Pathology of Uterus

Question 1

What is the effect of oestrogen in the proliferative phase of the menstrual cycle?

Answer 1

Growth

Question 2

What is the effect of progesterone in the secretory phase of the menstrual cycle?

Answer 2

Secretion

Question 3

What will the endometrium be like post-menopausal?

Answer 3

Inactive

Atrophic

Question 4

What is the graafian follicle?

Answer 4

The dominant follicle that is selected to become the corpus luteum

Question 5

What type of epithelium lines the endometrium?

Answer 5

Glandular (columnar) epithelium

Question 6

What is a mitotic figure?

Answer 6

Cell actively growing

Question 7

What is the corpus albicans?

Answer 7

As the corpus luteum is being broken down by macrophages, fibroblasts lay down type I collagen, forming the corpus albicans

Question 8

How will the histological slides change as the endometrium progresses from follicular to secretory?

Answer 8

Increased tortuosity and luminal secretions

Question 9

What are the indications for endometrial sampling?

Answer 9

Abnormal uterine bleeding
Ix for infertility
Spontaneous and therapeutic abortion
Assessment of response to hormonal therapy
Endometrial ablation; indication for abnormal bleeding
Work up prior to hysterectomy for benign indications
Incidental finding of thickened endometrium on scan
Endometrial cancer screening; lynch syndrome

Question 10

Why should you sample spontaneous and therapeutic abortions?

Answer 10

Exclude a molar pregnancy

Question 11

What is menorrhagia?

Answer 11

Prolonged and increased menstrual flow

Question 12

What is metorrhagia?

Answer 12

Regular intermenstrual bleeding

Question 13

What is polymenorrhoea?

Answer 13

Menses occuring at <21 days interval

Question 14

What is polymenorrhagia?

Answer 14

Increased bleedig and frequent cycle

Question 15

What is menometorrhagia?

Answer 15

Prolonged menses and intermenstrual bleeding

Question 16

What is amenorrhoea?

Answer 16

Absence of menstruation > 6 months

Question 17

What is oligoamenorrhoea?

Answer 17

Menses at intervals of > 35 days

Question 18

What is the definition of post menopausal bleeding?

Answer 18

Abnormal uterine bleeding > 1 year after cessation of menstruation

Question 19

What are causes of AUB in adolescence or early reproductive life?

Answer 19

DUB due to anovulatory cycles
Pregnancy/ miscarriage
Endometritis
Bleeding disorders; protein S or protein C deficiency

Question 20

What are causes of AUB in reproductive life/ perimenopause?

Answer 20

Pregnancy/ miscarriage 
DUB; anovulatory cycles, luteal phase defects
Endometritis 
Endometrial/ endocervical polyp
Leiomyoma = FIBROID
Adenomyosis
Exogenous hormone effects
Bleeding disorders
Hyperplasia
Neoplasia; cervical, endometrial

Question 21

What is adenomyosis?

Answer 21

Endometrial glands and stroma in the myometrium; causes painful menstruatio n

Question 22

What is dysmenorrhea?

Answer 22

Painful menses

Question 23

What is endometriosis?

Answer 23

Endometrial glands and stroma outwith the endometrial cavity

Question 24

What causes AUB postmenopausally?

Answer 24

Endometrial carcinoma 
Sarcoma 
Atrophy
Endometrial polyp
Exogenous hormones; HRT, tamoxifen
Endometritis
Bleeding disorders

Question 25

What is the gold standard for assessing the endometrium?

Answer 25

Transvaginal US

Question 26

In postmenopausal women what endometrial thickness is an indication for taking a biopsy?

Answer 26

More than 4mm | 16mm in premenopausal

Question 27

What are the 2 methods to sample the endometrium?

Answer 27

Endometrial pipelle | Dilation and curretage

Question 28

What is the difference between an endometrial pipelle and dilatation and curettage?

