Upload File

normal uterine anatomy and histology in the non-pregnant ...files. · normal uterine anatomy and...

  • Home
  • Documents
  • Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,
26
Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Pa7ent Evelyn Lockhart, MD Medical Director, UNM Hospital Transfusion Service Associate Professor, Pathology and Obstetrics/Gynecology University of New Mexico Health Science Center FWGBD Uterine Hemostasis Colloquium 4/5/2017

Upload: buikien

Post on 15-Apr-2019

217 views

Category:

Documents


0 download

Report

TRANSCRIPT

Page 1: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Pa7ent

EvelynLockhart,MDMedicalDirector,UNMHospitalTransfusionService

AssociateProfessor,PathologyandObstetrics/GynecologyUniversityofNewMexicoHealthScienceCenter

FWGBDUterineHemostasisColloquium4/5/2017

Page 2: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

• None

Disclosures

Page 3: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Uterus

•  Nulliparous:6-8cminlength

•  MulWparous:9-10cminlength

•  Consistsofthemainbody(corpus),withasuperiorfundus

•  ConstricWonofthebodyoccurssuperiortothecervix(isthmusofuterus)

Image©2015-2017TeachMeAnatomy.info[CC-BY-NC-ND4.0]

Isthmus

Page 4: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Source:Chapter14.FemaleReproducWveSystem,TheBigPicture:GrossAnatomyCitaWon:MortonDA,ForemanK,AlberWneKH.TheBigPicture:GrossAnatomy;2011

Page 5: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Uterus: Rela7onship to Pelvic Organs

UterusRectum

Ovary

Uterine(Fallopian)tube

Bladder

Anterior

Posterior

ImagefromPelvicandRetroperitonealSpace;SobodaAtlasofHumanAnatomy,Vol.2,Paulsen,FEd.Pg157-240,Fig7.76,©2013

Page 6: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Rela7onship of Bladder to Uterus

ImagefromPelvicandRetroperitonealSpace;SobodaAtlasofHumanAnatomy,Vol.2,Paulsen,FEd.Pg157-240,Fig7.76,©2013

Bladder

Uterus

Page 7: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Uterine Peritoneal Reflec7ons

Source: MaternalAnatomy, WilliamsObstetrics,24eCitation: Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS. WilliamsObstetrics,24e; 2013

UteruscoveredbyreflecWonofthepelvicperitoneum(liningoftheabdominalcavity)

•  ReflecWonconWnueslaterallytoformthebroadligament.

•  Broadligamenthousesthemajoruterinevesselsandthefallopiantubesattheirapices.

Page 8: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Uterine Size Through Lifespan

ImagefromObstetrics:NormalandProblemPregnancies.GabbeSEd.,pg1224.e16,E-FigA2-28.©2017.

Infant

Nulliparous

MulCparous

Followingmenopause,uterusshrinks,oientonulliparoussize

Page 9: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Uterine Fundus Levels During Pregnancy

ImagefromPelvicandRetroperitonealSpace;SobodaAtlasofHumanAnatomy,Vol.2,Paulsen,FEd.Pg157-240,Fig7.81,©2013

Page 10: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Uterus With Placenta and Fetus (near term)

Cervicalmucusplug

ImagefromPelvicandRetroperitonealSpace;SobodaAtlasofHumanAnatomy,Vol.2,Paulsen,FEd.Pg157-240,Fig7.80,©2013

Page 11: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Major Vessels of the Pelvis

Aorta

Commoniliacartery

Internaliliacartery

ImagefromObstetrics:NormalandProblemPregnancies.GabbeSEd.,pg1224.e16,E-FigA2-21.2017.

VenaCava

Page 12: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Uterine Arterial Supply

Image©2015-2017TeachMeAnatomy.info[CC-BY-NC-ND4.0]

DirectaorCcflow

Uterineartery:branchfrominternaliliacarteryOvarianartery:directbranchfromaortaDualarterialsupplytouterusfromanastomosesbetweenthesetwosystems

Page 13: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Uterine Venous Systems

Imagefrom:MaxBrödel'sPelvicAnatomy(Fig3-13),inAtlasofPelvicAnatomyandGynecologicSurgery.Baggish,MS,Ed.Pages75-92.©2016.

UterineveinsaccompanytheirrespecWvearteries.Uterineveinsemptyintointernaliliacvein.Ovarianveins:•  Right:empWesintovenacava

•  Lei:empWesintoleirenalvein

Page 14: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Uterine Histology

Threemajorlayers:1.   Endometrium:fibroblast

stromalcellsandendometrialglands

2.   Myometrium:smoothmusclecells,vascularplexus,andlymphaWcs

3.   Perimetrium:serosalconnecWveWssuelayer

ImagefromURL:hdp://medcell.med.yale.edu/histology/female_genital_tract_uterine_cycle.php,

lastaccessed4/1/2017

Page 15: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Myometrium

•  Mostlysmoothmuscle,butalsocontainscollagen,elasWnandfibronecWn.

