Every case of acute endometritis should be carefully watched and treated until the disease is cured. Acute endometritis, especially if gonorrhea is the cause, is very prone to become chronic and to extend to the mucous membrane of the Fallopian tubes and the ovaries.
CHRONIC CORPOREAL ENDOMETRITIS.
Chronic inflammation of the endometrium, or chronic endometritis, is much more frequently seen in practice than the acute form. It may occur as a primary disease, but it very often occurs as the result of some other pathological condition of the uterus, as, for instance, subinvolution or uterine fibroid.
A variety of confusing terms have been used to designate the different forms of endometritis. There seem to be two chief forms of the disease: I. Chronic interstitial endometritis; II. Chronic glandular endometritis.
In the first form of the disease the interglandular tissue is chiefly involved. The spaces between the glands are infiltrated with connective-tissue cells.
In the second or glandular form of endometritis the disease affects the glandular apparatus. The utricular glands become much elongated, branched, and increased in number. The accompanying illustrations (Figs. 117, 118) show the microscopic appearance of interstitial endometritis and glandular endometritis.
These two forms of endometritis are often mixed, and the same uterus may present the glandular form of inflammation upon part of the endometrium, the interstitial form upon another part, and the mixed form upon still another part.
The gross appearance of the endometrium varies with the form of the disease and its duration. It will be remembered that in the mature uterus, in the menstrual interval, the mucous membrane is a thin reddish-gray structure about 1 millimeter (1/25 inch) in thickness. In the different forms of endometritis the mucous membrane may become hypertrophied to three or four times this thickness. In some unusual cases the mucous membrane may become even still further hypertrophied, attaining a thickness of half an inch. A special name, fungous endometritis, has been given to the disease when it assumes this form. Microscopic examination shows that fungous endometritis is merely a mixed form of the glandular and the interstitial varieties, with a great increase of all the elements of the mucous membrane. In fungous endometritis the hypertrophy of the mucous membrane may be uniform throughout the body of the uterus or it may occur only in localized areas.
Fig. 117.—Interstitial endometritis: microscopic section of endometrium removed by the curette (Beyea).