pathology of the female genital tract 74_uterus.pdf · pathology of the female genital tract...

Pathology of the female genital

tract

III. Uterus, cervix, vagina and vulva

Pathology of the female genital tract

Topics

• Developmental anomalies

• Regressive changes

• Circulatory disturbances

• Inflammatory changes

• Neoplastic changes

• Sex determination

• Ovary

• Oviduct

• Uterus

• Cervix, vagina and

vulva

Uterus


Normal anatomy and histology

• Layers of the endometrium

• Role of estrogen and progesterone

• Changes due to the sexual cycle

– Macroscopic

– Microscopic

Estrus cycle, cow


Developmental anomalies

• Arrests in development

– Segmental aplasia• White heifer disease (white Shorthorn)

• Failure of fusion of the ducts

– Uterus didelphys• Divided cervix and uterine fundus

Pathology of the female genital tractUterine horn aplasia, mucometra, sow


Circulatory disturbances

• Haemorrhage

– Subinvolution of placental sites (bitch)

• Changes in position

– Torsion, prolapse, rupture, herniation


Torsion of one gravid uterine horn, cat


Abnormalities of endometrial

growth

• Hyperplasia

– Oestrogen-related

• ? Mycotoxicosis (zearalenone, F2) sow

• Phytoestrogens (subterranean clover) ewe

• Cystic follicles, granulosa cell tumors, phytoestrogens cow

• Cystic follicles, granulosa cell tumors, iatrogenic bitch

– Progesterone (and oestrogen) related

• Cystic endometrial hyperplasia – pyometra complex bitch, queen

• Cystic endometrial hyperplasia, unbred queens >5 years of age


Abnormalities of endometrial

growth

• Atrophy– Loss of ovarian function

• Hypopituitarism, debility, chromosomal aberrations, anestrus

• Metaplasia– Inflammatory changes

– Mycotoxicosis

Pathology of the female genital tractUteroferin accumulation, sow

Pathology of the female genital tractEndometrial metaplasia, sow


Noninflammatory changes

• Adenomyosis

– Nests of endometrium in the myometrium

• Endometriosis

– Endometrial glands or stroma outside the uterus

• Serous inclusion cysts

– Old dogs, cysts on the serosal surface, no consequence


Fluid accumulation

• Hydrometra

• Mucometra

– Developmental anomalies

– Hyperestrogenism

• Pyometra

– Accumulation of pus in the lumen


Inflammatory diseases

• Endometritis

– pyometra

• Metritis

• Perimetritis

• Uterine abscesses


Resistance of the genital tract

to infection

• Mechanical barriers

• Mechanical clearing

• Non-specific mucosal immunity

• Hormonal influences

– Estrogen

– Progesterone


Non-specific endometritis - sow

• Imbalance between bacterial flora of the female genital tract and host resistance

– Overwhelming bacterial contamination

– Diminished self-clearing ability

• Opportunistic bacteria – fecal flora

– E. coli, other enterobacteria, Proteus spp., Pseudomonas spp.

– Streptococcus spp., Staphylococcus spp.



• Post-farrowing endometritis

– Manual assistance at farrowing

– Unhygienic farrowing conditions

– Urocystitis

• Post-mating endometritis

– Unhygienic breeding conditions

– Unhygienic accommodation

– Insemination late in estrus (under progesteron influence)

– Urocystitis


• Post-farrowing endometritis

– Acute or chronic diffuse endometritis

– Metritis

– Systemic illness, fever, disturbance of milk

letdown (agalactia or hypogalactia)

• Endotoxins vs prolaktin

– Vaginal discharge (> 3 days post partum)

– Litter loss




• Post-mating endometritis

– Acute or chronic diffuse endometritis

– Disturbance of fertilization,

implantation or embryo development

– Repeat breeding

– Vaginal discharge

– Usually no systemic illness

Pathology of the female genital tractPurulent non-specific endometritis, sow

Pathology of the female genital tractChronic purulent non-specific endometritis, sow


