FEMALE REPRODUCTIVE
1 of 12
DISEASES OF THE VULVA
- Types
o Congenital
 Hypoplasia
 Duplication
 Imperforate hymen
o In...
FEMALE REPRODUCTIVE
2 of 12
 Atrophy and poor circulation in vulva  itching
 Overgrowth of candida  itching
 Increase...
FEMALE REPRODUCTIVE
3 of 12
- BARTHOLIN GLAND CYSTS
o Causes
 Gonorrhea “hangs out”  produces large abscesses
o Conseque...
FEMALE REPRODUCTIVE
4 of 12
 Not many cells in dermis
 Smooth, reddish and glazed at first 
 Whitish with mononuclear ...
FEMALE REPRODUCTIVE
5 of 12
 Invasive, infiltrates locally  spreads to regional
nodes
 Sometimes misdiagnosed as a leuk...
FEMALE REPRODUCTIVE
6 of 12
CONGENITAL
- GARTNER’S DUCT CYSTS
o Causes
 From remnants of mesonephric ducts
o Consequences...
FEMALE REPRODUCTIVE
7 of 12
 Infants and children less than 5 years old
o Consequences
 A malignant rhabdomyosarcoma – d...
FEMALE REPRODUCTIVE
8 of 12
o Causes
 Staph
 Strept
o Consequences
 Focal loss of mucosa
- CHRONIC CERVICITIS
o Causes
...
FEMALE REPRODUCTIVE
9 of 12
 Obliteration of external os and spread to fundus  spreads
to all organs of peritoneal cavit...
FEMALE REPRODUCTIVE
10 of 12
 Staph
- CHRONIC ENDOMETRITIS
o Causes
 Chronic PID
 Chlamydia
 Gonorrhea
 Tuberculosis
...
FEMALE REPRODUCTIVE
11 of 12
MENSTRUAL DISORDERS
- Causes
o ?
- Consequences
o ?
DISEASES OF THE FALLOPIAN TUBES
- Types
o...
FEMALE REPRODUCTIVE
12 of 12
?
- Causes
o ?
- Consequences
o ?
DISEASES OF THE PLACENTA
- Types
o Toxemia of pregnancy
 P...
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  1. 1. FEMALE REPRODUCTIVE 1 of 12 DISEASES OF THE VULVA - Types o Congenital  Hypoplasia  Duplication  Imperforate hymen o Inflammatory conditions (vulvitis)  Dermatological and nonspecific vulvitis  Pelvic inflammatory disease (PID)  Bartholin gland cysts  Miscellaneous infections of the vulva o Vulvar dystrophies (AKA leukoplakias)  Atrophic dystrophy (lichen sclerosis)  Hyperplastic dystrophy (squamous hyperplasia)  Mixed dystrophies o Tumors  Condyloma acuminatum  Papillary hidradenoma  Vulvar carcinoma CONGENITAL - IMPERFORATE HYMEN o Consequences  Usually found at the onset of menses  Blood accumulates in the vagina, uterus and tubes  blood spills out into peritoneal cavity through fallopian tubes  peritonitis INFLAMMATORY CONDITIONS - DERMATOLOGICAL AND NONSPECIFIC VULVITIS o Types  Psoriasis, eczema, allergic dermatitis, etc  General infections  Nonspecific vulvitis with itching  Blood dyscrasias (leukemia)  Uremia  Diabetes o Consequences  Diabetes 
  2. 2. FEMALE REPRODUCTIVE 2 of 12  Atrophy and poor circulation in vulva  itching  Overgrowth of candida  itching  Increased incidence of infection - PELVIC INFLAMMATORY DISEASE o Causes  Infections spread out through fallopian tubes and into the peritoneal cavity  PID  Vagina is resistant to most infections due to acidic environment but some can survive (candida, gardnerella, trichomonas etc)  Microbes = staph, strep, colifoms, Clostridium perfingens, mycoplasma, Chlamydia  Gonorrhea  Post-abortion & post-partum o Consequences  Acute suppuration  pus leaks into peritoneal cavity  Inflammation in glands  May spread to involve both Fallopian tubes   Acute salpingitis  can lead to infertility +/or ectopic pregnancy  Tubes may become sealed off from the uterine cavity  Tubes often bright red  Mucosa and submucosa only  Endometritis  Infection often remains chronic  Tubo-ovarian abscesses  Clinical features  Pelvic pain  Dysmenorrheal  Disturbed intestinal function  Menstrual abnormalities  Possible acute abdomen o Peritonitis o Intestinal obstruction o Bacteremia  endocarditis, meningitis, arthritis (esp w/gonorrhea=systemic problem)
