benign lesion of the uterus
TRANSCRIPT
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BENIGN LESION OF THE UTERUSNUR SAKINAH BINTI ZULKIFLI
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ENDOMETRIAL POLYPS
ADENOMYOSISLEIOMYOMA UTERUS (FIBROID)
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ENDOMETRIAL POLYPS
• Localized outgrowth of the endometrium• contain an inner core of blood vessel• surrounded by blood vessel and stroma
• Maybe benign or malignant• Benign : attached by pedicle
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Age • All age group• Peak (40-49 years)
Size• Few mm – several cm
Number• Single or multiple
Types • Pedunculated• Sessile• Mucous• Fibroid • Placental
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RISK FACTOR
HRT
Tamoxifen therapy
Diabetes
Hypertension
Obesity
Increased patient age
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PATHOLOGY
• BODY : a part of thick endometrium project into the cavity and ultimately attained pedicle/sessile
• CUT SECTION: grey or reddish brown
GROSS APPEARANCE
:
• Core : contain stromal cells gland and large thick walled vascular channel.
• Surface :lined by proliferative endometrial lining with cystic hyperplasia or squamous metaplasia
• Pedicle : contain thin fibrous tissue with thin blood vessel• Smooth muscle invade polyps : adenomyomatous polyps
MICROSCOPIC
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PREDICTOR OF MALIGNANCY
Size >10 mm
Postmenopausal status
Abnormal uterine
bleeding
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CLINICAL FEATURE
Maybe asymptomatic
Menorrhagia
Intermenstrual bleeding
Contact bleeding (polyps situated outside cervix)
Infertility and miscarriage
(multiple polyps)
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ON EXAMINATION
• Uterus normal/uniformly enlarged• Soft, slippery and small in size (outside the
cervix)
• PER SPECULUM : Reddish in color attached with slender pedicle
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INVESTIGATION
• Must be ruled out in women with abnormal uterine bleeding who do not respond to traditional treatment
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MANAGEMENT
Hysteroscopic polypectomy
Curettage of endometrium (to rule out
hyperplasia)
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ADENOMYOSIS
• Presence of endometrial tissue in myometrium >2.5mm from the basal layer of endometrium
• Endometrial gland and stroma must present
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PATHOGENESIS
• Oestrogen recepter mutation• Gene polymorphism
• Basal layer of endometrium including stroma and gland infiltrating myometrium.
• Surrounding myometrial tissue hypertrophied and hyperplasia
• Uterine enlargement
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PATHOLOGY
• DIFFUSE– Involve anterior and posterior uterine walls– Causes uniform uterine enlargement– Thickened myometrium and hemorrhagic foci of
adenomyosis• LOCALIZED– Grossly mimic leiomyoma (no capsule or distinct
plane of dissection)
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CLINICAL FEATURE
• Common in multiparous age 40-50• Does not occur before menarche and regress
after menopause • Uterus uniformly enlarged
• Palpable abdominally (<14 week’s size)
• May co-exist with other pelvic pathology– Leiomyoma– endometrial hyperplasia– endometriosis– endometrial carcinoma
• Dysmenorrhea (> with > duration of disease and depth of infiltration
• Menorrhagia
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INVESTIGATION
Transvaginal ultrasonography
• Asymmetrical thickening of uterine walls
Doppler sonography
• To differentiate from fibroid
MRI
• Conservative surgical or medical management preferred• Young lady with infertility
Image directed needle biopsy
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MEDICAL MANAGEMENTNSAID
• Androgen,estrogen and progesterone receptor present in lesion• Reduce in size, menorrhagia reduce• Temporary effect
COMBINED OCP
• Prior to surgery to reduce size and vascularity
DANAZOL
• Reduce pain and bleeding
GnRH ANALOGUE
AROMATASE INHIBITOR (anastrozole)
LEVONOGESTREL INTRAUTERINE SYSTEM (LNG-IUS)
DANAZOL LOADED INTRAUTERINE DEVICE
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SURGICAL MANAGEMENT
• Definitive surgery • Perimenopausal age• Poor response to medical
therapy• Associated pelvic pathology
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CONSERVATIVE SURGERY
•Localized adenomyoma by adenomyomectomy•Plane of dissection id difficult since no capsule
Resection of adenomyoma
•Diffuse adenomyosis•Partial resection of uterine walls
Myometrial reduction
•Submucosal adenomyosis/ polypoidal lesion
Hysteroscopic reduction
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NEWER INTERVENTIONAL TECHNIQUE
Endometrial ablation
Uterine artery embolisation
MRI guided focused
ultrasound surgery
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REFERENCE
• Essentials Of Gynaecology, Lakshmi Seshadri• DC Dutta Textbook Of Gynaecology
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THANK YOU