GENETALIA WANITA

Tuti Andayani, SpPA

ORGAN GENETALIA WANITA
VULVA
 Inflammatory disease : psoriasis, exzema,
allergic dermatitis
 Epidermal inclusion cyst, SCC, BCC and
melanoma can occur in vulva
 Common vulval disorders :
◦ Bartholin cyst
◦ Non neoplastic epithelial disorders
◦ Benign exophytic lesions
◦ tumors
Bartholin cyst

 Infections of bartholin gland produce an

acute inflammation abscess
 All age
 Cysts lines by transitional or squamous
epithelium
 3-5 cm in diameter
Non neoplastic epithelial lesion
 Lichen sclerosus :

 Squamous cell hyperplasia :

Benign exophytic lesion
 Condyloma acuminata
 Benign congenital warts, cause by HPV types
6, 11
 Solid, multifocal, may involve vulval, perineal,
vagina and cervix
 Papillary, exophytic, treelike cores of stroma
covered by thickened epithelium
 Surface epithelium shows viral cytophatic
change “koilocytic atypia” : nuclear
enlargement, hyperchromasia, cytoplasmic
nuclear halo
Condyloma acuminata..
Squamous neoplastic lesions
 Vulvar Intraepithelial Neoplasia
◦ Hyperkeratotic, pigmented lesion
◦ Epidermal thickening, nuclear atypia,increased
mitosis, lack of celluler maturation = analogue
to SILs
 Vulvar carcinoma : SCC
 Glandular neoplastic Lesion
 Papillary Hidradenoma :

 Extramammary Paget Disease :

VAGINA
Premalignant and Malignant
neoplasma of vagina
◦ Most benign tumors occur in reproductive
age : stromal polyp, leiomyomas, hemangiomas
◦ Most common malignant tumor to involve the
vagina spreding from cervix, followed by
primery SCC
Vaginal Intraepithelial Neoplasia and
SCC
 Primary carcinomas vagina : SCC associated
with high risk HPV
 Uncommon (0,6 per 100.000 women yearly)
 1% of malignant neoplasma in female genital
tract
 SCC vagina arises from Vaginal intraepithelial
neoplasia, analogous to Cervical Squamous
Intraepithelial Lesions (SILs)
Embryonal Rhabdomyosarcoma
◦ = sarcoma botryoides
◦ Uncommon, infant and children <5yo
◦ Makros : polypoid, rounded, bulky masses that
have appearance and consistency of grapelike
clusters
◦ Mikros : cells are small, oval nuclei, with small
protrusions of cytoplasm from one end,
resembling tenis racket.
sarcoma botryoides
CERVIX
HYSTOLOGY OF THE CERVIX
 CERVIX
 Inflammations
◦ Acute and chronic cervicitis
 Endocervical Polyps
◦ Common
◦ Benign exophytic growths arise in endocervical
canal
◦ Makros : small, sessile”bumps” to large polypoid
masses
◦ Mikros : compose of a loose fibromyxomatous
stroma covered by mucous secreting
endocervical glands, often accompanied by
inflammation
Endocervical polyp
 Premalignant and malignant neoplasms of
the cervix
◦ SILs
◦ Cervical carcinoma
Cervical intraepithelial Neoplasia
(Squamous Intraepithelial Lesions)
 The diagnosis of SIL is based on
identification of nuclear atypia
characterized by nuclear enlargement,
hyperchromasia (dark staining) coarse
chromatin granules and variation in
nuclear size and shape
 Nuclear change accompanied by
cytoplasmic halos : koilocytic atypia
 Grading of SIL into Low or High grade is
based on expansion of immature cell layer
from its normal, basal location
 If the immature squamous cells are
confined to the lower one third of the
epithelium: LSIL
 If expand to the upper two thirds of the
epithelial thickness :HSIL
 >80% LSIL and 100% HSIL associated with
high risk HPV---HPV-16
Cervical Carcinoma
 The average age : 45 yo
 SCC is the most common subtype (80%)
 Adenocarcinoma (15%)
 Rare (5%) : adenosquamouscarcinoma and
neuroendocrine carcinoma
 All types cause by HPV high risk
 Morphology
 Fungating (exophytic) or
infiltrative masse
 SCC : composes of nests of
malignant squamous
epithelium, either keratinizing
or non keratinizing, with
invade the underlying cervical
stroma
 Adenoca : proliferation of
glandular epithelium
composed of malignant
endocervical cells with large,
hyperchromatic nuclei and
relatively mucin depleted
cytoplasm
Non keratinizing keratinizing

