12019/4/ Uterus - Libre Pathology
Uterus
From Libre Pathology
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.
Contents
1 Operations
1.1 Grossing hysterectomy specimens
1.1.1 Hysterectomy specimens - orientation
2 Normal uterine wall
2.1 Gross
2.2 Microsopic
2.3 IHC
3 Tumours of the corpus
4 Endometrium
5 Specific conditions
5.1 Congenital absence of the uterus
5.1.1 General
5.2 Uterus didelphys
5.2.1 General
5.2.2 Gross
5.2.3 Microscopic
5.3 Uterine adenomyosis
5.4 Uterine prolapse
5.5 Dysfunctional uterine bleeding
5.5.1 General
5.5.2 Microscopic
5.5.3 Sign out
5.5.3.1 Block letters
5.6 BRCA carrier
5.6.1 General
5.6.2 Grossing
5.6.3 Microscopic
5.6.4 IHC
5.6.5 Sign out
6 See also
7 References
Operations
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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]
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.
Notes:
There are almost no quality of life differences between total & subtotal hysterectomy.[3]
Simple hysterectomy is removal of the uterus and cervix;[4] it can be used as a synonym for total
hysterectomy.[5]
Grossing hysterectomy specimens
Hysterectomy for endometrial cancer grossing.
Hysterectomy for endometrial hyperplasia grossing.
Hysterectomy for fibroids grossing.
Hysterectomy specimens - orientation
Orientation:
Less peritoneum on anterior (as the urinary bladder is there).
Posterior peritoneal edge: pointy (upside down triangle).
Anterior peritoneal edge: rounded/non-pointy.
Tubes on anterior-lateral aspect.[6]
Round ligaments posterior to tubes.
Normal uterine wall
Gross
Firm.
Pear-shaped.
Not quite true -- it is usu. flattened at the anterior and posterior.
Negatives:
No nodules.
No trabeculations.
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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.[7]
May be seen in the context of Müllerian agenesis. (???)
Features:[7]
Subdivided - as etiologies differ.
Thought to have a genetic component - autosomal dominant with variable penetration.
Treatment:
Uterine transplant - attempted.[8]
Uterus didelphys
General
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Benign - though may adversely affect fertility.[9]
Rare - seen in < 0.3% deliveries.[10]
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) (http://www.msdlatinamerica.com/ebooks/Radiol
ogyReviewManual/files/1de384e713476a71768c20e3b1f8c51b.gif).[11]
Gross
Two uteri - each have a cervix, each connect to one fallopian tube/ovary.
+/-Vaginal septum or double vagina.[10]
Microscopic
Non-specific - gross diagnosis.
Uterine adenomyosis
AKA adenomyosis of the uterus.
Main article: Uterine adenomyosis
Uterine prolapse
Urogenital prolapse redirects here.
Main article: Uterine prolapse
Dysfunctional uterine bleeding
Abbreviated DUB.
General
Clinical diagnosis based on negative pathology - specifically a negative endometrial biopsy.
Clinical:
Menorrhagia.
Microscopic
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Features:
Endometrium within normal limits - see proliferative phase endometrium and secretory phase endometrium.
Sign out
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.
Block letters
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.
BRCA carrier
General
Prophylatic bilateral salpingo-oophorectomies (BSOs) done in BRCA carriers to reduce risk of serous
carcinoma.[12]
Incidence of pathology in prophylatic BSOs in a series of 226 cases:[13]
Invasive carcinoma ~ 0.9%.
STIC ~ 6.2%
Grossing
In prophylatic procedures, the ovaries and tubes, endometrium, and lower uterine segment should all be
submitted in total.[14]
Microscopic
DDx:
Early serous carcinoma of the fallopian tube or ovary.
STIC.
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IHC
p53 -ve.
p16 -ve.
Ki-67 low.
Sign out
Uterus, Cervix, Fallopian Tubes and Ovaries, Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy:
- Uterus with fibrous serosal adhesions.
- Cervix within normal limits.
- Atherosclerosis, moderate.
- Inactive endometrium with cystic changes.
