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4. Female GU System > Uterus Pathology > Flashcards

Uterus Pathology Flashcards

1
Q

What are the 5 types of endometrial pathology in the uterus?

A 
Endometriosis
Adenomyosis
Benign endometrial polyps
Endometrial hyperplasia (typical/atypical)
Endometrial malignancy
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2
Q

What are the 3 types of endometrial malignancy?

A

Endometrial adenocarcinoma
Endometrial stromal tumour
Malignant mixed Mullerian tumour (MMMT)

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3
Q

What are the 2 types of myometrial pathology in the uterus?

A 
Benign leiomyomas (fibroids)
Malignant leiomyosarcomas
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4
Q

What are the 3 types of gestational pathology in the uterus?

A

Partial moles
Complete moles
Chorioncarcinoma

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5
Q

List the 2 layers of the endometrium.

Which layer has 2 sublayers? What are they?

A

Stratum basalis
Stratum functionalis

Stratum functionalis:

a. Stratum spongiosum
b. Stratum compactum

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6
Q

Briefly outline the normal uterine cycle of menstruation. Consider the 3 phases:

a) Proliferative phase (2)
b) Secretory phase (4)
c) Menstruation (3)

A

PROLIFERATIVE PHASE

  1. Epithelium: secretory columnar
  2. Endometrial cells proliferate extensively

SECRETORY PHASE

  1. Uterine glands become more spiral
  2. Uterine glands become bigger
  3. Uterine glands are filled with an eosinophilic secretion
  4. Endometrium thickens

MENSTRUATION

  1. Spiral arteries constrict, making the stratum functionalis ischaemic and necrotic
  2. Spiral arteries relax again - blood gushes out under high pressure, which flushes away necrotic functional layer
  3. Basal layer is supplied by straight arteries, so the basal layer remains & regenerates functional layer
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7
Q

Which problems in the uterus are associated with excess oestrogen? (3)

A

Overstimulation of endometrium
Endometrial hyperplasia
Endometrial adenocarcinoma

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8
Q

List some causes of excess oestrogen. Consider:

a) Endogenous oestrogen excess (4)
b) Exogenous oestrogen excess (2)

A 
ENDOGENOUS OESTROGEN:
Obesity (fat contains aromatase)
Polycystic ovarian disease
Oestrogen-secreting ovarian tumours
Longer ovulation lifespan

EXOGENOUS OESTROGEN:
Tamoxifen
Older forms of HRT

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9
Q

List 7 common sites of endometriosis.

A 
Ovaries (endometrioma)
Uterine ligaments
Pouch of Douglas
Pelvic peritoneum
Appendix
Scars
Colon
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10
Q

Describe the clinical features of endometriosis. (4)

What are the complications? (2)

A

Dysmenorrhoea
Pelvic pain
Haemorrhage during menstruation
Blood-filled cysts after menstrual cycle

COMPLICATIONS:
Infertility
Increased risk of malignancy

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11
Q

What is endometriosis caused by? (3)

A

Retrograde menstruation through fallopian tubes
Mullerian metaplasia of coelomic mesothelium
Spread of endometrial tissue via blood/lymphatics

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12
Q

What is adenomyosis?

A

A condition in which the endometrium herniates into the myometrium

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13
Q

List some clinical features of adenomyosis. (4)

What is the main complication of adenomyosis? (1)

A

Dysmenorrhoea
Severe menstrual cramps
Lower abdominal pressure
Heavy periods

COMPLICATIONS:
Infertility

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14
Q

List some clinical features of benign endometrial polyps. (5)

A 
Irregular menstrual bleeding
Bleeding between periods
Heavy periods
Vaginal bleeding after menopause
Infertility
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15
Q

Define the 2 types of endometrial hyperplasia.

A

TYPICAL HYPERPLASIA
Def.: “endometrial hyperplasia with normal nuclear features”

ATYPICAL HYPERPLASIA
Def. “endometrial hyperplasia with abnormal nuclear features, causing an increased risk of carcinoma development”

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16
Q

What are the 2 types of typical endometrial hyperplasia?

A

SIMPLE HYPERPLASIA:
Increased number of uterine glands
Increased complexity of uterine glands
Slight crowding of uterine glands

COMPLEX HYPERPLASIA:
Crowded uterine glands

17
Q

List 7 risk factors for endometrial adenocarcinoma.

A 
Obesity
Nulliparity
Early menarche, late menopause
Diabetes
Family history
Middle age
Tamoxifen use
18
Q

Describe the staging of endometrial carcinoma.

