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Other tumours are dealt with in [[uterine tumours]]. | Other tumours are dealt with in [[uterine tumours]]. | ||
=Operations= | |||
*Myomectomy. | |||
**Indication: [[uterine leiomyoma]]s. | |||
*Subtotal hysterectomy. | *Subtotal hysterectomy. | ||
**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: | **Indications: | ||
***Endometrial cancer (low stage, good histologic type), [[endometrial hyperplasia]]. | |||
***[[Uterine prolapse]]. | |||
***[[Uterine adenomyosis]]. | |||
***[[Uterine leiomyoma]]s. | |||
***Chronic pelvic pain.<ref name=pmid21508759>{{Cite journal | last1 = Lamvu | first1 = G. | title = Role of hysterectomy in the treatment of chronic pelvic pain. | journal = Obstet Gynecol | volume = 117 | issue = 5 | pages = 1175-8 | month = May | year = 2011 | doi = 10.1097/AOG.0b013e31821646e1 | PMID = 21508759 }}</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> | *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. | ||
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Notes: | Notes: | ||
*There are almost no quality of life differences between total & subtotal hysterectomy.<ref name=pmid12397189>{{Cite journal | last1 = Thakar | first1 = R. | last2 = Ayers | first2 = S. | last3 = Clarkson | first3 = P. | last4 = Stanton | first4 = S. | last5 = Manyonda | first5 = I. | title = Outcomes after total versus subtotal abdominal hysterectomy. | journal = N Engl J Med | volume = 347 | issue = 17 | pages = 1318-25 | month = Oct | year = 2002 | doi = 10.1056/NEJMoa013336 | PMID = 12397189 }}</ref> | *There are almost no quality of life differences between total & subtotal hysterectomy.<ref name=pmid12397189>{{Cite journal | last1 = Thakar | first1 = R. | last2 = Ayers | first2 = S. | last3 = Clarkson | first3 = P. | last4 = Stanton | first4 = S. | last5 = Manyonda | first5 = I. | title = Outcomes after total versus subtotal abdominal hysterectomy. | journal = N Engl J Med | volume = 347 | issue = 17 | pages = 1318-25 | month = Oct | year = 2002 | doi = 10.1056/NEJMoa013336 | PMID = 12397189 }}</ref> | ||
*''Simple hysterectomy'' is removal of the uterus and cervix;<ref>{{Cite journal | last1 = Somashekhar | first1 = SP. | last2 = Ashwin | first2 = KR. | title = Management of Early Stage Cervical Cancer. | journal = Rev Recent Clin Trials | volume = | issue = | pages = | month = Sep | year = 2015 | doi = | PMID = 26411950 }}</ref> it can be used as a synonym for ''total hysterectomy''.<ref>URL: [http://www.baymoon.com/~gyncancer/library/glossary/bldefhyster.htm http://www.baymoon.com/~gyncancer/library/glossary/bldefhyster.htm]. Accessed on: 8 October 2015.</ref> | |||
==Tumours of the corpus | ==Grossing hysterectomy specimens== | ||
*[[Hysterectomy for endometrial cancer grossing]]. | |||
*[[Hysterectomy for endometrial hyperplasia grossing]]. | |||
*[[Hysterectomy for fibroids grossing]]. | |||
===Hysterectomy specimens - orientation=== | |||
Orientation: | |||
*Less peritoneum on anterior (as the [[urinary bladder]] is there). | |||
**'''P'''osterior '''p'''eritoneal edge: '''p'''ointy (upside down triangle). | |||
***Anterior peritoneal edge: rounded/non-pointy. | |||
*Tubes on anterior-lateral aspect.<ref>{{Ref Lester3|425}}</ref> | |||
**Round ligaments posterior to tubes. | |||
=Normal uterine wall= | |||
===Gross=== | |||
*Firm. | |||
*Pear-shaped. | |||
**Not quite true -- it is usu. flattened at the anterior and posterior. | |||
Negatives: | |||
*No nodules. | |||
*No trabeculations. | |||
===Microsopic=== | |||
Features: | |||
*Smooth muscle arranged in fascicles. | |||
===IHC=== | |||
*ER +ve. | |||
*PR +ve. | |||
=Tumours of the corpus= | |||
{{Main|Uterine tumours}} | {{Main|Uterine tumours}} | ||
The most common is ''[[leiomyoma]]'' (uterine fibroids). | The most common is ''[[leiomyoma]]'' (uterine fibroids). | ||
=Endometrium= | |||
{{Main|Endometrium}} | {{Main|Endometrium}} | ||
