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Gyneco lect
 

Gyneco lect

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    Gyneco lect Gyneco lect Presentation Transcript

    • Female genital tract
    • Infections
      • Lower genital tract ( STD – HSV, molluscum contagiosum, HPV, trichomonas, chancroid, granuloma inguinale; endogenous – candida)
      • Entire genital tract ( STD – gonorrhea, chlamydia, mycoplasma, syphilis; endogenous – enteric bacteria), may end in PID
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    • Causes of female infertility
    • HSV
    • Syphilitic chancre
    • Syphilis
      • secondary stage – early generalisation
    • Acute salpingoophoritis
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    • PID - torsion
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    • Ovarian cysts
      • non-neoplastic – inclusion c. (mesothelial, epithelial)
      • functional c. (follicular, luteal, polycystic ovary syndrome, ovarian hyperstimulation syndrome)
      • endometriosis
      • neoplastic ( surface epithelial tumors, germ cell tu, sex-cord stromal tu, metastatic tu, etc.)
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    • Follicle cyst
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    • Endometriosis
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    • Ovarian tumors
    • Serous cystadenoma
    • Serous cystadenoma
    • Serous papillary cystadenoma
    • Serous papillary tumor of low malignant potential (papillary cystadenoma of borderline malignancy)
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    • serous cystadenocarcinoma
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    • ovarian adenocarcinoma – stromal invasion
    • Malignant cell clusters in ascites
    • Mucinous cystadenoma
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    • Mucinous papillary cystadenoma
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    • Mucinous cystic tumor of low malignant potential
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    • Germ cell tumors
      • dysgerminoma (ovarian counterpart of seminoma)
      • embryonal carcinoma
      • yolk sac tumor (endodermal sinus tumor)
      • choriocarcinoma
      • teratoma (mature – benign: dermoid cyst,
      • immature – malignant,
      • malignisation in a mature teratoma)
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    • Embryonal carcinoma
    • Choriocarcinoma
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    • Dermoid cyst
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    • Sex-cord stromal tumors
      • Granulosa cell tumors (potentially malignant, possible estrogen production – risk of abnormal uterine bleeding, endometrial hyperplasia or ca)
      • Thecoma-fibroma (most common, usually benign, possible association with ascites, rarely estrogen production)
      • Sertoli-Leydig cell tumors (possible masculinisation)
    • Granulosa cell tumor
    • Granulosa cell tumor
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    • Ovarian fibroma
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    • Sertoli-Leydig cell tumor
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    • Metastatic tumors
      • GIT (stomach, colorectal, commonly mucinous adenocarcinoma)
      • breast
      • ! synchronnous primary endometrial ca + primary endometroid ovarian ca
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    • Krukenberg tumor
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    • Fallopian tubes diseases
      • inflammation
      • cyst
      • tumors
      • GEU (ectopic pregnancy)
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    • Chronic salpingitis
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    • Hydrosalpinx
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    • Pathology of uterine corpus
      • congenital anomalies
      • inflammation
      • functional endometrial disorders
      • polyps (endometrial etc.)
      • adenomyosis
      • endometrial hyperplasia
      • tumors
    • Uterus bicornis
    • Uterus didelphys
    • Uterus unicornis with rudimentary horn
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    • Acute endometritis
    • Chronic endometritis
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    • Disordered early secretion - ovulation
    • Hypersecretion
    • Stromoglandular dissociation
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    • Epithelial changes – metaplasia squamous cell
    • Epithelial changes – metaplasia
    • Epithelial changes – metaplasia
    • Polyps
      • Endometrial polyp
      • Polypoid hyperplasia
      • Hyperplasia and polyps in tamoxifenem ther.
      • Polypoid tumors – adenomyoma, carcinoma, submucosal leiomyoma, stromal tumors, etc.
      • Pathological pregnancy (trofoblastic lesions, decidua etc.)
      • Pseudotumors –pathol. material accumulation etc.
    • Endometrial polyp
    • Endometrial polyp
    • Endometrial polyp
