Benign disease of the uterus

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Benign disease of the uterus

  1. 1. Benign Disease of The Uterus Khalid Sait (FRCSC) Professor of Gynecological Oncology Faculty of Medicine King Abdulaziz University
  2. 2. Anatomy of the uterus n  Endometrium n  Myometrium Both are mesodermal in origin Both formed secondary to fusion of mullarian ducts ( 8-9 weeks post ovulation)
  3. 3. Anatomy of the uterus Endometrium n  Cycle histological variation Important in : 1- diagnose luteal phase defect 2- Documentation of ovulation ( change of proliferative endometrium to secretary endometrium under influence of progesterone
  4. 4. Benign disease of the endometrium n  Endometrial Polyp Localized overgrowths of endometrial tissue covered by epithelium and containing a variable amount of glands ,stroma and blood vessels
  5. 5. endometrial polyps. n  a symptomatic n  excessive bleeding during a menstrual period, n  bleeding in between periods, n  spotting after intercourse. Some women report a few days of brown blood after a normal menstrual period. If the polyp interferes with the egg and sperm, it may make it hard to get pregnant. n  slightly higher chance of miscarriage n  could this be cancer?
  6. 6. endometrial polyps. n  Sonohysterogram (water ultrasound) The water opens the uterine cavity, allowing the doctor to see if any polyps are hanging around. n  hysterosalpingogram (HSG) n  hysteroscope
  7. 7. Benign disease of the endometrium n Inflammation Acute : mostly related with pregnancy and abortion ( multimicrobial ) Chronic non specific Endometrities: 1- pregnancy 2- PID 3-IUCD 4- Infarcted Polyps 5-Cancer Chronic specific endometrities: TB, Mycoplasma,Viral and Fungal
  8. 8. Benign disease of the endometrium n Endomtrial hyperplasia Proliferation of a glands of irregular size and shape with increase in the gland/ stroma ratio compared with proliferative endometrium
  9. 9. Classification Of Endometrial Hyperplasia WHO ( Kurman &Norris ) n  Simple ( Cystic ) Hyperplasia with and with out atypia n  Complex Hyperplasia with or with out atypia
  10. 10. Benign disease of the endometrium ( Endometrial hyperplasia……..) n  Unopposed estrogen exposure n  PCO and unovulation n  Estrogen producing tumor n  Estrogen therapy n  Obesity .DM . HTN n  2% of pt. with out atypia progress to cancer n  23 % of pt. with atypia progress to
  11. 11. Natural History of Endometrial Hyperplasia Type NO Mean age Regress (%) Progress to carcinoma no Mean ( years) Follow up ( years) Simple with out atypia 93 42 74(80) 1 11 1-26.7 10 preg. Complex with out atypia 29 39 23(79) 1 8.3 2-26 3 preg. Atypical hyperplasia 48 40 28(58) 11 4.1 1-25 3 preg. Atypical simple 13 9 1 Atypical complex 35 20 10 Kurman et al(170 patients )
  12. 12. Young patients ( Endometrial Status) No Atypia Atypia simple complex Simple Mild atypia Complex Moderate Or severe No abnormal bleeding Abnormal Bleeding observe Intermittent Progestin therapy Intermittent Or continues Progestin therapy Consider 6-month sample Especially for Abnormal bleeding Continuous High dose Progestin therapy Sample 6 months
  13. 13. Uterine preservation is not required ( Old Patients) Endometrial status NO CYTOLOGIC ATYPIA ATYPIA Intermittent or continuous therapy And sample in 6 months OR HYSTERECTOMY Pt. Is not surgical candida Fit for surgery Intermittent or continuous therapy And sample in 6 months Hysterectomy
  14. 14. Medical Treatment n  With out atypia: 1- Provera 10 mg for 10 days for 3 mos 2- OCP n  Atypia pt: mild: I) 10 mg bid continuously followed by intermittent therapy 14 days per month Or OCP if contraception is required n  MOD OR SEVER ATYPIA: 10 MG TID continuous for 6 mos (SAMPLE IN 6 MONTHS)
  15. 15. Medical Treatment n  PTS WANT TO CONCEIVE IS GIVEN GnRH agonist for 3 Months. Followed by Ovulation Induction n  LONG TERM PROGESTERONE : MEGACE 40-160 MG DAILY n  ALTERNATIVE: DEPOPROVERA 200 MG IM FOLLOWED BY 100 MG EVERY 2 WEEKS TWO TIMES AND THEN 100 MG MONTHLY FOR 6 MONTH
  16. 16. Benign disease of the Uterus n Congenital anomalies
  17. 17. Congenital Uterine Anomaly n  Precise incidence is unknown (range from 1-2 %) n  Clinical presentation: 1 Usually asymptomatic 2 Menstrual disorder 3 Dysmenorrhea 4 Recurrent abortion ( decrease intrauterine volume and vascularity, increase uterine irritability and cervical incompetance ) 5 Premature labor 6 Abnormal presentation 7 Primary infertility
  18. 18. Congenital Uterine Anomaly n  Diagnosis: History Pelvic exam Hysterosalpingography U/S MRI Laproscopy Hysteroscopy IVP or U/S (Exclude Renal anomaly )
  19. 19. Congenital Uterine Anomaly n  Treatment: 1- Double uterus (didelphic uterus): no need to treat. 2- Bicornate ut. --------- Strassmann procedure ( if indicated ) 3- Ut. Septum --------- (BCP for dysmenorrhea ), Tompkins metroplasty or Hysteroscopic resection of septum ) 4- Unicornate ut. -------- Surgery indicated if there is blind horn which cause symptom----- surgical resection of blind horn.
  20. 20. Benign disease of the Myometrium n Leiomyoma n Adenomyosis
  21. 21. Q5
  22. 22. What Is Fibroids? Are benign clonal tumours that arise from the smooth-muscle cells of the human uterus. Most uterine leiomyomas are asymptomatic. Uterine leiomyoma locations; Incidance 25-50%
  23. 23. Complication Of Fibroid n  Symptoms n  Infertility n  Degeneration
  24. 24. Symptomatic Asymptomatic Want future pregnancy Exclude other. Med. Surg. myom. Ut.a. emb. Depened on size. <12 week F.U >12week myomectomy Not want future pregnancy Exclude other. Med. Surg.myom.,TAH. Ut.a.emb. Depened on size. <12week F.U >12 week Myom.,TAH. MANEGMENT
  25. 25. MEDICAL MANEGMENT: oral-contraception. nsaids. antifibrinolytic agents. danazole. Gnrh agonist. progesterone antagonist.
  26. 26. SURGICAL MANEGMENT
  27. 27. Benign disease of the endometrium n DUB Abnormal uterine bleeding resulting from derangement in the magnitude or duration of estrogen and progestron on the endometrium. It is a clinical term used to describe bleeding not attributable to an underlying organic pathological condition
  28. 28. Benign disease of the endometrium ( DUB……) n  Condition has to be excluded before making the diagnosis of DUB: 1-Systemic causes 2-Local Cause 3-Pregnancy related

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