Uterine prolapse

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Uterine prolapse is a frequent benign pathology of the uterus and a common reason for hysterectomy.

General

  • Clinical diagnosis.
  • A common indication for a total hysterectomy.
  • Hysterectomy specimen usually comes with some vaginal mucosa.
  • Parous women, usually menopausal.[1]
  • Possibly obesity - studies vary.[2]

Gross

  • Long cervix.

Microscopic

Features:

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

Note:

  • Benign stromal atypia may be seen.[3][4]

Images

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Uterus, Cervix and Vagina Mucosa, Total Hysterectomy:
	- Uterine cervix with focal keratinization, otherwise within normal limits.
	- Inactive endometrium.
	- Squamous mucosa with keratinization, consistent with prolapse-associated 
	  changes in the vagina.
	- Medial calcific sclerosis.
	- Atherosclerosis, moderate-to-severe.
	- NEGATIVE for malignancy.
Submitted as "Uterine Cervix", Excision:
- Squamous mucosa with hyperplasia, parakeratosis, and stromal atypia, see comment.
- NEGATIVE for dysplasia and NEGATIVE for evidence of malignancy. 

Comment:
The stromal atypia is favoured to be benign change, as it is without significant proliferation, 
not mass forming and near the stromal-epithelial interface. 

The stromal cells stain as follows:
POSITIVE: vimentin, ER.
NEGATIVE: AE1/AE3, CD10.
PROLIFERATION (Ki-67): <1%.

Block letters

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.

See also

References

  1. 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.
  2. 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.
  3. Nucci, MR.; Young, RH.; Fletcher, CD. (Feb 2000). "Cellular pseudosarcomatous fibroepithelial stromal polyps of the lower female genital tract: an underrecognized lesion often misdiagnosed as sarcoma.". Am J Surg Pathol 24 (2): 231-40. PMID 10680891.
  4. Rodrigues, MI et al. (April-June 2009). [http://www.medigraphic.com/pdfs/patrevlat/rlp-2009/rlp092e.pdf "Atypical stromal cells as a diagnostic pitfall in lesions of the lower female genital tract and uterus: a review and presentation of some unusual cases"]. Patología 47 (2): 103-7. http://www.medigraphic.com/pdfs/patrevlat/rlp-2009/rlp092e.pdf.