Introduction
This topic covers three common disorders of the uterine body: chronic endometritis (persistent inflammation of the endometrium), endometriosis (endometrial glands and stroma outside the uterine cavity) and endometrial hyperplasia (an overgrowth of endometrial glands, the precursor of endometrioid carcinoma). For each you need the cause, the morphology and the consequences. Endometrial tumours themselves belong to the next topic.
Chronic endometritis
Definition: a chronic inflammation of the endometrium whose diagnostic hallmark is the presence of plasma cells in the endometrial stroma.
- Etiology: retained products of conception after abortion or delivery (fragments of placenta or fetal bone); intrauterine contraceptive device; pelvic inflammatory disease (Chlamydia trachomatis, Neisseria gonorrhoeae, mixed anaerobes and coliforms); tuberculosis (rare, usually from the fallopian tubes); chronic cervical or tubal infection; and in some cases no cause is found.
- Morphology: the stroma contains lymphocytes, plasma cells and macrophages, sometimes lymphoid follicles. The stroma may be fibrotic, and the glands show irregular, asynchronous development. Granulomas with caseation suggest tuberculosis. Neutrophils indicate an acute component.
- Consequences: abnormal uterine bleeding, pelvic pain, infertility and recurrent miscarriage, intrauterine adhesions (Asherman syndrome) after severe damage, and pyometra if the cervix is obstructed.