Female Genital Tract And Breast

Female Genital Tract & Breast

Infections of the Female genital tract Herpes Simplex

Vulva, vagina and cervix Teenager, young women 1/3 will have clinical symptoms Painful red papule that progress to vesicles and coalesce to form ulcers Fever, malaise, tender inguinal nodes

Yeast (Candida) 12/19/08

10 % of women, enhanced by DM, OCPfree teamplate from www.brainybetty.com

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Infections of the Female genital tract Trichomonas

15 % of women in STD clinics Purulent vaginal discharge “Strawberry cervix”

Mycoplasma Implicated in spontaneous abortion and chorioamnionitis

Gardnerella Gram negative small bacilli 12/19/08

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Pelvic Inflammatory Disease 

Pelvic pain, adnexal tenderness, fever & vaginal discharge  Gonococcus, chlamydia & enteric bacteria  Puerperal infections: Staphylococci, Streptococci, Clostridia, coliform bacteria  Acute suppurative salpingitis  Salpingooophoritis  Tuboovarian abscess  Pyosalpinx/Hydrosalpinx

 Complications  Peritonitis  Intestinal obstruction from adhesions  Bacteremia  Infertility 12/19/08

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VULVA Bartholin Cyst obstruction of the Bartholin duct, usually by a preceding infection 3 to 5 cm in diameter lined by either the transitional epithelium of the normal duct or squamous metaplasia.

Vestibular Adenitis

12/19/08

Vulvodynia inflammation of the surface mucosa and vestibular glands chronic, recurrent, and exquisitely painful free teamplate from www.brainybetty.com

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VULVA Non-Neoplastic Epithelial Disorders Lichen sclerosus  also called chronic atrophic vulvitis,  atrophy, fibrosis, and scarring  1) atrophy (thinning) of the epidermis, with disappearance of the rete pegs,  2) hydropic degeneration of the basal cells,  3) replacement of the underlying dermis by dense collagenous fibrous tissue, and  4) a monoclonal bandlike lymphocytic infiltrate

lichen simplex chronicus 12/19/08

 hyperplastic dystrophy free teamplate from www.brainybetty.com

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Lichen sclerosus

lichen simplex chronicus

12/19/08

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VULVA Neoplasms Benign  Papillary Hidradenoma  labia majora or interlabial folds  identical in appearance to intraductal papillomas of the breast

 Condyloma Acuminatum  verrucous gross appearance  HPV, types 6 and 11  koilocytotic atypia (nuclear atypia and perinuclear vacuolization)-that is considered a viral "cytopathic" effect 12/19/08

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12/19/08

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VULVA Neoplasm Pre-malignant and Malignant  Vulvar intraepithelial neoplasia  Pre-cancerous change  nuclear atypia in the epithelial cells, increased mitoses, and lack of surface differentiation

 Carcinoma  3 % of genital CA  85 % are SCCA, 15 % BCCA, adenoCA, melanoma

 Malignant melanoma  less than 5% of all vulvar cancers and 2% of all melanomas in women

 Pagets 12/19/08

 pruritic, red,from crusted, sharply demarcated, free teamplate www.brainybetty.com

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VAGINA Congenital anomalies Gartner duct cyst

12/19/08

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VAGINA Malignant & Pre Malignant Neoplasm Vaginal Intraepithelial Neoplasia Squamous cell carcinoma -95 %  HPV asscociated  Upper posterior vagina  irregular spotting or the development of a frank vaginal discharge (leukorrhea).

Adenocarcinoma 12/19/08

 0.14% DES-exposed young women free teamplate from www.brainybetty.com from their mothers

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 Embryonal Rhabdomyosarcoma  Also called sarcoma botryoides  polypoid, rounded, bulky masses  consistency of grapelike clusters  the tumor cells are crowded in a socalled cambium layer; but in the deep regions, they lie a teamplate loose from www.brainybetty.com 12/19/08 within free

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CERVIX Acute & chronic cervicitis Acute cervicitis  characterized by acute inflammatory cells, erosion, and reactive or reparative epithelial change

Chronic cervicitis  inflammation, usually mononuclear, with lymphocytes, macrophages, and plasma cells

12/19/08

HSV-epithelial ulcers C. trachomatis – lymphoid germinal centers free teamplate from www.brainybetty.com

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CERVIX

12/19/08

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CERVIX  Endocervical polyp  2-5 % of adult women  irregular vaginal "spotting" or bleeding  small and sessile to large, 5-cm masses that may protrude through the cervical os  a loose fibromyxomatous stroma harboring dilated, mucus12/19/08 secreting free teamplate from www.brainybetty.com

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CERVIX – Intraepithelial Neoplasia

