UTERUS BODY PATHOLOGY
DR. MONA RASHED
BODY OF UTERUS
The uterine corpus is composed of
endometrial mucosa and the underlying
smooth muscle myometrium
ENDOMETRITIS
Inflammation of the endometrium is classified as acute or
chronic.
Endometritis is commonly due to N. gonorrhoeae or C.
trachomatis.
Endometritis also may be due to retained products of
conception, or to presence of a foreign body such as an
intrauterine device.
Retained tissue or foreign bodies act as a nidus for
ENDOMETRITIS; cont.
Histologic examination reveals a neutrophilic
infiltrate
coexisting
with
a
stromal
lymphoplasmacytic infiltrate in the superficial
endometrium and glands
Clinically, endometritis manifest with fever,
abdominal pain, and menstrual abnormalities.
ADENOMYOSIS
Adenomyosis refers to the growth of the basal layer of the
endometrium down into the myometrium.
Nests of endometrial stroma, glands, or both, are found deep
in the myometrium interposed between the muscle bundles.
The presence of endometrial tissue induces reactive
hypertrophy of the myometrium, resulting in an enlarged
uterus, with a thickened uterine wall.
ADENOMYOSIS; cont.
Because the glands in adenomyosis derive from
the stratum basalis of the endometrium, they do
not undergo cyclic bleeding.
Clinically;
adenomyosis
may
produce
menorrhagia, dysmenorrhea, and pelvic pain
before the onset of menstruation.
ENDOMETRIOSIS
Definition: Endometrial glands or stroma outside
the uterus
Common sites of endometriosis: Ovaries,
uterine ligaments, recto-vaginal septum and
pelvic peritoneum, scars, umbilicus, vagina, vulva
and appendix
ENDOMETRIOSIS; cont.
Three hypotheses explain the endometriosis:
1.
The regurgitation theory, menstrual backflow through the
fallopian tubes leads to implantation.
2.
The metaplastic theory, endometrial differentiation of
coelomic epithelium (from which endometrium originates) as
the source.
3.
Vascular or lymphatic dissemination theory.
ENDOMETRIOSIS; MORPHOLOGY
Endometriosis
endometrium,
menstruation.
almost always contains functioning
which undergoes cyclic bleeding with
Because blood collects in these foci, they usually appear
grossly as red-brown nodules.
When the ovaries are involved, the lesions may form large,
blood-filled cysts that turn brown (chocolate cysts) as the
blood ages.
ENDOMETRIOSIS;
MORPHOLOGY; cont.
Organization of the blood causes widespread fibrosis, leading
to adhesions among pelvic structures, sealing of the tubal
fimbriated ends, and distortion of the oviducts and ovaries.
Clinical Effects of endometriosis: Infertility, dysmenorrhea,
pelvic pain
The histologic diagnosis at all sites is the presence of:
endometrial glands, endometrial stroma, and hemosiderin
pigment (old blood).
PROLIFERATIVE LESIONS OF THE
ENDOMETRIUM AND MYOMETRIUM
PROLIFERATIVE LESIONS OF THE
ENDOMETRIUM AND MYOMETRIUM
The most common proliferative lesions of the
uterine corpus are:
1.
2.
3.
4.
Endometrial hyperplasia
Endometrial carcinomas
Endometrial polyps
Smooth muscle tumors: leiomyoma & leiomyosarcoma
All tend to produce abnormal uterine bleeding as
their earliest manifestation.
Endometrial Hyperplasia
Excess of estrogen, can induce exaggerated endometrial
proliferation (hyperplasia), which is an important precursor
of endometrial carcinoma.
Causes of estrogen excess include
1.
2.
3.
4.
5.
Anovulation
Polycystic ovarian disease
Functioning granulosal cell tumors of ovary
Estrogen replacement therapy
Obesity, as adipose tissue converts steroid precursors into estrogens.
Classification of endometrial hyperplasia
1.
Hyperplasia Without Atypia (low grade)
Simple hyperplasia:. Rarely progress to carcinoma
Complex hyperplasia: Glandular crowding and branching with a
complex growth pattern. Less than 5% progress to carcinoma
2. Atypical Hyperplasia (high grade)
Histopathology: there are atypical cellular and nuclear
features. Approximately 25% progress to carcinoma
Endometrial Carcinoma
Usually arise in postmenopausal women; between
the ages of 55 and 65 years
Often present with postmenopausal bleeding
Endometrial carcinomas comprise two distinct
kinds of cancer: endometrioid and serous
carcinoma of the endometrium.
Endometrial Carcinoma; pathogenesis
The endometrioid type accounts for 80% of cases of
endometrial carcinomas.
Risk factors for endometrioid carcinoma include:
(1)
(2)
(3)
(4)
(5)
Obesity
Diabetes
Hypertension
Infertility
Exposure to unopposed estrogen.
Prolonged estrogen replacement therapy and estrogensecreting ovarian tumors increase the risk of endometrioid
type of endometrial carcinoma.
The serous type of endometrial carcinoma is much less
Endometrial Polyps
Sessile lesions range from 0.5 to 3 cm in diameter.
Larger polyps may project from the endometrial mucosa into the
uterine cavity.
On histologic examination, they are composed of endometrium
resembling the basalis, frequently with small muscular arteries.
Clinically; endometrial polyps cause abnormal uterine bleeding.
Commonly are detected around the time of menopause.
Leiomyoma
Benign tumors that arise from the smooth muscle
cells in the myometrium; termed leiomyomas.
Leiomyomas are the most common benign tumor
in females, affecting 30% to 50% of women of
reproductive age.
Leiomyoma; morphology
Leiomyomas are typically well circumscribed, firm gray-white masses
with a characteristic whorled cut surface.
They may occur singly, or multiple within the uterus myometrium, ranging
from small nodules to large tumors.
Leiomyoma may be embedded within the myometrium (intramural),
whereas others may lie directly beneath the endometrium (sub-mucosal) or
directly beneath the serosa (sub-serosal).
On histologic examination, the tumors are characterized by bundles of
smooth muscle cells mimicking the appearance of normal myometrium.
Leiomyoma; Clinically
The most frequent presenting sign is menorrhagia,
with or without metrorrhagia.
Large leiomyomas may be palpated by the
affected woman or may produce a dragging
sensation.
Leiomyomas
almost
never
transform
into
sarcomas, and the presence of multiple lesions
does not increase the risk of malignancy.
Leiomyosarcoma
Leiomyosarcomas do not arise from a preexisting
leiomyomas.
They are almost always solitary and most often occur in
postmenopausal women, in contradistinction to leiomyomas,
which frequently are multiple and usually arise
premenopausally.
Leiomyosarcomas typically take
hemorrhagic, necrotic masses.
the
form
of
soft,
Recurrence after removal is common, and they metastasize,
References:
ROBBINS Basic Pathology; 9th edition. Chapter
19: Female genital system and breast; Body of
uterus, pages: 689-694
