Uterus

structure
fundus

7
4 Body
Imitrium
cervix

Endometrial cycle

First 15days proliferationphase

Estrogen Mitosis
Eygg

Day 14 ovulation
Graffian follicle releases Ova

Corpus luteum cyst secretes Progesterone

If ten

chsefet.it into
After 10 days Menstruation Endometrium

If No pregnancy
hormone drop shedding bleeding
 Endometritis
Acute
Etiology After Labour Abortion if contaminated atmosphere
Ascending infection
Strept A staph C trachomatis N gonorrhea E coli

Gross Enlarged soft

Endometrial edema
M's Early congestion
Aggregates of Neutrophils
pus cells

Late Endometrial necrosis

spread of Infiltrate to myometrium pusNeutro

clinical
afiii.nu iYtsioruiantfiginiidscharge local
Pus

Chronic
Etiology PD intrauterine devices

M.s Plasma cells in endometrium

 Endometriosis
Seen underM.s

glandsfstrom
uterus
outs.de
Presence of endometrial
ectopic endometrium
functioning
Responds to hormonal change cyclic changes

in reproductive women
age

sites
ovaries Pouch of douglas
ovarian uterine ligaments serosa of bowel
Urinary bladder peritoneal cavity

clinical
chronic pelvic pain rectal pain
dysamenorrhea dyspareunia
Constipation frequentbleeding fibrosis obstruction

Abnormal uterine bleeding

Infertility fibrosis Adhesion

Gross
Red brown serosalnodules
Endometrioma chocolate hemolyzedblood cyst
chronichaemorrhage haemosidrin Laiden MQ
Necrotic tissue
Adenomyosis

Invagination of deep layers of endometrium

Into Myometrium

Postmenopausal

clinical Menorrhagia severe menstrual bleeding

Dysmenorrhea

Gross Diffusely enlarged

Endometrial hyperplasia Histological proliferation
of endometrial glands
35

Etiology
Excessive Estrogen relative to progesterone
so estrogen unopposed
Failure of ovulation
Prolonged admistration of exogenous HRT contraceptives

Est producing ovarian lesions

eg polycystic ovary Granulosa Theca cell tumour
Obesity
adiposetissueconverts steroid Precursors estrogens

Clinical Abnormal uterine bleeding

M.S 2 types
simple only increase in numberofglands
without Atypia
Endometrial intraepithelial
End hyperplasia with Atypia neoplasia EIN

Complex architecture c cytologicAtypla

B arrangement nuclearfeatures

Intact BM

Risks Endometrial Adenocarcinoma Malignant Transformation

Treatment hysterectomy
Editions
Progestin therapy
 Tumors

Benign
Leiomyoma fibroid Uterus

From smooth muscle Myometrium

30 50 of females in reproductive life

Etiology Estrogen dependant

Gross Well circumscribed

Firm rubbery whitetan ntramffff
subserosal
submuco.us

CS whorled Trabeculated
Single Multiple

M S
Well circumscribed Pseudocapsule Titi L I
Interlacing bundles of Sm ms fibers Dense collagen
bland nuclei no criteria of Malignancy

Clinical Uterine bleeding surfacearea of endometrium

Bladder disorders compression
Impaired fertility interrupts Implantation
Spontaneous abortion narrow cavity Fetal malpresentation
Postpartum haemorrhage

can be completely
Asymptomatic
discovered accidentally
 Metastatic
Malignant Epithelial
Primary Mesenchymal

_Epithelial Endometrial carcinoma Most common malignant

postmenopausal females
In
clinical Abnormal uterine bleeding

Etiology Estrogen
earlymenarche Latemenopause
Nulliparity ChronicAnovulation progesterone exposure

Est producing ovariantumours ERT Tamoxifen

EIN complex Atypicalneoplasia Transformation
Genetic predisposition LyncheSyndrome
colorectal endom ovariantumours

Hypertension DM obesity

Gross LocalisedPolypoid mass

or
Diffuse Irregular ulcerated necrotic

MS 2 Types
Endometrioid Adenocarcinoma Serous tumors
PTEN mutation TP 53 mutation Etonstressor
Resembles normalglands Small Tufts ofepith
around vascular core
with nuclear Atypia
Complex architecture Papillae
may show squamous differentiation More Aggressive

Prognosis Invasion of Myometrium

Spread Local Blood Lymphatic
t Mesenchymal Tumours

Leiomyosarcoma sm.ms

Etiology de novo from myometrium

not from Leiomyoma

Age Post menopause

Gross Enlarged soft HNC

Solitary bulky fleshy mass
Invades uterine wall

MS intersecting sm.ms fiber bundles

Nuclear Atypia
Necrosis Not in Leiomyoma

Mitosis

Carcino sarcoma Malignantmixed

mullerian Tumors

Very Aggressive
2 Components epithelial Glands
Mesenchymal Sm.msfibers C T

Endometrial stromal sarcoma