The document discusses diseases of the female reproductive system. It provides an overview of the major organs including the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. It then summarizes common diseases that affect each part, such as inflammatory lesions, infections, tumors, and abnormalities in menstruation or bleeding. The diseases discussed include conditions like herpes, syphilis, candidiasis, and various cancers. The document aims to introduce pathology found in the female genital tract.
Uterine polyps are abnormal tissue growths that can form on the uterus or cervix. There are two main types: mucoid polyps arising from the endometrium and fibroid polyps arising from submucosal fibroids. Polyps may cause irregular bleeding but often have no symptoms. Diagnosis involves transvaginal ultrasound, hysteroscopy, or endometrial biopsy. Small polyps are removed by twisting with forceps, while larger polyps require procedures like hysteroscopy or morcellation. Complications can include infertility or cervical injury.
This document discusses common breast disorders and their management. It covers topics such as breast masses, pain, nipple discharge, infections, lactation complications, mastitis, abscesses, inflammatory and non-inflammatory painful conditions. Diagnosis involves history, examination and investigations like ultrasound and mammography. Management depends on the condition and may include antibiotics, analgesia, drainage procedures or surgery. Benign and malignant breast conditions are also differentiated.
This document summarizes diseases of the ovaries, classifying them into primary inflammatory disorders, functional cysts, and ovarian tumors. It describes the histological structure of the normal ovary and then discusses each disease type in detail, including their morphology, pathogenesis, and potential complications. Primary inflammatory disorders cause premature ovarian failure through autoimmune destruction. Functional cysts include follicular, luteal, and stromal hyperthecosis cysts. Ovarian tumors are further divided into surface epithelial-stromal tumors, sex cord-stromal tumors, germ cell tumors, and metastatic cancers from other primary sites. Each tumor type has specific subtypes and histological features.
Amenorrhea is the absence of menstrual periods and is divided into primary and secondary types. Primary amenorrhea refers to the absence of periods by age 14 with no sexual development, or by age 16 with normal development. Secondary amenorrhea is defined as missing periods for 3 cycles or 6 months in women who previously menstruated regularly. Potential causes include pregnancy, breastfeeding, medical conditions, eating disorders, excessive exercise, and medications. Diagnosis involves medical history, physical exam, and lab tests. Treatment focuses on addressing the underlying cause through lifestyle changes, medication, surgery, or hormone therapy. Nurses educate and counsel patients, and emphasize healthy lifestyle behaviors.
This document discusses dysmenorrhea, or painful periods, which is divided into primary and secondary categories. Primary dysmenorrhea involves painful cramps without identifiable pelvic issues, while secondary dysmenorrhea occurs due to underlying pelvic or uterine conditions like endometriosis. The causes, symptoms, diagnostic process, and treatment options are outlined for both types of dysmenorrhea. Common symptoms include lower abdominal pain that may radiate to the back or thighs, and diagnosis involves physical exams, lab tests, and sometimes imaging or invasive procedures. Treatment focuses on pain relief through medications, lifestyle changes, and treating any underlying causes for secondary dysmenorrhea.
Congenital malformations of female genital tract pptAbhilasha verma
1) Congenital anomalies of the female genital tract refer to any physical abnormalities present at birth. The causes are mostly unknown but may involve hormone deficiencies, excesses, genetic factors or exposure to harmful substances.
2) Some common external anomalies include perineal or vestibular anus, ectopic ureters, and hymen abnormalities like imperforate hymen. Internal anomalies affect the vagina, uterus and ovaries.
3) Uterine anomalies are classified by the American Fertility Society and include conditions like arcuate uterus, bicornuate uterus, septate uterus and DES-related abnormalities. Clinical features may include infertility, dyspareunia and menstrual or obstet
This document provides an overview of diseases of the ovary, including both non-neoplastic and neoplastic lesions. It discusses common non-neoplastic conditions like follicular cysts and polycystic ovarian disease. It also covers the various types of ovarian tumors, including surface epithelial tumors (serous, mucinous, endometrioid), germ cell tumors, and sex cord-stromal tumors. For each type, it describes the gross and microscopic appearance as well as examples of histopathology slides. Metastatic tumors to the ovaries are also briefly discussed.
This document provides information on diseases of the vagina and vulva. It begins with the anatomy of the vagina and vulva. It then discusses common vaginal infections and inflammations like bacterial vaginosis, yeast infections, and trichomoniasis. Diagnosis and treatment of vaginal infections is outlined. Cysts and benign conditions of the vulva and vagina are described including lichen sclerosis and lichen planus. Finally, neoplasms of the vulva like vulvar intraepithelial neoplasia and squamous cell carcinoma are discussed.
Uterine polyps are abnormal tissue growths that can form on the uterus or cervix. There are two main types: mucoid polyps arising from the endometrium and fibroid polyps arising from submucosal fibroids. Polyps may cause irregular bleeding but often have no symptoms. Diagnosis involves transvaginal ultrasound, hysteroscopy, or endometrial biopsy. Small polyps are removed by twisting with forceps, while larger polyps require procedures like hysteroscopy or morcellation. Complications can include infertility or cervical injury.
This document discusses common breast disorders and their management. It covers topics such as breast masses, pain, nipple discharge, infections, lactation complications, mastitis, abscesses, inflammatory and non-inflammatory painful conditions. Diagnosis involves history, examination and investigations like ultrasound and mammography. Management depends on the condition and may include antibiotics, analgesia, drainage procedures or surgery. Benign and malignant breast conditions are also differentiated.
This document summarizes diseases of the ovaries, classifying them into primary inflammatory disorders, functional cysts, and ovarian tumors. It describes the histological structure of the normal ovary and then discusses each disease type in detail, including their morphology, pathogenesis, and potential complications. Primary inflammatory disorders cause premature ovarian failure through autoimmune destruction. Functional cysts include follicular, luteal, and stromal hyperthecosis cysts. Ovarian tumors are further divided into surface epithelial-stromal tumors, sex cord-stromal tumors, germ cell tumors, and metastatic cancers from other primary sites. Each tumor type has specific subtypes and histological features.
Amenorrhea is the absence of menstrual periods and is divided into primary and secondary types. Primary amenorrhea refers to the absence of periods by age 14 with no sexual development, or by age 16 with normal development. Secondary amenorrhea is defined as missing periods for 3 cycles or 6 months in women who previously menstruated regularly. Potential causes include pregnancy, breastfeeding, medical conditions, eating disorders, excessive exercise, and medications. Diagnosis involves medical history, physical exam, and lab tests. Treatment focuses on addressing the underlying cause through lifestyle changes, medication, surgery, or hormone therapy. Nurses educate and counsel patients, and emphasize healthy lifestyle behaviors.
This document discusses dysmenorrhea, or painful periods, which is divided into primary and secondary categories. Primary dysmenorrhea involves painful cramps without identifiable pelvic issues, while secondary dysmenorrhea occurs due to underlying pelvic or uterine conditions like endometriosis. The causes, symptoms, diagnostic process, and treatment options are outlined for both types of dysmenorrhea. Common symptoms include lower abdominal pain that may radiate to the back or thighs, and diagnosis involves physical exams, lab tests, and sometimes imaging or invasive procedures. Treatment focuses on pain relief through medications, lifestyle changes, and treating any underlying causes for secondary dysmenorrhea.
Congenital malformations of female genital tract pptAbhilasha verma
1) Congenital anomalies of the female genital tract refer to any physical abnormalities present at birth. The causes are mostly unknown but may involve hormone deficiencies, excesses, genetic factors or exposure to harmful substances.
2) Some common external anomalies include perineal or vestibular anus, ectopic ureters, and hymen abnormalities like imperforate hymen. Internal anomalies affect the vagina, uterus and ovaries.
3) Uterine anomalies are classified by the American Fertility Society and include conditions like arcuate uterus, bicornuate uterus, septate uterus and DES-related abnormalities. Clinical features may include infertility, dyspareunia and menstrual or obstet
This document provides an overview of diseases of the ovary, including both non-neoplastic and neoplastic lesions. It discusses common non-neoplastic conditions like follicular cysts and polycystic ovarian disease. It also covers the various types of ovarian tumors, including surface epithelial tumors (serous, mucinous, endometrioid), germ cell tumors, and sex cord-stromal tumors. For each type, it describes the gross and microscopic appearance as well as examples of histopathology slides. Metastatic tumors to the ovaries are also briefly discussed.
This document provides information on diseases of the vagina and vulva. It begins with the anatomy of the vagina and vulva. It then discusses common vaginal infections and inflammations like bacterial vaginosis, yeast infections, and trichomoniasis. Diagnosis and treatment of vaginal infections is outlined. Cysts and benign conditions of the vulva and vagina are described including lichen sclerosis and lichen planus. Finally, neoplasms of the vulva like vulvar intraepithelial neoplasia and squamous cell carcinoma are discussed.
This document discusses Pelvic Inflammatory Disease (PID), an infection of the female reproductive organs including the uterus, ovaries, and fallopian tubes. PID is caused by bacteria spreading from the vagina or cervix into the upper reproductive organs. Common causes are the sexually transmitted infections chlamydia and gonorrhea. Symptoms include abdominal pain and abnormal discharge. Treatment involves antibiotics to prevent complications like infertility or ectopic pregnancy. Prevention focuses on screening and treatment of chlamydia, as well as testing and treating partners of those diagnosed with PID.
Pelvic inflammatory disease (PID) is an inflammatory condition of the pelvic cavity that is usually caused by bacteria, viruses, or other microbes. It commonly affects sexually active young women and can cause long-term complications like infertility or ectopic pregnancy if left untreated. Symptoms include lower abdominal pain and vaginal discharge. Treatment involves antibiotics, bed rest, and care of any sexual partners. Nursing care focuses on monitoring, education, and supporting patients through treatment.
Explains the inflammatory process of endometrium,its causes and its two clinical variants as acute and chronic endometritis.
Describes the pathology of its two types with histologic perspective.
This document discusses diseases of the vulva, including benign and malignant conditions. It describes several benign vulvar lumps such as Bartholin's cyst, skin inclusion cysts, and sebaceous cysts. It also discusses non-neoplastic epithelial disorders including lichen sclerosus and squamous cell hyperplasia. Precancerous conditions like vulvar intraepithelial neoplasia are explained. Lastly, it provides an overview of vulvar carcinoma, including risk factors, staging, and treatment approaches.
Gynecomastia is a condition where breast tissue swells in boys and men, causing enlarged breasts. It is usually caused by an imbalance of male and female hormones. Gynecomastia commonly occurs during adolescence, older age, and can be caused by certain medications, diseases, or substance abuse. Evaluation may involve blood tests, imaging scans, and biopsies to determine the cause. Treatment options include antiestrogen medications, surgery to remove breast tissue or fat, and lifestyle changes to prevent future occurrence.
The document discusses amenorrhea, its classification, causes, diagnosis and management. It defines primary amenorrhea as the absence of menstruation by age 16 and secondary amenorrhea as absence of periods for 3 months in a previously menstruating woman. The main causes outlined include hypogonadotropic hypogonadism, polycystic ovary syndrome, premature ovarian failure, hyperprolactinemia, and weight-related issues. The diagnostic approach involves assessing the history, physical exam, ultrasound and hormonal levels. Management focuses on restoring ovulation if possible, or replacing hormones as needed to prevent health issues.
This document discusses menorrhagia, or abnormally heavy or prolonged menstrual bleeding. It defines menorrhagia as menstrual flow over 80 ml per cycle and lists potential causes like hormone imbalances, fibroids, polyps, and medications. Signs include soaking through a pad every hour for several hours. Tests to diagnose the cause may include blood tests, ultrasounds, and biopsies. Treatment options range from iron supplements and NSAIDs to hormonal treatments, surgical procedures like endometrial ablation, and hysterectomy in severe cases.
