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OF
FEMALE GENITAL TRACT
Complications
- Infertility
- Bacteremia (endocarditis,
meningitis, arthritis)
- Intestinal obstruction
(adhesions)
- Peritonitis
HSIL
HSIL
CERVICAL INTRAEPITHELIAL
NEOPLASIA (CIN)
Three grades of severity:
CIN I: mild dysplasia
CIN II: moderate dysplasia
CIN III: severe dysplasia (highest risk for
progression to invasive squamous cell
carcinoma)
Progression to invasion may take from a
few months to twenty years; unpredictable
CERVICAL INTRAEPITHELIAL
NEOPLASIA
NORMAL PREINVASIVE
SQUAMOUS CELL CARCINOMA
(CERVIX, VAGINA, VULVA)
NORMAL
SQUAMOUS CELL CARCINOMA
SQUAMOUS CELL CARCINOMA
May take years to evolve with only sign of
its presence the atypical cells shed from
the cervix and found by the PAP screen
Invasive cancers usually trigger
hysterectomy and possibly radiation
UTERINE DISEASES
BENIGN
- Adenomyosis
- Endometriosis
- Leiomyoma (fibroids)
MALIGNANT
- Endometrial carcinoma
- Leiomyosarcoma
ADENOMYOSIS
Adenomyosis
Endometrial tissue
(stroma with/without
glands) in the uterine
wall (myometrium)
During menstrual cycle
these glands have no
outlet to shed into
Menorhagia, colicky
dysmenorrhea,
dyspareunia and
pelvic pain
ENDOMETRIOSIS
Endometrial glands and stroma in abnromal
locations outside the uterus
Ovaries (chocolate cysts), uterine ligaments,
rectovaginal septum, pelvic peritoneum,
laparotomy scars; and rarely umbilicus, vagina,
vulva or appendix
Complications: infertility, dysmenorrhea, pelvic
pain
Disease of reproductive age group, afflicts 10%
of women
ENDOMETRIOSIS
THEORIES OF
SPREAD
- Regurgitation /
implantation theory
- Metaplasia
- Angiolymphatic spread
ENDOMETRIOSIS
ENDOMETRIOSIS
FALLOPIAN TUBE
ADENOCARCINOMA
ENDOMETRIAL CARCINOMA
Spread: direct and angiolymphatic
(myometrial invasion, regional lymph
nodes, lung, liver, bone)
LEIOMYOMA
Benign smooth muscle neoplasm
Affects 25% of women
Estrogen responsive
May produce abnormal bleeding, impaired
fertility, bladder compression,
spontaneous abortion
LEIOMYOMA
LEIOMYOSARCOMA
Malignant smooth muscle tumor
Uncommon
40 to 60 year peak
Tend to recur and spread via bloodstream
to lung, brain, and bone
LEIOMYOSARCOMA
OVARIAN DISEASES
BENIGN
- Polycystic ovaries
- Mature teratoma (dermoid cyst)
MALIGNANT
- Carcinomas: serous, mucinous
- Immature teratoma
POLYCYSTIC OVARIAN
DISEASE (PCOD)
aka Stein-Levanthal
Syndrome
- Oligomenorrhea
- Obesity
- Hirsutism
- Virilism
Etiology unknown
Multiple subcortical cysts
Increased production of
androgen which is
converted to estrone
OVARIAN TUMORS
Mostly benign (80%)
Affect young women (20 to 45-years-old)
Malignant forms are disproportionately
lethal and affect older women, 40 to 65-
years-old
Risk factors for ovarian cancer
- Nulliparity
- Family history, genetics (BRCA-1, BRCA-2
genes in hereditary forms)
EPITHELIAL TUMORS
SEROUS TUMORS
Cystic or solid, large masses (30-40 cm)
Subtypes
Benign (60%): serous cyst / cystadenoma
Borderline (10%): serous borderline tumor
(SBLT)
Malignant (30%): serous carcinoma
SEROUS TUMORS
Serous cyst /cystadenoma
- smooth, glistening cyst wall
- clear serous fluid
- tubal lining
- microscopic papillae
- psammoma bodies (concentric
calcification)
SEROUS TUMORS
Serous borderline Serous
tumor (SBLT) cystadenocarcinoma
- increased papillary - cystic to solid tumor
projections - complex growth pattern
- epithelial stratification - frank stromal invasion
- nuclear atypia present
- NO stromal invasion - peritoneal implants
- poor prognosis
EPITHELIAL TUMORS
MUCINOUS TUMORS
- Cystic or solid, large multiloculated masses
- Subtypes
Benign (80%): mucinous cyst / cystadenoma
Borderline (10%): mucinous borderline tumor
(MBLT)
Malignant (10%): mucinous carcinoma
- Rupture (mucinous cystadenomas or mucinous
cystadenocarcinomas) leads to pseudomyxoma
peritonei
GERM CELL TUMORS
15 20% ovarian tumors
Derivatives of all three germ-cell layers
present (teeth, hair, bone, cartilage, etc)
Less than 20 years
Most are mature cystic teratoma (aka
dermoid cyst; benign)
Immature form: more likely malignant
MATURE CYSTIC TERATOMA
TEETH
ECTOPIC PREGNANCY
1% of pregnancies
Implantation of the fetus
in any site other than a
normal uterine location
Sites: fallopian tubes
(90%), ovary, abdominal
cavity
Predisposing factors:
Previous scarring (PID
with chronic salpingitis)
Rupture is catastrophic