5. ENDOMETRIAL HYPERPLASIA
A spectrum of proliferative
abnormalities of
endometrium are
subdivided into:
CYSTIC HYPERPLASIA:
increase in the number of
glands.
ADENOMATOUS
HYPERPLASIA: back to
back crowding of glands
with little intervening
stroma.
ATYPICAL
HYPERPLASIA: glands
show nuclear
10. PATHOLOGY
GROSS FEATURES:
DIFFUSE TYPE:
Involves most of endometrium. May
reach the myometrium and serous
surface.
PYOMETRA:
uterus is enlarged due to the
formation of pyometra which is
formed following an infection of the
tumor with accumulation of pus due to
stenosis of internal cervical os
LOCALIZED TYPE:
It is limited to small area where it
forms a polypoidal growth. polyp is
friable, ulcerated and necrosed.
11. MICROSCOPIC FEATURES:
1.Adenocarcinoma(ca. arising from glandular tissue)
2.adenocanthoma.
3.Adenosquamous carcinoma
Histological grading of adenocarcinoma depends upon degre
of differentiation.
GRADE 1: <5% non squamous
Well differentiated
GRADE 2: < 6-50% non squamous
moderately differentiated
GRADE 3: >50% non squamous
undifferentiated
12. SPREAD
DIRECT:
Cervical canal: here the tumor may get infected and blocks the Cervix
leading to pyometra formation
Myometrium
Ovaries
LYMPHATIC SPREAD:
inguinal lymph nodes
para aortic lymph nodes.
BLOOD BORNE:
Lungs,
Liver,
Bone etc
IMPLANTATION:
During hysterectomy malignant cells may get implanted in the vaginal vault
causing recurrence.
13. CLINICAL FEATURES
SYMPTOMS
BLEEDING: due to ulceration and sloughing
off of the carcinoma.
Irregular vaginal bleeding.
Post menopausal bleeding.
MENORHAGIA in premenopausal patients.
VAGINAL DISCHARGE:
Brownish or blood stained, offensive or
purulent due to pyometra.
14. PAIN: late symptom.
Indicates advanced growth with metastasis.
Dull, colicky lower abdominal pain.
Occurs due to strong contractions of uterus to
expel the polypoid growth or pyometra.
ASYMPTOMATIC
15. PHYSICAL
EXAMINATION
Palpation of
supraclavicular and
groin nodes.
Breast is examined for
a co-existent primary or
secondary lesion.
Speculum
examination: done for
metastatic invasion of
vagina.in case of
pyometra a pyogenic or
blood stained discharge
pours from the cervix.
16. BIMANUAL PELVIC
EXAMINATION:
To assess the
size,consistency
and mobility of
uterus.
Findings: large
size,
soft consistency in
case of pyometra
Reduced mobility if
the tumor has
extended beyond
30. RADIOTHERAPY OPTIONS
COMBINED WITH SURGERY:
Treatment of choice for stage 1C or stage 2 in which
more than half of the myometrium and cervical
glands and stroma are involved.
RADIOTHERAPY ALONE:
If the growth is wide spread in the pelvis(stage 3,4)
or if the patient is too weak to undergo surgery.
ROUTES:
BRACHYTHERAPY:intracavitary
TELETHERAPY:by external routes
31. CHEMOTHERAPY OPTIONS
PROGESTOGEN:
For relief of pain in advanced cases.
2-3 injections are given before or after
surgery or radiotherapy.
Minimum duration of treatment is more
than 3 months.
PREPARATIONS:
Inj.medroxyprogesterone acetate 200
mg im weekly(depoProvera)
Inj.hydroxyprogesterone caproate 250
mg im weekly(proluton Depot)
Tab.norethisterone10 mg tid.(primolute
32. FOLLOW UP
TO DETECT THE RECURRENCE:
Vaginal recurrence is common so it should be examined
at every visit.
TO DETECT COMPLICATIONS OF THERAPY:
Hematuria,
Cystitis,
Diarrhea,
Melena
Rectal spasm,
Ilietus,
Vaginal stenosis,
Lymphedema etc