Uterus

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.
  • Indications: cervical cancers, advanced uterine cancers.

Notes:

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

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.

Congenital absence

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

Features:

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

Treatment:

• Uterine transplant - attempted.

Uterine adenomyosis

General

• Common - may be a cause of bleeding.
• Associated with endometriosis. (???)

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.

Note:

• Can be thought of as endometriosis of the myometrium.

DDx:

• Endometrioid endometrial carcinoma.

See also

• Gynecologic pathology.