DI

SEASESOFTHEUTERUS

TOPI
CS:

1.Endomet
ri
alHy
per
lapsi
a

2.Endomet
ri
osi
s

3.Lei
omy
oma

4.Endomet
ri
alCar
cinoma

5.CancerCer
vix

1.ENDOMETRI
ALHYPERLAPSI
A-VELARDE

Def
ini
ti
on:

 Hyper
lapsi
aoft
heendomet
ri
um asar
eact
iont
oabnor
mal
est
rogeni
c
st
imul
ation.

Age:

 Ar
oundmenopause

Causes:

Pr
olongedest
rogenst
imul
ati
onofendomet
ri
um duet
orel
ati
veorabsul
ute
hy
per
est
reni
sm e.
g

 Repeat
edanov
ulat
orycy
cles

 Est
rogenr
epl
acementt
her
apy

 Est
rogensecr
eti
ngov
ari
ant
umor
s

Ty
pes

1.Si
mpl
e(mi
ld-
cyst
ic)non-
aty
picalhy
per
plasi
as:

 Charact
erizedbyprol
if
erat
ingendomet
ri
algl
andsofv
ari
oussi
zes.The
sur
roundingstromalcel
laredense
 Noat
ypi
a

 Thesel
esi
onsuncommonl
ypr
ogr
esst
oadenocar
cinoma
2.Compl
exAt
ypi
calHy
per
plasi
as

 Exhi
bitani
ncreaseint
henumberandsizeofendomet
ri
algl
ands.Thegl
andsar
e
l
inedbymulti
plelay
ersofept
hel
i
alcel
l
sshowi ngat
ypi
a.

 Mostoft
hecasesar
efol
l
owedbyedomet
ri
aladenocar
cinoma
 2.ENDOMETRI
OSI
S-TEJERO&SURATE

Def
ini
ti
on

 Pr
esenceofendomet
ri
alt
issuei
nabnor
mal
sit
es.

Ty
pes

I
.Endomet
ri
osi
sInt
erna(
Adenomy
osi
s)

 Pr
esenceofendomet
ri
alt
issuei
nsi
det
hemy
omet
ri
um

 Pat
hogenesi
s:Di
ppi
ngoft
hebasal
lay
eroft
heendomet
ri
um i
nsi
det
he
myometr
ium

 Gr
ossl
y:

 Enl
argedUt
erus

 Thi
ckmy
omet
ri
um

 Showi
ngsmal
lgr
ayi
shorhemor
rhagi
cfoci

 Mi
croscopi
cal
ly

 Themyometr
ium showsi
slandsofendomet
ri
alt
issuef
ormedofendomet
ri
al
gl
andsandst
roma
  Compl
icat
ions

 Menor
rhagi
a

 Dy
smenor
rhea(
pai
nful
menst
ruat
ion)

I
I.Endomet
ri
osi
sExt
erna

Def
ini
ti
on

 Pr
esenceofendomet
ri
alt
issueout
sidet
heut
eri
newal
l

Si
tes

a.Geni
tal
:ov
ari
es,
F.Tubes

b.Ext
rageni
tal
:wall
ofuri
narybladderori
ntest
ine,
rect
ovagi
nal
sept
um,
pel
vi
c
per
it
oneum, umbi
li
cus,
lung,L.Ns..

Pat
hogenesi
s

 Unknown;
theor
ies;

1.Regurgi
tat
ionTheor
y-r
efl
uxthesheddedendomet
ri
alt
issuet
otheov
ari
es
andtubedduri
ngmenst
ruati
on.

2.Met
apl
asti
cTheor
y-met
apl
asi
aoft
heser
osal
cel
l
scov
eri
ngt
heov
ary
,
r
ect
um..
.

3.Vascul
arandLy
mphat
icTheor
y-Theendometr
ial
tissuedissemi
nat
ethr
ough
bl
oodvessel
sandl
ymphati
csi
mulat
ingthet
umorspr ead.

Gr
ossl
y

 Theaf
fect
edt
issueshowssmal
lgr
ayi
shorhemor
rhagi
cfoci

Mi
croscopi
cal
ly

 Endomet
ri
alt
issue(
glandsandst
roma)wi
thar
easofhemor
rhage

Compl
icat
ions

 Pai
nandhemor
rhagei
ntheaf
fect
edar
ea
 Theov
ari
esshowchocol
atecy
sts

 Per
it
oneal
hemor
rhagei
scompl
i
cat
edbyf
ibr
osi
sandadhesi
ons.