•  Outerlongitudinalmuscularlayer•  Innercircularsubmucosallayer•  ThickmiddlelayerrichwithvesselsandrandominterdigitaWngfibers

•  Moresmoothmuscleinbody,lessinloweruterinesegmentandcervix

Imagesfrom:FemaleReproducWveSystem,inStevens&Lowe'sHumanHistology.LoweJS,AndersonPG.Pages337-362.©2015.FIGURE17.10

Non-pregnant

8mo.pregnant

Page 16: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Myometrial Growth During Pregnancy

•  Estradioldrivesmyometrialhypertrophyandhyperplasia

• MyometrialcellshavedramaWcincreaseinnumberofgapjuncWons(topermitforcoordinateduterinecontracWons)

• Uterineweightincrease:~75gà~1300g

•  Followingdelivery:•  Lossof85%ofweightin3weeks,mostlyduetointracellularvolumecontracWonandcollagendegradaWon.

Page 17: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Myometrium

•  JuncWonalZone(JZ):lowsignalonT2-weightedMRIidenWfyingjuncWonbetweenbasalendometriumandmyometrium.

•  JZlessprominentinpre-menarcheandpost-menopause;poorlyseeninpregnancybutreappearsweekstomonthspost-delivery.

•  Moreconcentricmyocytearrangement(outerismorelongitudinal)

Novellas,etal.AJR.2011;196:1206–1213

JuncWonalZone:shortarrowsFullmyometrium:longarrows

Page 18: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Myometrialsmoothmusclecompressbloodvesselswhencontracted.

Source: MaternalAnatomy, WilliamsObstetrics,24eCitation: Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS. WilliamsObstetrics,24e; 2013

Page 19: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Uterine Corpus Endometrial Histology Twolayers:1.   Basalis

•  IrregularjuncWonwithmyometrium,interdigitatedwithsmoothmuscleandendometrialstroma

•  “Reservecelllayer”oftheendometrium

•  Fewchangeswithmenstrualcycle

2.   FuncConalis•  Containsdistalendometrialglands•  Significantchangeswithmenstrualcycle

ImagefromURL:hdp://medcell.med.yale.edu/histology/female_genital_tract_uterine_cycle.php,

lastaccessed4/1/2017

Page 20: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Source:Chapter9.FemaleReproducWveSystem,EndocrinePhysiology,4eCitaWon:MolinaPE.EndocrinePhysiology,4e;2013

Page 21: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Prolifera7ve Endometrium

ImagefromURL:hdps://librepathology.org/wiki/ProliferaWve_phase_endometrium,lastaccessed4/1/2017

Stromalcells:small,scantcytoplasm•  LateproliferaWve:increased

intra-andextracellularcollagen

Glands:small,straight

Page 22: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Secretory Endometrium

ImagefromURL:hdps://librepathology.org/wiki/Secretory_phase_endometriumlastaccessed4/1/2017

Glands:Coiled,serratedStromalcells:“PredecidualizaWon”—smallsheetsofpolygonalcellswithdisWnctcellsbordersduetoincreasedpericellularmatrixIncreasedstromaledema

Page 23: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Decidualized Endometrium

ImagefromURL:hdp://library.med.utah.edu/WebPath/PLACHTML/PLAC094.htmlLastaccessed4/1/2017

•  Decidua:specializedendometrialstromaofpregnancy

•  SecretesproductsinvolvedwithparacrineandautocrineregulaWonoffeto-maternalinterface.

•  DecidualcellsarecapableofphagocytosisandplayroleincollagenscaffoldbreakdownatimplantaWonsite.

Page 24: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Source: The Female Reproductive System, Junqueira's Basic Histology, 14e Citation: Mescher AL. Junqueira's Basic Histology, 14e; 2016

Microvascular Supply of Endometrium

Uterineandovarianarteriesgiverisetoarcuatearteries.Arcuatearteriesbranchintoradial,straightandspiralarteries,whichsupplyendometrium.

Page 25: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Uterine Microvasculature During Menses

Imagefrom:FemaleReproducCveSystem;TextbookofHistology.Gartner,LEd.Pages529-558.e3.©2017.Figure20–11

Withlossofendometriallayer,fluidwithintheuterinecavitycanentertheuterinevenoussystem.Uterineintrinsicveinsdonotcontainvalves;1lossofendometriallayeralsocausesvenousbloodloss.

Uterinecavity

1.Chap59:ManagementofpelviccongesWonsyndromeandperinealvaricosiWes.WhiteJV,SchwartzLB,RyjewskiC.InHandbookofVenousandLymphaWcDisorders,4thEd.GloviczkiP,Ed.2017CRCPressp685-687

Page 26: Normal Uterine Anatomy and Histology in the Non-pregnant ...files. · Normal Uterine Anatomy and Histology in the Non-pregnant and Pregnant Paent Evelyn Lockhart, MD Medical Director,

Ques7ons?