SCC of the cervix

Adenocarcinoma, endocervical type Villoglandular type

Adenoca of the cervix

 Adenosquamous ca : composed of
intermixed malignant glandular and
squamous epithelium
 Neuroendocrine cervical carcinoma :
similar to small cell ca of the lung
neuroendocrine
 UTERUS
 ENDOMETRITIS
◦ Miscarriage/delivery
◦ IUD
◦ GO
◦ Clamydia Trachomatis
◦ Tuberculosa
◦ Type : acute and chronic endometritis
ADENOMYOSIS
 Nest of endometrial stroma, gland in the
myometrium between muscle bundle
◦ Menorraghia
◦ Dismenorhoe
◦ Pelvic pain
ENDOMETRIOSIS
 Endometrial gland and stroma location
outside the endometrium
◦ 10% reproductive years
◦ 50% women with infertility
◦ Location : ovaries, pouch of douglas, uterine
ligaments, tubes, retrovaginal septum,
umbilicus, lungs, skeletal muscle/bone
DYSFUNGSIONAL UTERINE BLEEDING
Causes :
 Failure of ovulation
 Inadequate Lutheal Phase
 Oral Contraceptives
 Endometrial disorders:
◦ Chronic endometritis
◦ Endometrial Polyps
◦ Submucosal Leiomyoma
ENDOMETRIAL HYPERPLASIA
 Defined as an increase in the number of
glands relative to the stroma, apreciated as
crowded glands, often with abnormal shapes
 Commonly caused by unopposed estrogen
stimulation and is an important cause of
abnormal vaginal bleeding
 Type : atypical hyperplasia and non atypical
 Atypical : increased risk of endometrial ca
TUMOR OF ENDOMETRIUM
AND MYOMETRIUM
1. ENDOMETRIAL POLYPS
 exophytic masses of variable size that
project into the endometrial cavity
 Size 0,5—3 cm
 More commonly menopouse
 AUB/ abnormal uterine bleeding
 Risk to a cancer (rarely, adenoca arise
within endometrial polyp)
 II. LEIOMYOMA
 Benign tumor smooth muscle cells
 During reproductive life
 Estrogen stimulate the growth
 Morphology :
◦ Sharply circum scribed
◦ Gray white masses
◦ Characteristic : whorled cut surface
◦ Singly or multiple
◦ Intramural, submucosa/ subserosal
 Microscopic :
◦ Whorling bundle of smooth muscle cells
leiomyoma
III. LEIOMYOSARCOMA
 Almost always solitary tumors
 De novo from myometrium cells
 The distinction from leiomyoma based on
nuclear atypia, mitotic index and zonal
necrosis
 Morphology :
◦ Soft, hemorrhagic, necrotic
◦ Atipia, mitosis
leiomyosarcoma
IV. ENDOMETRIAL CARCINOMA

