female genital tract and breast

Female Genital Tract

& Breast

04/08/23 free teamplate from www.brainybetty.com

2

Infections of the Female genital tractHerpes Simplex

Vulva, vagina and cervixTeenager, young women1/3 will have clinical symptomsPainful red papule that progress to vesicles and

coalesce to form ulcersFever, malaise, tender inguinal nodes

Yeast (Candida)10 % of women, enhanced by DM, OCPLeukorrhea, priritus


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Infections of the Female genital tractTrichomonas

15 % of women in STD clinicsPurulent vaginal discharge“Strawberry cervix”

MycoplasmaImplicated in spontaneous abortion and

chorioamnionitis

GardnerellaGram negative small bacilli


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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


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VULVABartholin 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

Vulvodyniainflammation of the surface mucosa and

vestibular glands chronic, recurrent, and exquisitely painful


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VULVA

Non-Neoplastic Epithelial DisordersLichen 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 hyperplastic dystrophy acanthosis & hyperkeratosis


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Lichen sclerosus

lichen simplex chronicus


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VULVA

NeoplasmsBenign

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


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VULVANeoplasm

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

pruritic, red, crusted, sharply demarcated, maplike area, occurring usually on the labia majora


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VAGINACongenital anomaliesGartner duct cyst


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VAGINAMalignant & Pre Malignant Neoplasm

Vaginal Intraepithelial NeoplasiaSquamous cell carcinoma -95 %

HPV asscociated Upper posterior vagina irregular spotting or the development of a frank

vaginal discharge (leukorrhea).

Adenocarcinoma 0.14% DES-exposed young women from their mothers


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Embryonal RhabdomyosarcomaAlso called sarcoma botryoides polypoid, rounded, bulky

masses consistency of grapelike

clusters the tumor cells are crowded in

a so-called cambium layer; but in the deep regions, they lie within a loose fibromyxomatous stroma that is edematous


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CERVIXAcute & 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

HSV-epithelial ulcersC. trachomatis – lymphoid germinal centersT. vaginalis – epithelial spongiosis


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CERVIX


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CERVIXEndocervical 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, mucus-secreting endocervical glands, often accompanied by inflammation and squamous metaplasia


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CERVIX – Intraepithelial NeoplasiaPathogenesis

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 Genital infections (chlamydia)


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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

Recent data indicate that vaccines directed against papillomaviruses can prevent infection and the development of precancerous disorders

http://www.robbinspathology.com/passthru/linktopage.cfm?showtab=toc&xrefID=R022044


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CERVIX – Intraepithelial NeoplasiaCervical

Intraepithelial Neoplasia (CIN) I

Cervical Intraepithelial Neoplasia (CIN) II

Cervical Intraepithelial Neoplasia (CIN) III

Low Grade Squamous Intraepithelial Lesion (LSIL)

High Grade Squamous Intraepithelial Lesion (HSIL)


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CERVIX


21

CERVIX


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CERVIX


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Invasive Cervical Carcinoma40 to 45 years for invasive cancer and about

30 years for high-grade precancers. fungating (or exophytic), ulcerating, and

infiltrative cancers extends by

direct spread (peritoneum, urinary bladder, ureters, rectum, and vagina)

LymphaticsDistant metastasis (Liver, lungs, bone marrow )


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Invasive Cervical CarcinomaPatterns

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 (type 18)


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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 has involved the mucosa of the bladder or rectum. This stage obviously includes those with metastatic dissemination.


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UTERUSDating the endometrium


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Histology of menstrual cycle


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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 Anovulatory endometrium

with stromal breakdown (DUB)


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UTERUS Endometritis

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,


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UTERUSEndometriosis

presence of endometrial glands or stroma in abnormal locations outside the uterus.

Impt cause of dysmenorrhea, pelvic pain, infertility & other problem

Endometriotic cyst lining


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UTERUSAdenomyosis

presence of endometrial tissue in the uterine wall (myometrium)

small adenomyotic nests results in menorrhagia, colicky dysmenorrhea, dyspareunia, and pelvic pain

Adenomyosis


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UTERUSEndometrial polyps

sessile masses of variable size that project into the endometrial cavity

single or multiple 0.5 to 3 cm in diameter develop in association

with generalized endometrial hyperplasia

responsive to the growth effect of estrogen but exhibit no progesterone response

Endometrial polypAsymptomatic or may

cause bleeding


36

UTERUSEndometrial

Hyperplasiaincreased gland to

stroma ratio inactivation of the

PTEN tumor suppressor gene through deletion and/or inactivation

Simple hyperplasia without atypia


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UTERUSCARCINOMA OF THE ENDOMETRIUM

most common invasive cancer of the female genital tract

peak incidence is in the 55- to 65-year-old woman

Associated with 1) obesity, (2) diabetes (3) hypertension (4) infertility


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UTERUSCARCINOMA OF THE ENDOMETRIUM

85 % are adenocarcinomaspolypoid tumor or as a diffuse tumor involving the entire

endometrial surface grading system is applied to endometrioid tumors and

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


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UTERUSCARCINOMA OF THE ENDOMETRIUMStaging of endometrial adenocarcinoma

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 outside the true pelvis or has obviously involved the mucosa of the bladder or the rectum


41

UTERUSOther 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

(1) benign stromal nodules (2) endometrial stromal sarcomas.


42

UTERUSLEIOMYOMA

75% of females of reproductive age sharply circumscribed, discrete, round,

firm, gray-white tumors whorled pattern of smooth muscle

bundles on cut section usually makes these lesions readily identifiable on gross inspection


43

UTERUSLEIOMYOSARCOMA

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 ten or more mitoses per ten high-power


44

LEIOMYOSARCOMApeak incidence at

40 to 60 years of age

metastasize through the bloodstream to distant organs, such as lungs, bone, and brain


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Fallopian TubeTumors and Cysts

Paratubal cystsHydatids of Morgagni –remanants of

Mullerian duct


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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

Brenner tumor of borderline malignancy Malignant Brenner tumor Transitional cell carcinoma (non-Brenner

Sex Cord-Stromal Tumors Granulosa-stromal cell tumors

Granulosa cell tumors Tumors of the thecoma-fibroma 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 Primary)

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