- Uterine adenomyosis.
- Fallopian tubes within normal limits.
- Ovaries with benign cysts.
- NEGATIVE for malignancy.
See also
Gynecologic pathology.
References
Accessed on: 8 October 2015.
1. Lamvu, G. (May 2011). "Role of hysterectomy in the 6. Lester, Susan Carole (2010). Manual of Surgical
treatment of chronic pelvic pain.". Obstet Gynecol 117 Pathology (3rd ed.). Saunders. pp. 425. ISBN 978-0-
(5): 1175-8. doi:10.1097/AOG.0b013e31821646e1 (htt 323-06516-0.
p://dx.doi.org/10.1097%2FAOG.0b013e31821646e1). 7. URL:
PMID 21508759 (http://www.ncbi.nlm.nih.gov/pubme http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1832178
d/21508759). 8. URL: http://singularityhub.com/2011/06/18/in-a-
2. Frumovitz, M.; Sun, CC.; Schmeler, KM.; Deavers, medical-first-infertile-daughter-will-receive-uterus-
MT.; Dos Reis, R.; Levenback, CF.; Ramirez, PT. (Jul from-mother-video/. Accessed on: 17 June 2011.
2009). "Parametrial involvement in radical 9. Taylor, E.; Gomel, V. (Jan 2008). "The uterus and
hysterectomy specimens for women with early-stage fertility.". Fertil Steril 89 (1): 1-16.
cervical cancer.". Obstet Gynecol 114 (1): 93-9. doi:10.1016/j.fertnstert.2007.09.069 (http://dx.doi.org/1
doi:10.1097/AOG.0b013e3181ab474d (http://dx.doi.or 0.1016%2Fj.fertnstert.2007.09.069). PMID 18155200
g/10.1097%2FAOG.0b013e3181ab474d). (http://www.ncbi.nlm.nih.gov/pubmed/18155200).
PMID 19546764 (http://www.ncbi.nlm.nih.gov/pubme 10. Brown, DC.; Nelson, RF. (Mar 1967). "Uterus
d/19546764). didelphys and double vagina with delivery of a normal
3. Thakar, R.; Ayers, S.; Clarkson, P.; Stanton, S.; infant from each uterus." (https://www.ncbi.nlm.nih.go
Manyonda, I. (Oct 2002). "Outcomes after total versus v/pmc/articles/PMC1936081/). Can Med Assoc J 96
subtotal abdominal hysterectomy.". N Engl J Med 347 (11): 675-7. PMC 1936081 (http://www.pubmedcentra
(17): 1318-25. doi:10.1056/NEJMoa013336 (http://dx. l.gov/articlerender.fcgi?tool=pmcentrez&artid=193608
doi.org/10.1056%2FNEJMoa013336). 1). PMID 6019679 (http://www.ncbi.nlm.nih.gov/pubm
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4. Somashekhar, SP.; Ashwin, KR. (Sep 2015). 11. URL:
"Management of Early Stage Cervical Cancer.". Rev http://www.msdlatinamerica.com/ebooks/RadiologyRev
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doi:10.1016/j.path.2016.02.002 (http://dx.doi.org/10.10 14. Downes, MR.; Allo, G.; McCluggage, WG.; Sy, K.;
16%2Fj.path.2016.02.002). PMID 27241111 (http://ww Ferguson, SE.; Aronson, M.; Pollett, A.; Gallinger, S.
w.ncbi.nlm.nih.gov/pubmed/27241111). et al. (Aug 2014). "Review of findings in prophylactic
13. Mingels, MJ.; Roelofsen, T.; van der Laak, JA.; de gynaecological specimens in Lynch syndrome with
Hullu, JA.; van Ham, MA.; Massuger, LF.; Bulten, J.; literature review and recommendations for grossing.".
Bol, M. (Oct 2012). "Tubal epithelial lesions in Histopathology 65 (2): 228-39. doi:10.1111/his.12386
salpingo-oophorectomy specimens of BRCA-mutation (http://dx.doi.org/10.1111%2Fhis.12386).
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