Answer 28

Pipelle; no anaesthesia, outpatient procedure, very safe BUT limited sample Dilatation and curretage; most common op performed in women, most common sampling method, BUT can miss5% of hyperplasias/ cancers

Question 29

What is a required history in gynae?

Answer 29

``` Age Date of LMP and length of cycle Pattern of bleeding Hormones Recent pregnancy ```

Question 30

Should you take a pipelle when the women is menstruating?

Answer 30

No

Question 31

What is DUB?

Answer 31

Irregular uterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining (no organic cause for bleeding)

Question 32

What is the most common cause of DUB?

Answer 32

Anovulatory cycles; PCOS, hypothalamic dysfunction, thyroid disorders, hyperprolactinaemia

Question 33

When is DUB most common?

Answer 33

At either end of reproductive life

Question 34

Describe the pathogenesis of DUB?

Answer 34

Corpus luteum does not form | Continued growth of functionalis layer

Question 35

What is luteal phase deficiency?

Answer 35

Insufficient progesterone or poor response by endometrium to progesterone Abnormal follicular development (inadequate FSH/LH) Poor corpus luteum

Question 36

What is the pathology of organic causes of AUB?

Answer 36

Endometrium; endometritis, polyp, miscarriage | Myometrium; adenomyosis, leiomyoma

Question 37

How is endometritis pathologically diagnosed?

Answer 37

Recognition of abnormal pattern of inflammatory cells

Question 38

What is the role of the cervical plug?

Answer 38

Protects the endometrium from ascending infection

Question 39

What micro-organisms commonly cause endometritis?

Answer 39

``` N. gonorrhea Chlamydia TB CMV Actinomyces (fungal assoc with IUCD) HSV ```

Question 40

What can cause inflammation of the endometrium without a specific organism?

Answer 40

``` IUCD; copper coil Post-partum Postabortal Post-curretage Chronic endometritis Granulomatous (sarcoid, foreign body post ablation) Assoc with leiomyomata or polyps ```

Question 41

What is chronic plasmacytic endometritis assoc with?

Answer 41

PID; N. gonorrhoeae, chlamydia, enteric organisms)

Question 42

Will endometrial polyps be symptomatic?

Answer 42

Tend to be asymptomatic but may present with bleeding or discharge

Question 43

Is an endometrial polyp always benign?

Answer 43

No; endometrial cancer can present as a polyp

Question 44

When will polyps become painful?

Answer 44

They can tort and infarct | Can ulcerate

Question 45

What are the subunits of the placenta?

Answer 45

Chorionic villi; contains all the DNA of the foetus

Question 46

At what age will a foetus have nucleated blood vessels?

Answer 46

Below 12 weeks

Question 47

What is a molar pregnancy?

Answer 47

Abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus It's a form of gestational trophoblastic disease which grows as a mass characterized by swollen chorionic villi Partial or complete moles

Question 48

What is a trophoblast?

Answer 48

Cells that form the outer layer of a blastocyst, which provide nutrients to the embryo and develop into a large part of the placenta

Question 49

Which type of hydatidiform mole has a higher risk of malignant transformation to a choriocarcinoma (tumour of placenta)?

Answer 49

Complete rather than partial

Question 50

What is a complete molar pregnancy?

Answer 50

Only paternal DNA present | Sperm fertilises with an egg that has lost its DNA

Question 51

What is a partial molar pregnancy?

Answer 51

2 sperm fertilize one egg and therefore you will get 69 XXY (triploid) So will have both maternal and paternal DNA

Question 52

What is leiomyoma?

Answer 52

Benign tumour of smooth muscle, may be found in locations other that the uterus

Question 53

How can a leiomyoma present?

Answer 53

Menorrhagia Infertility Mass effect Pain

Question 54

How will a leiomyoma look microscopically?

Answer 54

Interlacing smooth muscle cells

Question 55

Can a leiomyoma transform malignant?

Answer 55

Yes; leiomyosarcoma