Histology of uterine endometrium.pptxXXX

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.

4. 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

5. 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.

6. Lymphatic drainage Fundus : Para aortic nodes. Body : External iliac nodes.

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

8. myometrium Thickest layer. Smooth muscle bundles. Inner and outer layers – longitudinal. Middle layer – circular and spiral.

9. Leiomyoma Localized hyperplasia of smooth muscle cells of myometrium .

10. endometrium Mucosal lining of uterine cavity. Simple columnar epithelium overlying thick lamina propria S imple tubular glands. (LP) - o pen to the surface and are coiled in deep portion. S piral arteries seen between the glands. Two zones : 1/3 deep – stratum basalis 2/3 superficial – stratum functionalis

11. Endometriosis Presence of endometrial tissue anywhere other than uterine endometrium. C10 highlights the areas of endometrial stroma.

12. Menstrual cycle

13. 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 St ratum basale . Evident by numerous mitotic division.

14. EARLY PROLIFERATIVE PHASE (day 4 to 7) Short straight glands, compact stroma , minimal mitotic activity,large nuclei. MID PROLIFERATIVE PHASE (day 8 to 10) Longer curving glands, stromal edema, numerous mitotic figures. LATE PROLIFERATIVE PHASE (day 11 to 14) Tortuous glands with prominent mitosis activity and pseudostratification , dense stroma,subnuclear vacuoles less than 50%.

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

16. Proliferative phase

17. 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.

18. 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.

19. 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 ).

20. 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 .

21. endometrial dating Determined by histologic appearance. Used to assess hormonal status. Document ovulation. Find the cause of bleeding. Infertility workup

22. Menstrual phase If ovum not fertilized St ratum functionalis sheds. Cessation of secretion of progesterone by corpus luteum. Day 1 to 3 . Endometrium degenerates and is sloghed off.

23. 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.

24. 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

25. References Robbins basics of pathology Gp pal textbook of histology Netter's textbook of histology Wheater's textbook of histology Pathology outline

26. Thank you