HINT: there are 4 stages.

A

Stage 1: confined to uterus
1A - no/inner half of myometrium involved
1B - outer half of myometrium involved

Stage 2: confined to uterus; cervical stromal involvement

Stage 3: local/regional spread
3A - serosal surface, uterine adnexae
3B - vagina, parametrium
3C - pelvic nodes, para-aortic lymph nodes

Stage 4: spread to bladder/bowel mucosa; distant metastases
4A - invasion of bladder, bowel
4B - distant metastases

19
Q

List 3 other pathological features of endometrial carcinoma, other than staging.

A

Grading (1, 2 or 3)
Lymphovascular space invasion (LVSI)
Positive peritoneal washings (i.e. tumour cells in peritoneal cavity)

20
Q

What is the treatment of endometrial carcinoma? Consider:

a) Normal endometrial carcinoma (3)
b) High risk endometrial carcinoma (4)

A

NORMAL ENDOMETRIAL CARCINOMA:
Hysterectomy
Salpingo-oopherectomy
Peritoneal cavity washings

HIGH RISK ENDOMETRIAL CARCINOMA:
All of above
Lymphadenectomy
Radiotherapy
Chemotherapy
21
Q

What is a malignant mixed Mullerian tumour (MMMT)?

A

“A poorly differentiated metaplastic endometrioid or serous adenocarcinoma; more often endometrial, with a poor prognosis”

22
Q

What investigations would you do for endometrial adenocarcinomas? (4)

A 
Vaginal exam
Endometrial biopsy
Transvaginal ultrasound (shows thickened endometrium)
Hysteroscopy (shows endometrium)
23
Q

What are leiomyomas?

What are they caused by?

A

Benign tumours of the smooth muscle cells in the myometrium (also called fibroids)

CAUSED BY:
Hormones, esp. high oestrogen levels

24
Q

List the clinical features of leiomyomas. (4)

Describe their gross appearance. (2)

A

Often asymptomatic
Dysmenorrhoea
Uterine enlargement
Pain

GROSS APPEARANCE:
Well-circumscribed, white nodule
Whorled, “watered silk” appearance when cut

25
Q

How are leiomyomas treated?

A

Hormone suppression

Hysterectomy (only if very big)

26
Q

What are leiomyosarcomas?

A

Malignant tumours of the smooth muscle cells in the myometrium

27
Q

List the clinical features of leiomyosarcomas. (6)

A 
Softer masses
Poorly circumscribed tumours
Haemorrhage
Necrosis
Vascular invasion
Metastasis to lungs
28
Q

What is a partial mole?

A

A pregnancy in which the embryo has a 69XXY chromosome

Non-viable foetus may be present

29
Q

What causes a partial mole? (2)

A

Endoreduplication (replication of genome after fertilisation without cell division)
Dispermic fertilisation

30
Q

What is a complete mole?

A

A pregnancy in which the embryo has either a 46XX or 46XY genome, but the chorionic villi are swollen and the placenta develops into an abnormal mass of cysts

No foetus develops

31
Q

What causes a complete mole? (1)

A

1 sperm fertilises an empty egg

32
Q

What are the consequences of partial and complete moles? (2)

A

Persistent trophoblastic disease (10-15%)

Chorioncarcinoma (2%)

33
Q

What is a molar pregnancy?

A

Condition in which there are swollen chorionic villi, but no foetus

34
Q

What is a choriocarcinoma?

A

Malignant tumour of the chorion during pregnancy

35
Q

Describe the 2 types of choriocarcinoma. For each, consider:

a) Origin of tumour cells
b) Prognosis

A

GESTATIONAL CHORIONCARCINOMA
Origin: foetus
Prognosis: better (more sensitive to chemo)

NON-GESTATIONAL CHORIONCARCINOMA
Origin: ovary/tests
Prognosis: much worse

36
Q

Describe the treatment of choriocarcinoma. (2)

A

Chemotherapy

hCG monitoring

37
Q

List 3 common locations of leiomyomas/fibroids.

A

Subserosal (outside myometrium)
Intramural (middle of myometrium)
Submucosal (near endometrium)

38
Q

Sometimes benign leiomyomas/fibroids can mimic malignant leiomyosarcomas. It can then be quite difficult to tell them apart histologically.

Which 2 features always suggest that it is a fibroid, NOT a malignant leiomyosarcoma?

A

No mitoses

No necrosis

4. Female GU System (9 decks)

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