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Female genital system

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 .

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Female genital system

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  1. Female genital system Dr. Amitabha Basu MD

  2. Topic of this Lecture • Disease of Cervix, Vagina, Vulva • Disease of endometrium • Disease of uterus • Disease of fallopian tube

  3. Disease of Cervix • T-zone • Cervicitis • CIN • Malignancy of cervix

  4. Normal cervix

  5. Histology: T zone T zone : Junction between squamous and columnar epithelium. Most malignancy begin here.

  6. Cervicitis • Types: • Etiology • Morphology • Clinical • Acute • Chronic Cervicitis

  7. Etiology • Mostly non specific Cervicitis • Specific form: • C. trachomatis. • Trichomonous and Candida infection.

  8. Chronic Cervicitis; Morphological features • Chronic inflammatory cells • Nabothian cyst. • Squamous metaplasia

  9. C. Trachomatis Cervicitis • It produce follicular Cervicitis ( Plenty lymphocytes form FOLLICLES)

  10. Clinical : Cervicitis • It can produce temporary Female infertility. • It provide a fertile soil for malignancy.

  11. Next topic CIN : Types

  12. CIN = SIL • CIN = Cervical intraepithelial neoplasia Or, • SIN = Squamous intraepithelial neoplasia

  13. 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

  14. CIN I = Flat Condyloma; will show koilocytic change CIN I : lower 1/3 rd of the epithelium is Dysplastic

  15. Koilocyte : Evidence of HPV infections HIGH POWER

  16. CIN II : lower 2/3 rd is dysplastic

  17. Carcinoma In Situ = CIN III : Entire epithelium is involved.

  18. Carcinoma in situ: intact basement membrane

  19. Screening of dysplasia : PAP smear of the exfoliated cell from the cervix: Most important cause of reduced mortality in west.

  20. Time for carcinoma of cervix

  21. 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.

  22. 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.

  23. Cervical carcinoma • Squamous cell carcinoma [ HPV 16, 18]- MOST COMMON • Clear cell carcinoma [ exposure to diethylstilbestrol (DES) ]. • Adenocarcinoma ( RARE) Rare thing : Think rarely

  24. Squamous cells carcinoma : gross Exophytic growth

  25. Squamous cells carcinoma of cervix

  26. Clear cell carcinoma microscopy: Recall etiology Exposure to diethylstilbestrol (DES)

  27. Clinical features of squamous cell carcinoma cervix • Dyspareunia. • Post coital bleeding. • Leucorrhoea. • Diagnosis: • Papanicolaou smear • Biopsy (cone) • Colposcopy.

  28. Staging of carcinoma cervix with prognosis

  29. Micro invasive carcinoma

  30. 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%

  31. Disease of vagina • Sarcoma botroid • Effect of diethylstilbestrol (DES) during pregnancy. • Vaginal adenosis • Clear cell carcinoma of vagina

  32. Sarcoma botroid • Age : 0-5 years • Type of malignancy : Embryonal rhabdomyosarcoma “Rare form” of Primary vaginal malignancy

  33. Clear cell carcinoma of vagina Common in the young girls whose mother took diethylstilbestrol (DES) during pregnancy.

  34. Now vulval diseases

  35. 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.

  36. Vulval disease • Lichen atrophicus • Thinning of the epidermis , dermal fibrosis, scant lymphocytes. • Pre-cancerous lesion.

  37. Disease of the uterus: Relax for a few minutes

  38. Disease of uterus • Endometritis • Adenomyosis • Endometriosis • Endometrial Hyperplasia.

  39. Endometritis Clinical Feature: infertility and dysmenorrhea

  40. Endometrial tissue deep in the myometrium of uterus. Gross : enlargement of uterus Clinical : irregular profuse menstruation Dysmenorrhea , menorrhagia Adenomyosis

  41. Adenomyosis Normal Endo-myometrium reaction Adenomyosis: Uterus enlarged

  42. Adenomyosis : Enlarged Uterus Clinical d/d : Fibroid C/F : irregular profuse menstruation (Dysmenorrhea , menorrhagia )

  43. Endometriosis • Location • Pathogenesis • Pathophysiology • Chocolate cyst ( endometriosis of Ovary) • Clinical Features

  44. Endometriosis • Endometrial tissue ( BOTH GLAND AND STROMA ) in any place out side the uterus. Ovary or other tissue

  45. Endometriosis: location And : Laparoscopic Scar ( during caesarian section).

  46. Endometriosis: pathogenesis • Metapalstic Differentiation of • Celomic Epithelium. • Lymphatic dissemination. • Regurgitation of endometrial fluid to ovary. • Dissemination throughpelvic vein.

  47. 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

  48. 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.

  49. Chocolate cyst of the ovary = endometriosis of ovary: Regurgitation of endometrial fluid to ovary.

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