Difference between revisions of "Uterine prolapse"

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#redirect [[Uterus#Uterine_prolapse]]
'''Uterine prolapse''' is a frequent benign pathology of the [[uterus]] and a common reason for [[hysterectomy]].
 
==General==
*[[Clinical diagnosis]].
*A common indication for a total hysterectomy. 
*Hysterectomy specimen usually comes with some [[vagina]]l mucosa.
*Parous women, usually menopausal.<ref name=pmid20607975>{{Cite journal  | last1 = Mladenović-Segedi | first1 = L. | last2 = Segedi | first2 = D. | title = [Most important etiologic factors in the development of genital prolapse]. | journal = Srp Arh Celok Lek | volume = 138 | issue = 5-6 | pages = 315-8 | month =  | year =  | doi =  | PMID = 20607975 }}</ref>
*Possibly [[obesity]] - studies vary.<ref name=pmid22732579 >{{Cite journal  | last1 = Thubert | first1 = T. | last2 = Deffieux | first2 = X. | last3 = Letouzey | first3 = V. | last4 = Hermieu | first4 = JF. | title = [Obesity and urogynecology: a systematic review]. | journal = Prog Urol | volume = 22 | issue = 8 | pages = 445-53 | month = Jul | year = 2012 | doi = 10.1016/j.purol.2012.03.009 | PMID = 22732579 }}</ref>
 
==Gross==
*Long cervix.
 
==Microscopic==
Features:
*Uterus: non-specific.
*Vaginal mucosa: (focal) keratinization due to rubbing - '''common finding'''.
 
Note:
*Benign stromal atypia may be seen.<ref name=pmid10680891>{{Cite journal  | last1 = Nucci | first1 = MR. | last2 = Young | first2 = RH. | last3 = Fletcher | first3 = CD. | title = Cellular pseudosarcomatous fibroepithelial stromal polyps of the lower female genital tract: an underrecognized lesion often misdiagnosed as sarcoma. | journal = Am J Surg Pathol | volume = 24 | issue = 2 | pages = 231-40 | month = Feb | year = 2000 | doi =  | PMID = 10680891 }}</ref><ref>{{Cite journal | last1 =  Rodrigues | first1 = MI ''et al.'' | last2 =  | first2 = | title = Atypical stromal cells as a diagnostic pitfall in lesions of the lower
female genital tract and uterus: a review and presentation of some unusual cases | journal = Patología | volume = 47 | issue = 2 | pages = 103-7 | month = April-June | year = 2009 | doi = | PMID = | PMC = | url = http://www.medigraphic.com/pdfs/patrevlat/rlp-2009/rlp092e.pdf }}</ref>
 
===Images===
<gallery>
Image: Keratinized cervix -- intermed mag.jpg | Keratinized cervix - intermed. mag. (WC)
Image: Keratinized cervix -- high mag.jpg | Keratinized cervix - high mag. (WC)
Image: Keratinized cervix -- very high mag.jpg | Keratinized cervix - very high mag. (WC)
</gallery>
 
==Sign out==
<pre>
Uterus, Cervix and Vagina Mucosa, Total Hysterectomy:
- Uterine cervix with focal keratinization, otherwise within normal limits.
- Inactive endometrium.
- Squamous mucosa with keratinization, consistent with prolapse-associated
  changes in the vagina.
- Medial calcific sclerosis.
- Atherosclerosis, moderate-to-severe.
- NEGATIVE for malignancy.
</pre>
 
<pre>
Submitted as "Uterine Cervix", Excision:
- Squamous mucosa with hyperplasia, parakeratosis, and stromal atypia, see comment.
- NEGATIVE for dysplasia and NEGATIVE for evidence of malignancy.
 
Comment:
The stromal atypia is favoured to be benign change, as it is without significant proliferation,
not mass forming and near the stromal-epithelial interface.
 
