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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



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: Polycystic ovary(Stein Leventhal syndrome) Estrogen secreting tumors as granulosa &theca cell tumors of the ovary. Therapeutic administration of estrogen.

3.2. • Classification of hyperplasia

3.2.1. WITHOUT ATYPIA SIMPLE: increased glands + dense stroma+ mitosis in both) - COMPLEX: focal or diffuse irregular Distribution. Back to back glands with intraluminal folding+ cellular Compact stroma

3.2.2. -WITH ATYPIA (COMPLEX WITH ATYPIA) atypia in the lining cells(sratification ,loss of polarity ,pleomorphic hyperchromatic nuclei ,prominent nucleoli and mitosis).


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 -Endometrial polyp occurs in postmenopausal females Gross Microscopic Stromal nodule Benign tumor occurring in peri-menopausal females Gross Microscopic Others Lipoma and vascular tumors as hemangioma and lymphangioma may occur in endometrium but they are very rare

5.1.2. Malignant 90 % of malignant tumors of the uterus are carcinoma , 95% of them are adenocarcinoma Types Epithelium Mesenchyme

5.2. Myometrium

5.2.1. Benign Leiomyoma (fibroid) is an extremely common tumor (20-30 % of females over 30 Ys It is an estrogen- dependent tumor and regresses after menopause Manifestations Atypical leiomyoma

5.2.2. Malignant Leiomyosarcoma It occurs in older age group (55 Years) It accounts for about 1% of uterine malignancy. Gross Microscopic


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

5.3.2. Adenofibroma It is a benign tumor appears as a large polypoid papillary mass filling the uterine cavity with spongy or microcytic appearance No tendency to infilitrate the myometrium Microscopic 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 ) It is the most common uterine sarcoma. ▪ Usually after menopause. ▪ It occurs in low grade and high grade forms