Diseases of the female genital system and breast
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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 the female genital system and breast

Diseases of the female genital system and breast


Diseases of the female genital system and breast

Anatomy of female genital system


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


Diseases of the female genital system and breast

Normal cervix


Diseases of the female genital system and 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


Diseases of the female genital system and breast

Chronic cervicitis

Erosion of cervix


Diseases of the female genital system and breast

Chronic cervicitis

Nabothian cyst


Diseases of the female genital system and breast

Cervical polyps


Diseases of the female genital system and breast

Chronic cervicitis


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


Diseases of the female genital system and breast

CIN

CIN I

CIN II

CIN III


Diseases of the female genital system and breast

Normal cervical squamous epithelium

CIN I


Diseases of the female genital system and breast

CIN II


Diseases of the female genital system and breast

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 microinvasion

Cervical carcinoma (early microinvasion)


Diseases of the female genital system and breast

Cervical carcinoma (early stage)

Abnormal hardness of the cervix


Diseases of the female genital system and breast

Cervical carcinoma ( late stage)

Fungating ulcerated areas destroy the cervix


Diseases of the female genital system and breast

Pap smear ( diagnostic cervical cytology)


Diseases of the female genital system and breast

Invasive carcinoma of 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


Diseases of the female genital system and breast

Adenomyosis and endometriosis


Adenomyosis

Adenomyosis


Diseases of the female genital system and breast

Endometriosis (uterine serosa)


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 the female genital system and breast

Endometrial hyperplasia


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


Diseases of the female genital system and breast

Endometrial carcinoma (early stage)


Diseases of the female genital system and breast

Endometrial carcinoma


Diseases of the female genital system and breast

Endometrial adenocarcinoma


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


Diseases of the female genital system and breast

Submucosal leiomyoma


Diseases of the female genital system and breast

Submucosal, intramural, subserosal leiomyomas


Diseases of the female genital system and breast

Leiomyoma


Clinical features

Clinical features

  • Abnormal menstrual bleeding

  • Dysmenorrhea

  • Infertility

  • Compression


Diseases of the female genital system and breast

Leiomyosarcoma


Diseases of the female genital system and breast

Leiomyosarcoma


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


Complete mole

Complete mole


Diseases of the female genital system and breast

Hydatidiform mole


Diseases of the female genital system and breast

Doppler scan


Diseases of the female genital system and breast

Partial mole


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)


Diseases of the female genital system and breast

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


Diseases of the female genital system and breast

Choriocarcinoma

Hemorrhagic necrotic masses


Diseases of the female genital system and breast

Choriocarcinoma

Villi are not present

Proliferation of bizarre trophoblastic cells

Highly aggressive


Diseases of the female genital system and breast

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


Diseases of the female genital system and breast

Classification of ovarian tumor


Tumors of the ovary

Tumors of the ovary

  • Responsible for more deaths than any other gynaecological malignancy


Diseases of the female genital system and breast

Serous cystadenoma


Diseases of the female genital system and breast

Serous papillary cystadenoma


Diseases of the female genital system and breast

Serous adenocarcinoma


Diseases of the female genital system and breast

Mucinous cystadenoma


Diseases of the female genital system and breast

Mucinous adenocarcinoma


Krukenberg tumor metastatic carcinoma from gastrointestinal tract

Krukenberg tumor (metastatic carcinoma from gastrointestinal tract)


Krukenberg tumor metastatic carcinoma from gastrointestinal tract1

Krukenberg tumor (metastatic carcinoma from gastrointestinal tract)


Outline of female genital system3

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 the female genital system and breast

Normal breast


Key facts for proliferative conditions of the breast

Key facts forproliferative 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


Diseases of the female genital system and breast

Fibrocystic changes


Diseases of the female genital system and breast

Fibrocystic changes


Key facts fibrocystic disease

Key facts 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 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


