How many uterine adnexa are there

The adnexa , or more formally the adnexa uteri , and also known as the uterine appendages , is a collective term for the: ovaries fallopian tubes broad ligaments Some texts also include the associated blood vessels, nerves and other supporting tissues in the definition. On this page:. William Alexander Newman Dorland.

Dorland's Illustrated Medical Dictionary. Terminologia Anatomica. Federative International Programme for Anatomical Terminology, Ian Brookes. The Chambers Dictionary. Related articles: Anatomy: Abdominopelvic. Promoted articles advertising. Loading more images Close Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Loading Stack - 0 images remaining. By System:. Patient Cases. Adnexal tenderness occurs when there is pain or general tenderness around the area where an adnexal mass is located.

Symptoms of adnexal tenderness are similar to those of uterine tenderness or cervical motion pain. You may have an adnexal mass if you experience any of the following symptoms that do not follow your normal menstrual symptoms or are present more than 12 times per month:.

To find a suspected adnexal mass, your doctor will typically do a pelvic examination. This consists of a physical examination of the vagina, cervix, and all organs in the pelvic area.

After that, ectopic pregnancy will be ruled out via an ultrasound , also called a sonogram. The ultrasound can also show cysts or certain tumors. If the mass cannot be found with a ultrasound, the doctor may order an MRI. Upon finding a mass, your doctor will most likely do a test to measure for cancer antigens. The antigens will be monitored to make sure that the adnexal mass does not become malignant. If the mass is larger than six centimeters, or the pain does not subside after three months, a gynecologist will usually discuss options for removal of the mass.

There are many types of adnexal masses that may be causing your adnexal tenderness. Once diagnosed, your doctor will make a plan for treatment or management for the mass. A simple cyst in the ovary or uterus could be the cause of pain. Many simple cysts will heal on their own. If the cyst is small and only causing mild discomfort, many doctors will opt to monitor the cyst for a period of time.

If the cyst remains for several months, a laparoscopic cystectomy may be performed to determine if the cyst is malignant. An ectopic pregnancy is a pregnancy that does not occur in the uterus. If the egg is fertilized or remains in the fallopian tubes, the pregnancy will not be able to be carried to term.

If you are found to have an ectopic pregnancy, you will require surgery or medication and monitoring to end the pregnancy. Ectopic pregnancies can be fatal to the mother. Dermoid cysts are a common type of germ cell tumors. There are three layers of musculature: the inner longitudinal, the middle circular layer, and the outer longitudinal layer.

There is some evidence that the isthmus may act as a sphincter. Photomicrograph showing the isthmic portion of the fallopian tube; it is in this portion of the tube that spasm may occur and close the lumen. The mucosa is lined by columnar epithelium which surrounds the lumen. The columnar cells have cilia. The circular muscle layer is thickest at the isthmus and thinnest at the infundibulum.

Photomicrograph low power of the ampullary portion of the fallopian tube. The mucosa forms folds which in transsection of the tube simulate glandular structures. There are, however, no true secreting glands in the oviduct. The ampulla is the largest and longest portion of the tube, approximately 5 cm or more in length.

The lumen enlarges from 1 or 2 mm near the isthmus to over a centimeter at the distal portion. The mucosa has multiple longitudinal folds. The ampulla is the portion usually involved in gonorrheal salpingitis and tubo-ovarian abscesses and is the site of most ectopic pregnancies.

At the distal end of the tube is the trumpet shaped infundibulum. The tube ends in a number of fimbriae or frond-like projections; the largest of these is ordinarily in contact with the ovary and is known as the ovarian fimbria.

The peritoneal cavity in the female is connected with the exterior of the body through the patent distal end of the tube by way of the uterus and vagina.

This opening is of considerable clinical importance as blood, ascending infections, or pus can pass out of the tube to invade the abdominal cavity, with resultant pain, endometriosis, or pelvic infection. The epithelial lining of the tube has been studied extensively by light and electron microscopy. On light microscopic examination, four types of cells can be readily seen.

Secretory cells or nonciliated cells have a heavily granular cytoplasm and an oval nucleus. The ciliated cells have fine granular cytoplasms and are relatively square with large round nuclei. Pauerstein 4 has reviewed and summarized the numerous studies on tubal ultrastructure. Two basic cell types have been described, ciliated and secretory. The ciliated cells have a clear cytoplasm with vesicular reticulum. Microvilli are seen extending from the luminal edge of the cell.

The cilia themselves have two central filaments and nine double, lateral filaments. Secretory cells have a dark cytoplasm with fine granules. Darker secretory granules are prominent, with irregularly distributed endoplasmic reticulum. The tubal epithelium is responsive to the estrogen and progesterone levels during the menstrual cycle, pregnancy, and the menopause.

The proliferative phase is characterized by elevated epithelium with ciliated and secretory cells of equal height. The luteal phase shows lower ciliated cells with higher and more prominent cytoplasm, sometimes with rupture and extrusion of the cytoplasm into the lumen. During menstruation and post-menstruation, cells are lower and smaller. During pregnancy, tubal epithelium remains low.