  3. 3. FEMALE REPRODUCTIVE 3 of 12 - BARTHOLIN GLAND CYSTS o Causes  Gonorrhea “hangs out”  produces large abscesses o Consequences  Cysts up to two inches in diameter  Local pain and discomfort - MISCELLANEOUS INFECTIONS o Syphilitic chancres o Condyloma lata o Chancroid  Hemophilus ducreyi (gram negative)  soft chancre that is painful o Granuloma inguinale  Calymmatobacterium granulomatous  extremely ulcerated epidermis  Donovan bodies observed inside of cells (facultatice intracellular bacteria) o Lymphogranuloma inguinale  Chlamydia trachomatis (L form)  buboes in lymph nodes o Herpes simplex virus II  Infection ---3-7 days-- painful red papules  vesicles  small ulcerations and leukorrhea  Clinical features  Fever  Malaise  Tender inguinal nodes  Vesicles and ulcers high in viral particles  Lesions heal in 1-3 weeks  latent infection  Pregnant mother may infect baby in birth canal VULVAR DYSTROPHIES - General o Plaque-like whitish mucosal thickening = leukoplakia o Itchy and scaly o Depigmentation in some cases  Vitiligo  Dermatitis with psoriasis  Carcinoma in situ - ATROPHIC DYSTROPHY (Lichen Sclerosis) o Causes  Women 45-55 years-old with atrophy of labia o Consequences  Atrophy of epidermis  sclerosis of dermis  Thinning of epidermis
  4. 4. FEMALE REPRODUCTIVE 4 of 12  Not many cells in dermis  Smooth, reddish and glazed at first   Whitish with mononuclear cells  Parchment-like areas that may be yellowish to blue as well - HYPERPLASTIC DYSTROPHY (Squamous Hyperplasia) o Consequences  Acanthosis (hyperplasia of prickle cell layer)  Also seen in genital warts  Dysplasia  Hyperkeratosis – not white b/c no increase in collagen  Often foci of carcinoma in situ (Bowen’s disease)  Itchy TUMORS - CONDYLOMA ACUMINATUM – not neoplastic o Causes  Human papilloma viruses types 6 and 11 o Consequences  Benign hyperplasias  Verrucous projections called venereal warts  Perianal, vulvar, perineal, vaginal  Grapelike projections of stratified squamous epithelium  Acanthosis  Hyperkeratosis  Koilocytosis – HPV particles found in koilocytes  Not premalignant - PAPILLARY HIDRADENOMA – a debatable neoplasm o Cause  Derived from apocrine sweat gland tumors o Consequences  In labia majora  May ulcerate but generally doesn’t  Mistaken occasionally for carcinoma  Found in vulva at milk line  Well-defined hard bump - VULVAR CARCINOMA o Squamous cell carcinoma  Causes  VIN 1-3 = vulvar intraepithelial neoplasia o Should be VID for dysplasia  Hyperplasia  dysplasia  squamous cell carcinoma  Consequences  Fissured and ulcerated with heaped up margins
  5. 5. FEMALE REPRODUCTIVE 5 of 12  Invasive, infiltrates locally  spreads to regional nodes  Sometimes misdiagnosed as a leukoplakia  Pain, itching and secondary infections o Basal cell carcinoma o Malignant melanomas  metastasis  May mimic Paget’s disease  Fatal if not picked up early o Carcinoma in situ (Bowen’s disease)  Causes  VIN 3 – full thickness dysplasia  30% of patients also have cervical or vaginal CA  90% of patients have antigens for HSV II  80% of patients have antigens for HPV-16 (100% have the viral DNA)  Consequences  Presents as a leukoplakia o Paget’s disease – not the