A Text-book of Diseases of Women

by Charles B. Penrose

Fig. 118.—Glandular endometritis: microscopic section of endometrium removed by the curette (Beyea).

Fig. 119.—Polypoid endometritis (Beyea).

In some cases the glandular hypertrophy of the mucous membrane assumes the form of polypoid growths projecting into the uterine cavity ([Fig. 119]).

In the advanced stages of all the forms of endometritis cicatricial formation takes place. The normal ciliated epithelium of the endometrium is cast off, and is replaced by flat squamous cells. The glands atrophy; the glandular openings become dilated, and ultimately appear as simple depressions on the surface. In time secretion from the glands ceases, and the cavity of the uterus becomes lined with simple connective tissue.

Chronic endometritis is always accompanied to a greater or less extent by inflammation of the muscular coat of the uterus. The pathological changes that take place resemble those occurring in chronic inflammation in similar musculo-fibrous structures in other parts of the body. A section of the uterine wall is much lighter in appearance than normal, and the whitish bundles of connective tissue are seen interlacing with the more vascular muscular fibers.

At first there is an hypertrophy of the uterine wall from infiltration of inflammatory material. In the latest stages organized connective tissue is formed, and there is produced a sclerotic condition of the uterus, with atrophy of its normal muscular elements.

The hypertrophy of the uterus, however, that accompanies most of the forms of endometritis is not due altogether to the presence of inflammatory deposits. The uterus possesses the peculiar property of enlarging, by a general hypertrophy of its elements, whenever there is present in its cavity any gross pathological condition. We see this in fibroid tumor. And, as a general rule, the enlargement is proportional to the mensurable size of the disease.

The metritis may involve the whole of the uterine body, or it may occur in localized areas. It may affect only the body of the uterus, or the body and the cervix, or, as we have already seen, the cervix alone. When the disease is localized to part of the uterine wall, the induration of the affected area may sometimes be determined by palpation.