This document summarizes the anatomy and pathologies of the female genital tract. It describes the components of the FGT including the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. It then discusses various cervical conditions like CIN, SIL, and invasive cervical carcinoma. It also covers uterine conditions such as endometrial hyperplasia, endometrial carcinoma types 1 and 2, and leiomyoma. Other topics mentioned include adenomyosis, endometriosis, and endocervical polyp. Risk factors, clinical features, gross and microscopic findings are provided for each condition.

1. FEMALE GENITAL
TRACT

2. FGT IS COMPOSED OF
VULVA
VAGINA
CERVIX
UTERUS
FALLOPIAN TUBE
OVARY

3. CERVIX

4. OVERVIEW
CIN
SQUAMOUS INTRA-EPITHELIAL LESION
CARCINOMA CERVIX

5. CERVICAL INTRAEPITHELIAL
NEOPLASIA (CIN)
CIN I : Less than one third involvement of the
thickness of lower 1/3 rd of epidermis
CIN 2: one third to two third involvement.
CIN 3: full thickness involvement ( carcinoma in
situ)

6. SQUAMOUS INTRAEPITHELEIAL
LESION ( SIL )
L-SIL (low grade) - corresponds to CIN 1
H-SIL (high grade) – CIN 2 and CIN 3

7. RISK FACTORS
Early onset of sexual activity
Multiple sexual partners
Women with HPV infection : 16, 18, 31, 33, 35
High risk male sexual partner
Multiparous women
Use of OCP
Cigarette smoking
HIV infection

8. PAP SCREENING:
◦ Annual cervical pap smear in all sexually active women
having any high risk factors.
◦ if negative in 3 consecutive smears, then the frequency
of PAP screening is reduced.

10. INVASIVE CERVICAL CARCINOMA
Gross:
3 types
fungating,
ulcerative and
infiltrative.

12. INVASIVE CERVICAL CARCINOMA
Microscopy:
1. Sq cell carcinoma - composed of nests and tongues of
malignant sq epithelium invading the underlying cervical
stroma.
2. Adenocarcinoma – proliferation of glandular endocervical
glands
3. Adenosquamous carcinoma- malignant glandular and sq
epithelium.

13. Squamous cell carcinoma
moderately differentiated non-
keratinising carcinoma.

14. UTERUS

15. OVERVIEW
ENDOMETRIAL HYPERPLASIA
ENDOMETRIAL CARCINOMA
LEIOMYOMA

16. Endometrial hyperplasia
Characterized by increased proliferation of endometrial
glands relative to stroma resulting in an increased gland to
stroma ratio when compared with normal proliferative
endometrium

17. Causes:
Prolonged estrogenic stimulation with absence of progestational
activity.
Anovulation,
obesity,
menopause,
PCOD,
functioning granulosa cell tumour,
adrenocortical hyperfunction,
estrogen replacement therapy

18. Classification of endometrial
hyperplasia
Simple hyperplasia (cystic hyperplasia)
◦ presence of glands of various sizes and irregular shape
with cystic dilatation
◦ mild increase in gland to stroma ratio

19. Complex hyperplasia(adenomatous hyperplasia)
◦ increase in no. of endometrial glands with variation in
size & shape
◦ marked glandular crowding (back to back glands)
◦ epithelial glands remain cytologically normal (no loss of
basal polarity no atypia)
◦ stroma is dense cellular & compact

20. Atypical hyperplasia
◦ Presence of atypical cells in the hyperplastic epithelium
◦ Extent of cytological atypia might be mild, moderate or severe.
• Glandular crowding with eosinophilic cytoplasm and nuclear
enlargement ,loss of polarity and prominent nucleoli.
• Stroma diminished,but remains present
◦ It is a precancerous condition.

