Difference between revisions of "Uterus"

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Uterus (view source)

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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>
==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=
=Normal uterine wall=
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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==
:''Urogenital prolapse'' redirects here.
:''Urogenital prolapse'' redirects here.
===General===
{{main|Uterine prolapse}}
*'''[[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'''.
 
====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 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>


==Dysfunctional uterine bleeding==
==Dysfunctional uterine bleeding==
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===Sign out===
===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>
<pre>
A. OMENTUM, BIOPSY:
A. OMENTUM, BIOPSY:
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- BILATERAL UTERINE TUBES WITHOUT SIGNIFICANT PATHOLOGY.
- BILATERAL UTERINE TUBES WITHOUT SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR MALIGNANCY.
- 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:
*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>
</pre>


Michael
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