Reproductive System. Ratirath Samol, MD

Size: px

Start display at page:

Download "Reproductive System. Ratirath Samol, MD"

Amberly Park
5 years ago
Views:

1 Reproductive System Ratirath Samol, MD

2 Content Female disease - genital tract : infection (PID), vulva, vagina, cervix, body of uterus with endometrium, ovaries - breast disease - gestational disorders

3 Content Male disease - gynecomastia - penis -testis - prostate gland

4 Female disease

8 Pelvic inflammatory disease (PID) Ascending infection begins in vulva or vagina and spreads upward to involve most structure in female genital tract Clinical : pelvic pain, fever, vaginal discharge

9 Pelvic inflammatory disease (PID) Organisms : - Neisseria gonorrhoaea - Chlamydia spp. - Staphylococcus spp. - Streptococcus spp. - Coliform bacteria

10 Pelvic inflammatory disease (PID)

11 Vulva Bartholin cyst and abscess Codyloma acuminatum Vulva carcinoma

12 Bartholin cyst and abscess Acute infection of Bartholin gland produces cyst or abscess Cyst result from obstruction of Bartholin duct, usually by preceding infection Cyst may become large, up to 3-5 cm. Clinical : pain, mass at labia Rx: excision

13 Bartholin cyst and abscess

14 Condyloma acuminatum Sexual transmitted, benign lesion Frequent multiple lesions involve vulva, perianal region and vagina Caused by HPV type 6, 11 Frequent regress spontaneously No precancerous lesion

15 Condyloma acuminatum Verrucous nodules Koilocytosis

16 Squamous cell carcinoma (SCCA) of Vulva Cancer-related HPV infection type 16, 18 May be genetic cause Tumor metastasis to any organs

17 Squamous cell carcinoma (SCCA) of Vulva

18 Vagina Squamous cell carcinoma (SCCA)

19 SCCA of vagina Uncommon primary SCCA of vagina 95% SCCA associated with HPV Greatest risk factor is previous SCCA of cervix or vulva

20 SCCA of vagina Clinical course - insidious tumor growth - irregular spotting or frank vaginal discharge (leukorrhea) - may be silent and become present with urinary or rectal fistulas

21 Squamous cell carcinoma

22 Cervix Cervicitis Intraepithelial and invasive squamous neoplasia - Cervical Intraepithelial Neoplasia (CIN) - Squamous cell carcinoma (SCCA)

23 Cervix

24 Cervicitis Acute and chronic inflammation of cervix Caused by bleeding, sexual intercourse, vaginal douching resulting lactobacilli decrease H2O2 production alkaline vaginal ph pathogenic organisms overgrowth cervicitis

25 CIN and Invasive squamous neoplasia Risk factors for cervical neoplasm - early age at first intercourse - multiple sexual partners - increased parity - a male partner with multiple previous sexual partners - HPV infection

26 CIN and Invasive squamous neoplasia Risk factors for cervical neoplasm - exposure to oral contraceptive - smoking - genital infections (chlamydia)

27 CIN and Invasive squamous neoplasia Specific HPV types associated with - Cervical cancers : high-risk HPV type 16,18,31,33 - Condyloma : low-risk HPV type 6,11,

28 Cervical Intraepithelial Neoplasia (CIN) Occurs in transformation zone Precancerous lesion of cervix, classified in a variety of ways - mild dysplasia (lower 1/3) = CIN I - moderate dysplasia (lower 2/3) = CIN II - severe dysplasia (nearly thickness) = CIN III - carcinoma in situ (CIS) (full thickness)=cin III

29 Cervical Intraepithelial Neoplasia (CIN)

30 Cervical Intraepithelial Neoplasia (CIN) Clinical course - CIN I: most likely no progress to carcinoma - CIN III and CIS most frequent associated with invasive SCCA - often no symptom

31 Squamous cell carcinoma (SCCA) Occurs at any age from second decade of life to senility Gross : 3 patterns - fungating (exophytic) mass - ulcerating mass - infiltrative mass

32 Squamous cell carcinoma (SCCA) Fig micro

33 Squamous cell carcinoma (SCCA) Clinical course - advanced carcinoma direct spread to any structure eg.urinary bladder,ureter, rectum, vagina, liver, lungs - no symptom, vaginal bleeding, contact bleeding, pain during sexual intercourse, swollen leg

34 Prevention and control of carcinoma of cervix Papanicolaou (PAP) smear screening Vaccines for preventing HPV infection

35 Body of uterus and Endometrium Endometrial carcinoma Endometriosis/Adenomyosis Leiomyoma (myoma uteri)

36 Uterus and Endometrium

37 Endometrial carcinoma Malignant endometrial epithelial tumor Arise mainly in postmenopausal women, causing abnormal postmenopausal bleeding Peak incidence yrs High frequent in obesity, diabetes, hypertension, infertility

38 Endometrial carcinoma Most develops on background of prolong estrogen stimulation Most endometrial adenocarcinoma

39 Endometrial carcinoma

40 Endometrial carcinoma Clinical course - irregular vaginal bleeding with excessive leukorrhea - diagnosis by curettage and histology - prognosis depend on clinical staging

