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Diseases of the female genital system and breast. Anatomy of female genital system. Diseases of female genital system. Diseases of the cervix Diseases of body of uterus Diseases of pregnancy Tumors of the ovary Diseases of the breast. Normal cervix. Normal cervix.

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Diseases of female genital system
Diseases of female genital system

  • Diseases of the cervix

  • Diseases of body of uterus

  • Diseases of pregnancy

  • Tumors of the ovary

  • Diseases of the breast



Normal cervix

Squamocoluminar junction is the seat of most of the epithelial diseases that occur in the cervix


Diseases of the cervix
Diseases of the cervix

  • Chronic cervicitis

  • Neoplasia of the cervix


Chronic cervicitis

Erosion of cervix


Chronic cervicitis

Nabothian cyst




Diseases of the cervix1
Diseases of the cervix

  • Chronic cervicitis

  • Neoplasia of the cervix


Neoplasia of the cervix

Cervical intraepithelial neoplasia(CIN)

Invasive carcinoma of the cervix

Neoplasia of the cervix


CIN

CIN I

CIN II

CIN III





Risk factors for cin and invasive carcinoma
Risk factors for CIN and invasive carcinoma

  • Sexual intercourse

  • Early age at first intercourse(≤ 17 years old)

  • Smoking

  • Human papillomavirus (HPV 16, 18, 33)

  • HIV infection

  • Male factors


Neoplasia of the cervix1

Cervical intraepithelial neoplasia(CIN)

Invasive carcinoma of the cervix

Neoplasia of the cervix


Invasive carcinoma of the cervix
Invasive carcinoma of the cervix

  • Vast majority are squamous cell carcinomas

  • Arise from transformation zone

  • Preceded by CIN

  • Average is 50 years



Cervical carcinoma (early stage)

Abnormal hardness of the cervix


Cervical carcinoma ( late stage)

Fungating ulcerated areas destroy the cervix




Clinical feature
Clinical feature

  • Unscheduled vaginal bleeding

  • Leukorrhea

  • Painful coitus (dyspareunia)

  • Dysuria (advanced stage)


Prognosis

The size and depth of invasion of the primary tumor

The prescence and the extent of lymph node metastasis

Prognosis


Outline of female genital system
Outline of female genital system

  • Diseases of the cervix

  • Diseases of body of uterus

  • Diseases of pregnancy

  • Tumors of the ovary

  • Diseases of the breast


Diseases of body of uterus
Diseases of body of uterus

  • Adenomyosis

  • Endometriosis

  • Endometrial hyperplasia

  • Tumors of the endometrium and myometrium


Adenomyosis and endometriosis

Adenomyosis: growth of endometrium down into the myometrium

Endometriosis: growth of endometrium outside the uterus

Adenomyosis and endometriosis

ovaries

fallopian tubes

round ligaments

pelvic peritoneum





Chocolate cyst of the ovary
Chocolate” cyst of the ovary


Clinical feature1

Menstrual abnormalities

dysmenorrhea

Cyclic pelvic pain

Dysmenorrhea

Dyspareunia (painful intercourse)

Infertility(30% of cases)

Clinical feature

Adenomyosis

Endometriosis


Diseases of body of uterus1
Diseases of body of uterus

  • Adenomyosis

  • Endometriosis

  • Endometrial hyperplasia

  • Tumors of the endometrium and myometrium


Endometrial hyperplasia
Endometrial hyperplasia

  • Occurs in the third and fourth decades

  • In response to estrogen stimulation

  • Functional uterine bleeding



Diseases of body of uterus2
Diseases of body of uterus

  • Adenomyosis

  • Endometriosis

  • Endometrial hyperplasia

  • Tumors of the endometrium and myometrium


Tumors of the endometrium
Tumors of the endometrium

Tumors of the myometrium

  • Endometrial carcinoma

  • Leiomyoma and leiomyosarcoma


Endometrial carcinoma
Endometrial carcinoma

  • The most common cancer of the female genital tract

  • Mean age : 56 years (80% of women are postmenopausal)


Risk factors

Hyperestrogenic state

Obesity

Diabetes

Late menopause

Prolonged use of estrogen

Estrogen-secreting tumors

Risk factors

  • Previous pelvic irradiation

  • Lower parity





Clinical feature2
Clinical feature

  • Irregular bleeding

  • Postmenopausal bleeding

  • Blood-stained discharge


Diagnosis of endometrial disease
Diagnosis of endometrial disease

  • Transvaginal ultrasonography

  • Hysteroscopy

  • Endometrial biopsy


Tumors of myometrium
Tumors of myometrium

  • Leiomyoma and leiomyosarcoma


Leiomyoma
Leiomyoma

  • Commonest tumor of all pelvic tumors (affect over half of all women over the age of 30)

  • Benign tumor

  • Arise from the smooth muscle cells in the myometrium


Risk factors1
Risk factors

  • Age: rare under 30 years.

