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Female genital system pathology Lec.1

Female genital system pathology Lec.1. Pathology of Vulva Include: 1. Vulvitis. 2. Non-Neoplastic Epithelial disorders (NNEDs). 3. Tumors of Vulva. Vulvitis: * Usually due to infections or non infectious dermatological causes. * The five most important infectious agents (STD) are:

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Female genital system pathology Lec.1

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  1. Female genital system pathologyLec.1

  2. Pathology of Vulva Include: 1. Vulvitis. 2. Non-Neoplastic Epithelial disorders (NNEDs). 3. Tumors of Vulva. Vulvitis: * Usually due to infections or non infectious dermatological causes. * The five most important infectious agents (STD) are: 1. Human papilloma virus (HPV) causes condylomata acuminate. 2. Herpes simplex (genitalis)---vesicular eruption. 3. Gonococcal infection. 4. Syphilis. 5. Candidiasis. Non Neoplastic Epithelial Disorders (NNEDs): Include: 1. Lichen sclerosus (atrophic thinning of vulvar mucosa). 2.Lichen simplex chronicus:(hyperplastic thickening of vulvar mucosa).

  3. both may coexist & both may appear grossly as depigmented white lesion (leukoplakia). differential diagnosis of NNEDs: 1. vetiligo. 2. Psoriasis &lichen planus. 3. Carcinoma insitu. 4. Paget's disease. 5. Invasive carcinoma. Tumors of vulva: Condylomas (Anogenital wart): 2 biological forms: 1. Condyloma lata: flat, moist, minimally elevated lesion occurs in secondary syphilis (RARE). 2. Condyloma acuminata:(commonst) Gross:papillary, elevated, commonly multiple ,few millimeters to many cm in diameter &are red pink to brown

  4. MIC:characteristic cellular morphology called koilocytosis (perinuclear cytoplasmic vaculation with nuclear angular pleomorphism), Koilocytosis is the hallmarks of HPV (6 &11). Vulvar Condylomas are not precancerous, but may coexist with foci of intraepithelial neoplasia in the vulva (VIN) & cervix (CIN). Carcinoma of vulva: Incidence: 3% of all genital cancers in women. Age: >60 years. Histological Type: 90% is squamous cell CA & are of 2 biological forms: 1. COMMONEST:seen in younger patients, cigarette smokers, associated with HPV16 &18 (90%), often precede by cancerous changes confined to epithelium (vulvar intraepithelial neoplasia VIN) by many years (can regress). In many cases coexist with vaginal or cervical carcinomas

  5. 2. Other:occurs in older females, not associated with HPV but preceded by NNEDs (lichen sclerosus), regression infrequent in this group. Morphology of vulvar carcinoma: Gross: VIN &early vulvar CA appear as area of leukoplakia (25% of cases are melanin pigmented), with time become advanced. Advances vulvar carcinoma: exophytic or ulcerative tumor. Mic: HPV positive tumors are multifocal &usually poorly differentiated squamous CA. HPV negative tumors are unifocal & well differentiated keratinizing \squamous CA . Pathology of Vagina Vaginitis:A common transient problem, producing vaginal discharge (leukorrhea). Causative organism: normal commensals (become pathogenic). Predisposing conditions: Diabetes, systemic antibiotic therapy, after abortion or pregnancy, elderly with compromise immune response &AIDS.

  6. Candida vaginitis: Type of discharge: cruddy white discharge. Causative agent: Candida albicans (commensal). Symptomatic infection occurs either due to deficient immunity or sexual transmission of new more aggressive strain. Trichomonas vaginitis: Type of discharge: watery copious gray green discharge in which the organism can identified microscopically in fresh specimens. Trichomonas present in 10% of asymptomatic women & so active infection usually represents a sexually transmitted new strain. In both above types of vaginitis the inflammation is limited to superficial squamous mucosa & sometimes to the submucosa. Vaginal tumors: Vaginal intraepithelial neoplasia & squamous cell carcinoma of vagina: uncommon malignancy, occur in females older than 60 yr. & may associated with concurrent or preexisting CA of cervix or vulva suggesting viral effect specially HPV.

  7. Pathology of Cervix Important notes on normal cervix: 1. Normal cervix consists of exocervix (lined by squamous epithelium), external os, endocervix (lined by mucus secreting columnar epithelium), & internal os. 2. During development, in most young women, there is downgrowth of the columnar epithelium below the external os which is called ectropion (means the squamocolumnar junction lies below the exocervix. In adult female, there is restoring of squamocolumnar at original site, this continuous regenerating region at squamocolumnar junction is called transformation zone. Such changes in the cervix epithelium results in change in PH of vagina & change in vaginal flora which predisposing to cervicitis.

  8. Cervicitis: Common clinical problem & associated with mucopurulent vaginal discharge. According to cytological examination of discharge, cervicitis divided into infectious &non infectious: (Differentiation between them is difficult because microorganisms are invariably present in the vagina with or without inflammation): Cervicitis represents a sexually transmitted disease because most of causative organisms are sexually transmitted including: (1) Chlamydia trachomatis (40% of cases). (2) Trichomonas vaginilis (3) Candida & Gonococci (4) Herpes simplex II (may transmitted to infants during passage through birth canal---serious or fatal systemic infection) (5)Human papiloma virus (HPV).

  9. Morphology of Cervicitis:cervicitis divided into specific & non specific. Then non specific cervicitis divided into acute & chronic Acute non specific cervicitis: in postpartum female & usually cause by staph. or strep. Chronic non specific cervicitis: Gross: red swelling & granularity around margin of external Os. MIC:Mono nuclear inflammation & inflammatory obstruction of cervical glands yield nobothian cyst. Cervical epithelium may show hyperplasia & reactive atypia (disorganization & nuclear alteration) &may depleted of their normal content of glycogen---false positive Schiller test (failure to take iodinate solution characteristic of CA). Clinical significance: (1) Cervicitis is not precancerous lesion, but secondary epithelial dysplastic changes in cervicitis are favorable soil for carcinogenic influences e.g HPV. (2) Severe cervicitis may lead to sterility through deformation & blocking of cervical os & produce unfavorable environment for sperms.

  10. Tumors of cervix: Endo cervical polyp: Inflammatory in origin. Gross: range up to few cms in diameter, soft, covered by smooth glistening surface. Mic: cystic dilated endocervical glands seen within edematous, inflamed & fibrotic stroma. The surface epithelium shows squamous metaplasia, these lesion may bleed but have no malignant potential.

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