Uterine Pathology Flashcards
What is in the ovarian cycle?
- Follicular
- Ovulation—day 14 (breaking of ovumin fallopian tube)
- Luteal—release of progesterone
What is in the uterine cycle?
- menstrual phase (day 1-3)
- proliferative—longest phase at 14 days (day 1-14)
- secretory phase (day 16-28) —wont get secretory unless ovulation occurs
What drives the proliferative phase?
ESTROGEN
What is the predominant hormone in the SECRETIVE phase?
- progestrone
What occurs in the uterus in menopause?
the uterine wall is not growing nor shedding
- very thin
What is the graafian follicle?
- the principle ovum
- surrounded by hormone secreting cells
WHat does the corpus luteum produce?
progesterone
What change is seen in the glands in the secretory phase?
- glands are more complex and wiggly
- cells are filled with secretions
Why do endometrial sampling?
Abnormal uterine bleeding
Investigation for infertility
Spontaneous and therapeutic abortion
Assessment of response to hormonal therapy –obesity > endometrial cancer
Endometrial ablation—eradication of the endometrium
Work up prior to hysterectomy for benign indications
Incidental finding of thickened endometrium on scan
Endometrial cancer screening in high risk patients
Wh./at is metorrhagia?
- regular INTERMENSTRUAL bleeding
What is DUB?
- DYSRUPTED uterine bleeding
- —d/t anovulatory cycles
Causes of AUB in adolesence.
PREGNANCY/ miscarriage
- endometritis
- bleeding d.o
- anovulatory cycle
Causes of AUB in peri-menopausal/reproductive women?
- pregnancy. miscarriage
- leiomyoma (fibroid/ smooth m. tumor)
- endometritis
- endocervical polyp
- adenomyosis (endometrium found in the smooth
m. ) - exogenous hormone
- hyperplasia
- neoplasia
How to asses the endometrium?
- TVUS
- – measure the thickness from one side to the other
- >4mm thickness= INDICATION for biopsy - hysteroscopy
Name an outpatient procedure for sampling the endometrium and why it is so?
Endometrial Pipelle
- no anesthesia
- very safe
- LIMITED sample (can’t reach further up)
What is D&C?
Dilatation and Curettage
- MOST COMMON sampling of endometrium
- —can miss 5% of cancer and hyperplasias
What is needed for hx prior to endometrial sampling?
- age
- Date of LMP
and length of cycle - pattern of bleeding
- hormones
- recent preg.
What to search histologically for a pt coming in with AUB?
- benign abnormality (polyp, endometritic, miscarriage)?
- DUB?
- hyperplasia
- evidence of fresh/old hemorrhage.
What is DUB defined as?
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)
Why does anovulatory cycle occur?
- d/t to no formation of Corpus Luteum. scretory phase does not occur and proliferation phase keeps going (continued growth of Stratum Functionalis)
What occurs in endometritis?
- - inflammation of uterine lining caused by: - MICROORGANISMS - IUD - POST-curettage - Postabortal -postpartum a/w polyps
What is a.w granulomatous endometritis ?
TB
SARCOIDOSIS
What is a consequence of endometrial polyps?
- twisting of the polyp around its stalk—may lead to ischemia
When does endometrial polyp appears?
- often AROUND MENOPAUSE
- almost always BENIGN (smooth contours)
What is a molar pregnancy>
- abnormal pregnancy
Who’s dna does a complete mole hold?
- ONLY PATERNAL DNA; 2 male copies or a single sperm combining with an empty egg —-placenta forms and no fetus
- genotypes of 46
How is Partial mole diff.?
- either: egg fertilized by 2 sperms OR single sperm REDUPLICATES itself and fetilizes egg
- genotypes of 69
Risk of complete mole ?
- — may progress to CHORIOCARCINOMA
- —higher risk than partial moles developing this cancer
WHat hormonal finding is found with molar pregnancy?
- high hCG levels
- released by the SYNCTIOTROPHOBLAST
How does a fibroid present as?
- menorrhagia/ infertility/ mass effect/ pain
- SINGLE or MULTIPLE
- growth is estrogen dependent
What is a malignant leiomyoma?
- pure smooth muscle
- spindle-y cells
What conditions cause anovulation?
- conditions causing Luteal Phase deficiency (either INSUFFICIENT progesterone or POOR response by the endometrium to progesterone)
- —Or could be inadequate FSH/LH (poor corpus luteum)
Microsomal Causes of Endometritis
Neisseria Chlamydia TB CMV Actinomyces HSV
How may an endometrial polyp present as?
- ASYMPTOMATIC
- may present with BLEEDING or DISCHARGE
What does adenomyosis present as?
- endometrial glands and STROMA is within the myometrium
- causes menorrhagia and dysmenorrhoea
