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Repro and Sexual Health > Uterine Pathology > Flashcards

Uterine Pathology Flashcards

1
Q

what are the phases of the ovarian cycle?

A

folliclar phase = oestrogen driven formation of follicle, ends with ovulation
ovulation = follicle ruptures and releases oocyte
luteal phase = formation of corpus luteum, ends with wither pregnancy or luteolysis

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2
Q

phases of uterine cycle?

A 
menstrual phase (day one-three when period starts)
proliferative phase (endometrium proliferates for around 14 days)
secretory phase (14 days exactly)
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3
Q

how long is uterine cycle?

A

28 days

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4
Q

what drives proliferation?

A

oestrogen

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5
Q

what triggers the switch between proliferative and secretory phase?

A

progesterone

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6
Q

what triggers menstrual phase?

A

withdrawal of hormones

causes necrosis

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7
Q

when is and what happens in the fertilised phase?

A

secretory phase onwards
triggered by progesterone and HCG
causes hypersecretion and decidualisation

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8
Q

what happens in post menopausal phase?

A

nothing
inactive, atrophic endometrium
non-cycling

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9
Q

histological signs of proliferative phase?

A

mitotic figures in round glands of endometrium

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10
Q

where are the cells which secrete progesterone to drive the secretory phase?

A 
corpus luteum
(degenerates if fertilisation doesnt take place)
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11
Q

signs of secretory phase on histology?

A

glands are less round
pale secretions can be seen around the outside of the glands
indicates that ovulation just occurred in past couple of days

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12
Q

indications for endometrial sampling/biopsy?

A

abnormal uterine bleeding
infertility investigation
spontaneous therapeutic abortion
assessment of response to hormonal therapy (e.g in endometrial cancer)
endometrial ablation
work up to prior to hysterectomy for benign indications
incidental finding of thickened endometrium on scan
endometrial cancer screening in high risk patients (obese)

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13
Q

what do the following terms mean?

  • menorrhagia
  • amenorrhoea
  • oligomenorrhoea
A 
menorrhagia = prolonged and increased menstrual bleeding
amenorrhoea = absence of emnstruation >6 months
oligomenorrhoea = menses at intervals of >35 days
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14
Q

what is post menopausal bleeding?

A

abnormal uterine bleeding 1 year after cessation of menstruation

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15
Q

what can cause AUB in adolescence/early reproductive life?

A

DUB usually due to anovulatory cycles
pregnancy/miscarriage
endometriosis
bleeding disorders

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16
Q

what can cause AUB in reproductive life/perimenopause?

A

pregnancy/miscarriage
DUB usually due to anovulatory cycles, luteal phase defects
endometritis
endometrial/endocervical poly
leiomyoma (smooth muscle tumour - may be called fibroid in endometrium)
adenomyosis (glands in smooth muscular wall of uterus)
exogenous hormone effects
bleeding disorders
hyperplasia
neoplasia (cervical, endometrial)

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17
Q

what can cause AUB post menopause?

A 
atrophy (usually only happens once)
endometrial poly
exogenous hormones (HRT, tamoxifen)
- tamoxifen often taken in breast cancer
endometritis
bleeding disorders 
hyperpalsia
endometrial carcinoma
sarcoma
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18
Q

what thickness of endometrium is too thick and warrants a biopsy?

A

16mm in premenopausal

4mm in post menopausal

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19
Q

how can the endometrium be assessed?

A

hysteroscopy

20
Q

how can the endometrium be sampled?

A

andometrial pipelle
- quick, easy
- done as outpatient
- not painful
- very safe but limited sample ability as doesnt reach whole uterus so can miss a cancer etc
dilation and curretage
- more thorough (can also miss few cancers)

21
Q

required history in uterine problem?

A 
Age
date of LMP and length of pregnancy
pattern of bleeding
hormones (drugs)
recent pregnancy
22
Q

do you need to know number of pregnancies or other drugs that arent hormonal?

A

no

23
Q

when should an endometrial sample be taken in uterine cycle?

A

not really informative in menstrual phase as infrastructure is falling apart
can tell theres not a cancer but thats about it

24
Q

what is DUB?

A

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

25
Q

what usually causes DUB?

A

anovulatory cycles

  • common at either end of repro life
  • corpus lueum does not form
  • continued growth of functionalis layer
26
Q

examples of anovulatory cycles?

A

PCOS
hypothalamic dysfunction
thyroid disorders
hyperproalctinaemia

27
Q

luteal phase deficiency?

A

insufficient progesterone or poor response by the endometrium to progesterone
causes abnormal follicular development (inadequate FSH/LH) and poor corpus luteum
causes anovulation and DUB?

28
Q

anovulatory cycle on histology?

A

disordered proliferation of glands and stroma

continue to grow without menstruation

29
Q

organic causes of AUB?

A 
endometrium problem
- endometritis
- polyp
- miscarriage
myometrium problem
- adenomyosis
- leiomyoma
30
Q

what is endometritis?

A

abnormal pattern of inflammatory cells
cervical mucous plug protects the endometrium from ascending infection
cyclical shedding of the endometrium also makes it relatively resistant

31
Q

infective causes of endometritis?

A 
neisseria
chlamydia
TB
CMV
actinomyces
HSV
32
Q

non-infective inflammatory causes of emdometritis?

A

intra-uterine contraceptive device (coil etc)
post-partum
post-abortal
post-curettage
chronic endometritis NOS
granulomatous (sarcoid, foreign body post ablation)
associated with leiomyoma or polyps

33
Q

what is chronic plasmacytic endometritis associated with?

A

pelvic inflammatory disease (infection unless proven otherwise)

  • chlamydia
  • gonorrhoea
  • enteric organisms
34
Q

what often causes granulomatous endometritis?

A

can be caused by TB

35
Q

features of an endometrial polyp?

A

usually asymptomatic but can cause bleeding or discharge
often occur around or after the menopause
almost always benign, but endometrial carcinoma can present as a polyp

36
Q

normal features of miscarriage on histology?

A

chorionic villi (sub-units of placenta)

37
Q

how can you tell if foetus was <12 weeks old?

A

red blood cells have nuclei

38
Q

what is a molar pregnancy?

A

abnormal form of pregnnacy in which a non-viable fertilized egg implants in the uterus (or tube)
form of gestational trophoblastic disease which grows as a mass characterised by swollen chorionic villi
can be partial or complete

39
Q

complete mole?

A

single or two sperm combinfing with an egg which has lost its DNA
therefore only paternal DNA is present
can only form a sort of placenta

40
Q

partial mole?

A

egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotype of 69 XXY(triploid)
have both maternal and paternal DNA

41
Q

which type of mole has a higher risk of developing into choriocarcinoma?

A

complete hydatidiform moles

complete moles

42
Q

signs of molar pregnancy on blood tests?

A

extremely high HCG??

43
Q

what does a complete mole look like on histology and imaging?

A

large chorionic villus
abnormal proliferating trophoblast all the way around it
huge enlarged uterus on imaging

44
Q

what problems in the myometrium can cause AUB?

A

adenomyosis
- endometrial glands and stroma within myometrium
- causes menorrhagia/dysmenorrhoea
leiomyoma
- benign tumour of smooth muscle
- may be found in locations other than uterus

45
Q

features of leiomyoma?

A 
can cause menorrhagia/infertility/mass effect/pain
may distort uterine cavity
growth is oestrogen dependent
interlacing smooth muscle cells
can be malignant
- meiomyosarcoma

Repro and Sexual Health (63 decks)

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