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Questions and Answers
What is an example of a congenital uterine anomaly characterized by two separate halves of the uterus?
What is an example of a congenital uterine anomaly characterized by two separate halves of the uterus?
Which uterine condition refers to excessive prolonged bleeding during menstruation?
Which uterine condition refers to excessive prolonged bleeding during menstruation?
What type of uterine anomaly is characterized by a heart-shaped uterus?
What type of uterine anomaly is characterized by a heart-shaped uterus?
Which of the following is a non-organic cause of dysfunctional uterine bleeding?
Which of the following is a non-organic cause of dysfunctional uterine bleeding?
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Which condition is NOT a classification of endometriosis?
Which condition is NOT a classification of endometriosis?
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Chronic endometrial inflammation can result from which of the following?
Chronic endometrial inflammation can result from which of the following?
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What is endometriosis primarily characterized by?
What is endometriosis primarily characterized by?
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Which hormonal condition is associated with hyper-estrogenic states leading to dysfunctional uterine bleeding?
Which hormonal condition is associated with hyper-estrogenic states leading to dysfunctional uterine bleeding?
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What is the primary characteristic of adenomyosis?
What is the primary characteristic of adenomyosis?
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Which type of endometrial hyperplasia involves cytologic changes?
Which type of endometrial hyperplasia involves cytologic changes?
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What is a common risk factor for carcinoma of the endometrium?
What is a common risk factor for carcinoma of the endometrium?
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What is a significant prognostic factor for endometrial carcinoma?
What is a significant prognostic factor for endometrial carcinoma?
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Which type of endometrial cancer is characterized as well differentiated?
Which type of endometrial cancer is characterized as well differentiated?
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What is the typical presentation for malignant mixed mesodermal tumors?
What is the typical presentation for malignant mixed mesodermal tumors?
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Which of the following is NOT a characteristic of endometrial polyps?
Which of the following is NOT a characteristic of endometrial polyps?
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What defines simple endometrial hyperplasia?
What defines simple endometrial hyperplasia?
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What is the site of myoma located just below the endometrium projecting into the uterine cavity called?
What is the site of myoma located just below the endometrium projecting into the uterine cavity called?
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Which of the following is a characteristic microscopic feature of a myoma?
Which of the following is a characteristic microscopic feature of a myoma?
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What serious complication can occur due to degenerations of myomas?
What serious complication can occur due to degenerations of myomas?
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What is the most common tumor found in the fallopian tubes?
What is the most common tumor found in the fallopian tubes?
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What condition results from the implantation of a fertilized ovum outside the uterine cavity?
What condition results from the implantation of a fertilized ovum outside the uterine cavity?
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What is one of the main effects of bilateral salpingitis on reproductive health?
What is one of the main effects of bilateral salpingitis on reproductive health?
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What is the survival rate at 5 years for patients diagnosed with leiomyosarcoma?
What is the survival rate at 5 years for patients diagnosed with leiomyosarcoma?
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Which type of salpingitis is primarily caused by infection with pyogenic organisms?
Which type of salpingitis is primarily caused by infection with pyogenic organisms?
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Study Notes
Female Genital Diseases - Uterine Disorders
- Congenital uterine anomalies occur in less than 5% of women but up to 25% of women with miscarriages or premature births.
- Types of uterine anomalies include:
- Didelphys: the two halves of the uterus are separate.
- Arcuate: a uterus with an indentation on the top.
- 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: a term for bleeding that doesn't have an underlying structural abnormality. Hormonal imbalances are a common cause.
- Dysfunctional uterine bleeding (DUB): uterine bleeding that lacks an underlying structural abnormality. It is caused by hormonal abnormalities.
- Menorrhagia: excessive prolonged menstrual bleeding.
- Metrorrhagia: bleeding between menstrual 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: such as polycystic ovarian disease, cortical stromal hyperplasia, and functioning ovarian tumors.
- Other systemic endocrine disorders: thyroid or adrenal diseases or pituitary tumors.
Inflammation of the Endometrium (Endometritis)
- Acute endometritis: caused by gonorrhea or puerperal sepsis.
- Chronic endometritis:
- Patients with Chlamydia and other intrauterine infections.
- Post-abortion or partial abortions 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 presents with pelvic pain.
- Adenomyosis: Presence of endometrial foci in the myometrium, causing diffuse enlargement and irregular thickening of the uterus. Cut sections show hemorrhagic spots.
Endometrial Polyps
- Sessile mass composed of endometrial glands and stroma.
- Benign, but occasionally may show endometrial hyperplasia or cancerous changes.
Endometrial Hyperplasia
- Characterized by glandular and stromal proliferation.
- Results from an abnormally high and prolonged level 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 dilation, and stromal cells are plump.
- Complex hyperplasia without atypia: glands of varying size are crowded 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 (post-menopause).
- Less common than cervical cancer.
- Risk factors include: obesity, diabetes mellitus, infertility, endometrial hyperplasia, and hyperestrogenemia.
- Morphology (gross): localized polypoid tumor; diffuse spreading lesion.
- Morphology (microscopic): well-differentiated adenocarcinoma (endometrioid) with squamous, secretory, or mucinous differentiation (metaplasia); poorly differentiated carcinoma (pattern of clear cell carcinoma and/or pattern of papillary serous carcinoma).
- Clinical features: abnormal uterine bleeding or abnormal Pap smear.
- Prognosis depends on tumor type and grade; 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: protruding into the endometrial cavity and vagina, bulky and polypoid.
- Microscopic: composed of glandular structures and stromal sarcomatous elements (muscle, cartilage, osteoid tissue).
- Prognosis: highly malignant; 5-year survival rate is 25%.
Tumors of the Myometrium (Leiomyomas)
- Most common tumor in women in their 30s and 40s.
- Related to estrogenic stimulation.
- Types of myomas:
- Intramural: arises within the uterine interstitium.
- Subserous: grows outward, covered by peritoneum.
- Submucosal: lies below the endometrium, projecting into the uterine cavity.
- Cervical: occurs within the cervical stroma.
- Morphology (gross): enlarged uterus, may be irregular with multiple myomas; cut section shows round, firm, gray-white masses that are well-circumscribed but not encapsulated, with a whorl appearance.
- Morphology (microscopic): interlacing bundles of smooth muscle fibers and fibrous tissue; mitotic figures are scarce.
- Effects/complications: menorrhagia or metrorrhagia, pressure on the bladder causing urinary frequency, infertility, degenerations (hyaline, red, cystic, necrosis), rare malignant change (leiomyosarcoma).
Leiomyosarcoma
- Uncommon tumor, 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.
- The tumor disseminates throughout the abdominal cavity and metastasizes aggressively.
- 5-year survival rate is 40%.
Diseases of the Fallopian Tubes
- Inflammation (salpingitis):
- Suppurative salpingitis: infection with pyogenic organisms (streptococci, staphylococci, gonococci).
- Tuberculous salpingitis: hematogenous spread of tuberculosis into the tubes or associated with tuberculous endometritis.
- Effects: fibrosis, which may cause infertility (bilateral).
- Tumors: 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; tube enlarges, then ruptures, causing hemorrhage and acute abdomen (severe pain).
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Description
Explore the various congenital uterine anomalies and disorders affecting the uterine body, ranging from abnormal uterine bleeding to specific types of uterine shapes. Understand the underlying causes and classifications of these conditions in this informative quiz.
