8/31/2011

1

Diseases of uterus

8/31/2011

2

Menstrual cycle

Endometrium

8/31/2011

3

Endometrium

Clinical manifestations • abnormal uterine bleeding (AUB) • lower abdominal pain / pelvic pain • dysmenorrhea • infertility

8/31/2011

4

Abnormal uterine bleeding • Normal bleeding : menstruation

• Menstrual blood (normal cycle)

• 28 +/-7 days (21-35 days) interval

• 3-4 days (2-7) duration

• 35 ml (20-80) volume

LMP = the first day of last menstruation

Menarche 12 (8-16)

Menopause 40-55

8/31/2011

5

Abnormal uterine bleeding • Dysfunctional uterine bleeding

(DUB)

• Leiomyoma (myoma uteri)

• Adenomyosis

Dysfunctional uterine bleeding • no organic cause • hormonal imbalance • Ovulatory • Anovulatory

8/31/2011

6

Ovulatory • Inadequate proliferative phase • Inadequate secretory phase • Irregular shedding

Anovulatory • prolonged estrogen stimulation • proliferative endometrium in

secretory phase • endometrial hyperplasia

8/31/2011

7

Endometritis • abortion • postpartum • instrumentation • IUD Pyometra : pus accumulation in uterine cavity

Endometritis

8/31/2011

8

Endometritis

Pelvic inflammatory disease (PID) Salpingitis Oophoritis Salpingo-oophoritis Tubo-ovarian abscess

8/31/2011

9

Endometriosis endometrial tissue in abnormal locations Theories • Regurgitation • Metaplastic • Lymphatic / vascular dissemination

Endometriosis

8/31/2011

10

Endometriosis

Adenomyosis • enclosed endometrial tissue in

myometrium • myometrial endometriosis

8/31/2011

11

Adenomyosis

Endometrial hyperplasia • perimenopausal period • hyperestrogenism • Stein-Leventhal syndrome • Granulosa cell tumor of ovary

8/31/2011

12

Endometrial hyperplasia • Simple hyperplasia : 0.5% - CA • Adenomatous hyperplasia • Atypical hyperplasia : 23% - CA • progestogen therapy • hysterectomy

Endometrial hyperplasia

8/31/2011

13

Endometrial hyperplasia

Endometrial tumors • Endometrial polyp : focal hyperplasia • Endometrial carcinoma • Stromal tumor

8/31/2011

14

Endometrial polyp

Endometrial carcinoma • perimenopause • hyperestrogenism • endometrial hyperplasia • High risk :

obesity, hypertension, DM, nulliparity

8/31/2011

15

Endometrial carcinoma • Endometrioid adenocarcinoma • Secretory carcinoma • Squamous cell carcinoma • Adenosquamous carcinoma • Mucinous carcinoma • Serous carcinoma

Endometrial carcinoma

8/31/2011

16

Endometrial carcinoma

Leiomyomas • most common benign tumor in

females : myoma uteri • locations : intramural, submucosal,

subserosal • Cellular leiomyoma • Atypical leiomyoma

8/31/2011

17

Leiomyoma

Leiomyoma

8/31/2011

18

Leiomyosarcoma

Investigations • pelvic examination • curettage : D/C, fractional curettage • ultrasonography