1. BENIGN LESION OF
THE UTERUS
NUR SAKINAH BINTI ZULKIFLI
43

2. ENDOMETRIAL
POLYPS
ADENOMYOSIS
LEIOMYOMA
UTERUS
(FIBROID)

5. ENDOMETRIAL POLYPS
• Localized outgrowth of the endometrium
• contain an inner core of blood vessel
• surrounded by blood vessel and stroma
• Maybe benign or malignant
• Benign : attached by pedicle

6. Age
• All age group
• Peak (40-49 years)
Size
• Few mm – several cm
Number
• Single or multiple
Types
• Pedunculated
• Sessile
• Mucous
• Fibroid
• Placental

7. RISK FACTOR
HRT
Tamoxifen
therapy
Diabetes
Hypertension
Obesity
Increased
patient age

8. PATHOLOGY
• BODY : a part of thick endometrium project into the
cavity and ultimately attained pedicle/sessile
• CUT SECTION: grey or reddish brown
GROSS
APPEARANCE:
• Core : contain stromal cells gland and large thick walled
vascular channel.
• Surface :lined by proliferative endometrial lining with
cystic hyperplasia or squamous metaplasia
• Pedicle : contain thin fibrous tissue with thin blood vessel
• Smooth muscle invade polyps : adenomyomatous polyps
MICROSCOPIC

10. PREDICTOR OF MALIGNANCY
Size >10 mm
Postmenopa
usal status
Abnormal
uterine
bleeding

11. CLINICAL FEATURE
Maybe
asymptomatic
Menorrhagia
Intermenstrual
bleeding
Contact bleeding
(polyps situated
outside cervix)
Infertility and
miscarriage
(multiple polyps)

12. ON EXAMINATION
• Uterus normal/uniformly enlarged
• Soft, slippery and small in size (outside the
cervix)
• PER SPECULUM : Reddish in color attached
with slender pedicle

13. INVESTIGATION
• Must be ruled out in women with abnormal
uterine bleeding who do not respond to
traditional treatment

14. MANAGEMENT
Hysteroscopic
polypectomy
Curettage of
endometrium
(to rule out
hyperplasia)

16. ADENOMYOSIS
• Presence of endometrial tissue in
myometrium >2.5mm from the basal layer of
endometrium
• Endometrial gland and stroma must present

17. PATHOGENESIS
• Oestrogen recepter mutation
• Gene polymorphism
• Basal layer of endometrium including stroma
and gland infiltrating myometrium.
• Surrounding myometrial tissue hypertrophied
and hyperplasia
• Uterine enlargement

18. PATHOLOGY
• DIFFUSE
– Involve anterior and posterior uterine walls
– Causes uniform uterine enlargement
– Thickened myometrium and hemorrhagic foci of
adenomyosis
• LOCALIZED
– Grossly mimic leiomyoma (no capsule or distinct
plane of dissection)

19. CLINICAL FEATURE
• Common in multiparous age 40-50
• Does not occur before menarche and regress
after menopause • Uterus uniformly enlarged
• Palpable abdominally (<14
week’s size)
• May co-exist with other
pelvic pathology
– Leiomyoma
– endometrial hyperplasia
– endometriosis
– endometrial carcinoma
• Dysmenorrhea
(> with > duration
of disease and depth
of infiltration
• Menorrhagia

20. INVESTIGATION
Transvaginal ultrasonography
• Asymmetrical thickening of uterine walls
Doppler sonography
• To differentiate from fibroid
MRI
• Conservative surgical or medical management preferred
• Young lady with infertility
Image directed needle biopsy

21. MEDICAL MANAGEMENT
NSAID
COMBINED OCP
DANAZOL
• Androgen,estrogen and progesterone receptor present in lesion
• Reduce in size, menorrhagia reduce
• Temporary effect
GnRH ANALOGUE
• Prior to surgery to reduce size and vascularity
AROMATASE INHIBITOR (anastrozole)
LEVONOGESTREL INTRAUTERINE SYSTEM (LNG-IUS)
DANAZOL LOADED INTRAUTERINE DEVICE
• Reduce pain and bleeding

22. SURGICAL MANAGEMENT
• Definitive surgery • Perimenopausal age
• Poor response to medical
therapy
• Associated pelvic pathology

23. CONSERVATIVE SURGERY
• Localized adenomyoma by
adenomyomectomy
• Plane of dissection id difficult since no capsule
Resection of
adenomyoma
• Diffuse adenomyosis
• Partial resection of uterine walls
Myometrial
reduction
• Submucosal adenomyosis/ polypoidal lesion
Hysteroscopic
reduction

24. NEWER INTERVENTIONAL TECHNIQUE
Endometrial
ablation
Uterine
artery
embolisation
MRI guided
focused
ultrasound
surgery

25. REFERENCE
• Essentials Of Gynaecology, Lakshmi Seshadri
• DC Dutta Textbook Of Gynaecology

26. THANK YOU