Lower female gen tract lecture


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  • This uterus has been opened anteriorly through cervix and into the endometrial cavity. High in the fundus and projecting into the endometrial cavity is a small endometrial polyp. Such benign polyps may cause uterine bleeding.
  • The endometrial cavity is opened to reveal lush fronds of hyperplastic endometrium. Endometrial hyperplasia usually results with conditions of prolonged estrogen excess and can lead to metrorrhagia (uterine bleeding at irregular intervals), menorrhagia (excessive bleeding with menstrual periods), or menometrorrhagia.
  • This adenocarcinoma of the endometrium is more obvious. Irregular masses of white tumor are seen over the surface of this uterus that has been opened anteriorly. The cervix is at the bottom of the picture. This enlarged uterus was no doubt palpable on physical examination. Such a neoplasm often present with abnormal bleeding.
  • The endometrial adenocarcinoma is present on the lumenal surface of this cross section of uterus. Note that the neoplasm is superficially invasive. The cervix is at the right.
  • The endometrial adenocarcinoma in the polyp at the left is moderately differentiated, as a glandular structure can still be discerned. Note the hyperchromatism and pleomorphism of the cells, compared to the underlying endometrium with cystic atrophy at the right.
  • This is endometrial adenocarcinoma which can be seen invading into the smooth muscle bundles of the myometrial wall of the uterus. This neoplasm has a higher stage than a neoplasm that is just confined to the endometrium or is superficially invasive.
  • When endometrial glands and stroma are found outside the uterus, the condition is known as endometriosis. Up to 10% of women may have this condition. It can be very disabling and painful, even when just a few foci are present. Diagrammed here are typical locations for foci of endometriosis. Sometimes the old dark brown blood collects over time from repeated hemorrhage in a cystic space in the ovary and produces a so-called "chocolate cyst".
  • The thickened and spongy appearing myometrial wall of this sectioned uterus is typical of adenomyosis. There is also a small white leiomyoma at the lower left.
  • Adenomyosis occurs when endometrial glands and stroma are found in the myometrium, not just in the endometrium where they belong. This condition leads to uterine enlargement and irregular bleeding.
  • This is a section through an enlarnged 12 cm ovary to demonstrate a cystic cavity filled with old blood typical for endometriosis with formation of an endometriotic, or "chocolate", cyst. The hemorrhage from endometriosis into the ovary may give rise to a large "chocolate cyst" so named because the old blood in the cystic space formed by the hemorrhage is broken down to produce much hemosiderin and a brown to black color.
  • Upon closer view, these five small areas of endometriosis have a reddish-brown to bluish appearance. Typical locations for endometriosis may include: ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum, and laparotomy scars. Endometriosis may even be found at more distant locations such as appendix and vagina.
  • Smooth muscle tumors of the uterus are often multiple. Seen here are submucosal, intramural, and subserosal leiomyomata of the uterus.
  • Here is the microscopic appearance of a benign leiomyoma. Normal myometrium is at the left, and the neoplasm is well-differentiated so that the leiomyoma at the right hardly appears different. Bundles of smooth muscle are interlacing in the tumor mass.
  • Here is the microscopic appearance of a leiomyosarcoma. It is much more cellular and the cells have much more pleomorphism and hyperchromatism than the benign leiomyoma. An irregular mitosis is seen in the center.
  • As with sarcomas in general, leiomyosarcomas have spindle cells. Several mitoses are seen here, just in this one high power field.
  • Lower female gen tract lecture

    1. 1. Surgical Pathology of the Female Genital Tract VULVA VAGINA CERVIX UTERI CORPUS UTERI by Noel C. Santos, M.D.