The document discusses different types of abortion including threatened abortion, inevitable abortion, incomplete abortion, complete abortion, missed abortion, and recurrent abortion. It describes the causes, signs, symptoms, management, and risks associated with each type. The most common cause of spontaneous abortion is a significant genetic abnormality in the fetus. Management depends on the type but may include bed rest, ultrasound, suction curettage, controlling bleeding, and emptying the uterus.
The document summarizes the normal menstrual cycle, which typically occurs over 4 phases in a 28 day cycle. It is regulated by the hypothalamus, pituitary gland, and ovaries. The follicular phase begins with menstruation and involves follicle development and estrogen rise. Ovulation occurs around day 14 when an egg is released. In the luteal phase, the corpus luteum forms and secretes progesterone to thicken the uterine lining. If implantation does not occur, progesterone drops and menstruation begins, restarting the cycle.
Ovarian cysts are sacs filled with liquid or semi-liquid material that arise in the ovaries. The majority are benign and not cancerous. There are several types of ovarian cysts including functional cysts (follicular, corpus luteum, and theca lutein cysts), endometriomas, and polycystic ovarian syndrome. Ovarian cysts may cause lower abdominal pain but many are asymptomatic. Ultrasound is used to examine cyst features and size while blood tests and further imaging can help determine if a cyst is benign or potentially cancerous. Most small, simple cysts can be monitored but larger or complex cysts may require surgical removal. The prognosis for benign ovarian cysts is
Types of Menstrual disorders and there causes and symptomsMedical Knowledge
In this slide, you can understand the types of menstrual disorders, Mahvari or haiz.
You can learn about the types of Menstruation.
Types of Menstrual disorders.
cause of menstruation
symptoms of menstruation
diagnosis of menstruation
Treatment of menstruation bleeding
Heavy bleeding or menstrual cramps
Menstrual cycle
Amenorrhea
Dysmenorrhea
Oligo menorrhea
PMS (Premenstrual syndrome) or PMDD (Premenstrual dystrophic disease)
Menorrhagia
You can download Powerpoint of menstrual disorders here:
https://docs.google.com/presentation/d/1SCDUYcPYP7vpE4kzWoBwzYnyg4vzNAcXWrFp_iIZAnA/edit#slide=id.p1
You can download video from:
https://youtu.be/APWG2liWR7E
Uterine fibroids are non-cancerous tumors that originate from the uterus. They are very common in women of reproductive age, affecting 20-40% of women. Symptoms can include abnormal uterine bleeding, infertility, pain, and pressure. Diagnosis involves physical exam, ultrasound, MRI, and sometimes biopsy. Treatment options include medical management using hormones to shrink fibroids, surgical procedures such as myomectomy to remove fibroids or hysterectomy to remove the uterus, and uterine artery embolization. Nursing care focuses on pain management, monitoring for bleeding and infection, encouraging mobility and nutrition, and providing education and emotional support.
Uterine fibroids are benign tumors that originate from the smooth muscle layer of the uterus. While the exact causes are unknown, risk factors include heredity, race, pregnancy, and obesity. Uterine fibroids can cause menstrual abnormalities, infertility, pain, and pressure symptoms. Diagnosis involves ultrasound, biopsy, or hysteroscopy. Treatment options depend on symptoms but may include medications, uterine artery embolization, myomectomy (surgical removal of fibroids), or hysterectomy.
This document discusses diseases of the female genital tract. It begins with an introduction and overview of the major organs. It then discusses various pathological conditions that can affect the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. Conditions discussed in detail include infections, abnormalities in menstruation and bleeding, and benign and malignant tumors that can arise in each organ system. The document provides clinical, pathological, and morphological details on many common and important female reproductive system diseases.
Vulvitis is irritation or inflammation of the vulva, the skin outside the vagina. It causes symptoms like itching, redness, swelling, soreness, and pain during sex. Vulvitis can be caused by infections, irritants like soaps or tight clothing, medications, douching, or poor hygiene. Diagnosis involves examining the vulva and testing for infections. Treatment depends on the underlying cause but may include anti-fungal or antibiotic creams, hydrocortisone cream for allergies, or estrogen cream for post-menopausal women. Preventing vulvitis involves keeping the vulva clean, dry, and cool and avoiding irritants.
Cryptorchidism, or undescended testes, is the most common congenital defect of the male genitalia where one or both testes fail to descend into the scrotum. It can occur unilaterally or bilaterally and if not corrected surgically, it may lead to infertility. The primary causes are idiopathic but risk factors include prematurity, low birth weight, maternal health issues like diabetes or obesity, and family history. Treatment involves initially monitoring for self-resolution, but primary management is surgical repositioning of the testes into the scrotum through orchiopexy to reduce infertility risks and prevent cancer or hernia.
This document discusses disorders of menstruation, including amenorrhea (absence of menstrual period), premenstrual syndrome (PMS), and menorrhagia (heavy menstrual bleeding). Amenorrhea can be primary (periods never start) or secondary (periods stop) and has many potential causes including pregnancy, breastfeeding, menopause, hormonal imbalances, medications, and structural issues. PMS involves physical and emotional symptoms in the one to two weeks before a woman's period, and is thought to be related to cyclic hormone changes. Menorrhagia is heavy or prolonged bleeding and can be caused by hormone imbalances, uterine fibroids, polyps, medications, and other medical conditions. Diagn
The female genital tract is susceptible to several cancers and dysfunctions. Cervical cancer is diagnosed through cytologic screening and treated with surgical removal or vaccines. Dysfunctional uterine bleeding can result from anovulatory or inadequate luteal cycles. Endometrial cancer risk increases with age, obesity, diabetes, and nulliparity. The most common type is endometrioid adenocarcinoma. Ovarian cancer risk is higher with nulliparity, family history, and certain genetic mutations. Choriocarcinoma is an invasive cancer preceded by conditions like hydatidiform mole.
The document summarizes the key components of the female reproductive system, including the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. It describes the normal anatomy and histology of these structures and discusses common inflammatory, benign, and malignant conditions that can affect each part. Examples of conditions mentioned include Bartholin cysts, lichen sclerosis, cervical dysplasia and cancer, endometrial hyperplasia and cancer, ovarian cysts and tumors, and complications of early and late pregnancy.
This document discusses Pelvic Inflammatory Disease (PID), an infection of the female reproductive organs including the uterus, ovaries, and fallopian tubes. PID is caused by bacteria spreading from the vagina or cervix into the upper reproductive organs. Common causes are the sexually transmitted infections chlamydia and gonorrhea. Symptoms include abdominal pain and abnormal discharge. Treatment involves antibiotics to prevent complications like infertility or ectopic pregnancy. Prevention focuses on screening and treatment of chlamydia, as well as testing and treating partners of those diagnosed with PID.
Pelvic inflammatory disease (PID) is an inflammatory condition of the pelvic cavity that is usually caused by bacteria, viruses, or other microbes. It commonly affects sexually active young women and can cause long-term complications like infertility or ectopic pregnancy if left untreated. Symptoms include lower abdominal pain and vaginal discharge. Treatment involves antibiotics, bed rest, and care of any sexual partners. Nursing care focuses on monitoring, education, and supporting patients through treatment.
Explains the inflammatory process of endometrium,its causes and its two clinical variants as acute and chronic endometritis.
Describes the pathology of its two types with histologic perspective.
This document discusses diseases of the vulva, including benign and malignant conditions. It describes several benign vulvar lumps such as Bartholin's cyst, skin inclusion cysts, and sebaceous cysts. It also discusses non-neoplastic epithelial disorders including lichen sclerosus and squamous cell hyperplasia. Precancerous conditions like vulvar intraepithelial neoplasia are explained. Lastly, it provides an overview of vulvar carcinoma, including risk factors, staging, and treatment approaches.
Gynecomastia is a condition where breast tissue swells in boys and men, causing enlarged breasts. It is usually caused by an imbalance of male and female hormones. Gynecomastia commonly occurs during adolescence, older age, and can be caused by certain medications, diseases, or substance abuse. Evaluation may involve blood tests, imaging scans, and biopsies to determine the cause. Treatment options include antiestrogen medications, surgery to remove breast tissue or fat, and lifestyle changes to prevent future occurrence.
The document discusses amenorrhea, its classification, causes, diagnosis and management. It defines primary amenorrhea as the absence of menstruation by age 16 and secondary amenorrhea as absence of periods for 3 months in a previously menstruating woman. The main causes outlined include hypogonadotropic hypogonadism, polycystic ovary syndrome, premature ovarian failure, hyperprolactinemia, and weight-related issues. The diagnostic approach involves assessing the history, physical exam, ultrasound and hormonal levels. Management focuses on restoring ovulation if possible, or replacing hormones as needed to prevent health issues.
This document discusses menorrhagia, or abnormally heavy or prolonged menstrual bleeding. It defines menorrhagia as menstrual flow over 80 ml per cycle and lists potential causes like hormone imbalances, fibroids, polyps, and medications. Signs include soaking through a pad every hour for several hours. Tests to diagnose the cause may include blood tests, ultrasounds, and biopsies. Treatment options range from iron supplements and NSAIDs to hormonal treatments, surgical procedures like endometrial ablation, and hysterectomy in severe cases.
The document discusses different types of abortion including threatened abortion, inevitable abortion, incomplete abortion, complete abortion, missed abortion, and recurrent abortion. It describes the causes, signs, symptoms, management, and risks associated with each type. The most common cause of spontaneous abortion is a significant genetic abnormality in the fetus. Management depends on the type but may include bed rest, ultrasound, suction curettage, controlling bleeding, and emptying the uterus.
The document summarizes the normal menstrual cycle, which typically occurs over 4 phases in a 28 day cycle. It is regulated by the hypothalamus, pituitary gland, and ovaries. The follicular phase begins with menstruation and involves follicle development and estrogen rise. Ovulation occurs around day 14 when an egg is released. In the luteal phase, the corpus luteum forms and secretes progesterone to thicken the uterine lining. If implantation does not occur, progesterone drops and menstruation begins, restarting the cycle.
Ovarian cysts are sacs filled with liquid or semi-liquid material that arise in the ovaries. The majority are benign and not cancerous. There are several types of ovarian cysts including functional cysts (follicular, corpus luteum, and theca lutein cysts), endometriomas, and polycystic ovarian syndrome. Ovarian cysts may cause lower abdominal pain but many are asymptomatic. Ultrasound is used to examine cyst features and size while blood tests and further imaging can help determine if a cyst is benign or potentially cancerous. Most small, simple cysts can be monitored but larger or complex cysts may require surgical removal. The prognosis for benign ovarian cysts is
Types of Menstrual disorders and there causes and symptomsMedical Knowledge
In this slide, you can understand the types of menstrual disorders, Mahvari or haiz.
You can learn about the types of Menstruation.
Types of Menstrual disorders.
cause of menstruation
symptoms of menstruation
diagnosis of menstruation
Treatment of menstruation bleeding
Heavy bleeding or menstrual cramps
Menstrual cycle
Amenorrhea
Dysmenorrhea
Oligo menorrhea
PMS (Premenstrual syndrome) or PMDD (Premenstrual dystrophic disease)
Menorrhagia
You can download Powerpoint of menstrual disorders here:
https://docs.google.com/presentation/d/1SCDUYcPYP7vpE4kzWoBwzYnyg4vzNAcXWrFp_iIZAnA/edit#slide=id.p1
You can download video from:
https://youtu.be/APWG2liWR7E
Uterine fibroids are non-cancerous tumors that originate from the uterus. They are very common in women of reproductive age, affecting 20-40% of women. Symptoms can include abnormal uterine bleeding, infertility, pain, and pressure. Diagnosis involves physical exam, ultrasound, MRI, and sometimes biopsy. Treatment options include medical management using hormones to shrink fibroids, surgical procedures such as myomectomy to remove fibroids or hysterectomy to remove the uterus, and uterine artery embolization. Nursing care focuses on pain management, monitoring for bleeding and infection, encouraging mobility and nutrition, and providing education and emotional support.
