to develop the themes:
It is a piriform unequal organ divided at the bottom, body and neck.
Position and ligaments
The uterus is placed in the center of the small pelvis, between the bladder (anteriorly)
and the rectum (posteriorly) .Anteriorly it rests on the bladder, from which it
is separated by the peritoneal recess (vesicrouterine cord) which is usually a
virtual cavity; posteriorly it is in relationship with the rectum through the
interposition of another peritoneal recess, the straight-uterine cable, also
called recess or cavum of the Douglas, that usually contains loops of the small intestine;
on both sides, the wide ligaments, the peritoneal formations containing
connective tissue and vascular and ligamentous structures (round ligament,
uterine tuba, ureter, part of the ovaries) are inserted on both sides.
Characteristic is the position of the uterus with respect to the pelvis: the
major axis of this form with the major axis of the pelvis an angle open anterior
(version angle) of about 60 ° (condition called physiological anteversion),
while the axis of the body forms with the axis of the uterine neck an angle
obtuse (bending angle) of about 150 °, open anteriorly (physiological
anti-reflexion).
The neck consists of a portion that is located inside the vagina and an area consisting of the cervical canal that continues through the uterine orifice inside with the uterine cavity.
The uterus, but mainly, the "portio", is worth the part of the cervix that protrudes into the vagina, is home to neoplasia and lesions. So it is a very studied part by gynecologists. In particular, it is the epithelium of neoplasms. Exactly it is the point of passage between the epithelium of the uterus, where it is reflected inside the vagina, called the area of transformation.
The structure of the epithelium that covers these various portions of the organ are
different; we find a multi-layered epithelium that covers the vagina and the uterine portion that juts into the opening of the same opening (portio), a
passage zone that takes the name of squamo-columnar junction that determines the conjunction of the multilayered epithelium with an epithelium simple bati-crism
constituted by columnar cibate cells with glands and, finally, this epithelium continues with the endometrium. The neoplasms that we will consider today are
those epithelial that arise at the level of the cervix, both of the external portion and those of the cervical canal which, I repeat, have two different
histogenesis because they originate from two different epithelia.
In the vagina and in the harpoon we have a multilayered epithelium for a
protective function, especially against traumas; This need is no longer in the
cervical canal. The squamo-columnar junction represents a critical point with
regard to neoplastic transformations; it is located roughly in correspondence
with the outer uterine but, following various conditions, it can move forward (when
we have an increase in the volume of the harpoon) and undergo a transformation:
in other words that epithelium that previously had to be protected inside the
cervical canal it moves downwards and as a reaction we have a squamous
metaplasia to face the greatest trauma to which it is subjected.
On the other
hand, in the period of menopause, with the disappearance of hormonal stimuli, a
reduction in the mass of the uterus is determined and therefore there can be a
rise in the junction within the cervical canal. All this is important because
there is an investigation, called PAP test, which means a cytological test with
Papanicolau staining that studies vaginal exfoliation cells and infections.
Various notions can be obtained with it:
- cellularity, in the sense that some cells have become atypical and attract the
attention of the oncologist for preventive purposes
- infections, in the sense that the hyphae of the fungi can be found by studying
the test, e.g. of candida, tricomonas vaginalis, herpes virus lesions or
papilloma virus.
Finally, let us remember that the internal epithelium of the uterus, called the
endometrium, undergoes cyclic changes that constitute the menstrual "cycle".
Vice versa, the muscular layer, or myometrium, undergoes other injuries, for
example myometrial lesions, called uterine myomas, which are very frequent in
women and cause infertility. The myoma, or fibroid, uterine is the most frequent
benign tumor of the uterus, it is present in over 35 percent of women over the
age of 30 years. Uterine myomas or fibroids are benign tumor alterations due to
the exaggerated development of smooth muscle cells of the uterus. For some
authors it would be an alteration of the immature smooth muscle cell, according
to others of a totipotent mesenchymal cell, this would explain the double
component of the tumor: muscular and fibrous. Estrogens that stimulate the
multiplication of cells of the same fibroid. It is not by chance that fibroids
are hardly exposed before puberty, whereas after the menopause, when estrogen
production is lacking, fibroids can reduce their size until they disappear. On
the other hand, during pregnancy, when the estrogen level is high, a possible
fibroma can increase considerably in volume, and the risk for pregnancy. If the
fibrous component predominates they are called fibroids, if the muscular myomas
prevails and if there is no difference it is called fibroids>
Fibromyoma
sexology index