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