Uterine fibroids are benign tumors that originate from the smooth muscle layer of the uterus. While the exact causes are unknown, risk factors include heredity, race, pregnancy, and obesity. Uterine fibroids can cause menstrual abnormalities, infertility, pain, and pressure symptoms. Diagnosis involves ultrasound, biopsy, or hysteroscopy. Treatment options depend on symptoms but may include medications, uterine artery embolization, myomectomy (surgical removal of fibroids), or hysterectomy.
This document discusses diseases of the female genital tract. It begins with an introduction and overview of the major organs. It then discusses various pathological conditions that can affect the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. Conditions discussed in detail include infections, abnormalities in menstruation and bleeding, and benign and malignant tumors that can arise in each organ system. The document provides clinical, pathological, and morphological details on many common and important female reproductive system diseases.
Vulvitis is irritation or inflammation of the vulva, the skin outside the vagina. It causes symptoms like itching, redness, swelling, soreness, and pain during sex. Vulvitis can be caused by infections, irritants like soaps or tight clothing, medications, douching, or poor hygiene. Diagnosis involves examining the vulva and testing for infections. Treatment depends on the underlying cause but may include anti-fungal or antibiotic creams, hydrocortisone cream for allergies, or estrogen cream for post-menopausal women. Preventing vulvitis involves keeping the vulva clean, dry, and cool and avoiding irritants.
Cryptorchidism, or undescended testes, is the most common congenital defect of the male genitalia where one or both testes fail to descend into the scrotum. It can occur unilaterally or bilaterally and if not corrected surgically, it may lead to infertility. The primary causes are idiopathic but risk factors include prematurity, low birth weight, maternal health issues like diabetes or obesity, and family history. Treatment involves initially monitoring for self-resolution, but primary management is surgical repositioning of the testes into the scrotum through orchiopexy to reduce infertility risks and prevent cancer or hernia.
This document discusses disorders of menstruation, including amenorrhea (absence of menstrual period), premenstrual syndrome (PMS), and menorrhagia (heavy menstrual bleeding). Amenorrhea can be primary (periods never start) or secondary (periods stop) and has many potential causes including pregnancy, breastfeeding, menopause, hormonal imbalances, medications, and structural issues. PMS involves physical and emotional symptoms in the one to two weeks before a woman's period, and is thought to be related to cyclic hormone changes. Menorrhagia is heavy or prolonged bleeding and can be caused by hormone imbalances, uterine fibroids, polyps, medications, and other medical conditions. Diagn
The female genital tract is susceptible to several cancers and dysfunctions. Cervical cancer is diagnosed through cytologic screening and treated with surgical removal or vaccines. Dysfunctional uterine bleeding can result from anovulatory or inadequate luteal cycles. Endometrial cancer risk increases with age, obesity, diabetes, and nulliparity. The most common type is endometrioid adenocarcinoma. Ovarian cancer risk is higher with nulliparity, family history, and certain genetic mutations. Choriocarcinoma is an invasive cancer preceded by conditions like hydatidiform mole.
The document summarizes the key components of the female reproductive system, including the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. It describes the normal anatomy and histology of these structures and discusses common inflammatory, benign, and malignant conditions that can affect each part. Examples of conditions mentioned include Bartholin cysts, lichen sclerosis, cervical dysplasia and cancer, endometrial hyperplasia and cancer, ovarian cysts and tumors, and complications of early and late pregnancy.
Common Disorders Of Male Female Reproductive Systems Ppt Sept 2006NorthTec
Common disorders of the male and female reproductive systems include benign prostatic hyperplasia (BHP) and prostate cancer in men, and pelvic inflammatory disease (PID), endometriosis, uterine prolapse, cystocele, rectocele, and ectopic pregnancy in women. BPH causes urinary obstruction and symptoms like difficulty initiating urination and frequent urination. Prostate cancer is usually asymptomatic early on but can cause urinary symptoms, bone pain, and infertility. PID is an infection of the female pelvic cavity that can lead to ectopic pregnancy and infertility if left untreated. Endometriosis involves endometrial tissue growing outside the uterus and causes pelvic pain and infertility.
The document describes images from a pathology lab showing abnormal tissue from the female genital tract. The images show grayish nodular tissue with enlarged fish eggs and chorionic villi that have undergone hydrophilic degeneration. Additional images show enlarged chorionic villi, syncytiotrophoblast proliferation, hair shafts and a protruding tooth emerging from the wall of a cyst lined with ectodermal stratified squamous epithelium, sweat glands and a hair follicle.
1. Ultrasound, CT, MRI, and other imaging modalities can be used to evaluate cancers of the female genital tract. Transvaginal ultrasound provides high quality images of the pelvic organs.
2. Imaging can detect masses in the uterus, ovaries, or other pelvic structures but often cannot distinguish between benign or malignant tumors. Features suggesting malignancy include solid components, thick septations, or invasion of surrounding tissues.
3. Common gynecologic cancers include those of the cervix, uterus, ovaries, vulva, and vagina. Leiomyomas (fibroids) are benign uterine tumors that can be identified on imaging. Sarcomas are rare malignant uterine tumors.
Benign & precancerous tumors of female genital organsberbets
Urethral caruncles are benign growths that occur most frequently in postmenopausal women. They arise from the distal edge of the urethra and are usually caused by chronic irritation or infection. Treatment options include topical estrogen, cryosurgery, laser therapy or excision if symptomatic. Cervical intraepithelial neoplasia (CIN) describes premalignant changes to the cervix epithelium with varying degrees of cellular atypia. Risk factors include HPV infection and multiple sexual partners. Progression risk is greatest for CIN III and least for CIN I.
The document discusses infections of the female genital tract caused by various etiological agents including bacteria, fungi, viruses, and parasites. It describes key microscopic and cytological features of infections caused by organisms like Chlamydia trachomatis, Gardnerella vaginalis, Candida albicans, human papillomavirus, cytomegalovirus, and Trichomonas vaginalis. Infections of the female genital tract present with symptoms like abnormal vaginal discharge and can be diagnosed by examining cellular changes on microscopy and cultures.
This document discusses menstrual disorders and provides information about normal menstrual cycles as well as common disorders. It describes that a normal menstrual cycle is typically between 20-40 days with bleeding lasting 2-7 days and average blood loss of 40cc. Common symptoms include cramps and feelings of unpleasantness due to hormonal withdrawal. Main disorders discussed are premenstrual syndrome (PMS), abnormal menstruation, and dysfunctional uterine bleeding (DUB). PMS occurs in the 4-5 days before a period due to water and electrolyte imbalance from estrogen. Abnormal menstruation encompasses conditions like menorrhagia and metrorrhagia. DUB results in excessive bleeding that is irregular in duration, amount and frequency
This document discusses the diagnosis and management of menstrual disorders. It begins by reviewing normal menstrual physiology and providing terminology used to describe different types of menstrual disorders. It then discusses the general approach to taking a history and performing an examination for patients presenting with menstrual complaints. Specific sections cover the evaluation and treatment of dysmenorrhea, menorrhagia, amenorrhea, and anovulatory bleeding. Causes and management approaches are provided for different menstrual disorders.
The document discusses several common diseases in the female reproductive system. Fibrocystic breast disease causes painful lumps in the breasts and is linked to hormone fluctuations. Dysmenorrhea results in painful menstruation due to high prostaglandin levels. Vaginismus is an involuntary spasm of the vaginal muscles that causes pain during intercourse. Endometriosis occurs when uterine tissue grows outside the uterus, leading to pelvic pain and infertility. The document provides information on symptoms, causes, and treatment options for each condition.
This document discusses menstrual disorders and their management. It defines conditions like menorrhagia, dysmenorrhea, and amenorrhea. It emphasizes taking a thorough history and physical exam to determine the cause and guide appropriate testing. For abnormal bleeding, it is important to determine if the bleeding is ovulatory or anovulatory. Treatment involves medical options like hormones or IUDs, or surgical procedures if medical management fails. Amenorrhea requires evaluating for problems of the hypothalamic-pituitary-ovarian axis, chronic illnesses, or structural issues.
This document discusses lower genital tract infections, including types of lesions, common symptoms, and the vaginal ecosystem. It describes vaginitis, bacterial vaginosis (BV), trichomoniasis, vulvovaginal candidiasis, and other vulvar infections. For each condition, it discusses signs/symptoms, diagnosis, and treatment recommendations. It also covers cervicitis, chlamydia, gonorrhea, and Bartholin's gland cysts/abscesses. The document provides detailed information on classifying, diagnosing, and managing common lower genital tract infections.
This document discusses menstrual disorders and abnormal uterine bleeding. It begins by outlining the objectives and introducing the topics of menstrual disorders, abnormal uterine bleeding, and when to refer to secondary care. It then describes the normal menstrual cycle and hormone-pituitary-ovarian axis. It defines abnormal uterine bleeding and discusses causes, including anovulatory and ovulatory bleeding. It also covers amenorrhea, dysmenorrhea, presenting several case studies and treatment approaches.
This document provides a summary of diseases of the vagina. It begins with an overview of the biology and structure of the vagina. It then discusses common inflammatory conditions of the vagina including bacterial vaginosis, candidiasis, chlamydia, and atrophic vaginitis. It provides details on the etiology, clinical presentation, diagnosis, and management of each condition. For each disease, it includes pictures and descriptions to help with clinical diagnosis.
The female reproductive system consists of internal and external organs that work together to produce eggs, facilitate fertilization and pregnancy, and nourish infants. The internal organs include the uterus, ovaries, fallopian tubes, and vagina. The ovaries produce eggs and hormones, the fallopian tubes transport eggs to the uterus, and the uterus houses and nourishes an embryo. The external genitalia include the vagina and breasts. The vagina receives sperm and acts as the birth canal, while the breasts produce milk to nourish newborns.
Vulvar cancer accounts for about 5% of cancers of the female genital system in the US. Possible signs include bleeding, itching, lumps or growths on the vulva, skin color changes, or ulcers. Risk factors include HPV infection, smoking, and precancerous skin conditions. Treatment depends on stage but may involve surgery to remove the tumor and nearby lymph nodes, radiation therapy, or chemoradiation. Side effects can include skin irritation in the vulvar area, as well as urinary and bowel issues. Overall survival rates vary from over 80% for local stage to under 20% for distant stage disease.
This document provides information on Pelvic Inflammatory Disease (PID), including its definition, epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, differential diagnosis, staging, and management. PID is an inflammatory condition of the female upper genital tract that is usually caused by sexually transmitted pathogens like Neisseria gonorrhoeae and Chlamydia trachomatis. It is commonly associated with sexually transmitted infections and can lead to long-term complications if not properly treated. Diagnosis is based on clinical criteria established by the CDC and may involve imaging and laboratory tests. Treatment involves antibiotics according to CDC guidelines.
The document discusses the male reproductive system, including its organs and functions. It identifies the testes, epididymis, vas deferens, seminal vesicles, prostate gland, and bulbourethral glands as the internal organs that produce, store, and transport sperm. It describes sperm production through spermatogenesis in the seminiferous tubules and storage in the epididymis, and it traces the pathway of sperm from the testes through the vas deferens and urethra during ejaculation.
Leiomyoma is a benign smooth muscle tumor that is the most common tumor in females of reproductive age. It presents as round, gray-white nodules within the myometrium. Leiomyosarcoma is a rare malignant tumor that arises from the myometrium and can disseminate widely. Abnormal uterine bleeding is a common gynecologic problem that can be caused by organic lesions, anovulatory cycles, or other disorders and has various histological presentations depending on the cause.
