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The document provides an overview of the female reproductive system, covering topics such as the vulva, vagina, cervix, uterus, fallopian tubes, ovaries, pregnancy, and placenta. Key points include common diseases and disorders that can affect each part of the reproductive system such as cysts, infections, inflammation, benign and malignant tumors. Early and late pregnancy complications are discussed as well as placental anomalies, infections, and rare tumors. Anatomical structures and terms are defined throughout.
23 female
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- 2. TOPICS –Vulva –Vagina – Cervix, uterus –Body, uterus –Tubes – Ovaries – Placenta
- 3. VULVA • Synonymouswith EXTERNAL genitalia • Everything ANTERIOR to the INTROITUS • Usual classification of Degen., Inflam., Neopl. • Common Diseases: – BARTHOLIN Cyst – Vulvar Vestibulitis – Deg./Inflam. Epithelial: LICHEN diseases – BENIGN tumors: Condyloma(ta) – MALIGNANT tumors: VIN, SCC
- 4. Result from Inflammation/Obstruction of the Bartholin glands (i.e., greater vestibular glands) Often result in abscesses Surgical removal is curative when local procedures are inadequate or often recurrent NEVER become malignant
- 5. VULVAR VESTIBULITIS, assoc.w. vulvodynia
- 6. “LICHEN” DISORDERS LICHENSclerosis (atrophic skin) LICHEN Simplex Chronicus (hypertrophic skin) Common features of FIBROSIS and INFLAMMATION
- 8. Mucosal Atrophy Fibrosis(sclerosis) Inflammation
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- 10. The types oflichen lesions which show HYPER-plastic mucosal changes are often regarded as being potentially malignant
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- 12. VIN, SCC •Like condylomas, HIGHLY linked to HPV • VIN=changes leading to SCC-in- situ, look like “plaques” • BEYOND VIN = INFILTRATION
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- 17. VAGINA • CONGENITAL:Parallel Uterus • INFLAMMATORY –PRE-menopausal: STD –POST-menopausal: ATROPHY • BENIGN: Hidradenoma, Condyloma • MALIGNANT: VIN, INFILTRATING SCC
- 18. CONGENITAL • Imperforatehymen (hematocolpos) • Atresia • Absence (agenesis) • Septate • Double (didelphys)
- 19. Atresia, Double vagina, Double uterus.
- 20. VAGINITIS • 90% • Bacterial Vaginitis is the most common cause of vaginitis, accounting for 50% of vaginitis cases. As previously mentioned, BV is caused by an overgrowth of organisms such as Gardnerella vaginalis (gram-variable coccobacillus), Mobiluncus species, Mycoplasma hominis, and Peptostreptococcus species. Risk factors include pregnancy, intrauterine device (IUD) use, and frequent douching. • Candida species (C albicans, C tropicalis, and C glabrata) are airborne fungi that are natural inhabitants of the vagina in as many as 50% of women, and vaginal candidiasis is the second most common cause of vaginitis. Risk factors include oral contraceptive use, IUD use, young age at first intercourse, increased frequency of intercourse, receptive cunnilingus, diabetes, HIV or other immunocompromised states, chronic antibiotic use, and pregnancy. • T. vaginalis infection, the third most common cause of vaginitis, is caused by trichomonads. These organisms are flagellated protozoans. Trichomonads primarily infect vaginal epithelium, and they less commonly infect the endocervix, urethra, and Bartholin and Skene glands. Trichomonads are transmitted sexually and can be identified in as many as 80% of male partners of infected women. Risk factors include tobacco use, unprotected intercourse with multiple sexual partners, and the use of an IUD.
- 22. VAGINAL NEOPLASIA •VIN • INFILTRATING SCC • ADENOSIS (D.E.S.) •ADENOCARCINOMA (Di-Ethyl-Stilbestrol)
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- 29. CERVIX • NORMAL • METAPLASIA • INFLAMMATION • POLYPS • DYSPLASIA • CIN • INFILTRATING SCC
- 37. DYSPLASIA / CIN/ SIL
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- 40. How have we“CURED” Cervical Carcinoma?
