Lymphovascular Supply

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The uterus is supplied by the uterine arteries. These are bilateral paired arteries which arise from the internal iliac arteries. The veins of the uterus drain into the uterovaginal venous plexus which is located within the broad ligament. These veins ultimately open into the internal iliac veins. Uterine lymphatics drain into the pelvic and peri-aortic lymph nodes (Figure 23.2).

Clinical features related to uterine pathology are most commonly those of abnormal uterine bleeding. In premenopausal patients this may take the form of menorrhagia (heavy periods), dysmenorrhoea (painful periods) or a variety of other forms of abnormal uterine bleeding. In postmenopausal patients, the most common symptomatology is postmenopausal bleeding. This should always be taken seriously and uterine malignancy excluded. Other symptomatologies related to uterine pathology include a palpable abdominal or pelvic mass, pain within the pelvis or abdomen (often deep seated), a feeling of fullness within the abdomen and uterine prolapse. Uterine pathology may also be associated with symptoms such as constipation, urinary frequency or infertility.

Figure 23.2. Uterus - regional lymph nodes. 1. Hypogastric internal iliac. 2. Comon iliac. 3. External iliac. 4. Lateral sacral. 5. Para-aortic. Reproduced from Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (eds.). TNM Atlas: illustrated guide to the TNM/pTNM classification of malignant tumours, 4th edition. Springer-Verlag: Berlin and Heidelberg, 1997.

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