1. The document discusses diseases of the female reproductive system including the endometrium, fallopian tubes, and ovaries. It covers conditions such as endometritis, adenomyosis, endometrial hyperplasia and cancer, salpingitis, and ovarian cysts and cancers.
2. Various tumors are described such as endometrial polyps, endometrial cancer, and the different subtypes of ovarian tumors including serous and mucinous cystadenomas and cystadenocarcinomas.
3. The causes, histological features, clinical presentations and diagnoses of these diseases are provided, with examples of microscopic images.
Endometriosis is the presence of endometrial tissue outside the uterus, most commonly found on the ovaries, pelvic peritoneum, and ligaments. It affects 6-10% of women and is a common cause of infertility and pelvic pain. Diagnosis is typically made by laparoscopy where lesions are visualized and biopsied. Treatment aims to reduce pain and fertility issues through hormonal suppression or surgery to remove lesions. Complications can include infertility, pregnancy issues, intestinal obstruction, and in rare cases, malignant transformation of lesions.
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.
This presentation touches briefly on the vaginal discharges, both physiological and pathological, approach to management, and a brief touch on pelvic inflammatory disease.
This document summarizes various pathologies that can affect the female genital tract, including infections, inflammatory conditions, benign and malignant tumors of the ovaries, fallopian tubes, uterus, cervix, vagina and vulva. It describes common sexually transmitted infections and endogenous infections that can involve the lower or entire genital tract. Causes of female infertility are outlined. Benign and malignant tumor types are enumerated for each organ with a focus on histopathological classification. Pre-malignant conditions like cervical intraepithelial neoplasia are also discussed in relation to HPV infection and progression risk.
This document provides an overview of the female reproductive system, including the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. It discusses common diseases and disorders that can affect each part. For the vulva, it outlines conditions like Bartholin cysts, lichen sclerosus, and various tumors. For the vagina, it mentions inflammatory conditions, benign and malignant neoplasms. The cervix section discusses dysplasia, CIN, and infiltrating squamous cell carcinoma. The document also reviews the endometrium, endometrial disorders, and cancers. Other topics covered include fallopian tube diseases, ovarian cysts and tumors, early and late pregnancy complications,
This document discusses congenital malformations of the female genital tract. It begins by outlining the normal development of the Mullerian ducts and Wolffian ducts. It then describes various types of malformations that can occur due to abnormalities in this development, including aplasia, hypoplasia, atresia, nonfusion, hermaphroditism and others. Specific conditions like vaginal atresia, imperforate hymen, and uterine fusion defects are explained. The clinical features, diagnosis and treatment of some of these congenital anomalies are provided.
Menstrual disorders, peri menopausal period kumar vikash -55vikash915
1. Menstrual disorders include amenorrhea, dysfunctional uterine bleeding, and symptoms during peri-menopause.
2. Amenorrhea is the absence of menstrual periods and can be primary or secondary. It has various causes including hormonal imbalances, excessive exercise, eating disorders, and medical conditions.
3. During the peri-menopausal period, women may experience symptoms of the climacteric syndrome like hot flashes, night sweats, and mood changes due to declining estrogen levels.
This document discusses the diagnosis and management of adnexal masses. It provides information on the normal size and variation of ovaries and lifetime risk of ovarian neoplasms. Differential diagnoses of adnexal masses are outlined based on patient age. Diagnostic evaluation includes physical exam, ultrasound, CT or MRI if needed. Common ovarian tumors at different life stages are described. Functional cysts, endometriomas, benign and borderline tumors are discussed. Complications, clinical presentation, imaging and tumor markers are summarized. Guidelines for management of asymptomatic cysts and indications for surgery are provided.
The document provides an overview of endometriosis, including its introduction, epidemiology, risk factors, sites, theories of pathogenesis, clinical features, types, and impact on fertility. It describes endometriosis as the presence of endometrial tissue outside the uterus, most commonly involving the ovaries, pelvic peritoneum, and deep infiltrating sites. Retrograde menstruation and coelomic metaplasia are discussed as theories for how it develops. Clinical features include pelvic pain and infertility.
The document discusses several uterine disorders including endometrial polyps, uterine fibroids, endometriosis, and adenomyosis. It provides details on their characteristics, risk factors, clinical presentation, investigations, and treatment options. The document also discusses malignant disorders of the uterus including endometrial cancer and cervical cancer. It covers their etiology, staging, signs and symptoms, diagnostic workup, and management approaches.
This document provides notes on the female reproductive system prepared by Mark Fredderick R. Abejo. It describes the internal and external female reproductive organs including the vagina, cervix, uterus, fallopian tubes, ovaries, vulva, and clitoris. It also discusses common female reproductive disorders such as ovarian cysts, endometriosis, and uterine fibroids/leiomyomas. The causes, risk factors, clinical manifestations, diagnostic tests, and collaborative management of each condition are described.
This document discusses several conditions related to pregnancy and childbirth:
1. Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes, and can cause severe abdominal pain and rupture.
2. Placental infections can occur through ascending or hematogenous routes of infection and cause inflammation of the chorionic villi that can lead to premature delivery.
3. Preeclampsia is a condition characterized by new onset hypertension and proteinuria during pregnancy, caused by endothelial dysfunction. It can progress to eclampsia and other complications if untreated.
4. Gestational trophoblastic disease includes conditions like hydatidiform moles and choriocarc
Homoeopathic point of view Benign lesion of the Cervix & Malignancy of female...NomanAhmad69
This document discusses various lesions of the cervix including cervical erosion, cervical polyps, cervical intraepithelial neoplasia (CIN), and cancer of the cervix. It provides details on the causes, symptoms, diagnosis, and treatment of each condition. Screening is important for early detection of premalignant lesions and cancers of the reproductive organs. Cervical cancer remains a major public health problem worldwide and its prevention through screening and HPV vaccination is crucial.
This document summarizes key medical issues related to women's reproductive health. It discusses common breast, uterine, cervical, ovarian, and vaginal conditions as well as cancers that can affect these areas. It also covers pelvic inflammatory disease, endometriosis, hysterectomy, oophorectomy and other procedures. The document emphasizes the importance of screening and early detection for many of these conditions. It stresses gathering information from multiple sources to make informed health care decisions.
This document defines abnormal uterine bleeding and outlines its various clinical types including menorrhagia, hypomenorrhoea, metrorrhagia, polymenorrhoea, menometrorrhagia, oligomenorrhoea, contact bleeding, and amenorrhoea. It also discusses the evaluation and management of abnormal uterine bleeding which involves obtaining a clinical history, performing a physical exam, ordering investigations, and considering general treatment principles. Causes and characteristics are provided for each type of abnormal bleeding.
This document defines abnormal uterine bleeding and outlines its various clinical types including menorrhagia, hypomenorrhoea, metrorrhagia, polymenorrhoea, menometrorrhagia, oligomenorrhoea, contact bleeding, and amenorrhoea. It also discusses the evaluation and management of abnormal uterine bleeding which involves obtaining a clinical history, performing a physical exam, ordering investigations, and considering general treatment principles. Causes and characteristics are provided for each type of abnormal bleeding.
This document discusses endometrial carcinoma (cancer of the uterus). It provides information on:
- Risk factors including prolonged estrogen exposure, nulliparity, obesity, and tamoxifen use.
- Types include endometrioid adenocarcinoma (most common), adenocarcinoma with squamous differentiation, clear cell carcinoma, and uterine papillary serous carcinoma.
- Staging from Stage I (limited to uterus) to Stage IV (distant metastases). Prognosis is generally good due to late invasion and spread but worsens with higher stage, grade, and certain histological types.
- Investigations include ultrasound, endometrial biopsy/sampling, and MRI or
Obstetric hemorrhages of the 1st half of pregnancy.pptTARUNKUMAR472866
1. The main causes of hemorrhages in the first half of pregnancy are spontaneous abortion, ectopic pregnancy, and hydatidiform mole.
2. Spontaneous abortions can be threatened, initial, inevitable, complete, incomplete, or missed depending on clinical signs and symptoms.
3. Ectopic pregnancies occur when implantation happens outside of the uterus, most commonly in the fallopian tubes, and can cause life-threatening hemorrhage if ruptured.
4. Hydatidiform mole results in an abnormal conceptus without an embryo or fetus and causes symptoms of vaginal bleeding and elevated hCG levels.
Similar to DISEASES OF THE FEMALE REPRODUCTIVE SYSTEM (20)
The document provides information on the human respiratory system and diseases that can affect it. It describes the components and functions of the upper and lower respiratory tract. It then discusses various diseases that can impact the upper respiratory tract, including the nose, sinuses, pharynx and larynx. Examples mentioned are sinusitis, rhinitis, tonsillitis, nasal polyps, papillomas and various cancers. It also provides microscopic images of some conditions.
This document defines neoplasia and provides details on the classification and nomenclature of tumors. It begins by defining a neoplasm as an abnormal mass of tissue that grows in an uncoordinated manner. Benign tumors are non-invasive and localized, while malignant tumors are invasive and spreading. Tumors are classified based on the tissue of origin, such as carcinomas arising from epithelial tissue and sarcomas from connective tissue. The document further describes features of benign versus malignant tumors and provides examples of tumor classifications and histological slides.
The document discusses hematological malignancies and acute leukemias. It defines hematological malignancies as clonal expansion of hematopoietic cells that have undergone genetic mutations. It describes the main types and subtypes of acute leukemias, including ALL and AML, and how they are classified and diagnosed based on blood counts, bone marrow aspiration, immunophenotyping and cytogenetics. Environmental and genetic factors that influence the development of hematological malignancies are also summarized.
Iron deficiency anemia (IDA) results from a multi-step process where iron stores become depleted due to blood loss or insufficient dietary iron intake. As iron levels decrease, changes occur in red blood cell production leading to microcytic hypochromic anemia. The body attempts to compensate for iron loss by increasing iron absorption, but this is insufficient to prevent a net iron loss over time. Without treatment, prolonged iron deficiency will eventually cause the hematologic and clinical manifestations of anemia.
Antibiotics are chemicals produced by microorganisms that inhibit the growth of other microorganisms. There are two main types of antibiotics - broad spectrum antibiotics which affect a wide range of bacteria, and narrow spectrum antibiotics which affect selective groups. Antibiotics work by disrupting cell wall synthesis, cell membrane function, protein synthesis, nucleic acid synthesis or metabolic pathways. Tests determine antibiotic sensitivity using diffusion or pour plate methods to see the effect on bacterial growth and identify resistant, sensitive or intermediate responses.
The document discusses different types of immune disorders:
1. Hypersensitivity reactions (allergies) are caused by an exaggerated immune response upon re-exposure to an antigen and are classified into four types.
2. Autoimmune diseases occur when the immune system attacks the body's own tissues.
3. Immunodeficiency diseases result from inadequate immune response.
4. Amyloidosis involves abnormal protein buildup in tissues.
Immunodeficiency disorders are associated with defects or impairments in immune function that can be congenital or acquired. Primary immunodeficiency diseases involve genetic defects affecting B cell, T cell, or phagocytic cell development. Common symptoms include recurrent infections, failure to thrive, and increased susceptibility to opportunistic infections. HIV/AIDS is an acquired immunodeficiency disorder that progressively weakens the immune system by attacking CD4 cells, leaving the body vulnerable to opportunistic infections.
Hemodynamic disorders med- 2011, final iiدكتور مريض
1. Thrombosis is the formation of a blood clot (thrombus) within the circulatory system of a living organism. It is caused by endothelial injury, changes in blood flow, and hypercoagulability according to Virchow's triad.
2. Thrombi form in arteries and veins, and can cause obstruction, ischemia, infarction, or embolization if parts break off. Common sites are the legs, lungs, heart, and brain.