Dealt with in ''[[endometrium]]'', ''[[endometrial hyperplasia]]'' and ''[[endometrial carcinoma]]'' articles. | Dealt with in ''[[endometrium]]'', ''[[endometrial hyperplasia]]'' and ''[[endometrial carcinoma]]'' articles. | ||
==Congenital absence== | =Specific conditions= | ||
*Often | ==Congenital absence of the uterus== | ||
* | ===General=== | ||
*Often associated with absence of the deep portion of the vagina; thus, may be ''congenital absence of the uterus and vagina'' (CAUV). | |||
*May go by the name ''Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome''.<ref name=pmc1832178>URL: [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1832178/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1832178/].</ref> | |||
*May be seen in the context of ''Müllerian agenesis''. (???) | |||
Features:<ref name=pmc1832178/> | Features:<ref name=pmc1832178/> | ||
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Treatment: | Treatment: | ||
*Uterine transplant - attempted.<ref>URL: [http://singularityhub.com/2011/06/18/in-a-medical-first-infertile-daughter-will-receive-uterus-from-mother-video/ http://singularityhub.com/2011/06/18/in-a-medical-first-infertile-daughter-will-receive-uterus-from-mother-video/]. Accessed on: 17 June 2011.</ref> | *Uterine transplant - attempted.<ref>URL: [http://singularityhub.com/2011/06/18/in-a-medical-first-infertile-daughter-will-receive-uterus-from-mother-video/ http://singularityhub.com/2011/06/18/in-a-medical-first-infertile-daughter-will-receive-uterus-from-mother-video/]. Accessed on: 17 June 2011.</ref> | ||
==Uterus didelphys== | |||
===General=== | |||
*Benign - though may adversely affect fertility.<ref name=pmid18155200>{{Cite journal | last1 = Taylor | first1 = E. | last2 = Gomel | first2 = V. | title = The uterus and fertility. | journal = Fertil Steril | volume = 89 | issue = 1 | pages = 1-16 | month = Jan | year = 2008 | doi = 10.1016/j.fertnstert.2007.09.069 | PMID = 18155200 }}</ref> | |||
*Rare - seen in < 0.3% deliveries.<ref name=pmid6019679/> | |||
*Can be thought of as ''double uterus'' - a consequence of the Muellerian ducts '''not''' fusing. | |||
Related conditions: | |||
*Arcuate uterus - fundus has a concave contour towards the uterine cavity. | |||
*Septate uterus. | |||
*Bicornuate uterus. | |||
*Uterus didelphys. | |||
Image: | |||
*[http://www.msdlatinamerica.com/ebooks/RadiologyReviewManual/files/1de384e713476a71768c20e3b1f8c51b.gif Schematic of uterine abnormalities (msdlatinamerica.com)].<ref>URL: [http://www.msdlatinamerica.com/ebooks/RadiologyReviewManual/sid1652818.html http://www.msdlatinamerica.com/ebooks/RadiologyReviewManual/sid1652818.html]. Accessed on: 28 April 2012.</ref> | |||
===Gross=== | |||
*Two uteri - each have a cervix, each connect to one [[fallopian tube]]/[[ovary]]. | |||
*+/-Vaginal septum ''or'' double [[vagina]].<ref name=pmid6019679>{{Cite journal | last1 = Brown | first1 = DC. | last2 = Nelson | first2 = RF. | title = Uterus didelphys and double vagina with delivery of a normal infant from each uterus. | journal = Can Med Assoc J | volume = 96 | issue = 11 | pages = 675-7 | month = Mar | year = 1967 | doi = | PMID = 6019679 | PMC = 1936081}}</ref> | |||
===Microscopic=== | |||
*Non-specific - gross diagnosis. | |||
==Uterine adenomyosis== | ==Uterine adenomyosis== | ||
*[[AKA]] ''adenomyosis of the uterus''. | |||
{{Main|Uterine adenomyosis}} | |||
==Uterine prolapse== | |||
:''Urogenital prolapse'' redirects here. | |||
{{main|Uterine prolapse}} | |||
==Dysfunctional uterine bleeding== | |||
*Abbreviated ''DUB''. | |||
===General=== | ===General=== | ||
* | *Clinical diagnosis based on negative pathology - specifically a negative [[endometrium|endometrial biopsy]]. | ||
* | |||
Clinical: | |||
*[[Menorrhagia]]. | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
* | *Endometrium within normal limits - see [[proliferative phase endometrium]] and [[secretory phase endometrium]]. | ||
===Sign out=== | |||
