ENDOMETRIUM NORMAL MENTRUAL CYCLE NORMAL HISTOLOGY ENDOMETRIOSIS ADENOMYOSIS

ENDOMETRIUM

NORMAL MENTRUAL CYCLE NORMAL HISTOLOGY ENDOMETRIOSIS ADENOMYOSIS ENDOMETRIUM HYPERPLASIA LEIOMGOMAS (FIBROIDS)

NORMAL MENSTRUAL CYCLE ØPROLIFERATIVE STAGE-ESTROGEN DEPENDENT ØSECRETORY PHASE-PROGESTRONE DEPENDENT

PROLIFERATIVE PHASE-HISTOPATHLOGY üGLANDS ARE STRAIGHT TUBULAR AND STRUCTURES ARE LINED BY REGULAR TALL , PSEUDOSTRATIFIED COLUMNAR CELLS üMITOTIC FIGURES ARE NUMEROUS üNO EVIDENCE OF MUCUS SECRETIONS üNO VACUOLATION üSTROMA-THICKLY COMPACTED SPINDLE CELLS THAT HAVE SCANT CYTOPLASM BUT ABUNDANT MITOTIC ACTIVITY

SECRETORY PHASE-HISTOPATHOLOGY • POST OVULATORY PHASE-BASAL SECRETORY GRANULES IN GLANDS • DILATED TORTOUS GLANDS GIVING IT A SERRATED APPEARANCE • SECRETIONS IN THE LUMEN • STROMAL CHANGES-1. PROMINENT SPIRAL ARTERIOLES 2. STROMAL OEDEMA 3. CYTOPLASMIC EOSINOPHILIA(PREDICIDUAL CHANGE)

Proliferative endometrium

Secretory endometrium

ENDOMETRIAL HYPERPLASIA v. NOW CALLED AS ENDOMETRIAL INTRAEPITHELIAL NEOPLASIA v. DUE PROLONGED ESTROGEN EXPOSURE 1. MENOPAUSE 2. POLYCYCTIC OVARIAN DISEASE 3. FUNCTIONING GRANULOSA CELL TUMORS OF OVARY 4. ESTROGEN REPLACEMENT THERAPY v. KEY FACTOR INACTIVATION OF PTEN TUMOUR SUPPRESSOR GENE

ENDOMETRIAL HYPERPLASIA-HISTOPATHOLOGY 1. SIMPLE HYPERPLASIA TYPICAL ATYPICAL 2. COMPLEX HYPERPLASIA TYPICAL ATYPICAL

HISTOPATHOLOGY –SIMPLE HYPERPLASIAS TYPICAL –CYSTIC DILATIONS OF THE GLANDS WITH VARIOUS SIZES CALLED CYSTO-GLANDULAR HYPERPLASIA ATYPICAL-CYTOLOGIC ATYPIA

Cystic glandular hyperplasia

Simple hyperplasia with atypia

HISTOPATHLOGY-COMPLEX HYPERPLASIAS TYPICAL-INCREASE IN SIZE OF ENDOMETRIAL GLANDS WITH GLAND OVERCROWDING , ENLARGEMENT AND IRREGULAR IN SHAPE. ATYPICAL-1. NUCLEAR ENLARGEMENT STRATIFICATION ALSO CALLED AS ENDOMETRIAL INTRAEPITHELIAL NEOPLASIA. 2. BORDERS ON ENDOMETRIAL ADENOCARCINOMA. 3. INCREASED MITOTIC FIGURES.

Complex hyperplasia with atypia

ENDOMETRIOSISPRESENCE OF ENDOMETRIAL GLANDS OR STROMA IN ABNORMAL LOCATIONS OUTSIDE THE UTERUS ØOVARIES ØUTERINE LIGAMENTS ØRECTOVAGINAL SEPTUM ØPELVIC PERITONEUM ØLAPROTOMY SCARS ØUMBLLICUS, VAGINA, VULVA, APPRENDIX. C/F: INFERTILITY, DYSMENORRHEA, PELVIC PAIN.

THEORIES OF ENDOMETRIOSIS üREGURGITATION IMPLANTATION THEORY üMETAPLASTIC THEORY üVASCULAR OR LYMPHATIC DISSEMINATION THEORY

Theories of endometriosis

ENDOMETRIOSIS-HISTOPATHLOGY v. THESE ECTOPIC FOCI RESPOND TO HARMONAL STIMULATION WITH CYCLICAL BLEEDING v. ORGANISED HAEMORRAGE CAN CAUSE FIBROSIS AND ADHESIONS BETWEEN TUBES AND OVARIES v. C/S OVARIES-CHOCOLATE CYSTS v. HISTOPATHLOGICAL EXAMINATION: ENDOMETRIAL GLANDS ENDOMETRIAL STROMA HAEMOSIDERIN PIGMENT

Chocolate cyst of the ovary-ovarian endometriosis

ADENOMYOSIS ØPRESENCE OF ENDOMETRIAL TISSUE IN THE UTERINE WALL ØDOWNGROWTH OF ENDOMETRIAL TISSUE IN THE MYOMETRIUM Ø 2 -3 MM BELOW THE STRATUM BASALIS ØHISTOPATHLOGICAL EXAMINATION: ENDOMETRIAL TISSUE WITH STROMA IN THE MYOMETRIUM ØC/F-MENORRHGIA, COLICKY DYSMENORRHEA, DYSPAREUNIA

LEIOMYOMAS(FIBROIDS) n n n 75% FEMALES IN REPRODUCTIVE AGE GROUP Usually asymptomatic Clinical features abnormal bleeding urinary frequency back pain impaired fertility spontaneous abortion fetal malpresentation post partum hemorrhage

Gross morphology Well circumscribedsolid grey white with a whorled appeareance n Submucosal fibroid -fibroid within the endometrial cavity n Intramural fibroid -fibroid within the myometrium n Subserosal fibroid -fibroid growing on the serosa of uterus

Intramural and subserosal fibroid

MICROSCOPY n n n WHORLED PATTERN OF SMOOTH MUSCLE BUNDLES INDIVIDUAL MUSCLE CELLS ARE UNIFORM IN SIZE AND SHAPE AND HAVE CHARACTERISTIC OVAL NUCLEUS WITH LONG SLENDER BIPLOAR CYTOPLASMIC PROCESSESS RARE MITOSIS

Leiomyoma -microscopy

VARIANTS-LEIOMYOMAS n n n Atypical/Bizzare leiomyomas-also called symplastic leiomyomas Benign metastasising leiomyomas-extends into vessels and migrates to other sites like lung Disseminated peritoneal leiomyomatosis (parasitic leiomyomas)

DEGENERATIONS n Red degenerations n Hyaline degenerations n Fatty degenerations n Osteiod degenerations n Mucoid degenerations