3. Embolism occurs when a thrombus or other mass travels through the bloodstream and blocks a vessel in another part of the body, potentially causing infarction or sepsis. Pulmonary embolism from deep leg vein
Pathology is the study of diseases through identifying changes in tissues and cells. It examines the patterns, causes, mechanisms, and effects of diseases. Pathology bridges clinical practice and basic science. Cell injury can result from physical, chemical, infectious, or environmental factors and causes damage through mechanisms like ATP depletion, oxygen deprivation, calcium dysregulation, and mitochondrial dysfunction. Cells respond to injury through reversible or irreversible changes, repair, or death by necrosis or apoptosis.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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2. Objectives
Introduction of FGT
Clinical manifestations of FGT pathology
Pathology of Valva
Pathology of Vagina
Pathology of Cervix
Pathology of Myometrium
Pathology of Endometrium
Pathology of Fallopian tube
Pathology of Ovary
Pathology Gestational and placental disorders
3. Female Reproductive System
-The female reproductive system consists of
-The ovaries
-Secondary sex organs - which are involved in coitus,
fertilization & development, birth & nursing of the
baby.
-
4.
5. Major Organs of FGT
Vulva
Vagina
Cervix
Uterus
Uterine tubes [ fallopian tubes]
Ovaries ( The gonads )
6.
7. DISEASES OF F.G.T. INCLUDE:
-Diseases of the vulva
-Diseases of the vagina
-Diseases of the cervix
-Diseases of the Body of Uterus And Endometrium
-Diseases of the Fallopian tubes
-Diseases of the Ovaries
-Gestational and Placental disorders
8. Pathological basis of signs & symptoms in the FGT
Sign or symptom Pathological basis
-Vaginal discharge Inflammation
-Vaginal bleeding
In pregnancy Hemorrhage from placenta
(placenta
(praevia), placental bed
(miscarriage) or decidua
(ectopic pregnancy)
Post-coital Hemorrhage from cervical
lesion (carcinoma, erosion)
Post-menopausal Hemorrhage from uterine
9. -Abnormal menstruation Psychological disturbance
(timing or volume of loss) Hormonal dysfunction
Defect in local haemostasis
Uterine lesions (Fibroid,polyp, IUD)
-Pain Pathologic distension/rupture
(tubal ectopic pregnancy),Muscular
spasm (uterine),Ischemia or
infarction (ovarian torsion),
menstrual pain due to
adenomyosis, functional etc
-Abdominal distension Ascites (Ovarian tumors involving
peritoneum), uterine enlargement
(pregnancy), ovarian cyst.
10. ABNORMAL UTERINE BLEEDING:
The most common gynecologic problem in women during active
reproductive life
- Polymenorrhea: cycles shorter than 3 weeks
- Oligomenorrhea: cycles longer than 6-7 weeks
- Metrorrhagia: intermenstrual bleeding (MC organic )
- Hypermenorrhea: excessive flow (MC organic )
- Menorrhea: prolonged duration of flow
- Menorrhagia: increase amount & duration of flow
- Menometrorrhagia: prolonged flow with irregular
intermittent spotting ( organic)
11. Causes of abnormal uterine bleeding according to age group
Age group Causes
Pre-puberty Precocious puberty ( hypothalamic, pituitary, or ovarian origin)
Adolescence Anovulatory cycles , coagulation disorders
Reproductive age - Complications of pregnancy ( abortion, ectopic pregnancy,
trophoblastic diseases)
- Organic lesions ( leiomyomas, adenomyosis, polyps,
endometrial hyperplasia , carcinomas)
- Anovulatory cycles
-Ovarian dysfunctional bleeding (i.e. inadequate luteal phase)
Perimenopausal -Anovulatory cycles
- Irregular shedding
Postmenopausal -Organiclesions ( carcinoma, hyperplasia, polyps)
- Endometrial atrophy
12. DYSFUNCTIONAL UTERINE BLEEDING (FUNCTIONAL
ENDOMETRIAL DISORDERS):
Definition: It is abnormal bleeding in absence of organic uterine lesions.
MCC is anovulatory cycles (hyperestrogenic states). It is due to:
- Endocrine disorders - : pituitary, adrenal, and thyroid diseases.
- Ovarian disorders - : polycystic ovaries, hormone secreting tumors.
- Metabolic causes - : obesity, malnutrition,..
- Unexplained causes - : (?? Cryptogenic).
Morphology:
- Premenstrual endometrial biopsy shows a persistent proliferation
pattern with variable degree of hyperplasia, cystic glandular change -
Sporadic endometrial breakdown & bleeding ( estrogen effect unopposed
by progesterone).
14. Inflammatory lesion of Valva
Non neoplastic disorders
Tumours of Valva
15. Inflammatory lesions of the Vulva:
All skin disorders can be seen
Herpes virus infection:
STD, HSV type 2,
Painful ulceration in the skin. Intraepithelial
blisters & viral inclusion & eosinophilic swelling
of epithelial cells
Syphilis:
Primary syphilis - : Chancer - indurated lesion with
central ulceration & LN – heals even without Tt.
Secondary syphilis: Condyloma latum (inflammed
hyperplasia of epithelium with underlying chronic
inflammation rich in plasma cells & end arteritis
obliterans), Silver stain demonstrates the
spirochetes.
18. Granuloma inguinale (Donovanosis):
STD affecting the genitalia, inguinal & perianal region ,
gram negative bacilli (Calymmatobacterium donovani) -
Chronic valvular papule/nodule/ ulceration, tropical areas,
can spread to other parts of FGT, ulcer margins show
epithelial hyperplasia & Ulcer bed filled with neutrophil
abscesses. Sliver stain demonstrates bacilli within
macrophages (Donovan bodies)
19. Lymphgranuloma venereum:
STD, Chlamydia trachomatis, tropical areas, vesicles that
rupture and form punched out painless ulcer, secondary
infection, abundant granulation tissue, fibrosis, fistula,
lymphatic obstruction (chronic form of the disease),
necrotizing granuloma may occur
20. Candidiasis :
Chronic irritation & inflammation, white thick
discharge, DM, may be associated with vaginitis
Diagnosis: ME of skin scrapping or culture,
nonspecific histological picture, fungi can be
demonstrated within the keratin layer or
superficial epithelium by sliver stain
Bartholin’sAbscessCyst:
inflammatory occlusion of the main duct of Bartholin’s
vulvo-vaginal gland, most common cause is gonorrhea
Vulvodynia (vestibular adenitis) : inflammation of the
minor vestibular glands (unkown cause) causing very
painful ulceration. Treatment is often surgical.
21. Infection involving the lower and the
upper genital tract
(Pelvic inflammatory disease =PID)
Definition: an ascending infection that
begins in he vulva & spreads upward to
involve the entire genital tract.
22. Causes:
1- Sexually transmitted disease (STD):
gonococcal (MC) or chlamydial infection:
acute suppurative inflammation confined
to mucosa and submucosa (spread via
mucosa).
2- Postabortal or postpartal; caused by
staphylococci, streptococci, E. coli &
clostridium perfringens. Spread is through
uterine wall leading to affection of serosa
and peritoneum.
23. Morphology: acute suppurative inflammation
of the Bartholin’s glands, periuretheral glands,
endocervical glands & fallopian tubes.
Pathological lesions & complications: Acute
salpingitis, salpingo-oophoritis, tubo-ovarian
abscess, pyosalpinyx (distention of the
fallopian tube with pus). It may cause
peritonitis, septicemia, fibrous adhesion
(intestinal obstruction), tubal occlusion &
infertility or ectopic pregnancy.
24. *Non-neoplastic epithelial disorders
(Vulvar Dystrophy- old name):
Benign (non-dysplastic) mucosal alterations of the vulva; of
unknown etiology predominantly in peri & postmenopausal
periods
Types: Two types that may coexist:
G)Lichen Sclerosus et Atrophicus
H)Lichen Simplex Chronicus
25. • Lichen Sclerosus et Atrophicus: gray, parchment-like areas, of
thin atrophic epithelium + sube-pithelial fibrosis+ mononuclear
peri-vascular reaction & occasionally marked hyperkeratosis.
B) Lichen Simplex Chronicus (Squamous Hyperplasia =
Hyperplastic Dystrophy):
- It is the physiologic outcome to rubbing the vulva mucosa in
response to pruritis .
- PP causes: irritant exposure, dermatitis, pre-invasive or invasive
neoplasm (biopsy is indicated)
- Morphology: white plaques (leukoplakia) of thick hyperplastic
& hyperkeratotic epithelium (without dysplasia) and
leukocytic dermal inflammation.
.
26. N.B.: Neither
lichen sclerosus
nor simplex
chronicus is
classified as
premalignant per
se, but
cytogenetic
abnormalities,
including P53
mutations, may
precede the onset
of atypia in these
lesions. Thus,
they are
considered “ Risk
Factors” for
vulvar neoplasia
28. Condyloma Accuminatum: multiple, benign, wart-like verrucous
STD, caused by HPV types 6&11. (vulva, perineum, vagina, rarely
cervix). It is squamous cell papilloma with marked
acanthosis,hyperkeratosis & parakeratosis, some showing cells with
cytoplasmic clearing and nuclear atypia (i.e. koilocytic atypia =
koilocytosis indicating viral infection).
29.
30. Papillary Hidradenoma: benign, well
circumscribed nodule of modified apocrine
sweat gland. It is composed of tubular
structures lined by both epithelial(columner) &
myoepithelial cells.
31. Vulvar Intraepithelial Neoplasia (VIN=
Vulvar Dysplasia):
- A premalignant intramucosal squamous neoplasm
that frequently precedes invasive carcinoma occurs 4th
– 5th decades.
- Mucosal lesions with cellular anaplasia and marked
nuclear atypia, caused by HPV type 16. Synonyms:
VIN III= carcinoma in situ (CIS)= Bowen’s disease.
Tends to progress to invasive carcinoma ( in old &
immunosuppressed patients).
-
32.
33. Differentiate (simplex) VINs are usually
HPV-negative, associated with Lichen
sclerosus or Lichen simplex chronicus. These
precancers usually arise after menopause and
leading to well differentiated keratinized
squamous cell carcinoma in the 6th – 8th
decade.
34. N.B.
HPV
- E6 protein of HPV type 16 & 18 can bind to P53 gene
leading to P53 inactivation
- E7 protein of HPV 16 & 18 binds to Rb gene products
Leading to promotion of neoplastic growth through:
1- deregulation of cell cycle
2- Production of genomic instability
3- Increase telomerase expression
-Types 6 & 11 of HPV with no or low risk of malignancy
do not form a complex with P53 & typically give rise to
benign condylomas
35. Invasive vulvar Squamous cell carcinoma: may
arise de novo or on top of VIN. Spreads to inguinal LNs & is
of poor prognosis. The prognosis depends on size, depth of
invasion, and lymph nodes status
Verrucous Carcinoma: A rare locally aggressive neoplasm.
Usually does not metastasize.
,
36. Extramammary Paget’s Disease:
- An eczyma-like, red crusted sharply demarcated map-like
areas ( on labia majora), characterized by large anaplastic
tumor cells, lying singly or in small groups within the
epidermis. The cytoplasm of the tumor cells is clear, and
mucin positive.
- Unlike Paget’s disease of the breast, the presence of
underlying adenocarcinoma of the vulva is uncommon.
Other rare tumors: Basal cell carcinoma, Malignant
melanoma
39. 1-Vaginitis & vulvovaginitis
Since both vulva and vagina are anatomically close to each
other, often inflammation of one affects the other.
Common infections –
Bacterial - streptococci,staphalococci, E.coli,
H. vaginalis
Protozoal - Trichomonas vaginalis
Viral - Herpes simplex
Fungal – Candida albicans
The most common causes of vaginitis are Candida
albicans ( monaliasis) and Trichomonas
( Trichomonaliasis )
41. Carcinoma: primary carcinoma of the vagina is rare, but 1-2%
women with cervical squamous cell carcinoma develop a
concomitant squamous cell carcinoma in the vagina. Age: 60-70
yrs. Morphology; plaque-like, fungating /ulcerative lesion that
infiltrates cervix, urethera, bladder or rectum.
