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

• 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.
• Radical hysterectomy - total hysterectomy + parametrial tissue.
  • 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.

Normal uterine wall

Gross

• Firm.
• Pear-shaped.
  • Not quite true -- it is usu. flattened at the anterior and posterior.

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.
• May be seen in the context of Müllerian agenesis. (???)

Features:

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

Treatment:

• Uterine transplant - attempted.

Uterus didelphys

General

• Benign - though may adversely affect fertility.
• Rare - seen in < 0.3% deliveries.
• 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:

• Schematic of uterine abnormalities (msdlatinamerica.com).

Gross

• Two uteri - each have a cervix, each connect to one fallopian tube/ovary.
• +/-Vaginal septum or double vagina.

Microscopic

• Non-specific - gross diagnosis.

Uterine adenomyosis

Uterine adenomyoma redirects here.

• AKA adenomyosis of the uterus.

General

• Common.
• May be a cause of bleeding.
• Dysmenorrhea - painful menses.
• Associated with endometriosis.^{[citation needed]}

Gross

Features:

• Trabeculated cut surface +/- small foci of hemorrhage.
  • Often described as "basket-weave" pattern.
• Globoid, slightly enlarged.

Note:

• May form a mass - known as adenomyoma.

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.

Note:

• Can be thought of as endometriosis of the myometrium.

DDx:

• Endometrioid endometrial carcinoma.

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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.

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UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
- UTERINE CERVIX WITH FOCAL KERATINIZATION OTHERWISE WITHIN NORMAL LIMITS.
- NONPROLIFERATIVE ENDOMETRIUM.

UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
- UTERINE CERVIX WITH KERATINIZATION, OTHERWISE WITHIN NORMAL LIMITS.
- CYSTIC NONPROLIFERATIVE ENDOMETRIUM.
- UTERINE SMOOTH MUSCLE AND SEROSA WITHIN NORMAL LIMITS.
- NEGATIVE FOR MALIGNANCY.

UTERUS AND CERVIX, TOTAL HYSTERECTOMY:
- UTERINE CERVIX WITH MILD CHRONIC INFLAMMATION AND EXOCERVICAL DENUDATION,
  NO EVIDENCE OF DYSPLASIA.
- CYSTIC NONPROLIFERATIVE ENDOMETRIUM.
- UTERINE CORPUS WITH BENIGN HYALINIZED NODULE.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
Levels were cut on the uterine cervix sections (A1 and A2).

Dysfunctional uterine bleeding

• Abbreviated DUB.

General

• Clinical diagnosis based on negative pathology - specifically a negative endometrial biopsy.

Clinical:

• Menorrhagia.

Microscopic

Features:

• Endometrium within normal limits - see proliferative phase endometrium and secretory phase endometrium.

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A. OMENTUM, BIOPSY:
- FIBROADIPOSE TISSUE WITHIN NORMAL LIMITS -- CONSISTENT WITH OMENTUM.

B. UTERUS, SUBTOTAL HYSTERECTOMY:
- SECRETORY PHASE ENDOMETRIUM.
- UTERINE WALL WITHIN NORMAL LIMITS.

UTERUS, CERVIX, AND BILATERAL UTERINE TUBES, TOTAL HYSTERECTOMY AND BILATERAL SALPINGECTOMY:
- UTERINE CERVIX WITHIN NORMAL LIMITS.
- PROLIFERATIVE PHASE ENDOMETRIUM WITH FOCAL FIBROSIS, COMPATIBLE WITH PRIOR ABLATION.
- UTERINE LEIOMYOMAS.
- BILATERAL UTERINE TUBES WITHOUT SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR MALIGNANCY.

See also

• Gynecologic pathology.