Difference between revisions of "Uterus"

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(+uterine prolapse)
Line 5: Line 5:
Other tumours are dealt with in [[uterine tumours]].
Other tumours are dealt with in [[uterine tumours]].


==Operations==
=Operations=
*Subtotal hysterectomy.
*Subtotal hysterectomy.
**Discouraged... as the cervix remains and can develop a cancer.
**Discouraged... as the cervix remains and can develop a cancer.
Line 18: Line 18:
*There are almost no quality of life differences between total & subtotal hysterectomy.<ref name=pmid12397189>{{Cite journal  | last1 = Thakar | first1 = R. | last2 = Ayers | first2 = S. | last3 = Clarkson | first3 = P. | last4 = Stanton | first4 = S. | last5 = Manyonda | first5 = I. | title = Outcomes after total versus subtotal abdominal hysterectomy. | journal = N Engl J Med | volume = 347 | issue = 17 | pages = 1318-25 | month = Oct | year = 2002 | doi = 10.1056/NEJMoa013336 | PMID = 12397189 }}</ref>
*There are almost no quality of life differences between total & subtotal hysterectomy.<ref name=pmid12397189>{{Cite journal  | last1 = Thakar | first1 = R. | last2 = Ayers | first2 = S. | last3 = Clarkson | first3 = P. | last4 = Stanton | first4 = S. | last5 = Manyonda | first5 = I. | title = Outcomes after total versus subtotal abdominal hysterectomy. | journal = N Engl J Med | volume = 347 | issue = 17 | pages = 1318-25 | month = Oct | year = 2002 | doi = 10.1056/NEJMoa013336 | PMID = 12397189 }}</ref>


==Tumours of the corpus==
=Tumours of the corpus=
{{Main|Uterine tumours}}
{{Main|Uterine tumours}}
The most common is ''[[leiomyoma]]'' (uterine fibroids).
The most common is ''[[leiomyoma]]'' (uterine fibroids).


==Endometrium==
=Endometrium=
{{Main|Endometrium}}
{{Main|Endometrium}}
Dealt with in ''[[endometrium]]'', ''[[endometrial hyperplasia]]'' and ''[[endometrial carcinoma]]'' articles.
Dealt with in ''[[endometrium]]'', ''[[endometrial hyperplasia]]'' and ''[[endometrial carcinoma]]'' articles.
=Specific conditions=
==Congenital absence==
==Congenital absence==
*Often in association with vaginal absence; ergo ''congenital absence of the uterus and vagina'' (CAUV).  
*Often in association with vaginal absence; ergo ''congenital absence of the uterus and vagina'' (CAUV).  
Line 59: Line 60:
*[[Endometrioid endometrial carcinoma]].
*[[Endometrioid endometrial carcinoma]].


==See also==
==Uterine prolapse==
===General===
*'''Clinical diagnosis'''.
*A common indication for a total hysterectomy. 
*Hysterectomy specimen usually comes with some vaginal mucosa.
 
===Gross===
*Long cervix.
 
===Microscopic===
Features:
*Uterus: non-specific
*Vaginal mucosa: (focal) keratinization due to rubbing - '''common finding'''.
 
=See also=
*[[Gynecologic pathology]].
*[[Gynecologic pathology]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Gynecologic pathology]]
[[Category:Gynecologic pathology]]

Revision as of 01:02, 18 January 2012

The uterus is essential for survival of the species. It is commonly afflicted with tumours.

Endometrium and its pathology is dealt with in the endometrium, endometrial hyperplasia and endometrial carcinoma articles.

Other tumours are dealt with in uterine tumours.

Operations

  • Subtotal hysterectomy.
    • Discouraged... as the cervix remains and can develop a cancer.
  • Total hysterectomy.
  • Radical hysterectomy - total hysterectomy + parametrial tissue.[1]
    • Indications: cervical cancers, advanced uterine cancers.
      • This is typically done by gynecologists with additional training at larger centres.
      • Usually done with a bilateral salpingo-opherectomy (both tubes and ovaries) and pelvic lymph node dissection.

Notes:

  • There are almost no quality of life differences between total & subtotal hysterectomy.[2]

Tumours of the corpus

Main article: Uterine tumours

The most common is leiomyoma (uterine fibroids).

Endometrium

Main article: Endometrium

Dealt with in endometrium, endometrial hyperplasia and endometrial carcinoma articles.

Specific conditions

Congenital absence

  • Often in association with vaginal absence; ergo congenital absence of the uterus and vagina (CAUV).
    • AKA Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.[3]

Features:[3]

  • Subdivided - as etiologies differ.
  • Thought to have a genetic component - autosomal dominant with variable penetration.

Treatment:

  • Uterine transplant - attempted.[4]

Uterine adenomyosis

General

Microscopic

Features:

  • Endometrial glands within uterine muscle - key feature.
    • Endometrial glands:
      • Circular.
      • Simple epithelial or pseudostratified epithelium +/- mitoses.
    • +/-Surrounded by endometrial stroma.
    • Blood:
      • Within glands.
      • Hemosiderin-laden macrophages.

Note:

DDx:

Uterine prolapse

General

  • Clinical diagnosis.
  • A common indication for a total hysterectomy.
  • Hysterectomy specimen usually comes with some vaginal mucosa.

Gross

  • Long cervix.

Microscopic

Features:

  • Uterus: non-specific
  • Vaginal mucosa: (focal) keratinization due to rubbing - common finding.

See also

References

  1. ↑ Frumovitz, M.; Sun, CC.; Schmeler, KM.; Deavers, MT.; Dos Reis, R.; Levenback, CF.; Ramirez, PT. (Jul 2009). "Parametrial involvement in radical hysterectomy specimens for women with early-stage cervical cancer.". Obstet Gynecol 114 (1): 93-9. doi:10.1097/AOG.0b013e3181ab474d. PMID 19546764.
  2. ↑ Thakar, R.; Ayers, S.; Clarkson, P.; Stanton, S.; Manyonda, I. (Oct 2002). "Outcomes after total versus subtotal abdominal hysterectomy.". N Engl J Med 347 (17): 1318-25. doi:10.1056/NEJMoa013336. PMID 12397189.
  3. ↑ 3.0 3.1 URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1832178/.
  4. ↑ URL: http://singularityhub.com/2011/06/18/in-a-medical-first-infertile-daughter-will-receive-uterus-from-mother-video/. Accessed on: 17 June 2011.
  5. ↑ Reinhold, C.; Tafazoli, F.; Mehio, A.; Wang, L.; Atri, M.; Siegelman, ES.; Rohoman, L. (Oct 1999). "Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation.". Radiographics 19 Spec No: S147-60. PMID 10517451.
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