Benign disease of the uterus.ppt

8/10/2019 Benign disease of the uterus.ppt

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Endometrial

HyperplasiaZakaria Sanad,MD


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Definition

Abnormal endometrial glandularproliferation

Spectrum of morphologic and biologicalteration of end glands and stroma(exaggerated physiologic state to CIS)


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Etiology

Usually a result of chronic unopposedestrogen stimulation in absence of

progesterone influence


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Risk Factors

Obesity

Age above 40 y

Nulliparity

Early menarche , late menopause

Chronic anovulation , PCOS Estrogen-producing ovarian tumors

Menopausal use of ERT without proges

Tamoxifen used for tt of cancer breast


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DM , Hypertension

Family history

Alcohol intake

High animal fat

Chronic liver disease


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Decreased Risk

Combined pills

Pregnancy

Smoking


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Clinical Importance

May be associated w estrogen-producingovarian tumors

May result from exog unopposed E therapy

May cause abnormal uterine bleedig

May precede or occur simultaneously withendometrial cancer


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Classification (ISGP)

Based on architectural and cytologicfeatures as well as long-term prognosis

Simple (cystic without atypia) 1 %

Complex (adenomatous without atypia) 3 %

Atypical : Simple (cystic w atypia)8%.............Complex (adenomatous watypia) 29 %


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Simple : dilated,cystic glands w round shapesincreased G/S ratio , no crowding , no atypia

Complex : budding and infolding , crowdedglands w less stroma , no atypia

Atypical : large nuclei of variable size and

shape , loss of polarity , increased N/C ratio ,prominent nucleoli , irreg clumped chromatinw parachromatin clearing


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Diagnosis

Endometrial tissue sampling : Pipelle ,Novak , Vabra

D & C biopsy


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Treatment

Depends onage , desire for future fertility, surgical risk , presence of atypia

H without atypia: Some recommend D&C+ Cyclic progestin ( MPA 10 mg / day for14 days per cycle for 3-6 m) or Mirena orcombined pills + re-biopsy

H w atypia: Hystrectomy is recommended,continuous progestin ( Megestrol A 40 mg2-4 times daily for 3-6 m )+maint if d F


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Asherman Syndrome

Destruction of the endometrium andintra-uterine synechia resulting in 2ry

amenorrhea 5-7 % of women w 2ry amenorrhea

1-2 % of infertile women


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Risk Factors

Overzealous postpartum or post-abortivecurettageIU scarification (bleeding after

delivery ,placental remnants,septicabortion,repeat D&C for retained POC)

Uterine surgery:CS , myomectomy ,metroplasty

Endometritis,TB,B,severe pelvic infection

Postpartum hypogonadism(Sheehan synd)

UAE (endom damage from ischemia)


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Presenting Complaints

Menstrual disorders ( 60 % ) : 2ryamenorrhea,hypomenorrhea,dysmenorrhea

Infertility after possible ut insult ( 40 % )

Repeated miscarriage


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Diagnosis

HSG

Sonohysterograpgy (SIS)

Diagnostic office hysteroscopy

MRI


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Treatment

Hysteroscopy with direct lysis of adhesionsby cutting , cautery or laser

Prevention of reformation of adhesions: apediatric Foley catheter (3 ml,7 d), broad-sp antibiotic for 10 d , high dose estrogen

for 2 m Repeat attemptsare worthwile


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Prognosis

Restoration of menses: more than 90%

Successful pregnancy: 70-80%

Live-birth: 30-70%

Pregnancy complicated bypreterm labor,p accreta, p previa, postpartum hem


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Uterine Polyps-Corporeal

Adenomatous (mucous)

Fibroid

Placental

Malignant


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Uterine Polyps - Cervical

Adenomatous ( mucous )

Fibroid

Malignant

Bilharzial

Tuberculous

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Benign disease of the uterus.ppt