Uterine pathology Flashcards
(26 cards)
the three stages of the ovarian cycle
follicular phase
ovulation
luteal phase
the three stages of the uterine cycle
menstrual phase
proliferative phase
secretory phase
what happens to the cells in the secretory phase
and when does this happen
they become increasingly torturous and luminal secretions
day 16 of the 18 day cycle
why is an endometrial biopsy one of the most difficult things to interpret
constant physiological changed before, during and after repro life
changes due to hormonal therapy
lack of clinical data
what are the indications for endometrial sampling
abnormal uterine bleeding
ix for infertility
spontaneous and therapeutic abortion
assessment of response to hormonal therapy
endometrial ablation
work prior to hysterectomy for benign indications
incidental finding of thickened endometrium on scan
endometrial cancer screening in high risk patients
menorrhagia metrohhagia polymenorrhoea polymenorrhagia menemetrorrhagia amen oligo
prolonged and increased flow regular intermenstrual bleeding menses at <21 day intervals increased bleeding and frequent cycle prolonged menses and intermensual bleeding absence of menstruation >6months menses intervals of >35 days
when does post menopausal bleeding occur
> 1 year after cessation of menstruation
causes of abnormal uterine bleeding in adolescence/repro life
DUB usually due to anovulatory cycles
preg/misc
endometritis
bleeding disorders
what does dub mean
dysfunctional uterine bleeding - AUB with no cause
causes of AUB: repro life/perimenopause
preg/misc DUB: anovultaroy cycles, luteal phase defects endometritis endometrial/endocervical polio leiomyoma adenomyosis exogenous hormonal effects bleeding disorders hyperplasia neoplasia: cervical, endometrial
causes of AUB: post menopausal
atrophy endometrial polyp exogenous hormone: HRT, tamoxifen endometritis bleeding disorders
hyperplasia
endometrial carcinoma
sarcoma
assessing endometrium TVUS
when would a biopsy be taken depending on the US
transvaginal US
endometrial thickness of >4mm in post menopausal woman and 16mm in premeno is taken as indication for biopsy
what is another method of assessing the endometrium and what can be done with that
hysteropscopy
endometrial pipelle - 3.1mm dm, no dilatation needed, no anaesthesia, out[atient procedure, safe
dilatation and curettage - most common operation performed on women, can miss 5% hyperplasias/cancers
what is the required history
age date of LMP and length of cycle pattern of bleeding hormones recent preg
histological assessment of endometrial sample for AUB
is the sample adequate/representaive for the given clinical scenario
evidence of fresh/old breakdown heam
organic benign abnormality (polyp, endometritis, misc)
dysfunctional bleeding?
hyperplasia, malig?
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 the bleeding
what is DUB most commonly due to
when is it the commonest
what happens (2) and why
anovulatory cycles
either end of repro life
CL does not form and continued growth of functionalis layer (PCOS, hypothalamic dysfunction, thyroid disorders, hyperprolacinoma)
luteal phase deficiency - insuffienient prog or poor response by the endometrium to prog - abnormal follicular development (inadequate FSH/LH) - poor CL
histology of DUB
disordered prolif
organic causes of AUB
endo: endometritis, polyp, misc
myo: adenomyosis, leiomyoma
endometritis
dx
2
histologically dx - abnormal pattern of inflam cells
cervical mucous plug prevents the endometrium from ascending infection
cyclical shedding of the endometrium also makes it relatively resistant
causes of endometritis
neiseeria, chalmydia, TB, CMV, actinomycetes, HSV
without specific organisms:
IUD, post partum, post abortal, post curratege, chronic endometritis, granulomatous, assoc with leiomyomata or polyps
chronic plasmacytic endometritis
infectious unless proven otherwise
assoc with PID (gonorrhoea, chlamydia, enteric organisms)
endometrial polyps
symp
when
risk
common
asymp - can present with bleeding/discharge
around and after meno
almost always benign BUT endometrial carcinoma can present as a polyp
molar preg is what
types
risk
abnormal form of preg where non viable fertilised egg implants - form of gestational trophoblastic disease
complete - single/two sperm combining with an egg that has lost its DNA only Y/YY
partial - egg fertilised by 2 or 1 sperm which replicates itself XXY instead of XY
complete hydatidiform moles have a higher risk of developing into a choriocarcinoma than partial moles
