Difference between revisions of "Uterus"

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==Uterine adenomyosis==
==Uterine adenomyosis==
:''Uterine adenomyoma'' redirects here.
*[[AKA]] ''adenomyosis of the uterus''.
*[[AKA]] ''adenomyosis of the uterus''.
===General===
{{Main|Uterine adenomyosis}}
*Common.
*May be a cause of bleeding.<ref>{{Cite journal  | last1 = Reinhold | first1 = C. | last2 = Tafazoli | first2 = F. | last3 = Mehio | first3 = A. | last4 = Wang | first4 = L. | last5 = Atri | first5 = M. | last6 = Siegelman | first6 = ES. | last7 = Rohoman | first7 = L. | title = Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. | journal = Radiographics | volume = 19 Spec No | issue =  | pages = S147-60 | month = Oct | year = 1999 | doi =  | PMID = 10517451 | URL = http://radiographics.rsna.org/content/19/suppl_1/S147.full }}</ref>
*Dysmenorrhea - painful menses.<ref name=pmid22594861>{{Cite journal  | last1 = Cockerham | first1 = AZ. | title = Adenomyosis: a challenge in clinical gynecology. | journal = J Midwifery Womens Health | volume = 57 | issue = 3 | pages = 212-20 | month =  | year =  | doi = 10.1111/j.1542-2011.2011.00117.x | PMID = 22594861 }}</ref>
*Associated with [[endometriosis]].{{fact}}
 
===Gross===
Features:
*Trabeculated cut surface +/- small foci of hemorrhage.<ref name=Ref_Lester3_432>{{Ref Lester3|432}}</ref>
**Often described as "basket-weave" pattern.
*Globoid, slightly enlarged.<ref name=pmid20291238>{{Cite journal  | last1 = HUNTER | first1 = WC. | last2 = SMITH | first2 = LL. | last3 = REINER | first3 = WC. | title = Uterine adenomyosis; incidence, symptoms, and pathology in 1,856 hysterectomies. | journal = Am J Obstet Gynecol | volume = 53 | issue = 4 | pages = 663-8 | month = Apr | year = 1947 | doi =  | PMID = 20291238 | URL = http://journals.lww.com/obgynsurvey/Citation/1947/10000/The_Uterus__Uterine_Adenomyosis__Incidence,.61.aspx }}</ref>
 
Note:
*May form a mass - known as ''[[adenomyoma]]''.<ref name=pmid16990713>{{Cite journal  | last1 = Tahlan | first1 = A. | last2 = Nanda | first2 = A. | last3 = Mohan | first3 = H. | title = Uterine adenomyoma: a clinicopathologic review of 26 cases and a review of the literature. | journal = Int J Gynecol Pathol | volume = 25 | issue = 4 | pages = 361-5 | month = Oct | year = 2006 | doi = 10.1097/01.pgp.0000209570.08716.b3 | PMID = 16990713 }}
</ref>
 
Image:
*[http://www.flickr.com/photos/34342634@N02/5036818444/ Uterine adenomyosis (flickr.com/infopathic)].
*[http://www.flickr.com/photos/34342634@N02/5036818516/ Uterine adenomyosis - close-up (flickr.com/infopathic)].
 
===Microscopic===
Features:
*Endometrial glands within uterine muscle - '''key feature'''.
**Endometrial glands:
***Circular.
***Simple epithelial or pseudostratified epithelium +/- mitoses.
**+/-Surrounded by endometrial stroma.
***Densely packed spindle cells without [[nuclear atypia]].
**Blood:
***Within glands.
***Hemosiderin-laden macrophages.
 
Note:
*Can be thought of as [[endometriosis]] of the myometrium.
 
DDx:
*[[Endometrioid endometrial carcinoma]].
 