The stromal cells stain as follows:
POSITIVE: vimentin, ER.
NEGATIVE: AE1/AE3, CD10.
PROLIFERATION (Ki-67): <1%.
</pre>
 
===Block letters===
<pre>
UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
- UTERINE CERVIX WITH FOCAL KERATINIZATION OTHERWISE WITHIN NORMAL LIMITS.
- NONPROLIFERATIVE ENDOMETRIUM.
</pre>
 
<pre>
UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
- UTERINE CERVIX WITH KERATINIZATION, OTHERWISE WITHIN NORMAL LIMITS.
- CYSTIC NONPROLIFERATIVE ENDOMETRIUM.
- UTERINE SMOOTH MUSCLE AND SEROSA WITHIN NORMAL LIMITS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
===Denudated exocervix===
<pre>
UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
- UTERINE CERVIX WITH MILD CHRONIC INFLAMMATION AND EXOCERVICAL DENUDATION,
  NO EVIDENCE OF DYSPLASIA.
- CYSTIC NONPROLIFERATIVE ENDOMETRIUM.
- UTERINE CORPUS WITH BENIGN HYALINIZED NODULE.
- NEGATIVE FOR MALIGNANCY.
 
COMMENT:
Levels were cut on the uterine cervix sections (A1 and A2).
</pre>
 
===Focal ulceration===
<pre>
- UTERINE CERVIX WITH PARAKERATOSIS, ACANTHOSIS, CHRONIC INFLAMMATION, AND FOCAL
  ULCERATION ASSOCIATED WITH GRANULATION TISSUE FORMATION.
- PARTIALLY CYSTIC NONPROLIFERATIVE ENDOMETRIUM.
- UTERINE CORPUS WITH LEIOMYOMA.
- NO EVIDENCE OF DYSPLASIA.
- NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
===With endometrial polyp===
<pre>
UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
- BENIGN ENDOMETRIAL POLYP WITH NONPROLIFERATIVE ENDOMETRIAL GLANDS.
- UTERINE CERVIX WITH MILD CHRONIC INFLAMMATION AND FOCAL EXOCERVICAL DENUDATION,
  NO EVIDENCE OF DYSPLASIA.
- VERY WEAKLY PROLIFERATIVE ENDOMETRIUM, MOSTLY ATROPHIC APPEARING, NEGATIVE FOR
  ENDOMETRIAL HYPERPLASIA.
- UTERINE CORPUS WITHIN NORMAL LIMITS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
==See also==
*[[Uterus]].
*[[Prolapse]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Gynecologic pathology]]

Latest revision as of 19:10, 8 July 2016

Uterine prolapse is a frequent benign pathology of the uterus and a common reason for hysterectomy.

General

  • Clinical diagnosis.
  • A common indication for a total hysterectomy.
  • Hysterectomy specimen usually comes with some vaginal mucosa.
  • Parous women, usually menopausal.[1]
  • Possibly obesity - studies vary.[2]

Gross

  • Long cervix.

Microscopic

Features:

  • Uterus: non-specific.
  • Vaginal mucosa: (focal) keratinization due to rubbing - common finding.

Note:

  • Benign stromal atypia may be seen.[3][4]

Images

  • Keratinized cervix - intermed. mag. (WC)

  • Keratinized cervix - high mag. (WC)

  • Keratinized cervix - very high mag. (WC)

Sign out

Uterus, Cervix and Vagina Mucosa, Total Hysterectomy:
	- Uterine cervix with focal keratinization, otherwise within normal limits.
	- Inactive endometrium.
	- Squamous mucosa with keratinization, consistent with prolapse-associated 
	  changes in the vagina.
	- Medial calcific sclerosis.
	- Atherosclerosis, moderate-to-severe.
	- NEGATIVE for malignancy.

Submitted as "Uterine Cervix", Excision:
- Squamous mucosa with hyperplasia, parakeratosis, and stromal atypia, see comment.
- NEGATIVE for dysplasia and NEGATIVE for evidence of malignancy. 

