ACADs TEAM Lecture # 4 SPath

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GROSS AND MICROSCOPIC SLIDES
Female Genital Tract
Lectured by: Dr. Chiochoco
Date: July 8, 2014

LESIONS OF VULVA AND VAGINA
BARTHOLIN CYST
Glands that are obstructed due to inflammation (adenitis)
May become abscess
Common in sexually active females
Lined by ductal squamous metaplastic &/or epithelium
Cause: Gonococcal
Management: Excision or Marsupialization
o Make a slit but dont suture
o Kangaroo pouch
o Excise and drain


ACUTE VULVITIS
Inflammation of external genitalia
Viral(herpes), bacterial( spirochetes), fungal(candida)
(+) punctate ulcer
Biopsy at lesion: (+) whitish film cover-this will be
scraped
The viruses cannot be identified


BENIGN EXOPHYTIC LESIONS
Exophytic or benign/wart-like lesions of the vulva
Mainly sexually transmitted

CONDYLOMATA LATA/LATUM
Egiology: Treponema pallidum (Syphilis)
(+) painless solidary ulcers: CHANCRE
Elevated warty (CONDYLOMATA)

CONDYLOMATA ACUMINATA/ACUMINATUM
Etiology: HPV
Warts at vulvar area (ano-genital warts)
Extends at perinatal area

Condylomata lata Condylomata acuminata

CONGENITAL ANOMALIES
ATRESIA
Initial finding
(+) difficult urination
The vulva is not quite developed
The vagina is covered with a thin membrane
(-) canal
Known as: Vulvar atresia

IMPERFORATED HYMEN
Adolescence starts of menstruation
(+) mass protrusion
(+) abdominal pain initially because the menstrual fluid
cannot come out at the imperforated hymen
o You need to excise it to evacuate the fluid and then
suture it

Vulvar Atresia Imperforated hymen

DOUBLE UTERUS
This will cause infertility
(+) 2 horns
Uterus didelphys
o Bicornuate uterus or double uterus
o Some have separate corpus




ACADs TEAM Lecture # 4 SPath

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MALIGNANT LESIONS OF THE VULVA
EMBRYONAL RHABDOMYOSARCOMA
Aka. Sarcoma botryoides
Common malignant lesion among female children (<5y/o)
Grows as polypoid, rounded, bulky mass that sometimes fill
& projects out of the vagina grape-like clusters













MALIGNANT MELANOMA
Arising from vagina & vulva
5% of all vulvar CA & 2% of all melanomas in women
Characteristics is similar to other melanomas
o (+) dark pigmentation and lesions
o (+) melanoma invasion & metastasis
o May resemble Paget disease













SQUAMOUS CELL CARCINOMA -SCC
o (+) invasion of the entire labia
o Compromise the urethra
o Unable to urinate
o Sexual active patients, with multiple partners
o Pathogenesis: assoc w/ HPV
o Arise from pre maliganant lesion (vaginal intraepithelial
neoplasia)
o Lower 2/3 metastasize to inguinal nodes; upper lesions
involves regional iliac nodes
o Management: radiation therapy & radical vulvectomy

TAHBSO FOR SCC
Cervix (A)
o (+) erosions
o (+) squamous columnar junctions
Cervix & Uterus (B)
o (+) creamy white lesion

SCC FROM LONG STANDING PROCIDENTIA UTERI
o Procidentia uteri, laxity & atony of the uterine wall
o (+) uterine prolapsed
o (+) malignant cervix
o Usually seen in older women


SCC HISTOPATH
o Nest of squamous cells (violet) invading & undermining the
submucosa & myometrium
o The pink are the muscle cells (bottom)


LESIONS OF THE CERVIX, UTERUS AND ENDOMETRIUM
PYOMETRA IN A UTERUS WITH CERVICAL STENOSIS
o Uterus remove with cervix, bilateral fallopian tubes and
ovaries
o (+) creamy white pus
o STD gonococcal in origin
o If stenotic Cervix: (+) difficulty passing of purulent material
accumulated in the endometrium
o Sxmgt: TAHBSO
A B
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ENDOCERVICAL POLYP
Mass at the endocervical canal
(+) post coital bleeding
(+) polyps: exaggerated folds of mucosa
Etiology: chronic cervicitis/ inflammation


ENDOMETRIAL HYPERPLASIA
Due to hormone
Can be pathologic/ physiologic:
o Physiologic : Pregnancy
o Pathologic:
Simple w/o atypia
Simple w/ atypia
Complex w/o atypia
Complex w/ atypia
Histopath:
o (+) thickening of the endometrium
o Hyperplasia due to prolonged estrogen stimulation
o The endometrium is diffusely thickened
o Tubular glands are dilated
o Compactly arranged
Type of hyperplasia:
o Typical
o Atypical
(+) danger of progression to malignancy
(+) hormone production
Challenge the uterus to return to normal function
We dont wait for malignancy
Once it occurs, prognosis becomes worse
Gynecologist will remove the uterus
(hysterectomy)

ENDOMETRIAL POLYP
Histopathology assoc w/ & almost same as endometrial
hyperplasia but with a define fibro-vascular stalk


ENDOMETRIAL CA
Cauliflower like cancer which occupies the entire
endometrial cavity
Clinically: dysfunctional bleeding and uterine bleeding
Bleeding: leads to malignancy
Curettage dx:
o (+) irregular glands and necrosis


INVASION OF MYOMETRIUM
Especially in elderly: (+) papillae and myometrial invasion
Management: TAHBSO


CHORIOCARCINOMA*
(-) in non-pregnant women
From chorion or trophoblast
Developed during gestation
(+) bloody lesion
(+) bizarre looking trophoblastic lesion
Metastasize via hematogenous route to the lungs cannon
ball lesion/s in radiograph
Affected: uterus/ ovary

