Download - Benign lesion of the uterus
BENIGN LESION OF THE UTERUSNUR SAKINAH BINTI ZULKIFLI
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ENDOMETRIAL POLYPS
ADENOMYOSISLEIOMYOMA UTERUS (FIBROID)
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
Age • All age group• Peak (40-49 years)
Size• Few mm – several cm
Number• Single or multiple
Types • Pedunculated• Sessile• Mucous• Fibroid • Placental
RISK FACTOR
HRT
Tamoxifen therapy
Diabetes
Hypertension
Obesity
Increased patient age
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
PREDICTOR OF MALIGNANCY
Size >10 mm
Postmenopausal status
Abnormal uterine
bleeding
CLINICAL FEATURE
Maybe asymptomatic
Menorrhagia
Intermenstrual bleeding
Contact bleeding (polyps situated outside cervix)
Infertility and miscarriage
(multiple polyps)
ON EXAMINATION
• Uterus normal/uniformly enlarged• Soft, slippery and small in size (outside the
cervix)
• PER SPECULUM : Reddish in color attached with slender pedicle
INVESTIGATION
• Must be ruled out in women with abnormal uterine bleeding who do not respond to traditional treatment
MANAGEMENT
Hysteroscopic polypectomy
Curettage of endometrium (to rule out
hyperplasia)
ADENOMYOSIS
• Presence of endometrial tissue in myometrium >2.5mm from the basal layer of endometrium
• Endometrial gland and stroma must present
PATHOGENESIS
• Oestrogen recepter mutation• Gene polymorphism
• Basal layer of endometrium including stroma and gland infiltrating myometrium.
• Surrounding myometrial tissue hypertrophied and hyperplasia
• Uterine enlargement
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)
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
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
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
SURGICAL MANAGEMENT
• Definitive surgery • Perimenopausal age• Poor response to medical
therapy• Associated pelvic pathology
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
NEWER INTERVENTIONAL TECHNIQUE
Endometrial ablation
Uterine artery embolisation
MRI guided focused
ultrasound surgery
REFERENCE
• Essentials Of Gynaecology, Lakshmi Seshadri• DC Dutta Textbook Of Gynaecology
THANK YOU