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Gyneco lect

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  • 1. Female genital tract
  • 2. Infections <ul><li>Lower genital tract ( STD – HSV, molluscum contagiosum, HPV, trichomonas, chancroid, granuloma inguinale; endogenous – candida) </li></ul><ul><li>Entire genital tract ( STD – gonorrhea, chlamydia, mycoplasma, syphilis; endogenous – enteric bacteria), may end in PID </li></ul>
  • 3.  
  • 4.  
  • 5.  
  • 6. Causes of female infertility
  • 7. HSV
  • 8. Syphilitic chancre
  • 9. Syphilis <ul><li>secondary stage – early generalisation </li></ul>
  • 10. Acute salpingoophoritis
  • 11.  
  • 12. PID - torsion
  • 13.  
  • 14. Ovarian cysts <ul><li>non-neoplastic – inclusion c. (mesothelial, epithelial) </li></ul><ul><li>functional c. (follicular, luteal, polycystic ovary syndrome, ovarian hyperstimulation syndrome) </li></ul><ul><li>endometriosis </li></ul><ul><li>neoplastic ( surface epithelial tumors, germ cell tu, sex-cord stromal tu, metastatic tu, etc.) </li></ul>
  • 15.  
  • 16.  
  • 17. Follicle cyst
  • 18.  
  • 19.  
  • 20.  
  • 21.  
  • 22.  
  • 23. Endometriosis
  • 24.  
  • 25.  
  • 26.  
  • 27.  
  • 28. Ovarian tumors
  • 29. Serous cystadenoma
  • 30. Serous cystadenoma
  • 31. Serous papillary cystadenoma
  • 32. Serous papillary tumor of low malignant potential (papillary cystadenoma of borderline malignancy)
  • 33.  
  • 34.  
  • 35.  
  • 36.  
  • 37. serous cystadenocarcinoma
  • 38.  
  • 39. ovarian adenocarcinoma – stromal invasion
  • 40. Malignant cell clusters in ascites
  • 41. Mucinous cystadenoma
  • 42.  
  • 43. Mucinous papillary cystadenoma
  • 44.  
  • 45.  
  • 46.  
  • 47.  
  • 48.  
  • 49.  
  • 50.  
  • 51.  
  • 52. Mucinous cystic tumor of low malignant potential
  • 53.  
  • 54. Germ cell tumors <ul><li>dysgerminoma (ovarian counterpart of seminoma) </li></ul><ul><li>embryonal carcinoma </li></ul><ul><li>yolk sac tumor (endodermal sinus tumor) </li></ul><ul><li>choriocarcinoma </li></ul><ul><li>teratoma (mature – benign: dermoid cyst, </li></ul><ul><li>immature – malignant, </li></ul><ul><li>malignisation in a mature teratoma) </li></ul>
  • 55.  
  • 56.  
  • 57.  
  • 58. Embryonal carcinoma
  • 59. Choriocarcinoma
  • 60.  
  • 61.  
  • 62.  
  • 63. Dermoid cyst
  • 64.  
  • 65.  
  • 66.  
  • 67.  
  • 68.  
  • 69. Sex-cord stromal tumors <ul><li>Granulosa cell tumors (potentially malignant, possible estrogen production – risk of abnormal uterine bleeding, endometrial hyperplasia or ca) </li></ul><ul><li>Thecoma-fibroma (most common, usually benign, possible association with ascites, rarely estrogen production) </li></ul><ul><li>Sertoli-Leydig cell tumors (possible masculinisation) </li></ul>
  • 70. Granulosa cell tumor
  • 71. Granulosa cell tumor
  • 72.  
  • 73. Ovarian fibroma
  • 74.  
  • 75. Sertoli-Leydig cell tumor
  • 76.  
  • 77.  
  • 78. Metastatic tumors <ul><li>GIT (stomach, colorectal, commonly mucinous adenocarcinoma) </li></ul><ul><li>breast </li></ul><ul><li>! synchronnous primary endometrial ca + primary endometroid ovarian ca </li></ul>
  • 79.  
  • 80. Krukenberg tumor
  • 81.  
  • 82. Fallopian tubes diseases <ul><li>inflammation </li></ul><ul><li>cyst </li></ul><ul><li>tumors </li></ul><ul><li>GEU (ectopic pregnancy) </li></ul>
  • 83.  
  • 84.  
  • 85.  
  • 86. Chronic salpingitis
  • 87.  
  • 88. Hydrosalpinx
  • 89.  
