Uterus, Fallopian Tubes, and Ovaries Pathology Physiology

Acute Endometritis: Primary Etiology

Bacterial infections secondary to parturition or retained products of conception.

Acute Endometritis: Key Histological Feature

Interstitial inflammation with predominant neutrophilic infiltration.

Chronic Endometritis: Diagnostic Cell Type

Stromal plasma cells.

Chronic Endometritis: Common Infectious Causes

Gonorrhea and Tuberculosis secondary to tuberculous salpingitis.

Chronic Endometritis: Non-infectious Etiologies

Retained gestational tissue, intrauterine devices (IUD), and idiopathic causes.

Adenomyosis: Definition

Growth of the basal layer of endometrium into the myometrium.

Adenomyosis: Functional Status of Infiltrating Endometrium

Nonfunctional; it generally does not undergo cyclic bleeding.

Adenomyosis: Myometrial Response

Reactive hypertrophy of the myometrium causing uterine wall thickening.

Adenomyosis: Physical Examination Finding

Symmetrical (diffuse) enlargement of the uterus.

Adenomyosis: Classic Clinical Presentation

Menorrhagia (excessive bleeding) and dysmenorrhea (pelvic pain before menstruation).

Endometriosis: Definition

Presence of endometrial glands and stroma outside the uterine cavity.

Endometriosis: Gross Appearance in Ovaries

"Chocolate" cysts filled with degenerated old blood.

Endometriosis: Appearance of Implants

Yellow-brown nodular implants across pelvic structures.

Endometriosis: Tissue Response to Cyclic Bleeding

Organizing blood causes fibrosis, pelvic adhesions, and sealed fallopian tubes.

Endometriosis Pathogenesis: Regurgitation Theory

Menstrual backflow through fallopian tubes leads to pelvic cavity implantation.

Endometriosis Pathogenesis: Metaplastic Theory

Endometrial differentiation of coelomic epithelium.

Endometriosis Pathogenesis: Vascular/Lymphatic Theory

Dissemination via vessels explains distant foci like lymph nodes.

Endometriosis: Triad of Common Symptoms

Infertility, dysmenorrhea, and chronic pelvic pain.

Endometriosis: Symptom of Rectal Involvement

Pain on defecation (dyschezia).

Endometriosis: Symptom of Bladder Involvement

Dysuria.

Endometriosis: Symptom of Uterine/Vaginal Involvement

Dyspareunia (painful sexual intercourse).

Endometriosis: Biopsy Diagnostic Requirement

At least two: endometrial glands, stroma, or hemosiderin pigment.

Menorrhagia: Definition

Profuse or prolonged uterine bleeding at the regular time of menstruation.

Metrorrhagia: Definition

Irregular, acyclic uterine bleeding occurring between menstrual periods.

Ovulatory Bleeding: Definition

Intermenstrual bleeding occurring around the time of ovulation.

Dysfunctional Uterine Bleeding (DUB): Definition

Abnormal uterine bleeding in the absence of well-defined organic structural lesions.

DUB Pathogenesis: Primary Hormonal Imbalance

Excess of estrogen relative to progesterone.

DUB Pathogenesis: Endometrial Phase Disruption

Proliferative phase initiates without entering a normal subsequent secretory phase.

DUB Pathogenesis: Cause of Arterial Rupture

Sparse supporting stroma collapses due to lack of progesterone, rupturing spiral arteries.

Anovulatory DUB: Common Demographics

Females at the extremes of reproductive life (menarche and perimenopause).

Anovulatory DUB: Secondary Causes

HPA axis dysfunction, endocrine disorders, hyperestrogenism, malnutrition, obesity, stress.

Inadequate Luteal Phase: Definition

Corpus luteum fails to mature properly or prematurely regresses, causing low progesterone.

Granulosa-Theca Cell Tumors: Link to Bleeding

Estrogen-producing ovarian lesions causing persistent endometrial growth and DUB.

DUB Workup Finding

Endometrial hyperplasia observed on endometrial biopsy.

Leiomyoma: Definition

Benign tumor arising from uterine smooth muscle cells.

Leiomyoma: Prevalence

Present in up to 50% of women during their reproductive years.

Leiomyoma: Postmenopausal Fate

Shrinks in size; may undergo collagenization or calcification.

Intramural Leiomyoma: Location

Within the muscular layer (myometrium) of the uterine wall.

Subserosal Leiomyoma: Location

Beneath the peritoneal serosa of the uterus.

Parasitic Leiomyoma: Definition

A subserosal fibroid that attaches to adjacent organs for blood supply.

Submucosal Leiomyoma: Location

Beneath the endometrial mucosa, protruding into the uterine cavity.

Leiomyoma Type Most Associated with Menorrhagia

Submucosal leiomyoma.

Leiomyoma: Gross Pathology

Well-circumscribed, gray-white firm mass with a characteristic whorled cut surface.

Leiomyoma: Microscopic Feature

Interlacing bundles of uniform smooth muscle cells.

Leiomyoma: Surgical Management Options

Myomectomy (fertility-sparing) or hysterectomy.

Leiomyosarcoma: Origin

Arises de novo from mesenchymal cells of the myometrium.

Leiomyosarcoma: Macroscopic Growth Patterns

Infiltrating muscular masses or soft polypoid masses projecting into cavity.

Leiomyosarcoma vs Leiomyoma: Key Histological Features

Anaplasia, marked cellular atypia, and frequent/atypical mitotic figures.

Endometrial Carcinoma: Histological Type

Adenocarcinoma (most common malignancy of female genital tract).

Endometrial Carcinoma: Peak Incidence Age

Between 55 and 65 years of age.

Endometrial Carcinoma: Macroscopic Growth Patterns

Infiltrating and exophytic patterns.

