Uterine Pathology Flashcards
what are the three phases of the ovarian cycle?
follicular phase
ovulation
luteal phase
what are the three phases of the uterine cycle?
menstrual phase
proliferative phase
secretory phase
what is the time, hormones involved and the effect in the following phases?
a) proliferative
b) secretory
c) menstrual
d) fertilised
e) post-menopausal
a) day 1-14, oestrogen, growth
b) day 16-28, progesterone, secretion
c) day 1-3, withdrawal, necrosis
d) secretory onwards, progesterone and HCG, hypersecretion and decidualisation
e) non-cycling, inactive and atrophic
what is a graafian follicle?
fluid-filled structure in the mammalian ovary within which an ovum develops prior to ovulation
*contains oocyte and granulosa cells
what is the regressed form of the corpus luteum called?
corpus albicans
what occurs histologically during the secretory phase?
increasing tortuosity and lumenal secretions
what are the 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 dysfunctional uterine bleeding?
abnormal uterine bleeding with no organic cause
what is post menopausal bleeding?
abnormal uterine bleeding >1 year after cessation of menstruation
what are causes of AUB in adolescence / early reproductive life?
DUB - anovulatory cycles
pregnancy / miscarriage
endometritis
bleeding disorders
what are causes of AUB in reproductive life / perimenopause?
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 the causes of AUB post menopause?
atrophy endometrial polyp exogenous hormones: HRT, tamoxifen endometritis bleeding disorders
hyperplasia
endometrial carcinoma
sarcoma
what is most common method of assessing the endometrium?
TVUS
*hysteroscopy is also a good method
an endometrial thickness of what is generally taken as an indication for biopsy?
> 4mm post menopausal
16mm in premenopausal
how is an endometrial pipelle carried out?
3.1mm in diameter, no dilatation needed no anaesthesia outpatient procedure very safe limited sample
what is the most thorough sampling method which is the most common operation performed on women?
dilatation and curretage
*although can miss 5% of hyperplasias / cancers
what history is required for uterine pathology?
age date of LMP and length of cycle pattern of bleeding hormones recent pregnancy
*do not need to know number of pregnancies, drugs without normal influences etc
how are the endometrial samples for AUB assessed histologically?
is the sample adequate for given clinical scenario?
is there evidence of fresh/old breakdown?
is there an organic benign abnormality (polyp, endometritis, miscarriage)?
is there evidence for dysfunctional bleeding?
is there hyperplasia or malignancy?
what is the least informative phase for endometrial sampling?
menstrual phase
what are most cases of DUB due to?
anovulatory cycles
- commonest at either end of reproductive life
- corpus luteum does not form
- continued growth of functionalis layer (PCOS, hypothalamic dysfunction, thyroid disorders, hyperprolactinaemia)
how is luteal phase deficiency another common cause of DUB?
insufficient progesterone or poor response by the endometrium to progesterone
abnormal follicular development (inadequate FSH/LH) = poor corpus luteum
what causes within the endometrium cause AUB?
endometritis
polyp
miscarriage
what causes within the myometrium cause AUB?
adenomyosis
leiomyoma
what does endometritis look like histologically?
abnormal pattern of inflammatory cells
*normally, cervical mucuous plug and cyclical shedding protects endometrium from ascending infection
