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REPRODUCTION & GYNAECOLOGY > Uterine Pathology > Flashcards

Uterine Pathology Flashcards

1
Q

What phase of the uterine cycle corresponds to the follicular phase of the ovarian cycle?

A

Menstrual phase (endometrium is shedding)

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2
Q

What phase of the uterine cycle occurs alongside ovulation in the ovarian cycle?

A

Proliferative phase - endometrium is growing

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3
Q

What phase of the uterine cycle occurs in the ovarian luteal phase and how long does this normally last?

A

Secretory phase - always lasts 14 days (does not change regardless of cycle length)

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4
Q

Which of the 3 uterine phases will elongate if a woman’s cycle is longer than the 28 day average?

A

Proliferative phase

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5
Q

The secretory phase cannot occur without ovulation. Why is this the case?

A

Progesterone is needed from the corpus luteum to stop the endometrium proliferating and start the secretory phase

=> once it becomes secretory it is ready to accept the blastocyst

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6
Q

Withdrawal of progesterone during the secretory phase causes what to occur?

A

Shedding of the endometrium

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7
Q

Describe the appearance of the endometrium in post-menopausal women.

A
  • Thin and atrophic lining
  • Occasional glands
  • Does not grow or shed
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8
Q

What cells surround the oocyte in the Graafian follicle and produce oestrogen?

A

Granulosa cells

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9
Q

Describe the histological appearance of the endometrium during the proliferative phase

A
  • Glandular epithelium
  • Mitotic figures present at the edge of glands (shows glands are actively growing)
  • No secretions present (white)
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10
Q

What colour is the corpus luteum on a biopsy and what happens after each one regresses?

A
  • Yellow on biopsy

- After each one regresses it forms a scar

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11
Q

Describe the histological appearance of the endometrium early in the secretory phase.

A
  • glands still relatively round
  • 1 or 2 mitotic figures seen (but most glands have ceased growing)
  • White secretions released from nuclei around edge of gland
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12
Q

Describe the histological appearance of the endometrium later in the secretory phase.

A
  • Glands appear “wiggly”

- filled with white secretion

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13
Q

What drugs make an endometrial biopsy difficult to interpret?

A
  • endometrium responds to hormonal changes

=> pathology need to know if patient is on hormonal drugs (contraceptive, HRT etc) before interpreting biopsy

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14
Q

What indications are there for an endometrial biopsy?

A
  • Bleeding
  • Miscarriage or therapeutic abortion
  • Check response to hormone therapy
  • Prior to Endometrial ablation
  • Prior to hysterectomy
  • Check for endometrial cancer in patient groups with increased risk (e.g. Lynch syndrome)
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15
Q

What is Lynch Syndrome and what cancers can it predispose to?

A

Hereditary Non-Polyposis Colorectal Cancer (HNPCC)

=> predisposes to cancers in the colon, rectum and endometrial cancer

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16
Q

Why may hormonal therapy be used to treat certain patients with endometrial cancer?

A

If patients are overweight or obese - they are at a higher risk of developing endometrial cancer

These patients are also a high risk for surgery => they can be given hormonal therapy to attempt to control the cancer instead

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17
Q

What do the clinical terms menorrhagia, amenorrhoea and oligomenorrhoea mean?

A

Menorrhagia = longer and heavier periods

Amenorrhoea = absence of period for > 6 months

Oligomenorrhoea = Periods after a cycle > 35 days

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18
Q

What is meant by AUB and DUB?

A

AUB - Abnormal Uterine Bleeding

DUB - Dysfunctional Uterine Bleeding (no organic cause)

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19
Q

What is the definition of post-menopausal bleeding?

A

abnormal uterine bleeding > 1 year after cessation of menstruation

bleeding at time of menopause = peri-menopausal bleeding

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20
Q

What usually causes abnormal uterine bleeding in younger age during a woman’s early reproductive life?

A
  • DUB usually due to anovulatory cycles
  • Pregnancy/miscarriage
  • Endometritis
  • Bleeding disorders
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21
Q

What can cause abnormal uterine bleeding in patients who are in their reproductive age OR are perimenopause?