- 41. ENDOMETRIUM • FUNCTIONALHISTOLOGY • D.U.B. (Dysfunctional Uterine Bleeding) • INFLAMMATION • ADENOMYOSIS/ENDOMETRIOSIS • POLYPS/HYPERPLASIA • ADENOCARCINOMA and/or STROMAL • LEIOMYOMYOMAS, -SARCOMAS • MITOSES differentiate benign from malignant
- 43. MITOSES (Glandular andStromal) = PRE-ovulatory VACUOLES/SECRETION = POST-ovulatory
- 44. DYSFUNCTIONAL UTERINE BLEEDING(DUB) • Anovulatory Cycle • Inadequate Luteal Phase • Oral Contraceptives • Menopause • Post-Menopause
- 45. ENDOMETRITIS •PID •Post-partumSepsis • BCP’s •TB
- 46. ADENOMYOSIS • Definedas normal endometrial glands deep within the myometrium
- 48. ENDOMETRIOSIS Defined asnormal endometrial glands OUTSIDE the confines of the myometrium Reverse menstruation vs. Embryologic “rest” theories EXTREMELY common cause of cyclical abdominal/pelvic pain Broad Ligament, Ovary (“chocolate cysts”), Peritoneum, Bowel, Umbilicus
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- 56. Adenocarcinoma of theEndometrium = Carcinoma of the Uterus
- 59. ADENOCARCINOMA of theENDOMETRIUM • Papillary, Polypoid • Clear Cell • Adeno-Squamous • Mucinous • Serous • Preceded by hyperplasia (EIN), dysplasia • Estrogenic, DES effects • Ass. w.: obesity, diabetes, hypertension, infertility • Stromal “sarcomatous” conditions can co-exist, i.e., “adenosarcoma”
- 60. GRADING and STAGING • GRADING – 1, 2, 3 – Well, Moderate, Poor • STAGING – (I) Corpus – (II) Corpus + Cervix – (III) Beyond uterus, but inside true pelvis – (IV) Outside true pelvis or involving bladder or rectal mucosa
- 61. Fallopian Tubes •Inflammation •Cysts •Neoplasms
- 62. SALPINGITIS/PID GC and CHLAMYDIA PYOSALPINX PERITONITIS TUBO-OVARIAN ADHESIONS STERILITY INFERTILITY
- 63. Peritubal CYSTS •Endometriosis • Hydatid Cysts of Morgagni (Mullerian rests) Para-, Peri-tubal)
- 64. TUBAL NEOPLASMS Adenocarcinomas Leiomyomas
- 65. DISEASES of OVARIES PREGNANCY PLACENTA
- 66. DISEASES of OVARIES • DEGENERATIVE? • INFLAMMATORY? • CYSTS • TUMORS – Müllerian (“Germinal”) – Germ Cell – Sex Cord/Stromal – Metastatic
- 67. DISEASES of PREGNANCY •EARLY Pregnancy •LATE Pregnancy
- 68. DISEASES of PLACENTA • “BENIGN” tumors (MOLES) • MALIGNANT tumors (CHORIOCARCINOMA)
- 69. 6 WEEKS GENITALRIDGE
- 72. Everything you cansee or feel is lined by serosa (i.e., mesothelial cells, visceral and parietal
- 75. TERMS • “Germinal”Epithelium (Mesothelium) • Ovum (Oocyte) • Tunica Albuginea • Primordial Follicle • Primary Follicle • Mature “Graffian” follicle (antral or secondary) • Granulosa cells ( Estrogen) • Thecal cells ( Estrogen) • Corpus luteum ( Progesterone) • “Atretic” follicle • Corpus Albicans • “Stroma”
- 80. B=GRANULOSA D=THECA INTERNAE=THECA EXTERNA
- 83. ESTROGEN • Controlledby FSH and LH • Develop, Lactate Breast Lobules • Proliferate Endometrial Glands • “Cardioprotective” • “Bone Mass” protective
- 84. PROGESTERONE • Controlledby FSH and LH • SECRETE Endometrial Glands • IMPLANTATION of the blastocyst • Lactation
- 85. DISEASES of OVARIES •CYSTS: –Follicular –Luteal
- 86. FOLLICULAR CYST MOSTCOMMON
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- 88. POLY-Cystic Ovarian Disease (Stein-Leventhal syndrome) 5% Prevalence Anovulation Oligomenorrhea Obesity Hirsutism
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- 90. OVARIAN TUMORS •MÜLLERIAN (MAJORITY) – Serous (Benign, Borderline, Malignant) – Mucinous (Benign, Borderline, Malignant) – Endometroid (Benign, Borderline, Malignant) – Adenosarcoma (Carcinoma AND Sarcoma) – Mesodermal Mixed (MULTIPHASIC Sarcoma) – Clear Cell – Brenner (almost always benign) – Transitional (almost always look like Brenner) • Germ Cell • SEX-CORD/STROMAL • METASTATIC
- 91. OVARIAN TUMORS •Solid vs. Cystic • Functional vs. NON-functional • Benign vs. Malignant • First clinical presentation may be ascites • Malignant ascites in a woman is ovarian cancer until proven otherwise • CA-125 is THE important tumor marker in ovarian cancer, especially as a follow up.
