UTERUS

PATHOLOGY

UTERINE
1. Fibroids
(leiomyoma)
i.
submucosal
ii. intramural
iii.
subserosal
iv.
pedunculate
d
2.
Leiomyosarcom
a
3. Adenomyosis
4.

ENDOMETRIAL
1.Endometrial Polyps
2.Endometrial Carcinoma
3.Endometrial hyperplasia
4.Endometritis
5.Cystic hyperplasia
secondary to Tamoxifen
6.Adhesions- Ashermans
Syndrome
7.Submucosal fibroids
8.Arteriovenous
malformation (AVM)
9.Hydro/haematometra
10.Blood/fluid/infection or
retained products of
conception (RPOC)

VAGINAL
1. Gartners duct
cyst
2. Vaginal
carcinoma
3. Hydro/haematoc
olpos
(secondary to
imperforate
hymen or
vaginal
stenosis)
4. Foreign body

CERVICAL
1. Nabothian
(retention) cysts
2. Polyps
3. Cervical fibroids
4. Cervical carcinoma
5. Cervical stenosis

UTERUS
PATHOLOGY

UTERINE LEIOMYOMAS
Uterine leiomyomas(uterinefibroids) are benign
tumours of myometrial origin and are the most common
solid benign uterine neoplasm. Commonly an incidental
finding on imaging, they rarely cause a diagnostic
dilemma.
Fibroids may have a number of locations within or
external to the uterus:
intra-uterine
intramural leiomyoma:most common
subserosal leiomyoma
submucosal leiomyoma:least common (10-15%)
extra-uterine
broad ligament leiomyoma
cervical leiomyoma
parasitic leiomyoma
diffuse uterine leiomyomatosis

UTERINE LEIOMYOMAS
Fibroids may have a number of locations within
or external to the uterus:
intra-uterine
intramural leiomyoma:most common
subserosal leiomyoma
submucosal leiomyoma:least common (1015%)
extra-uterine
broad ligament leiomyoma
cervical leiomyoma
parasitic leiomyoma
diffuse uterine leiomyomatosis

UTERINE LEIOMYOMAS
They can also undergo several types of
degeneration:
hyaline degeneration:
focal or generalized
hyalinization: this is the most common type of
degeneration (can occur in ~60% of cases)6
cystic degeneration: ~5%
myxoid degeneration:
generally
considered
uncommon although reported as high a 50% by
some authors
red/carneous degeneration: due to haemorrhagic
infarction, which can occur particularly during
pregnancy, and may present with acute
abdominal pain

UTERINE LEIOMYOMAS
Pelvic ultrasound
ultrasound is used to diagnose the
presence and monitor the growth of
fibroids
uncomplicated leiomyomas are usually
hypoechoic, but can be isoechoic, or even
hyperechoic compared to normal
myometrium
calcification is seen as echogenic foci with
shadowing
cystic areas of necrosis or degeneration
may be seen

Sub-serosal leiomyoma

b-mucosal leiomyoma that extends

o the endometrial cavity

Intra-mural leiomyoma

Broad ligament fibroids

LIPOLEIOMYOMA OF
UTERUS

One of the rarer and less well known

uterine masses is the lipoleiomyoma. Like
the leiomyoma of the uterus, the
lipoleiomyoma is also a benign, well
defined mass but has a very high content
of fatty or adipose tissue.

LIPOLEIOMYOMA OF
UTERUS
These sections of the uterus show an echogenic, well
defined lobulated mass in a posterior location in the
body of the uterus. It is typically intramural in
location as seen in the images above; however it can
be submucosal or subserosal in location.
In addition, note the presence of a sonographic halo
around the mass, typically seen in lipoleiomyomas.
This halo represents compressed myometrial tissue
around the margins of the tumor. Image-1 also shows
a small amount of fluid in the uterine cavity, an
incidental finding. CT scan imaging further confirmed
the presence of fatty tissue within this mass

ADENOMYOSIS
Adenomyosis of the uterusis a relatively common,
benign uterine pathology. It is thought by many to be on
the spectrum ofendometriosis, with ectopic endometrial
tissue in the myometrium. Adenomyosis may present
with menorrhagia and dysmenorrhea.
The spectrum of findings includes:
normal appearing uterus
focal or diffuse myometrial bulkiness, typically of the
posterior wall thickening of the transition zone can
sometimes be visualized as a hypoechoic halo
surrounding the endometrial layer of 12 mm
thickness.
subendometrial echogenic linear striations

ADENOMYOSIS
Sub endometrial echogenic nodules (specific sign)
Small myometrial cysts /sub endometrial cysts
(specific sign)
heterogeneous
echogenicity
(heterogenous
myometrial echotexture)
hyperechoic: islands of endometrial glands
hypoechoic: associated muscle hypertrophy
a "Venetian blind" appearance may be seen due to
subendometrial echogenic linear striations and
acoustic shadowing where endometrial tissues
cause a hyperplastic reaction
When anadenomyomais
present,
then
appearances may closely mimic those of auterine
fibroid, which may also co-exist.

Typical appearances of adenomyosis at transvaginal

ultrasound include poorly marginated hypoechoic and
heterogeneous
areas
within
the
myometrium,
myometrial cysts, and a globular or enlarged uterus with
asymmetry.

