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Repro HK > uterine pathology > Flashcards

uterine pathology Flashcards

1
Q

causes of abnormal uterine bleed in adolescence/early reproductive life

A

dysfunctional uterine bleeding
pregnancy/miscarriage
endometritis
bleeding disorders

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2
Q

what endometrial thickness on TVUS indicates need for biopsy

A

> 4mm postmenopausal

>16mm pre-menopausal

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3
Q

what is dysfunctional uterine bleeding

A

bleeding disrupting normal cycle

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4
Q

common cause of dysfunctional uterine bleeding

A

anovulatory cycles (start/end reproductive life)

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5
Q

corpus luteum does/doesn’t form in dysfunctional uterine bleeding

A

doesn’t

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6
Q

what layer of uterus has overgrown in dysfunctional uterine bleeding

A

functionalis

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7
Q

diagnosis of dysfunctional uterine bleeding

A

diagnosis of exclusion

rule out other things - FBC, cervical smear, thyroid, renal and LFTs, endometrial sampling

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8
Q

management of dysfunctional uterine bleeding

A 
progesterone/COCP
GnRH analogues
NSAIDs
anti-fibrinolytics
mirena IUS
endometrial resection
hysterectomy
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9
Q

what is endometritis

A

infection of uterus

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10
Q

endometritis is common/uncommon

why?

A

uncommon
cervical mucous plug and acidic vaginal pH protect uterus from ascending infection
cyclical endometrial shedding

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11
Q

what would disrupt protective barriers against ascending infection

A 
miscarriage 
TOP
child birth 
IUD insertion 
surgery
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12
Q

presentation of endometritis

A

lower abdo pain
fever
tender
discharge

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13
Q

diagnosis of endometritis

A

diagnosed on histology - abnormal pattern of inflammatory cells
neutrophils are normal
plasma cells are abnormal

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14
Q

organisms causing endometritis

A 
Neisseria
chlamydia 
TB 
CMV
actinomyces
HSV
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15
Q

what are endometrial polyps

A

growths in the uterus

often incidental on scans

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16
Q

polyps are benign/malignant

A

usually benign - can have focal parts which are malignant

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17
Q

what des miscarriage look like histologically

A

trophoblasts or chorionic villi

foetal red cells (still have nuclei)

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18
Q

what is molar pregnancy

A

non-viable egg implants uterus or tube

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19
Q

what is a complete mole

A

one or two sperm in an egg which has lost its DNA

sperm reduplicate forming 46 chromosome set (only paternal DNA)

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20
Q

what is a partial mole

A

egg and two sperm causing triploidy (69XXY)

contain maternal and paternal DNA

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21
Q

what can molar pregnancies turn into

A

choriocarcinoma

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22
Q

what type of mole has highest risk of turning malignant

A

complete hydatidiform

23
Q

what is adenomyosis

A

presence of endometrial glands in myometrium (seen in endometriosis)

24
Q

what is leiomyoma

A

benign tumour of smooth muscle

UTERINE FIBROID

25
Q

presentation of leiomyoma

A 
menorrhagia
infertility 
pressure symptoms
pain/tenderness 
women >40
may be multiple
26
Q

histology of leiomyoma

A

interlacing smooth muscle cells
very white
spindle cells

27
Q

what is growth of leiomyoma dependant on

A

oestrogen

28
Q

treatment for leiomyoma

A

ullipristal acetate

surgery (hysterectomy if family complete)

29
Q

most common age group affected by endometrial cancer

A

post menopausal

30
Q

risk factors for uterine cancer

A 
obesity 
nulliparity
anovulatory cycles
PCOS
early/late menopause
lynch syndrome 
breast cancer 
oestrogen only HRT
31
Q

protective factors of endometrial cancer

A

parity

COCP

32
Q

what hormone can cause growth of most endometrial cancers

A

oestrogen (especially if unopposed by progesterone)

33
Q

what is endometrial hyperplasia

A

proliferation of endometrium in response to prolonged oestrogen exposure

34
Q

treatment for endometrial hyperplasia

A

if no abnormality on histology, treat with progestogens and re-biopsy in 6-12 months
if atypia - surgery

35
Q

what can endometrial hyperplasia turn into

A

endometrial carcinoma

36
Q

what are the 2 main groups of endometrial carcinoma

A 
endometroid (type 1)
serous carcinoma (type 2)
37
Q

what do endometrial carcinoma and endometrial hyperplasia both present with

A

abnormal bleeding

38
Q

precursor of endometroid carcinoma

A

atypical hyperplasia

39
Q

precursor of serous carcinoma

A

serous intraepithelial carcinoma

40
Q

what are most endometrial cancers

A

adenocarcinoma

41
Q

where do endometrial cancers spread to

A

myometrium and cervix

lymphatics and blood

42
Q

risk factor for endometrioid carcinoma

A

unopposed oestrogen

PTEN, KRAS, PIK3CA mutations

43
Q

risk factor for serous carcinoma

A

elderly

TP53 mutation

44
Q

why is obesity a risk factor for endometrial cancer

A

adipocytes convert ovarian androgens into oestrogens inducing abnormal proliferation
Insulin also induces growth

45
Q

what is lynch syndrome

A

hereditary non-polyposis colorectal cancer

46
Q

mode of inheritance of lynch syndrome

A

autosomal dominant

47
Q

what is mutation in lynch syndrome

A

defective DNA mismatch repair gene

48
Q

what can help identify tumours due to lynch syndrome

A

staining for mismatch repair protein

microsatellite instability

49
Q

what is more aggressive, type 1 or type 2 cancers

A

type 2

50
Q

why does serous carcinoma have a worse prognosis than endometroid

A

serous spreads early to peritoneal cavity

51
Q

what is endometrial stromal sarcoma

A

from endometrial stroma
invasive
lymphovascular effects

52
Q

what is carcinosarcoma

A

high grade tumour with carcinomatous and sarcomatous elements

53
Q

causes of tubal swellings

A

ectopic pregnancy
hydrosalpinx
pyosalpinx
paratubal cysts (embryological remnants)

Repro HK (37 decks)

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