1. UTERINE CORPUS

2. ACUTE ENDOMETRITIS Is most often related to intrauterine trauma from instrumentation, intrauterine contraceptive device or complications of pregnancy such as post partum retention of placental fragments. Is most often related to intrauterine trauma from instrumentation, intrauterine contraceptive device or complications of pregnancy such as post partum retention of placental fragments. Is most often caused by staph aureus and streptococcus. Is most often caused by staph aureus and streptococcus.

3. CHRONIC ENDOMETRITIS Granulomatous endometritis is seen in TB. Granulomatous endometritis is seen in TB.

4. ENDOMETRIOSIS Is charcterized by the presence and proliferation of ectopic endometrial tissue. Is charcterized by the presence and proliferation of ectopic endometrial tissue. is non-neoplastic, not associated with carcinoma. May cause infertility. is non-neoplastic, not associated with carcinoma. May cause infertility. There is menstrual bleeding in the ectopic endometrium, resulting in blood filled spaces (chocolate cyst). There is menstrual bleeding in the ectopic endometrium, resulting in blood filled spaces (chocolate cyst). Sites: commonly in the pelvic area eg. ovary, pelvic ligaments etc. Sites: commonly in the pelvic area eg. ovary, pelvic ligaments etc.

5. Adenomyosis Is characterized by islands of endometrium in the myometrium of uterus. Is characterized by islands of endometrium in the myometrium of uterus.

6. ENDOMETRIAL POLYP Is a benign lesion Is a benign lesion Usually in females > 40yrs Usually in females > 40yrs May result in uterine bleeding. May result in uterine bleeding.

9. Endometrial Hyperplasia

10. Induced by Prolonged or marked excess of estrogen relative to progestin. Induced by Prolonged or marked excess of estrogen relative to progestin. Hyperplasia ranging from simple hyperplasia to complex hyperplasia. Hyperplasia ranging from simple hyperplasia to complex hyperplasia. Both are classified as with or without atypia. Both are classified as with or without atypia. Appears to be a continuum based on the level and duration of the estrogen excess. Appears to be a continuum based on the level and duration of the estrogen excess.

11. Endometrial Hyperplasia The endometrial hyperplasia may progress to endometrial carcinoma. The endometrial hyperplasia may progress to endometrial carcinoma. The development of cancer is based on the level and duration of the estrogen excess. The development of cancer is based on the level and duration of the estrogen excess. The risk is depending on the severity of the hyperplastic changes and associated cellular atypia. The risk is depending on the severity of the hyperplastic changes and associated cellular atypia.

12. Endometrial Hyperplasia Other potential factors include : Other potential factors include : - failure of ovulation - prolonged administration of estrogenic steroids without counter balancing progestins - Polycystic ovary - Cortical stromal hyperplasia - Granulosa-Theca cell tumors.

13. Endometrial Hyperplasia Milder forms of hyperplasia tends to occur in younger patients. Milder forms of hyperplasia tends to occur in younger patients. The great majority of mild hyperplasia regress, either spontaneously or after treatment. The great majority of mild hyperplasia regress, either spontaneously or after treatment. The more severe forms,occur predominantly in peri- and postmenopausal women. The more severe forms,occur predominantly in peri- and postmenopausal women. The last form has a significant premalignant potential. The last form has a significant premalignant potential.

14. Endometrial Hyperplasia,Clinical Abnormal uterine bleeding. Abnormal uterine bleeding. The severity of bleeding is not necessarily proportional to that of the histologic changes. The severity of bleeding is not necessarily proportional to that of the histologic changes. Hyperplasia are uncommon in asymptomatic women. Hyperplasia are uncommon in asymptomatic women.

15. Endometrial Hyperplasia, Risk Factors Obesity Obesity Western diet Western diet Nulliparity Nulliparity Diabetes Mellitus Diabetes Mellitus Hypertension Hypertension Hyperestrinism Hyperestrinism

16. Macroscopic,Endometrial Hyperplasia Might be close to normal, or may show considerable thickening of either the entire mucosa or focal regions. Might be close to normal, or may show considerable thickening of either the entire mucosa or focal regions. When it is focal,the lesion may acquire a polypoid aspect. When it is focal,the lesion may acquire a polypoid aspect. The color is pale pink The color is pale pink Curettage usually yields increased amount of tissue Curettage usually yields increased amount of tissue

