Uterine pathology

Question 1

What are some indications for endometrial sampling?

Answer 1

abnormal uterine bleeding
investigations for infertility
spontaneous and therapeutic abortion
assess response to hormonal therapy
endometrial ablation
incidental finding of thickened endometrium on scan
endometrial cancer screening in high-risk patients

Question 2

prolonged and increased menstrual flow

Answer 2

menorrhagia

Question 3

regular inter-menstrual bleeding

Answer 3

metrorrhagia

Question 4

menses occurring at <21 day interval

Answer 4

polymenorrhoea

Question 5

increased bleeding and frequent cycle

Answer 5

polymenorrhagia

Question 6

menometrorrhagia

Answer 6

prolonged menses & intermenstrual bleeding

Question 7

amenorrhoea

Answer 7

absence of menstruation >6 months

Question 8

oligomenorrhoea

Answer 8

menses at intervals of >35 days

Question 9

What is the criteria for post-menopausal bleeding (PMB)?

Answer 9

abnormal uterine bleeding (AUB) >1 year after cessation of menstruation

Question 10

What finding in post-menopausal women on TVUS is generally taken as an indication for biopsy?

Answer 10

endometrial thickness of >4mm

Question 11

Which phase of the menstrual cycle is inadequate for histological assessment of the endometrium?

Answer 11

menstrual phase - endometrium is shedding to can’t comment on architecture

Question 12

What is dysfunctional uterine bleeding (DUB)?

Answer 12

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

Question 13

Describe luteal phase deficiency.

Answer 13

Insufficient progesterone or poor response by the endometrium to progesterone.
Abnormal follicular development (inadequate FSH/LH) - poor corpus luteum.

Question 14

How is endometritis histologically diagnosed?

Answer 14

by recognising an abnormal pattern of inflammatory cells (e.g. plasma cells in endometrium)

Question 15

What natural protective factors are in place to prevent endometritis?

Answer 15

cervical mucous plug - protects endometrium from ascending infection
cyclical shedding - makes endometrium relatively resistant to infection

Question 16

Which micro-organism most commonly causes endometritis?

Answer 16

neisseria

Question 17

When do endometrial polyps tend to occur?

Answer 17

around or after the menopause

Question 18

What is the typical PC of endometrial polyps?

Answer 18

usually asymptomatic but may present with bleeding or discharge
can tort and cut off blood supply
can become ulcerated and bleed

Question 19

What is the histological hallmark of miscarriage?

Answer 19

swollen chorionic villi (subunits of placenta)

Question 20

What is a molar pregnancy?

Answer 20

A form of gestational trophoblastic disease (abnormal pregnancy) which grows a non-viable fertilised egg in the uterus or tube.

Question 21

What is a complete mole?

Answer 21

Caused by a single (/2) sperm combining with an egg which has lost its DNA. The sperm then reduplicates forming a “complete” 46 chromosome set.
only paternal DNA is present

Question 22

What is a partial mole?

Answer 22

When egg is fertilised by 2 sperm or by 1 sperm which reduplicates itself yielding the genotypes 69 XXY (triploid)
Both maternal and paternal DNA

Question 23

Which type of mole has a high-risk of developing into a tumour? Which kind of tumour?

Answer 23

complete (hydatidiform) moles

choriocarcinoma (malignano trophoblast tumour)

Question 24

What symptoms might an adenomyosis cause? What is seen in a specimen of this?

Answer 24

menorrhagia/dysmenorrhoea

endometrial glands and stroma within the myometrium

Question 25

What is a benign tumour of smooth muscle which can be found in the uterus amongst other locations?

Answer 25

leiomyoma

Question 26

What is seen macroscopically in a leiomyoma?

Answer 26

interlacing smooth muscle cells

Question 27

What symptoms can be seen in a leiomyoma?

Answer 27

menorrhagia/infertility/mass effect, pain

Question 28

Which hormone controls the growth of a smooth muscle tumour found in the uterus?

Answer 28

oestrogen