Uterine Pathology Flashcards

1
Q

what are the three phases of the ovarian cycle?

A

follicular phase
ovulation
luteal phase

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2
Q

what are the three phases of the uterine cycle?

A

menstrual phase
proliferative phase
secretory phase

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3
Q

what is the time, hormones involved and the effect in the following phases?

a) proliferative
b) secretory
c) menstrual
d) fertilised
e) post-menopausal

A

a) day 1-14, oestrogen, growth
b) day 16-28, progesterone, secretion
c) day 1-3, withdrawal, necrosis
d) secretory onwards, progesterone and HCG, hypersecretion and decidualisation
e) non-cycling, inactive and atrophic

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4
Q

what is a graafian follicle?

A

fluid-filled structure in the mammalian ovary within which an ovum develops prior to ovulation

*contains oocyte and granulosa cells

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5
Q

what is the regressed form of the corpus luteum called?

A

corpus albicans

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6
Q

what occurs histologically during the secretory phase?

A

increasing tortuosity and lumenal secretions

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7
Q

what are the indications for endometrial sampling?

A

abnormal uterine bleeding
investigation for infertility
spontaneous and therapeutic abortion
assessment of response to hormonal therapy
endometrial ablation
work up prior to hysterectomy for benign indications
incidental finding of thickened endometrium on scan
endometrial cancer screening in high risk patients

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8
Q

what is dysfunctional uterine bleeding?

A

abnormal uterine bleeding with no organic cause

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9
Q

what is post menopausal bleeding?

A

abnormal uterine bleeding >1 year after cessation of menstruation

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10
Q

what are causes of AUB in adolescence / early reproductive life?

A

DUB - anovulatory cycles
pregnancy / miscarriage
endometritis
bleeding disorders

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11
Q

what are causes of AUB in reproductive life / perimenopause?

A
pregnancy / miscarriage 
DUB - anovulatory cycles, luteal phase defects
endometritis 
endometrial / endocervical polyp
leiomyoma 
adenomyosis 
exogenous hormone effects 
bleeding disorders

hyperplasia
neoplasia - cervical, endometrial

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12
Q

what are the causes of AUB post menopause?

A
atrophy 
endometrial polyp 
exogenous hormones: HRT, tamoxifen 
endometritis 
bleeding disorders

hyperplasia
endometrial carcinoma
sarcoma

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13
Q

what is most common method of assessing the endometrium?

A

TVUS

*hysteroscopy is also a good method

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14
Q

an endometrial thickness of what is generally taken as an indication for biopsy?

A

> 4mm post menopausal

16mm in premenopausal

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15
Q

how is an endometrial pipelle carried out?

A
3.1mm in diameter, no dilatation needed
no anaesthesia 
outpatient procedure 
very safe
limited sample
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16
Q

what is the most thorough sampling method which is the most common operation performed on women?

A

dilatation and curretage

*although can miss 5% of hyperplasias / cancers

17
Q

what history is required for uterine pathology?

A
age 
date of LMP and length of cycle
pattern of bleeding 
hormones 
recent pregnancy 

*do not need to know number of pregnancies, drugs without normal influences etc

18
Q

how are the endometrial samples for AUB assessed histologically?

A

is the sample adequate for given clinical scenario?
is there evidence of fresh/old breakdown?
is there an organic benign abnormality (polyp, endometritis, miscarriage)?
is there evidence for dysfunctional bleeding?
is there hyperplasia or malignancy?

19
Q

what is the least informative phase for endometrial sampling?

A

menstrual phase

20
Q

what are most cases of DUB due to?

A

anovulatory cycles

  • commonest at either end of reproductive life
  • corpus luteum does not form
  • continued growth of functionalis layer (PCOS, hypothalamic dysfunction, thyroid disorders, hyperprolactinaemia)
21
Q

how is luteal phase deficiency another common cause of DUB?

A

insufficient progesterone or poor response by the endometrium to progesterone
abnormal follicular development (inadequate FSH/LH) = poor corpus luteum

22
Q

what causes within the endometrium cause AUB?

A

endometritis
polyp
miscarriage

23
Q

what causes within the myometrium cause AUB?

A

adenomyosis

leiomyoma

24
Q

what does endometritis look like histologically?

A

abnormal pattern of inflammatory cells

*normally, cervical mucuous plug and cyclical shedding protects endometrium from ascending infection

25
Q

what are the likely causes of endometritis?

A

organisms = neisseria, chlamydia, TB, CMV, actinomyces, HSV

inflammation without organism = IUCD, postpartum, postabortal, post curettage, chronic endometritis NOS, granulomatous, assoc with leiomyomata or polyps

26
Q

what is chronic plasmacytic endometritis and what condition is it associated with?

A

chronic endometritis which is infectious unless proved otherwise

associated with pelvic inflammatory disease (neiserria gonorrhoea, chlamydia, enteric organisms)

27
Q

what are the symptoms of endometrial polyps?

A

usually asymptomatic but may present with bleeding or discharge

often occur around and after the menopause

28
Q

endometrial polyps are almost always malignant - true or false?

A

false - almost always benign

*BUT endometrial carcinoma can present as a polyp

29
Q

what is a molar pregnancy?

A

abnormal form of pregnancy in which a non-viable fertilised egg implants in the uterus (or tube)

30
Q

how are molar pregnancies characterised?

A

a form of gestational trophoblastic disease which grows a mass characterised by swollen chorionic villi

31
Q

how can molar pregnancies be categorised?

A

partial moles or complete moles

  • complete = single (90%) or two (10%) sperm combining with egg which has lost its DNA (the sperm then reduplicates forming a complete 46 chromosome set but only paternal DNA present
  • partial = egg fertilised by two sperm or by one sperm which reduplicates itself yielding genotype of 69XXY (have maternal and paternal DNA)
32
Q

what has a higher risk of developing into choriocarcinoma (a malignant tumour of trophoblast) - complete hydatidiform or partial moles?

A

complete

33
Q

what is adenomyosis and what are the symptoms?

A

endometrial glands and stroma break through to the the myometrium

causes menorrhagia / dysmenorrhea

34
Q

what is a leiomyoma?

A

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

35
Q

what may be the symptoms of a leiomyoma?

A

menorrhagia
infertility
mass effect
pain

*single or multiple, may distort uterine cavity

36
Q

what does the growth of a leiomyoma depend on?

A

oestrogen

37
Q

what does a leiomyoma look like microscopically?

A

interlacing smooth muscle cells

38
Q

what is the rare malignant transformation of a leiomyoma called?

A

leiomyosarcoma