8/6/2019 Pathology of Uterus

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a o ogy o erus

Pathology

Endometrium Myometrium

Epithelium

Stroma (benign, malignant)

Leiomyoma

Leiomyosarcoma

Adenomyosis

Adenomyoma

Normal Endometrium

Proliferative Phase Secretory Phase

Tall columnar epithelium

Frequent mitotic activity

Tubular glands

Cellular stroma

Tortuous glands

Cuboidal cells

Subnuclear vacoulation

Edematous stroma

Stimulation

Estrogen Progesterone

Stimulate gland (labile cells) Stimulate stroma (stable cells)

Atypia

Nuclear : Cytoplasmic ratio

Hyperchromatism of nucleus

Mitotic activity

Lose polarity

Signs & Symptoms

Abnormal uterine bleeding

Massive per vaginal bleeding

Size of uterus

If menopause, obese likely carcinoma

If perimenopause hyperplasia

If young fibroid, stromal tumour

Menstrual Disorders (DUB Dysfunctional Uterine Bleeding)

Anovulatory cycle (Prolonged estrogen stimulation)

y  Causes Endocrine disorder (eg. Diabetes Mellitus)

y  Primary ovarian disease

y  Generalized metabolic disturbance

(eg. Severe obesity, malnutrition)

Inadequate luteal phase

OCP induced endometrial changes

Endometrial Hyperplasia

Occur after/ around menopause

Cause

Estrogen (abnormal)Absent progestational activity

Endometrial cancer risk

Risk parallel to degree of atypia

Hyperplasia without atypia 2% risk

Hyperplasia with atypia 23% risk

Pathology

Simple Hyperplasia

without atypia

Complex Hyperplasia

(adenomatous

hyperplasia)

Atypical Hyperplasia

(adenomatous

hyperplasia with

atypia)

Cystic/mild

hyperplasia

Stoma cellular

Mitosis scanty

Rarely progress to ca

Loss of polarity

Complex glands

Altered N:C ratio

Mitoses

Morphology

Normal Cystic Glandular Hyperplasia

Adenomatous Hyperplasia

without atypia

Adenomatous Hyperplasia

with atypia

Endometrial Hyperplasia

Thickened endometrium

Endometrial Hyperplasia

Cystic glandular hyperplasia

Endometrial Hyperplasia with atypia

Back-to-back configuration

Intraluminal papillary infolding into gland

Tall, columnar, basophilic

8/6/2019 Pathology of Uterus

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Endometrial Carcinoma

Uncommon < 40 y/o

Risk factors

Obesity

Diabetes

Hypertension

Infertility

Single, nulliparous

History of anovulatory cycles

Breast cancer

Endometrial carcinoma

Fungating, friable

Infiltrating myometrium

Size of uterus

Endometrial carcinoma (Invade myometrium)  

Endometrial g land (labile cells)

Atypical

Infiltrative

Investigations

Pap smear (not helpful)

Ultrasound vaginal, abdominal

Endometrial curettage

Pippelle sampling

Endometrial Stromal Tumour

Types

Benign Malignant

Endometrial stromal nodule Endometrial stromal sarcoma

Mean age 30 y/o Mean age 60 y/o

Very rare

Histopathology diagnosis

Abnormal uterine bleeding

Endometrial Stromal Tumour

Leiomyoma

Most common benign tumours of uterus

Leiomyoma

Non-encapsulated

Whorl appearance

Leiomyoma Leiomyosarcoma

Adenomyosis

Adenomyosis 

Adenomyosis