same as the Paget’s disease of the bone  Consequences  Neoplasms along the milk line  Red-crusted maplike areas  Paget cells = large watery anaplastic cells in epidermis of labia majora o Halo around nucleus is PAS+ and CEA+ DISEASES OF THE VAGINA - Types o Congenital  Abnormalities of size and shape  Absent  Atresia  Septate or double – failure of fusion of Mullerian ducts  Gartner’s duct cysts o Inflammatory conditions (vaginitis)  Trichomonal vaginitis  Others o Tumors  Common benign tumors  Squamous cell carcinomas  Adenocarcinoma  Sarcoma botryoides
  6. 6. FEMALE REPRODUCTIVE 6 of 12 CONGENITAL - GARTNER’S DUCT CYSTS o Causes  From remnants of mesonephric ducts o Consequences  In lateral walls of vagina in submucosa  Usually less than 1 inch in diameter INFLAMMATORY CONDITIONS - TRICHOMONAL VAGINITIS o Causes  A flagellated protozoan – 30 microns long  Mostly in postmenopausal women o Consequences  Strawberry cervix - OTHERS o Candidiasis o HSV II o Bacterial vaginosis  Gardnerella  E coli TUMORS - COMMON BENIGN TUMORS - SQUAMOUS CELL CARCINOMA o Consequences  Well-differentiated  Usually upper posterior wall near exocervix  About 95% of all at this location - ADENOCARCINOMA o Causes  In young women whose mother took DES during pregnancy  Adenosis appear first – age 15-20  A proliferation of glandular epithelium that can be seen forming in the wall of the vagina deep down in the muscle o Consequences  Clear cell carcinoma – clear, watery cytoplasmic cells  Upper anterior wall  Also in cervix - SARCOMA BOTRYOIDES o Causes
  7. 7. FEMALE REPRODUCTIVE 7 of 12  Infants and children less than 5 years old o Consequences  A malignant rhabdomyosarcoma – derived from satellite cells = stem cells  Very bulky, polypoid, gelatinous, friable  Fragments easily break off with bleeding and infections  invade locally   Spreads throughout peritoneal cavity  may cause death  May obstruct urinary tract DISEASES OF THE CERVIX - Types o Congenital  Hypoplasia  Duplications  Stenosis o Inflammatory conditions  Nonspecific  From normal flora of vagina  Specific  Gonococcus  Syphilis  Trichomona vaginalis  Candida albicans  Acute cervicitis  Chronic cervicitis o Tumors  Carcinoma  Polyps INFLAMMATORY CONDITIONS - Predisposing factors o Microbes o Trauma of childbirth o ObGyn instrumentation o Hyperestrinism o Early and frequent intercourse - Clinical correlations o Discomfort or asymptomatic o Inflamed cervix o Colposcopy - ACUTE CERVICITIS
  8. 8. FEMALE REPRODUCTIVE 8 of 12 o Causes  Staph  Strept o Consequences  Focal loss of mucosa - CHRONIC CERVICITIS o Causes o Consequences  Most often in endocervix at external os first  Loss of glycogen  positive Schiller test  Metaplasia at transformation zone may enter the endocervical canal  Swollen, red, granular, lots of polys and lymphoid follicles TUMORS - CARCINOMA (SQUAMOUS CELL) o Types  Fungating  Ulcerative  Infiltrative o Causes  Low socioeconomic groups  Blacks are twice as likely  Low in Jewish populations  Early marriage with multiple births  Early age of onset of sexual activity  Correlated directly with frequency of intercourse and number of sexual partners  Pregnancy at an early age  HSV II infections are common  HPV 16,18,31  cervical dysplasia (loss of cell polarity, increased mitosis, pleomorphism, abnormal nucleocytoplasmic ratios) – begins at squamocolumnar junction  cells become aneuploid  CIN  carcinoma in situ  CIN = cervical intraepithelial neoplasia o Grade 1 = dysplasia of less than 1/3 thickness o Grade 2 = dysplasia of 1/3-2/3 of thickness o Grade 3 = dysplasia of 2/3 to full thickness o Consequences  Tumor cells express the viral mRNA of HSV II  Positive Schiller test