A
  • Pregnancy/miscarriage
  • DUB: anovulatory cycles, luteal defects,
  • Endometritis
  • Endometrial/endocervical polyp
  • Leiomyoma (fibroid)
  • Adenomyosis
  • Exogenous hormone effects (HRT etc)
  • Bleeding disorders
  • Neoplasia: cervical, endometrial
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22
Q

What is an endometrial or endocervical polyp?

A
  • outpouching of the endometrium into the cavity

- covered by the normal fibrous stroma of the endometrium BUT does not shed every month

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23
Q

What is a fibroid?

A

Also known as a Leiomyoma

=> benign tumour of the smooth muscle

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24
Q

What occurs in endometriosis?

A
  • Endometrial glands and stroma grow outwith uterine cavity
  • still under hormonal control so they proliferate and bleed every month (this causes a lot of pain)
  • Can be found in abdominal cavity (e.g. pelvic side wall)
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25
Q

What is meant by adenomyosis?

A

Endometrial glands and stroma grow inside the MYOmetrium
i.e. the muscular layer

  • again they proliferate and bleed under hormonal control each month => causing patients significant pain
26
Q

What are the main causes of abnormal uterine bleeding post-menopause?

A
  • Atrophy
  • Endometrial polyp
  • Exogenous hormones: HRT, tamoxifen
  • Endometritis
  • Bleeding disorders
  • Endometrial carcinoma
  • Sarcoma
27
Q

Why may HRT cause bleeding after the menopause has occured?

A

The oestrogen causes a small amount of the proliferative phase to occur again in the endometrium

28
Q

Why does tamoxifen cause AUB after the meno-pause has occurred?

A

It decreases the oestrogen in breast tissue (to counteract cancer) however has a slightly pro oestrogenic effect in the uterus

=> it also causes a small amount of the proliferation phase to occur

29
Q

How is endometrial thickness investigated?

A

Transvaginal ultrasound

30
Q

An endometrial thickness on TVUS of what value would indicate the need for further investigation?

A

> 4mm in postmenopausal women
16mm in premenopausal

indication for biopsy

31
Q

How can the endometrium be assessed on investigation?

A

Transvaginal US

Hysteroscopy

32
Q

How can the endometrium be sampled?

A

Endometrial pipelle

Dilatation and curretage

33
Q

What are the advantages of using the endometrial pipelle to sample the endometrium?

A

No dilatation needed
No anaesthesia
Outpatient procedure
Very safe

34
Q

What are the disadvantages of an endometrial pipelle sample and why would this possibly prompt a dilatation and curettage sample?

A
  • Pipelle sample is limited and may not reach area of pathology if it is high in uterus
  • Dilatation and curettage = most thorough sampling method
35
Q

What should be noted in a patients history before sending a biopsy to pathology for interpretation?

A
  • Age
  • Date of Last Menstrual Period and length of cycle
  • Pattern of bleeding
  • Hormones
  • Recent pregnancy
36
Q

How should a sample be histologically analysed if the patient is experiencing abnormal uterine bleeding?

A
  • Is sample adequate?
  • Any evidence of fresh/old haemorrhage?
  • Organic benign abnormality? (polyp, endometritis, miscarriage)
  • Any evidence for dysfunctional bleeding?
  • Hyperplasia (atypical/non atypical) or malignancy?
37
Q

During which phase of the uterine cycle is a biopsy the least informative?

A

Menstrual phase

  • can confirm no cancer
  • difficult to comment on endometrial architecture as it is “falling away” during this phase
38
Q

What causes anovulatory cycles and at what ages do these tend to occur?

A
  • No ovulation => Corpus luteum does not form
  • Continued proliferation phase, no secretory phase
  • Commonest at extremes of reproductive life

E.g. Polycystic ovary syndrome, hypothalamic dysfunction, thyroid disorders, hyperprolactinaemia

39
Q

How is DUB caused by a luteal phase insufficiency?