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LEIYOMYOMAS
Form beneath endometrial lining
(+) profused prolonged vaginal bleeding
Most are aymptomatic
Gross: Pedunculated, sharply circumscribed, firm & white
submucosal, subserosal &/or intramural mass
Histopath: interlacing bundles (fascicles) of uniform spindle
cells resembling smooth muscles
o Benign:
Uniformity
Less or no mitotic figures
o Malignant (Leiyomyosarcoma):
Mitoses (>5/10hpf)
Degree of atypia
Presence of zonal necrosis
Sxmgt: Myomectomy (conservative) or radical hysterectomy


ADENOMYOSIS
Endometrial glands embedded in the myometrium
During the menstrual cycle: glands bleeds
Mistaken with myoma because it also cause uterine
enlargement but adenomyosis has no definite boarder
(capsule)
(+) thick myometrium

PYOSALPINX
(+) mass also at ovaries
(+) abundant inflammatory cells
(+) PMN at the walls of the mucosa
Common cause: Gonorrheal infection


BENIGN LESION OF THE OVARY
SIMPLE OVARIAN CYSTS, POLYCYSTIC OVARY AND CYSTIC
CORPUS LUTEUM
Primarily caused by decrease estrogen and progesterone

SIMPLE OVARIAN CYST (A)
Cystic follicle accumulated forming a bluish cyst
1 or 2 cysts present

POLYCYSTIC OVARY (B)
Part of the syndrome: Stein-Leventhal syndrome
Infertility
No normal ova,(-) ovulation


CYSTIC CORPUS LUTEUM
Secretory (estrogen & progesterone
It is yellow boarder
(+) corpus luteum lined with luteinized theca cells


SEROUS CYST
Aka. Serous cystadenoma
Benign, grows slowly
Arise from ovarian mulerian surface epithelium
Typically unilocular thin walled cyst filled w/ serous fluids
Flattened cuboidal/ low columnar
A B
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OVARIAN ENDOMETRIOTIC CYST
Aka. Endometrioma or Chocolate cyst
(+) endometriosis
Glands of the endometrium are present in ovary and other
organs
Resemble lining epithelium of the endometrium
Cystic cavity filled w/ thick old blood hemosiderin
dark-brown/chocolate color
(+) hemosiderin-laden macrophages


MUCINOUS ADENOMA
Multinucleated
(+) gelatinous mucoid fluid
Honeycomb appearance
Multicystic
Epithelium:
o Mucous secreting
o Nuclei at the basal area
o Abundant cytoplasm
same with cervical mucosa


TERATOMA DERMOID CYST
Derived: All germ cell layers
o Ectoderm
o Mesoderm
o Endoderm
Tumors have balls of hair, (+) teeth
(+) Stratified squamous epithelium
(+) Smooth muscle cells
(+) cartilages and blood vessels
Malignancy can form leading to squamous cell carcinoma


STROMAL TUMORS
FIBROMA (A)
White, firm mass
Fibrous tissue which forms the thecoma

THECOMA-LUTEINIZED (B)
Dispersed, yellowish mass
(+) fibroblast
(+) luteinizing cells containing lipids and are steroid
producers


FIBROTHECOMA
Secretory (steroid producers)
(+) fibroblast & luteinized theca cells
Composed of plump, differentiated stromal cells with thecal


MALIGNANT OVARIAN LESIONS
MUCINOUS CARCINOMA
Multinucleated like
(+) solid priable tumor
Cancer with a mucinous pattern
A B
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Maybe from a borderline ovarian tumor
Frank malignant tumor
May rupture affecting the peritoneum and malignant glands
invade the peritoneal cavity Pseudomyxoma peritonae
If you open the abdomen; gelatin-like
2 types of Epithelium
o Resembles endo-cervical epithelium
o Resembles intestinal type epithelium


SEROUS CARCINOMA
Cauliflower- like w/in locules
Papilla formation
Usually found in elderly
Bilateral that invades beyond the capsule


ENDOMETRIOID TUMOR
Solid & cystic appearance
From long standing endometriosis-externa of ovary
(+) well differentiated glands w/ focally villous architecture
Same with the glands of the endometrium
(+) hemorrhagic and cystic areas


GERM CELL TUMOR
DYSGERMINOMA
Solid tumor w/ cream colored to fleshy appearance
Usually in younger female
Resembles tumor of testicles- seminoma in males
(+) polyhedral cells represents primitive cells
Histopath: polyhedral tumor cells with dark, round nuclei
w/ abundant mature lymphocytes


GRANULOSA CELL TUMOR
From granulose cells comprise the ovarian follicles
(+) hemorrhage, cyst and yellow areas
(+) hormone production
(+) large ovarian mass
Vaginal bleeding: (+) endometrial hyperplasia
Cells: same with follicles
Pathognomonic: primitive follicles (CALL-EKNER BODIES)


YOLK SAC TUMOR
Among younger females in early 20s
Primitive tumor from germ cells of vitelline/embryonic yolk
sac
Looks like BALOT
Typically bleeds
Typical rosette like body
Pathognomonic: blood vessels surrounded by tumor cells
(Shiller duval bodies)


ACADs TEAM Lecture # 4 SPath

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OTHERS (REFER TO LEC:3, GESTATIONAL & PLACENTAL
DISORDERS)
PICTURES
ECTOPIC PREGNANCY (FALLOPIAN & OVARIAN)














COMPLETE HYDATIDIFORM MOLE












INCOMPLETE (PARTIAL) HYDATIDIFORM MOLE


PLACENTA ACCRETA


-Choriocarcinoa* also refer to lec:3
-Other ref: R&C, chp 22, p.1005
R&C atlas, chp 13, p.316
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