UTERINE CORPUSUTERINE CORPUS

ACUTE ENDOMETRITISACUTE ENDOMETRITIS

• Is most often related to intrauterine Is most often related to intrauterine trauma from instrumentation, trauma from instrumentation, intrauterine contraceptive device or intrauterine contraceptive device or complications of pregnancy such as complications of pregnancy such as post partum retention of placental post partum retention of placental fragments.fragments.

• Is most often caused by staph aureus Is most often caused by staph aureus and streptococcus.and streptococcus.

CHRONIC ENDOMETRITISCHRONIC ENDOMETRITIS

• Granulomatous endometritis is seen Granulomatous endometritis is seen in TB.in TB.

ENDOMETRIOSISENDOMETRIOSIS

• Is charcterized by the presence and Is charcterized by the presence and proliferation of ectopic endometrial tissue.proliferation of ectopic endometrial tissue.

• is non-neoplastic, not associated with is non-neoplastic, not associated with carcinoma. May cause infertility.carcinoma. May cause infertility.

• There is menstrual bleeding in the ectopic There is menstrual bleeding in the ectopic endometrium, resulting in blood filled endometrium, resulting in blood filled spaces (chocolate cyst).spaces (chocolate cyst).

• Sites: commonly in the pelvic area eg. Sites: commonly in the pelvic area eg. ovary, pelvic ligaments etc.ovary, pelvic ligaments etc.

AdenomyosisAdenomyosis

• Is characterized by islands of Is characterized by islands of endometrium in the myometrium of endometrium in the myometrium of uterus.uterus.

ENDOMETRIAL POLYPENDOMETRIAL POLYP

• Is a benign lesionIs a benign lesion

• Usually in females > 40yrsUsually in females > 40yrs

• May result in uterine bleeding.May result in uterine bleeding.

Endometrial HyperplasiaEndometrial Hyperplasia

Endometrial HyperplasiaEndometrial Hyperplasia

• Induced by Prolonged or marked excess Induced by Prolonged or marked excess of estrogen relative to progestin .of estrogen relative to progestin .

• Hyperplasia ranging from simple Hyperplasia ranging from simple hyperplasia to complex hyperplasia .hyperplasia to complex hyperplasia .

• Both are classified as with or without Both are classified as with or without atypia.atypia.

• Appears to be a continuum based on Appears to be a continuum based on the level and duration of the estrogen the level and duration of the estrogen excess. excess.

Endometrial HyperplasiaEndometrial Hyperplasia

• The endometrial hyperplasia may The endometrial hyperplasia may progress to endometrial carcinoma.progress to endometrial carcinoma.

• The development of cancer is based The development of cancer is based on the level and duration of the on the level and duration of the estrogen excess.estrogen excess.

• The risk is depending on the severity The risk is depending on the severity of the hyperplastic changes and of the hyperplastic changes and associated cellular atypia.associated cellular atypia.

Endometrial HyperplasiaEndometrial Hyperplasia

• Other potential factors include :Other potential factors include :- failure of ovulation failure of ovulation - prolonged administration of prolonged administration of

estrogenic steroids without counter estrogenic steroids without counter balancing progestinsbalancing progestins

- Polycystic ovaryPolycystic ovary- Cortical stromal hyperplasiaCortical stromal hyperplasia- Granulosa-Theca cell tumors. Granulosa-Theca cell tumors.

Endometrial HyperplasiaEndometrial Hyperplasia

• Milder forms of hyperplasia tends to occur in Milder forms of hyperplasia tends to occur in younger patients .younger patients .

• The great majority of mild hyperplasia The great majority of mild hyperplasia regress , either spontaneously or after regress , either spontaneously or after treatment .treatment .

• The more severe forms ,occur predominantly The more severe forms ,occur predominantly in peri- and postmenopausal women .in peri- and postmenopausal women .

• The last form has a significant premalignant The last form has a significant premalignant potential.potential.

Endometrial Endometrial Hyperplasia ,Clinical Hyperplasia ,Clinical

• Abnormal uterine bleeding .Abnormal uterine bleeding .

• The severity of bleeding is not The severity of bleeding is not necessarily proportional to that of necessarily proportional to that of the histologic changes.the histologic changes.

• Hyperplasia are uncommon in Hyperplasia are uncommon in asymptomatic women . asymptomatic women .

Endometrial Hyperplasia,Endometrial Hyperplasia,Risk FactorsRisk Factors

• ObesityObesity

• Western dietWestern diet

• NulliparityNulliparity

• Diabetes MellitusDiabetes Mellitus

• HypertensionHypertension

• HyperestrinismHyperestrinism

Macroscopic ,Endometrial Macroscopic ,Endometrial HyperplasiaHyperplasia

• Might be close to normal, or may Might be close to normal, or may show considerable thickening of either show considerable thickening of either the entire mucosa or focal regions.the entire mucosa or focal regions.

• When it is focal ,the lesion may When it is focal ,the lesion may acquire a polypoid aspect.acquire a polypoid aspect.

