Hysteroscopy Pictures

Dysmorphic uterus

  The new classification system of Müllerian anomalies developed by the ESGE/ESHRE CONUTA working group has dedicated a specific interest to those uteri, named “dysmorphic”, characterized by a normal outline but with an abnormal lateral wall’s shape of the uterine cavity ( i.e. T-shaped uterus and tubular-shaped/infantilis uteri). These uteri are associated with infertility and pregnancy loss and in the previous American Fertility Society classification were included in class VII and mainly related to diethylstilbestrol-related (DES) exposure. However clinical experience has shown that these uteri are more common than expected, mostly diagnosed in young infertile patients with no history of DES exposure.

  Recently, Dr. Attilio di Spiezio Sardo has developed a new outpatient minimally invasive technique yielding an increase in volume and an improved morphology of both tubular uterine cavities and T-shaped (Hysteroscopic Outpatient Metroplasty To Expand Dysmorphic Uteri: the HOME-DU technique). The technique, performed under conscious sedation, involves that two incisions of 3–4 mm in depth are made with a 5- Fr bipolar electrode along the lateral walls of the uterine cavity in the isthmic region, followed by additional incisions placed on the anterior and posterior walls of the fundal region up to the isthmus.

Cervical Stenosis

There is no consensus on the definition of cervical stenosis, but from the hysteroscopy point of view, it could defined as the cervix that present a difficult access and require special maneuvers to introduce the hysteroscope into the cervical canal. Perhaps, the definition proposed by Bandalf defining cervical stenosis when the cervical canal does not allow the passage of a Hegar dilator 2.5 mm is more objective. Stenosis of the external os has been defined when there is less than 4.5 mm expansion. Cervical stenosis and pain during the procedure, are the main causes of failure to perform in office hysteroscopy.

Acquired stenosis is the most common cause of cervical atresia and is related to age, hormonal status and previous surgical procedures on the cervix. Cervical stenosis may affect the external os, the internal os or the entire cervical canal. In all hree locations, the most frequently affected by stenosis is the IO. Cervical stenosis is a condition that affects mainly postmenopausal women.

Endometrial Polyp

 Endometrial polyps are considered areas of focal proliferation of the endometrial mucosa. They consist of fibrous stroma and endometrial glands that are arranged around a vascular axis.

  They represent one of the most frequent endometrial pathologies and can lead to irregular menstrual bleeding and infertility. The prevalence in the general population is 24 % being even greater in postmenopausal women.

 The etiology and pathogenesis of endometrial polyps has been debated for years. There are several theories that try to explain their etiology. The studies seem to conclude that their appearance due to a proliferative process associated with hormonal and inflammatory factors at the level of the endometrium.

 There are multiple risk factors for the development of endometrial polyps such as age, BLC-2 protein, obesity, and estrogen treatment.

AV Malformation

The infrequency of hysteroscopic images of uterine arteriovenous fistulas (AVF) that occur after pregnancy makes almost impossible to establish a defined hysteroscopic pattern of this condition, however, a number of common hysteroscopic characteristics had been identified.

In the presence of uterine AVF, the hysteroscopist will find an ill-defined and highly vascularized mass. The localized vasodilation may appear as tortuous or pulsatile vessels.

Importantly, both clinical and ultrasound findings are essential in the diagnosis of this infrequent pathology.

 

Cervical Canal

 The name cervix derives from the Latin word "Cervic" meaning "neck". It represents the lower portion of the uterus and communicates the uterine cavity with the vagina. It has a cylindrical shape with a length of about 3 cm and a diameter of about 2 cm. The uterine cervix has an opening to the vagina called the "external os" (EO). In the area of division between the cervix and uterine body lies a fibromuscular area called the "internal os" (IO). The area located between EO and IO is called the "endocervical canal", which has a fusiform shape and an oval cross section, the endocervial canal has a diameter ranging between 3 and 10 millimiters.

  The epithelium of the cervix in its intravaginal portion corresponds to squamous epithelium. It changes to columnar epithelium in the endocervical canal. The area of transition between the two epithelia corresponds to the squamocolumnar junction also known as the transformation zone. The arrangement of the epithelium at the level of the cervical canal is made of longitudinal ridges along the canal, this is called "plica palmatae". On top of the longitudinales ridges there are also oblique branches that give it the appearance of tree branches that is also called "arbor vitae".