  • Parity: more common in nulliparous and women with low fertility.

  • Genetic: often with a family history


Features of leiomyoma
Features of leiomyoma

  • Estrogen sensitive

  • Fast growing in pregnancy

  • Shrink at menopause





Clinical features
Clinical features

  • Abnormal menstrual bleeding

  • Dysmenorrhea

  • Infertility

  • Compression




Outline of female genital system1
Outline of female genital system

  • Diseases of the cervix

  • Diseases of body of uterus

  • Diseases of pregnancy

  • Tumors of the ovary

  • Diseases of the breast


Diseases of pregnancy

Gestational trophoblastic tumors

Hydatidiform mole

Invasive mole

Diseases of pregnancy

  • Choriocarcinoma


Hydatidiform mole
Hydatidiform mole

  • Chracterised by swollen chorionic villi and trophoblastic hyperplasia

  • Associated with high HCG levels

  • Complete mole: no fetus

  • Partial mole: fetus or placenta may be present

  • May be complicated by chriocarcinoma






Clinical feature3
Clinical feature

  • Amenorrhea followed by continuous or intermittent vaginal bleeding

  • Other symptoms of pregnancy: vomoting

  • Human chorionic gonadotropian (HCG)

  • Enlarged soft uterus (often larger than dates would suggest)


Invasive mole

Hemorrhage


Choriocarcinoma
Choriocarcinoma

  • Malignant tumor of trophoblastic tissue

  • With a propensity for invading vessel walls

  • Blood-borne metastasis occur early to many sites (lung, brain…)


Etiology
Etiology

  • 50% develop from a hydatidiform mole

  • 20% arise after a normal pregnancy


Choriocarcinoma

Hemorrhagic necrotic masses


Choriocarcinoma

Villi are not present

Proliferation of bizarre trophoblastic cells

Highly aggressive


Choriocarcinoma

Dissemination to lung


Prognosis1
Prognosis

  • Excellent as the tumors respond well to cytotoxic chemotherapy


Outline of female genital system2
Outline of female genital system

  • Diseases of the cervix

  • Diseases of body of uterus

  • Diseases of pregnancy

  • Tumors of the ovary

  • Diseases of the breast



Tumors of the ovary
Tumors of the ovary

  • Responsible for more deaths than any other gynaecological malignancy









Outline of female genital system3
Outline of female genital system tract)

  • Diseases of the cervix

  • Diseases of body of uterus

  • Diseases of pregnancy

  • Tumors of the ovary

  • Diseases of the breast



Key facts for proliferative conditions of the breast
Key facts for tract)proliferative conditions of the breast

  • Present as diffuse granularity, ill-defined lump or discrete swelling

  • Increased in frequency towards menopause, then rapid decrease

  • Variety of histological changes




Key facts fibrocystic disease
Key facts tract)Fibrocystic disease

  • Increased risk of subsequent development of carcinoma is related to the presence of epithelial hyperplasia, particularly atypical hyperplasia

  • Sclerosing adenosis can be clinically and radiologically confused with carcinoma


Predisposing factors for breast carcinoma
Predisposing factors tract)for breast carcinoma

  • Atypical epithelial proliferation

  • Mutations of BRCA 1 and 2 genes

  • Long interval between menarche and menopause

  • Older age at first pregnancy

  • Obesity

  • High-fat diet

  • Lonizing radiation



Carcinoma tract)

Fibroadenoma


Paget tract)’s disease


Prognosis2
Prognosis tract)

  • Tumor grade and type

  • Size of the tumor

  • Lymph node status

  • Estrogen receptor status





Diagnostic methods
Diagnostic methods tract)

  • Fine-needle aspiration cytology

  • Tru-cut biopsy

  • Examination of frozen section

  • Mammography and ultrasound




Diagnostic methods1
Diagnostic methods tract)

  • Fine-needle aspiration cytology

  • Tru-cut biopsy

  • Examination of frozen section

  • Mammography and ultrasound


Case study
Case study tract)

  • A 35-year-old sales assistant at a discount frozen-food warehouse, attends her doctor for a routine cervical smear. She is asymptomatic and well, but has not visited her doctor for the previous five years and has not had a smear in that time.

