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Uterine polyp

• Focal endometrial overgrowth that prolapses into the uterine cavity


causing bleeding
• May occur at any age, but most common in perimenopausal period
• Usually sessile, 0.5-3cm in diameter
• Smaller ones are asymptomatic
• Large ones can ulcerate, degenerate and bleed
Morphology
Clinical presentation
• Menorrhagia
• Dyspareunia
• Post menopausal bleeding
• Mass per vagina
Diagnosis
• Clinically, uterine polyp may not be evident and uterus may or may
not be enlarged
• It is easy to diagnose when the polypus protrudes through the
cervical canal
• Ulrasound can detect the uterine polyp
• Saline sonosalphingogram/hysterosalphingogram
Management
• D&C can scrape the polyp
• Hysteroscopic removal of multiple polyps may be desirable to ensure
their complete removal.
Adenomyosis
Definition

• Presence of ectopic endometrial glands and


stroma within the myometrium
• The presence of endometrial glands and
stroma in the myometrium will induce a
hypertrophic and hyperplastic reaction in
the myometrium
Characteristics
• Usually occurs in 4th or 5th decade of life
• Commonly occurs in women of high parity
• Associated with other conditions such as fibroid, endometriosis,
polyps
• Adenomyoma is a condition in which there is a focus of adenomyosis
within a leiomyoma(fibroid)
Clinical presentation
• 40-50 years
• Multiparity
• Menorrhagia
• Congestive dysmenorrhea
• Dyspareunia
• Chornic pelvic pain
• Anemic symptoms
Diagnosis
• Definitive diagnosis is made by histopathological investigation post
operatively.
• TVS
• MRI
• Others: CA 125, hysterosalphingography
TVS
• meta analysis shows that the sensitivity is 82.5% and specificity is 84.6
• Findings: uterine enlargement,
cystic anechoic spaces/lakes within myometrium,
heterogenous echo texture
obscured endometrial and myometrial border
subendometrial halo thickening
Cystic echoic space
Loss of junction between endo-
myometrium
MRI
• More accurate
• Findings: uterine enlargement
diffuse or local widening of junctional zones on T2 weighted
images > 12mm
small hypointense myometrial spots
Management
• HYSTERECTOMY with or without ovarian conservation
• Conservative surgery
• GNRH analogues
• Levonogestrel IUD
• Endometrial ablation
• Uterine artery ambolisation
Leiomyoma
Definition
• Benign monoclonal tumors arising from the smooth muscle cells of
myometrium
• Most common pelvic tumor in women
• Risk of malignancy is 0.2%
Pathology
• Gross : pseudoencapsulated solid tumors, well demarcated from
surrounding myometrium

• Microscopy: longitudinal smooth muscle cells mixed with fibrous


connective tissue, vascular structures are less
Risk factors
• High BMI
Clinical presentation
• Mostly asymptomatic
• Menorrhagia
• Abdominal distension/mass
• Dysmenorrhea
• Pressure symptoms-polyuria, incomplete emptying, obstruction
• Acute pain- red degeneration and torsion of pedunculated tumor
• Infertility- intramural or submucosal
• Adverse pregnancy outcome- preterm labor, placental abruption
Diagnosis
• USG
• Diagnostic hysteroscopy
• MRI
• HSG
Management
• Observation
• Pre-operative tumor shrinkage
• Hysterectomy
• Myomectomy
• Embolisaton
Pre-operative tumour shrinkage
• GnRH analogues for 3-6 months
-reduces tumour size
-less vascularity
-better surgical plane
-reduce operative time
-better operative outcome
-Capsule shrinkage