Uterus and Adnexal Diseases

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19 Uterus and Adnexal Diseases

Anatomy of the Uterus, Adnexa, and Vagina

Uterus and Adnexa

Uterus

• Derived from fusion of paired embryonic paramesonephric (müllerian) ducts: basis for divided, asymmetrical, or bifid (didelphic) uteruses

• Endometrium: highly vascular and glandular uterine lining; thickness or state varies with menstrual cycle

• Myometrium: dense, fibrous connective tissue and smooth muscle, derived from embryonic splanchnic mesoderm

• Mesometrium: peritoneal covering of the uterus, continuous with peritoneum of broad, transverse (cardinal), uterosacral, and suspensory (infundibulopelvic) ligaments

• Fundus: dome superior to uterine tube orifices

• Body: superior 2/3

• Cervix: inferior 1/3; inferior aspect opens into vagina

• Isthmus: surface narrowing marking transition from body to cervix

• Uterine ostia: internal orifices of uterine tubes

• Uterine cavity: typically conical, apex down when not gravid

• Internal os: superior opening of cervical canal

• External os: inferior opening of cervical canal

Position of the Uterus and Pouches

• Typical, nongravid position: body anteflexed, lies against bladder

• Cervix between rectum and inferior bladder

• Nongravid uterus is thus anteverted relative to the vaginal canal and anteflexed on its own axis.

• Rectouterine pouch (of Douglas): posterior, pre-rectal peritoneal recess

• Vesicouterine pouch: anterior peritoneal recess between bladder and uterine fundus; also uterovesical

Uterine (Fallopian) Tubes (Ducts)

• Fimbriae: fringe around infundibular orifice

• Infundibulum: initial, funnel-like section proximal to fimbriae

• Ampulla: middle, wide portion proximal to infundibulum

• Isthmus: narrower portion approaching uterine wall

• Uterine portion: tube within uterine wall

Ovaries

• Normally almond-shaped and -sized

• Lie laterally and posterior to the broad ligament, attached near its upper borders via a peritoneal mesovarium

• Attached to body of uterus via ovarian ligaments running within broad ligament

• Contain follicles embedded in germinal epithelium and stroma

Primary, secondary and mature (Graafian) ovarian follicles

Corpus luteum (postovulatory follicle of current cycle)

Corpus albicans (scar of degenerated corpus luteum)

• Granulosa cells surround an oocyte in its follicle.

• Theca interna and externa cells enclose the mass of granulosa cells and ovum.

• Interna layer differentiates into theca lutein cells of corpus luteum, which secrete estradiol.

• Vascularized stroma surrounds follicles.

• Thin surface epithelium (tunica albuginea) of fusiform cells in connective tissue

• Originally smooth surface epithelium becomes progressively scarred by ovulation.

Vagina

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