  • The cervical cytological report shows severe dyskarosis.


  • She is recalled and has colposcopy performed which demonstrates the abnormal area of the cervical squamous epithelium which is biopsied. The changes seen colposcopically extend up the endocervical canal, and the upper margin of the abnormality can not be seen.

  • Histology shows that this is indeed an area of CIN (cervical intraepithelial neoplasia) grade 3, at the transformation zone, with atypical cells extending through the full thickness of the epithelium and showing no maturation towards the surface.


  • Mitotic figures, including abnormal forms, are present through all layers. There is no evidence of invasion in the biopsy.

  • She then has a cone biopsy performed. This confirms that CIN 3 is present at the transformation zone. There is no evidence of invasive squamous-cell carcinoma, no glandular atypia and the sever atypia is completely excised at both ecto- and endocervical margins.


Questions
Questions through all layers. There is no evidence of invasion in the biopsy.

  • If she had not had the disease identified by screening what would have been her risk of developing invasive cervical carcinoma?


Questions1
Questions through all layers. There is no evidence of invasion in the biopsy.

  • What are the risk factors for developing cervical carcinoma?


Diseases of reproductive system
Diseases of reproductive system through all layers. There is no evidence of invasion in the biopsy.

  • Diseases of male reproductive system

  • Sexually transmitted disease (STD)

  • Diseases of female reproductive system


Male reproductive system through all layers. There is no evidence of invasion in the biopsy.


Normal prostate through all layers. There is no evidence of invasion in the biopsy.


Normal prostate through all layers. There is no evidence of invasion in the biopsy.


Normal adult prostate through all layers. There is no evidence of invasion in the biopsy.


Diseases of prostate gland
Diseases of prostate gland through all layers. There is no evidence of invasion in the biopsy.

  • Prostatitis

  • Nodular hyperplasia of the prostate

  • Carcinoma of the prostate


Chronic prostatis through all layers. There is no evidence of invasion in the biopsy.


Nodular hyperplasia of the prostate
Nodular hyperplasia of the prostate through all layers. There is no evidence of invasion in the biopsy.

  • The most common disorder of the prostate

  • A common non-neoplastic lesion

  • Often involves peri-urethral zone


Nodular hyperplasia of the prostate1
Nodular hyperplasia of the prostate through all layers. There is no evidence of invasion in the biopsy.

  • Nodular hyperplasia affects most males over the age of 70 years

  • Nodular hyperplasia is termed glandular and stromal hyperplasia


Etiology1
Etiology through all layers. There is no evidence of invasion in the biopsy.

  • Androgen-estrogen imblance

  • Dehydrotesterone (DHT) is the main stimulator

  • DHT binds to nuclear receptors on both stromal and epithelial cells

  • Other factors


Affected lobes
Affected lobes through all layers. There is no evidence of invasion in the biopsy.

  • Arises most commonly in the inner, periurethral glands of the prostate

  • Arises particularly from those that lie above the seminal vesicles


Gross feature
Gross feature through all layers. There is no evidence of invasion in the biopsy.

  • Nodular pattern of hyperplastic glandular acini separated by fibrous stroma

  • Some nodules are cystically dilated and contain a milky fluid

  • Other nodules contain numerous calcific concretions(corpora amylacea)


Nodular prostatic hyperplasia through all layers. There is no evidence of invasion in the biopsy.

Normal prostate gland


Nodular prostatic hyperplasia through all layers. There is no evidence of invasion in the biopsy.


Histological feature
Histological feature through all layers. There is no evidence of invasion in the biopsy.

  • Reveals two components: hyperplasia of both glands and of stroma

  • The acini are larger than normal


Prostatic hyperplasia through all layers. There is no evidence of invasion in the biopsy.


Prostatic hyperplasia through all layers. There is no evidence of invasion in the biopsy.


Clinical presentation
Clinical presentation through all layers. There is no evidence of invasion in the biopsy.

  • Compression of the urethra difficulties with micturition

  • Complications- prolonged prostatic obstruction can lead to outflow diseases


Acute cystitis through all layers. There is no evidence of invasion in the biopsy.


Trabeculation of the bladder through all layers. There is no evidence of invasion in the biopsy.

Stone formation

Enlarged prostate gland


Treatment
Treatment through all layers. There is no evidence of invasion in the biopsy.

  • Anti-androgens

  • Surgical treatment


Prostate gland
Prostate gland through all layers. There is no evidence of invasion in the biopsy.

  • Prostatitis

  • Nodular hyperplasia of the prostate

  • Carcinoma of the prostate


PIN (prostatic intraepithelial neoplasia) low grade through all layers. There is no evidence of invasion in the biopsy.


