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The Reproductive System. MIS311 Imaging Pathology 2 Prepared by S. Beatty 1998. The Reproductive System. Infection and Inflammation Benign Growth & Proliferative Growth Female Infertility Disorders of the Male Reproductive System Disorders of the breast.
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The Reproductive System MIS311 Imaging Pathology 2 Prepared by S. Beatty 1998
The Reproductive System • Infection and Inflammation • Benign Growth & Proliferative Growth • Female Infertility • Disorders of the Male Reproductive System • Disorders of the breast
Infection & InflammationPelvic Inflammatory Disease (PID) • Any inflammatory condition of the female pelvic organs. • Usually caused through bacterial infection • Symptoms include: • fever, foul-smelling vaginal discharge, lower abdominal pain, pain with coitus. • If an abscess has developed then a fluid-filled mass may be palpated.
PID • Fibrosis associated with PID may cause uterine tube blockage infertility. • Ultrasound is often used with diagnosis of PID and associated pelvic abscesses. • Hysterosalpingogram is still performed in checking uterine tube patency.
PID • May involve any organ, or combinations of organs, of the upper genital tract: • uterus, fallopian tubes or ovaries • in severe form the entire peritoneal cavity. • Usually PID is caused by sexually transmitted microorganisms that migrate from the vagina to the uterus, fallopian tubes and the ovaries.
PID Under Ultrasound Tubo-ovarian abscess
PID Under Ultrasound Chronic PID
Normal PID Under Hysterosalpingogram
Not So Normal PID Under Hysterosalpingogram
Benign Growth and Proliferative Condition Benign Ovarian Cysts
Benign Ovarian Cysts • Simple ovarian cysts are usually follicular or corpus luteum in origin. • Follicular cysts • Develops from a fominant ovarian follicle that does not release its own ovum but remains active • Not usually systematic • Usually require no treatment • They either regress or rupture spontaneously.
Benign Ovarian Cysts • Symptoms include (if any): • Painful intercourse, chronic lower abdominal pain and menstrual irregularities. • Corpus Luteum Cysts • Develops from a mature corpus luteum - persists abnormally and continues to secrete progesterone. • The cyst contains blood or fluid that accumulates in the corpus luteum cavity.
Benign Ovarian Cysts • Symptoms if any include: • Dull pelvic pain, delayed menstruation followed by irregular or heavier than normal bleeding. • Rupture can cause excruciating pain levels and requires immediate surgery • Oral contraceptives may be used to prevent cysts in the future
Dermoid Cysts • The teratoma is the most common germ cell tumour and it contains a varying mixture of skin, hair, fatty elements and calcified teeth.
Leiomyomas (Uterine Fibroids) • Benign tumours that develop from smooth muscle cells in the myometrium. • Most common benign tumours of the uterus. • Size of the tumour relates to hormonal fluctuations.
Leiomyomas (Uterine Fibroids) • Characteristic mottled, mulberry, or popcorn type of appearance. • Able to be seen on plain abdominal x-ray as smooth or lobulated nodules with a stippled appearance. • A large Fibroid adenoma may occupy the entire pelvis.
Leiomyomas (Uterine Fibroids) • I.V.P. • Persistent uterine opacification is seen in patients with underlying fibroid tumour. • The tumour typically presses on the fundus of the bladder, causing a lobulated impression usually seen with ovarian cysts. • Extension of a fibroid into the adjacent tissues may cause medial displacement of the pelvic ureter or ureteral compression leading to hydronephrosis.
Leiomyomas (Uterine Fibroids) • Ultrasound shows a hypoechoic, solid contour-deforming mass in an enlarged inhomogenous uterus.
Endometriosis • Most lesions are small and difficult to distinguish from normal tissue even when using modalities like CT and MRI. • This is the presence of normal appearing endometrium in sites other than their normal location inside the uterus. • Usually the ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum are most frequent, but the GI and Urinary tracts may also become affected.
Endometriosis • Symptoms • Abdominal cramps, diarrhoea during menstruation and may appear either as single or multiple masses in the colon. • Endometriosis involving the urinary tract most commonly produces ureteral obstruction below the level of the pelvis brim.
Cervical Cancer • May be detected in the early, curable stage by Pap test. • Increased manifestations may occur due to: • early age coitus, many sexual partners, genital herpes virus infections, poor obstetric and gynaecological care. • May be watery vaginal discharge or occasional spotting of blood.
Cervical Cancer • Advanced lesions may have the following symptoms: • foul smelling vaginal discharge, leaking from bladder or rectal fistulas, anorexia, weight loss, back and leg pains.
Cervical Cancer • Ultrasound usually demonstrates a cervical carcinoma as a solid echogenic mass behind the bladder.
Cervical Cancer • CT is more accurate in detecting pelvic sidewall invasion and therefore is usually the initial staging procedure in patients in whom there is a clinical suspicion of advanced disease. • May show bladder invasion of carcinoma.
Cervical Cancer • MRI can allow the cervix to be distinguished from the uterus and vagina.
Endometrial Cancer • A malignant disease of the endometrium of the uterus • Most commonly occurs in the 5th or 6th decade of life. • Abnormal vaginal bleeding is the most common sign especially in a post menopausal woman • Endometrial lesions may invade the cervix but rarely the vagina.
Endometrial Cancer • Typical Ultrasound appearance is an enlarged uterus with irregular areas of low-level echoes and bizarre clusters of high-intensity echoes.
Endometrial Cancer • CT demonstrates focal or diffuse enlargement of the body of the uterus.
Endometrial Cancer • MRI allows differentiation of the endometrium (inner layer) from the myometrium (muscle layer) of the uterus and has been useful in demonstrating focal or diffuse endometrial tumours.
Ovarian Cancer • Asymptomatic in early stages and therefore it is often not detected until it has metastasised. • Cystadenocarcinoma of the ovary often shows on ultrasound examination as a large cystic mass with internal septa. • Difficult to distinguish from Cystadenoma. • They often calcify.
Disorders of the Male Reproductive System Penis Scrotum Testis Epididymis
Disorders of the Penis • Phimosis • condition where the foreskin cannot be pulled back because it is too tight