Clear cell adenocarcinoma: is rare (MC in young women, whose
mothers had received Diethylstilbestrol (DES) during pregnacy for treatment of
threatened abortion). The tumor cells are vacuolated and contained glycogen.
42. Embryonal
rhabdomyosarcoma:
uncommon, a highly
malignant tumor of
infants and children;
polypoid bulky mass
(Botryoid= grape-like)
protruding from vagina.
That is why also known
as Sarcoma Botroides
43. Histopathology
It is composed of rounded malignant (embryonal)
rhabdomyoblasts, some tumor cells have a “tennis-
racket” shape with striated cytoplastmic extension.
Tumor cells are +ve for desmin & myosin
immunostain. These cells are characterstically lying
underneath the vaginal epithelium, called CAMBIUM
LAYER
The central core of polypoid masses composed of
loose and myxoid stroma with many inflammatory
cella
46. DISEASES OF THE CERVIX
Inflammation of Cervix: Cervicitis
Cervical Tumors
47. Inflammation of Cervix: Cervicitis
- May be acute or chronic; specific or non-specific
- Non-specific: Strept., Staph., enterococci, E. coli
- Specific (STD): gonococci, Chlamydia, Mycoplasma,
Trichomonas, Candida….
- Acute cervicitis: - rare (postpartal and nonspecific)
- Neutrophilic infiltration beneath the lining mucosa
48. Chronic cervicitis:
- More common Bacterial growth & alteration in
pH - May be specific, non-specific or of unknown cause
-- ----- - Common cause of leukorrhoea
Predisposing factors – sexual intercourse, trauma of child
birth, instrumentation and excess or deficiency of
estrogen.
49. Morphology:
Gross- eversion of ectocervix with hyperemea, edema and
granular surface.Nabothian(retention cysts) may be
grossly visible as pearly grey vesicles.
Histopathology - squamous metaplasia, chronic
inflammatory cells, columnar cell proliferation (micro-
glandular change), reactive epithelial atypia (mistaken for
CIN), and Nabothian cysts (due to occlusion of cervical
gland ducts ) & squamous metaplasia
54. Cervical Tumors
•Endocervical polyp: benign tumors composed of C.T. stroma
showing dilated endocervical glands and lined by endocervical
epithelium
•Squamous intraepithelial lesions (SIL)
CERVICAL INTRAEPITHELIAL NEOPLASIA(CIN)
-It is caused by a sexually transmitted disease; 2nd – 3rd decades ,
caused by cancer-related (high risk) HPV type
16,18,31,33,35,39,51,52,53,56,58,59.
- It usually precedes invasive squamous cell carcinoma (4th – 5th decades)
55. - Risk factors: early age of first intercourse,
multiple sex partners & high-risk male sex
partners; that suggests a sexually
transmitted oncogenic agent from male to
female at an early age. HPV acts as a
promotor, and herpes virus type II ,
tobacco, constitution , environment &
others may be cofactors.
56. Morpholgy:
CIN I = dysplasia in the deeper 1/3rd of the
epithelium & preserved maturation in the
upper 2/3rd.
CIN II = dysplasia in the deeper 2/3rd &
less maturation.
CIN III = dysplasia in all layers & no
maturation i.e carcinoma in situ (CIS)
58. Bethesda system : a new classification for CIN (National Cancer
Institute) for reporting cervical & vaginal cytology.
Besthesda HPV Morphology CIN Dysplasia
system type
-Low grade SIL 6,11 Koilocytic atypia, flat CIN I Mild
(L-SIL) – condyloma
-High grade SIL Progressive cellular
16,18 CIN II Moderate,
(H-SIL) atypia , loss of & CIN severe,
maturation III carcinoma in
situ
N.B.:
The oncoproteins (E6 &E7) of high-risk HPVs deregulate the cell cycle, produce
genomic instability, and increase telomerase expression. All these molecular events
promote neoplastic cell growth.
The low risk HPVs (HPV 6,11) do not possess these properties and typically give rise to
benign condyloma.
L-SIL –Low grade – Sq. Intraepithelial Lesion
59.
60. INVASIVE CERVICAL CARCINOMA:
-Up to 70% of CIN III (CIS) progress to invasive carcinoma.
-Gross: fungating, ulcerative or infiltrative lesions
-Histology: most cases are squamous cell carcinoma of varying degree
of differentiation (65% = large cell non-keratinizing, 25% large cell
keratinizing, 10% small cell poorly differentiated sq.c.c.)
-Other non-squamous carcinomas (adenocarcinoma, adenosquamous,
neuroendocrine=small cell undifferentiated) are less common and
strongly associated with HPV type 18.
64. Clinical staging:
- Stage 0: CIS Stage I: confined to the cervix
- Stage II: extending beyond the cervix but not into
- the pelvic wall; into vagina but not to
- lower 1/3 of vagina
- Stage III: reaching the pelvic wall or lower 1/3 of
- vagina
- Stage IV: spreading out side the pelvis
Prognosis: depends on stage ( 100% cure for stage 0 &
10% of stage IV).
65.
66.
67. DISEASES OF THE ENDOMETRIUM
ENDOMETRITIS:
ADENOMYOSIS & ENDOMETRIOSIS:
ENDOMETRIAL HYPERPLASIA
TUMORS OF THE ENDOMETRIUM
68. ENDOMETRITIS:
Acute endometritis:
Histological : Neutrophilic infiltration of the endometrium,
caused by Staph., Strept., …; following abortion, delivery or
instrumentation.
Chronic endometritis:
Clinically : Abnormal endometrial bleeding
Histological : Mononuclear (plasma cell & macrophages
infiltration of the endometrium.
Etiology : in chronic PID, tuberculous, in user of IUDs,
actinomycosis and due to retained gestational tissue.
69. ADENOMYOSIS & ENDOMETRIOSIS:
Adenomyosis : Defined as presence of nests of benign
endometrial glands & stroma within the myometrium, deep in the
wall of the uterus. It leads to uterine enlargement & irregular
thickening of the uterine wall.
-Possible cause – metaplasia or oestrogenic stimulation due to
endocrine dysfunction of ovary
-Clinically- menorrhagia, colicky dismenorrheoa and menstrual
pain in the sacral or sacrococcycygeal regions.
- Critaria for diagnosis – The minimum distance between the
endometrial islands within the myometrium and the basal
endometrium should be one low power microscopic field (2-3
mm ).
75. Endometriosis:
- Presence of nests of endometrial glands & or stroma
outside the uterus in ovaries, fallopian tubes, pelvic
peritoneum, uterine ligaments, and rarely in vulva,
vagina, laparotomy scar, umbilicus, and appendix.
- Ectopic endometrium may undergo cyclic menstrual
changes and periodic bleeding.
- Clinically: dysmenorrhea, dyspareunia , pelvic pain &
infertility.
- Diagnosis depends on the presence of 2 out of 3
following features :
1- Endometrial glands ,
2-Stroma, and
3- RBCs or hemosiderin pigment.
81. ENDOMETRIAL INTRAEPITHELIAL NEOPLASIA = EIN
( ENDOMETRIAL HYPERPLASIA )
Definition: It is abnormal proliferation of endometrial
glands.
The most common cause of dysfunctional uterine
bleeding (DUB) & is associated with
hyperestrogenemia.
82. Types:
1- Simple hyperplasia= cystic hyperplasia, mild hyperplasia:
Cystic dilated glands, non-neoplastic, due to
anovulatory cycles.
2- Complex hyperplasia= adenomatous hyperplasia:
Overcrowded, closely opposed glands. Some of these are
neoplastic (contain PTEN (Phosphatase and tensin
homolog ) mutations & considered as EIN). PTEN- tumor
suppressor gene
3-Atypical hyperplasia = complex / adenomatous hyperplasia
with atypia:
Overcrowded glands with cytological atypia. Most cases of
this category are neoplastic (EIN) and many contain
PTEN mutations
83. N.B.: Endometrial hyperplasia:
- It is an important cause of
abnormal uterine bleeding.
- A subset (EIN) is considered a
risk factor for endometrial
carcinoma.
-The risk of carcinoma increases
as function of the degree of
atypia.
- Both endometrial hyperplasia
and adenocarcinoma are
associated with
hyperestrogenism, microsatellite
instability, and mutation of PTEN
gene.
86. TUMORS OF THE ENDOMETRIUM
Endometrial polyp:
- Sessile tumors composed of endometrial glands and stroma.
- May be associated with hyperestrogenism or Tamoxifen therapy.
- Usually benign, but may show foci of hyperplasia or cancer.
87. Endometrial carcinoma:
- 7% of all invasive carcinomas in women
- Most common invasive cancer of the female genital
tract.
Epidemiologic & pathophysiologic types:
1- Endometrial adenocarcinoma: Common,55-65 yrs.
Old.
- Risk factors: Obesity, nulliparity, early menarche & late
menopause, granulosa cell tumor of the ovary, breast
cancer, diabetes, hypertension,infertility&unopposed
estrogen..
-
88. Gross: Fungating polypoid or infiltrating mass
(diffuse involving the entire endometrial surface).
- Histopathology: Adenocarcinoma usually well
differentiated with often associated with metaplastic
changes ( squamous, secretory or mucinous
differentiation). Other histological forms:
adenosquamous or clear cell adenocarcinoma.
- Containing mutations in PTEN gene, microsatellite
instability, often pre-exciting EIN.
89. 2) Papillary serous adenocarcinoma: -
Associated with older age , - Often arising in endometrial
polyps or endometrial surface epithelium, and - Associated
with multiple P53 mutations.
-Spread: invades the myometrium, and spread by
lymphatics & blood (MC to the lung). Serous tumors can
spread quickly, even when non-invasive
90. - Prognosis: depends on extend of spread (stage).
Excellent prognosis when the carcinoma is confined
to corpus uteri itself. However papillary serous tumor
spreads quickly even when non-invasive.
Biologically: more aggressive neoplasms are poorly
differentiated carcinomas including clear cell &
papillary serous carcinoma.
Clinically Abnormal uterine bleeding
91.
92.
93.
94.
95. ENDOMETRIAL STROMAL SRCOMA ( MALIGNANT MIXED
MESODERMAL = MULLERIAN TUMOR ): TUMORS WITH
STROMAL DIFFERENTIATION
-Rare tumors. Highly malignant. Derived from primitive stromal cells
(mullerian mesoderm origin). Consists of glandular (carcinomatous) &
stromal (sarcomatous) elements. The stromal elements may show
muscle, cartilage or osteoid differentiation.
--Gross: bulky polypoid tumor protruding into endometrial cavity and
vagina.
96. - Other variants of endometrial stromal
tumors:
1)Benign stromal nodules: discrete nodules of
stromal neoplasm within the myometrium.
2)Endometrial stromal sarcoma (Endolymphatic
stromal myosis): well & poorly differentiated
stromal neoplasm, may penetrate into lymphatic
channels.
3)High-grade sarcoma not otherwise specified:
high grade unclassified tumor capable of
widespread metastases. Occurs in postmenopausal
females; presents with uterine bleeding. Overall 5-
years survival is 25%.
97. TUMORS OF THE MYOMETRIUM
Benign tumors
♦ Leiomyoma
Malignant tumors
♦ Leiomyosarcoma
98. Leiomyoma:
-Benign smooth muscle tumor, MC overall tumor of females in
the active reproductive age, related to increased estrogen
stimulation, and associated with a number of specific cytogenetic
abnormalities.
- Sharply circumscribed, round
gray-white firm nodules, located -
1-within the myometrium (intramural),
2-beneath the serosa (subserous)
3-beneath the endometrium (submucous).
