Uterine Pathology

Question 1

What phases make up the ovarian cycle?

Answer 1

Follicular phase
Ovulation (Day 14)
Luteal phase

Question 2

What phases make up the uterine cycle?

Answer 2

Menstrual phase (day 1)
Proliferative phase
Secretory phase

Question 3

Describe the proliferative phase of the endometrium:
Time
Hormone involved
Effect

Answer 3

Day 1 - 14
Oestrogen
Growth

Question 4

Describe the secretory phase of the endometrium:
Time
Hormone involved
Effect

Answer 4

Day 16 - 28
Progesterone
Secretion

Question 5

Describe the menstrual phase of the endometrium:
Time
Hormone involved
Effect

Answer 5

Day 1 - 3
Withdrawal of hormones
Necrosis

Question 6

Describe the fertilised phase of the endometrium:
Time
Hormone involved
Effect

Answer 6

From secretory phase onwards (day 16)
Progesterone and HCG
Hypersecretion and decidualisation

Question 7

What are indications for endometrial sampling?

Answer 7

Abnormal uterine bleeding
Investigations for infertility
Spontaneous and therapeutic abortion
Assessment of response to hormonal therapy
Prior to ablation to check that tissue is benign
Prior to hysterectomy
Endometrial cancer screening in high risk patients e.g. Lynch syndrome

Question 8

Define menorrhagia

Answer 8

Prolonged and increased menstrual flow

Question 9

Define metrorrhagia

Answer 9

Regular intermenstrual bleeding

Question 10

Define polymenorrhoea

Answer 10

Menses occuring at <21 day interval

Question 11

Define polymenorrhagia

Answer 11

Increased bleeding and frequent cycle

Question 12

Define menometorrhagia

Answer 12

Prolonged menses and intermenstrual bleeding

Question 13

Define amenorrhoea

Answer 13

Absence of menstruation >6 months

Question 14

Define oligomenorrhoea

Answer 14

Menses at intervals >35 days

Question 15

What is dysfunctional uterine bleeding?

Answer 15

Abnormal uterine bleeding without an organic cause

Question 16

What is peri-menopausal bleeding?

Answer 16

Abnormal uterine bleeding (AUB) more than 1 year after cessation of menstruation

Question 17

What is the most common cause of AUB in adolescence?

Answer 17

Anovulatory cycles - if the woman doesn’t ovulate then the endometrium keeps growing until it outgrows its blood supply and dies

Question 18

What is the most common cause of AUB in reproductive life?

Answer 18

Pregnancy/ miscarriage

Question 19

What is the most common cause of AUB in post-menopausal women?

Answer 19

Atrophy

Question 20

How can the breast cancer drug Tamoxifen cause uterine bleeding?

Answer 20

Anti-oestrogenic drug but paradoxical stimulation of oestrogen in endometrium

Question 21

What does sarcoma in uterus affect?

Answer 21

Stromal cells of endometrium

Smooth muscle cells of myometrium

Question 22

How can the endometrium be assessed?

Answer 22

Transvaginal ultrasound

Hysteroscopy - endometrial pipelle or dilatation and curettage

Question 23

What are the indications for a biopsy after transvaginal ultrasound?

Answer 23

If the endometrial thickness is:
>4mm in postmenopausal
>16mm in premenopausal

Question 24

What are organic causes of AUB in the endometrium?

Answer 24

Endometriosis
Polyps
Miscarriage

Question 25

What are organic causes of AUB in myometrium?

Answer 25

Adenomyosis | Leiomyoma

Question 26

What are causes of endometriosis?

Answer 26

``` Infection - neisseria, chlamydia, TB, CMB, acinomyces, HSV IUD Post-partum Post-curattage Granulomatous (sarcoid etc) Associated with leiomyomata or polyps ```

Question 27

What is chronic plasmacytic endometritis?

Answer 27

Infectious - associated with PID | Plasma cells in endometrium

Question 28

What is granulomatous endometritis?

Answer 28

Collection of epithelial macrophages | Granular disease - sarcoid, TB

Question 29

What are the clinical signs and symptoms of endometrial polyps?

Answer 29

Usually asymptomatic | Sometimes bleeding or discharge

Question 30

Are endometrial polyps benign or malignant?

Answer 30

Almost always benign | Can occur due to endometrial carcinoma

Question 31

What is a molar pregnancy?

Answer 31

Non-viable fertilised egg implants in uterus | A form of gestational trophoblastic disease characterised by swollen chorionic villi

Question 32

What are the types of molar pregnancies?

Answer 32

Complete mole | Partial mole

Question 33

How is a complete mole formed?

Answer 33

One or two sperm combine with egg that has no DNA (i.e. only paternal DNA)

Question 34

How is a partial mole formed?

Answer 34

When an egg is fertilised by 2 sperm or by 1 sperm which reduplicates i.e. 69XXY

Question 35

What is a potential malignancy risk of complete moles?

Answer 35

Risk of developing into choriocarcinoma (malignant tumour of trophoblast)

Question 36

What is adenomyosis?

Answer 36

Endometrial glands and stroma within the myometrium

Question 37

What is leiomyoma?

Answer 37

Benign tumour of the smooth muscle