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Gynaecology > Pathology - Uterus > Flashcards

Pathology - Uterus Flashcards

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1
Q

3 phases of the ovarian cycle

A

follicular

ovulation

luteal

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2
Q

3 phases of uterine cycle

A

menstrual phase

proliferative phase

secretory phase

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3
Q

Time, Hormone, effect of each uterine cycle phase

A

Proliferative - D 1-14 , Oestrogen, Growth

Secretory - D16-28, Progesterone, Secretion

Menstrual- D1-3, Withdrawal, Necrosis

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4
Q

effect of fertilisation on endometrium (+ responsible hormones)

A

progesterone - hypersecretion

HCG - decidualisation

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5
Q

Post-menopausal effect on endometrium

A

atrophy, inactivity

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6
Q

histological features of secretory phase

A

increasing tortuosity and lumenal secretions

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7
Q

3 limitations in interpreting endometrial biopsies

A

Constant physiological changes before, during and after reproductive life

Changes due to hormone therapy

Lack of clinical data

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8
Q

8 indications for endometrial sampling

A

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

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9
Q

Menorrhagia

A

prolonged and increased menstrual flow

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10
Q

Metrorrhagia

A

regular IMB

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11
Q

Polymenorrhea

A

Menses occurring

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12
Q

Polymenorrhagia

A

increased bleeding and frequent cycle

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13
Q

Menometrorrhagia

A

Prolonged/heavy menses and IMB

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14
Q

Amenorrhoea

A

absence of menses >6m

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15
Q

Oligomenorrhoea

A

Menses at intervals >35 days

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16
Q

DUB

A

AUB with no organic cause

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17
Q

PMB

A

AUB > 1 year after cessation of menstruation

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18
Q

Painful bleeds (term)

A

Dysmenorrheoa

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19
Q

Causes of AUB in adolescence/early reproductive life (4)

A

DUB due to anovulatory cycles

Pregnancy/miscarriage

Endometritis

Bleeding disorders

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20
Q

Causes of AUB: Reproductive life/perimenopause (10)

A

pregnancy/miscarriage

endometritis

DUB: anovulatory/luteal phase defects

Endocervical/endometrial polyps

leiomyoma

adenomyosis

exogenous hormone effects

bleeding disorders

hyperplasia

neoplasia: cervical, endometrial

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21
Q

Causes of post menopausal AUB (8)

A

endometrial polyps

atrophy

endometritis

bleeding disorders

exogenous hormones: HRT, tamoxifen

hyperplasia

neoplasia: endometrial

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22
Q

Methods of assessing the endometrium

A

TVUS

Hysteroscopy

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23
Q

What endometrial thickness on TVUS is an indication for biopsy? (postmenopausal and premenopausal)

A

Endometrial thickness of:

> 4mm in Postmenopausal

> 16mm in Premenopausal

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24
Q

2 ways of sampling the endometrium

A
  1. Endometrial pipelle

2. Dilatation and Curretage

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25
Which endometrial sampling method is the most thorough?
D & C
26
Endometrial pipelle pros (4)
no anaesthesia outpatient procedure very safe 3.1mm diameter no dilatation needed
27
Endometrial pipelle cons
Limited sample
28
What is the most common operation performed on women
D&C
29
Pros of D&C (1)
most thorough sampling method
30
Cons of D&C (1)
Can miss 5% hyperplasia/cancers
31
Required History for endometrial biopsy (5)
``` Age Date of LMP and length of cycle Pattern of bleeding Hormones Recent pregnancy ```
32
What information do pathologists NOT need to know with endometrial biopsy
drugs WITHOUT hormonal influences Number of pregnancies
33
Questions to ask yourself in the histological assessment of endometrial samples for AUB (5)
is the sample adequate/representative for the given clinical scenario? Is there evidence of fresh/old breakdown/haemorhage? Is there an organic benign abnormality? (polyp, endometritis, miscarriage) Is there evidence for dysfunctional bleeding? Is there hyperplasia (atypical/non-atypical) or malignancy?
34
During what phase is the endometrial biopsy least informative?
Menstrual
35
What is the definition of DUB
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)
36
What % of DUB are due to anovulatory cycles?
85%
37
When is anovulatory DUB most common?
either ends of reproductive life
38
What happens in anovulatory DUB?
Corpus luteum does not form continued growth of the functionalis layer
39
Other causes of anovulation? (4)
PCOS Hypothalamic dysfunction Thyroid disorders Hyperprolactinaemia
40
What happens in luteal phase deficiency?
insufficient progesterone or poor response by the endometrium to progesterone. Abnormal follicular development - inadequate FSH/LH Poor corpus Luteum
41
Histological features of anovulatory cycle
disordered proliferation eg. LMP 8 weeks previously yet glands and stroma continue to grow
42
Organic ENDOMETRIAL causes of AUB (3)
endometritis polyps miscarriage
43
organic MYOMETRIAL causes of AUB (2)
Leiomyoma Adenomyosis
44
Endometritis histological diagnosis
abnormal pattern of inflammatory cells
45
What are the endometrial defences to ascending infection? (2)
cervical mucus plug cyclical shedding
46
Mico-organism causes of endometritis? (6)
``` CMV HSV Actinomyces TB Gonorrhea Chlamydia ```
47
non-specific inflammatory causes of endometritis? (7)
``` post partum post curettage post abortion Granulomatous - sarcoid/FB post-ablative IUD associated with leiomyomata or polyps ```
48
What is chronic plasmacytic endometritis and what is it associated with?
infectious until proven otherwise associated with PID (gonorrhea, chlamydia, enteric organisms)
49
Are endometrial polyps rare?
nope, they are common
50
How do endometrial polyps present?
asymptomatic, but may present with bleeding or discharge
51
When do endometrial polyps occur?
around and after the menopause (40-60s) or pregnancy
52
Are endometrial polyps benign?
almost always
53
What may be mimicked by endometrial polyp?
Endometrial carcinoma
54
How are endometrial polyps diagnosed?
TVUS
55
Miscarriage histology - what will be seen
products of conception (fetal RBC and chorionic villi)
56
Molar pregnancy histological features
abnormally proliferating trophoblasts
57
Genetics of a complete mole
Complete mole is caused by a single (incidence is about 90%) or two (incidence is about 10%) sperm combining with an egg which has lost its DNA (the sperm then reduplicates forming a "complete" 46 chromosome set. Only paternal DNA is present in a complete mole.
58
Genetics of partial mole
Partial mole occurs when egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid). Partial moles have both maternal and paternal DNA
59
Complete v partial moles - which have a higher risk developing into choriocarcinoma
Complete hydatidiform moles have a higher risk of developing into choriocarcinoma (a malignant tumour of trophoblast) than partial moles.
60
What will MRI of complete mole show?
enlarged uterus
61
Adenomyosis
aka fibroid Endometrial glands and stroma within the myometrium Causes menorrhagia/dysmenorrhoea
62
Leiomyoma
Benign tumour of smooth muscle, may be found in locations other than the uterus menorrhagia / dysmenorrhoea
63
Microscopic leiomyoma
interlacing smooth muscle cells
64
Presentation of leiomyoma
menorrhagia infertility mass effect pain
65
Do leiomyomas occur as single or multiple and what are its complications
Single or multiple, may disort uterine cavity
66
what is fibroid growth dependent on?
oestrogen
67
what is the cancerous version of leiomyoma
leiomyosarcoma
68
Management of fibroids
myomectomy

Gynaecology (7 decks)

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