Diseases of the female genital system and breast

Breast carcinoma


Diseases of the female genital system and breast

Carcinoma

Fibroadenoma


Diseases of the female genital system and breast

Paget’s disease


Prognosis2

Prognosis

  • Tumor grade and type

  • Size of the tumor

  • Lymph node status

  • Estrogen receptor status


Diseases of the female genital system and breast

Estrogen receptror staining


Diseases of the female genital system and breast

Progesterone receptor staining


Diseases of the female genital system and breast

Cerb-B2 staining


Diagnostic methods

Diagnostic methods

  • Fine-needle aspiration cytology

  • Tru-cut biopsy

  • Examination of frozen section

  • Mammography and ultrasound


Fine needle aspiration

Fine Needle Aspiration


Diseases of the female genital system and breast

Fine needle aspiration under control of mammography


Diagnostic methods1

Diagnostic methods

  • Fine-needle aspiration cytology

  • Tru-cut biopsy

  • Examination of frozen section

  • Mammography and ultrasound


Case study

Case study

  • 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.


Diseases of the female genital system and breast

  • 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.


Diseases of the female genital system and breast

  • 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

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


Questions1

Questions

  • What are the risk factors for developing cervical carcinoma?


Diseases of reproductive system

Diseases of reproductive system

  • Diseases of male reproductive system

  • Sexually transmitted disease (STD)

  • Diseases of female reproductive system


Diseases of the female genital system and breast

Male reproductive system


Diseases of the female genital system and breast

Normal prostate


Diseases of the female genital system and breast

Normal prostate


Diseases of the female genital system and breast

Normal adult prostate


Diseases of prostate gland

Diseases of prostate gland

  • Prostatitis

  • Nodular hyperplasia of the prostate

  • Carcinoma of the prostate


Diseases of the female genital system and breast

Chronic prostatis


Nodular hyperplasia of the prostate

Nodular hyperplasia of the prostate

  • 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

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

  • Nodular hyperplasia is termed glandular and stromal hyperplasia


Etiology1

Etiology

  • 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

  • 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

  • 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)


Diseases of the female genital system and breast

Nodular prostatic hyperplasia

Normal prostate gland


Diseases of the female genital system and breast

Nodular prostatic hyperplasia


Histological feature

Histological feature

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

  • The acini are larger than normal


Diseases of the female genital system and breast

Prostatic hyperplasia


Diseases of the female genital system and breast

Prostatic hyperplasia


Clinical presentation

Clinical presentation

  • Compression of the urethra difficulties with micturition

  • Complications- prolonged prostatic obstruction can lead to outflow diseases


Diseases of the female genital system and breast

Acute cystitis


Diseases of the female genital system and breast

Trabeculation of the bladder

Stone formation

Enlarged prostate gland


Treatment

Treatment

  • Anti-androgens

  • Surgical treatment


Prostate gland

Prostate gland

  • Prostatitis

  • Nodular hyperplasia of the prostate

  • Carcinoma of the prostate


Diseases of the female genital system and breast

PIN (prostatic intraepithelial neoplasia) low grade


Diseases of the female genital system and breast

PIN (high grade)


Prostatic carcinoma

Prostatic carcinoma

  • 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

  • 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


Diseases of the female genital system and breast

Prostatic carcinoma


Diseases of the female genital system and breast

Adenocarcinoma of the prostate

Well differentiated

Poorly differentiated


Diseases of the female genital system and breast

Prostatic adenocarcinomawithprominent nucleoli


Diseases of the female genital system and breast

Carcinoma of the prostate


Diseases of the female genital system and breast

PSA staining of prostate carcinoma


Clinical feature4

Clinical feature

  • 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

  • Direct

  • Lymphatic

  • Hematogenic: most commonly to bone


Diseases of the female genital system and breast

Bone metastasis of prostatic carcinoma


Treatment1

Treatment

  • Radical prostatectomy

  • Reduce androgen levels

  • Orchidectomy

  • Treatment with estrogenic drugs


Diseases of the female genital system and breast

Squamous carcinoma of the penis


Diseases of the female genital system and breast

Squamous carcinoma of the penis


Germ cell neoplasms

Germ cell neoplasms

  • 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)


