Uterine Pathology Flashcards
What are the stages of the ovarian cycle?
1 – follicular phase.
2 – ovulation.
3 – luteal phase.
What are the stages of the uterine cycle?
1 – menstrual phase.
2 – proliferative phase.
3 – secretory phase.
What is the proliferative phase driven by?
Oestrogen
What is the secretory phase driven by?
Progesterone
Note - (just after ovulation; main purpose is to produce endometrium to support fertilised egg)
What is fertilisation driven by?
Progsterone + HCG
What days is the proliferative phase between?
1-14
What days does menstruation occur?
1-3
What days does the secretory phase occur?
16-28
What is the effect of the proliferative phase?
Growth
What is the effect of the secretory phase?
Secretion
What is the effect of the menstrual phase?
Necrosis
What is the effect of fertilisation?
Hypersecretion + decidualisation
What produce oestrogen and progesterone?
Granulosa cells - therefore drive the menstrual cycle
What cell type initiates the menstrual cycle?
Granulosa cells (as these produce oestrogen and progesterone)
What do glands look like in the secretory phase?
Curvy-looking glands which will become saw-toothed and irregular.
What is DUB usually due to?
Anovulatory cycles
List some causes of AUB in early adulthood.
- DUB usually due to anovulatory cycles
- Pregnancy/miscarriage
- Endometritis
- Bleeding disorders
List cause of AUB in reproductive life/perimenopausal.
- Pregnancy/miscarriage
- DUB: anovulatory cycles, luteal phase defects,
- Endometritis
- Endometrial/endocervical polyp
- Leiomyoma
- Adenomyosis
- Exogenous hormone effects
- Bleeding disorders
- Hyperplasia
- Neoplasia: cervical, endometrial
What are leiomyoma aka?
Fibroids
What is the commonest female benign tumour?
Leiomyoma
What is adenomyosis?
Endometrium in the smooth muscle of the uterus
List causes of AUB post-menopause.
- 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
List causes of AUB post-menopause.
- Atrophy
- Endometrial polyp
- Exogenous hormones: HRT, tamoxifen
- Endometritis
- Bleeding disorders
- Hyperplasia
- Endometrial carcinoma
- Sarcoma
How does an endometrial polyp cause bleeding?
Fibrous stroma which hangs down and can cause a bit of bleeding
During a TVUS, a biopsy is taken. What thickness of biopsy is taken for i) postmenopausal women ii) premenopausal women?
i) 4 mm
ii) 16 mm
What should you NEVER do if the biopsy is negative?
Don’t take it as 100% revealing of the truth. If sx continue, and you feel that something isn’t right, biopsy again.
Give 2 methods of sampling the endometrium.
- Endometrial pipelle.
* Dilatation and curettage.
Describe endometrial pipelle.
3.1mm diameter, no dilatation needed
- No anaesthesia needed
- Done as an outpatient procedure
- VERY safe
What is the biggest disadvantage of an endometrial pipelle?
Limited sample
What is the most common operation performed on women?
Dilatation and curettage
Dilatation and curettage is the most thorough method of sampling, BUT
It can miss 5% of hyperplasia/cancers
What 5 things are REQUIRED when taking a history from a lady before she gets endometrial sampling?
- Age
- Date of LMP and length of cycle
- Pattern of bleeding
- Hormones
- Recent pregnancy
What is DUB?
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)
What are most cases of DUB due to?
Anovulatory cycles
When are anovulatory cycles most common?
At either end of reproductive life
What does not form in an anovulatory cycle?
The corpus luteum
What continues in an anovulatory cycle?
The growth of the functionalis layer
Name 4 different conditions which cause anovulatory cycles.
- PCOS
- Hypothalamic dysfunction
- Thyroid disorders
- Hyperprolactinaemia
Describe a luteal phase deficiency.
- Insufficent progesterone or poor response by the endometrium to progesterone.
- Abnormal follicular development (inadequate FSH/LH) – poor corpus luteum.
In the endometrium, what may cause AUB?
- Endometritis.
- Polyp.
- Miscarriage.
In the myometrium, what may cause AUB?
- Adenomyosis.
* Leiomyoma.
Histologically, what is endometritis diagnosed by?
Recognising an abnormal pattern of inflammatory cells
What protects the endometrium from ascending infection?
Cervical mucous plug
What also makes the endometrium relatively resistant to infection?
Cyclical shedding of the endometrium
Give examples of organisms which may cause endometritis.
Neisseria Chlamydia TB CMV Actinomyces HSV
Give examples of causes of inflammation without specific organisms.
Intra-uterine contraceptive device Postpartum Postabortal Post curettage Chronic endometritis NOS Granulomatous (sarcoid, foreign body post ablation) Associated with leiomyomata or polyps
Unless proven otherwise, the cause of Chronic Plasmacytic Endometritis is __________?
Infectious
What is Chronic Plasmacytic Endometritis associated with?
Pelvic inflammatory disease
How do endometrial polyps present?
Usually asymptomatic, but may present with bleeding or discharge
When do endometrial polyps often occur?
Around and after the menopause
Polyps are ______
Benign
How can endometrial carcinoma sometimes present?
As a polyp
Histologically, how can a pregnancy be confirmed?
Confirm pregnancy by confirming the presence of chorionic villi or trophoblasts
What is adenomyosis? What does it cause?
Where there are endometrial glands and stroma within the myometrium
- Menorrhagia/dysmenorrhoea.
On histology, how does adenomyosis appear?
As endometrial glands and stroma within the myometrium.
What is leiomyoma?
A benign tumour of smooth muscle, which may be found in locations other than the uterus
What are the signs + symptoms of a leiomyoma?
Menorrhagia.
Infertility.
Mass effect.
Pain.
What is the growth of a leiomyoma dependant on?
Oestrogen
On microscopy of a leiomyoma, what is seen?
Interlacing smooth muscle cells
How can a leiomyoma look?
Yellow or white
