Uterine pathology Flashcards
What are some indications for endometrial sampling?
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
prolonged and increased menstrual flow
menorrhagia
regular inter-menstrual bleeding
metrorrhagia
menses occurring at <21 day interval
polymenorrhoea
increased bleeding and frequent cycle
polymenorrhagia
menometrorrhagia
prolonged menses & intermenstrual bleeding
amenorrhoea
absence of menstruation >6 months
oligomenorrhoea
menses at intervals of >35 days
What is the criteria for post-menopausal bleeding (PMB)?
abnormal uterine bleeding (AUB) >1 year after cessation of menstruation
What finding in post-menopausal women on TVUS is generally taken as an indication for biopsy?
endometrial thickness of >4mm
Which phase of the menstrual cycle is inadequate for histological assessment of the endometrium?
menstrual phase - endometrium is shedding to can’t comment on architecture
What is dysfunctional uterine bleeding (DUB)?
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)
Describe luteal phase deficiency.
Insufficient progesterone or poor response by the endometrium to progesterone.
Abnormal follicular development (inadequate FSH/LH) - poor corpus luteum.
How is endometritis histologically diagnosed?
by recognising an abnormal pattern of inflammatory cells (e.g. plasma cells in endometrium)
What natural protective factors are in place to prevent endometritis?
cervical mucous plug - protects endometrium from ascending infection
cyclical shedding - makes endometrium relatively resistant to infection
Which micro-organism most commonly causes endometritis?
neisseria
When do endometrial polyps tend to occur?
around or after the menopause
What is the typical PC of endometrial polyps?
usually asymptomatic but may present with bleeding or discharge
can tort and cut off blood supply
can become ulcerated and bleed
What is the histological hallmark of miscarriage?
swollen chorionic villi (subunits of placenta)
What is a molar pregnancy?
A form of gestational trophoblastic disease (abnormal pregnancy) which grows a non-viable fertilised egg in the uterus or tube.
What is a complete mole?
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
What is a partial mole?
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
Which type of mole has a high-risk of developing into a tumour? Which kind of tumour?
complete (hydatidiform) moles
choriocarcinoma (malignano trophoblast tumour)
What symptoms might an adenomyosis cause? What is seen in a specimen of this?
menorrhagia/dysmenorrhoea
endometrial glands and stroma within the myometrium
