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UTERUS by Mind Map: UTERUS

1. Endometritis

1.1. Acute

1.1.1. After septic abortion

1.2. Chronic

1.2.1. non- specific: IUCD or retained endometrial tissue after abortion

1.2.2. Specific: secondary to T.B salpingitis and ch. gonorrhea

1.2.3. Microscopic.: irregular proliferation of endometrial glands+ chronic inflammatoy infiltrate mainly plasma cells

1.2.4. Complications: salpingitis and infertility

2. ABNORMAL UTERINE BLEEDING

3. ENDOMETRIAL HYPERPLASIA

3.1. Causes : prolonged estrogen stimulation

3.1.1. 1-Rpeated anovulatory cycles.

3.1.2. 2-Other causes of increased estrogen level as in:

3.1.2.1. Polycystic ovary(Stein Leventhal syndrome)

3.1.2.2. Estrogen secreting tumors as granulosa &theca cell tumors of the ovary.

3.1.2.3. Therapeutic administration of estrogen.

3.2. • Classification of hyperplasia

3.2.1. WITHOUT ATYPIA

3.2.1.1. SIMPLE: increased glands + dense stroma+ mitosis in both)

3.2.1.2. - COMPLEX: focal or diffuse irregular Distribution. Back to back glands with intraluminal folding+ cellular Compact stroma

3.2.2. -WITH ATYPIA (COMPLEX WITH ATYPIA)

3.2.2.1. atypia in the lining cells(sratification ,loss of polarity ,pleomorphic hyperchromatic nuclei ,prominent nucleoli and mitosis).

4. ENDOMETRIOSIS

4.1. benign endometrial glands and stroma in abnormal site

4.2. Types

4.2.1. endometriosis interna(adenomyosis) due to down growth of basal endometrium.

4.2.2. endometriosis externa (Broad Ligament, Ovary (“chocolate cysts”), Peritoneum, Bowel, Umbilicus)

4.3. Pathogenesis

4.3.1. -Implantation.(regurgitation) theory: retrograde menstruation with expulsion of endometrial fragments through the fallopian tube to peritoneal cavity followed by implantation on ovaries &pelvic peritoneum

4.3.2. -Hematogenous &lymphatic dissemination

4.4. Gross

4.4.1. yellowish nodules + fibrosis

4.4.2. chocloate cyst in ovary

4.4.3. adhesions to surroundings

4.5. Microscopic

4.5.1. endometrial glands & stroma w/ haemposidrine laden macrophage

4.6. Complications

4.6.1. infertility & pain

5. Tumors

5.1. Endometrium

5.1.1. Benign

5.1.1.1. -Endometrial polyp

5.1.1.1.1. occurs in postmenopausal females

5.1.1.1.2. Gross

5.1.1.1.3. Microscopic

5.1.1.2. Stromal nodule

5.1.1.2.1. Benign tumor occurring in peri-menopausal females

5.1.1.2.2. Gross

5.1.1.2.3. Microscopic

5.1.1.3. Others

5.1.1.3.1. Lipoma and vascular tumors as hemangioma and lymphangioma may occur in endometrium but they are very rare

5.1.2. Malignant

5.1.2.1. 90 % of malignant tumors of the uterus are carcinoma , 95% of them are adenocarcinoma

5.1.2.2. Types

5.1.2.2.1. Epithelium

5.1.2.2.2. Mesenchyme

5.2. Myometrium

5.2.1. Benign

5.2.1.1. Leiomyoma (fibroid)

5.2.1.1.1. is an extremely common tumor (20-30 % of females over 30 Ys

5.2.1.1.2. It is an estrogen- dependent tumor and regresses after menopause

5.2.1.1.3. Manifestations

5.2.1.1.4. Atypical leiomyoma

5.2.2. Malignant

5.2.2.1. Leiomyosarcoma

5.2.2.1.1. It occurs in older age group (55 Years)

5.2.2.1.2. It accounts for about 1% of uterine malignancy.

5.2.2.1.3. Gross

5.2.2.1.4. Microscopic

5.3. MIXED EPITHELIAL-MESENCHYMAL TUMORS

5.3.1. They develop from undifferentiated Müllerian cells which have the capacity to differentiate into epithelial and mesenchymal cells.

5.3.2. Adenofibroma

5.3.2.1. It is a benign tumor appears as a large polypoid papillary mass filling the uterine cavity with spongy or microcytic appearance

5.3.2.2. No tendency to infilitrate the myometrium

5.3.2.3. Microscopic

5.3.2.3.1. It contains epithelial elements e.g. endocervical, endometrial, squamous or tubal type, mixed with benign fibroblasts and stromal cells. ▪ Mitosis is less than 4/10 H.F.

5.3.3. Carcinoma-sarcoma ( Mixed müllerian tumors )

5.3.3.1. It is the most common uterine sarcoma. ▪

5.3.3.2. Usually after menopause. ▪

5.3.3.3. It occurs in low grade and high grade forms