Uterine pathology Flashcards
How long is the average menstrual cycle
28 days (can be anything between 21-35 days)
What are the phases in the uterine cycle
Menstrual, proliferative and secretory
What are the phases in the ovarian cycle
Follicular and luteal
When is the proliferative phase
In the first half of the cycle (This is the one that can be longer if the whole cycle is longer)
When is the secretory phase
In the second half of the cycle (This usually stays constant no matter how long your cycle is)
What happens in the proliferative phase
Oestrogen is the main influencing hormone and allows the endometrium to thicken and allows formation of glandular epithelium
What happens at ovulation
~day 14, the Graafian follicle releases an ovum after a LH surge
What happens in the secretory phase
This is driven by progesterone secreted by the corpus luteum (remnant of the Graafian follicle) and allow secretion from the endometrium to maximise implantation of the fertilised egg (if it becomes fertilised)
What happens in the menstrual phase
If no fertilisation occurs, the corpus luteum degenerates and the endometrial layer that grew in the proliferative phase is shed from vasoconstriction and ischaemia to the functional layer of the endometrium
What are indications to endometrial sampling/biopsy
abnormal uterine bleeding AUB
infertility investigation
pre hysterectomy
pre endometrial ablation
spontaneous or therapeutic abortion
endometrial thickness >4mm in post menopausal women
screening in high risk groups eg Lynch syndrome
assessment of response to hormonal therapy
Definition of menorrhagia
prolonged and increased bleeding
Definition of metrorrhagia
intermenstrual bleeding
Definition of polymenorrhagia
cycles <21 days
Definition of Menometrorrhagia
Increased flow and intermenstrual bleeding
Definition of amenorrhoea
no periods for >6 months
Definition of oligomenorrhoea
cycles >35 days
What are some causes of AUB in the young age group
pregnancy/miscarriage
endometritis
bleeding disorders
anovulatory cycles
What are some additional causes of AUB in the middle aged group
same as young plus: polyps fibroids/leiomyomas hyperplasia adenomyosis neoplasia exogenous hormone effects
What are some additional causes of AUB in the post menopausal group
atrophy polyps fibroids/leiomyomas endometrial cancer exogenous hormones
What techniques are used to assess the endometrium
TVUSS
pipelle
hysteroscope
dilatation and curettage
What additional information should be given to the pathologist along with the sample
Age date of LMP and pattern of bleeding taking hormones or anything else relevant recent pregnancy cycle length
What is the pathology behind dysfunctional uterine bleeding DUB
That there is no organic cause found and it is more likely to be as a result of hormone dysregulation
there is a luteal phase deficiency and so not enough progesterone is secreted and a poor corpus luteum is present
What would you expect to see histologically in someone with DUB
disordered proliferation with glands and stroma growing
what are the 2 main layers of the uterus affected in AUB
Endometrium
Myometrium
Give some endometrial causes of AUB
Endometrial polyps
Endometritis
Pregnancy / miscarriage
What is endometritis and what are some causes
Inflammation (+-infection) of the endometrium
Infective causes: gonorrhoea, chlamydia, actinomyces, HSV, TB, CMV
Non-infective causes: IUCD, post ablative, post partum, post abortive, post curettage
What is chronic plasmacytic endometritis
infection where plasma cells are present that should not usually be present
What are endometrial polyps
common after the menopause
usually asymptomatic but can have AUB
almost always benign but some tumours can appear as a polyp so must rule this out
polyps are independent of the endometrium and so can cause heavy bleeding constantly
Why must endometrial sampling occur if you have had a miscarriage
To rule out molar pregnancy
Allows us to see chorionic villi = products of conception
What is a molar pregnancy
When a non-viable fertilised egg is implanted in the uterus, it is a form of gestational trophoblastic disease with swollen chorionic villi
describe a complete molar pregnancy
only contains paternal DNA
describe a partial molar pregnancy
Contain 2 copies paternal DNA and 1 of maternal DNA for every cell
What is choriocarcinoma
Aggressive but treatable cancer
trophoblastic malignant tumour
Is choriocarcinoma more likely to develop with a complete or partial mole
Complete molar pregnancy
Give some myometrial causes of AUB
Adenomyosis
Leiomyoma
What is adenomyosis
presence of endometrial glands and stroma in the myometrium
What is a leiomyoma
benign growth of smooth muscle
growth is oestrogen dependent
mesenchymal origin
therefore malignant form = leiomyoSARCOMA