99. It may undergo cystic degeneration and
calcification.
- May be asymptomatic or associated with
abnormal uterine bleeding, pain, urinary
disorders.
- Malignant transformation is exceptionally rare (?
almost none).
100.
101.
102. LEIOMYOSARCOMA -:
- Uncommon, most arise de novo and not from leiomyomas.
- Bulky, fleshy, infiltrative mass in the uterine wall
-Disseminate in the peritoneal cavity & widely by blood stream.
- Overall 5-years survival is 40%
103. Histologically distinguished
from leiomyomas by:
1- More than 10 mitotic
figures/ 10 H.P.F. ( with or
without cellular atypia), or
2- Between 5-10 mitotic
figures with cellular atypia.
N.B.: Smooth muscle tumor of
uncertain malignant
potential: A subset of
smooth muscle tumors
displays some but not all of
the features of malignancy
104.
105.
106.
107.
108. DISEASES OF THE FALLOPIAN TUBES
1-INFLAMMATORY - SALPINGITIS:
2- TUMORS OF FALLOPIAN TUBE-
109. 1-INFLAMMATORY - SALPINGITIS:
Suppurative salpingitis:
-Infection by pyogenic organisms: streptococci, staphylococci,
& gonococci (PID)
-May cause tubo-ovarian abscesses, pyosalpinx, peritonitis &
“violin string” adhesion that may cause intestinal obstruction.
Tuberculous salpingitis:
-Hematogenous dissimination from other foci . May be
associated with T.B. of endometrium & peritoneum.
Histologically: caseating granulomas with giant cells.
-May cause infertility, or ectopic pregnancy
113. 2- TUMORS OF FALLOPIAN TUBE-
- Rare. Most common is adenocarcinoma (like
serous adenocarcinoma of the ovary).
- Recently, adenocarcinoma of the fallopian tubes
has been associated with BRCAI & BRCA 2
mutations?.
- Many arise in the fimbriated portion of the
tube.
117. Embryological development
Precursor Ovarian component Other female genital tract
structures
1.Coelomic epithelium Surface epithelium 1.Fallopian tubes( ciliated
2. Ectopic endometrial columnar serous cells)
epithelium—Mullerian 2.Endometrial lining(non
Epithelium ciliated columnar cells)
3. Endocervical glands
(mucinous non ciliated)
1.Yolk Sac Germ cells(toti potent)
1. Sex cords Stroma of the ovary Endocrine apparatus of post
natal ovary.
118. Importance of embryological
development
1.Primary Ovarian tumours are classified on the
basis of their site of origin.
2.Still some tumours do not fall in any of the
categories and are put into Malignant (Not
Otherwise Specified)
3.A third category of neoplasms of the ovary are
Metastatic tumours from non ovarian primaries.
119. OVARIAN DISEASES
Manifestations of ovarian diseases:
- Pelvic pain
- Menstrual irregularities ( abnormal pattern of ovarian
hormone secretion).
- Infertility; failure of ovulation (Stein-Leventhal).
- Ovarian mass : either non-neoplastic (cysts) or neoplastic
(cystic or solid).
120. INFLAMMATORY - OOPHORITIS:
- Inflammation of the ovaries is always secondary to
salpingitis or peritonitis.
- If chronic & bilateral leading to extensive fibrosis &
infertility.
121. NON-NEOPLASTIC OVARIAN CYSTS
1- Follicular and Luteal cysts: Common, 1-8
cm in diameter. They are lined by follicular
(granulosa) cells or luteinized cells.
Asymptomatic, but may rupture, causing
peritoneal reaction & pain.
2 - Chocolate cysts: Blood-filled cysts, due
to endometriosis of the ovaries.
122. 3 – Polycystic ovarian ( Stein - Leventhal
syndrome (PCOD) -:
It is important cause of infertility. There is excessive production
of androgens, increase conversion of androgens to estrogen,
insulin resistance, and inappropriate gonadotrophin production by
the pituitary.
Morphology: Ovaries are large, white, many subcortical follicular
cysts(0.5-1 cm.) in diameter, and covered by thickened fibrosed
outer tunica. No corpora lutea (= no ovulation).
Manifestations: Young females with Oligomenorrhea, infertility,
obesity & hirsuitism.
130. OVARIAN TUMORS
- Common forms of neoplasia in women.
- 80-90% of ovarian tumors are benign.
- Most ovarian tumors occur between 20-45 years.
- Ovarian cancer is second MC malignancy of the female genital tract
(after endometrial cancer).
- Most ovarian tumors are derived from surface epithelium, and
“CA-125” is the tumor marker for surface epithelial tumors of the
ovary.
- Malignant ovarian tumors present at a late stage, thus are associated
with high mortality rate.
- Known risk factors are nulliparity, family history, and specific
inherited mutations (BRCAI & BRCAII) genes.
131. Tumour types-- a basic classification
Site of origin Types Frequency Age group
Surface epithelial 1.Serous 60%-70% 20 years and greater
tumours 2.Mucinous
3.Endometroid
4.Clear cell
5.Brenner
Germ cell 1.Teratoma 15%-20% 0 to 25 years and
2.Dysgerminoma greater
3.Endodermal Sinus(Yolk Sac
Tumour)
4.Choriocarcinoma
Sex cord stromal 1.Granulosa Theca cell tumours 5%-10% All ages
tumours 2.Sertoli-Leydig cell tumours
3.Gynandroblastoma
Miscellaneous 1.Lipid cell tumour Variable variable
2.Gonadoblastoma
Metastasis Krukenberg tumours 5% variable
132. CLASSIFICATION OF OVARIAN TUMORS
(A) PRIMARY OVARIAN TUMORS:
(B) METASTATIC NON-OVARIAN CANCER (Krukenberg’s tumor)
A: PRIMARY OVARIAN TUMORS:
I. Surface mullerian epithelial tumors: (Benign, Borderline, and
Malignant)
II. GERM CELL TUMORS:
III. SEX CORD-STROMAL TUMORS:
133. I. Surface mullerian epithelial tumors: (Benign,
Borderline, and Malignant)
1-Serous tumors: composed of ciliated columnar
(tubal type) epithelium
2- Mucinous tumors: composed of mucus-secreting
(cervical canal type) epithelium
3- Endometrioid tumors: composed of glandular
(endometrium-like) epithelium.
4- Brenner’s tumors: composed of transitional
(urothelium-like) epithelium
5- Clear cell tumors.
134. II. GERM CELL TUMORS:
1- Teratoma
2- Dysgerminoma (seminoma ovarii)
3- Yolk sac tumor= Endodermal sinus tumor
4- Embryonal carcinoma (MC mixed with other
types)
5- Choriocarcinoma (MC mixed with other types)
135. III. SEX CORD-STROMAL TUMORS:
1- Granulosa-Theca cell tumor: secrete
estrogen
2- Sertoli-Leydig cell tumor: secrete androgens
3- Fibroma: associated with Meig’s syndrome
4- Sex cord stromal tumor with annual tubules
5- Gynandroblastoma
6- Steroid (Lipid)cell tumors
136.
137. SEROUS TUMORS
-The MC cystic neoplasms of the ovary.
- Cysts are lined by tall columnar, ciliated epithelial cells (fallopian tube
type) & filled with serous fluid. Types:
1-Benign Serous Tumors (Cystadenomas):
(60%), smooth lining & no papillary or solid areas. 20% are bilateral.
2- Borderline Serous Tumors (low malignant potential):
(15%), epithelial atypia, solid areas, but no stromal invasion. 30% are
bilateral.
3- Malignant Serous Tumors (Cystadenocarcinomas):
(25%); multilayered epithelium, solid areas & papillary structures
invasing the stroma. 65% are bilateral. The prognosis depends on stage, and
the presence of peritoneal implants means poor prognosis.
149. MUCINOUS TUMORS
Large cystic masses, huge size, and multiloculated. Cysts filled with sticky
gelatinous fluid. They either lined by tall columnar mucus-secreting epithelium
(intestinal-type mucinous cystomas) or show papillary architectures and focal
cilia (mullerian mucinous tumors), which may be associated with endometriosis.
Types:
1- Benign Mucinous Tumors (cystadenomas):
80%; large cysts with smooth lining & no atypia. 5% are bilateral.
2- Borderline Mucinous Tumors (of low malignant potential):
10-15%; cellular atypia, but no stromal invasion.
3- Malignant Mucinous Tumors (Cystadenocarcinomas):
5-10%; atypia, solid sheets & stromal invasion.
20% bilateral.
Seeding in the peritoneum with malignant deposits causes
pseudomyxoma peritonei.
Usually mucinous cystadenocarcinomas are of intestinal type.
153. SEROUS TUMOUR MUCINOUS TUMOUR
Serous papillary cystic tumor Mucinous cystic tumor of
of borderline malignancy. borderline malignancy,
There is extensive, orderly endocervical type. Many cells
invagination of the neoplastic have abundant eosinophilic
glands, most with intraluminal cytoplasm.
papillae, into the stromal
component of the neoplasm.
The stroma is unaltered in
appearance.
154. SEROUS MUCINOUS
TUMOURS TUMOURS
Cystadenocarcinomas– Cystadenocarcinomas– more
complex growth pattern, frank complex and solid growth
effacement of stroma, usual pattern with atypia and
features of malignancy and stratification, loss of glandular
extremes of atypia. Concentric architecture and necrosis.
calcifications (Psammoma
Bodies) may be seen.
155. ENDOMETROID TUMOURS
• 20% of all ovarian tumours.
• Majority are carcinomas, if benign forms are
present they are cyst adenofibromas.
• Distinguished from serous and mucinous
tumours by presence of tubular glands bearing
close resemblance to benign or malignant
endometrial glands.
• 30% associated with carcinoma endometrium
and 15% with endometriosis whereas 40%
involve both ovaries.
156. ENDOMETRIOD CARCINOMA
Gross: presence of both solid Microscopic: Tubular
and cystic areas glands resemble those of
typical endometrial
adenocarcinoma.
157. CLEAR CELL TUMOUR
These are uncommon and aggressive tumours.
Grossly can present in solid and or cystic pattern (figure
solid tumour with cysts and necrosis)
Microscopically: large epithelial cells with abundant clear
cytoplasm.
158. BRENNER TUMOUR
Uncommon adenofibromas
Epithelial components– nests of transitional cells
resembling urinary bladder.
Most are benign,variable size(1cm to 30 cm).
Gross—solid or cystic
Microscopic – fibrous stroma resembling normal
ovarian stroma seperated by sharply demarcated
nests of urinary tract, with mucinous glands.
159. BRENNER TUMOUR
Gross:A sharply Microscopically:Nests of
demarcated, yellow-white transitional cells, some
fibromatous tumor occupies containing cysts, lie in a
a portion of the sectioned fibromatous stroma.
surface of the ovary.
160. GERM CELL TUMORS
- 15-20% of all ovarian tumors. It arises from
totipotent germ cells capable of
differentiation into the three germ layers.
- Mostly benign cystic teratomas while Other
tumours are found principally in children
and young adults.
- Homologous to germ cell tumours in male testis.
161. II. GERM CELL TUMORS:
1- Teratoma
2- Dysgerminoma (seminoma ovarii)
3- Yolk sac tumor= Endodermal sinus tumor
4- Embryonal carcinoma (MC mixed with other
types)
5- Choriocarcinoma (MC mixed with other types)
163. 1-TERATOMAS
1-Mature (Benign) Teratoma: MC germ cell tumors of the ovary, cystic
(dermoid cysts), lined by skin & hairs, and filled with sebaceous secretion.
There may be mature cartilage, bone (teeth) & other structures. 10-15% are
bilateral. < 1% undergo malignant transformation (MC sq.c.c.).
