This document provides an overview of the female reproductive system, including common pathologies that can affect each organ. It discusses disorders of the lower genital tract and cervix, uterus, fallopian tubes, ovaries, and pregnancy-related conditions. Some key topics covered include infections, endometrial diseases, cervical intraepithelial neoplasia, ovarian cysts and tumors, and trophoblastic diseases. The document aims to describe the clinical presentations, risk factors, pathological findings, and management considerations for various female reproductive system disorders.

1. Female Reproductive
System
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PATHOLOGY OF

2. Female Reproductive System
Lower genital tract & cervix
Uterus
Tubes and ovaries
Disorders of pregnancy
infertility
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3. Clinical Presentations
• Lower abdominal and pelvic pain.
• Vaginal bleeding.
• Vaginal discharge
• Abdominal mass
• Complications of pregnancy
• Infertility.
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4. Infections
Clinical importance
Anatomical classification
Lower
Upper and lower (PID).
Causative classification
Viral
Bacterial
Parasitic
 ....
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5. Diseases of Endometrium
Infections
Endometriosis
Endometrial hyperplasia / polyps
Endometrial carcinoma
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6. Endometriosis
Endometrial tissue outside the uterine cavity
Sites: myometrium, tubes , ovary, bowel .
Pathology :
Glands + stroma ( hormone responding )
Clinically : bleeding, pain, adhesion
Pathogenesis
menstrual blood flows back through the fallopian tubes and into t
pelvic cavity
Metaplasia
 Hormonal imbalance In the body
• Surgical scars: from surgeries such as a Cesarean (C-section) or
hysterectomy
• Immune system problems
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7. Endometrial hyperplasia
↑↑ of endometrial glands and stroma
Due to ↑↑ ostrogen as in : .....
(no balance between the female hormones, estrogen and
progesterone)
Clinical effect : postmenopausal bleeding
Pathology : 3 types
1- simple : dilated glands
2- complex: irregular glands
2- atypical : cellular atypia
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8. Endometrial polyps
• Localized projections
• Pathology : hyperplasia
• Bleeding , pain , infertility
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9. Endometrial carcinoma
Common ,
Age 55 – 65 yrs
Risk factors
- any cause of ↑ostrogen
Clinically :
- general
- local
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10. Spread
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11. Disease of Myometrium
Leiomyoma
Leiomyosarcoma
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12. Leiomyoma ( fibroid)
Benign tumors of smooth muscles
Very common
20 – 40 yrs
Clinically : pain , bleeding , asymptomatic
Complications:
1- infertility 2- Torsion
3- necrosis , degeneration & infection
4- malignancy ( 1%)
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13. Leiomyosarcoma
Rare
Large
Malignant spindle cells
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14. Disorders of uterine cervix
Cevicitis
CIN
Ca Cx
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15. Cervicitis
Acute : viral , bacterial,...
Chronic :
• columnar metaplasia
• of the extocervic: cervical erosion
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16. Cervical intraepithelial neoplasia (C I
N )
• Non invasive carcinoma
• Caused by HPV (16, 18, 45, 31)
• Clinically : silent or mild bleeding
• Screening : pap smear
( Papanecoulao) ,,,, biopsy
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17. Pap smear
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Mohammed
Fathalla
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18. Grading of CIN
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Normal CIN I II III

19. Invasive Ca Cx
Very common , NO 2 in females
Mortality : No 8
Risk factors
1- HPV (16, 18, 4)
2- CIN
3- sexual activity , parity , smoking ,...
Clinically : .....
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20. Diagnosis and management
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21. Disorders of
Pregnancy
Ectopic pregnancy
Abortion
Trophoblastic tumors
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22. Entopic pregnancy
• Definition
• Causes
• Sites
• Clinical effects
• Diagnosis
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Mohammed
Fathalla
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Causes
Exact cause is not known, it is believed that the
following conditions can cause ectopic pregnancy:
Hormonal factors
Damaged fallopian tubes by either previous
injury or surgery
Genetic abnormalities
Abnormal development of fallopian tubes or
other reproductive organs
The risk factors include:
Previous ectopic pregnancy
Sexually transmitted infections such as
gonorrhea or chlamydia
Undergone fertility treatment
In rare cases, when IUDs are used for birth
control
Smoking