A
  • Insufficent progesterone production by corpus luteum
    OR
  • Poor response by the endometrium to progesterone
  • often occurs in perimenopausal women, as least suitable eggs have been left till last
    => poor eggs cause poor corpus luteum
40
Q

What can be visualised histologically in the endometrium if a patient is having anovulatory cycles?

A
  • Disordered proliferation of glands
  • Abnormal gland shape
  • No secretions present
41
Q

What organic causes of AUB originate in the endometrium?

A
  • Endometritis
  • Polyp
  • Miscarriage
42
Q

What causes of AUB originate in the myometrium?

A
  • Adenomyosis

- Leiomyoma

43
Q

What usually contributes to the lack of endometrial infection?

A
  • Cervical mucous plug protects endometrium from ascending infection
  • Cyclical shedding of the endometrium also helps with resistance (as microorganisms are shed with it each month)
44
Q

What microorganisms normally cause infection of the endometrium, resulting in endometritis?

A

Neisseria
Chlamydia
TB (not common in UK)
Actinomyces (fungal infection caused by some IUDs)

45
Q

What can cause the inflammation of endometritis without evidence of infection?

A
  • Intra-uterine contraceptive device (IUD)
  • Postpartum/Postabortal
  • Post curettage
  • Chronic endometritis
  • Granulomatous disease (e.g. sarcoid? TB?)
  • Associated with leiomyomata or polyps
46
Q

What cell indicates chronic infectious endometritis on histology until proven otherwise?

A
  • Plasma cell (these should NOT be found in the endometrium)
47
Q

What organisms related to pelvic inflammatory disease may cause a chronic infectious endometritis?

A

Neiserria gonorrhoea
Chlamydia
enteric organisms

48
Q

How do patients with endometrial polyps usually present?

A
  • Usually asymptomatic
  • May present with bleeding or discharge
  • Some polyps can twist on their axis, damage their blood supply and cause infarction
49
Q

When do patients usually get endometrial polyps?

A
  • Occur around and after the menopause
50
Q

Polyps are always benign. TRUE/FALSE?

A

FALSE - ALMOST always benign

BUT endometrial carcinoma can present as a polyp

51
Q

Describe how the growth of an endometrial cancer is similar to that of a polyp?

A

Exophytic growth off of endometrial wall and into cavity

  • polyps have a smooth outline whereas cancers grow into “craggy” appearance
52
Q

What signs on histology would indicate that AUB has been caused by a miscarriage?

A
  • presence of chorionic villi (placental tissue)

- RBCs with nuclei in cytotrophoblast (only present in foetus <12 weeks => these indicate foetal tissue is present)

53
Q

What is meant by a molar pregnancy?

A

An abnormal growth of cells caused by a non-viable pregnancy

54
Q

What is the difference between a partial and complete molar pregnancy?

A

Complete - Only the fathers DNA is present
=> Placenta can form, but NO foetus can form

Partial - 2x copies of father’s DNA, 1x copy of mother’s DNA
=> Part of a foetus can form along with a “crazy” placenta

55
Q

How do the chorionic villi appear on histology in a molar pregnancy ?

A
  • Swollen
  • trophoblast growing off ALL sides rather than just one
  • grow in clusters resembling bunches of grapes
56
Q

A complete molar pregnancy increases the risk of what rare and aggressive form of cancer?

A

Choriocarcinoma

57
Q

How does adenomyosis appear on histology?

A

Endometrial glands and stroma within the myometrium

58
Q

How do patients with leimyomas usually present?

A

Menorrhagia
infertility
mass effect,
pain

Single or multiple, may distort uterine cavity

59
Q

What does a microscopic view of a leiomyoma show?

A

interlacing smooth muscle cells

60
Q

What name would be given to the cancer that develops from the glandular tissue of the endometrium?

A

Carcinoma

61
Q

What name would be given to a cancer developing from the muscle in the myometrium?

A

LeiomyoSARCOMA

REPRODUCTION & GYNAECOLOGY (58 decks)

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