PATHOLOGY OF CORPUS UTERY

DR. HENNY SULASTRI, SpPA(K)

PATHOLOGY OF ENDOMETRIAL
- Menstrual cycles
- Pregnancy
- Disfunctional Uterine Bleeding
A. Anovulatoir cycles
B. Irregular maturation
C. Irregular sheeding
- Adenomyosis
- Endometrial Polyps
- Endometrial Hyperplasia

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Menstrual Cycles

3
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 Department of Anatomical Pathology
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 Endometrial of Pregnancy
 Luteal corpus  preserved by continues
stimulation of hCG  secretioned by placental
trophoblast.
 Trophoblast  starts to grow ± days 23rd
 hCG

luteal corpus progesterone

fluid secretion stimulation by endometrial glands.

 These features can persist for up to 8 weeks after

delivery.
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 Dysfunctional Uterine Bleeding

• Appear at / between menstrual periode

• Causa : is outside uterine
 usually because endocrine disorders

hypothalamic-pituitary-ovarian axis
• Pathology of gynecologic on reproductive age ♀
is the most common.
• Anovulatory Bleeding  the most common
feature of Dysfunctional Bleeding.
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 Anovulatory Bleeding

• Anovulatory bleeding is a complex syndrome of many

causes that manifests as the absence of ovulation
during the reproductive years.
• Menarche & Menopause

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Causes of Abnormal Uterine Bleeding (Including
Uterine & Extrauterine Causes)

Newborn Maternal estrogen

Childhood Iatrogenic (trauma, foreign body, infection of
vagina)
Vaginal neoplasms (sarcoma botryoides)
Ovarian tumors (functional)

Adolescence Hypothalamic immaturity

Psychogenic and nutritional problems
Inadequate luteal function
Iatrogenic: anticoagulants, IUD
Irregular shedding

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Reproductive age Anovulatory
Central: psychogenic, stress
Systemic: nutritional and
endocrinedisease
Gonadal: functional tumors
End-organ: benign endometrial
hyperplasia
Pregnancy : ectopic, retained placenta,
abortion, mole
Ovulatory
Organic: neoplasia, infections (PID),
leiomyomas
Polymenorrhea: short follicular or luteal
phases
Iatrogenic: anticoagulants, IUD
Irregular shedding
Menopause Carcinoma, EIN, benign hyperplasias,
EIN = endometrial intraepithelial neoplasia;
IUD = intrauterinedevice; polyps, leiomyomata
PID = pelvic inflammatory disease.
Postmenopause Carcinoma, EIN, polyps, leiomyomata
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 Adenomyosis
• Adenomyosis is the presence of endometrial
glands and stroma within the myometrium
• Clinical symptoms  usually asymptomatic
pelvic pain, dysmenorrhea, DUB or
menorrhagia, dyspareunia & pathological
findings of the presence of adenomyosis if the
glands are located min. 1 mm / > in endometrial
myometrial junction.
• Causa : unknown
• Reproductive age ♀
• Regress at menopause
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• Uterine can be enlarged.
myometrium discloses small, soft, tan areas,
some of which are cystic.

• Surface cut of uterine

 small, red area
shows endometrial
glands in myometrium.

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• A microscopic view shows an endometrial gland
and stroma in the myometrium.

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 Endometrial Polyp

• Endometrial Polyp is a Benign Stromal Neoplasm

in the Endometrial Cavity (exophagotic masses
that project into cavum uteri)
• Perimenopausal  most often
• Pre menarche  (-)
• Location : usually  fundus
• Solitair  but 20% multiple
• Clinic : intermenstrual bleeding

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 MORFOLOGI
• Stromal hiperplasia maybe hyperplastic or
atropic sometimes secretory changes
 Endometrial polyp

• A. A single polyp extends into the endometrial cavity. The necrotic

tip is responsible for clinical bleeding.
• B. On microscopic section, a polyp exhibits slightly dilated
endometrial glands embedded in a markedly fibrous stroma.
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 Benign Endometrial Hyperplasia

• Benign endometrial hyperplasia refers to a spectrum

of endometrial wide changes resulting from
abnormal estrogenic stimulation, exhibiting randomly
distributed architectural and cytologic changes .
• Causa : estrogenic stimulation >>
- anovulatory cycles,
- polycystic ovary syndrome
- an estrogen-producing tumor
- therapeutic administration of estrogens
- obesity.
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 HISTOLOGICALLY

