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Reproduction and Sexual Health > Uterine Pathology > Flashcards

Uterine Pathology Flashcards

1
Q

What are the stages of the ovarian cycle?

A

1 – follicular phase.
2 – ovulation.
3 – luteal phase.

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2
Q

What are the stages of the uterine cycle?

A

1 – menstrual phase.
2 – proliferative phase.
3 – secretory phase.

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3
Q

What is the proliferative phase driven by?

A

Oestrogen

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4
Q

What is the secretory phase driven by?

A

Progesterone

Note - (just after ovulation; main purpose is to produce endometrium to support fertilised egg)

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5
Q

What is fertilisation driven by?

A

Progsterone + HCG

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6
Q

What days is the proliferative phase between?

A

1-14

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7
Q

What days does menstruation occur?

A

1-3

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8
Q

What days does the secretory phase occur?

A

16-28

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9
Q

What is the effect of the proliferative phase?

A

Growth

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10
Q

What is the effect of the secretory phase?

A

Secretion

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11
Q

What is the effect of the menstrual phase?

A

Necrosis

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12
Q

What is the effect of fertilisation?

A

Hypersecretion + decidualisation

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13
Q

What produce oestrogen and progesterone?

A

Granulosa cells - therefore drive the menstrual cycle

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14
Q

What cell type initiates the menstrual cycle?

A

Granulosa cells (as these produce oestrogen and progesterone)

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15
Q

What do glands look like in the secretory phase?

A

Curvy-looking glands which will become saw-toothed and irregular.

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16
Q

What is DUB usually due to?

A

Anovulatory cycles

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17
Q

List some causes of AUB in early adulthood.

A
  • DUB usually due to anovulatory cycles
  • Pregnancy/miscarriage
  • Endometritis
  • Bleeding disorders
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18
Q

List cause of AUB in reproductive life/perimenopausal.

A
  • Pregnancy/miscarriage
  • DUB: anovulatory cycles, luteal phase defects,
  • Endometritis
  • Endometrial/endocervical polyp
  • Leiomyoma
  • Adenomyosis
  • Exogenous hormone effects
  • Bleeding disorders
  • Hyperplasia
  • Neoplasia: cervical, endometrial
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19
Q

What are leiomyoma aka?

A

Fibroids

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20
Q

What is the commonest female benign tumour?

A

Leiomyoma

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21
Q

What is adenomyosis?

A

Endometrium in the smooth muscle of the uterus

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22
Q

List causes of AUB post-menopause.

A
  • Atrophy
  • Endometrial polyp – fibrous stroma which hangs down and can cause a bit of bleeding
  • Exogenous hormones: HRT, tamoxifen
  • Endometritis
  • Bleeding disorders
  • Hyperplasia
  • Endometrial carcinoma
  • Sarcoma
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23
Q

List causes of AUB post-menopause.

A
  • Atrophy
  • Endometrial polyp
  • Exogenous hormones: HRT, tamoxifen
  • Endometritis
  • Bleeding disorders
  • Hyperplasia
  • Endometrial carcinoma
  • Sarcoma
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24
Q

How does an endometrial polyp cause bleeding?

A

Fibrous stroma which hangs down and can cause a bit of bleeding

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25
Q

During a TVUS, a biopsy is taken. What thickness of biopsy is taken for i) postmenopausal women ii) premenopausal women?

A

i) 4 mm

ii) 16 mm

26
Q

What should you NEVER do if the biopsy is negative?

A

Don’t take it as 100% revealing of the truth. If sx continue, and you feel that something isn’t right, biopsy again.

27
Q

Give 2 methods of sampling the endometrium.

A
  • Endometrial pipelle.

* Dilatation and curettage.

28
Q

Describe endometrial pipelle.

A

3.1mm diameter, no dilatation needed

  • No anaesthesia needed
  • Done as an outpatient procedure
  • VERY safe
29
Q

What is the biggest disadvantage of an endometrial pipelle?

A

Limited sample

30
Q

What is the most common operation performed on women?

A

Dilatation and curettage

31
Q

Dilatation and curettage is the most thorough method of sampling, BUT

A

It can miss 5% of hyperplasia/cancers

32
Q

What 5 things are REQUIRED when taking a history from a lady before she gets endometrial sampling?

A
  • Age
  • Date of LMP and length of cycle
  • Pattern of bleeding
  • Hormones
  • Recent pregnancy
33
Q

What is DUB?

A

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

34
Q

What are most cases of DUB due to?

A

Anovulatory cycles

35
Q

When are anovulatory cycles most common?

A

At either end of reproductive life

36
Q

What does not form in an anovulatory cycle?

A

The corpus luteum

37
Q

What continues in an anovulatory cycle?

A

The growth of the functionalis layer

38
Q

Name 4 different conditions which cause anovulatory cycles.

A
  • PCOS
  • Hypothalamic dysfunction
  • Thyroid disorders
  • Hyperprolactinaemia
39
Q

Describe a luteal phase deficiency.

A
  • Insufficent progesterone or poor response by the endometrium to progesterone.
  • Abnormal follicular development (inadequate FSH/LH) – poor corpus luteum.
40
Q

In the endometrium, what may cause AUB?

A
  • Endometritis.
  • Polyp.
  • Miscarriage.
41
Q

In the myometrium, what may cause AUB?

A
  • Adenomyosis.

* Leiomyoma.

42
Q

Histologically, what is endometritis diagnosed by?

A

Recognising an abnormal pattern of inflammatory cells

43
Q

What protects the endometrium from ascending infection?

A

Cervical mucous plug

44
Q

What also makes the endometrium relatively resistant to infection?

A

Cyclical shedding of the endometrium

45
Q

Give examples of organisms which may cause endometritis.

A 
Neisseria
Chlamydia
TB
CMV
Actinomyces
HSV
46
Q

Give examples of causes of inflammation without specific organisms.

A 
Intra-uterine contraceptive device
Postpartum
Postabortal
Post curettage
Chronic endometritis NOS
Granulomatous (sarcoid, foreign body post ablation)
Associated with leiomyomata or polyps
47
Q

Unless proven otherwise, the cause of Chronic Plasmacytic Endometritis is __________?

A

Infectious

48
Q

What is Chronic Plasmacytic Endometritis associated with?

A

Pelvic inflammatory disease

49
Q

How do endometrial polyps present?

A

Usually asymptomatic, but may present with bleeding or discharge

50
Q

When do endometrial polyps often occur?

A

Around and after the menopause

51
Q

Polyps are ______

A

Benign

52
Q

How can endometrial carcinoma sometimes present?

A

As a polyp

53
Q

Histologically, how can a pregnancy be confirmed?

A

Confirm pregnancy by confirming the presence of chorionic villi or trophoblasts

54
Q

What is adenomyosis? What does it cause?

A

Where there are endometrial glands and stroma within the myometrium

  • Menorrhagia/dysmenorrhoea.
55
Q

On histology, how does adenomyosis appear?

A

As endometrial glands and stroma within the myometrium.

56
Q

What is leiomyoma?

A

A benign tumour of smooth muscle, which may be found in locations other than the uterus

57
Q

What are the signs + symptoms of a leiomyoma?

A

Menorrhagia.
Infertility.
Mass effect.
Pain.

58
Q

What is the growth of a leiomyoma dependant on?

A

Oestrogen

59
Q

On microscopy of a leiomyoma, what is seen?

A

Interlacing smooth muscle cells

60
Q

How can a leiomyoma look?

A

Yellow or white

Reproduction and Sexual Health (51 decks)

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