31. Endometrial Hyperplasia, Risk for Cancer Hyperplasia with nuclear atypia has Hyperplasia with nuclear atypia has 20-25 % progression to carcinoma 20-25 % progression to carcinoma Hyperplasia without atypia has 3% progression to carcinoma Hyperplasia without atypia has 3% progression to carcinoma

32. Endometrial Adenocarcinoma In the USA,Endometrial Carcinoma is the most frequent cancer of the female genital tract. In the USA,Endometrial Carcinoma is the most frequent cancer of the female genital tract. Before it was much less common than Before it was much less common than cervical cancer

33. Endometrial Adenocarcinoma Epidemiology Most frequently between the ages of 55 and 65 Most frequently between the ages of 55 and 65 Uncommon under 40 years of age Uncommon under 40 years of age

34. Endometrial Carcinoma, Risk Factors Obesity Obesity Diabetes Diabetes Hypertension Hypertension Infertility ;single and nulliparous, and non ovulatory cycles Infertility ;single and nulliparous, and non ovulatory cycles Any factor increases the estrogen stimulation. Any factor increases the estrogen stimulation.

35. Endometrial Carcinoma The majority of the cases arise on a background of endometrial hyperplasia The majority of the cases arise on a background of endometrial hyperplasia 20% of endometrial carcinoma there is no association with hyperestrinism or preexisting hyperplasia,these cancers tend to occur late in life and have a poor prognosis. 20% of endometrial carcinoma there is no association with hyperestrinism or preexisting hyperplasia,these cancers tend to occur late in life and have a poor prognosis.

36. Endometrial Adenocarcinoma, Morphology May closely resemble normal endometrium May closely resemble normal endometrium May be exophytic May be exophytic May be Infiltrative May be Infiltrative May be polypoid May be polypoid

37. Endometrial Carcinoma, Grading and staging Grading is from 1 to 3 Grading is from 1 to 3 Staging is from 1 to 4 Staging is from 1 to 4 Stage 1 : Confined to uterus corpus Stage 1 : Confined to uterus corpus Stage 2 : Cervix involvement Stage 2 : Cervix involvement Stage 3 : beyond the uterus,but within the true pelvis Stage 3 : beyond the uterus,but within the true pelvis Stage 4 : Distant metastasis Stage 4 : Distant metastasis

38. Endometrial Adenocarcinoma Clinical Outcome First signs are marked leukorrhea and irregular bleeding,in a postmenopausal woman First signs are marked leukorrhea and irregular bleeding,in a postmenopausal woman This reflect erosion and ulceration of the endometrial surface This reflect erosion and ulceration of the endometrial surface In end stages the uterus might be palpated,and in time it becomes fixed to surrounding structures In end stages the uterus might be palpated,and in time it becomes fixed to surrounding structures

39. Endometrial Adenocarcinoma Survival,5 year Stage 1: 95% Stage 1: 95% Stage 2 : 30-50 % Stage 2 : 30-50 % Stage 3 and 4 : less than 20% Stage 3 and 4 : less than 20%

50. LEIOMYOMA / FIBROIDS Is the most common uterine tumor. Is the most common uterine tumor. It is a benign neoplasm. Can be multiple. It is a benign neoplasm. Can be multiple. Is estrogen sensitive. The tumor often increases in pregnancy and decreases following menopause. Is estrogen sensitive. The tumor often increases in pregnancy and decreases following menopause. Can be sub-endometrial, intramural or sub-serosal. Can be sub-endometrial, intramural or sub-serosal. Presents as menorrhagia, can cause infertility. Presents as menorrhagia, can cause infertility.

51. Figure 22-34 A, Leiomyomas of the myometrium. The uterus is opened to reveal the tumors bulging into the endometrial cavity and displaying a firm white appearance on sectioning. B, Leiomyoma showing well-differentiated, regular, spindle-shaped smooth muscle cells. Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 26 May 2009 09:39 PM) © 2007 Elsevier

53. LEIOMYOSARCOMA Malignant smooth muscle tumor. Malignant smooth muscle tumor. Arises denovo. Arises denovo. Is uncommon. Is uncommon.

54. Figure 22-35 Leiomyosarcoma. A, A large hemorrhagic tumor mass distends the lower corpus and is flanked by two leiomyomas. B, The tumor cells are irregular in size and have hyperchromatic nuclei. Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 26 May 2009 09:39 PM) © 2007 Elsevier