Downloaded 185 times
More Related Content
Similar to Benign lesion of the uterus
Benign lesion of the uterus
- 1. BENIGN LESION OF THEUTERUS NUR SAKINAH BINTI ZULKIFLI 43
- 2.
- 5. ENDOMETRIAL POLYPS • Localizedoutgrowth of the endometrium • contain an inner core of blood vessel • surrounded by blood vessel and stroma • Maybe benign or malignant • Benign : attached by pedicle
- 6. Age • All agegroup • Peak (40-49 years) Size • Few mm – several cm Number • Single or multiple Types • Pedunculated • Sessile • Mucous • Fibroid • Placental
- 7.
- 8. PATHOLOGY • BODY :a part of thick endometrium project into the cavity and ultimately attained pedicle/sessile • CUT SECTION: grey or reddish brown GROSS APPEARANCE: • Core : contain stromal cells gland and large thick walled vascular channel. • Surface :lined by proliferative endometrial lining with cystic hyperplasia or squamous metaplasia • Pedicle : contain thin fibrous tissue with thin blood vessel • Smooth muscle invade polyps : adenomyomatous polyps MICROSCOPIC
- 10. PREDICTOR OF MALIGNANCY Size>10 mm Postmenopa usal status Abnormal uterine bleeding
- 11. CLINICAL FEATURE Maybe asymptomatic Menorrhagia Intermenstrual bleeding Contact bleeding (polypssituated outside cervix) Infertility and miscarriage (multiple polyps)
- 12. ON EXAMINATION • Uterusnormal/uniformly enlarged • Soft, slippery and small in size (outside the cervix) • PER SPECULUM : Reddish in color attached with slender pedicle
- 13. INVESTIGATION • Must beruled out in women with abnormal uterine bleeding who do not respond to traditional treatment
- 14.
- 16. ADENOMYOSIS • Presence ofendometrial tissue in myometrium >2.5mm from the basal layer of endometrium • Endometrial gland and stroma must present
- 17. PATHOGENESIS • Oestrogen receptermutation • Gene polymorphism • Basal layer of endometrium including stroma and gland infiltrating myometrium. • Surrounding myometrial tissue hypertrophied and hyperplasia • Uterine enlargement
- 18. PATHOLOGY • DIFFUSE – Involveanterior and posterior uterine walls – Causes uniform uterine enlargement – Thickened myometrium and hemorrhagic foci of adenomyosis • LOCALIZED – Grossly mimic leiomyoma (no capsule or distinct plane of dissection)
- 19. CLINICAL FEATURE • Commonin multiparous age 40-50 • Does not occur before menarche and regress after menopause • Uterus uniformly enlarged • Palpable abdominally (<14 week’s size) • May co-exist with other pelvic pathology – Leiomyoma – endometrial hyperplasia – endometriosis – endometrial carcinoma • Dysmenorrhea (> with > duration of disease and depth of infiltration • Menorrhagia
- 20. INVESTIGATION Transvaginal ultrasonography • Asymmetricalthickening of uterine walls Doppler sonography • To differentiate from fibroid MRI • Conservative surgical or medical management preferred • Young lady with infertility Image directed needle biopsy
- 21. MEDICAL MANAGEMENT NSAID COMBINED OCP DANAZOL •Androgen,estrogen and progesterone receptor present in lesion • Reduce in size, menorrhagia reduce • Temporary effect GnRH ANALOGUE • Prior to surgery to reduce size and vascularity AROMATASE INHIBITOR (anastrozole) LEVONOGESTREL INTRAUTERINE SYSTEM (LNG-IUS) DANAZOL LOADED INTRAUTERINE DEVICE • Reduce pain and bleeding
- 22. SURGICAL MANAGEMENT • Definitivesurgery • Perimenopausal age • Poor response to medical therapy • Associated pelvic pathology
- 23. CONSERVATIVE SURGERY • Localizedadenomyoma by adenomyomectomy • Plane of dissection id difficult since no capsule Resection of adenomyoma • Diffuse adenomyosis • Partial resection of uterine walls Myometrial reduction • Submucosal adenomyosis/ polypoidal lesion Hysteroscopic reduction
- 24. NEWER INTERVENTIONAL TECHNIQUE Endometrial ablation Uterine artery embolisation MRIguided focused ultrasound surgery
- 25. REFERENCE • Essentials OfGynaecology, Lakshmi Seshadri • DC Dutta Textbook Of Gynaecology
- 26.