PIN (high grade) through all layers. There is no evidence of invasion in the biopsy.


Prostatic carcinoma
Prostatic carcinoma through all layers. There is no evidence of invasion in the biopsy.

  • Adenocarcinoma occurring in males usually > 50 years (peak incidence: 60-85 years)

  • Metastasis mainly to bone (osteosclerotic metastasis)

  • Obstructs bladder outflow

  • Many are hormone(androgen)-dependent

  • Genetic and environmental factors may play a role in pathogenesis


Types of prostatic carcinoma
Types of prostatic carcinoma through all layers. There is no evidence of invasion in the biopsy.

  • Latent- small foci of well-differentiated carcinoma, remain confined to prostate for a long period

  • Invasive- invade locally and metastasize

  • Occult- not clinically apparent in primary site but present as metastatic disease


Prostatic carcinoma through all layers. There is no evidence of invasion in the biopsy.


Adenocarcinoma of the prostate through all layers. There is no evidence of invasion in the biopsy.

Well differentiated

Poorly differentiated


Prostatic adenocarcinoma through all layers. There is no evidence of invasion in the biopsy.withprominent nucleoli


Carcinoma of the prostate through all layers. There is no evidence of invasion in the biopsy.


PSA staining of prostate carcinoma through all layers. There is no evidence of invasion in the biopsy.


Clinical feature4
Clinical feature through all layers. There is no evidence of invasion in the biopsy.

  • Often clinically silent

  • Urinary symptoms (delay in starting to pass urine, poor stream, terminal dribbling)

  • Hard, craggy prostate on rectal examination


Spread of prostatic carcinoma
Spread of prostatic carcinoma through all layers. There is no evidence of invasion in the biopsy.

  • Direct

  • Lymphatic

  • Hematogenic: most commonly to bone


Bone metastasis of prostatic carcinoma through all layers. There is no evidence of invasion in the biopsy.


Treatment1
Treatment through all layers. There is no evidence of invasion in the biopsy.

  • Radical prostatectomy

  • Reduce androgen levels

  • Orchidectomy

  • Treatment with estrogenic drugs


Squamous carcinoma of the penis through all layers. There is no evidence of invasion in the biopsy.


Squamous carcinoma of the penis through all layers. There is no evidence of invasion in the biopsy.


Germ cell neoplasms
Germ cell neoplasms through all layers. There is no evidence of invasion in the biopsy.

  • Most common types of testicular neoplasm

  • Most common in the 15 to 34 age range

  • Types:

  • Seminoma (malignant)

  • Embryonal carcinoma (malignant)

  • Teratoma (benign and malignant)

  • Yolk sac tumor (malignant)


Seminoma of the testis through all layers. There is no evidence of invasion in the biopsy.


Seminoma through all layers. There is no evidence of invasion in the biopsy.


Embryonal carcinoma through all layers. There is no evidence of invasion in the biopsy.


Teratoma through all layers. There is no evidence of invasion in the biopsy.


Yolk sac tumor through all layers. There is no evidence of invasion in the biopsy.


Outline
Outline through all layers. There is no evidence of invasion in the biopsy.

  • Diseases of male reproductive system

  • Sexually transmitted disease(STD)


Classical veneral diseases
Classical veneral diseases through all layers. There is no evidence of invasion in the biopsy.

  • Syphilis

  • Gonorrhea

  • Chancroid

  • Lymphogranuloma venereum

  • Granuloma inguinale


Sexually transmitted diseases std
Sexually transmitted diseases (STD) through all layers. There is no evidence of invasion in the biopsy.

  • Spectrum has broadened

  • Transmitted by sexual contact

  • Transmitted by other means


Classification of important STDs through all layers. There is no evidence of invasion in the biopsy.


Sexually transmitted disease std
Sexually transmitted disease(STD) through all layers. There is no evidence of invasion in the biopsy.

  • Gonorrhea

  • Syphilis

  • Condylomata acuminata


Gonorrhea
Gonorrhea through all layers. There is no evidence of invasion in the biopsy.

  • Causative organism: Neisseria gonorrheae

  • Almost always acqiured during sexual intercourse

  • Morphology: intense suppurative inflammation


Neisseria gonorrheae through all layers. There is no evidence of invasion in the biopsy.


Gonorrhea through all layers. There is no evidence of invasion in the biopsy.

Purulent urethral discharge


Abscess of epididymitis through all layers. There is no evidence of invasion in the biopsy.


