This document summarizes several topics related to the female genital system: 1) It describes carcinoma of the cervix, noting the main risk factors as HPV infection, early sexual activity, and multiple partners. It discusses the pathogenesis from precancerous dysplasia to invasive cancer. 2) It briefly covers uterine fibroids, noting they are benign smooth muscle tumors that can cause heavy bleeding. 3) Carcinoma of the endometrium is summarized as the most common female cancer, associated with obesity, diabetes, and excess estrogen exposure. 4) Gestational trophoblastic diseases like hydatidiform and choriocarcinoma are also summarized in terms of their pathogenesis and morphology.

1. FEMALE GENITAL
SYSTEM
Dr. Salman Ansari
Dept. of Pathology
Kanachur Institute of Medical Sciences

2. Contents
● Anatomy
● Fibroid
● CA cervix
● CA endometrium
● Vesicular mole
● Choriocarcinoma

6. CARCINOMA CERVIX

8. CA cervix
Malignant tumour arising from the female genital tract
● Most common cancer in women in India
● The early form is called Cervical Intraepithelial
Neoplasia(CIN)
● CIN is a precancer - detected by Pap smear

9. Etiology
Risk factors:
- Early age at first sexual intercourse
- Multiple sexual partners
- High parity(more number of pregnancies)
- Infection with HPV types 16, 18, 45 and 31
- STDs: herpes, syphilis
- Cigarette smoking
- HIV infection

10. Pathogenesis
- “Transformation Zone”: area around the cervical os
where the endocervix and ectocervix meet
- High cellular proliferation occurs here

12. Pathogenesis
Repeated cervical trauma causes changes in TZ
↓
Risk of HPV infection
↓
HPV causes neoplastic transformation of TZ - called “dysplasia”
↓
Severe dysplasia: called carcinoma-in-situ
↓
If the carcinoma cells cross the basement membrane and involve
deeper tissues, it is called invasive cancer

13. Morphology
Gross:
- Cervix shows mosaic or punctate abnormalities
- Invasive tumour can be:
Exophytic: cauliflower-like growth
Endophytic: crater-like ulceration

16. Exophytic
growth
Endophytic
growth

17. Microscopy:
Squamous cell carcinoma
adenocarcinoma(rare)

18. Staging of cervical cancer
Stage 0 carcinoma limited to mucosa(CIN) - no gross lesion
Stage 1 invasive carcinoma limited to cervix
Stage 2 Carcinoma extends beyond cervix but within pelvic wall
and upper part of vagina
Stage 3 Reaches pelvic wall and invades lower third of vagina
Stage 4 Spreads beyond the pelvis and infiltrates adjacent
organs - metastasis occurs

20. Clinical features
- Cervical cancer: median age of 50 years
- CIN: median age of 35 years
- Asymptomatic initially
- Vaginal discharge
- Post coital bleeding(bleeding after sexual intercourse)
- Vaginal bleeding(rare)
- In advanced cases: urinary urgency

21. Prognosis
● Depends on stage of disease
● Preinvasive(CIN): curable
● Stage 4: lethal
- Important to do Pap smear on regular basis
- HPV vaccine

22. FIBROID UTERUS

23. Fibroid
● Also called leiomyoma
● Benign tumour arising from the smooth muscles of the
myometrium
● Most common benign tumour in woman of reproductive
age group
● Growth stimulated by estrogen, OCPs
● Shrinks in postmenopausal women

24. Pathology
Gross:
● Sharply circumscribed mass
● Cut surface: grey white in colour, with whorled
appearance
● Single or multiple
● Small in size to massive tumour
● Classified into 3, based on location: subserosal,
intramural and submucosal

26. (diagram)

28. Microscopy:
● Bundles of smooth muscle cells arranged in whorls
● Areas of fibrosis, calcification, necrosis or
hemorrhage may be present

30. Clinical features
● May be asymptomatic
● Menorrhagia(excessive menstrual bleeding)
● Metrorrhagia(intermenstrual irregular bleeding)
● Large fibroids can cause compression of bladder or
rectum and cause urinary urgency and constipation

32. CARCINOMA ENDOMETRIUM

33. Anatomy

34. CA endometrium
Most common malignant tumor of female genital tract
worldwide
● Used to be less common than cervical cancer - early
detection of CIN has drastically reduced the
incidence of cervical cancer

35. Etiology
Perimenopausal age group - excess of estrogen
Risk factors:
- Obesity
- Diabetes
- Hypertension
- Nulliparity
- Those taking exogenous estrogen
- Estrogen-producing tumours

36. Pathogenesis
Estrogen
↓
Stimulation of endometrial glands
↓
Excess estrogen increases chances of
malignant transformation

37. Morphology
Gross:
- Early stage: small polyps, prone to bleeding
- Can be exophytic(fungating mass) or
endophytic(ulcer)
- Friable and bleeds on touch
- Can extend to endocervix and vagina

39. Microscopy:
These tumours are adenocarcinomas - malignant glands
are seen

40. Staging of endometrial carcinoma
Stage 1 carcinoma limited to endometrium
Stage 2 Carcinoma extends down into cervix and invades
myometrium
Stage 3 Extends into wall of uterus but within true pelvis
Stage 4 Cancer infiltrates bladder/rectum/extends outside of
true pelvis

41. Clinical features
● Postmenopausal bleeding
Diagnosis: by endometrial biopsy
Treatment: hysterectomy(surgical removal of uterus),
radiation therapy

42. Gestational trophoblastic diseases

43. Gestational trophoblastic diseases
Hydatidiform mole(vesicular mole)
Invasive mole
Choriocarcinoma

44. Hydatidiform mole(also called vesicular
mole)
Proliferation of trophoblast cells of placenta along with
hydropic degeneration of chorionic villi
2 types
Complete mole: no fetal parts
Incomplete mole(partial): has fetal parts

45. Pathogenesis of complete mole
- Due to abnormal fertilisation
- Normally, fetus has 46 chromosomes(23 from mother, 23
from father)
- In complete mole, all 46 chromosomes are from father.
Maternal set is lost at the time of fertilisation, so paternal set
duplicates to bring the total to 46. This process is called
“androgenesis”
- Embryo cannot develop and undergoes hydropic
degeneration

46. Pathogenesis of incomplete mole
- Ovum gets fertilised by 2 sperms
- Cells have 69 chromosomes
- Embryo does not die immediately so it has time to
develop fetal parts(but dies later on)

47. Morphology
Gross:
- Placenta is transformed into many vesicles(cysts)
- Looks like a bunch of grapes
- Round villi, filled with fluid
- In partial mole, fetal parts will be seen

50. Microscopy:
- Hydropic swelling of villi
- Absence of capillaries

51. Clinical features
Diagnosed by enlarged uterus with absence of fetal
movements
Aborts spontaneously
High hCG levels
- All parts of the abnormal placenta MUST be removed,
to avoid development of malignancy(called
choriocarcinoma)

52. CHORIOCARCINOMA

53. Choriocarcinoma
- Highly malignant tumour of chorionic epithelium
Etiology:
Following a hydatidiform mole(50%), abortion or normal
pregnancy

54. Pathology:
Gross: Hemorrhagic and necrotic
nodules within uterus
Microscopy: anaplastic
cytotrophoblasts and
syncytiotrophoblastic cells

55. Clinical features
● Heavy vaginal bleeding
● High hCG levels
Treatment:
Chemotherapy, surgery

56. References:
● Dr. Purnima S. Rao - Textbook of Pathology & Genetics For
Nursing
Questions:
salman.s.ansari92@gmail.com