Chap. 19: Pathology of the corpus uteri Flashcards
Par. I: benign pathology
about
Endometrial polyps in general
Polyps are growths exophytic size, shape, number and appearance variables. Polyps
endometrial, in particular, are growths of the mucosa of the corpus uteri, the location of which can
be anywhere in the endometrium (but also at the endocervix).
Regarding the dimensions, may be a few mm or several cm, occupying, in this second case,
much of the uterine cavity and escaping from the external genitalia.
Regards the number may be single or multiple.
Considering the role exerted by estrogen stimulation on their formation, the frequency is
greater in the age group between 30 and 50 years (generally, if encountered in menopause, were already present).
Endometrial polyps. important features. pathology
Important features are:
• Pathology: always consist of an axis-vascular connective covered with epithelium
Endometrial. They have a yellowish-red color and possible neoplastic evolution (therefore,
should always be eliminated). They can be of different nature depending on the content of the surface
pathological:
or adenomatous: glandular ducts lined by cuboidal epithelium
or with adenomatous hyperplasia: very crowded glands with epithelial proliferation type
papillary
or fibrous: poor content with glandular prevalent fibrous structure
Endometrial polyps. important features. symptoms
Symptoms
or Menorrhagia: abundant and prolonged menstruation (a normal menstrual period, you
recalls, involves loss of 70-80 mL of blood per day for 4-5 days)
or Metrorrhagia: bleeding outside the menstrual period (or postmenopausal)
or Menometrorragia: menstruation abundant and prolonged throughout the cycle. All these
un’anemizzazione hemorrhagic conditions can cause slow, progressive and
worsening (since the need for transfusion)
or pain due to uterine contraction (to expel the octopus, recognized as the body
stranger)
Endometrial polyps. Diagnostic imaging
Diagnostic Imaging
or transvaginal ultrasound allows you to evaluate the thickness of the endometrial rhyme: a rhyme
thickened, in fact, allows to suspect a polyp
or hysteroscopy: provides for the introduction into the uterine cavity of a hysteroscope, which, thanks
the use of a physiological solution, will go to distend the uterine cavity.
Nell’isteroscopio is an optical camera connected to an external camera, which
allows a macroscopic view of the cavity. Hysteroscopy allows removing (and
subsequent evaluation biopsy)
or curettage diagnostic and therapeutic
Endometrial hyperplasia
about it in general
Endometrial hyperplasia
It is a condition common in women in perimenopausal period and more rare in the more
young. It is a result of hormonal imbalances hyperestrogenism characterized by absolute or relative, due to
anovulation or luteal insufficiency, or secondary to estrogen therapies do not adequately
balanced with the progestin: it is as if, under the stimulus of estrogen and / or lack of adequate
stimulus progestin, endometrial epithelium proliferasse more than they should (therefore, the pill, being a
estrogen-progestagen does not cause endometrial hyperplasia).
By the term “hyperplasia” is included, then, various morphological aspects of the endometrium, ranging from
simple glandular crowding, bordering the proliferative endometrium, up hyperplasia
adenomatous with cytologic atypia, virtually indistinguishable from a well-differentiated carcinoma
endometrial hyperplasia. pathology.
Important aspects are:
• Pathology:
or Types
Simple: increased number of glands, but no branching glandular
Cystic: is a variant of the previous one, in which there is expansion and modification
morphological glands
Complex or adenomatous: polymorphism with buttressing of glandular
glands (look “back to back”), and the reduction of glandular ramifications
stromal component
or atypia: the above types may arise or less with atypia: the presence of atypia is very
important because it does veer toward a benign lesion preneoplastic
Endometrial hyperplasia. symptoms
• Symptoms
or polimenorrea: menstruation that lasts for several days
or Main-, metr- or menometroragie
Endometrial hyperplasia. diagnostic imaging.
Diagnostic Imaging
or transvaginal ultrasound
or hysteroscopy
Treatment of polyps
• Polyps: are always eliminated the risk of evolution
treatment of typical Hyperplasia
or Typical: hormonal treatment with progestins
treatment of atypical hyperplasia. adolescents. inwoman of reproductive age, in woman over fourty
or Atypical: should be treated more aggressively:
Adolescent: progesterone or progestogens
In women of reproductive age: as above (curettage in cases where the therapy
hormone is not possible)
In women with more than 40 years:
• Danazol
• GnRH Analogs: allow a state of hypoestrogenism only transitional and, therefore, are shown only in view of a surgical treatment
• Endometrial ablation transuterina
treatment of atypical hyperplasia. in menopause.
In menopause:
• Hysterectomy with annessectomia
• Ablation is more conservative and its use is supplanting what
hysterectomy
Leiomyomas
growth location, constitution, distinguishing by
Uterine growths are benign and of various volume (even weigh a few kilograms);
are the most common benign neoplasm of the female genitalia (especially between 40 and
50 years) and are constituted by bundles of smooth muscle cells and connective tissue intertwined in
varying proportions. Therefore, they are distinguished, according to the ratio of the muscular component and Connective: myomas, fibroids and fibroids
leiomyomas. location details
The location can be single or multiple (but always with distinct nodules). For uterus is fibromatous
intends, however, a womb in which the fibrous component has taken precedence over that muscle: it has,
therefore, an invasion fibrous uterus in full (and not as in nodular fibroids)
leiomyomas. localization of nodules.
mportant features are:
• Localization of nodules (which may be pedunculated or sessile):
or subserosal: nodules develop under the perimetrium, extend into the abdominal cavity
and, being furthest from the uterine cavity, rarely give symptoms
or Intramural: develop in the thickness of the myometrium
or Submucosa: protrude into the uterine cavity and are clearly visible in hysteroscopy. Those Ones
pedunculated with long stalk can leak from the cervix. However, the
subserosal generally are those that give more challenges, changing the scale
menstruation and going to alter the phenomena of hemostasis local
or Intralegamentare: you go to locate the margins in the wall of the uterus, within the
broad ligament, in the vicinity of the vessels
or “in transit”: a few nodules, for example, depart from outside (subserosal) and reach the
uterus (intramural and then submucosal)
