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Uterus - Normal

Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 2 October 2011, last major update September 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.


● Corpus is upper 2/3 of uterus above level of internal cervical os
● Uterus is hollow, pear shaped, 40-80 g and 7-8 cm
● Peritoneal reflection is lower posteriorly than anteriorly because bladder is anterior; this is used to orient uterus
● Myometrium has a rich network of blood vessels; arteries are sometimes found within dilated venous channels (Am J Surg Pathol 2002;26:232); myometrium is PLAP positive
● Width varies from 27 mm in nulliparous women to 32 mm in women with 2+ pregnancies (Obstet Gynecol 2010;116:305)
● Drains to parametrial, paracervical, internal iliac, external iliac, common iliac, periaortic and inguinal lymph nodes
● Note: menstruating tissue is replaced by cells from basalis, isthmus and ostio of tubes
Before puberty: endometrial tissue is inactive and composed of tubular glands, dense fibroblastic stroma and thin blood vessels
After menopause: inactive (no proliferation or secretion), thin, often with cystic cavities lined by flat or cuboidal cells and fibrotic stroma

Anatomical divisions

Fundus: cephalad to line connecting the insertion of fallopian tubes
Cornua: lateral regions of fundus associated with intramural fallopian tubes
Isthmus / lower uterine segment: portion of corpus connecting with cervix
Cervix: lower 1/3 of uterus; at and below level of internal cervical os


Various diagrams

Gross images

Normal - anterior; posterior; secretory endometrium

Bifid uterus

Micro description

● Uterine cavity: 6 cm long, triangular shape and lined by endometrial mucosa / endometrium, then myometrium, then serosa, which extends to peritoneal reflection
● Basalis layer is retained; functionalis layer (superficial 1/2 to 2/3) is shed monthly
● Functionalis is divided into spongiosum (near basalis) and compactum (near surface)
● Stroma is composed of stromal cells, vessels, stromal granulocytes (T cells, macrophages) and foamy cells
● May have lymphoid follicles

Micro images

Normal endometrium and cyclin D1 (figures 1A/1B)

Lymphoid aggregate in proliferative endometrium is a normal finding, not endometritis

Proliferative endometrium with artifactual changes secondary to curettage, which was misinterpreted as endometrial hyperplasia. The glands in this field are neither architecturally irregular nor cystically dilated. The ratio of glands to stroma is about normal for a midproliferative endometrium, and a general orientation of the glands from upper left to lower right is noteworthy

End of Uterus - Normal

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