Gonorrhea through all layers. There is no evidence of invasion in the biopsy.

Purulent infection of eye


Clinical feature5
Clinical feature through all layers. There is no evidence of invasion in the biopsy.

  • Presence of dysuria

  • Urinary frequency

  • Mucopurulent urethral or vaginal exudate


Complication
Complication through all layers. There is no evidence of invasion in the biopsy.

  • Disseminated infection

  • Chronic stricture

  • Chronic scarring of fallopian tubes (salpingitis)

  • Chronic urethral stricture

  • Male sterility

  • Female infertility


Neonatal gonorrhea through all layers. There is no evidence of invasion in the biopsy.

Transmitted to infants

Ophthalmia neonatorum

Blindness


Standard for diagnosis
Standard for diagnosis through all layers. There is no evidence of invasion in the biopsy.

  • Detection of gonococci

Bacterial culture


Syphilis
Syphilis through all layers. There is no evidence of invasion in the biopsy.

  • Causative organism:Treponema pallidum, a kind of spirochete

  • Almost always acqiured during sexual intercourse


Pathological change
Pathological change through all layers. There is no evidence of invasion in the biopsy.

  • Infiltration of lymphocytes and plasma cells

  • Endoarteritis

  • Gumma ( a kind of granuloma)


Histological feature through all layers. There is no evidence of invasion in the biopsy.


Clinicopathological feature
Clinicopathological feature through all layers. There is no evidence of invasion in the biopsy.

  • Acquired syphilis

  • Congenital syphilis


Acquired syphilis
Acquired syphilis through all layers. There is no evidence of invasion in the biopsy.

  • Primary stage

  • Secondary stage

  • Tertiary stage


Primary stage through all layers. There is no evidence of invasion in the biopsy.

Chancre


Secondary stage through all layers. There is no evidence of invasion in the biopsy.

Lymphode enlargement

Syphilid


Systemic involement in tertiary syphilis through all layers. There is no evidence of invasion in the biopsy.

Gumma formation


Tertiary stage through all layers. There is no evidence of invasion in the biopsy.

Gumma


Clinicopathological feature1
Clinicopathological feature through all layers. There is no evidence of invasion in the biopsy.

  • Acquired syphilis

  • Congenital syphilis


Congenital syphilis
Congenital syphilis through all layers. There is no evidence of invasion in the biopsy.

  • Syphilitic hepatitis

  • Syphilitic pneumonia

  • Desquamation of skin

Early death

  • Osteochondritis

  • Perichondritis

Bone deformities


Malformation of the teeth through all layers. There is no evidence of invasion in the biopsy.

Saddle nose


Sexually transmitted disease std1
Sexually transmitted disease(STD) through all layers. There is no evidence of invasion in the biopsy.

  • Gonorrhea

  • Syphilis

  • Condylomata acuminata


Condylomata acuminata veneral warts
Condylomata acuminata (veneral warts) through all layers. There is no evidence of invasion in the biopsy.

  • Causative organism:Human papillomavirus(HPV)6,11

  • Spread of infection

Sexal intercourse

Indirect contact


Condylomata acuminata through all layers. There is no evidence of invasion in the biopsy.


Condylomata acuminata through all layers. There is no evidence of invasion in the biopsy.

Koliocytosis


Gold criteria for diagnosis through all layers. There is no evidence of invasion in the biopsy.

In situhybridization (ISH)

Electronmicroscopy


Suggested reading through all layers. There is no evidence of invasion in the biopsy.


Case study1
Case study through all layers. There is no evidence of invasion in the biopsy.

  • A 74-year-old retired fruit-farm labourer says that he has been feeling unusually tired and has lost his appetite. Initial blood tests show that he is anemic, with an Hb of 9.8g/dl and has renal failure with a blood urea of 26mmol/l and a creatinine of 280mmol/l.On further enquiry, you find out that he has had a poor urinary system, with some frequency, nocturia and a post-micturitional dribble.


Physical examination
Physical examination through all layers. There is no evidence of invasion in the biopsy.

  • Rectal examination reveals a rubbery, firm, smooth enlargement of the prostate gland. Further investigations include an intravenous urogram (IVU) which showed both kidneys to be functioning but also showed bilateral hydronephrosis with hydroureter.


Questions2
Questions through all layers. There is no evidence of invasion in the biopsy.

  • what is the most likely diagnosis?


Questions3
Questions through all layers. There is no evidence of invasion in the biopsy.

  • what further tests may be helpful?


Questions4
Questions through all layers. There is no evidence of invasion in the biopsy.

  • what abnormality is seen in the bladder?


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