 Age : 55-65 yo
 Risk fx : obecity, DM, Hypertension,
infertility
 Morphology :
◦ Type 1 : Low grade
◦ Type II : (serous) high grade
Type 1 endometrial ca
Tipe 2 endometrial ca
 OVARIES
Non neoplastic and Functional cysts
1. Follicles and lutheal cyst
◦ Cystic follicles >>>, from unruptured graafian
follicles or in follicles that have ruptured and
immediately sealed
◦ Lutheal cyst are present in the normal ovaries in
reproductive age
2. Polycistic Ovaries and stromal Hyperthecosis
Ovarian tumors
WHO Classification of
Ovarian Neoplasms
Surface epithelial-stromal tumors
Serous tumors
 Benign (cystadenoma, cystadenofibroma)
 Borderline (serous borderline tumors)
 Malignant (Low and high grade serous
adenocarcinoma)
…WHO Classification of
Ovarian Neoplasms
Mucinous tumors, endocervical like and
intestinal type
 Benign (cystadenoma, cystadenofibroma)
 Borderline (mucinous borderline tumors)
 Malignant (mucinous adenocarcinoma)
Endometrioid tumors
 Benign (cystadenoma, cystadenofibroma)
 Borderline (endometrioid borderline
tumors)
 Malignant (endometrioid adenocarcinoma)
…WHO Classification of Ovarian
Neoplasms
Clear cell tumors
◦ Benign
◦ Borderline
◦ Malignant (clear cell adenocarcinoma)
Transitional cell tumors
• Benign Brenner tumors
• Brenner tumor of borderline malignancy
• Malignant Brenner tumors
Epithelial stromal
 Adenosarcoma
 Malignant mixed mullerian tumor
…WHO Classification of Ovarian
Neoplasms
Sex cord- stromal tumor
Granulosa tumors
Fibroma
Fibrothecomas
Sertoli-leyding cell tumors
Steroid (lipid) cell tumor
Germ cell tumors
 Teratoma
 Dysgerminoma
 Yolk sac tumor
 Mixed germ cell tumors
Metastatic cancer from non ovarian
primary
Serous tumors
 >>, 40% of all ca in ovary
 70% are benign and borderline
 Morphology :
◦ Multicystic lesion in which papillary epithelium is
cointain with a few fibrous walled cysts
(intracystic) or as a mass projecting from ovarian
surface
◦ Borderline cointain an increased number of
papillary projections
◦ Larger areas of solid or papillary tumor mass,
tumor irregularity and fixation or nodularity of
the capsule : malignancy
…Serous tumors
 Micros :
 cyst are lined by columnar epithelium,
which has abundant cilia in benign tumor,
papillae may be found
 Borderline :
◦ increase complexity of the stromal papillae,
◦ stratification of epithelium
◦ mild nuclear atypia
◦ Invasi of the stroma (-)
…Serous tumors
Mikros :
Serous carcinoma
 Low grade and high grade
 Marked nuclear atypia, pleomorphism,
atypical mitotic figure, multinucleation
 High grade are distiguised from low grade
by having more complex growth pattern
and in filtration of the underlying stroma
…Serous tumors
Mucinous tumors
 20-25% all ovarian neoplasm
 Occur in middle adult and rare before
puberty and after menopouse
 Primary ovarian mucinous ca are are (3%)
of all ovarian neoplasma
 Makros :
◦ tend to produce large masses—25kg,
multiloculated filled with sticky, gelatinous
fluid rich in glycoprotein
.. Mucinous tumors
Micros :
Benign :
 lining of tall, columnar epithelial cells with
apical mucin that lack cilia
 Type:
◦ gastric and intestional type >>
◦ Endocervical type <<
Borderline :
 Epithelial stratification, tufting and or
papillary intraglandular growth
.. Mucinous cystadenoma
Clear cell tumors
 Benign and borderline are rare
 Clear cell carcinomaa are uncommon
 Composed of large epithelial cells with
abundant clear cytoplasm
 Solid or cystic
Mature(benign) teratomas
 90% unilateral
 Unilocular cyst cointaining hair and
sebaceous material
 Micros :
◦ cyst wall lined by epidermis
◦ Cointain with : foci calcification, teeth, bone and
cartilage, thyroid, neural tissue
 = dermoid cyst
 1% undergo malignant transformation : SCC;
other cancer as well (thyroid ca, melanoma)
…Mature(benign) teratomas
DISEASE OF PREGNANCY
 Ectopic pregnancy
 Gestational trophoblastic disease :
◦ Hydatidiform mole : complete and partial
◦ Invasive mole
◦ Chorio carcinoma
Complete mole
choriocarcinoma
 Macros : soft, fleshy, yellow-white tumor,
large pale areas of necrosis and
haemorhage
 Micros :
◦ proliferating synctiotrophoblast and
cytotrtophoblast
◦ Mitosis abundant and abnormal
◦ Tumor invades underliying myometrium,
blood vessel, extend out the uterine serosa
and adjecent structur
choriocarcinoma