Difference between revisions of "Uterus"
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*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> | ||
=Normal uterine wall= | |||
===Gross=== | |||
*Firm. | |||
Negatives: | |||
*No nodules. | |||
*No trabeculations. | |||
===Microsopic=== | |||
Features: | |||
*Smooth muscle arranged in fascicles. | |||
===IHC=== | |||
*ER +ve. | |||
*PR +ve. | |||
=Tumours of the corpus= | =Tumours of the corpus= | ||
Revision as of 13:21, 28 March 2013
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
- Myomectomy.
- Indication: uterine leiomyomas.
- Subtotal hysterectomy.
- Discouraged... as the cervix remains and can develop a cancer.
- Total hysterectomy.
- Indications:
- Endometrial cancer (low stage, good histologic type), endometrial hyperplasia.
- Uterine prolapse.
- Uterine adenomyosis.
- Uterine leiomyomas.
- Chronic pelvic pain.[1]
- Indications:
- Radical hysterectomy - total hysterectomy + parametrial tissue.[2]
- 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.
- Indications: cervical cancers, advanced uterine cancers.
Notes:
- There are almost no quality of life differences between total & subtotal hysterectomy.[3]
Normal uterine wall
Gross
- Firm.
Negatives:
- No nodules.
- No trabeculations.
Microsopic
Features:
- Smooth muscle arranged in fascicles.
IHC
- ER +ve.
- PR +ve.
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 of the uterus
General
- Often associated with absence of the deep portion of the vagina; thus, may be congenital absence of the uterus and vagina (CAUV).
- May go by the name Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.[4]
- May be seen in the context of Müllerian agenesis. (???)
Features:[4]
- Subdivided - as etiologies differ.
- Thought to have a genetic component - autosomal dominant with variable penetration.
Treatment:
- Uterine transplant - attempted.[5]
Uterus didelphys
General
- Benign - though may adversely affect fertility.[6]
- Rare - seen in < 0.3% deliveries.[7]
- Can be thought of as double uterus - a consequence of the Muellerian ducts not fusing.
Related conditions:
- Arcuate uterus - fundus has a concave contour towards the uterine cavity.
- Septate uterus.
- Bicornuate uterus.
- Uterus didelphys.
Image:
Gross
- Two uteri - each have a cervix, each connect to one fallopian tube/ovary.
- +/-Vaginal septum or double vagina.[7]
Microscopic
- Non-specific - gross diagnosis.
Uterine adenomyosis
- AKA adenomyosis of the uterus.
General
- Common.
- May be a cause of bleeding.[9]
- Dysmenorrhea - painful menses.[10]
- Associated with endometriosis.[citation needed]
Gross
Features:
- Trabeculated cut surface +/- small foci of hemorrhage.[11]
- Often described as "basket-weave" pattern.
Image:
- Uterine adenomyosis (flickr.com/infopathic).
- Uterine adenomyosis - close-up (flickr.com/infopathic).
Microscopic
Features:
- Endometrial glands within uterine muscle - key feature.
- Endometrial glands:
- Circular.
- Simple epithelial or pseudostratified epithelium +/- mitoses.
- +/-Surrounded by endometrial stroma.
- Densely packed spindle cells without nuclear atypia.
- Blood:
- Within glands.
- Hemosiderin-laden macrophages.
- Endometrial glands:
Note:
- Can be thought of as endometriosis of the myometrium.
DDx:
Sign out
UTERUS, UTERINE CERVIX, TOTAL HYSTERECTOMY: - UTERUS WITH ADENOMYOSIS. - UTERINE CERVIX WITHIN NORMAL LIMITS. - PROLIFERATIVE PHASE ENDOMETRIUM.
Uterine prolapse
- Urogenital prolapse redirects here.
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.
Sign out
UTERUS AND CERVIX, TOTAL HYSTERECTOMY: - UTERINE CERVIX WITH FOCAL KERATINIZATION OTHERWISE WITHIN NORMAL LIMITS. - NON-PROLIFERATIVE ENDOMETRIUM.
Dysfunctional uterine bleeding
- Abbreviated DUB.
General
- Clinical diagnosis based on negative pathology - specifically a negative endometrial biopsy.
Microscopic
Features:
- Endometrium within normal limits - see proliferative phase endometrium and secretory phase endometrium.
Sign out
A. OMENTUM, BIOPSY: - FIBROADIPOSE TISSUE WITHIN NORMAL LIMITS -- CONSISTENT WITH OMENTUM. B. UTERUS, SUBTOTAL HYSTERECTOMY: - SECRETORY PHASE ENDOMETRIUM. - UTERINE WALL WITHIN NORMAL LIMITS.
See also
References
- ↑ Lamvu, G. (May 2011). "Role of hysterectomy in the treatment of chronic pelvic pain.". Obstet Gynecol 117 (5): 1175-8. doi:10.1097/AOG.0b013e31821646e1. PMID 21508759.
- ↑ 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.
- ↑ 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.
- ↑ 4.0 4.1 URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1832178/.
- ↑ URL: http://singularityhub.com/2011/06/18/in-a-medical-first-infertile-daughter-will-receive-uterus-from-mother-video/. Accessed on: 17 June 2011.
- ↑ Taylor, E.; Gomel, V. (Jan 2008). "The uterus and fertility.". Fertil Steril 89 (1): 1-16. doi:10.1016/j.fertnstert.2007.09.069. PMID 18155200.
- ↑ 7.0 7.1 Brown, DC.; Nelson, RF. (Mar 1967). "Uterus didelphys and double vagina with delivery of a normal infant from each uterus.". Can Med Assoc J 96 (11): 675-7. PMC 1936081. PMID 6019679. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936081/.
- ↑ URL: http://www.msdlatinamerica.com/ebooks/RadiologyReviewManual/sid1652818.html. Accessed on: 28 April 2012.
- ↑ 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.
- ↑ Cockerham, AZ.. "Adenomyosis: a challenge in clinical gynecology.". J Midwifery Womens Health 57 (3): 212-20. doi:10.1111/j.1542-2011.2011.00117.x. PMID 22594861.
- ↑ Lester, Susan Carole (2010). Manual of Surgical Pathology (3rd ed.). Saunders. pp. 432. ISBN 978-0-323-06516-0.