Gyneco lect

3,748 views
3,526 views

Published on

0 Comments
6 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
3,748
On SlideShare
0
From Embeds
0
Number of Embeds
6
Actions
Shares
0
Downloads
157
Comments
0
Likes
6
Embeds 0
No embeds

No notes for slide

Gyneco lect

  1. 1. Female genital tract
  2. 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. 6. Causes of female infertility
  4. 7. HSV
  5. 8. Syphilitic chancre
  6. 9. Syphilis <ul><li>secondary stage – early generalisation </li></ul>
  7. 10. Acute salpingoophoritis
  8. 12. PID - torsion
  9. 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>
  10. 17. Follicle cyst
  11. 23. Endometriosis
  12. 28. Ovarian tumors
  13. 29. Serous cystadenoma
  14. 30. Serous cystadenoma
  15. 31. Serous papillary cystadenoma
  16. 32. Serous papillary tumor of low malignant potential (papillary cystadenoma of borderline malignancy)
  17. 37. serous cystadenocarcinoma
  18. 39. ovarian adenocarcinoma – stromal invasion
  19. 40. Malignant cell clusters in ascites
  20. 41. Mucinous cystadenoma
  21. 43. Mucinous papillary cystadenoma
  22. 52. Mucinous cystic tumor of low malignant potential
  23. 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>
  24. 58. Embryonal carcinoma
  25. 59. Choriocarcinoma
  26. 63. Dermoid cyst
  27. 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>
  28. 70. Granulosa cell tumor
  29. 71. Granulosa cell tumor
  30. 73. Ovarian fibroma
  31. 75. Sertoli-Leydig cell tumor
  32. 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>
  33. 80. Krukenberg tumor
  34. 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>
  35. 86. Chronic salpingitis
  36. 88. Hydrosalpinx
  37. 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>
  38. 96. Uterus bicornis
  39. 97. Uterus didelphys
  40. 98. Uterus unicornis with rudimentary horn
  41. 100. Acute endometritis
  42. 101. Chronic endometritis
  43. 107. Disordered early secretion - ovulation
  44. 108. Hypersecretion
  45. 109. Stromoglandular dissociation
  46. 111. Epithelial changes – metaplasia squamous cell
  47. 112. Epithelial changes – metaplasia
  48. 113. Epithelial changes – metaplasia
  49. 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>
  50. 115. Endometrial polyp
  51. 116. Endometrial polyp
  52. 117. Endometrial polyp
  53. 118. Atypical polypoid adenomyoma Mixed tumor, stromal smooth muscle + glands (appearance of complex hyperplasia, epithelial atypias)
  54. 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>
  55. 120. Adenomyosis
  56. 121. Adenomyosis
  57. 122. Adenomyosis + leiomyoma
  58. 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>
  59. 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>
  60. 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>
  61. 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>
  62. 129. Classification of endometrial hyperplasis Simple Complex Atypical (specify architecture: simple or complex)
  63. 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>
  64. 131. Simple hyperplasia
  65. 132. Complex hyperplasia
  66. 135. Endometrioid carcinoma
  67. 139. Endometrioid. ca – cervical invasion
  68. 140. EIN in polyp
  69. 143. Metaplastic carcinoma
  70. 144. Carcinosarcoma = metaplastic carcinoma
  71. 151. ESS - HG
  72. 154. Leiomyoma
  73. 156. Leiomyosarcoma
  74. 158. Adenosarcoma
  75. 159. Breast ca metastasis
  76. 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>
  77. 162. Endocervical polyp
  78. 163. Endocervical polyp with squamous metaplasia
  79. 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>
  80. 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
  81. 168. HPV – koilocytosis - LSIL
  82. 169. HPV - immunohistochemistry
  83. 172. HPV CIN II.
  84. 174. Invasive squamous cell carcinoma
  85. 178. Cervical squamous cell carcinoma
  86. 179. Endocervical (glandular) intraepithelial neoplasia – ECCIN
  87. 183. Adenosquamous carcinoma – alcian blue staining
  88. 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>
  89. 189. vaginal adenosis
  90. 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>
  91. 196. Extensive HPV condylomatosis
  92. 202. Lichen sclerosus
  93. 204. Vulvar squamous carcinoma

×