ANATOMY TO HISTOLOGY

1. Dr.N.Manjula, MBBS, MD (Pathology)
UTERUS

2. ANATOMY
 Pear shaped organ.
 Three parts: fundus, body, cervix.
 Measures: 7.5*5*2.5 cm.
 Three layers: endometrium, myometrium, perimetrium.

3. ORIENTATION OF UTERUS
 Anterior: Convex.
Peritoneum upto isthumus.
Reflected to upper surface of urinary
bladder.
 Posterior: Flat.
Peritoneum extends downward upto
posterior fornix.
Reflected to anterior aspect of rectum.

5. BLOOD SUPPLY
 Arterial supply: Uterine artery branch of anterior
division of internal iliac artery.
 Venous drainage: Veins corresponding to artery form
venous plexus that drain into internal iliac vein via uterine
and vaginal veins.
 Nerve supply:
Sympathetic:- T12 to L2 - uterine contraction
and vasoconstriction.
Parasympathetic:- S2 to S4 - inhibits uterine
muscle and vasodilatation

6. UTERINE ARTERY BRANCHES
 Arcuate branches: outer 1/3 rd of myometrium.
 Radial branches: inner2/3 rd of Myometrium.
 Basal arteries: basal part of endometrium.
 Spiral arteries: superficial part of endometrium.

7. LYMPHATIC DRAINAGE
 Fundus: Para aortic nodes.
 Body: External iliac nodes.

8. PERIMETRIUM
 Two layers: 1.Mesothelial lining.
2.Connective tissue – blood vessels,
elastic fibres.
 Continuation of peritoneum of broad ligament.

9. MYOMETRIUM
 Thickest layer.
 Smooth muscle bundles.
 Inner and outer layers – longitudinal.
 Middle layer – circular and spiral.

10. LEIOMYOMA
 Localized
hyperplasia of
smooth muscle cells
of myometrium.

11. ENDOMETRIUM
 Mucosal lining of uterine cavity.
 Simple columnar epithelium overlying thick lamina
propria
 Simple tubular glands.(LP) - open to the surface
and are coiled in deep portion.
 Spiral arteries seen between the glands.
 Two zones: 1/3 deep – stratum basalis
2/3 superficial – stratum functionalis

14. ENDOMETRIOSIS
 Presence of endometrial tissue
anywhere other than uterine
endometrium.
 C10 highlights the areas of
endometrial stroma.

15. MENSTRUAL CYCLE

16. FOLLICULAR/PROLIFERATIVE
PHASE
 Preovulatory phase.
 Day 4 to 14.
 Estrogen – developing follicle in ovary.
 Begins at end of menstrual phase.
 Repair of damaged endometrium by proliferation
of cells in Stratum basale.
 Evident by numerous mitotic division.

18. LATE PROLIFERATIVE PHASE
 Occasional lymphoid aggregates are normal feature of
this phase.
 But plasma cells are abnormal and indicate chronic
infection endometritis

20. Proliferative phase

21. END OF PROLIFERATIVE PHASE
 ET – 3-4 mm.
 Stroma is highly cellular.
 Endometrial glands have narrow lumen, slightly
wavy appearance.
 Glands are lined by regular pseudostratified columnar
cells.
 Endometrial stroma is composed of spindle cells with
scant cytoplasm.
 Spiral arteries are long and slightly coiled.

23. OVULATION
 Endometrial proliferation ceases and differentiation
commences under the influence of progesterone.
 Sub nuclear vacuoles in 50 % of glands.
 To rule out anovulatory cycle biopsy of stratum
functionalis is done 2 days before menstruation.

24. POST OVULATION
 Marked by appearance of secretory vacuoles
beneath the nuclei in glandular epithelium.
 Prominent in 3 rd week.
 Basal vacuoles progressively move towards apical
surface.
 By 4 th week glands are tortuous - serrated saw
tooth appearence(corckscrew).

26. SECRETORY PHASE
 Progesterone – corpus luteum.
 Day 15 to 28.
 ET – 6-7 mm.
 Stromal edema.
 Endometrial glands – increased secretory activity
more tortuous, lateral sacculation, dilated lumen.
 Spiral arteries highly coiled.

29. ENDOMETRIAL DATING
 Determined by histologic appearance.
 Used to assess hormonal status.
 Document ovulation.
 Find the cause of bleeding.
 Infertility workup

32. MENSTRUAL PHASE
 If ovum not fertilized Stratum functionalis sheds.
 Cessation of secretion of progesterone by corpus
luteum.
 Day 1 to 3.
 Endometrium degenerates and is sloghed off.

34. PROLIFERATIVE
Low power blue
appearence.
Tubular glands.
Pseudostratified
columnar cells.
Numerous mitotic figure.
SECRETORY
Low power relatively pink
appearance.
Irregular shaped glands.
Single layer of columnar
cells.
EARLY
Sub nuclear vacuoles
Stromal edema
LATE
Secretions increase
MENSTRUAL
Low power areas of red
seen.
stromal breakdown.

35. IHC MARKERS
 ER
 PR
 Her 2 neu
 CK 7 glands
 CD 34 stroma
 Ki 67 marker of cellular proliferation
 Cyclin D1, Cyclin E cell cycle related protein

36. REFERENCES
 Robbins basics of pathology
 Gp pal textbook of histology
 Netter's textbook of histology
 Wheater's textbook of histology
 Pathology outline

37. THANK
YOU