2-Immature (Malignant) Teratoma: Rare , solid, bulky, with areas of hemorrhage
and necrosis. It contains embryonic elements of he three germ layers. Age:
adolescent & young women. Grading is based on the amount of immature
neuroepithelium. It causes wide spread extraovarian metatases depending on
the degree of the immaturity of the including tissues.
3- Monodermal (Specialized )Teratomas: differentiate along the line of single
tissue. Examples:- Strauma ovarii is MC (mature thyroid tissue) – Carcinoid
tumor.
164. MATURE CYSTIC TERATOMA
GROSS: unilocular cysts with hair MICROSCOPIC: cyst wall stratified
and cheesy material. Thin walled squamous epithelium and underlying
gray white wrinkled epidermis.hair, sebaceous,sweat glands and other
tooth and calcification are found adnexa.other structures like thyroid
within walls. tissue,cartilage bone may be seen.
171. 2- Dysgerminoma
The ovarian counterpart of testicular seminoma.
GROSS- Yellowish white to gray pink solid, fleshy
tumors, of children & young adults
-10% are bilateral.
Microscopic picture: sheets of large cells
separated by fibrous stroma infiltrated by small
lymphocytes
- Non-functional, but may be mixed with other
germ cell elements that produce hCG
- Malignant, but radiosensitive & chemosensitive, with
relative good prognosis if treated early.
172. DYSGERMINOMA
GROSS: Small nodules to Microscopic:large vesicular
very large size.Cut surface: cells, clear cytoplasm and well
yellow white to gray pink defined boundaries and
appearance and are soft centrally placed regular
and fleshy. nuclei.cells in sheets or cords
seperated by scant fibrous
stroma, which has mature
lymphocytes.
175. 3- Endodermal Sinus Tumor ( Yolk Sac Tumor =
Infantile embryonal carcinoma)
-It arises from mutlipotent embryonal carcinoma cells differentiating
towards yolk sac structures.
- Affects children & adolescents; grows rapidly & spreads widely, but
is radio- & chemosensitive.
- Histologically: it shows cystic spaces into which papillary structures
with central blood vessels , the cyst spaces and papillary
structures are lined by immature epithelium giving glomeruloid
or “Schiller-Duval” bodies; There are intracellular and
extracellular hyaline droplet (characteristic feature). Tumor
cells are positive for Alpha-fetoprotein (tumor marker).
177. 4- Choriocarcinoma
- It is due to teratogenous development of germ cells.
- Most cases exist in combination with other germ cell
tumors.
- Resembles gestational choriocarcinoma, highly
malignant, spreads widely & elaborates hCG (tumor
marker).
- Microscopic picture: malignat syncitiotrophoblasts
& cytotrophoblasts in a hemorrhagic stroma.
N.B. Gonadal choriocarcinomas are more resistant to
chemotherapy than Gestational choriocarcinomas.
178. III. SEX CORD-STROMAL TUMORS:
1- Granulosa-Theca cell tumor: secrete
estrogen
2- Sertoli-Leydig cell tumor: secrete androgens
3- Fibroma: associated with Meig’s syndrome
4- Sex cord stromal tumor with annual tubules
5- Gynandroblastoma
6- Steroid (Lipid)cell tumors
179. 1- GRANULOSA - THECA CELL TUMOR
- 5% of all ovarian tumors, of peri & post-menopausal
women.
- Usually unilateral, solid white yellow, consisting of theca
cells & granulosa cells, arranged in “Call-Exner” rosettes.
- Elaborated large amount of estrogen & may cause
precocious sexual development in children, endometrial
hyperplasia, cystic changes of the breast or endometrial
carcinoma (estrogen effects).
- Pure granulosa cell tumors are potentially malignant, clinical
malignancy occurs in 5-25% of cases, but they are slowly growing &
10-years survival is above 85%.
- Pure Theca cell Tumors - THECOMA
180. GRANULOSA CELL TUMOUR
Gross: small partly solid,
partly cystic and mostly
unilateral.The neoplasm
composed of yellow-
white tissue with
hemorrhage, some of
which is intracystic
181. Microscopically:
granulosa cell arranged in
various patterns like
micro,macro follicular,
trabecular,bands and
sheets.CALL-EXNER
BODIES characterstic
rosette like structures
having central rounded
pink mass surrounded by
granulosa
182.
183.
184.
185. THECOMA
Pure thecoma are almost always benign.
Occur in post menopausal women.
Oestrogen dominant tumours– endometrial
disorders , carcinoma and cystic disease of
breast.
If androgen secreting – virilizing effects.
186. THECOMA
Gross: a solid firm mass Microscopically : spindle
upto 10 cm in shaped theca cells along
diameter.Section shows. with variable amount of
solid, lobulated, yellow hyalinized collagen,
tissue. cytoplasm of these cells is
vacuolated and lipid laden.
187. 2- SERTLOI-LEYDIG CELL TUMORS ( Androblastoma=
Arrhenoblastoma= Hilus Cell Tumors = Gonadoblastomas)
.Androgen producing neoplasm (rarely produce estrogen)
-Recapitulate the testicular counterpart & produce
masculinization or defemenization (Androgen)
effeect.
-Usually unilateral & benign.
-Gross: cut surface is solid and colour gray to golden
brown.
-Microscopic picture: Tubules lined with Sertoli cells
and Leydig cells interspersed in the stroma.
3- GYNANDROBLASTOMA: Extremely rare
- It consists of a mixture of granulosa/theca & sertoli/
leydig cells.
189. 4) FIBROMA
Common ovarian tumours. Usually bilateral
Harmonally inactive
Meig’s syndrome: fibroma with pleural
effusion and benign ascites.
Gross large firm fibrous usually bi-lateral mass.
Microscopic composed of spindle shaped well
differentiated fibroblasts and collagen.
Fibrothecoma: combination of fibroma and
thecoma.
190.
191.
192. METASTATIC TUMOR
- Very common,
- The primary tumors is from abdominal and breast
tumors.
Krukenberg tumor
A bilateral metastatic ovarian carcinoma, composed of
mucin-producing signet ring cells, metastasizing from
GIT, mostly from the stomach, it may produce
pseudomyxoma peritonei like well differentiated
appendicial tumors.
197. ECTOPIC PREGNANCY : Disorders of early
pregnancy
Definition: implantation of the embryo in any site
other than uterus; Most common- the fallopian
tube (> 90%), rarely in ovary or abdominal
cavity.
Associated with PID & endometriosis; but 50%
occur with no known cause.
198. May end in:
1- Spontaneous regression with resorption of the products
of conception
2- Intratubal hemorhage (hematosalpinx)
3- Tubal abortion or rupture & extrusion into abdominal
cavity →
intraperitoneal hemorrhage and shock i.e. acute
abdomen
(medical emergency).
- Diagnosis:
High hCG, sonography & endometrial biopsy showing
decidual reaction but no chorionic villi.
199.
200.
201.
202.
203.
204. Disorders of late pregnancy
1- Placental inflammation or infection:
A) Disorder of ascending infection
(Chorioamnionitis):
- infection of the fetal membrane
- Usually ascending from the vagina, in case of
premature rupture of the membranes.
- Most common cause is group B streptococci.
- Acute suppurative inflammation of the chorion &
amnion, and acute vasculitis of the umbilical
cord (funisitis).
B) Hematogenous (transplacental ) infection:
- It is derived from maternal septicemia (Listeria,
streptococcus & TORCH = Toxoplasma, Rubella,
Syphilis, Cytomegalovirus, Herpes) → villous
inflammation (villitis) and acute intervillositis.
205. 2- Toxemia of pregnancy:
-Occurs in 6% of pregnancies, in the last trimester & most common in
primiparas.
1- Pre-eclaspia = hypertension , proteinuria & edema, headache & visual
disturbances
2- Eclampsia = severe pre-eclapsia + convulsions & coma.
Associated with widespread endothelial injury & DIC (Desseminated
Intravascular Coagulation) affecting kidneys, liver, brain & other
organs.
- Resembles GVH( Graft Versus Host Reaction , but etiopathogenesis is poorly
understood.
- Delivery is the only definitive treatment for pre-eclampsia and eclampsia.
Pathogenesis of Toxemia of pregnancy: Unclear;
- The primary cause may be immune or genetic factors → mechanical or functional
obstruction of the uterine spiral arterioles → placental ischemia → endothelial injury &
activation of disseminated intravascular coagulation, leading to decrease in glomerular
filtrate, CNS disturbances, abnormal liver functions, and fibrin thrombi and ischemia
in most organs.
206. THEORIES OT TOXEMIA OF PREGNANCY:
1- Inadequate placental implantation → decrease in
uteroplacental perfusion and placental ischemia → increase
production of vasoconstrictors (e.g. thromboxane ,
angiotensin) & decrease of vadodilators(e.g. prostaglandin
I2, prostaglandin E2)
→ arteriolar vasocontriction & hypertension.
2- Recently ; Factors imbalance → premature
termination of placental vascular growth. There is
abnormal increase in an anti-angiogenic factor (sflt-1)
and reduction in pro-angiogenic factors (Vascular
endothelial-derived growth factor= VEGF & placental
growth factor =PLGF ).
207. GESTATIONAL TROPHOBLASTIC DISEASES
1- HYADATIDIFORM (VESICULAR) MOLE: defined by-
1- Enlarged edematous and hydropic change of chorionic villi
which become vesicular(Cystic swelling). Gross -Grape like
2-Variable trophoblastic proliferation.
Two types:
- Complete (diploid) &
- Partial/Incomplete (triploid).
- 10% develop into invasive mole, and 2.5% develop into
choriocarcinoma.
2- INVASIVE MOLE:
- Penetrates the uterine wall, produce hemorrhage but does not
metastasize. - Responds well to chemotherapy.
208. Feature Complete mole Partial mole
-Karyotype -Diploid (46 xxor 46xy), two sperms -Triploid(69 ). Two sperms fertilize an egg
fertilize an empty egg. All genetic with normal chromosomes
material is paternal
-Rarely seen or absent
- Fetal parts - Usually present with abnormalities
- All villi - Some villi
- Villous edema
- Diffuse & circumferential - Focal and slight
- Trophoblastic
proliferation
- Atypia -Often present -Abscent
-Serum hCG - Elevated - less elevated
-hCG in tissue - ++++ - +
- Behavior - 2% choriocarcinoma - Rare choriocarcinoma
209.
210.
211.
212.
213.
214.
215.
216. 3- Choriocarcinoma:
- 50% follow hydatidiform mole & 25% follow normal
pregnancy, 20% follow abortion & 5% follow
ectopic pregnancy.
- Highly malignant & metastasize widely.
-Gross: Large, soft, yellowish white & fleshy with areas of
hemorrhage and necrosis.
-Histology: Abnormal proliferation of both cytotrophoblasts
& cyncytiotrophoblasts invading the endometrium, blood
vessels, lymphatics, no chorionc villi are seen.
- Spread:
To lung, bone marrow, liver & other organs.
217. Clinical features:
Vaginal bleeding & discharge in the course of
apparently normal prgnancy, after miscarriage, or high
hCG titers.
N.B.: All gestational trophoblastic
disorders are associated with high level of
hCG (tumor marker).
218.
219.
220.
221.
222. 4- Placental site trophoblastic Tumor:
- A rare tumor composed of proliferating
intermediate trophoblasts (larger than cytotrophoblasts
but mononuclear than cyncytial).
- D.D. from choriocarcinoma by the absence of
cytotrophoblastic elements and low level of hCG
production.
- Mostly are locally invasive only, but malignant
variants are distinguished by:
- A high mitotic index,
- Extensive necrosis, and
- local spread.
- About 10% result in metastases and death.
Each month the uterus goes through a cyclical change, first building up its endometrium or inner lining to receive a fertilized egg, then, if conception does not occur, shedding the unused tissue through the vagina in the monthly process called menstruation