Week 2- pathology Flashcards
What are the three phases of the ovarian cycle?
Follicular phase
Ovulation
Luteal phase
What are the three stages of the menstrual cycle?
Menstrual phase
Proliferative phase
Secretory phase- just after ovulation. Glands stop proliferating and start to produce secretion.
What occurs in the proliferative phase of the menstrual cycle?
The endometrium is exposed to an increase in oestrogen levels by FSH and LH stimulating the ovaries. This causes repair and growth of the functional endometrium layer.
What occurs in the secretory phase of the menstrual cycle?
This begins once ovulation has occurred. This phase is driven by progesterone released from the corpus luteum. It results in the endometrial glands releasing certain substances. These secretions make the uterus more friendly to an egg.
What occurs in the menstrual phase of the menstrual/uterine cycle?
The loss of the corpus luteum results in less progesterone. The decreasing levels of progesterone cause the spiral arteries in the functional endometrium to constrict. The loss of blood supply causes the endometrium to become ischaemic and die. It is then shed.
What hormone controls the proliferative stage?
Oestrogen
What hormone controls the secretory phase?
Progesterone
Which cells in the ovary produce oestrogen and progesterone?
Granulosa cells.
On gram stain, how does the proliferative stage of menstruation look?
Small round glands set in stroma. Can see mitotic figures (looks like the cell has just split into two).
On gram stain, what does the secretory stage of menstruation look like?
No mitoses. Glands look tortuous and show little secretions under their nuclei. As the phase continues they become saw tooth and more irregular in shape.
When is endometrial sampling indicated?
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
Menorrhagia
Prolonged and increased menstrual flow
Metrorrhagia
Intermenstrual bleeding
Polymenorrhea
Cycle less than 21 days.
Polymenorrhagia
Increased bleeding and frequent cycle
Menometrorrhagia
Prolonged menses and intermenstrual bleeding.
Amenorrhoea
Absence of periods >6 months
Oligomenorrhoea
Menses at greater than 35 day intervals.
What is dysfunctional uterine bleeding?
Abnormal uterine bleeding with no organic cause.
What general things can cause abnormal uterine bleeding?
Endometriosis
Anovulatory cycles
Pregnancy/miscarraige
Bleeding disorders
What is adenomyosis?
Endometrium in the myometrial layer (muscle layer).
What is leiomyoma?
Fibroid. Incredibly common tumours. Almost always benign.
What methods can you use to assess the endometrium?
Transvaginal ultrasound
Hysteroscopy
When is a biopsy after a transvaginal ultrasound indicated?
If the endometrium in post menopausal women is >4mm or premenopausal women >16mm.
What methods can be used to sample the endometrium?
Endometrial pipelle
Dilatation and curetage
What are the advantages and disadvantages of using endometrial pipelle?
No anaesthetic needed
No dilatation needed
Outpatient procedure
Very safe
Disadvantage- limited sample.
What are the advantages and disadvantages of using dilatation and curettage?
Advantage- more thorough sampling method
Disadvantage- its an operation.
What is required to be taken in a history before biopsy?
Age Date of last menstrual period and length of cycle Pattern of bleeding Hormones Recent pregnancy
What questions should you answer when looking at an endometrial biopsy sample?
Is the sample adequate?
Is there evidence of previous haemorrhage?
Is there an organic benign abnormality e.g. polyp.
Is there evidence for dysfunctional bleeding?
Is there hyperplasia/malignancy?
What is the definition of dysfunctional uterine bleeding?
Irregular uterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation of the endometrial lining.
What is meant by the term anovulatory?
Absence of ovulation in the cycle.
What are most cases of DUB due to?
What in the cycle causes this?
Anovulatory cycles. Could be due to:
Corpus luteum not forming
Continued growth of functionalis layer
Luteal phase deficiency- insufficient progesterone or poor response of the endometrium to progesterone.
What might a gram stain of the proliferative phase look like in an anovulatory cycle?
Glands and stroma continue to grow and proliferate. BIG glands, still look fairly regular.
What is endometritis?
Inflammation of the endometrium.
How is endometritis diagnosed?
Diagnosed histologically by abnormal inflammatory cells present.
What protects the endometrium from ascending infection?
What else contributes to infection in the endometrium being difficult?
The cervical mucous plug.
Cyclical lining shedding also stops infection sticking around.
What micro-organisms can cause endometritis?
Neisseria Chlamydia TB CMV Actinomyces HSV
What other (non-infective) things can cause endometritis?
Intra-uterine contraceptive device Postpartum Postabortal Post curretage Chronic endometritis Granulomatous Associated with leiomyomata or polyps
What is chronic plasmacytic endometritis?
What does It lead too?
Chronic inflammation of the endometrium. Its infectious until proven otherwise.
Leads to pelvic inflammatory disease (neisseria gonorrhoea, chlamydia).
How do endometrial polyps present?
Usually are asymptomatic but may present with bleeding or discharge.
Are endometrial polyps benign?
Almost always benign however endometrial carcinoma also presents like polyps.
Who is likely to get endometrial polyps?
Women after menopause.
What is the way to 100% confirm pregnancy on histology?
Chorionic villi or trophoblasts.
What is a molar pregnancy?
An abnormal form of pregnancy when a non-fertilised egg implants in the uterus. Its a gestational trophoblastic disease where a mass of cells grows.
What cells characterise molar pregnancy?
Swollen chorionic villi.
What is a complete mole?
A single, or two sperm combining with an egg that has lost its DNA. Therefore you only have the paternal contribution of DNA- but you do have 23 pairs of chromosomes. (haploid)
What is a partial mole?
A partial mole is when the egg is fertilised by two sperm, or one sperm that duplicates itself, to make 69 chromosomes. These have both paternal and maternal DNA. (triploid)
What moles have a higher risk of developing into what carcinoma?
Complete hydatidiform moles are at risk of developing into choriocarcinoma (a malignant tumour of trophoblasts).
What symptoms does adenomyosis present with?
Menorrhagia (heavy) and dysmenorrhoea (painful periods)
What is leiomyoma?
A benign tumour of the smooth muscle.
On histological slide, what will adenomyosis look like?
Shows glands in the muscle layer.
What is growth of leiomyoma dependent on?
Oestrogen.
What symptoms does leiomyoma cause?
Menorrhagia/infertility/mass effect/pain
