DR. ROOPAM JAIN, Professor & Head, Department of Pathology & Blood Bank

1. FEMALE GENITAL SYSTEM INVASIVE
CERVICAL CANCER
DR. ROOPAM JAIN
PROFESSOR & HEAD, PATHOLOGY

2. INVASIVE
CERVICAL CANCER

3. • Invasive cervical cancer in about 80% of cases is epidermoid (squamous
cell) carcinoma.
• The risk factors and etiologic factors are the same as for CIN discussed
above.
• The peak incidence of invasive cervical cancer is in 4th to 6th decades of
life.

4. MORPHOLOGIC FEATURES - Grossly
• Invasive cervical carcinoma may present 3 types of patterns:
fungating,
ulcerating
infiltrating
• Characteristically, cervical carcinoma arises from the squamocolumnar
junction.
• The advanced stage of the disease is characterised by widespread
destruction and infiltration into adjacent structures including the urinary
bladder, rectum, vagina and regional lymph nodes.
• Distant metastases occur in the lungs, liver, bone marrow and kidneys

5. Invasive carcinoma of the cervix common gross appear ance is of a
fungating or exophytic, caulifl ower-like tumour. Gross photograph on
right shows replacement of the cervix by irregular grey-white friable
growth (arrow) extending into cervical canal as well as distally into
attached vaginal cuff .

7. MORPHOLOGIC FEATURES - Grossly
• Histologically, the following patterns are seen:
• 1. Epidermoid (Squamous cell) carcinoma – 70%
• The most common pattern (70%) is moderatelydifferentiated non-
keratinising large cell type and has better prognosis (Fig.).
• Next in frequency (25%) is well-differentiated keratinising epidermoid
carcinoma.
• Small cell undifferentiated carcinoma (neuro endocrine or oat cell
carcinoma) is less common (5%) and has a poor prognosis

8. MORPHOLOGIC FEATURES - Grossly
• 2. Adenocarcinoma
Adenocarcinomas comprise about 20-25% of cases. These may be well-
differentiated mucussecreting adenocarcinoma, or clear cell type
• 3. Others
The remaining 5% cases are a variety of other patterns such as
adenosquamous carcinoma, verrucous carcinoma and undifferentiated
carcinoma

9. Invasive cancer cervix
Common histologic type is epidermoid (squamous cell) carcinoma
showing the pattern of a moderately differentiated non-keratinising
large cell carcinoma

10. CLINICAL STAGING
FIGO clinical staging
of carcinoma of the
cervix uteri.

11. MYOMETRIUM AND
ENDOMETRIUM

13. DYSFUNCTIONAL UTERINE BLEEDING (DUB)
• Dysfunctional uterine bleeding (DUB) may be defined as excessive
bleeding occurring during or between menstrual periods without a
causative uterine lesion such as tumour, polyp, infection, hyperplasia,
trauma, blood dyscrasia or pregnancy.

14. ENDOMETRITIS AND MYOMETRITIS
• Inflammatory involvement of the endometrium and myometrium are
uncommon clinical problems;
• myometritis is seen less frequently than endometritis and
• occurs in continuation with endometrial infections.
• Endometritis and myometritis may be acute or chronic.

15. ENDOMETRITIS AND MYOMETRITIS
• Acute form generally results from 3 types of causes
• puerperal (following full-term delivery, abortion and retained products of
conception),
• intrauterine contraceptive device (IUCD), and
• extension of gonorrheal infection from the cervix and vagina.
• Chronic form is more common and occurs by the same causes which
result in acute phase.

16. • Tuberculous endometritis is almost always associated with
tuberculous salpingitis and shows small caseating
granulomas (Fig

17. Tuberculous endometritis
The stroma has caseating epithelioid cell granulomas having Langhans’
giant cells and peripheral layer of lymphocytes

18. ADENOMYOSIS
• Adenomyosis is defined as abnormal distribution of
histologically benign endometrial tissue within the
myometrium alongwith myometrial hypertrophy.
• The term adenomyoma is used for actually circumscribed
mass made up of endometrium and smooth muscle tissue.

19. Adenomyosis
The endometrial
glands are present
deep inside the
myometrium (arrow).

20. ENDOMETRIOSIS
• presence of endometrial glands and stroma in abnormal locations
outside the uterus.
• Endometriosis and adenomyosis are closely inter linked

22. ENDOMETRIAL HYPERPLASIAS
• Endometrial hyperplasia is characterised by exaggerated proliferation of
glandular and stromal tissues.
• it is commonly associated with prolonged, profuse and irregular uterine
bleeding in a menopausal or postmenopausal woman.
• Hyperplasia results from prolonged oestrogenic stimulation. Such
conditions include SteinLeventhal syndrome, functioning granulosa -
theca cell tumours, adrenocortical hyper function and prolonged
administration of oestrogen.
• Endometrial hyperplasia is clinically significant due to the presence of
cellular atypia which is closely linked to endo metrial carcinoma.

23. ENDOMETRIAL HYPERPLASIAS
Classification of endometrial hyperplasias :
• 1. Simple hyperplasia without atypia (Cystic glandular hyperplasia).
• 2. Complex hyperplasia without atypia (Complex nonatypical
hyperplasia).
• 3. Complex hyperplasia with atypia (Complex atypical hyperplasia).