena IUS endometrial resection hysterectomy
what is endometritis
infection of uterus
endometritis is common/uncommon
why?
uncommon
cervical mucous plug and acidic vaginal pH protect uterus from ascending infection
cyclical endometrial shedding
what would disrupt protective barriers against ascending infection
miscarriage TOP child birth IUD insertion surgery
presentation of endometritis
lower abdo pain
fever
tender
discharge
diagnosis of endometritis
diagnosed on histology - abnormal pattern of inflammatory cells
neutrophils are normal
plasma cells are abnormal
organisms causing endometritis
Neisseria chlamydia TB CMV actinomyces HSV
what are endometrial polyps
growths in the uterus
often incidental on scans
polyps are benign/malignant
usually benign - can have focal parts which are malignant
what des miscarriage look like histologically
trophoblasts or chorionic villi
foetal red cells (still have nuclei)
what is molar pregnancy
non-viable egg implants uterus or tube
what is a complete mole
one or two sperm in an egg which has lost its DNA
sperm reduplicate forming 46 chromosome set (only paternal DNA)
what is a partial mole
egg and two sperm causing triploidy (69XXY)
contain maternal and paternal DNA
what can molar pregnancies turn into
choriocarcinoma
what type of mole has highest risk of turning malignant
complete hydatidiform
what is adenomyosis
presence of endometrial glands in myometrium (seen in endometriosis)
what is leiomyoma
benign tumour of smooth muscle
UTERINE FIBROID
presentation of leiomyoma
menorrhagia infertility pressure symptoms pain/tenderness women >40 may be multiple
histology of leiomyoma
interlacing smooth muscle cells
very white
spindle cells
what is growth of leiomyoma dependant on
oestrogen
treatment for leiomyoma
ullipristal acetate
surgery (hysterectomy if family complete)
most common age group affected by endometrial cancer
post menopausal
risk factors for uterine cancer
obesity nulliparity anovulatory cycles PCOS early/late menopause lynch syndrome breast cancer oestrogen only HRT
protective factors of endometrial cancer
parity
COCP
what hormone can cause growth of most endometrial cancers
oestrogen (especially if unopposed by progesterone)
what is endometrial hyperplasia
proliferation of endometrium in response to prolonged oestrogen exposure
treatment for endometrial hyperplasia
if no abnormality on histology, treat with progestogens and re-biopsy in 6-12 months
if atypia - surgery
what can endometrial hyperplasia turn into
endometrial carcinoma
what are the 2 main groups of endometrial carcinoma
endometroid (type 1) serous carcinoma (type 2)
what do endometrial carcinoma and endometrial hyperplasia both present with
abnormal bleeding
precursor of endometroid carcinoma
atypical hyperplasia
precursor of serous carcinoma
serous intraepithelial carcinoma
what are most endometrial cancers
adenocarcinoma
where do endometrial cancers spread to
myometrium and cervix
lymphatics and blood
risk factor for endometrioid carcinoma
unopposed oestrogen
PTEN, KRAS, PIK3CA mutations
risk factor for serous carcinoma
elderly
TP53 mutation
why is obesity a risk factor for endometrial cancer
adipocytes convert ovarian androgens into oestrogens inducing abnormal proliferation
Insulin also induces growth
what is lynch syndrome
hereditary non-polyposis colorectal cancer
mode of inheritance of lynch syndrome
autosomal dominant
what is mutation in lynch syndrome
defective DNA mismatch repair gene
what can help identify tumours due to lynch syndrome
staining for mismatch repair protein
microsatellite instability
what is more aggressive, type 1 or type 2 cancers
type 2
why does serous carcinoma have a worse prognosis than endometroid
serous spreads early to peritoneal cavity
what is endometrial stromal sarcoma
from endometrial stroma
invasive
lymphovascular effects
what is carcinosarcoma
high grade tumour with carcinomatous and sarcomatous elements
causes of tubal swellings
ectopic pregnancy
hydrosalpinx
pyosalpinx
paratubal cysts (embryological remnants)
