Female Genital Diseases - Uterine Disorders

Female Genital Diseases - Uterine Disorders

• Uterine anomalies occur in less than 5% of women, but are seen 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 an indentation on the top part.
  • Unicornuate: only one half of the uterus develops.
  • Bicornuate: a heart-shaped uterus.
  • Septate: uterus with a partition in the middle.

Disorders of the Uterine Body

• Abnormal uterine bleeding: These terms are crucial.
  • Dysfunctional uterine bleeding: bleeding without underlying structural problems, often caused by hormonal imbalances during the menstrual cycle.
  • Menorrhagia: excessive and prolonged bleeding during menstruation.
  • Metrorrhagia: bleeding between periods.

Organic Causes of Uterine Bleeding

• Pregnancy complications (abortion, trophoblastic disease, ectopic pregnancy).
• Infections (cervicitis, endometritis).
• Tumors (leiomyoma, endometrial polyps, cervical cancer).
• Blood disorders.

Non-Organic (Hormonal) Causes of Dysfunctional Uterine Bleeding

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

Inflammation of the Endometrium (Endometritis)

• Acute endometritis: often caused by gonorrhea or puerperal sepsis.
• Chronic endometritis:
  • Chlamydia and 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, ligaments, peritoneum, etc.).
• Adenomyosis: endometrial tissue within the uterine muscle, causing uterine enlargement and irregular thickening.

Endometrial Polyps

• Sessile mass composed of endometrial glands and stroma.
• Benign, but can occasionally show endometrial hyperplasia or cancerous changes.

Endometrial Hyperplasia

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

Types of Endometrial Hyperplasia

• Simple hyperplasia (cystic glandular hyperplasia): glands with cystic dilatation.
• Complex hyperplasia without atypia: crowded glands with no cytologic changes.
• Complex hyperplasia with atypia (EIN): crowded glands with cytologic changes.

Carcinoma of the Endometrium

• Peak incidence in women aged 55-65 (post-menopause).
• Less common than cervical cancer.
• Risk factors: obesity, diabetes, infertility, endometrial hyperplasia, and hyperestrogenemia.

Morphology (Gross) of Endometrial Carcinoma

• Localized polypoid tumor.
• Diffuse spreading lesion.

Morphology (Microscopic) of Endometrial Carcinoma

• Well-differentiated adenocarcinoma (e.g., endometrioid, with squamous, secretory, or mucinous differentiation).
• Poorly differentiated carcinoma (e.g., clear cell carcinoma, papillary serous carcinoma).

Clinical Features of Endometrial Carcinoma

• Abnormal uterine bleeding.
• Abnormal Pap smear.

Prognosis of Endometrial Carcinoma

• Good in localised well-differentiated tumors.
• Poor in spreading or poorly differentiated tumors.

Malignant Mixed Mesodermal Tumors

• Rare tumors derived from primitive stromal cells in post-menopausal women.
• Gross: bulky, protrude into endometrial cavity and vagina, polypoid.
• Microscopic: glandular structures and stromal sarcomatous elements (muscle, cartilage, osteoid tissue).
• Prognosis: highly malignant, with a 5-year survival rate of 25%.

Tumors of the Myometrium (Leiomyomas)

• Leiomyomas (fibroids): most common uterine tumor in women aged 30-50, related to estrogen stimulation.
• Types of myomas:
  • Intramural: within the uterine wall.
  • Subserous: grows outwards.
  • Submucosal: beneath the endometrium.
  • Cervical: in the cervix.

Morphology of Leiomyomas (Gross)

• Enlarged uterus, irregular, multiple myomas.
• Round, firm, gray-white masses, well-circumscribed, with whorl appearance.

Morphology of Leiomyomas (Microscopic)

• Interlacing bundles of smooth muscle fibers and fibrous tissue.
• Mitotic figures are few.

Effects and Complications of Myomas

• Menorrhagia or metrorrhagia (excessive bleeding).
• Pressure on bladder causing micturition frequency.
• Infertility.
• Degenerations (hyaline, red, cystic, necrosis).
• Malignant change is rare (leiomyosarcoma).

Leiomyosarcoma

• Uncommon tumor, forms bulky, fleshy masses in the uterine wall.
• Microscopic: fascicles of eosinophilic spindled cells with blunt-ended nuclei, showing variable pleomorphism, presence of 10 mitoses per 10 high-power fields.
• Aggressive, widespread dissemination, with a 5-year survival rate of 40%.

Diseases of the Fallopian Tubes

• Inflammation (salpingitis):
  • Suppurative salpingitis: infection with pyogenic organisms (e.g., streptococci, staphylococci, gonococci).
  • Tuberculous salpingitis: hematogenous spread of tuberculosis, or associated with tuberculous endometritis.
• Effects of inflammation: fibrosis, which can cause infertility (if bilateral).

Tumors of the Fallopian Tubes

• Rare.
• Adenocarcinoma: usually arises in the fimbriated portion of the tube.
• Ectopic (tubal) pregnancy: implantation of the fertilized ovum outside the uterine cavity (in the fallopian tube), which can rupture causing hemorrhage.

Explore the different types of uterine anomalies and their impact on women's health. This quiz covers essential topics such as abnormal uterine bleeding, its causes, and specific disorders. Test your knowledge on the anatomical and functional aspects of the uterine body.