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Diseases of the uterus

Diseases of the uterus. * Topics: . 1. Endometrial hyperplasia. 2. Endometriosis. 3. leiomyoma. 4. Endometrial carcinoma. 5. Cancer cervix. 1. Endometrial hyperplasia. * Def. hyperplasia of the endometrium reaction to abnormal estrogenic stimulation. * Age: around menopause.

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Diseases of the uterus

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  1. Diseases of the uterus

  2. * Topics: 1. Endometrial hyperplasia. 2. Endometriosis. 3. leiomyoma. 4. Endometrial carcinoma. 5. Cancer cervix

  3. 1. Endometrial hyperplasia

  4. * Def.hyperplasia of the endometrium reaction to abnormal estrogenic stimulation. * Age: around menopause. * Causes: prolonged estrogen stimulation of endometrium due to relative or absolute hyperestrenism e.g. • Repeated anovulatory cycles. • Estrogen replacement therapy. • Estrogen secreting ovarian tumors.

  5. * Types: • Simple (mild – cystic) non-atypical hyperplasias: • Characterized by proliferating endometrial glands of various sizes. The surrounding stromal cell are dense. • No atypia. • These lesions uncommonly progress to adenocarcinoma.

  6. Proliferative endometrium

  7. Simple endometrial hyperplasia

  8. 2. Complex atypical hyperplasias: • Exhibit an increase in the number and size of endometrial glands. The glands are lined by multiple layers of epithelial cells showing atypia. • Most of the cases are followed by endometrial adenocarcinoma.

  9. Complex atypical endometrial hyperplasia

  10. Complex atypical endometrial hyperplasia

  11. 2. Endometriosis

  12. * Def:presence of endometrial tissue in abnormal sites. * Types: I. Endometriosis interna (adenomyosis): • Presence of endometrial tissue inside the myometrium. * Pathogenesis: Dipping of the basal layer of the endometrium inside the myometrium.

  13. * Grossly: - Enlarged uterus.- Thick myometrium showing small grayish or hemorrhagic foci.

  14. * Microscopically: • The myometrium shows islands of endometrial tissue formed of endometrial glands and stroma.

  15. myometrium endometrium

  16. * Complications: • Menorrhagia. • Dysmenorrhea (painful menstruation).

  17. II. Endometriosis externa: * Def:presence of endometrial tissue outside the uterine wall. * Sites: a. Genital: ovaries, F. tubes. b. Extragenital: wall of urinary bladder or intestine, rectovaginal septum, pelvic peritoneum, umbilicus, lung, L.Ns..

  18. * Pathogenesis:unknown; theories; 1. Regurgitation theory:reflux the shedded endometrial tissue to the ovaries and tubes during menstruation. 2. Metaplastic theory: metaplasia of the serosal cells covering the ovary, rectum… 3. Vascular and lymphatic theory: the endometrial tissue disseminate through Blood vessels and lymphatic simulating the tumor spread.

  19. * Grossly:the affected tissue shows small grayish or hemorrhagic foci. * Microscopically: endometrial tissue (glands and stroma) with areas of hemorrhage. * Complications: • Pain & hemorrhage in the affected area. • The ovaries show chocolate cysts. • Peritoneal hemorrhage is complicated by fibrosis and adhesions.

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