<pre> | |||
Uterus, Cervix, and Bilateral Uterine Tubes, Total Hysterectomy and Bilateral Salpingectomy: | |||
* | - Uterine cervix within normal limits. | ||
- Proliferative phase endometrium with focal fibrosis, compatible with prior ablation. | |||
- Uterine leiomyomas. | |||
- Bilateral uterine tubes without significant pathology. | |||
- NEGATIVE for malignancy. | |||
</pre> | |||
====Block letters==== | |||
<pre> | |||
A. OMENTUM, BIOPSY: | |||
- FIBROADIPOSE TISSUE WITHIN NORMAL LIMITS -- CONSISTENT WITH OMENTUM. | |||
B. UTERUS, SUBTOTAL HYSTERECTOMY: | |||
- SECRETORY PHASE ENDOMETRIUM. | |||
- UTERINE WALL WITHIN NORMAL LIMITS. | |||
</pre> | |||
<pre> | |||
UTERUS, CERVIX, AND BILATERAL UTERINE TUBES, TOTAL HYSTERECTOMY AND BILATERAL SALPINGECTOMY: | |||
- UTERINE CERVIX WITHIN NORMAL LIMITS. | |||
- PROLIFERATIVE PHASE ENDOMETRIUM WITH FOCAL FIBROSIS, COMPATIBLE WITH PRIOR ABLATION. | |||
- UTERINE LEIOMYOMAS. | |||
- BILATERAL UTERINE TUBES WITHOUT SIGNIFICANT PATHOLOGY. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
==BRCA carrier== | |||
===General=== | |||
*Prophylatic bilateral salpingo-oophorectomies (BSOs) done in [[BRCA1|BRCA carrier]]s to reduce risk of [[serous carcinoma]].<ref name=pmid27241111>{{Cite journal | last1 = Shaw | first1 = PA. | last2 = Clarke | first2 = BA. | title = Prophylactic Gynecologic Specimens from Hereditary Cancer Carriers. | journal = Surg Pathol Clin | volume = 9 | issue = 2 | pages = 307-28 | month = Jun | year = 2016 | doi = 10.1016/j.path.2016.02.002 | PMID = 27241111 }}</ref> | |||
Incidence of pathology in prophylatic BSOs in a series of 226 cases:<ref name=pmid22710074>{{Cite journal | last1 = Mingels | first1 = MJ. | last2 = Roelofsen | first2 = T. | last3 = van der Laak | first3 = JA. | last4 = de Hullu | first4 = JA. | last5 = van Ham | first5 = MA. | last6 = Massuger | first6 = LF. | last7 = Bulten | first7 = J. | last8 = Bol | first8 = M. | title = Tubal epithelial lesions in salpingo-oophorectomy specimens of BRCA-mutation carriers and controls. | journal = Gynecol Oncol | volume = 127 | issue = 1 | pages = 88-93 | month = Oct | year = 2012 | doi = 10.1016/j.ygyno.2012.06.015 | PMID = 22710074 }}</ref> | |||
* | *Invasive carcinoma ~ 0.9%. | ||
*STIC ~ 6.2% | |||
===Grossing=== | |||
*In prophylatic procedures, the ovaries and tubes, endometrium, and lower uterine segment should all be [[submitted in total]].<ref name=pmid24495259>{{Cite journal | last1 = Downes | first1 = MR. | last2 = Allo | first2 = G. | last3 = McCluggage | first3 = WG. | last4 = Sy | first4 = K. | last5 = Ferguson | first5 = SE. | last6 = Aronson | first6 = M. | last7 = Pollett | first7 = A. | last8 = Gallinger | first8 = S. | last9 = Bilbily | first9 = E. | title = Review of findings in prophylactic gynaecological specimens in Lynch syndrome with literature review and recommendations for grossing. | journal = Histopathology | volume = 65 | issue = 2 | pages = 228-39 | month = Aug | year = 2014 | doi = 10.1111/his.12386 | PMID = 24495259 }}</ref> | |||
===Microscopic=== | |||
DDx: | DDx: | ||
*[[ | *Early [[serous carcinoma]] of the fallopian tube or ovary. | ||
*[[STIC]]. | |||
===IHC=== | |||
*p53 -ve. | |||
*p16 -ve. | |||
*Ki-67 low. | |||
===Sign out=== | |||
<pre> | |||
Uterus, Cervix, Fallopian Tubes and Ovaries, Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy: | |||
- Uterus with fibrous serosal adhesions. | |||
- Cervix within normal limits. | |||
- Atherosclerosis, moderate. | |||
- Inactive endometrium with cystic changes. | |||
- Uterine adenomyosis. | |||
- Fallopian tubes within normal limits. | |||
- Ovaries with benign cysts. | |||
- NEGATIVE for malignancy. | |||
</pre> | |||
=See also= | |||
*[[Gynecologic pathology]]. | *[[Gynecologic pathology]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gynecologic pathology]] | [[Category:Gynecologic pathology]] |
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