Comment:
The stromal atypia is favoured to be benign change, as it is without significant proliferation, 
not mass forming and near the stromal-epithelial interface. 

The stromal cells stain as follows:
POSITIVE: vimentin, ER.
NEGATIVE: AE1/AE3, CD10.
PROLIFERATION (Ki-67): <1%.

Block letters

UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
- UTERINE CERVIX WITH FOCAL KERATINIZATION OTHERWISE WITHIN NORMAL LIMITS.
- NONPROLIFERATIVE ENDOMETRIUM.

UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
- UTERINE CERVIX WITH KERATINIZATION, OTHERWISE WITHIN NORMAL LIMITS.
- CYSTIC NONPROLIFERATIVE ENDOMETRIUM.
- UTERINE SMOOTH MUSCLE AND SEROSA WITHIN NORMAL LIMITS.
- NEGATIVE FOR MALIGNANCY.

Denudated exocervix

UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
- UTERINE CERVIX WITH MILD CHRONIC INFLAMMATION AND EXOCERVICAL DENUDATION,
  NO EVIDENCE OF DYSPLASIA.
- CYSTIC NONPROLIFERATIVE ENDOMETRIUM.
- UTERINE CORPUS WITH BENIGN HYALINIZED NODULE.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
Levels were cut on the uterine cervix sections (A1 and A2).

Focal ulceration

- UTERINE CERVIX WITH PARAKERATOSIS, ACANTHOSIS, CHRONIC INFLAMMATION, AND FOCAL
  ULCERATION ASSOCIATED WITH GRANULATION TISSUE FORMATION.
- PARTIALLY CYSTIC NONPROLIFERATIVE ENDOMETRIUM.
- UTERINE CORPUS WITH LEIOMYOMA.
- NO EVIDENCE OF DYSPLASIA.
- NEGATIVE FOR HYPERPLASIA AND NEGATIVE FOR MALIGNANCY.

With endometrial polyp

UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
- BENIGN ENDOMETRIAL POLYP WITH NONPROLIFERATIVE ENDOMETRIAL GLANDS.
- UTERINE CERVIX WITH MILD CHRONIC INFLAMMATION AND FOCAL EXOCERVICAL DENUDATION,
  NO EVIDENCE OF DYSPLASIA.
- VERY WEAKLY PROLIFERATIVE ENDOMETRIUM, MOSTLY ATROPHIC APPEARING, NEGATIVE FOR
  ENDOMETRIAL HYPERPLASIA.
- UTERINE CORPUS WITHIN NORMAL LIMITS.
- NEGATIVE FOR MALIGNANCY.

See also

References

  1. ↑ Mladenović-Segedi, L.; Segedi, D.. "[Most important etiologic factors in the development of genital prolapse].". Srp Arh Celok Lek 138 (5-6): 315-8. PMID 20607975.
  2. ↑ Thubert, T.; Deffieux, X.; Letouzey, V.; Hermieu, JF. (Jul 2012). "[Obesity and urogynecology: a systematic review].". Prog Urol 22 (8): 445-53. doi:10.1016/j.purol.2012.03.009. PMID 22732579.
  3. ↑ Nucci, MR.; Young, RH.; Fletcher, CD. (Feb 2000). "Cellular pseudosarcomatous fibroepithelial stromal polyps of the lower female genital tract: an underrecognized lesion often misdiagnosed as sarcoma.". Am J Surg Pathol 24 (2): 231-40. PMID 10680891.
  4. ↑ Rodrigues, MI et al. (April-June 2009). [http://www.medigraphic.com/pdfs/patrevlat/rlp-2009/rlp092e.pdf "Atypical stromal cells as a diagnostic pitfall in lesions of the lower female genital tract and uterus: a review and presentation of some unusual cases"]. Patología 47 (2): 103-7. http://www.medigraphic.com/pdfs/patrevlat/rlp-2009/rlp092e.pdf.
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