生殖系统疾病

1. 生殖系统疾病 • 1 子宫颈疾病 • 2 子宫体疾病 • 3 妊娠滋养层细胞疾病 • 4 卵巢疾病 Zhu keqing 竺可青 Pathology Department Zhejiang University School of Medicine 2015-6-30

2. 1. Cervix diseases

3. CERVIX NORMAL METAPLASIA INFLAMMATION POLYPS DYSPLASIA CIN INFILTRATING SCC

4. Cervical cancer 病因 • Early age at first intercourse • Multiple sexual partners • Increased parity • A male partner with multiple previous sexual partners • The presence of a cancer-associated HPV • The persistent detection of a high-risk HPV, particularly in high concentration (viral load) • Certain HLA and viral subtypes • Exposure to oral contraceptives and nicotine • Genital infections (chlamydia) 衣原体

5. Spectrum of cervical intraepithelial neoplasia: normal squamous epithelium for comparison; CIN I with koilocytotic atypia; CIN II with progressive atypia in all layers of the epithelium; CIN III (carcinoma in situ) with diffuse atypia and loss of maturation.

6. The cytology of cervical intraepithelial neoplasia as seen on the Papanicolaou smear. Cytoplasmic staining in superficial cells (A&B) may be either red or blue. A, Normal exfoliated superficial squamous epithelial cells. B, CIN I. C, CIN II. D, CIN III.

7. The spectrum of invasive cervical cancer. A, Carcinoma of the cervix, well advanced. B, Early stromal invasion occurring in a cervical intraepithelial neoplasm.

8. Morphology of cervical cancers. A, Squamous carcinoma. B, Adenocarcinoma in situ (lower), associated with CIN 3 (upper). C, Adenocarcinoma. D, Neuroendocrine carcinoma.

9. 2. 子宫体疾病 • Endometriosis 子宫内膜异位症 • Adenomyosis 子宫腺肌病 • Carcinoma of Corpus Uteri 子宫癌 • Leiomyoma of uterus 子宫平滑肌瘤

10. Endometriosis 子宫内膜异位 The presence of endometrial glands or stroma in abnormal locations beyond the endometrium of uterus. 部位 : • ovaries • uterine ligaments • recto-vaginal septum • pelvic peritoneum….

11. Adenomyosis 子宫腺肌病 The endometrial glands may extend deep within the myometrium. Pathological changes • 显微镜下:The endometrial glands and the stroma appear in the site of involvement. • 大体:Red-blue or yellow-brown nodules, hemorrhage --- chocolate cysts

12. Carcinoma of Corpus Uteri Incidence: less than carcinoma of cervix, about 1 : 5~8 Peak age: 55~65 yr Arise in : columnar cells

13. Pathological changes Carcinoma of Corpus Uteri Endometrioid adenocarcinomas 子宫内膜腺癌 • well differentiated • moderate differentiated • poorly differentiated • endometrioid adenocarcinomas with foci of squamous differentiation

14. Metastasis Carcinoma of Corpus Uteri • direct extension: fallopian tube, ovary, cervix myometriun, broad ligament, peritoneum, bladder, rectum. • lymphoatic : obturator, illic, periaortic, sacral, lumbar, inguinal lymph nodes • bloodstream:lung, liver, bone

15. Clinical presentations Carcinoma of Corpus Uteri • Irregular vaginal bleeding and leukorrhea • Uterine enlargement • In advanced case, tumor can press the nerve, inducing hypogastric, lumbar and leg’s pain

16. Leiomyoma of uterus The most common tumor in women. Incidence: 25% in active reproductive life, estrogen responsive.

17. Leiomyoma of uterus Pathological changes Microscopically: whorled bundles of smooth muscle cells Grossly: varying in size, sharply circumscribed, discrete, round, gray-white cut section:whorled pattern of smooth muscle

18. 3. Hydatidiform mole葡萄胎/ Choriocarcinoma绒癌 • The hydatidiform mole is a common complication of gestation怀孕, occurring about once in every 1000 to 2000 pregnancies in the United States and, curiously, far more commonly in the Far East. • It has become possible, by monitoring the circulating levels of human chorionic gonadotropin, to determine the early development of persistent trophoblastic disease. • Choriocarcinoma, once a dreaded恐怖 and uniformly fatal complication, is now highly responsive to chemotherapy.

19. Hydatidiform Mole 1/1000 in USA 1% in Indonesia Also called NON-invasive mole in its most common benign variant, but can also be “invasive” Complete (2% chorioCA incidence) or partial (0% incidence) Grapelike clusters, i.e., swollen villi

21. The MAIN thing differentiating benign from malignant from worrisome trophoblastic neoplasms is INVASIVENESS of the trophoblast

24. 4. Tumors of the ovary 1. Surface epithelial tumors 上皮 serous 浆液性/ mucinous 粘液性 tumor benign --- cystadenoma borderline malignancy malignant --- cystadenocarcinoma 2. Sex cord -stromal tumors 性索间质 cord-stromal tumors granulosa cell tumor 颗粒细胞瘤 3.Germ cell tumors 生殖细胞 teratoma 畸胎瘤

25. Serous tumor 浆液性肿瘤 • Most common cystic neoplasm • Lined by columnar ciliated epithelialcell • Filled with clear serious fluid • Bilaterality : common

26. Serouscystadenoma ---- benign Pathologic changes Grossly : one or a few fibrous smooth walled cysts, with a small papillary projections Microscopically: 1)lining epithelium---one layer columnar ciliated epithelium 2) papillae may be found.

27. Seroustumors ---- borderline Grossly: Increasing amount of papillary projections Microscopically: 1) 2~3 layers cells; 2) cells with atypia; 3) papillae are more complex

28. Serous tumors borderline

29. Serous cystadenocarcinoma ----malignant Grossly: large amount of solid or papillary tumor mass Microscopically: 1) epithelium: >3 layers 2) with more atypia 3) invade capsule and stroma, 4) psammosa body

30. Serous cystadenocarcinoma

31. Mucinous tumor粘液性肿瘤 less common, lined by tall, columnar cell filled with mucin

32. mucinous cystadenoma ---- benign Grossly: multilocular tumor,with smooth cyst wall, filled with sticky, gelatinous fluid.

33. Mucinous cystadenoma Microscopically: 1. lining epitheliun -- one layers tall columnar cells 2. with apical mucin, absence of cilia

34. Mucinous tumors ---- borderline G: increasing amount of papillary projections M: 1) 2~3 layers cells 2) cells with atypia 3) no invasion

35. Mucinous cystadenocarcinoma ----malignant G: larger amounts of solid or papillary tumor mass, often with bleeding and necrosis M: 1) >3 layers epithelial cells 2) cells with more conspicuous atypia 3) invade capsule and stroma

36. Germ cell tumor 2.Dysgeminoma 无性细胞瘤 site: ovary - dysgeminoma testicle -seminoma age: 10~30 yr arise in: germ cell malignant tumor

37. Pathological changes Microscopically: 1) Dispersed in sheets or cords by fibrous stroma; 2) Tumor cells: large, round, clear cytoplasm and central regular nuclei with prominent nucleoli 3) the stroma is infiltrated with lymphocytes Grossly: solid tumor cut section: soft and fleshy, yellow-white to gray –pink