  • 90.  
  • 91.  
  • 92.  
  • 93.  
  • 94.  
  • 95. Pathology of uterine corpus <ul><li>congenital anomalies </li></ul><ul><li>inflammation </li></ul><ul><li>functional endometrial disorders </li></ul><ul><li>polyps (endometrial etc.) </li></ul><ul><li>adenomyosis </li></ul><ul><li>endometrial hyperplasia </li></ul><ul><li>tumors </li></ul>
  • 96. Uterus bicornis
  • 97. Uterus didelphys
  • 98. Uterus unicornis with rudimentary horn
  • 99.  
  • 100. Acute endometritis
  • 101. Chronic endometritis
  • 102.  
  • 103.  
  • 104.  
  • 105.  
  • 106.  
  • 107. Disordered early secretion - ovulation
  • 108. Hypersecretion
  • 109. Stromoglandular dissociation
  • 110.  
  • 111. Epithelial changes – metaplasia squamous cell
  • 112. Epithelial changes – metaplasia
  • 113. Epithelial changes – metaplasia
  • 114. Polyps <ul><li>Endometrial polyp </li></ul><ul><li>Polypoid hyperplasia </li></ul><ul><li>Hyperplasia and polyps in tamoxifenem ther. </li></ul><ul><li>Polypoid tumors – adenomyoma, carcinoma, submucosal leiomyoma, stromal tumors, etc. </li></ul><ul><li>Pathological pregnancy (trofoblastic lesions, decidua etc.) </li></ul><ul><li>Pseudotumors –pathol. material accumulation etc. </li></ul>
  • 115. Endometrial polyp
  • 116. Endometrial polyp
  • 117. Endometrial polyp
  • 118. Atypical polypoid adenomyoma Mixed tumor, stromal smooth muscle + glands (appearance of complex hyperplasia, epithelial atypias)
  • 119. Adenomyosis <ul><li>irregular bleeding, dysmenorrhea, pelvialgia </li></ul><ul><li>more common in perimenopause after repeated births („diverticulosis“) </li></ul><ul><li>may predispose to uterine prolaps into vagina </li></ul><ul><li>myometrial reaction incl. hyperplasia </li></ul><ul><li>possible origo of endometrial tu in myometrium (! x ca invasion into myometrium) </li></ul>
  • 120. Adenomyosis
  • 121. Adenomyosis
  • 122. Adenomyosis + leiomyoma
  • 123.  
  • 124.  
  • 125. Uterine corpus tumors – WHO <ul><li>Epithelial tu and related lesions : </li></ul><ul><li>Endometrial carcinoma – endometrioid (type 1, estrogen-dependent; type 2 -non estrogen-dependent) mucinous, serous, clear cell, squamous cell, metaplastic (carcinosarcoma = malignant mixed müllerian tumor), others </li></ul><ul><li>Endometrial hyperplasia (+ endometrial intraepithelial neoplasia ) </li></ul><ul><li>Endometrial polyps </li></ul><ul><li>Tamoxifen related lesions </li></ul>
  • 126. Uterine corpus tumors – WHO <ul><li>Mesenchymal tumors: </li></ul><ul><li>endometrial stromal lesions: endom. stromal nodule (benign), low grade endom. stromal sarcoma, undifferentiated endom. stromal sarcoma </li></ul><ul><li>smooth muscle tumors: leiomyoma (+ variants), tu of uncertain malignant potential, leiomyosarcoma (+ variants) </li></ul><ul><li>tumors from perivascular epitheloid cells (PECom) </li></ul><ul><li>other mesenchymal tumors </li></ul>
  • 127. Uterine corpus tumors – WHO <ul><li>Mixed epithelial and mesenchymal tumors : adenomyoma, adenofibroma, adenosarcoma etc. </li></ul><ul><li>Gestational trophoblastic disease </li></ul><ul><li>Other tumors: adenomatoid tumor (mesothelial), … </li></ul><ul><li>Secondary tumors </li></ul>
  • 128. Hyperplasia, intraepithelial neoplasia <ul><li>Non-physiological non-invasive proliferation of endometrium, benign lesion (reactive) -> premalignant condition (monoclonal) </li></ul><ul><li>Hormone dysbalance - persistent estrog. stimulation without secretory transformation, incl. relative (progestin inssuf.). ~ endometr. ca type 1. </li></ul><ul><li>endogennous : path. ovarian regulation, polycystic ovaries, hormon. active processes (tu), obesity with hyperestrinism etc. </li></ul><ul><li>exogennous : hormon. therapy (pure estrogens) </li></ul>
  • 129. Classification of endometrial hyperplasis Simple Complex Atypical (specify architecture: simple or complex)
  • 130. <ul><li>Endometrial intraepithelial neoplasia (EIN) ~ to complexní atyp. hyperplasia > 1 mm, different from surrounding tissue </li></ul><ul><li>intraglandular or superficial </li></ul>
  • 131. Simple hyperplasia
  • 132. Complex hyperplasia
  • 133.  