    2. 2. VULVA <ul><li>Inflammatory Conditions </li></ul><ul><li>Pre-malignant: VIN (Vulvar Intraepithelial Neoplasia I to III) </li></ul><ul><li>Malignant </li></ul><ul><ul><li>Squamous Cell Carcinoma </li></ul></ul><ul><ul><li>Skin Tumors </li></ul></ul>
    3. 5. Vagina <ul><li>Inflammatory Conditions </li></ul><ul><li>Pre-malignantL VaIN (Vaginal Intraepithelial Neoplasia I to III) </li></ul><ul><li>Malignant </li></ul><ul><ul><li>Squmous Cell Carcinoma </li></ul></ul><ul><ul><li>Sarcoma botryoides </li></ul></ul>
    4. 6. Uterine Cervix <ul><li>Inflammatory Conditions </li></ul><ul><li>Pre-malignant: CIN (Cervical Intraepithelial Neoplasia) I to III </li></ul><ul><li>Malignant </li></ul><ul><ul><li>Squamous Cell Carcinoma </li></ul></ul><ul><ul><li>Adenocarcinoma </li></ul></ul><ul><ul><li>Stromal Tumors </li></ul></ul>
    5. 8. Pathogenesis: Cervical Transformation Zone Sexual Exposure HPV Infection Squamous Ep Columnar Ep Squamous Ca Adeno Ca High Risk Types (16,18) Low Risk-6,11 Smoking, Hormone, Oral contr. parity, Altered immune response etc.
    6. 12. Pap Smear Results:
    7. 14. Normal Cervix:
    8. 15. Normal Cervix : SUPER F INTERM BASAL
    9. 16. Condyloma Cx.
    10. 17. Cervical Dysplasia:
    11. 19. Ulcerating Ca Cx:
    12. 20. Cervical HPV infection:
    13. 21. Who should have PAP test <ul><li>Every woman should have an annual Pap examination when she becomes sexually active or turns 18 years old --- whichever comes first. </li></ul><ul><li>Regular Pap examinations (yearly) should continue after menopause and after a hysterectomy </li></ul>
    14. 22. What is the best time for PAP: <ul><li>The best time for a Pap examination is during the two weeks following the end of menstrual flow. (Proliferative phase) </li></ul><ul><li>If menopause, Pap examination can be scheduled anytime </li></ul>
    15. 23. Who are at more risk of Cx Ca. <ul><li>Any woman can develop Ca Cx. </li></ul><ul><li>multiple sex partners or a partner who has had multiple female partners. </li></ul><ul><li>have had genital warts. </li></ul><ul><li>sexual relations before the age of 18. </li></ul><ul><li>previous abnormal Pap examination. </li></ul><ul><li>(Rare in virgins and with use of condoms) </li></ul>
    16. 24. Fungating Ca Cx
    17. 25. Stage IV – Ca Cx (Block Dissection)
    18. 26. Carcinoma Cervix:
    19. 27. Infiltrating Carcinoma Cx:
    20. 28. Squamous Carcinoma:
    21. 29. Uterus – Endometrium <ul><li>Inflammatory Conditions </li></ul><ul><li>Pre-malignant: Hyperplasia </li></ul><ul><ul><li>Simple </li></ul></ul><ul><ul><li>Complex: with or without Atypia </li></ul></ul><ul><li>Adenocarcinoma </li></ul><ul><li>Endometrial Stromal Tumors </li></ul>
    22. 44. Uterus – Smooth Muscle (Myometrium) <ul><li>Tumors </li></ul><ul><ul><li>BENIGN: Leiomyoma </li></ul></ul><ul><ul><li>MALIGNANT: Leiomyosarcoma, Malignant Mixed Tumor </li></ul></ul>
    23. 50. Summary <ul><li>Clinical History and Physical Examination </li></ul><ul><li>Laboratory and Imaging Studies </li></ul><ul><li>Biopsy </li></ul><ul><li>Stage: Clinical, Diagnostic Imaging and Surgical </li></ul>
    24. 51. Surgical Pathology of the Female Genital Tract VULVA VAGINA CERVIX UTERI CORPUS UTERI by Noel C. Santos, M.D.