Uterus

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.
  • Indication: uterine leiomyomas.
• Subtotal hysterectomy.
  • Discouraged... as the cervix remains and can develop a cancer.
• Total hysterectomy.
  • Indications: endometrial cancer (low stage, good histologic type), endometrial hyperplasia, uterine prolapse, uterine adenomyosis, uterine leiomyomas.
• Radical hysterectomy - total hysterectomy + parametrial tissue.
  • 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.

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

Features:

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

Treatment:

• Uterine transplant - attempted.

Uterus didelphys

General

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

• Schematic of uterine abnormalities (msdlatinamerica.com).

Gross

• Two uteri - each have a cervix, each connect to one fallopian tube/ovary.
• +/-Vaginal septum or double vagina.

Microscopic

• Non-specific - gross diagnosis.

Uterine adenomyosis

• AKA adenomyosis of the uterus.

General

• Common.
• May be a cause of bleeding.
• Dysmenorrhea - painful menses.
• Associated with endometriosis.^{[citation needed]}

Gross

Features:

• Trabeculated cut surface +/- small foci of hemorrhage.
  • Often described as "basket-weave" pattern.

Image:

• Uterine adenomyosis (flickr.com/infopathic).
• 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

Urogenital prolapse redirects here.

General

• Clinical diagnosis.
• A common indication for a total hysterectomy.
• Hysterectomy specimen usually comes with some vaginal mucosa.

Gross

• Long cervix.

Microscopic

Features:

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

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UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
- UTERINE CERVIX WITHIN NORMAL LIMITS.
- WEAKLY PROLIFERATIVE ENDOMETRIUM.
- UTERINE ADENOMYOSIS.

See also

• Gynecologic pathology.