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- 97. PSAMMOMA bodies aredried up papillae of papillary adenocarcinomas, usually in the thyroid, but in ANY papillary adenocarcinoma
- 99. OTHER MÜLLERIAN •ENDOMETRIOD, malignant – (looks like endometrium) • CLEAR CELL, malignant – (clear cells, reminiscent of renal clear cell ca.) • CYSTADENOFIBROMA, benign – (BENIGN “FIBROUS” COMPONENT) • BRENNER TUMOR, benign – (transitional cell nests) • CARCINOMA with SARCOMA – (adenosarcoma, mixed Müllerian)
- 100. “GERM CELL” Tumors • Teratomas (usually benign in ovary), i.e., “mature” cystic teratoma or dermoid cyst • “Immature” teratomas are regarded as malignant • Dysgerminoma (look exactly like the testicular seminoma), malignant • Endodermal Sinus (Yolk Sac), malignant, Just like testicular • Choriocarcinoma, malignant, just like testicular
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- 106. ENDODERMAL SINUS TUMOR,aka YOLK SAC TUMOR
- 107. CHORIOCARCINOMA, Just liketestis or placenta
- 108. SEX-CORD/STROMAL TUMORS •Chiefly benign and NON-cystic, i.e., “solid”, often functional (hyper-estrogen-ism) • Granulosa-Theca • Fibroma-Theca • Sertoli-Leydig (Androblastoma)
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- 110. B=GRANULOSA D=THECA INTERNAE=THECA EXTERNA
- 112. DISEASES of PREGNANCY •EARLY Pregnancy •LATE Pregnancy
- 113. EARLY PREGNANCY •SPONTANEOUS ABORTION • ECTOPIC PREGNANCY
- 114. Spontaneous Abortion •15% - 35% • Fetal Causes –Usually Genetic • Maternal Causes (placental, uterus infections or trauma) –Toxo, Mycoplasma, Listeria –Trauma
- 115. Ectopic Pregnancy •Chiefly TUBAL, but ovarian or abdominal rare •1% OF NORMAL WOMEN •35%-50% OF WOMEN with previous SALPINGITIS/PID • + HCG, Abdominal pain, 1st trimester, ultrasound
- 117. LATE PREGNANCY •PLACENTAL ANOMALIES • TWIN PLACENTAS • PLACENTAL INFLAMMATIONS • TOXEMIA (ECLAMPSIA/PRE-ECLAMPSIA) • INTRAUTERINE GROWTH RETARDATION
- 118. PLACENTAL ANOMALIES •Accessory Lobes • Bipartite Placenta • Circumvallate Placenta • Placenta Accreta, chorion going DIRECTLY to the myometrium
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- 123. PLACENTA ACCRETA NODECIDUA BETWEEN VILLI AND MYOMETRIUM
- 124. MRI of PlacentaPREVIA, or LOW-LYING placenta, usually anatomically normal, but just lies LOWER than it should.
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- 126. TOXEMIA of PREGNANCY (PRE-eclampsia) • Hypertension • Proteinuria • Edema • Related to Placental Ischemia • Risk for DIC, convulsions (eclampsia)
- 127. Intrauterine Growth Retardation • Fetal causes: Genetic, malformations • Maternal Causes, vascular diseases, toxemia, infections, placental diseases • Placenta size (350-700g) ~ Fetal size (7.5lb)
- 128. Placental Infections •Villitis vs. chorionamnionitis vs. funisitis • ASCENDING vs. hematogenous • ASCENDING are usually bacterial, and chorionamnionitis • Hematogenous are often TORCH, and villitis
- 129. Placental Neoplasms, i.e.gestational trophoblastic disease • Benign: MOLES (Hydatidiform moles) • Malignant: CHORIOCARCINOMA • BOTH are associated with increased or persistent levels of the placental hormone HCG
- 131. Hydatidiform Mole •1/1000 in USA • 1% in Indonesia • Also called NON-invasive mole in its most common benign variant, but can also be “invasive” • Complete (2% chorioCA incidence) or partial (0% incidence) • Grapelike clusters, i.e., swollen villi
- 133. The MAIN thing differentiating benign from malignant from worrisome trophoblastic neoplasms is INVASIVENESS of the trophoblast