Pathology of the female genital tract

1. Pathology of the female genital tract

2. This is a low power view of a condyloma acuminatum. Note the large papillomatous processes (arrows) and see the residual connective tissue stalk (arrowheads). Multiple venereal warts excised from the vulva of a woman aged 29. These lesions are sometimes referred to as condylomataacuminata. Aetiology??? They are caused by infection with the human papilloma virus, particularly types 6 and 11

3. Moderately well differentiated squamous cell carcinoma (arrows) of the vulva in a woman aged 60. Operative surgical specimen. Precursor Lesion??? Most vulval carcinomas are squamous cell carcinoma. Preceding vulval intraepithelial neoplasia is graded from mild vulval intraepithelial neoplasia I (VIN I) to severe (VIN III).

4. Bartholin's glands are vulvovaginal glands that are located beneath the fascia at about 4 and 8 o'clock, respectively, on the posterolateral aspect of the vaginal orifice. Each lobulated, racemose gland is about the size of a pea. Histologically the gland is composed of cuboidal epithelium. The duct from each gland is lined by transitional epithelium and is approximately 2 cm in length. Bartholin's ducts open into a groove between the hymen and the labia minora. Bartholin's glands are homologous to Cowper's glands in the male. Cyst (arrows) of Bartholin's gland What is Bartholin’s gland?

5. Internal genitalia from a 20 year old woman who was killed in a motor vehicle accident. The ovary (arrows) is frequently cystic during the reproductive period of life and this is not an abnormal finding.

6. Atrophy of internal genitalia in a woman aged 74.

7. Cervical polyp (blue arrow). Uterine fibroids (black arrows). Woman aged 75.

8. Squamous cell carcinoma (arrows) of the cervix. Woman aged 24. Operative surgical specimen.

9. This is a photomicrograph of a biopsy of the uterine cervix. Beneath the squamous epithelium of the ectocervix (medium arrows) lies one of the mucus secreting glands of the endocervix(long arrow). There is some vacuolationaround the nuclei of the squamous epithelial cells. This is called ‘koilocytosis’ and is the hallmark of HPV infection. (arrow heads)

10. 7 Spectrum of cervical intraepithelial neoplasia: normal squamous epithelium for comparison; LSIL (CIN I) with koilocyticatypia; HSIL (CIN II) with progressive atypia and expansion of the immature basal cells above the lower third of the epithelial thickness; HSIL (CIN III) with diffuse atypia, loss of maturation, and expansion of the immature basal cells to the epithelial surface.

11. Name the pathology and the two complications (aside from uterus invasion)… Squamous cell carcinoma (blue arrows) of the cervix with extensive local spread. Woman aged 42 whose blood urea was over 50 mmolL shortly before death. Dilated bladder (black arrow) is present adjacent to the cervix and hydroureter can be seen on the back of the specimen. A loop of bowel has become attached to the superior aspect of the uterus.

12. Uterine prolapse. Ulceration of cervix (black arrow) and vagina. Bilateral hydroureter (blue arrows). Woman aged 78.

13. What are the blue, black and red arrows? Chronic pyometra (black arrows). Thrombosis of parauterine veins (red arrows). Small subserous fibroid (blue arrow). Female diabetic aged 67 who died of pulmonary embolism.

14. Which food is this condition named after? Ovarian endometriosis. The appearance here is known as a chocolate cyst. Operative surgical specimen. The distal half of the adjacent fallopian tube is included.

15. This is a cross section through a uterus. What is the pathology? This is a section through a uterus showing the normal endometrial lining (long arrows) together with foci of glands and stroma (short arrows) present within the myometrium, quite separate from the endometrium. This is an example of adenomyosis. Two horizontal sections through the uterus. The endometrial cavity is not seen here. Uterine adenomyosis (arrows). Patient aged 48.

16. Adenocarcinoma (arrows) of the endometrium in a woman aged 68. She had suffered from intermittent vaginal bleeding for 3 years. Benign endometrial polyp (arrows) in a woman aged 75. Match the histology!

17. Ruptured tubal ectopic pregnancy. Woman aged 37. Operative surgical specimen

18. This is a uterus with no pathology. When? Normal, full-term, post-partum uterus. Woman aged 31 with primary pulmonary hypertension who died soon after childbirth.

19. Placenta accreta (arrows). Hysterectomy performed following massive postpartum haemorrhage. Retained placental tissue prevents the uterus from contracting properly to occlude the bleeding vessels that result from the separation of the placenta. What is this post partum condition?

20. Hydatidiform mole in a woman aged 50; hysterectomy specimen. She sought medical advice because of colicky pain in the lower abdomen and back for 3 days and bleeding per vagina for one day. She had had her last menstrual period 13 weeks previously and there had been moderate morning sickness. Examination revealed a uterus the size of a 20 weeks' pregnancy. Note the distended uterus filled with grape- like vesicles and the absence of a foetus.

21. Multiple uterine leiomyomas ("fibroids") in a woman aged 49. Some are intramural (red arrows) and some are subserosal (blue arrows).

22. Pedunculated submucosal leiomyoma (arrows) which has been extruded through the cervical os. Note the acute inflammation and the ulceration of its surface. Woman aged 37 who complained of excessive menstrual bleeding for 18 months before hysterectomy was performed.