22. Tumours of endometrium
Endometrial carcinoma
Most common invasive cancer of FGT
Clinical features is abnormal bleeding
1. Type 1
2. Type 2

23. TYPE 1 ENDOMETRIAL
CARCINOMA
◦ Most common type (reproductive age group)
◦ Referred as endometrioid carcinoma
◦ Associated with
obesity,
diabetes,
hypertension &
unopposed estrogen stimulation
ASSOCIATED WITH ENDOMETRIAL HYPERPLASIA

24. TYPE 1 ENDOMETRIAL
CARCINOMA
◦ Gross: 2 patterns –
 localized polypoidal tumour
 diffuse tumour
◦ Extension of growth into
myometrium by direct invasion,
periuterine structures by direct continuity,
lymphatic metastasis,
haematogenous metastasis

25. TYPE 1 ENDOMETRIAL
CARCINOMA
◦ M/E:
most endometrial carcinomas are endometrioid
adenocarcinomas
Depending on the pattern of glands & cell changes they
are
 well differentiated,
 moderately differentiated or
 poorly differentiated

26. TYPE 2 ENDOMETRIAL
CARCINOMA
◦ Arise in atrophied endrometrium
◦ Age group 65-75 yrs (post-menopausal age group)
◦ Poorly differentiated tumours
◦ Aggressive tumours

29. Tumours of myometrium
Leiomyoma
Most common uterine tumour
Benign smooth muscle neoplasm
Gross types:
Sub-mucosal,
intramural,
sub-serosal

31. LEIOMYOMA
Gross :
round, well circumscribed, well encapsulated, firm, homogenous grey
white masses of variable sizes showing whorled appearance.
M/E:
•smooth muscle cells arranged in fascicles and bundles admixed with
fibrous tissue.
•individual smooth muscle cells are uniform in size & shape with
abundant cytoplasm & central oval nucleus.

33. LEIOMYOMA

35. Leiomyosarcoma
Uncommon malignant neoplasm of myometrium
C/F :
uterine enlargement, abnormal uterine bleeding
Gross:
bulky fleshy mass that invade the uterine wall or polypoid mass projecting into
lumen
M/E:
whorled arrangement of spindle cells with large hyperchromatic nuclei(nuclear
atypia),
No. of mitosis per HPF(mitotic index) = 10 or more

38. Thankyou

39. Adenomyosis
Presence of endometrial tissue within the myometrium
Clinical features:
◦ menorrhagia,
◦ dysmennorhoea,
◦ pelvic pain

40. Adenomyosis
Gross : uterus enlarged
C/S: areas of hemorrhage
M/E:
◦ irregular nests of endometrial stroma & glands arranged within
myometrium
◦ separated from basal endometrium by 2-3mm

42. Endometriosis
Presence of endometrial glands & stroma outside the uterus
Site:
Ovary
uterine ligaments
rectovaginal septum
cul-de –sac
pelvic peritoneum
mucosa of cervix, vagina fallopian tubes
large& small bowel & appendix

43. Endometriosis
Clinical Features:
infertility,
dysmennorhoea,
pelvic pain,
dyspareunia
Seen only in reproductive years of life

44. ENDOMETRIOSIS SEEN IN THE MUCOSA OF COLON

45. Two theories of development of endometriosis
Metastatic theory: retrograde menstruation through fallopian tube
Metaplastic theory: metaplasia of coelomic epithelium

46. Gross: foci of endometriosis appear blue or brownish black in the sites
mentioned
When disease is extensive organizing hemorrhages causes extensive
fibrous adhesions
Ovaries show numerous cysts filled with dark brown blood called as
chocolate cysts

47. Microscopy:
Presence of endometrial glands & stroma, areas of hemorrhage,
haemosiderin laden macrophages, surrounding zone of inflammation &
fibrosis

49. ENDOCERVICAL POLYP
◦ Benign exophytic growths
◦ Gross appearance: Small or sessile or may protrude
throught the external os.
◦ Microscopic appearance:
Soft , mucoid lesions composed of loose
fibromyxomatous stroma ,
mucus secreting endocervical glands and
variable dergee of inflammatory infitrate.

50. ENDOCERVICAL POLYP