===Sign out===
<pre>
UTERUS, UTERINE CERVIX, TOTAL HYSTERECTOMY:
- UTERUS WITH ADENOMYOSIS.
- UTERINE CERVIX WITHIN NORMAL LIMITS.
- PROLIFERATIVE PHASE ENDOMETRIUM.
</pre>
 
<pre>
UTERUS, UTERINE CERVIX, TOTAL HYSTERECTOMY:
- UTERUS WITH SUPERFICIAL ADENOMYOSIS.
- UTERINE CERVIX WITH PARTIAL DENUDATION, FOCUS OF ENDOMETRIOSIS AND INFLAMMATION,
  OTHERWISE WITHIN NORMAL LIMITS.
- SUPERFICIAL FIBROSIS AND HYALINE CHANGE OF THE UTERINE LINING -- COMPATIBLE
  WITH PRIOR ABLATION.
</pre>


==Uterine prolapse==
==Uterine prolapse==

Revision as of 03:15, 7 March 2014

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

  • Myomectomy.
  • Subtotal hysterectomy.
    • Discouraged... as the cervix remains and can develop a cancer.
  • Total hysterectomy.
  • Radical hysterectomy - total hysterectomy + parametrial tissue.[2]
    • 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.[3]

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 article: Uterine tumours

The most common is leiomyoma (uterine fibroids).

Endometrium

Main article: Endometrium

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

Specific conditions

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.[4]
  • May be seen in the context of Müllerian agenesis. (???)

Features:[4]

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

Treatment:

  • Uterine transplant - attempted.[5]

Uterus didelphys

General

  • Benign - though may adversely affect fertility.[6]
  • Rare - seen in < 0.3% deliveries.[7]
  • 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:

Gross

Microscopic

  • Non-specific - gross diagnosis.

Uterine adenomyosis

  • AKA adenomyosis of the uterus.
Main article: Uterine adenomyosis

Uterine prolapse

Urogenital prolapse redirects here.

General

  • Clinical diagnosis.
  • A common indication for a total hysterectomy.
  • Hysterectomy specimen usually comes with some vaginal mucosa.
  • Parous women, usually menopausal.[9]
  • Possibly obesity - studies vary.[10]

Gross

  • Long cervix.

Microscopic

Features:

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

Images

  • Keratinized cervix - intermed. mag. (WC)

  • Keratinized cervix - high mag. (WC)

  • Keratinized cervix - very high mag. (WC)

Sign out

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.

Dysfunctional uterine bleeding

  • Abbreviated DUB.

General

  • Clinical diagnosis based on negative pathology - specifically a negative endometrial biopsy.

Clinical:

Microscopic

Features:

Sign out

A. OMENTUM, BIOPSY:
- FIBROADIPOSE TISSUE WITHIN NORMAL LIMITS -- CONSISTENT WITH OMENTUM.

B. UTERUS, SUBTOTAL HYSTERECTOMY:
- SECRETORY PHASE ENDOMETRIUM.
- UTERINE WALL WITHIN NORMAL LIMITS.

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.

See also

References

  1. ↑ Lamvu, G. (May 2011). "Role of hysterectomy in the treatment of chronic pelvic pain.". Obstet Gynecol 117 (5): 1175-8. doi:10.1097/AOG.0b013e31821646e1. PMID 21508759.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 4.0 4.1 URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1832178/.
  5. ↑ URL: http://singularityhub.com/2011/06/18/in-a-medical-first-infertile-daughter-will-receive-uterus-from-mother-video/. Accessed on: 17 June 2011.
  6. ↑ Taylor, E.; Gomel, V. (Jan 2008). "The uterus and fertility.". Fertil Steril 89 (1): 1-16. doi:10.1016/j.fertnstert.2007.09.069. PMID 18155200.
  7. ↑ 7.0 7.1 Brown, DC.; Nelson, RF. (Mar 1967). "Uterus didelphys and double vagina with delivery of a normal infant from each uterus.". Can Med Assoc J 96 (11): 675-7. PMC 1936081. PMID 6019679. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936081/.
  8. ↑ URL: http://www.msdlatinamerica.com/ebooks/RadiologyReviewManual/sid1652818.html. Accessed on: 28 April 2012.
  9. ↑ 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.
  10. ↑ 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.
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