• The color is pale pink The color is pale pink • Curettage usually yields increased Curettage usually yields increased

amount of tissueamount of tissue

Endometrial Hyperplasia ,Endometrial Hyperplasia ,Risk for CancerRisk for Cancer

• Hyperplasia with nuclear atypia has Hyperplasia with nuclear atypia has

20-25 % progression to carcinoma20-25 % progression to carcinoma

• Hyperplasia without atypia has 3% Hyperplasia without atypia has 3% progression to carcinomaprogression to carcinoma

Endometrial Endometrial AdenocarcinomaAdenocarcinoma

• In the USA ,Endometrial Carcinoma is In the USA ,Endometrial Carcinoma is the most frequent cancer of the the most frequent cancer of the female genital tract.female genital tract.

• Before it was much less common Before it was much less common than than

cervical cancercervical cancer

Endometrial AdenocarcinomaEndometrial AdenocarcinomaEpidemiologyEpidemiology

• Most frequently between the ages of Most frequently between the ages of 55 and 6555 and 65

• Uncommon under 40 years of ageUncommon under 40 years of age

Endometrial Carcinoma ,Endometrial Carcinoma ,Risk FactorsRisk Factors

• ObesityObesity

• DiabetesDiabetes

• HypertensionHypertension

• Infertility ;single and nulliparous, and Infertility ;single and nulliparous, and non ovulatory cyclesnon ovulatory cycles

• Any factor increases the estrogen Any factor increases the estrogen stimulation.stimulation.

Endometrial CarcinomaEndometrial Carcinoma

• The majority of the cases arise on a The majority of the cases arise on a background of endometrial background of endometrial hyperplasiahyperplasia

• 20% of endometrial carcinoma there 20% of endometrial carcinoma there is no association with hyperestrinism is no association with hyperestrinism or preexisting hyperplasia ,these or preexisting hyperplasia ,these cancers tend to occur late in life and cancers tend to occur late in life and have a poor prognosis.have a poor prognosis.

Endometrial Adenocarcinoma,Endometrial Adenocarcinoma,MorphologyMorphology

• May closely resemble normal May closely resemble normal endometrium endometrium

• May be exophytic May be exophytic

• May be InfiltrativeMay be Infiltrative

• May be polypoidMay be polypoid

Endometrial Carcinoma ,Endometrial Carcinoma ,Grading and stagingGrading and staging

• Grading is from 1 to 3Grading is from 1 to 3

• Staging is from 1 to 4Staging is from 1 to 4

• Stage 1 : Confined to uterus corpusStage 1 : Confined to uterus corpus

• Stage 2 : Cervix involvementStage 2 : Cervix involvement

• Stage 3 : beyond the uterus ,but Stage 3 : beyond the uterus ,but within the true pelviswithin the true pelvis

• Stage 4 : Distant metastasis Stage 4 : Distant metastasis

Endometrial AdenocarcinomaEndometrial AdenocarcinomaClinical OutcomeClinical Outcome

• First signs are marked leukorrhea First signs are marked leukorrhea and irregular bleeding ,in a and irregular bleeding ,in a postmenopausal womanpostmenopausal woman

• This reflect erosion and ulceration of This reflect erosion and ulceration of the endometrial surfacethe endometrial surface

• In end stages the uterus might be In end stages the uterus might be palpated ,and in time it becomes palpated ,and in time it becomes fixed to surrounding structuresfixed to surrounding structures

Endometrial AdenocarcinomaEndometrial AdenocarcinomaSurvival ,5 yearSurvival ,5 year

• Stage 1: 95% Stage 1: 95%

• Stage 2 : 30-50 %Stage 2 : 30-50 %

• Stage 3 and 4 : less than 20%Stage 3 and 4 : less than 20%

LEIOMYOMA / FIBROIDSLEIOMYOMA / FIBROIDS

• Is the most common uterine tumor.Is the most common uterine tumor.

• It is a benign neoplasm. Can be multiple.It is a benign neoplasm. Can be multiple.

• Is estrogen sensitive. The tumor often Is estrogen sensitive. The tumor often increases in pregnancy and decreases increases in pregnancy and decreases following menopause.following menopause.

• Can be sub-endometrial, intramural or sub-Can be sub-endometrial, intramural or sub-serosal.serosal.

• Presents as menorrhagia, can cause Presents as menorrhagia, can cause infertility.infertility.

Figure 22-34 A, Leiomyomas of the myometrium. The uterus is opened to reveal the tumors bulging into the endometrial cavity and displaying a firm Figure 22-34 A, Leiomyomas of the myometrium. The uterus is opened to reveal the tumors bulging into the endometrial cavity and displaying a firm white appearance on sectioning. B, Leiomyoma showing well-differentiated, regular, spindle-shaped smooth muscle cells.white appearance on sectioning. B, Leiomyoma showing well-differentiated, regular, spindle-shaped smooth muscle cells.

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© 2007 Elsevier © 2007 Elsevier

LEIOMYOSARCOMALEIOMYOSARCOMA

• Malignant smooth muscle tumor.Malignant smooth muscle tumor.

• Arises denovo. Arises denovo.

• Is uncommon.Is uncommon.

Figure 22-35 Leiomyosarcoma. A, A large hemorrhagic tumor mass distends the lower corpus and is flanked by two leiomyomas. B, The tumor cells Figure 22-35 Leiomyosarcoma. A, A large hemorrhagic tumor mass distends the lower corpus and is flanked by two leiomyomas. B, The tumor cells are irregular in size and have hyperchromatic nuclei.are irregular in size and have hyperchromatic nuclei.

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© 2007 Elsevier © 2007 Elsevier