9: Pathology of the uterus

Question 1

Which hormone causes the endometrium to proliferate?

Answer 1

Oestrogen

Question 2

Which hormone maintains the endometrium during the luteal phase and encourages uterine secretions?

Answer 2

Progesterone

Question 3

What term is used to describe the appearance of the endometrium when the egg cell is fertilised?

Answer 3

Decidualised

Question 4

Which hormones are involved in the uterine cycle if the egg is cell is actually fertilised?

Answer 4

hCG

Progesterone

if not, corpus luteum degenerates and these aren’t produced

Question 5

What are the elements of the proliferative endometrium which you can see on histology?

Answer 5

Columnar epithelium

Stromal cells

Glands

Question 6

In the proliferative phase of the uterine cycle, which aspects of the endometrium grow?

Answer 6

Stroma

Glands

Question 7

What is the corpus luteum?

Answer 7

Remnant of leading follicle left when egg is released

Produces progesterone to maintain endometrium

Question 8

In the event of no fertilisation, what does the corpus luteum degenerate to form?

Answer 8

Corpus albicans

Question 9

What phase of the uterine cycle starts when ovulation occurs?

Answer 9

Secretory phase

because progesterone is being produced

Question 10

How does the endometrium change in the secretory phase?

Answer 10

Glands become torturous - wiggly

Glands fill with secretions

Question 11

If no fertilisation occurs, what happens to the endometrium?

Answer 11

Loss of blood supply

Sloughing > Menstruation

Question 12

What is a genetically inherited syndrome which causes GI polyposis and increases a woman’s chances of developing endometrial cancer?

Answer 12

Lynch syndrome / HNPCC

Question 13

What is the difference between abnormal and dysfunctional uterine bleeding?

Answer 13

Abnormal bleeding - organic cause: infection, tumour, miscarriage, ectopic/molar pregnancy

Dysfunctional bleeding - no abnormal cause: pathology is hormonal or idiopathic

Question 14

What is the most common cause of dysfunctional uterine bleeding?

Answer 14

Anovulation

common at extremes of age

Question 15

How does anovulation cause dysfunctional uterine bleeding?

Answer 15

No ovulation > no corpus luteum to produce progesterone

Prolonged oestrogen production > Prolonged proliferation of endometrium

Eventually sloughs due to loss of blood supply > Heavy bleeding

Question 16

Which tumours can cause abnormal uterine bleeding?

Answer 16

Endometrial polyps

Leiomyomas (fibroids)

Question 17

What are endometriosis and adenomyosis?

Answer 17

Growth of endometrium / glands outwith the uterus

Grow in response to oestrogen

Cause pain

Question 18

What inflammatory condition causes abnormal uterine bleeding?

Answer 18

Endometritis

Question 19

What drugs used to control menopausal symptoms can cause abnormal uterine bleeding?

Answer 19

HRT

Tamoxifen

Question 20

An endometrial thickness of over ___ mm is an indication for biopsy.

Answer 20

4 mm

Question 21

What investigation is used to assess endometrial thickness?

Answer 21

Transvaginal ultrasound

Question 22

Which investigation is used to view the endometrium?

Answer 22

Hysteroscopy

Question 23

What are two methods of taking an endometrial biopsy?

Answer 23

Pipelle biopsy

Dilatation and curettage

Question 24

What is a disadvantage of using a pipelle over D&C for taking an endometrial biopsy?

Answer 24

You can’t see the endometrium while taking the sample

Question 25

Between **pipelle biopsy** and **D&C**, what is the preferred method for taking endometrial samples?

Answer 25

**D&C** Because you can see the endometrium while you're doing it

Question 26

During which phase of the uterine cycle are endometrial biopsies not particularly useful?

Answer 26

**Menstrual phase** because glands and stroma are falling apart

Question 27

If endometrial glands grow for months e.g anovulation, what can they form?

Answer 27

**Cysts**

Question 28

Despite being in the **muscle layer**, how do **leiomyomas** cause abnormal uterine bleeding?

Answer 28

**Contraction stretches blood vessels, stroma and glands**

Question 29

**Endometritis** is inflammation of the endometrium which can be either infectious or non-infectious. What symptom can it cause? How do you recognise it on histology?

Answer 29

**Abnormal uterine bleeding** **Inflammatory cells** (shouldn't be there; chronic - plasma cells, acute - neutrophils & macrophages)

Question 30

What type of **endometritis** does **tuberculosis** cause?

Answer 30

**Granulomatous endometritis** big closed off rings of inflammatory cells

Question 31

**Endometrial polyps** are usually **(benign / malignant).**

Answer 31

**benign**

Question 32

Some **endometrial polyps** progress to form \_\_\_.

Answer 32

**carcinomas**

Question 33

When do women tend to develop **endometrial polyps**?

Answer 33

**Menopause**

Question 34

What structures, belonging to the foetus, are seen on histology of a miscarriage sample?

Answer 34

**Chorionic villi** **Foetal red blood cells**

Question 35

How can you tell **foetal RBCs apart from maternal RBCs** on histology?

Answer 35

**Foetal RBCs are nucleated** **Maternal RBCs aren't**