 Pathogenesis

12/19/08

 Early age at first intercourse  Multiple sexual partners  Increased parity  A male partner with multiple previous sexual partners  The presence of a cancer-associated HPV  The persistent detection of a high-risk HPV, particularly in high concentration (viral load)  Certain HLA and viral subtypes  Exposure to oral contraceptives and nicotine free teamplate from www.brainybetty.com

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CERVIX – HPV & CA HPV DNA is detected by hybridization techniques in over 95% of cervical CA Specific HPV types are associated with cervical cancer (high risk) versus condylomata (low risk);

   

low (include types 6, 11, 42, 44, 53, 54, 62, and 66) and high-risk types (include types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68)

Experimental data indicate that viral (E6 and E7) genes of high risk HPVs can disrupt the cell cycle via binding to RB with up-regulation of Cyclin E (E7) and p16INK4;

 

the two viral oncogenes cooperate to promote DNA synthesis while interrupting p53-mediated growth arrest and apoptosis of genetically altered cells.

The physical state of the virus differs in different lesions,

  

integrated into the host DNA in cancers, free (episomal) viral DNA in condylomata and most precancerous lesions.44

Certain chromosome abnormalities, including deletions at 3p and amplifications of 3q, have been associated with cancers containing specific (HPV-16) papillomaviruses  12/19/08 free teamplate from vaccines www.brainybetty.com Recent data indicate that directed against 

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CERVIX – Intraepithelial Neoplasia Cervical Low Grade Intraepithelial Squamous Neoplasia Intraepithelial (CIN) I Lesion (LSIL) Cervical High Grade Intraepithelial Squamous Neoplasia Intraepithelial (CIN) II Lesion (HSIL) Cervical Intraepithelial 12/19/08

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CERVIX

12/19/08

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CERVIX

12/19/08

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CERVIX

12/19/08

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12/19/08

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12/19/08

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12/19/08

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Invasive Cervical Carcinoma

40 to 45 years for invasive cancer and about 30 years for high-grade precancers. fungating (or exophytic), ulcerating, and infiltrative cancers extends by

12/19/08

direct spread (peritoneum, urinary bladder, ureters, rectum, and vagina) free teamplate from www.brainybetty.com Lymphatics

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Invasive Cervical Carcinoma Patterns

12/19/08

Keratinizing SCCA - (Well differentiated) Non-keratinizing – (moderately diff) Small cell squamous CA – (poorly diff) Small cell undifferentiated – (neuroendocrine/ oat cell CA) associated with high risk HPV free teamplate from www.brainybetty.com

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Staging Cervical Carcinoma 

Stage 0. Carcinoma in situ (CIN III)  Stage I. Carcinoma confined to the cervix  Ia. Preclinical carcinoma, that is, diagnosed only by microscopy  Ia1. Stromal invasion no greater than 3 mm and no wider than 7 mm (so-called microinvasive carcinoma)  Ia2. Maximum depth of invasion of stroma greater than 3 mm and no greater than 5 mm taken from base of epithelium, either surface or glandular, from which it originates; horizontal invasion not more than 7 mm  Ib. Histologically invasive carcinoma confined to the cervix and greater than stage Ia2

 Stage II. Carcinoma extends beyond the cervix but not onto the pelvic wall. Carcinoma involves the vagina but not the lower third.  Stage III. Carcinoma has extended onto pelvic wall. On rectal examination, there is no cancer-free space between the tumor and the pelvic wall. The tumor involves the lower third of the vagina.  Stage IV. Carcinoma has extended beyond the true pelvis or free hasteamplate involvedfrom thewww.brainybetty.com mucosa of the bladder or 12/19/08

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UTERUS Dating the endometrium

12/19/08

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 Histology of menstrual cycle 12/19/08

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UTERUS  Dysfunctional uterine bleeding  Excessive prolonged estrogenic stimulation  Persistent proliferative phase  Lack of ovulation  Endocrine d/o  Ovarian lesion  Metabolic disturbance

12/19/08

 Anovulatory endometrium with stromal breakdown (DUB)

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UTERUS  Endometritis

12/19/08

 1) in patients suffering from chronic PID (gonococcal)  (2) in patients with postpartal or postabortal endometrial cavities, usually due to retained gestational tissue  (3) in patients with intrauterine contraceptive devices  (4) in patients with tuberculosis, free teamplate from www.brainybetty.com

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UTERUS Endometriosi s

12/19/08

presence of endometrial glands or stroma in abnormal locations Endometriotic outside the cyst lining uterus. Impt cause of dysmenorrhe a, pelvic pain, free teamplate from www.brainybetty.com

