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Reproductive & Sexual Health > Pathology of the uterus > Flashcards

Pathology of the uterus Flashcards

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1
Q

What are the three stages in the ovarian cycle?

A

Follicular phase Ovulation Luteal phase

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2
Q

What are the three stages in the uterine cycle?

A

Menstrual phase proliferative phase secretory phase

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3
Q

When does the proliferative phase of the uterine cycle occur? What hormone influences it? What effect does it have?

A

D1 -14 Oestrogen Growth

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4
Q

When does the secretory phase of the uterine cycle occur? What hormone influences it? What effect does it have?

A

D16-28 Progesterone Secretion

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5
Q

When does the menstrual phase of the uterine cycle occur? What hormone influences it? What effect does it have?

A

D1-3 Withdrawal Necrosis

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6
Q

What phase does the endometrium enter if there has been implantation? What hormone influences it and what is the effect?

A

Fertilised Progesterone & HCG Hypersecretion Decidualisation

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7
Q
A
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8
Q

What stage in the endometrial cycle is shown?

A

Proliferative phase

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9
Q

Which phase in the menstrual cycle is shown and how can you tell?

A

Secretory phase

Increasing tortuosity

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10
Q

Why is the endometrial biopsy difficult to interpret?

A

Constant physiological changes before, during and after reproductive life

Changes due to hormone therapy

Lack of clinical data

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11
Q

List the indications for endometrial sampling?

A
  1. Abnormal uterine bleeding
  2. Investigation for infertility
  3. Spontaenous and therapeutic abortion
  4. Assessment of response to hormonal therapy
  5. Endometrial ablation
  6. Work up prior to hysterectomy for benign indications
  7. Incidental finding of thickened endometrium on scan
  8. Endometrial cancer screening in high risk patients
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12
Q

What does menorrhagia mean?

A

Prolonged and increased menstrual flow

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13
Q

What does metrorrhagia mean?

A

Regular intermenstrual bleeding

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14
Q

What does polymenorrhoea mean?

A

Menses ocurring at <21 day interval

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15
Q

What does polymenorrhagia mean?

A

Increased bleeding and frequent cycle

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16
Q

What does menometorrhagia mean?

A

Prolonged menses and intermenstrual bleeding

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17
Q

What does amenorrhoea mean?

A

Absence of menstruation > 6 months

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18
Q

What does oligomenorrhoea mean?

A

Menses at intervals of >35 days

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19
Q

What is dysfunctional uterine bleeding

A

Abnormal uterine bleeding with no organic cause

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20
Q

Define post-menopausal bleeding

A

Abnormal uterine bleeding >1 year after cessation of menstruation

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21
Q

What are the common causes of abnormal uterine bleeding in adolescence/early reproductive life?

A
  • anovulatory cycles
  • pregnancy/miscarriage
  • endometritis
  • bleeding disorders
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22
Q

What are the causes of abnormal uterine bleeding during reproductive life/perimenopause?

A
  • pregnancy/miscarriage
  • DUB: anovulatory cycles, luteal phase defects
  • Endometritis
  • Endometrial/endocervical polyp
  • Leiomyoma
  • Adenomyosis
  • exogenous hormone effects
  • bleeding disorders
  • hyperplasia
  • neoplasia: cervical, endometrial
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23
Q

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

A
  • atrophy
  • endometrial polyp
  • exogenous hormones: HRT, tamoxifen
  • endometritis
  • bleeding disorders
  • > hyperplasia*
  • > endometrial carcinoma*
  • > sarcoma*
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24
Q

Endometrial thickness of ____ in postmenopausal women (____ in premenopausal) is generally taken as an indication for biopsy

Study These Flashcards
A

Endometrial thickness of >4mm in postmenopausal women (16mm in premenopausal) is generally taken as an indication for biopsy

