Uterine pathology Flashcards Preview

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Flashcards in Uterine pathology Deck (26):
1

the three stages of the ovarian cycle

follicular phase
ovulation
luteal phase

2

the three stages of the uterine cycle

menstrual phase
proliferative phase
secretory phase

3

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

4

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

5

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

6

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

7

when does post menopausal bleeding occur

>1 year after cessation of menstruation

8

causes of abnormal uterine bleeding in adolescence/repro life

DUB usually due to anovulatory cycles
preg/misc
endometritis
bleeding disorders

9

what does dub mean

dysfunctional uterine bleeding - AUB with no cause

10

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

11

causes of AUB: post menopausal

atrophy
endometrial polyp
exogenous hormone: HRT, tamoxifen
endometritis
bleeding disorders

hyperplasia
endometrial carcinoma
sarcoma

12

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

13

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

14

what is the required history

age
date of LMP and length of cycle
pattern of bleeding
hormones
recent preg

15

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?

16

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

17

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

18

histology of DUB

disordered prolif

19

organic causes of AUB

endo: endometritis, polyp, misc
myo: adenomyosis, leiomyoma

20

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

21

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

22

chronic plasmacytic endometritis

infectious unless proven otherwise
assoc with PID (gonorrhoea, chlamydia, enteric organisms)

23

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

24

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

25

adenomyosis

endometrial glands and stroma within the myometrium causes menorrhagia/dysmenohhoea

26

leiomyoma
symp
types
growth
microscopic
leiomyosarcoma

benign tumour os smooth muscle, may be found in locations other than the uterus

menorrhagia/infertility/mass effect/pain

single or multiple, may distort uterine cavity

oestrogen dependant

interlacing smooth muscle cells

rare