Female Genital Diseases - Uterine Disorders

Female Genital Diseases - Uterine Disorders

• Uterine anomalies occur in less than 5% of women, but are present in up to 25% of women with miscarriages or premature births.
• Types of uterine anomalies include:
  • Didelphys: The two halves of the uterus remain separate.
  • Arcuate: A uterus with a dent (indentation) on the top part.
  • Unicornuate: Only one half of the uterus has developed.
  • Bicornuate: A heart-shaped uterus.
  • Septate: Uterus with a partition in the middle.

Disorders of the Uterine Body

• Abnormal uterine bleeding: This includes dysfunctional uterine bleeding (DUB) which lacks underlying structural problems and is often related to hormonal imbalances.
• Menorrhagia: Excessive and prolonged bleeding during menstruation.
• Metrorrhagia: Bleeding between periods.

Organic Causes of Uterine Bleeding

• Complications of pregnancy (abortion, trophoblastic disease, ectopic pregnancy).
• Infections (cervicitis, endometritis).
• Tumors (leiomyoma, endometrial polyps, cancer cervix).
• Blood diseases.

Non-Organic (Hormonal) Causes of Dysfunctional Uterine Bleeding

• Hyper-estrogenic states with anovulation (e.g., polycystic ovarian disease, stromal hyperplasia, functioning ovarian tumors).
• Other systemic endocrine disorders (e.g., thyroid or adrenal diseases or pituitary tumors).

Inflammation of the Endometrium (Endometritis)

• Acute endometritis: Caused by gonorrhea or puerperal sepsis.
• Chronic endometritis may occur in:
  • Patients with Chlamydia or other intrauterine infections.
  • Post-abortion or partial abortion, due to retained gestational tissue.
  • Intrauterine contraceptive devices.
  • Endometrial tuberculosis (granulomatous).

Endometriosis and Adenomyosis

• Endometriosis: Endometrial glands or stroma in abnormal locations outside the uterus (ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum, laparotomy scars, umbilicus, vagina, vulva, or appendix). The tissue undergoes cyclic changes with periodic bleeding, and pelvic pain occurs as a result.
• Adenomyosis: Presence of endometrial foci in the myometrium (muscular tissue of the uterus), causing diffuse enlargement and irregular thickening of the uterus. A cut section shows hemorrhagic spots.

Endometrial Polyps

• Sessile mass composed of endometrial glands and stroma.
• Usually benign, but can sometimes show endometrial hyperplasia or cancerous changes.

Endometrial Hyperplasia

• Characterized by glandular and stromal proliferation.
• Resulting from abnormally high and prolonged levels of estrogen (e.g., Stein-Leventhal syndrome, granulosa and theca cell tumors, estrogen therapy).

Types of Endometrial Hyperplasia

• Simple hyperplasia (cystic glandular hyperplasia): Some glands show cystic dilatation, and the stromal cells are plump.
• Complex hyperplasia without atypia: Glands of varying sizes are crowded together in clusters, with no cytologic changes.
• Complex hyperplasia with atypia (EIN): Gland crowding is accompanied by cytologic changes.

Carcinoma of the Endometrium

• Peak incidence is 55-65 years (after menopause).
• Less common than cancer of the cervix.
• Risk factors include obesity, diabetes, infertility, and endometrial hyperplasia/hyperestrogenemia.

Morphology of Endometrial Carcinoma

• Gross: Localized polypoid tumor or a diffuse spreading lesion.
• Microscopic: Well-differentiated adenocarcinoma (endometrioid), with squamous, secretory, or mucinous differentiation (metaplasia); poorly differentiated carcinoma (including clear cell carcinoma, or papillary serous carcinoma).

Clinical Features of Endometrial Carcinoma

• Patient presents with abnormal uterine bleeding or an abnormal Pap smear.
• Prognosis depends on the type and grade of the tumor (good in localized, well-differentiated tumors, poor in spreading or poorly differentiated tumors).

Malignant Mixed Mesodermal Tumors

• Rare tumors derived from primitive stromal cells in postmenopausal women.
• Gross: Bulky, polypoid tumor that protrudes into the endometrial cavity and vagina.
• Microscopic: Composed of glandular and stromal sarcomatous elements (muscle, cartilage, osteoid tissue).
• Poor prognosis (5-year survival rate ≈25%).

Tumors of the Myometrium (Leiomyomas)

• Leiomyomas (fibroids): The most common tumor in women in their 30s and 40s, related to estrogen stimulation.
• Types: Intramural (within the uterine wall), subserous (growing outward, covered by peritoneum), submucosal (lying below the endometrium, projecting into the uterine cavity), cervical (within the cervical stroma)..
• Gross: Enlarged uterus, may be irregular due to multiple myomas. Cut section shows round, firm, gray-white masses.
• Microscopic: Interlacing bundles of smooth muscle fibers and fibrous tissue, with few mitotic figures.
• Effects/complications: Menorrhagia, pressure on bladder causing micturition frequency, infertility, and degeneration (hyaline, red, cystic change, necrosis).
• Malignant change rare (leiomyosarcoma).

Leiomyosarcoma

• Uncommon tumor that forms bulky, fleshy masses in the uterine wall.
• Microscopic: Fascicles of eosinophilic spindled cells with blunt nuclei, displaying variable pleomorphism and 10+ mitoses per 10 high-power fields.
• Disseminates throughout the abdominal cavity and aggressively metastasizes.
• 5-year survival rate ≈40%.

Diseases of the Fallopian Tubes

• Inflammation (Salpingitis):

  • Suppurative salpingitis: Infection with pyogenic organisms (streptococci, staphylococci, gonococci).
  • Tuberculous salpingitis: Hematogenous spread of tuberculosis or associated with tuberculous endometritis.

• Effect: Fibrosis, potentially causing infertility (if bilateral).

• Tumors: Rare, adenocarcinoma most common, often arising in the fimbriated portion of the tube.

• Ectopic (Tubal) Pregnancy: Implantation of the fertilized ovum outside the uterine cavity, in the fallopian tube leading to potential rupture, hemorrhage, and severe abdominal pain.

This quiz covers various uterine disorders including anomalies and abnormal bleeding. You will learn about the types of uterine anomalies and the causes of irregular bleeding. Additionally, the quiz explores common conditions such as menorrhagia and potential organic causes.