Uterine Pathology

Question 1

stages in the ovarian cycle of the menstrual cycle

Answer 1

Follicular phase
Ovulation
Luteal phase

Question 2

stages in the uterine cycle of the menstrual cycle

Answer 2

menstrual phase (day 1 of period)
proliferative phase (14 days, includes menstrual phase) 
secretory phase (14 days long)

Question 3

what hormone controls proliferation in the first 14 days

Answer 3

oestrogen

causes growth

Question 4

when would you not have a secretory phase

Answer 4

if there was no ovulation

Question 5

what hormone controls secretion

Answer 5

progresterone

stops proliferation and starts secretion of endometrium which can accept the blastocysts

Question 6

what hormone causes the menstrual phase of the endometrium

Answer 6

withdrawal of progesterone when there is no fertilisation

leads to necrosis of the endometrium

Question 7

what hormones control the uterine cycle if the egg is fertilised

Answer 7

progesterone - causes hypersecretory phase

HCG - causes decidualisation

Question 8

what is in a Graafian follicle

Answer 8

oocyte

granuloma cells

Question 9

what is the uterine cavity lined with

Answer 9

glandular epithelium

Question 10

what is it difficult to interpret endometrial biopsy

Answer 10

because the physiology changes all the time in response to hormones

Question 11

what are some indications for endometrial sampling

Answer 11

Abnormal uterine bleeding

Investigation for infertility

Spontaneous and therapeutic abortion

Assessment of response to hormonal therapy

Endometrial ablation

Work up prior to hysterectomy for benign indications

Incidental finding of thickened endometrium on scan

Endometrial cancer screening in high risk patients

Question 12

what is menorrhagia

Answer 12

prolonged and increased menstrual flow

Question 13

what is metrorrhagia

Answer 13

regular intermenstrual bleeding

Question 14

what is polymenorrhoea

Answer 14

menses occurring at <21 day interval

Question 15

what is polymenorrhagia

Answer 15

increased bleeding and frequent cycle

Question 16

what is menometrorrhagia

Answer 16

prolonged menses and intermenstrual bleeding

Question 17

amenorrhoea

Answer 17

absence of mensuration >6 months

Question 18

oligomenorrhoea

Answer 18

menses at intervals of >35 days

Question 19

causes of abnormal uterine bleeding in adolescence/early reproductive life

Answer 19

anovulatory cycles
pregnancy.miscarriage
endometritis
bleeding disorders

Question 20

causes of abnormal uterine bleeding in perimenopause/reproductive life

Answer 20

Pregnancy/miscarriage

DUB: involuntary cycles, luteal phase defects

Endometrial/endocervical poll

Leiomyoma

Andenomyosis (in muscle wall)

Exogenous hormone effects

Bleeding disorders

Hyperplasia

Neoplasia

Question 21

causes of abnormal uterine bleeding post-menopause

Answer 21

Atrophy

Endometrial polyp

Exogenous hormones (HRT, tamoxifen for breast cancer)

Endometritis

Bleeding disorders

Hyperplasia

Endometrial carcinoma

Sarcoma

Question 22

what is thickness of >4mm in postmenopausal women an indication for

(tell this via ultrasound)

Answer 22

endometrial biopsy

in post-menopausal women the endometrium should be v thin

Question 23

how can the endometrium be assessed

Answer 23

hysteroscopy

Question 24

two sampling methods for sampling endometrium

Answer 24

Endometrial pipelle

• no dilation needed
• no anaesthesia
• limited sample

Dilatation and curettage

• most common
• thorough sampling method
• can miss 5% of hyperplasias/cancers

Question 25

History needed for uterine pathology

Answer 25

Age 
Date of LMP (last menstrual period)  and length of cycle 
Pattern of bleeding 
Hormones 
Recent pregnancy

Question 26

what to think about when assessing an endometrial sample

Answer 26

Is sample adequate

Is there evidence of fresh/old breakdown/haemorrhage

Is there an organic benign abnormality

is there evidence of dysfunctional bleeding

is there hyperplasia or malignancy

Question 27

what phase of the uterine cycle is least informative for biopsy

Answer 27

menstrual

everything shedding and breaking down so cant tell what’s what

Question 28

what is DUB

Answer 28

dysfunctional uterine bleeding

reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining

Question 29

common causes of DUB

Answer 29

most commonly due to anovulatory cycles

• more common at end of reproductive life
• corpus luteum does not form
• continued growth of functionalists layer

Question 30

what does an anovulatory cycle look like histologically

Answer 30

disordered proliferation

secretory phase hasn’t come so endometrium has been proliferating for longer than normal

Question 31

pathology of the organic causes of abnormal uterine bleeding

Answer 31

Endometriosis
Polyp
Miscarriage

Aenomyosis
Leiomyoma
(moth in myometrium)

Question 32

what is endometritis

Answer 32

abnormal pattern of inflammatory cells in there endometrium

Question 33

causes of endometritis

Answer 33

micro-organisms 
Inflammation without specific organisms
-IU contraception 
-post party 
-post abortion 
-post curettage 
-chronic endometritis 
-granulomatous 
-association with leiomyomatoma or polyps

Question 34

what micro-organisms can cause endometritis

Answer 34

Neisseria 
Chlamydia 
TB
CMV
Actinomyces 
HSV

Question 35

features of endometrial polyps

Answer 35

common
asymptomatic (or with bleeding/discharge)
occur around menopause
benign
endocarcinoma can present as polyp sometimes

Question 36

what does a miscarriage specimen look like

Answer 36

need to exclude a molar pregnancy

look for chorionic villi next to mothers cells

Question 37

what are the subunits of the placenta

Answer 37

chorionic villi

Question 38

how can you age a foetus via histology

Answer 38

<12 weeks if the RBCs have nuclei

Question 39

what is a molar pregnancy

Answer 39

a non-viable egg implants in the uterus (or tube)

Question 40

what is a complete mole pregnancy

Answer 40

single (or 2) sperm combining with an egg which has lost its DNA

Sperm reduplicated forming a 46 chromosome set

only paternal DNA is present

Question 41

what is a partial mole pregnancy

Answer 41

egg is fertilised by two sperm or by one sperm which reduplicates its self giving an XXY chromosome set

both maternal and paternal DNA

Question 42

what are molar pregnancies dangerous

Answer 42

complete moles have high risk of developing into choriocarcinoma
(malignant tumour of trophoblasts)

Question 43

what are myometrium causes of abnormal uterine bleeding

Answer 43

adenomyosis

• endometrial glands and stoma within myometrium
• causes menorrhagia/dysmenorrhoea

Leiomyoma
-benign tumour of smooth muscle

Question 44

what is a malignant leiomyoma

Answer 44

a leiomyoma sarcoma (as it is from smooth muscle)