870 likes | 1.7k Views
Female genital system. Dr. Amitabha Basu MD. Topic of this Lecture. Disease of Cervix, Vagina, Vulva Disease of endometrium Disease of uterus Disease of fallopian tube. Disease of Cervix. T-zone Cervicitis CIN Malignancy of cervix. Normal cervix. Histology: T zone .
E N D
Female genital system Dr. Amitabha Basu MD
Topic of this Lecture • Disease of Cervix, Vagina, Vulva • Disease of endometrium • Disease of uterus • Disease of fallopian tube
Disease of Cervix • T-zone • Cervicitis • CIN • Malignancy of cervix
Histology: T zone T zone : Junction between squamous and columnar epithelium. Most malignancy begin here.
Cervicitis • Types: • Etiology • Morphology • Clinical • Acute • Chronic Cervicitis
Etiology • Mostly non specific Cervicitis • Specific form: • C. trachomatis. • Trichomonous and Candida infection.
Chronic Cervicitis; Morphological features • Chronic inflammatory cells • Nabothian cyst. • Squamous metaplasia
C. Trachomatis Cervicitis • It produce follicular Cervicitis ( Plenty lymphocytes form FOLLICLES)
Clinical : Cervicitis • It can produce temporary Female infertility. • It provide a fertile soil for malignancy.
CIN = SIL • CIN = Cervical intraepithelial neoplasia Or, • SIN = Squamous intraepithelial neoplasia
CIN [ cervical intraepithelial neoplasia] • Etiology : Humane papilloma virus ( 16,18), or inflammation. CIN III = Carcinoma in situ = severe dysplasia = irreversible : progress to invasive squamous cell carcinoma
CIN I = Flat Condyloma; will show koilocytic change CIN I : lower 1/3 rd of the epithelium is Dysplastic
Koilocyte : Evidence of HPV infections HIGH POWER
Carcinoma In Situ = CIN III : Entire epithelium is involved.
Screening of dysplasia : PAP smear of the exfoliated cell from the cervix: Most important cause of reduced mortality in west.
Etiopathogenesis- CA cervix • Etiology : HPV type 16,18 • Age : Peak incidence 45 years • High risk group:- • Multiple sex partner • Early age of 1st intercourse. • Persistent infection with HIGH RISK HPV infection • A male partner with multiple previous sex partner.
Cervical carcinoma and HPV • Squamous cell carcinoma MOST COMMON by this infection. • Viral Oncogenes of HPV are • E6 (bind to TP53) and E7 ( bind to RB) • Cause inactivation of these two tumor suppressor genes.
Cervical carcinoma • Squamous cell carcinoma [ HPV 16, 18]- MOST COMMON • Clear cell carcinoma [ exposure to diethylstilbestrol (DES) ]. • Adenocarcinoma ( RARE) Rare thing : Think rarely
Clear cell carcinoma microscopy: Recall etiology Exposure to diethylstilbestrol (DES)
Clinical features of squamous cell carcinoma cervix • Dyspareunia. • Post coital bleeding. • Leucorrhoea. • Diagnosis: • Papanicolaou smear • Biopsy (cone) • Colposcopy.
Prognosis [ 5 year survival] • Stage 0 ( ca-in situ) = 100% • Stage 1( tumor confined to cervix)= 90% • Stage 2 = 82% • Stage 3 = 35% • Stage 4 ( tumor with distant metastasis)=10%
Disease of vagina • Sarcoma botroid • Effect of diethylstilbestrol (DES) during pregnancy. • Vaginal adenosis • Clear cell carcinoma of vagina
Sarcoma botroid • Age : 0-5 years • Type of malignancy : Embryonal rhabdomyosarcoma “Rare form” of Primary vaginal malignancy
Clear cell carcinoma of vagina Common in the young girls whose mother took diethylstilbestrol (DES) during pregnancy.
Vulval disease • Extra mammary pagets disease • Gross: crushed rash • Micro: intraepithelial malignant cells and intraepithelial spread. • Condyloma acuminatum • Wart like, HPV 6, 11 • Micro: koilocytic change, hyperkeratois.
Vulval disease • Lichen atrophicus • Thinning of the epidermis , dermal fibrosis, scant lymphocytes. • Pre-cancerous lesion.
Disease of uterus • Endometritis • Adenomyosis • Endometriosis • Endometrial Hyperplasia.
Endometritis Clinical Feature: infertility and dysmenorrhea
Endometrial tissue deep in the myometrium of uterus. Gross : enlargement of uterus Clinical : irregular profuse menstruation Dysmenorrhea , menorrhagia Adenomyosis
Adenomyosis Normal Endo-myometrium reaction Adenomyosis: Uterus enlarged
Adenomyosis : Enlarged Uterus Clinical d/d : Fibroid C/F : irregular profuse menstruation (Dysmenorrhea , menorrhagia )
Endometriosis • Location • Pathogenesis • Pathophysiology • Chocolate cyst ( endometriosis of Ovary) • Clinical Features
Endometriosis • Endometrial tissue ( BOTH GLAND AND STROMA ) in any place out side the uterus. Ovary or other tissue
Endometriosis: location And : Laparoscopic Scar ( during caesarian section).
Endometriosis: pathogenesis • Metapalstic Differentiation of • Celomic Epithelium. • Lymphatic dissemination. • Regurgitation of endometrial fluid to ovary. • Dissemination throughpelvic vein.
Endometriosis: Pathophysiology • In this case Endometrial glands respond to the cyclical change of Hormone. • So, it bleeds along with menstruation. • And produce hemorrhage at the site of endometriosis. Uterus Ovary
Gross • Red – blue nodule at the site of implant. • Ovary: • Produce chocolate cyst (hemosiderin) • In ovary it occurs due to regurgitation of endometrial fluid in fallopian tube.
Chocolate cyst of the ovary = endometriosis of ovary: Regurgitation of endometrial fluid to ovary.