uterine pathology

Question 1

causes of abnormal uterine bleed in adolescence/early reproductive life

Answer 1

dysfunctional uterine bleeding
pregnancy/miscarriage
endometritis
bleeding disorders

Question 2

what endometrial thickness on TVUS indicates need for biopsy

Answer 2

> 4mm postmenopausal

>16mm pre-menopausal

Question 3

what is dysfunctional uterine bleeding

Answer 3

bleeding disrupting normal cycle

Question 4

common cause of dysfunctional uterine bleeding

Answer 4

anovulatory cycles (start/end reproductive life)

Question 5

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

Answer 5

doesn’t

Question 6

what layer of uterus has overgrown in dysfunctional uterine bleeding

Answer 6

functionalis

Question 7

diagnosis of dysfunctional uterine bleeding

Answer 7

diagnosis of exclusion

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

Question 8

management of dysfunctional uterine bleeding

Answer 8

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

Question 9

what is endometritis

Answer 9

infection of uterus

Question 10

endometritis is common/uncommon

why?

Answer 10

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

Question 11

what would disrupt protective barriers against ascending infection

Answer 11

miscarriage 
TOP
child birth 
IUD insertion 
surgery

Question 12

presentation of endometritis

Answer 12

lower abdo pain
fever
tender
discharge

Question 13

diagnosis of endometritis

Answer 13

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

Question 14

organisms causing endometritis

Answer 14

Neisseria
chlamydia 
TB 
CMV
actinomyces
HSV

Question 15

what are endometrial polyps

Answer 15

growths in the uterus

often incidental on scans

Question 16

polyps are benign/malignant

Answer 16

usually benign - can have focal parts which are malignant

Question 17

what des miscarriage look like histologically

Answer 17

trophoblasts or chorionic villi

foetal red cells (still have nuclei)

Question 18

what is molar pregnancy

Answer 18

non-viable egg implants uterus or tube

Question 19

what is a complete mole

Answer 19

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

sperm reduplicate forming 46 chromosome set (only paternal DNA)

Question 20

what is a partial mole

Answer 20

egg and two sperm causing triploidy (69XXY)

contain maternal and paternal DNA

Question 21

what can molar pregnancies turn into

Answer 21

choriocarcinoma

Question 22

what type of mole has highest risk of turning malignant

Answer 22

complete hydatidiform

Question 23

what is adenomyosis

Answer 23

presence of endometrial glands in myometrium (seen in endometriosis)

Question 24

what is leiomyoma

Answer 24

benign tumour of smooth muscle

UTERINE FIBROID

Question 25

presentation of leiomyoma

Answer 25

``` menorrhagia infertility pressure symptoms pain/tenderness women >40 may be multiple ```

Question 26

histology of leiomyoma

Answer 26

interlacing smooth muscle cells very white spindle cells

Question 27

what is growth of leiomyoma dependant on

Answer 27

oestrogen

Question 28

treatment for leiomyoma

Answer 28

ullipristal acetate | surgery (hysterectomy if family complete)

Question 29

most common age group affected by endometrial cancer

Answer 29

post menopausal

Question 30

risk factors for uterine cancer

Answer 30

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

Question 31

protective factors of endometrial cancer

Answer 31

parity | COCP

Question 32

what hormone can cause growth of most endometrial cancers

Answer 32

oestrogen (especially if unopposed by progesterone)

Question 33

what is endometrial hyperplasia

Answer 33

proliferation of endometrium in response to prolonged oestrogen exposure

Question 34

treatment for endometrial hyperplasia

Answer 34

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

Question 35

what can endometrial hyperplasia turn into

Answer 35

endometrial carcinoma

Question 36

what are the 2 main groups of endometrial carcinoma

Answer 36

``` endometroid (type 1) serous carcinoma (type 2) ```

Question 37

what do endometrial carcinoma and endometrial hyperplasia both present with

Answer 37

abnormal bleeding

Question 38

precursor of endometroid carcinoma

Answer 38

atypical hyperplasia

Question 39

precursor of serous carcinoma

Answer 39

serous intraepithelial carcinoma

Question 40

what are most endometrial cancers

Answer 40

adenocarcinoma

Question 41

where do endometrial cancers spread to

Answer 41

myometrium and cervix | lymphatics and blood

Question 42

risk factor for endometrioid carcinoma

Answer 42

unopposed oestrogen | PTEN, KRAS, PIK3CA mutations

Question 43

risk factor for serous carcinoma

Answer 43

elderly | TP53 mutation

Question 44

why is obesity a risk factor for endometrial cancer

Answer 44

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

Question 45

what is lynch syndrome

Answer 45

hereditary non-polyposis colorectal cancer

Question 46

mode of inheritance of lynch syndrome

Answer 46

autosomal dominant

Question 47

what is mutation in lynch syndrome

Answer 47

defective DNA mismatch repair gene

Question 48

what can help identify tumours due to lynch syndrome

Answer 48

staining for mismatch repair protein | microsatellite instability

Question 49

what is more aggressive, type 1 or type 2 cancers

Answer 49

type 2

Question 50

why does serous carcinoma have a worse prognosis than endometroid

Answer 50

serous spreads early to peritoneal cavity

Question 51

what is endometrial stromal sarcoma

Answer 51

from endometrial stroma invasive lymphovascular effects

Question 52

what is carcinosarcoma

Answer 52

high grade tumour with carcinomatous and sarcomatous elements

Question 53

causes of tubal swellings

Answer 53

ectopic pregnancy hydrosalpinx pyosalpinx paratubal cysts (embryological remnants)