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UTERUS Adenomyosis presence of endometrial tissue in the uterine wall (myometrium) small adenomyotic nests results in Adenomyosis menorrhagia, colicky dysmenorrhea, dyspareunia, 12/19/08 free teamplate from www.brainybetty.com

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UTERUS  Endometrial polyps

12/19/08

 sessile masses of variable size that project into the endometrial cavity  single or multiple  0.5 to 3 cm in  Endometrial diameter polyp  develop in association with  Asymptomatic generalized or may cause endometrial bleeding hyperplasia free teamplate  responsive to from www.brainybetty.com

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UTERUS Endometrial Hyperplasia

12/19/08

increased gland to stroma ratio inactivation of the PTEN Simple tumor suppressor hyperplasia gene through without deletion atypia and/or free teamplate from www.brainybetty.com

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12/19/08

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UTERUS CARCINOMA OF THE ENDOMETRIUM most common invasive cancer of the female genital tract peak incidence is in the 55- to 65year-old woman Associated with

12/19/08

 1) obesity,  (2) diabetes  (3) hypertension  (4) infertility

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UTERUS  CARCINOMA OF THE ENDOMETRIUM  85 % are adenocarcinomas  polypoid tumor or as a diffuse tumor involving the entire endometrial surface  grading system is applied to endometrioid tumors and

12/19/08

 well differentiated (grade 1), with easily recognizable glandular patterns  moderately differentiated (grade 2), showing well-formed glands mixed with solid sheets of malignant cell  poorly differentiated (grade 3), characterized by solid sheets of cells with barely recognizable glands and a greater degree of nuclear atypia and mitotic activity free teamplate from www.brainybetty.com

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UTERUS CARCINOMA OF THE ENDOMETRIUM Staging of endometrial adenocarcinoma

12/19/08

Stage I. Carcinoma is confined to the corpus uteri itself. Stage II. Carcinoma has involved the corpus and the cervix. Stage III. Carcinoma has extended outside the uterus but not outside the true pelvis. Stage IV. Carcinoma has extended free teamplate from www.brainybetty.com

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UTERUS Other tumors Carcinosarcomas  malignant stromal differentiation  malignant mesodermal components, including muscle, cartilage, and even osteoid

Adenosarcomas  large broad-based endometrial polypoid growths  malignant appearing stroma, which coexists with benign but abnormally shaped endometrial glands

Stromal tumors 12/19/08

 (1)free teamplate from www.brainybetty.com benign stromal nodules

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UTERUS LEIOMYOMA

12/19/08

75% of females of reproductive age sharply circumscribed, discrete, round, firm, graywhite tumors whorled pattern of smooth muscle bundles on cut section usually makes these lesions readily identifiable on free teamplate from www.brainybetty.com

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UTERUS LEIOMYOSARCOMA

12/19/08

uncommon malignant neoplasms bulky, fleshy masses that invade the uterine wall, or polypoid masses that project into the uterine lumen degree of nuclear atypia, mitotic index, and zonal necrosis free teamplate from www.brainybetty.com

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 LEIOMYOSARC OMA peak incidence at 40 to 60 years of age metastasize through the bloodstream to distant organs, such as lungs, 12/19/08 free teamplate from www.brainybetty.com

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Fallopian Tube Tumors and Cysts Paratubal cysts Hydatids of Morgagni – remanants of Mullerian duct

12/19/08

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Table 22-3. Ovarian Neoplasms (1993 WHO Classification)  Surface Epithelial-Stromal Tumors  Serous tumors   

Benign (cystadenoma) Cystadenoma of borderline malignancy Malignant (serous cystadenocarcinoma)

 Mucinous tumors, endocervical-like and intestinal type   

Benign Of borderline malignancy] Malignant

 Endometrioid tumors   

Benign Of borderline malignancy MalignantEpithelial-stromal

 Adenosarcoma  Mesodermal (müllerian) mixed tumor  Clear cell tumors   

Benign Of borderline malignancy Malignant

 Transitional cell tumors  Brenner tumor 

12/19/08



 Sex Cord-Stromal Tumors  Granulosa-stromal cell tumors  Granulosa cell tumors  Tumors of the thecomafibroma group  Sertoli-stromal cell tumors; androblastomas  Sex cord tumor with annular tubules  GYnandroblastoma  Steroid (lipid) cell tumors

 Germ Cell Tumors  TeratomaImmatureMature (adult)SolidCystic (dermoid cyst)Monodermal (e.g., struma ovarii, carcinoid)  Dysgerminoma  Yolk sac tumor (endodermal sinus tumor)  Mixed germ cell tumors  Malignant, Not Otherwise Specified

 Metastatic Nonovarian Cancer (from Nonovarian Brenner tumor of borderline malignancy Primary) freeBrenner teamplate Malignant tumor from www.brainybetty.com

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