  9. 9. FEMALE REPRODUCTIVE 9 of 12  Obliteration of external os and spread to fundus  spreads to all organs of peritoneal cavity  metastasis to liver, lungs, bone marrow  Takes many years to develop  PAP smear is not diagnostic but biopsy is  Colposcopy shows mottled whitish areas  Clinical features  Vaginal bleeding  Leukorrhea  Pain on coitus  Dysuria - POLYPS o Common in the 4th and 5th decade of life o Seen esp in chronic cervicitis o Most are single – 90% DISEASES OF THE UTERUS - Types o Congenital  Hypoplasia  Septate or duplication o Inflammatory conditions  Interstitial and nonspecific inflammation  Chronic endometritis o Adenomyosis o Endometriosis o Menstrual disorders o Endometrial hyperplasia  Cystic hyperplasia  Adenomatous hyperplasia  Atypical hyperplasia o Endometrial atrophy o Tumors  Polyps  Leiomyoma (AKA fibroids)  Carcinoma  Sarcoma  Endometrial stromal tumors INFLAMMATORY CONDITIONS - INTERSTITIAL & NONSPECIFIC INFLAMMATION o Causes  Group A hemolytic strept
  10. 10. FEMALE REPRODUCTIVE 10 of 12  Staph - CHRONIC ENDOMETRITIS o Causes  Chronic PID  Chlamydia  Gonorrhea  Tuberculosis  Postpartum/postabortion – from retained tissues  IUDs – actinomycetes infection ADENOMYOSIS - Causes o Downgrowth of basal cells  nests of endometrium in myometrium - Consequences o Common at autopsy (10-15% of autopsies) ENDOMETRIOSIS - Causes o Never over 50 years of age o In 3rd or 4th decade of life o Higher in upper socioeconomic groups o Higher when marry later in life o Higher incidence when very few children o Endometrium sloughs off  exits into peritoneal cavity through fallopian tubes in a retrograde fashion  ectopic implantation o Hematogenous spread = lymphatic & blood vessel spread  endometrial tissue in eyes, etc - Consequences o Endometrium found outside of uterus o Common sites – ovaries, uterine ligaments, rectum, peritoneum, umbilicus, vagina o Cycles with ovarian hormones  bleeding o Located on serosal membranes o Fibroblast proliferation and fibrosis  adhesions o Chocolate cysts in ovaries – bloody cysts o Clinical features  Often asymptomatic for long periods  May show as infertility  Often severe dysmenorrheal and pelvic pain  Pain during intercourse  Pain while defecating
  11. 11. FEMALE REPRODUCTIVE 11 of 12 MENSTRUAL DISORDERS - Causes o ? - Consequences o ? DISEASES OF THE FALLOPIAN TUBES - Types o Inflammatory conditions  PID  Tuberculosis o Tumors  Carcinoma – rare  Parovarian cyst ? - Causes o ? - Consequences o ? DISEASES OF THE OVARIES - Types o Non-neoplastic cysts  Follicular cysts  Luteal cysts  Polycystic ovaries o Tumors  Coelomic epithelial  Serous  Mucinous  Endometrioid  Germ cell  Benign cystic teratomas  Dysgerminoma  Yolk sac tumor  Choriocarcinoma  Stromal cell  Granulosal/thecal cell  Fibroma  Sertoli cell/Leydig cell  Krukenberg
  12. 12. FEMALE REPRODUCTIVE 12 of 12 ? - Causes o ? - Consequences o ? DISEASES OF THE PLACENTA - Types o Toxemia of pregnancy  Preeclampsia  Eclampsia o Inflammatory conditions o Spontaneous abortion o Ectopic pregnancy o Neoplasms ? - Causes o ? - Consequences o ?

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