Endometritis - mare

• Age-related changes

– Repeated changes related to sexual cycle

– Rare < 9 years; very frequent > 17 years

• Endometrial biopsy

– Changes are related to fertility – prognostic value

– Kenney & Doig grade I - II – III• Inflammation (mononucleal cell infiltration)

• Periglandular fibrosis (development of gland nests and cysts)

• Nonseasonal atrophy

Grade I Grade III

Grade IIIGrade II


Endometritis - mare

• Pyometra

– Rare

– Mainly post

partum

– No

extragenital

lesions


Pyometra - cow

• Endometrial loss (endometritis) prevent prostaglandin F2 release

– Dystochia, retained placenta

– Venereal infections, insemination during luteal phase

• Persistent corpus luteum

– Closure of the cervix

– Susceptibility to infection

• Accumulation of purulent exsudate


Cystic endometrial hyperplasia

pyometra complex - dog, cat

• Sequence of events

– Prolonged oestrogenic stimulation of the endometrium• older age

– No pregnancy• nulliparous animals

– Cystic endometrial hyperplasia

– Bacterial superinfection

– Mucometra or pyometra

– Systemic changes




• Possible causes

– Inappropriate response to progesterone• A receptor problem?

– Bacterial infection, uterine mucosal damage - a primary cause?

– Iatrogenic• Progesterone or oestrogen treatment




• Genital tract lesions

– Retained corpora lutea

– Enlargement and dilation of uterine glands

– Accumulation of inflammatory cells in the

propria

– Accumulation of exsudate and inflammatory

cells in the lumen

– Closed or partially open cervix

Cystic

endometrial

hyperplasia

bitch

Pyometra, cat




• Extragenital lesions

– Toxemia, bacteremia

– Immune-complex glomerulonephritis

– Bone marrow depression

– Anemia

– Peritonitis


Granulomatous infections

• Necrobacillosis

– Parturition-related, cattle

• Tuberculosis

– Hematogenous or descending spread

– Disseminated miliary tuberculosis

– Diffuse caseating tuberculosis

• Staphylococcal granuloma


Tumors

• Epithelial tumors

– Adenoma

– Adenocarcinoma

• Mesenchymal tumors

– Fibroma, fibrosarcoma

– Leiomyoma, leiomyosarcoma

– Lymphoma (cattle)

Uterine lymphoma, cow

Cervix, vagina and vulva


Developmental anomalies

• Arrests in development

– Segmental aplasia• Imperforate hymen

• Failure of fusion of the ducts

– Double cervix and/or vagina

• Cysts in the wall

– Bartholin’s glands

– Gartner’s ducts (Wolffian remnants)


Circulatory disturbances

• Haemorrhage

– Trauma during breeding or parturition

• Changes in position

– Prolapse

Pathology of the female genital tractVaginal prolapse, bitch


Noninflammatory changes

• Tumefaction of the vulva

– Normal in estrus

– Estrogenic mycotoxicosis - swine

• Epithelial metaplasia

– Estrogenic mycotoxicosis -swine


Inflammatory changes

• Non-specific vaginitis

– Postparturient, post-mating

• Herpesvirus infections

– Infectious pustular vulvovaginitis cattle, IBR-virus

– Dog, CHV-1

– Coital exanthema, horse, EHV-3

– Infectious bovine cervicovaginitis „EPIVAG”

• Cattle, herpesvirus, Africa


Inflammatory changes

• Spirochaetosis, doe

– Treponema cuniculi

– Spongiosis, vesicle formation, crusting


Tumors

• Epithelial tumors– Squamous cell carcinoma

• Cattle, non-pigmented skin

– Papilloma

• Mesenchymal/mixed tumors– Fibropapilloma

– Polyp

• Transmissible venereal tumor– Transmitted at coitus

– Self-limiting, metastasis rare

pathology of the female genital tract 74_uterus.pdf · pathology of the female genital tract...

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