Endometrial Carcinoma: Primary Lymphatic Spread

Metastasis to regional pelvic lymph nodes.

Endometrial Carcinoma: Major Precursor Lesion

Endometrial hyperplasia (especially with atypia).

Endometrial Carcinoma Risk Factor: Estrogen Exposure

Prolonged estrogen stimulation unopposed by progesterone.

Endometrial Carcinoma Risk Factor: Obesity Mechanism

Increased peripheral conversion of androgens to estrogens in adipose tissue.

Endometrial Carcinoma: Key Metabolic Risk Factors

Obesity, Diabetes Mellitus (DM), and Hypertension (HTN).

Endometrial Carcinoma: Reproductive Risk Factor

Infertility associated with chronic anovulation.

Endometrial Carcinoma: Pathophysiology of Unopposed Estrogen

Endometrium remains constantly in the proliferative phase, predisposing to dysplasia.

Endometrial Carcinoma: Early Classic Symptoms

Leukorrhea and irregular postmenopausal vaginal bleeding.

Endometrial Carcinoma: Cause of Postmenopausal Bleeding

Erosion and ulceration of the tumor surface.

Endometrial Carcinoma: Sign of Advanced Local Spread

Enlarged, fixed uterus on pelvic examination.

Salpingitis: Definition

Inflammation of the fallopian tubes.

Salpingitis: Common Clinical Setting

Pelvic Inflammatory Disease (PID).

Postpartum Salpingitis: Primary Pathogens

Streptococci and Staphylococci.

Sexually Transmitted Salpingitis: Primary Pathogens

Neisseria gonorrhoeae and Chlamydia trachomatis.

Acute Salpingitis: Classic Presentation

Fever, lower abdominal pain, and pelvic tenderness.

Salpingitis Complication: Reproductive Failure

Tubal scarring leading to sterility.

Salpingitis Complication: Pregnancy Placement

Increased risk of ectopic pregnancy due to luminal narrowing.

Follicular and Luteal Cysts: Derivation

Unruptured or resealed graafian follicles.

Follicular Cysts: Fluid Content

Filled with clear serous fluid.

Ovarian Cyst Rupture: Clinical Presentation

Acute abdominal pain and intraperitoneal bleeding (Mittelschmerz syndrome).

Follicular Cysts: Natural History & Management

Usually involute spontaneously within a few months without treatment.

Polycystic Ovary Syndrome (PCOS): Core Anovulatory State

Chronic anovulation affecting postmenarchal young females.

PCOS: Inheritance Pattern

Autosomal dominant with variable penetrance.

PCOS Pathophysiology: Hormone Production Source

Excessive production of androgens and estrogens by multiple cystic follicles.

PCOS Pathophysiology: Role of Peripheral Estrone

Androgens convert to estrone, which suppresses FSH pituitary release.

PCOS Pathophysiology: Pituitary Feedback Failure

Absence of normal midcycle FSH and LH surge prevents ovulation.

PCOS Presentation: Symptom Spectrum

Oligomenorrhea, hirsutism, infertility, and obesity.

PCOS: Serum LH Levels

Higher than normal LH level relative to FSH.

PCOS: Serum FSH Levels

Lower than normal FSH due to negative feedback from estrone.

PCOS Pathophysiology: Cause of Progesterone Deficiency

Lack of ovulation leads to absence of functional corpora lutea.

PCOS Gross Pathology: Ovarian Appearance

Enlarged ovaries studded with subcortical cysts.

PCOS Microscopic Pathology: Cortical Changes

Thickened outer tunica with cortical stromal fibrosis.

PCOS Histology: Luteal Tissue Finding

Absence of corpora lutea.

PCOS Cysts Prevalence

Up to 30% of patients meeting PCOS clinical criteria do not show classic ovarian cysts.

Rotterdam Criteria for PCOS Diagnosis

Requires 2 of 3: Oligo/anovulation, hyperandrogenism, polycystic ovaries on ultrasound.

Ovarian Tumors: Three Primary Cell Origins

Surface (coelomic) epithelium, germ cells, and sex cord-stromal cells.

Ovarian Tumors: Epithelial Origin Percentage

Surface coelomic epithelium accounts for 90% of all ovarian cancers.

Multipotential Coelomic Epithelium: Derivatives

Gives rise to serous, mucinous, and endometrioid tumors.

Totipotential Ovarian Germ Cells: Derivatives

Gives rise to teratomas, dysgerminomas, endodermal sinus tumors, and choriocarcinomas.

Multipotential Sex Cord-Stromal Cells: Derivatives

Gives rise to granulosa, theca, and Sertoli-Leydig cell tumors.

Ovarian Carcinoma: Common Molecular Genetic Alteration

Mutations affecting the p53 tumor suppressor gene.

Ovarian Cancer Protective Factor: Pregnancy

Reduces ovulation frequency, lowering gonadotropin (LH/FSH) exposure.

Ovarian Cancer Protective Factor: Oral Contraceptives

Suppresses LH and FSH levels, suppressing continuous ovulation.

Endometrioma: Alternative Name

"Chocolate cyst" of the ovary containing altered blood.

Endometritis vs Adenomyosis: Key Anatomical Difference

Endometritis is mucosal inflammation; adenomyosis is deep invasion of myometrium.

Leiomyoma vs Leiomyosarcoma: Malignant Potential

Leiomyosarcomas arise independently from mesenchymal cells, not from pre-existing fibroids.

Mittelschmerz Syndrome: Clinical Trigger

Rupture of follicular or luteal ovarian cyst during ovulation or luteal phase.

Ectopic Pregnancy Pathophysiology in Salpingitis

Tubal scarring impairs ovum transport without completely blocking sperm movement.