Uterus Pathology

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Segments of uterus

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cerix; lower uterine segment; body (corpus)

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Embryonic origin of body of uterus

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fusion of mullerian ducts in sixth week

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excessive menstrual bleeding

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Menorrhagia bleeding between menses Metrorrhagia

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too much bleeding & bleeding between menses

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menometrorrhagia

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cause of abnormal uterine bleeding in prepubertal

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precociaius puberty (hypothalamus, pituitary, ovarian origin)

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cause of abnormal uternine bleeding in adolescence

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anovulatory cycle

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abnormal uterine bleeding in reproductive age

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complication of pregnancy; anovulatory cycle; luteal phase defect; anatomic lesions (polyps; chronic endometritis; adenomyosis; leiomyoma; hyperplasia; carcinoma – uncommon)

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abnormal uterine bleeding perimenopausal

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anovulatory cycle; irregular shedding; anatomic lesions (hyperplasia, carcinoma, polyps)

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abnormal uterine bleeding in postemenopause

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atrophy; anatomic lesions (hyperplasia; carcinoma; polyps)

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dysfunctional uterine bleeding

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functional /hormonal disorders causing abnormal uterine bleeding, particularly in reproductive and perimenopausal. Non neoplastic or pre neoplastic

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most common cause of dysfunctional uterine bleeding

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anovulatory cycle

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pathogenesis excess bleeding from anovulatory cycle

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in absence of ovulation no corpus luteum and endometrium subject to ‘unopposed’ estrogen and no development of secretory pattern

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luteal phase defect

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deficient ovarian corpus luteum function; low progesterone; often abnormal bleeding and infertility; delayed endometrium post ovulatory chronological state

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endometritis

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bacterial infection of endometrium

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acute endometritis

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uncommon, associated with retained degenerating tissue after miscarriage or delivery; polymicrobial; may progress to PID (puerperal fever; semmelweiss, etc)

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Chronic endometritis

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usually associated with pelvic inflammatory disease, also affecting fallopian tubes and ovaries; Chlamydia common agent. Also associated with retained gestation tissues; or intrauterine contraception

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Signs and symptoms of chronic endometritis

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abnormal bleeding; pain; discharge; infertility; biopsy shows abnormal proliferative phase pattern; PLASMA CELLS and other chronic inflammation

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Anatomic non neoplastic lesions of uterus

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endometritis; polyps; adenomyosis

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endometrial polyps

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occur in middle aged and older women; non neoplastic overgrowths of endometrium; usually posterior wall; can cause abnormal bleeding; estrogen responsive; can be seen w/ tamoxifen therapy; adenocarcinoma may arise within polyp

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Adenomyosis

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presence of endometrial glands and stroma within myometrium

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Gross features adenomyosis

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diffuse enlargement of uterus; +/- extreme thickening of myometrium; cystic spaces possible

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Microscopic features adenomyosis

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endometrial glands and or stroma in myometrium; separate from true endometrial basalis by 2-3 mm

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Epidemiology adenomyosis

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perimenopausal womaen; seen in 15% surg path uteri; less likely symptomatic than endometriosis; pain and abnormal bleeding

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Endometrial hyperplasia

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increased gland to stromal ration; too many glands

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Epidemiology/etiology of endometrial hyperplasia

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related to prolonged exposure to estrogen in absence of progesterone (unopposed estrogen); most commonly in perimenopausal women; women with increased estrogen

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Classification of endometrial hyperplasia

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based on architecture of glands (simple vs complex); cytological features of epithelia cells (no atypia vs atypia)

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appearance of endometrial hyperplasia with simple architecture

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glands with tubular configuration and circular outlines, similar to normal endometrium

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endometrial hyperplasia with cytologic atypia appearance

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nuclear stratification with loss of nuclear polarity, increase in nucleus to cytoplasm, hyperchromasia, prominent nucleoi, increased mitotic figures

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precursor to endometroid adenocarcinoma, 23%

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atypical endometrial hyperplasia

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histological spectrum of complex atypical hyperplasia to what

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low grade endometroid adenocarcinoma, hinges on presence or absence of stromal invasion, which may be subtle

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endometrial adenocarcinoma risk factors, age

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peri and post menopausal, obesity, diabetes, hypertension, inifertility, decreased w/ smoking, wtf

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endometrioid adenocarcinoma pathogenesis

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increased estrogen, obesity, anovulation, PCOD, hormonally active tumors, tamoxife therapyu

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gross appearance endometrioid adenocarcinoma

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localized polypoioid masses or diffuse lesions replacing endometrial surface

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histo appearance endometrioid adenocarnicoma

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glands lined by stratified columnar cytologically malignant cells that invade endometrial stroma. glands contain central areas of squamous metaplasia, spread by invading myometrium and extending into the pelvis, late lymphovascular dissemination

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serous adenoacarcinoma of uterus

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less common type of adenocarcinom a (vis a vis endometrioid) occurs in elderyly, not assoc with hyper estrogen, p53 mutasions, high grade, nasty

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Malignant mixed mullerian tumor

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highly aggressive, malignant epithelial and mesenchymal elements, aka carcinosarcoma, differentiation toward elements found in uterus or other elements (heterologous)

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malignant mixed mullerian tumor age, presentation

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elderly patients, postmenopausal bleeding, mass originating from uterine funddus

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endometrial stromal tumor types

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stromal nodule and endometrial stromalsarcoma

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Types of molar pregnancy

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complete mole; fertilization of empty egg; partial mole from fertilization of normal egg by two sperm