    • Atypical polypoid adenomyoma Mixed tumor, stromal smooth muscle + glands (appearance of complex hyperplasia, epithelial atypias)
    • Adenomyosis
      • irregular bleeding, dysmenorrhea, pelvialgia
      • more common in perimenopause after repeated births („diverticulosis“)
      • may predispose to uterine prolaps into vagina
      • myometrial reaction incl. hyperplasia
      • possible origo of endometrial tu in myometrium (! x ca invasion into myometrium)
    • Adenomyosis
    • Adenomyosis
    • Adenomyosis + leiomyoma
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    • Uterine corpus tumors – WHO
      • Epithelial tu and related lesions :
      • 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
      • Endometrial hyperplasia (+ endometrial intraepithelial neoplasia )
      • Endometrial polyps
      • Tamoxifen related lesions
    • Uterine corpus tumors – WHO
      • Mesenchymal tumors:
      • endometrial stromal lesions: endom. stromal nodule (benign), low grade endom. stromal sarcoma, undifferentiated endom. stromal sarcoma
      • smooth muscle tumors: leiomyoma (+ variants), tu of uncertain malignant potential, leiomyosarcoma (+ variants)
      • tumors from perivascular epitheloid cells (PECom)
      • other mesenchymal tumors
    • Uterine corpus tumors – WHO
      • Mixed epithelial and mesenchymal tumors : adenomyoma, adenofibroma, adenosarcoma etc.
      • Gestational trophoblastic disease
      • Other tumors: adenomatoid tumor (mesothelial), …
      • Secondary tumors
    • Hyperplasia, intraepithelial neoplasia
      • Non-physiological non-invasive proliferation of endometrium, benign lesion (reactive) -> premalignant condition (monoclonal)
      • Hormone dysbalance - persistent estrog. stimulation without secretory transformation, incl. relative (progestin inssuf.). ~ endometr. ca type 1.
      • endogennous : path. ovarian regulation, polycystic ovaries, hormon. active processes (tu), obesity with hyperestrinism etc.
      • exogennous : hormon. therapy (pure estrogens)
    • Classification of endometrial hyperplasis Simple Complex Atypical (specify architecture: simple or complex)
      • Endometrial intraepithelial neoplasia (EIN) ~ to complexní atyp. hyperplasia > 1 mm, different from surrounding tissue
      • intraglandular or superficial
    • Simple hyperplasia
    • Complex hyperplasia
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    • Endometrioid carcinoma
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    • Endometrioid. ca – cervical invasion
    • EIN in polyp
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    • Metaplastic carcinoma
    • Carcinosarcoma = metaplastic carcinoma
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    • ESS - HG
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    • Leiomyoma
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    • Leiomyosarcoma
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    • Adenosarcoma
    • Breast ca metastasis
    • Pathology of the cervix
      • cervicitis
      • polyps
      • physiological and pre-neoplastic epithelial changes – metaplasia, dysplasia (CIN)
      • tumors
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    • Endocervical polyp
    • Endocervical polyp with squamous metaplasia
    • Cervical intraepithelial neoplasia
      • flat HPV condyloma (without dysplasia)
      • mild dysplasia (CIN I)
      • moderate dysplasia (CIN II)
      • severe dysplasia (CIN IIIa)
      • carcinoma in situ (CIS, CIN IIIb)
      • Cytology:
      • Low grade squamous intraepithelial lesion (LSIL): condyloma + CIN I
      • High grade SIL (HSIL): CIN II + CIN III
    • 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
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    • HPV – koilocytosis - LSIL
    • HPV - immunohistochemistry
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    • HPV CIN II.
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    • Invasive squamous cell carcinoma
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    • Cervical squamous cell carcinoma
    • Endocervical (glandular) intraepithelial neoplasia – ECCIN
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    • Adenosquamous carcinoma – alcian blue staining
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    • Vaginal pathology
      • inflammation
      • polyps, cysts
      • vaginal squamous intraepithelial neoplasia (VaIN)
      • vaginal adenosis (glands)
      • tumors
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    • vaginal adenosis
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    • Vulvar pathology
      • inflammatory disorders (infectious, noninfectious)
      • cysts
      • vulvar intraepithelial neoplasia (VIN)
      • tumors
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    • Extensive HPV condylomatosis
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    • Lichen sclerosus
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    • Vulvar squamous carcinoma
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