Uterine pathology

Question 1

How long is the average menstrual cycle

Answer 1

28 days (can be anything between 21-35 days)

Question 2

What are the phases in the uterine cycle

Answer 2

Menstrual, proliferative and secretory

Question 3

What are the phases in the ovarian cycle

Answer 3

Follicular and luteal

Question 4

When is the proliferative phase

Answer 4

In the first half of the cycle (This is the one that can be longer if the whole cycle is longer)

Question 5

When is the secretory phase

Answer 5

In the second half of the cycle (This usually stays constant no matter how long your cycle is)

Question 6

What happens in the proliferative phase

Answer 6

Oestrogen is the main influencing hormone and allows the endometrium to thicken and allows formation of glandular epithelium

Question 7

What happens at ovulation

Answer 7

~day 14, the Graafian follicle releases an ovum after a LH surge

Question 8

What happens in the secretory phase

Answer 8

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)

Question 9

What happens in the menstrual phase

Answer 9

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

Question 10

What are indications to endometrial sampling/biopsy

Answer 10

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

Question 11

Definition of menorrhagia

Answer 11

prolonged and increased bleeding

Question 12

Definition of metrorrhagia

Answer 12

intermenstrual bleeding

Question 13

Definition of polymenorrhagia

Answer 13

cycles <21 days

Question 14

Definition of Menometrorrhagia

Answer 14

Increased flow and intermenstrual bleeding

Question 15

Definition of amenorrhoea

Answer 15

no periods for >6 months

Question 16

Definition of oligomenorrhoea

Answer 16

cycles >35 days

Question 17

What are some causes of AUB in the young age group

Answer 17

pregnancy/miscarriage
endometritis
bleeding disorders
anovulatory cycles

Question 18

What are some additional causes of AUB in the middle aged group

Answer 18

same as young plus:
polyps 
fibroids/leiomyomas
hyperplasia 
adenomyosis 
neoplasia 
exogenous hormone effects

Question 19

What are some additional causes of AUB in the post menopausal group

Answer 19

atrophy
polyps 
fibroids/leiomyomas 
endometrial cancer 
exogenous hormones

Question 20

What techniques are used to assess the endometrium

Answer 20

TVUSS
pipelle
hysteroscope
dilatation and curettage

Question 21

What additional information should be given to the pathologist along with the sample

Answer 21

Age 
date of LMP and pattern of bleeding 
taking hormones or anything else relevant 
recent pregnancy 
cycle length

Question 22

What is the pathology behind dysfunctional uterine bleeding DUB

Answer 22

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

Question 23

What would you expect to see histologically in someone with DUB

Answer 23

disordered proliferation with glands and stroma growing

Question 24

what are the 2 main layers of the uterus affected in AUB

Answer 24

Endometrium

Myometrium

Question 25

Give some endometrial causes of AUB

Answer 25

Endometrial polyps
Endometritis
Pregnancy / miscarriage

Question 26

What is endometritis and what are some causes

Answer 26

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

Question 27

What is chronic plasmacytic endometritis

Answer 27

infection where plasma cells are present that should not usually be present

Question 28

What are endometrial polyps

Answer 28

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

Question 29

Why must endometrial sampling occur if you have had a miscarriage

Answer 29

To rule out molar pregnancy

Allows us to see chorionic villi = products of conception

Question 30

What is a molar pregnancy

Answer 30

When a non-viable fertilised egg is implanted in the uterus, it is a form of gestational trophoblastic disease with swollen chorionic villi

Question 31

describe a complete molar pregnancy

Answer 31

only contains paternal DNA

Question 32

describe a partial molar pregnancy

Answer 32

Contain 2 copies paternal DNA and 1 of maternal DNA for every cell

Question 33

What is choriocarcinoma

Answer 33

Aggressive but treatable cancer

trophoblastic malignant tumour

Question 34

Is choriocarcinoma more likely to develop with a complete or partial mole

Answer 34

Complete molar pregnancy

Question 35

Give some myometrial causes of AUB

Answer 35

Adenomyosis

Leiomyoma

Question 36

What is adenomyosis

Answer 36

presence of endometrial glands and stroma in the myometrium

Question 37

What is a leiomyoma

Answer 37

benign growth of smooth muscle
growth is oestrogen dependent
mesenchymal origin
therefore malignant form = leiomyoSARCOMA