  • 134.  
  • 135. Endometrioid carcinoma
  • 136.  
  • 137.  
  • 138.  
  • 139. Endometrioid. ca – cervical invasion
  • 140. EIN in polyp
  • 141.  
  • 142.  
  • 143. Metaplastic carcinoma
  • 144. Carcinosarcoma = metaplastic carcinoma
  • 145.  
  • 146.  
  • 147.  
  • 148.  
  • 149.  
  • 150.  
  • 151. ESS - HG
  • 152.  
  • 153.  
  • 154. Leiomyoma
  • 155.  
  • 156. Leiomyosarcoma
  • 157.  
  • 158. Adenosarcoma
  • 159. Breast ca metastasis
  • 160. Pathology of the cervix <ul><li>cervicitis </li></ul><ul><li>polyps </li></ul><ul><li>physiological and pre-neoplastic epithelial changes – metaplasia, dysplasia (CIN) </li></ul><ul><li>tumors </li></ul>
  • 161.  
  • 162. Endocervical polyp
  • 163. Endocervical polyp with squamous metaplasia
  • 164. Cervical intraepithelial neoplasia <ul><li>flat HPV condyloma (without dysplasia) </li></ul><ul><li>mild dysplasia (CIN I) </li></ul><ul><li>moderate dysplasia (CIN II) </li></ul><ul><li>severe dysplasia (CIN IIIa) </li></ul><ul><li>carcinoma in situ (CIS, CIN IIIb) </li></ul><ul><li>Cytology: </li></ul><ul><li>Low grade squamous intraepithelial lesion (LSIL): condyloma + CIN I </li></ul><ul><li>High grade SIL (HSIL): CIN II + CIN III </li></ul>
  • 165. Sexual activity ↓ HPV exposure ↓ cervical transformation zone ↓ ↓ squamous differentiation glandular ↓ ↓ ↓ CIN low grade high ECCIN, AIS (low- or high-risk HPV) (high-risk HPV) (low- or high-risk HPV) ↓ ↓ ↓ ↓ ↓ ↓ ↓ regression progression progression regression progression (rare) smoking, high parity, oral contraceptives, immunity, time ↓ ↓ ↓ invasive squamous ca invasive adenoca
  • 166.  
  • 167.  
  • 168. HPV – koilocytosis - LSIL
  • 169. HPV - immunohistochemistry
  • 170.  
  • 171.  
  • 172. HPV CIN II.
  • 173.  
  • 174. Invasive squamous cell carcinoma
  • 175.  
  • 176.  
  • 177.  
  • 178. Cervical squamous cell carcinoma
  • 179. Endocervical (glandular) intraepithelial neoplasia – ECCIN
  • 180.  
  • 181.  
  • 182.  
  • 183. Adenosquamous carcinoma – alcian blue staining
  • 184.  
  • 185.  
  • 186.  
  • 187. Vaginal pathology <ul><li>inflammation </li></ul><ul><li>polyps, cysts </li></ul><ul><li>vaginal squamous intraepithelial neoplasia (VaIN) </li></ul><ul><li>vaginal adenosis (glands) </li></ul><ul><li>tumors </li></ul>
  • 188.  
  • 189. vaginal adenosis
  • 190.  
  • 191.  
  • 192. Vulvar pathology <ul><li>inflammatory disorders (infectious, noninfectious) </li></ul><ul><li>cysts </li></ul><ul><li>vulvar intraepithelial neoplasia (VIN) </li></ul><ul><li>tumors </li></ul>
  • 193.  
  • 194.  
  • 195.  
  • 196. Extensive HPV condylomatosis
  • 197.  
  • 198.  
  • 199.  
  • 200.  
  • 201.  
  • 202. Lichen sclerosus
  • 203.  
  • 204. Vulvar squamous carcinoma
  • 205.  
  • 206.  
  • 207.  
  • 208.  
  • 209.  
  • 210.  
  • 211.  

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