Focal adenomyoma

LEIOMYOSARCOMA
Leiomyosarcoma(Gr. "smooth muscle connective
tissue tumor"), also referred to as LMS, is a malignant (
cancerous)smooth muscle tumor.
It must not be confused withleiomyoma, which is a
benign tumororiginating from the same tissue.
It is also important to note that leiomyosarcomas do
not arise from leiomyomas
Pelvic ultrasound is typically the first-line study to
evaluate women for potential uterine pathology.
Sonographic evaluation of a uterine mass may identify
features suggestive of sarcoma (mixed echogenic and
poor echogenic parts, central necrosis, and color
Doppler findings of irregular vessel distribution, low
impedance to flow, and high peak systolic velocity);
however, many of these characteristics may also be
found in benign leiomyomas

LEIOMYOSARCOMA

NDOMETRIAL PATHOLOGY

ENDOMETRIAL POLYPS
Endometrium is the lining of the inside of the womb
(uterus). Overgrowth of this lining can create polyps.
Polyps are fingerlike growths that attach to the wall of
the uterus. They can be as small as a sesame seed or
larger than a golf ball. There may be just one or
many polyps.

ENDOMETRIAL
CARCINOMA

Endometrial cancer starts when cells in the inner

lining of the uterus (endometrium) begin to grow
out of control

ENDOMETRIAL
HYPERPLASIA

Endometrial hyperplasiais a condition of

excessive proliferationof the cells of the
endometrium, or inner lining of theuterus.
Most cases of endometrial hyperplasia result
from high levels ofestrogens, combined with
insufficient
levels
of
theprogesterone-like
hormones which ordinarily counteract estrogen's
proliferative effects on this tissue.
This may occur in a number of settings,
including
obesity,polycystic ovary syndrome,
estrogen producing tumours (e.g.granulosa cell
tumour)
and
certain
formulations
of
estrogen replacement therapy.
Endometrial hyperplasia is a significant risk
factor for the development or even co-existence

ENDOMETRIAL
HYPERPLASIA

ENDOMETRITIS
Endometritisisinflammationof theendometrium,
the inner lining of theuterus.
Pathologistshave
traditionally
classified
endometritis as eitheracuteorchronic:
Acute endometritis is characterized by the presence
of
microabscesses
orneutrophilswithin
the
endometrialglands.
While chronic endometritis is distinguished by
variable
numbers
ofplasma cellswithin
the
endometrialstroma.
The most common cause of endometritis isinfection
. Symptoms include lower abdominal pain, fever

ENDOMETRITIS

Adhesions- Ashermans
Syndrome
Asherman's syndrome(AS) orFritsch syndrome, is a
condition characterized by adhesions and/or fibrosis
of the endometrium particularly but can also affect
the myometrium.
It is often associated withdilation and curettageof
the intrauterine cavity.
A number of other terms have been used to describe
the
condition
and
related
conditions
including:intrauterine
adhesions(IUA),uterine/cervical
atresia,traumatic
uterine atrophy,sclerotic endometrium,endometrial
sclerosis, andintrauterine synechiae

Adhesions- Ashermans
Syndrome

ARTERIOVENOUS
MALFORMATION

Uterine arteriovenous malformation(AVM) is a rare

vascular condition, with less than 100 cases reported in the
literature. It is a dilatation of the intervillous space deep inside
the myometrium, allowing a direct flow from the arterial
system towards the venous system, without participation of
capillary vessels

HYDROMETRA
Refers to a distendeduterusfilled with clear,noninfected fluid.

PYOMETRA

RETAINED PRODUCTS OF
CONCEPTION

HAEMATOMETRA

Cervical
pathology

NABOTHIAN CYST
Nabothian cysts are very small cysts that
develop on cervix. Theyre also known as
cervical cysts, mucinous retention cysts,
or epithelial cysts.
Theyre benign, which means theyre
noncancerous, and they arent a sign of
cervical cancer. In fact, theyre fairly
common.

Typically seen an anechoic well defined

cystic lesions near the endocervical canal.
If the cysts are large, the cervical region
can appear enlarged. Colour Doppler
interrogation shows no associated colour

NABOTHIAN
CYST

NABOTHIAN CYST

CERVICAL POLYP
Cervical polypsare growths that usually
appear on thecervixwhere it opens into
the vagina.
Polypsare usually cherry-red to reddishpurple or grayish-white. They vary in size
and often look like bulbs on thin stems.
Cervical
polypsare
usually
not
cancerous (benign) and can occur alone or
in groups.

large polypoid mass of 1.2 to 1.5 cm protruding from

the lower segment of the uterus to the cervix, or to
be more precise into the endocervical canal. In
addition there is a cystic fluid collection in the
endocervical canal which may be due to obstruction

CERVICAL
FIBROID

CERVICAL
STENOSIS
Cervical stenosis means that the
opening in the cervix (the endocervical
canal) is more narrow than is typical. In
some cases, the endocervical canal may
be completely closed.
A stenosis is any passage in the body
that is more narrow than it should
typically be.

CERVICAL
CARCINOMA

VAGINAL PATHOLOGY

GARTNERS DUCT
CYST
AGartner's duct cyst(sometimes incorrectly
referred to as vaginal inclusioncyst) is a benign
vaginalcysticlesion that arises from the vestigial
remnant of a mesonephricductorGartner's
duct.

HYDRO/HAEMATOCALP
OS
Hydrocolposis characterised by an expanded fluid
filled vaginal cavity when it is associated with
distention of the uterine cavity, the term
hydrometrocolposshould then be used.

Haematocolposis a term given to a blood filled

dilated vagina but without any accompanying blood
(often menstrual blood) within the uterine cavity.

HYDROCOLPOS

HAEMATOCOLPOS