25
How can the endometrium be sampled?
Endometrial pipelle Dilatation and curettage
26
Describe an endometrial pipelle
* 3.1mm diameter, no dilatation needed * no anaesthesia * outpatient procedure * very safe * limited sample
27
Describe dilatation and curettage
* most common operation performed on women * most thorough sampling method * can miss 5% hyperplasias/cancers
28
What history is required for interpreting an endometrial sample
- age - date of LMP and length of cycle - pattern of bleeding - hormones - recent pregnancy * do not need to know number of pregnancies, drugs withough hormonal influences*
29
What is considered in histological assessment of endometrial samples for abnormal uterine bleeding
- is the sample **adequate/representative** for the given clinical scenario - is there evidence of **fresh/old breakdown/haemorrhage** - is there an **organic benign abnormality**? (polyp, endometritis, miscarriage) - is there evidence for **dysfunctional bleeding**? - is there **hyperplasia** (atypical/non atypical) or **malignancy**?
30
In which phase of the menstrual cycle is the endometrial sample the least informative?
Menstrual phase
31
Define dysfunctional uterine bleeding
Irregular uterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining (no organic cause for the bleeding)
32
What is dysfunctional uterine bleeding normally caused by?
Anovulatory cycles
33
Describe an anovulatory cycle
Commonest at either end of reproductive life Corpus luteum does not form Continuous growth of functionalis layer
34
What can cause anovulatory cycles?
PCOS hypothalamic dysfunction thyroid disorders hyperprolactinaemia
35
What is luteal phase deficiency
Insufficient progesterone or poor response by the endometrium to progesterone. Abnormal follicular development (inadequate FSH/LH)- poor corpus luteum
36
What organic causes from the endometrium can cause abnormal uterine bleeding?
Endometritis Polyp Miscarriage
37
What organic pathologies in the myometrium can result in AUB?
Adenomyosis Leiomyoma
38
How is endometritis diagnosed histologically?
By recognising an abnormal pattern of inflammatory cells
39
What is the role of the cervical mucous plug in protecting the endometrium?
Protects from ascending infection
40
What makes the endometrium relatively resistant to infection?
Cyclical shedding
41
Which micro-organisms can cause endometritis?
Neisseria Chlamydia TB CMV Actinomyces HSV
42
What can cause endometritis without specific organisms?
IUCD Postpartum Postabortal Post curettage Chronic endometritis- NOS Granulomatous (sarcoid, foreign body post ablation) Associated with leiomyomata or polyps
43
What is chronic plasmacytic endometritis?
Infectious unless proven otherwise Associated with PID (neisseria gonorrhoea, chlamydia, enteric organisms)
44
How may endometrial polyps present?
Usually asymptomatic but may present with bleeding or discharge
45
When do endometrial polyps occur?
Often occur around and after the menopause
46
What is the prognosis of endometrial polyps
Almost always benign BUT endometrial carcinoma can present as a polyp
47
What may be seen on a miscarriage specimen
Products of conception - chorionic villi - foetal RBCs
48
What is a molar pregnancy?
Abnormal form of pregnancy in which a non-viable fertilised egg implants in the uterus (or tube)
49
Molar pregnancy is a gestational _____________ disease which grows as a mass characterised by swollen _______ \_\_\_\_\_. Categorised as ______ \_\_\_\_\_\_ or _______ \_\_\_\_\_.
Molar pregnancy is a gestational trophoblastic disease which grows as a mass characterised by swollen chorionic villi. Categorised as partial moles or complete moles.
50
What causes a complete mole?
Caused by one or two sperm combining with an egg that has lost its DNA.
51
How does a complete mole form?
The sperm reduplicates forming a complete 46 chromosome set but only paternal DNA is present
52
When does a partial mole occur?
When an egg is fertilised by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69 XXY (triploid)
53
Which type of molar pregnancy has the greatest potential to become choriocarcinoma?
Complete hydatidiform moles
54
55
What is adenomyosis?
Endometrial glands and stroma within the myometrium
56
How does adenomyosis present?
Causes menorrhagia/dysmenorrhoea
57
What is a leiomyoma
Benign tumour of smooth muscle, may be found in locations other than the uterus
58
How may a leiomyoma present?
Menorrhagia/infertility/mass effect, pain Single or multiple, may distort uterine cavity
59
What is the growth of leiomyomas dependent upon?
Oestrogen

Reproductive & Sexual Health (54 decks)

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