The Incidence of Postpartum Hemorrhage in Pregnant … · between endometrial damage and uterine scarring and subsequent placenta previa [4]. Mean-while, the condition is frequently

Uterine endoplasmic reticulum stress-unfolded protein response … · plications that adversely effect neonatal health (3, 4). In this study, we demonstrate that the pregnant rodent

Uterine torsion of term pregnant uterus due to anterior fibroid

Uterine sarcoma: a rare cause of uterine inversion · Uterine sarcoma: a rare cause of uterine inversion To the Editor: We describe a case of uterine inversion associated with endometrial

Uterine Gland Microstructure in the Pregnant and the Non … · Uterine Gland Microstructure in the Pregnant and the Non-pregnant Lesser Galago (Galago senegalensis) Microestructura

Uterine Anomaly, Fibroid Uterus, Ovarian Tumor, Uterine Prolapse

tortion.pdf · Introduction Uterine torsion is one of the most common affections, of pRgnant buffaloes and cattle in upper Egypt. It affects the pregnant animals in the last

Adenomyosis: Difficult to Diagnose, and Difficult to Treatdownloads.hindawi.com/journals/dte/2001/340321.pdf · 90 C. WOOD women having MRI and uterine histology have adenomyosis[12]

Uterine Manipulator Manipulador Uterino Uterine Manipulator

Treating Symptomatic Uterine Fibroids with Uterine Fibroid

Introduction to Histology - JU Medicinedoctor2017.jumedicine.com/.../7/2018/01/Introduction-to-Histology-.pdfIntroduction to Histology . Histology The term "Histology" is derived from

Reproductive diseases of sheep and goats · •Pregnant animals shed large amounts of C. abortus in the placentaand uterine discharges when they abort or givebirth. •Can cause abortion

Abnormal Uterine Bleeding and Uterine Fibroids (for …...Title Abnormal Uterine Bleeding and Uterine Fibroids (for Louisiana Only) – Community Plan Medical Policy Author UnitedHealthcare

Female Reproductive System - PUMCanatomy.sbm.pumc.edu.cn/mobile/files/pdf/Histology...Dept. of Anatomy, Histology & Embryology PUMC [email protected] 69156461 N I. Ovary II. Uterine

Dysfunctional uterine bleedingDysfunctional uterine bleeding: Abnormal uterine bleeding is a common presenting problem. (DUB) is defined as abnormal uterine

Uterine Fibroids Training - Boston · PDF fileSelect from these topics Uterine Fibroids Anatomy Standard Treatments Uterine Fibroid Embolization UFE Clinical Outcomes UTERINE FIROIDS

Uterine fibroid tumors | treatment of uterine cysts | plano, tx

Histology 1 - Histology methods

Abnormal Uterine Bleeding and Uterine Fibroids (for

Vascularização uterina de éguas prenhes de jumento e de ...Pregnant mares mated by asses presented higher uterine vascularization in non-pregnant horn than pregnant mares mated

Case Report First Trimester Uterine Rupture, a Rare but ...ijms.sums.ac.ir/index.php/article_44948_a6624227a6846620761f343… · of probable diagnosis of uterine rupture in a pregnant

IS UTERINE FIBROID EMBOLIZATION UTERINE RIGHT FOR YOU

Uterine Fibroids Training - Boston Scientific · PDF fileSelect from these topics Uterine Fibroids Anatomy Standard Treatments Uterine Fibroid Embolization UFE Clinical Outcomes UTERINE

Cytology and Histology of Glandular Lesions of the Uterine ... · Cytology and Histology of Benign Glandular Lesions of the Uterine Cervix Máire A. Duggan MD, FRCPC, 9. th. Annual

Abnormal Uterine Bleeding and Uterine Fibroids

Abnormal Uterine Bleeding in Non-Pregnant …...Polyps and fibroids can lead to abnormal uterine bleeding. Polyps are non-cancerous growths of the lining of the uterus. Fibroids are

Interactions between inflammatory signals and the ... · Interactions between inflammatory signals and the progesterone receptor in regulating gene expression in pregnant human uterine

OBG028_Abnormal Uterine Bleeding Uterine Fibroids_12-12.pdf

Female genital system - JU Medicine...(Junqueira's Basic Histology Text and Atlas, 14th Edition. Uterine Tube. Uterine Tube It has 4 segments Intramural part in uterine wall Isthmus

times a day. Dose of diclofenac higher than 225 mg/day is not · uterine rupture. uterine rupture has been reported when misoprostol was administered in pregnant women to induce labor

Uterine Fibroids - Scbtmr€¦ · Uterine Fibroids: Not As Simple As You Think [email protected] . Uterine Leiomyoma •Most common uterine neoplasm –20-30% women >35yo •Under

Effect of Camphor on Uterus Histology of Pregnant Rats · 2010-02-27 · Effect of Camphor on Uterus Histology of Pregnant Rats 81 Fig. 3. A cross-section for one week gestation (5

Management of uterine adenomyosis: current trends and uterine … · 2019. 4. 27. · EDUCATIONAL REVIEW Open Access Management of uterine adenomyosis: current trends and uterine

Uterine myomas: management - Uterine Fibroids - Hope For Fibroids

Effect of Camphor on Uterus Histology of Pregnant Rats