Uterine lesions
Congenital anomalies (Figure 10.1)
- Normal müllerian duct fusion during embryogenesis results in a triangular-shaped uterine cavity and canalized upper vagina. Incomplete fusion results in a variety of congenital anomalies.
- Uterine didelphys is the most extreme form of incomplete fusion with two separate uteri and possibly two cervices, and a septate upper vagina. Partial fusion is more common, resulting in an arcuate septate, bicornuate, or septate uterus. A unicornuate uterus arises from one müllerian duct and its attached tube; the other müllerian duct may be rudimentary or absent.
Fibroids (leiomyomas, myomas) (Figure 10.2)
The most common neoplasm of the female pelvis present in about 50% of women and the leading indication for hysterectomy.
- Etiology. Uterine fibroids are benign proliferations of smooth muscle and fibrous connective tissue that originate from a single cell. They are usually multiple, range in diameter from 1 mm to >20 cm, and are surrounded by a pseudocapsule of compressed smooth muscle fibers. Fibroids may increase in size in response to estrogen therapy and most regress to some degree after menopause. Progestins, clomiphene, and pregnancy occasionally induce a rapid increase in size, with hemorrhagic degeneration and pain. Fibroids are more common in black women.
- Classification. All fibroids begin within the myometrium. Continued growth in one direction will ultimately determine how the fibroids are classified by location as subserosal, intramural, or submucosal. Occasional fibroids have more numerous mitotic figures (mitotically active leiomyoma) or densely cellular fascicles of smooth muscle (cellular leiomyoma). These subtypes do not meet diagnostic criteria for leiomyosarcoma and have no malignant risk.
- Symptoms. Most patients are asymptomatic. Women may seek treatment for abnormal uterine bleeding, pelvic pressure, or pain.
- Diagnosis. Palpation of an enlarged, irregular uterus on bimanual examination is suggestive. Ultrasound may be used to confirm the diagnosis. Grossly, fibroids can have a variety of appearances depending on the location and presence of degeneration.
- Expectant management.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