24. Trophoblastic Diseases
Placenta parts
Chrionic villi
Decidua
space
Disorder
Hydatidiform mole
Invasive mole
Choriocarcinoma
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25. Hydatidiform Mole
 Chorionic villi odema with trophblastic
proliferation
Three forms
A. Complete : fertilization by two sperms with
ova death ( 46 XX or 46 XY from father), no
fetal parts.
B. Partial: two sperms+ ova (triple), some fetal
parts
C. Invasive : local invasion with no metastasis
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vaginal bleeding and absence of fetal heart tones.
Laboratory studies; beta-HCG levels –
extreme elevations of this pregnancy
hormone may suggest molar pregnancy
(greater than 100,000 mIU/ml)

27. Choriocarcinoma
• Malignant trophoblastic tumor arising
from normal or abnormal pregnancy.
Pathology:
• large fleshy mass, with cyto and
cyncytiotrophoblastic cells,
• High metastasis potential
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28. Ch Ca.
• Clinically:
–V. bleeding and discharge
–Very high HCG
–..of malignancy &metastasis
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29. Disorders of the Ovary
Inflammations = Oophoritis= PID
Ovarian cysts
- Non neoplastic( functional)
-Neoplastic
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30. Ovarian Cysts
• Cystic structures lined by epithelium,
• Unilocular or multilocular
• Types
Ovarian Cysts
Functional
Neoplastic
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31. Functional cysts
• Represents stages of follicle development but
↑size.
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1)Follicular cyst
2)Corpus luteaum cyst
3)Theca- leuteal cyst

32. A- follicular Cyst
Small , unilocular
↑Granulosa cells→ ↑ ostrogen
In un ovulatory cycles (↓LH,FSH)
Endometrial ↑ plasia and carcinoma.
If multiple → polycystic ovary ( Stein-
leventhal syndrome)
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33. B-Corpus luteal cyst
 3- 8 cm
 Filled with brown fluid
 Both theca & granulosa cells
C- theca- luteal cyst
 ↑↑Thecal cells
 Associated with ↑HCG
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34. Ovarian Tumors
• 3rd female genital tumors, No I killer
Risk factors
– Family history
– Nulliparty
– Genetic mutations (BRCA-1,HER…)
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35. WHO Classification
1) Surface epithelial tumors
2) Germ cell tumors
3) Sex cord-Stromal tumors
4) Secondary tumors
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Mohammed
Fathalla
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36. 1- Surface Epithelial tumors
The commonest ( 60%)
Age (20-50) and older for malignant
According to Embryonic origin
Fallopian → Serous cyst adenoma/carcinoma
Cervical → Mucinous cystadenoma/ carcinoma
Endometrium → Endometriod
Urothelium → Brenner tumor
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37. A- Serous tumors
Very common ( 35%)
75% benign
 Cystadenoma, cystadenocarcinoma,
borderline
 Uni or multi locular cyst , clear fluid
 Signs of malignancy :nodularity, papillary
projections, solidity
 Mic: like tube
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38. Pathology
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Mohammed
Fathalla
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B M

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Mohammed
Fathalla
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Cystadenoma Cystadenocarcinoma

40. B- Mucinous tumors
Larger size
25%
Micro: endocervical cell type
Complications
1- Rupture : pseudomyxoma overii
2- Torsion: pain
3- Malignancy
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42. Other surface epithelial tumors
• Endomeriod : usually malignant
• Brenner tumors : usually benign
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43. 2- Germ Cell Tumors
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Mature Immature
Cystic
Teratoma
Embryonic
Extraembryonic
Somatic
Trophoblastic
Dysgerminoma
No
Differentiation
With
Differentiation

44. Mature Cystic Teratoma
• Called dermoid cyst
• Very common ( 30%)
• Large cyst with sebum, hair, teeth
• MIC: any mature tissue
• May ↑thyroid →stroma overii
• Complications
– Rupture, Torsion, malignancy (1%)
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Mohammed
Fathalla
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46. 3- Sex cord- Stromal tumors
Sex cord cells
Granulosa cells tumors ( ↑Estrogen)
Theca cells →thecoma
Sertoli- leidge cell→ androblastoma
Stromal cells
fibroma
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47. Secondary Tumors
• From any where
• Eg . Krukenburge tumors from the stomach
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