I. Non Atypical Hyperplasia

• Increase in the gland to stromal ratio
• Gland variation in size and shape, tubular,
cystic
• The lining epithelium hyperplasia,
pseudostratified
• No cellular atypic
• 1 % - 3 % progress to endometrial carcinoma

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 ATYPICAL HIPERPLASIA
(Endomertial Intraepitelial Neoplasia)
(EIN)

• Complex pattern ofproliferating

gladsdisplaying nuclear atypia.
• Commonly back to back pattern
• Complex outline glands due to branching
architexture
 ATYPICAL HIPERPLASIA
• Epitel cells lose the perpendicular orientation
• Nuclei vesicular, chromatic coarse and nucleoli
conspicuous
• 20% - 25% risk of adenocarcinoma
• 23% - 48% atypical hiperplasia are found to
have carninoma when hysterectomi is
performed.
 ENDOMETRIAL CARCINOMA

• 7% of all invasive cancer in women

• Base on clinical pathologic studies and
molecular EC divided into two distinc type
 Endometrial carcinoma / type I
Adenocarcinoma endometrial
• Arround menopause women
• Associated with obesity diabetic, hipertension,
infertility, prolong menopause estrogen
stimulation
• Low grade , ussualy indolent
• Proceded by atypical hiperplasia (EIN)
• Mutasi in the PTEN, PIK3 CA, KRAS andARID IA
genes
 HISTOLOGIC OF TYPE I
• Three histologic grade :

1. Well differentiated
2. Moderately differentiated
3. Poorly differentiated
 Endometrial carcinoma type II
( Serous ) carcinoma endometrium
• 15% of cases endometrial carcinomas
• Occur in women who are about 10 years older than
type
• Carcinoma ussualy arise in the sedding of
endometrial atropy
• High grade agressive tumor and have poor prognosis
• Precursor is serous endometrial intra epithelial
carcinoma (EIC)
• Mutation in TP 53, also the precursor
 HISTOLOGIC of tipe II
• Serous carcinoma invasive lesion may have
papilary growth pattern.
 Endometriosis
 Endometriosis is the presence of benign
endometrial glands and stroma outside the uterus
 5-10% ♀ reproductive age & regress after natural /
artificial menopause
 Location :
- ovary (>60%),
- other uterine adnexae (uterine ligaments,

rectovaginal septum, pouch of Douglas)

- pelvic peritoneum that covering the uterine,
fallopian tube, rectosigmoid colon, & bladder
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Sites of endometriosis

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  Hystogenesis  3 theory

1. Transplantation of endometrial fragments

to ectopic sites
2. Metaplasia of the multipotential celomic
peritoneum
3. Benign metastase theory endometrial tissue from
the uterus can spread to bone , brain and
lung via blood vessel and lymphatic channels.
4. The extrauterine stern cell / progenitor cell from the
bone moarrow diffrentiated into endometrial
tissue.
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 LEIOMYOMAS
• Leiomyomas( fibroid ) are benign smooth
muscle neoplasia.
• The most common tumor in women
• Occur single , more often multiple.
• Morphology : sharply circumscribe, discrete,
round, firm , gray – white.
• Associated with MED12 mutation
• Location : muscle cells proliferation, cell
uniform, oval nucleus , longslender bipolar
cytoplasmic proscesses.
• Variant : - atypical (synoplastic)
- cellular leiomyoma.
 LEIOMYOSARCOMA
• Uncommon , ussualy arise de novo
• Morphology :
1. Bulky , flashy masses
2. Polipoid masses project into cavum uteri
Microscopic :
1) Nuclear atypia , from well differentiated
higly anaplastic
2) Mitotic index :10 or more / 10 HPF indicate
malignant
3) Nekrosis
if finded a proportion neoplasmas tumor of
uncertain malignant potential.
 Uterine Myoma

• A, Leiomyomas of the myometrium. The uterus is opened to reveal

the tumors bulging into the endometrial cavity & displaying a firm
white appearance on sectioning.
• B, Leiomyoma showing well-differentiated, regular, spindle-shaped
smooth muscle cells.
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