Diseases of the female genital system and breast

Seminoma of the testis


Diseases of the female genital system and breast

Seminoma


Diseases of the female genital system and breast

Embryonal carcinoma


Diseases of the female genital system and breast

Teratoma


Diseases of the female genital system and breast

Yolk sac tumor


Outline

Outline

  • Diseases of male reproductive system

  • Sexually transmitted disease(STD)


Classical veneral diseases

Classical veneral diseases

  • Syphilis

  • Gonorrhea

  • Chancroid

  • Lymphogranuloma venereum

  • Granuloma inguinale


Sexually transmitted diseases std

Sexually transmitted diseases (STD)

  • Spectrum has broadened

  • Transmitted by sexual contact

  • Transmitted by other means


Diseases of the female genital system and breast

Classification of important STDs


Sexually transmitted disease std

Sexually transmitted disease(STD)

  • Gonorrhea

  • Syphilis

  • Condylomata acuminata


Gonorrhea

Gonorrhea

  • Causative organism: Neisseria gonorrheae

  • Almost always acqiured during sexual intercourse

  • Morphology: intense suppurative inflammation


Diseases of the female genital system and breast

Neisseria gonorrheae


Diseases of the female genital system and breast

Gonorrhea

Purulent urethral discharge


Diseases of the female genital system and breast

Abscess of epididymitis


Diseases of the female genital system and breast

Gonorrhea

Purulent infection of eye


Clinical feature5

Clinical feature

  • Presence of dysuria

  • Urinary frequency

  • Mucopurulent urethral or vaginal exudate


Complication

Complication

  • Disseminated infection

  • Chronic stricture

  • Chronic scarring of fallopian tubes (salpingitis)

  • Chronic urethral stricture

  • Male sterility

  • Female infertility


Diseases of the female genital system and breast

Neonatal gonorrhea

Transmitted to infants

Ophthalmia neonatorum

Blindness


Standard for diagnosis

Standard for diagnosis

  • Detection of gonococci

Bacterial culture


Syphilis

Syphilis

  • Causative organism:Treponema pallidum, a kind of spirochete

  • Almost always acqiured during sexual intercourse


Pathological change

Pathological change

  • Infiltration of lymphocytes and plasma cells

  • Endoarteritis

  • Gumma ( a kind of granuloma)


Diseases of the female genital system and breast

Histological feature


Clinicopathological feature

Clinicopathological feature

  • Acquired syphilis

  • Congenital syphilis


Acquired syphilis

Acquired syphilis

  • Primary stage

  • Secondary stage

  • Tertiary stage


Diseases of the female genital system and breast

Primary stage

Chancre


Diseases of the female genital system and breast

Secondary stage

Lymphode enlargement

Syphilid


Diseases of the female genital system and breast

Systemic involement in tertiary syphilis

Gumma formation


Diseases of the female genital system and breast

Tertiary stage

Gumma


Clinicopathological feature1

Clinicopathological feature

  • Acquired syphilis

  • Congenital syphilis


Congenital syphilis

Congenital syphilis

  • Syphilitic hepatitis

  • Syphilitic pneumonia

  • Desquamation of skin

Early death

  • Osteochondritis

  • Perichondritis

Bone deformities


Diseases of the female genital system and breast

Malformation of the teeth

Saddle nose


Sexually transmitted disease std1

Sexually transmitted disease(STD)

  • Gonorrhea

  • Syphilis

  • Condylomata acuminata


Condylomata acuminata veneral warts

Condylomata acuminata (veneral warts)

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

  • Spread of infection

Sexal intercourse

Indirect contact


Diseases of the female genital system and breast

Condylomata acuminata


Diseases of the female genital system and breast

Condylomata acuminata

Koliocytosis


Diseases of the female genital system and breast

Gold criteria for diagnosis

In situhybridization (ISH)

Electronmicroscopy


Diseases of the female genital system and breast

Suggested reading


Case study1

Case study

  • 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

  • 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

  • what is the most likely diagnosis?


Questions3

Questions

  • what further tests may be helpful?


Questions4

Questions

  • what abnormality is seen in the bladder?


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