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VULVA
VULVA: NON-NEOPLASTIC
EPITHELIAL DISORDERS
GROSS:
Develop in the region of the transformation zone
Range from microscopic foci to grossly conspicuous tumors
May be invisible or exophytic.
Tumors encircling the cervix and penetrating into the underlying
stroma produce a "barrel cervix," which can be identified by direct
palpation.
Extension into the parametrial soft tissues, pelvic lymph nodes, bladder
or rectum.
Distant metastases, including para-aortic nodal involvement
staged from 1 to 4 depending on clinical spread
Here is a normal cervix with a smooth, glistening mucosal
surface. There is a small rim of vaginal cuff from this
hysterectomy specimen. The cervical os is small and round,
typical for a nulliparous woman. The os will have a fish-
mouth shape after one or more pregnancies.
This is the gross appearance of a cervical squamous cell
carcinoma that is still limited to the cervix (stage I). The
tumor is a fungating red to tan to yellow mass.
Here is another cervical squamous cell carcinoma. Note the
IUD string protruding from the cervix. This implies that
someone could have done a Pap smear when it was inserted.
There is a natural history of progression of dysplasia to
carcinoma, so don't leave dysplasias alone.
This is a larger cervical squamous cell carcinoma which
spread to the vagina. A total abdominal hysterectomy with
bilateral salpingo-oopherectomy (TAH-BSO) was performed.
This is a pelvic exenteration done for
stage IV cervical carcinoma. At the
left, dark vulvar skin leads to vagina
and to cervix in the center, where an
irregular tan tumor mass is seen
infiltrating upward to the bladder. A
slit-like endometrial cavity is
surrounded by myometrium at the
mid-right. The rectum and sigmoid
colon are at the bottom extending to
the right.
INVASIVE CARCINOMA OF THE
CERVIX
MICROSCOPIC:
The most common cervical carcinomas are:
squamous cell carcinomas (75%), followed by
adenocarcinomas and adenosquamous carcinomas (20%)
small cell neuroendocrine carcinomas (less than 5%).
With the exception of neuroendocrine tumors, which
are uniformly aggressive in their behavior, cervical
carcinomas are graded from 1 to 3 based on cellular
differentiation.
This is why you do Pap smears--to prevent invasive squamous
cell carcinomas from occurring. With Pap smears, pre-
neoplastic and neoplastic cervical lesions can be detected
when small and treated. Nests of squamous cell carcinoma
have invaded underlying stroma at the center and left.
Diseases of Uterine Corpus
Endometrial hyperplasia
Endometrial Polyp
Endometrial carcinoma
Endometritis
Endometriosis and adenomyosis
Dysfunctional uterine bleeding
Leiomyoma and leiomyosarcoma.
Endometrial Carcinoma
Pathogenesis
Histologically, it is
characterized by
presence of chronic
inflammatory cells
primarily plasma
cells.
Theories of Endometriosis Origin
Endometriosis
Gross
Endometriosis of the
ovary
The ovaries may become
markedly distorted by
large cystic spaces (3 to
5 cm in diameter) filled
with brown blood debris
to form so-called chocolate
cysts
Follicular and Luteal Cyst
(Functional cyst)
Very common.
Originate on the ovarian cortex in unruptured
graafian follicles (follicular cyst) or follicles that
ruptured and resealed immediately (Luteal cyst).
Usually small, 1- 1.8 cm. filled with clear fluid.
Occasionally rupture causing pain & intraperitoneal
bleeding.
Lined by granulosa or luteal cells.
Serous Tumor