Endometriosis

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Endometriosis

  1. 2. ENDOMETRIOSIS <ul><li>Dr. Shahab Riaz </li></ul><ul><li>Pathology Dept. </li></ul><ul><li>PMC. </li></ul>
  2. 3. <ul><li>Non-neoplastic functional ectopic endometrial tissue. </li></ul><ul><li>Pre-menopause, ovarian hormones influence. </li></ul><ul><li>Ovaries, pouch of Douglas, uterine ligament, tubes, recto-vaginal septum </li></ul><ul><li>Peritoneal cavity, about umbilicus </li></ul><ul><li>Lymph nodes, lungs, heart, bone, joints, skin, kidneys </li></ul><ul><li>Chocolate Cyst or Endometrioma in Ovary. </li></ul><ul><li>Infertility, dysmenorrhea, pelvic pain (cyclical), dyspareunia (uterine serosa), dysuria (bladder serosa), dyschezia (rectal wall) </li></ul>
  3. 5. Gross Features <ul><li>Reddish blue or yellowish brown nodules </li></ul><ul><li>Microscopic – 1-2 cms </li></ul><ul><li>On or just under affected serosal surface </li></ul><ul><li>Coalesce sometimes to large size </li></ul><ul><li>Ovaries, large chocolate cysts </li></ul><ul><li>Fibrosis, adhesions, with later seepage and organisation </li></ul><ul><li>Sealing of tubal fimbrae, oviduct or ovary distortion </li></ul>
  4. 6. GROSS SPECIMENS
  5. 11. PATHOPHYSIOLOGY <ul><li>REGURGITATION THEORY </li></ul><ul><li>Animal experiments, females with outflow abnormality have common </li></ul><ul><li>METAPLASTIC THEORY </li></ul><ul><li>Coelomic epithelial transformation, common origin of mullerian duct, peritoneum and ovarian cells, cells  dedifferentiate  primitive origin  transform to endometrial cells </li></ul><ul><li>Ovarian hormones?? Uterine endometrium?? Inflammatory?? </li></ul><ul><li>VASCULAR / LYMPHATIC SPREAD </li></ul><ul><li>Embolization  distant sites  sites outside P.Cavity supports this theory (rare) </li></ul><ul><li>GENETIC / IMMUNOLOGIC FACTORS </li></ul><ul><li>or susceptibility of women </li></ul><ul><li>incidence in 1 st degree relatives of patients + racial differences </li></ul><ul><li>in Oriental women and in Afro-Caribbean. </li></ul>
  6. 12. HISTOPATHOLOGY <ul><li>Histological Dx if 2 out of following 3 present within lesion. </li></ul><ul><li>ENDOMETRIAL GLANDS </li></ul><ul><li>STROMA </li></ul><ul><li>HEMOSIDERIN PIGMENT </li></ul>
  7. 13. FALLOPIAN TUBE SECTION
  8. 14. COLONIC WALL (higher magnif.)
  9. 15. CLASSIFICATION (correlation b/w histological, morphological and functional activity) White nodule or flattened fibrotic scar No response Glands only HEALED Papule and (later) nodule Proliferative, variable secretory change, no menstruation Glands and stroma ENCLOSED Haemorrhagic vesicle /bleb Proliferative, secretory and menstrual changes Surface epithelium, glands and stroma FREE Laparoscopic appearance Hormonal response Components Histological subtype
  10. 20. IN THE END A SMALL VIDEO AND THANK YOU

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