Uterine Pathology Flashcards
stages in the ovarian cycle of the menstrual cycle
Follicular phase
Ovulation
Luteal phase
stages in the uterine cycle of the menstrual cycle
menstrual phase (day 1 of period) proliferative phase (14 days, includes menstrual phase) secretory phase (14 days long)
what hormone controls proliferation in the first 14 days
oestrogen
causes growth
when would you not have a secretory phase
if there was no ovulation
what hormone controls secretion
progresterone
stops proliferation and starts secretion of endometrium which can accept the blastocysts
what hormone causes the menstrual phase of the endometrium
withdrawal of progesterone when there is no fertilisation
leads to necrosis of the endometrium
what hormones control the uterine cycle if the egg is fertilised
progesterone - causes hypersecretory phase
HCG - causes decidualisation
what is in a Graafian follicle
oocyte
granuloma cells
what is the uterine cavity lined with
glandular epithelium
what is it difficult to interpret endometrial biopsy
because the physiology changes all the time in response to hormones
what are some indications for endometrial sampling
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
what is menorrhagia
prolonged and increased menstrual flow
what is metrorrhagia
regular intermenstrual bleeding
what is polymenorrhoea
menses occurring at <21 day interval
what is polymenorrhagia
increased bleeding and frequent cycle
what is menometrorrhagia
prolonged menses and intermenstrual bleeding
amenorrhoea
absence of mensuration >6 months
oligomenorrhoea
menses at intervals of >35 days
causes of abnormal uterine bleeding in adolescence/early reproductive life
anovulatory cycles
pregnancy.miscarriage
endometritis
bleeding disorders
causes of abnormal uterine bleeding in perimenopause/reproductive life
Pregnancy/miscarriage
DUB: involuntary cycles, luteal phase defects
Endometrial/endocervical poll
Leiomyoma
Andenomyosis (in muscle wall)
Exogenous hormone effects
Bleeding disorders
Hyperplasia
Neoplasia
causes of abnormal uterine bleeding post-menopause
Atrophy
Endometrial polyp
Exogenous hormones (HRT, tamoxifen for breast cancer)
Endometritis
Bleeding disorders
Hyperplasia
Endometrial carcinoma
Sarcoma
what is thickness of >4mm in postmenopausal women an indication for
(tell this via ultrasound)
endometrial biopsy
in post-menopausal women the endometrium should be v thin
how can the endometrium be assessed
hysteroscopy
two sampling methods for sampling endometrium
Endometrial pipelle
- no dilation needed
- no anaesthesia
- limited sample
Dilatation and curettage
- most common
- thorough sampling method
- can miss 5% of hyperplasias/cancers
History needed for uterine pathology
Age Date of LMP (last menstrual period) and length of cycle Pattern of bleeding Hormones Recent pregnancy
what to think about when assessing an endometrial sample
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
what phase of the uterine cycle is least informative for biopsy
menstrual
everything shedding and breaking down so cant tell what’s what
what is DUB
dysfunctional uterine bleeding
reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining
common causes of DUB
most commonly due to anovulatory cycles
- more common at end of reproductive life
- corpus luteum does not form
- continued growth of functionalists layer
what does an anovulatory cycle look like histologically
disordered proliferation
secretory phase hasn’t come so endometrium has been proliferating for longer than normal
pathology of the organic causes of abnormal uterine bleeding
Endometriosis
Polyp
Miscarriage
Aenomyosis
Leiomyoma
(moth in myometrium)
what is endometritis
abnormal pattern of inflammatory cells in there endometrium
causes of endometritis
micro-organisms Inflammation without specific organisms -IU contraception -post party -post abortion -post curettage -chronic endometritis -granulomatous -association with leiomyomatoma or polyps
what micro-organisms can cause endometritis
Neisseria Chlamydia TB CMV Actinomyces HSV
features of endometrial polyps
common
asymptomatic (or with bleeding/discharge)
occur around menopause
benign
endocarcinoma can present as polyp sometimes
what does a miscarriage specimen look like
need to exclude a molar pregnancy
look for chorionic villi next to mothers cells
what are the subunits of the placenta
chorionic villi
how can you age a foetus via histology
<12 weeks if the RBCs have nuclei
what is a molar pregnancy
a non-viable egg implants in the uterus (or tube)
what is a complete mole pregnancy
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
what is a partial mole pregnancy
egg is fertilised by two sperm or by one sperm which reduplicates its self giving an XXY chromosome set
both maternal and paternal DNA
what are molar pregnancies dangerous
complete moles have high risk of developing into choriocarcinoma
(malignant tumour of trophoblasts)
what are myometrium causes of abnormal uterine bleeding
adenomyosis
- endometrial glands and stoma within myometrium
- causes menorrhagia/dysmenorrhoea
Leiomyoma
-benign tumour of smooth muscle
what is a malignant leiomyoma
a leiomyoma sarcoma (as it is from smooth muscle)