.
 3.LEI
OMYOMA-SAWADJAAN

 Commonestbeni
gnt
umori
nfemal
es

 Occur
sdur
ingchi
l
dbear
ingper
iod

Pr
edi
sposi
ngf
act
ors:

 Pr
olongedest
rogeni
cst
imul
ati
on

Gr
ossl
y-ut
eri
newal
lmass(
es)

 Si
ngleormulti
ple,r
ounded,
fir
minconsi
stency
,pal
ebr
owni
ncol
or,
sur
rounded
bypseudocapsule

 Cutsect
ioni
swhor
ly

 Themass(
es)maybei
nter
sti
ti
al,
subser
ousorsubmucous

 Themass(
es)mayshowsecondar
ychanges;

 Degener
ati
ons-hy
ali
ne,
myxomat
ous,
fat
ty,
cyst
ic,
reddegener
ati
on

 N.B:RedDegenerati
on-hemorrhagi
cinfar
cti
onoccuri
nginlei
omyomae.
g.
duri
ngpregnancyduetovascul
arobstr
ucti
onbythrombosisorut
eri
ne
contr
acti
on

 Cal
cif
icat
ion,
ossi
fi
cat
ion

 2r
ybact
eri
ali
nfect
ion:
especi
all
ywi
thsubmucousl
eiomy
oma

 At
rophyandf
ibr
osi
s-af
termenopause

Mi
croscopi
cal
ly

 I
nterl
aci
ngbundlesofsmoothmusclecel
l
s.Thecel
lsarespi
ndl
eshapedwith
rod-
shapednucl
eiandabundantcyt
opl
asm.Themusclebundl
esar
esurrounded
byfi
brousst
roma,whichi
ncreasesi
noldmasses(f
ibr
omy oma)

Compl
icat
ions

 Abnor
mal
uter
nebl
eedi
ng i
rondef
ici
encyanemi
a

 Mal
i
gnantchange(
rar
e0.
5-1%):
Lei
omy
osar
coma

 Fer
ti
li
typr
obl
ems:
int
erf
erewi
thi
mpl
ant
ati
on,
mycauseabor
ti
onandi
nter
fer
e
wi
thchi
l
dbi
rt
h.
 4.ENDOMETRI
ALCARCI
NOMA-USUP

I
nci
dence

 Thecommonestmal
i
gnantt
umori
nfemal
egeni
tal
syst
em

Age

 Usual
l
ypost
menopausal
55-
65y
ear
s

Pr
edi
sposi
ngFact
ors

1.Fami
l
ial
predi
sposi
ti
on

2.Nul
l
ipar
a

3.Hy
per
est
eri
sm

4.Endomet
ri
alpol
yp

Gr
ossl
y

 Endomet r
ial
carci
nomapr esent
seitherasal ocali
zedpolypoidtumororasa
di
ffusetumorinvol
vingtheent i
reendomet r
ialsurface.Spreadgeneral
l
yoccur
s
bydirectmyometri
alinvasionwitheventualextensiontotheperiut
eri
ne
str
ucturesbydir
ectspread.

Mi
croscopi
cal
ly

 Mostendomet r
ialcarci
nomas(about85%)ar
eadenocar
cinomaschar
act
eri
zed
bymoreorlesswel l
-defi
nedgl
andpatter
nscl
osel
yresembli
ngnormal
endometr
ialepi
theli
um
 5.CANCERCERVI
X-TI
NGKONG

Age

 Ar
ound40y
ear
s

Ri
skFact
ors

a.Sexual
Act
ivi
ty

 Ear
lyMar
ri
age

 Mul
ti
plesexual
par
tner
s

b.Mul
ti
par
it
y

c.Oncogeni
cVi
rus-HPV

d.Pr
ecancer
ousEpi
thel
i
alLesi
ons

 Squamouscel
lpapi
l
loma

 Squamousmet
apl
asa

Gr
ossl
y

 Commonatt
hesquamo-
col
umnarj
unct
ion

 Maybef
ungat
ing,
ulcer
ati
veori
nfi
l
trat
ive

Mi
croscopi
cal
ly

1.SquamousCel
lCarci
noma(
95%)-f
rom ect
ocer
vixorendocer
vixhadunder
gone
squamousMet
aplasi
a

2.Adenocar
cinoma(
5%)-f
rom endocer
cix