Difference between revisions of "Uterus"

Jump to navigation Jump to search

Uterus (view source)

Revision as of 19:33, 6 June 2018

2,689 bytes added ,  19:33, 6 June 2018
→‎BRCA carrier
 
(37 intermediate revisions by the same user not shown)
Line 11: Line 11:
**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.
**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.
Line 19: Line 24:
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>
==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=
=Tumours of the corpus=
Line 65: Line 102:
==Uterine adenomyosis==
==Uterine adenomyosis==
*[[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.
 
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]].


==Uterine prolapse==
==Uterine prolapse==
:''Urogenital prolapse'' redirects here.
:''Urogenital prolapse'' redirects here.
{{main|Uterine prolapse}}
==Dysfunctional uterine bleeding==
*Abbreviated ''DUB''.
===General===
===General===
*'''Clinical diagnosis'''.
*Clinical diagnosis based on negative pathology - specifically a negative [[endometrium|endometrial biopsy]].
*A common indication for a total hysterectomy. 
*Hysterectomy specimen usually comes with some [[vagina]]l mucosa.


===Gross===
Clinical:
*Long cervix.
*[[Menorrhagia]].


===Microscopic===
===Microscopic===
Features:
Features:
*Uterus: non-specific.
*Endometrium within normal limits - see [[proliferative phase endometrium]] and [[secretory phase endometrium]].
*Vaginal mucosa: (focal) keratinization due to rubbing - '''common finding'''.


===Sign out===
===Sign out===
<pre>
<pre>
UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
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.
- UTERINE CERVIX WITHIN NORMAL LIMITS.
- WEAKLY PROLIFERATIVE ENDOMETRIUM.
- PROLIFERATIVE PHASE ENDOMETRIUM WITH FOCAL FIBROSIS, COMPATIBLE WITH PRIOR ABLATION.
- UTERINE ADENOMYOSIS.
- UTERINE LEIOMYOMAS.
- BILATERAL UTERINE TUBES WITHOUT SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR MALIGNANCY.
</pre>
</pre>


==Dysfunctional uterine bleeding==
==BRCA carrier==
*Abbreviated ''DUB''.
===General===
===General===
*Clinical diagnosis based on negative pathology - specifically a negative [[endometrium|endometrial biopsy]].
*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===
===Microscopic===
Features:
 
*Endometrium within normal limits - see [[proliferative phase endometrium]] and [[secretory phase endometrium]].
DDx:
*Early [[serous carcinoma]] of the fallopian tube or ovary.
*[[STIC]].
 
===IHC===
*p53 -ve.
*p16 -ve.
*Ki-67 low.


===Sign out===
===Sign out===
<pre>
<pre>
A. OMENTUM, BIOPSY:
Uterus, Cervix, Fallopian Tubes and Ovaries, Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy:
- FIBROADIPOSE TISSUE WITHIN NORMAL LIMITS -- CONSISTENT WITH OMENTUM.
    - Uterus with fibrous serosal adhesions.
 
    - Cervix within normal limits.
B. UTERUS, SUBTOTAL HYSTERECTOMY:
    - Atherosclerosis, moderate.
- SECRETORY PHASE ENDOMETRIUM.
    - Inactive endometrium with cystic changes.
- NEGATIVE FOR ADENOMYOSIS.
    - Uterine adenomyosis.
- NEGATIVE FOR LEIOMYOMATA.
    - Fallopian tubes within normal limits.
    - Ovaries with benign cysts.
    - NEGATIVE for malignancy.
</pre>
</pre>


Michael
48,466

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/19247...49080"

Navigation menu