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Reproductive Pathology DR ELNEMR The Uterine Body Ä Endometrial changes In Menstrual Cycle: Refer To Histology Book. Inflammatory Disorders Endometritis A- Acute Endometritis: It may be due to: 1) Bacterial infections: that arise after delivery or miscarriage, (puerperal sepsis) 2) Sexually trans...

Reproductive Pathology DR ELNEMR The Uterine Body Ä Endometrial changes In Menstrual Cycle: Refer To Histology Book. Inflammatory Disorders Endometritis A- Acute Endometritis: It may be due to: 1) Bacterial infections: that arise after delivery or miscarriage, (puerperal sepsis) 2) Sexually transmitted diseases : as chlamydial or gonococcal infections. Ä Puerperal sepsis: Þ Definition: § It is acute suppurative inflammation of the uterus after labor or abortion. § Mainly due to retained blood clots or placental fragments. Þ Aetiology: § It is caused by pyogenic bacteria as streptococcus hemolyticus or E coli. § Bacteria reach the endometrium mainly through ascending infection from contaminated instruments or gloves, or less commonly spread from other organs. Þ Gross: § The uterus: is large (subinvoluted), soft with shreddy (purulent) yellowish endometrium. § The myometrium: shows septic thrombi in the veins (septic thrombophelipitis) & may show multiple abscesses. Þ Microscopic: § The endometrium shows picture of septic endometritis (inflammation rich in neutrophils, pus cells, with necrosis). § Inflammation may extend to myometrium with multiple abscesses formation. 7 Reproductive Pathology DR ELNEMR Þ Complications: 1) Severe toxemia and septicemia. 2) Septic thrombophelipitis may cause pyemia. 3) Spread of infection to the parametrium, and tubes causing parametritis and salpingitis. 4) Spread of infection to peritoneum may cause localized (in the pelvis) or diffuse peritonitis. 5) Healing of salpingitis causes fibrosis and infertility. B- Chronic Endometritis: Ä Chronic endometritis occurs in association with the following disorders: § Chronic pelvic inflammatory disease (PID) § Intrauterine contraceptive devices Ä The diagnosis of chronic endometritis rests on the identification of plasma cells in the stroma, which are not seen in normal endometrium. Ä Chronic specific inflammations of the endometrium include tuberculosis and bilharziasis. v Chronic tuberculous endometritis § Infection of endometrium is either from: miliary spread or, more often, from drainage of tuberculous salpingitis. § It may present as: abnormal bleeding, pain, discharge, and most important infertility § On biopsy: the endometrium shows multiple granulomata of epithelioid cells, lymphocytes, and Langhans’ giant cells, with foci of caseation. 8 Reproductive Pathology DR ELNEMR Endometriosis & Adenomyosis Endometriosis § Definition: It is the presence of endometrial galnds and stroma in a location outside the inner lining of the uterus. § Sites: It is frequently multifocal and often involves: § Pelvic structures (Douglas pouch, uterine ligaments, and fallopian tubes). § Ovaries. § Peritoneal cavity § Periumbilical tissue § Rarely lymph nodes, lungs or bone. § Pathogenesis: Unknown but theories used to explain endometriosis include: The regurgitation theory The metaplastic theory (more accepted). Proposes menstrual backflow through the fallopian tubes with subsequent implantation Proposes endometrial metaplasia of serosal cells covering ovaries or fallopian tubes. Lymphatic or vascular dissemination theory Used to explain extra pelvic endometriosis. § Gross: § Endometriosis contains functional endometrium which undergoes cyclic bleeding. Þso they appear as red brown foci or nodules. § In the ovaries blood filled cysts are formed. § By time the blood becomes brown in color and are called chocolate cysts. § Organization of the blood occurs leading to Fibrosis and adhesions around the fallopian tubes, and ovaries. 9 Reproductive Pathology DR ELNEMR § Microscopic: diagnosis depends on finding two of the following: endometrial glands, endometrial stroma or hemosiderin pigments. § Complications: § Painful menstruation (dysmenorrhea) due to intrapelvic bleeding. § Pain on defecation or painful intercourse (dyspareunia). § Adhesions around the tubes cause infertility. ADENOMYOSIS § Definition: It is a down growth of endometrium and its entrapment deep within the myometrium. The myometrium undergoes reactive hypertrophy. § Gross: Enlarged uterus with thick myometrium showing trabeculations and haemorrhagic foci. § Microscopic: The myometrium shows foci of endometrial Glands and stroma with hemorrhage or may be endometrial stroma only. § Complications: § Menorrhagia. § Dysmenorrhea. 10