Difference between revisions of "Uterus"

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**Discouraged... as the cervix remains and can develop a cancer.
**Discouraged... as the cervix remains and can develop a cancer.
*Total hysterectomy.
*Total hysterectomy.
**Indications: endometrial cancer (low stage, good histologic type), [[endometrial hyperplasia]], [[uterine prolapse]], [[uterine adenomyosis]], [[uterine leiomyoma]]s.
*Radical hysterectomy - total hysterectomy + parametrial tissue.<ref name=pmid19546764>{{Cite journal  | last1 = Frumovitz | first1 = M. | last2 = Sun | first2 = CC. | last3 = Schmeler | first3 = KM. | last4 = Deavers | first4 = MT. | last5 = Dos Reis | first5 = R. | last6 = Levenback | first6 = CF. | last7 = Ramirez | first7 = PT. | title = Parametrial involvement in radical hysterectomy specimens for women with early-stage cervical cancer. | journal = Obstet Gynecol | volume = 114 | issue = 1 | pages = 93-9 | month = Jul | year = 2009 | doi = 10.1097/AOG.0b013e3181ab474d | PMID = 19546764 }}</ref>
*Radical hysterectomy - total hysterectomy + parametrial tissue.<ref name=pmid19546764>{{Cite journal  | last1 = Frumovitz | first1 = M. | last2 = Sun | first2 = CC. | last3 = Schmeler | first3 = KM. | last4 = Deavers | first4 = MT. | last5 = Dos Reis | first5 = R. | last6 = Levenback | first6 = CF. | last7 = Ramirez | first7 = PT. | title = Parametrial involvement in radical hysterectomy specimens for women with early-stage cervical cancer. | journal = Obstet Gynecol | volume = 114 | issue = 1 | pages = 93-9 | month = Jul | year = 2009 | doi = 10.1097/AOG.0b013e3181ab474d | PMID = 19546764 }}</ref>
**Indications: cervical cancers, advanced uterine cancers.
**Indications: cervical cancers, advanced uterine cancers.
***This is typically done by gynecologists with additional training at larger centres.
***This is typically done by gynecologists with additional training at larger centres.
***Usually done with a bilateral salpingo-opherectomy (both tubes and ovaries) and pelvic lymph node dissection.


Notes:
Notes:

Revision as of 00:56, 18 January 2012

The uterus is essential for survival of the species. It is commonly afflicted with tumours.

Endometrium and its pathology is dealt with in the endometrium, endometrial hyperplasia and endometrial carcinoma articles.

Other tumours are dealt with in uterine tumours.

Operations

  • Subtotal hysterectomy.
    • Discouraged... as the cervix remains and can develop a cancer.
  • Total hysterectomy.
  • Radical hysterectomy - total hysterectomy + parametrial tissue.[1]
    • Indications: cervical cancers, advanced uterine cancers.
      • This is typically done by gynecologists with additional training at larger centres.
      • Usually done with a bilateral salpingo-opherectomy (both tubes and ovaries) and pelvic lymph node dissection.

Notes:

  • There are almost no quality of life differences between total & subtotal hysterectomy.[2]

Tumours of the corpus

The most common is leiomyoma (uterine fibroids).

Endometrium

Dealt with in endometrium, endometrial hyperplasia and endometrial carcinoma articles.

Congenital absence

  • Often in association with vaginal absence; ergo congenital absence of the uterus and vagina (CAUV).
    • AKA Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.[3]

Features:[3]

  • Subdivided - as etiologies differ.
  • Thought to have a genetic component - autosomal dominant with variable penetration.

Treatment:

  • Uterine transplant - attempted.[4]

Uterine adenomyosis

General

Microscopic

Features:

  • Endometrial glands within uterine muscle - key feature.
    • Endometrial glands:
      • Circular.
      • Simple epithelial or pseudostratified epithelium +/- mitoses.
    • +/-Surrounded by endometrial stroma.
    • Blood:
      • Within glands.
      • Hemosiderin-laden macrophages.

Note:

DDx:

See also

References

  1. Frumovitz, M.; Sun, CC.; Schmeler, KM.; Deavers, MT.; Dos Reis, R.; Levenback, CF.; Ramirez, PT. (Jul 2009). "Parametrial involvement in radical hysterectomy specimens for women with early-stage cervical cancer.". Obstet Gynecol 114 (1): 93-9. doi:10.1097/AOG.0b013e3181ab474d. PMID 19546764.
  2. Thakar, R.; Ayers, S.; Clarkson, P.; Stanton, S.; Manyonda, I. (Oct 2002). "Outcomes after total versus subtotal abdominal hysterectomy.". N Engl J Med 347 (17): 1318-25. doi:10.1056/NEJMoa013336. PMID 12397189.
  3. 3.0 3.1 URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1832178/.
  4. URL: http://singularityhub.com/2011/06/18/in-a-medical-first-infertile-daughter-will-receive-uterus-from-mother-video/. Accessed on: 17 June 2011.
  5. Reinhold, C.; Tafazoli, F.; Mehio, A.; Wang, L.; Atri, M.; Siegelman, ES.; Rohoman, L. (Oct 1999). "Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation.". Radiographics 19 Spec No: S147-60. PMID 10517451.