There is considerable variation in postmenopausal changes in the tubal epithelium. Apparently significant secretory activity ceases, but the onset of atrophy is variable and deciliation may not occur until years after the menopause.

The principal blood supply of the tube is from the upper end of the uterine artery, which bifurcates and sends a large branch or ramus below the tube to anastomose with the ovarian artery.

The proximal two-thirds of the tube is chiefly supplied by the uterine artery. The arterial supply is quite variable and there may be three branches medial, intermediate, and lateral or a branch from the uterine and another from the ovarian artery. Anastomoses between uterine and ovarian arteries in the mesosalpinx are variable but always present. The venous system accompanies the arterial distribution.

Capillary networks are to be found in subserosal, muscularis, and mucosal layers. The arrangement varies in different portions of the tube, but the venous plexuses become confluent in the subserosal layer. The lymphatic drainage runs along the upper edge of the broad ligament to the lymphatic network below the hilus of the ovary. From here the flow from uterus, tube, and ovary drains to the para-aortic or lumbar nodes. The tube is provided with both sympathetic and parasympathetic innervation.

Sympathetic fibers from T10 through L2 reach the inferior mesenteric plexus. Postganglionic fibers then pass to the oviduct. The fibers from the inferior mesenteric plexus pass to the cervicovaginal plexus, which in turn sends fibers to the isthmus and part of the ampulla.

Some sympathetic fibers from T10 and T11 reach the celiac plexus and provide postganglionic fibers to the ovarian plexus, which supplies the distal ampulla and fimbriae. The parasympathetic supply is by vagal fibers from the ovarian plexus supplying the distal portion of the tube. Part of the isthmus receives its parasympathetic supply from S2, S3, and S4 via the pelvic nerve and the pelvic plexuses.

The sympathetic innervation of the female pelvis is depicted in Fig. Diagram of the sympathetic connections in the female pelvis, viewed from the front and above. In the early embryo, differentiation of gonadal tissue occurs anterior to the mesonephros and along the entire medial aspect of the urogenital ridge.

The cranial portions of the gonadal ridge degenerate, leaving an indifferent genital gland near the mesonephros. Primitive germ cells originate in the epithelial lining of the dorsal part of the hindgut.

They migrate to the gonad and are seen as radial strands extending into the mesenchymal tissue. The migrating cells consist of primordial egg cells and prospective granulosa cells Fig.

Photomicrograph low power of the cortex of the ovary of a human infant. The cortex of the ovary has numerous primordial germ cells with relatively little stroma. The ovarian stroma is more abundant in the medulla, where the larger follicles are seen. The glistening white ovaries are generally oval in shape but may vary in size, position, and appearance, depending on the age and the reproductive activities of the individual.

The ovaries of a normal adult woman are 2. A woman will release up to ova, on average, during her lifetime. Histologically the ovary is divided into the outer cortex and the inner medulla.

The cortex consists of a cellular connective tissue stroma in which the ovarian follicles are embedded. The medulla is composed of loose connective tissue which contains blood vessels and nerves. The cortex is surrounded by a single layer of cuboidal epithelium called the germinal epithelium. Low magnification view of the pre-ovulation human ovary. The germinal epithelium of the ovary rests upon the ovarian stroma. The primordial germ cells embedded in the stroma are in the cortex of the ovary.

In the nullipara, the ovary typically lies in the ovarian fossa, a depression in the pelvic wall below the external iliac vessels and in front of the ureter. A mesovarium attaches the ovary to the posterior wall of the broad ligament, while the posterior margin is free.

The peritoneum does not cover the ovary proper, which is covered by germinal epithelium. At either end the ovary is supported by ligaments. At the tubal pole the ovary is attached to the suspensory ligament, a fold of peritoneum which forms a mesentery for the ovary and contains the ovarian vessels. This suspensory ligament is often called the infundibulopelvic ligament.

At the other pole is the uteroovarian ligament. The hilus is the base of the ovary; at this point the ovarian blood vessels enter. The ovarian arteries arise from the abdominal aorta just below the renal arteries. They pass downward across the pelvic brim, cross the external iliac artery, and traverse the infundibulopelvic fold of peritoneum.

Branches go to the ureter, round ligament, and tube and anastomose with the uterine artery. As the ovarian artery passes through the mesovarium, it separates into multiple branches that enter the ovarian hilus. Each of these arteries divides into two medullary branches which cross the ovary. Cortical branches arise from the medullary branches and supply the cortex and follicles. Two prominent veins enter the hilus and, in general, follow the arterial pattern. At the hilus venous drainage forms a pampiniform plexus, which consolidates to form the ovarian vein.

On the right side the ovarian vein drains into the inferior vena cava, while the left ovarian vein drains into the left renal vein. The ovarian as well as the uterine blood supply frequently is anomalous.