41 Endometriosis Endometrium locate outer site eg. cervix, myometrium, ovary Endometrium invade in myometrium = adenomyosis Endometrium locate in ovary forming cyst = endometriotic cyst or chocolate cyst Clinical : dysmenorrhea

42 Chocolate cyst

43 Leiomyoma (myoma uteri) Most common benign tumor of smooth muscle cells (myometrium) Present in 75% of female reproductive age Malignant change in leiomyoma is extremely rare

44 Leiomyoma (myoma uteri) Gross finding - well circumscribed, gray white mass with whorled, trabeculation cut section - variable in size

45 Leiomyoma (myoma uteri) circumscribed gray-white mass with whorled trabeculation Interlacing fascicles of spindle cells

46 Leiomyoma (myoma uteri) Clinical course : may asymptomatic or symptoms Most important symptoms - abnormal uterine bleeding (submucosal) - compress bladder (urinary frequency) - sudden pain if disruption of blood supply - impaired fertility - myoma in pregnancy increase frequency of spontaneous abortion, fetal malpresentation, postpartum hemorrhage

47 Ovaries Functional cysts - Follicular cysts - Corpus luteum (luteal) cysts Ovarian tumor - mucinous tumor - serous tumor - germ cell tumor (teratoma) - krukenberg tumor

48 Follicular cysts Cysts >2 cm, originate in unruptured graafian follicles or in follicles Usually no symptom May be pain from rupture, rapid growth, bleeding into cyst, or twisting of cyst

49 Corpus luteum cysts Occurs when an egg is released from follicle Variable in size of cyst Usually no symptom May be pain from rupture, rapid growth, bleeding into cyst, or twisting of cyst

50 Ovarian tumors 80% are benign and occurs in young women (20-45 yrs) Malignant tumor common in old women (40-65 yrs) High frequent in unmarried and in married with low parity

51 Ovarian tumors Clinical features - abdominal mass, pain and distension - ascites with peritoneal seeding - urinary and GI tract symptom due to compression or invasion by tumor

53 Surface-epithelial stromal tumor Most primary neoplasm in ovary Gross finding - cysts : most benign - risk of malignancy increase as : solid growth thick cystic wall necrotic friable tissues

54 Serous tumors Classified 3 types - Benign (serous cystadenoma) - Borderline serous tumor - Malignant (serous cystadenocarcinoma) : most common malignant ovarian tumors Common in yrs

55 Serous cystadenoma Gross finding : single or multiple, smooth cysts filled with clear fluid

56 Borderline serous tumor Gross finding : cysts with increase number of papillary projection

57 Serous cystadenocarcinoma Gross finding : large amounts of solid or papillary tumor mass

58 Mucinous tumors Common in middle age women Classified 3 types - Benign (mucinous cystadenoma) - Borderline mucinous tumor - Malignant (mucinous cystadenocarcinoma) : 10% of malignant ovarian tumors

59 Mucinous tumors Less frequency of bilateral If bilateral mucinous ovarian tumors, must exclusion of non-ovarian origin tumor eg. appendix, GI tract

60 Mucinous cystadenoma Gross finding : single or multiple, smooth cysts filled with sticky, gelatinous fluid

61 Borderline mucinous tumor Gross finding : single or multiple, smooth cysts filled with sticky, gelatinous fluid, hemorrhage, necrosis, some solid area

62 Mucinous cystadenocarcinoma Gross finding : single or multiple cysts filled with scant sticky, gelatinous fluid, but predominate hemorrhage, necrosis and solid mass

63 Germ cell tumor Occurs in children and young adult women Most are mature teratoma

64 Teratoma Germ cell tumor derived from pluripotential cells and made up of elements of different types of tissue from one or more of the three germ cell layers (endoderm, mesoderm, ectoderm) Endoderm : GI tract Mesoderm : bone, muscle, fat, cartilage Ectoderm : skin and appendage, brain

65 Teratoma Divided to 3 categories - mature teratoma (benign) - immature teratoma (malignant) - monodermal or specialized teratoma

66 Mature teratoma Most are cystic and known as Dermoid cyst or Mature cystic teratoma Bilateral 10-15% of cases 1% of dermoid cyst have malignant change of any components

67 Dermoid cyst Gross : unilocular cyst contains hair, tooth, and cheesy sebaceous materials

68 Dermoid cyst

69 Dermoid cyst Microscopic : - cyst wall is squamous epithelium with sebaceous glands, hair shafts - other germ layers : cartilage, bone, brain, fat, thyroid tissue, GI epithelium etc.

70 Krukenberg tumor Metastatic GI tumor to ovary, most often from stomach Often bilateral metastasis

71 Krukenberg tumor Gross: multiple masses in both ovaries Micro: mucin-producing signet ring cells

72 Female breast disease Acute mastitis Fibrocystic change Fibroadenoma Invasive ductal carcinoma

73 Female breast

74 Normal breast Ducts and lobules lined by two cell types Myoepithelial cells lies on basement membrane and luminal epithelial cells lines lumens Luminal epithelial cells produce milk

75 Clinical presentations of breast disease Pain Palpable mass Nipple discharge or skin discharge

76 Acute mastitis Occur during lactation Cracks and fissures in nipples Usually Staphylococcus aureus Erythematous painful breast, usually accompanied by fever If not treated, infection may spread to entire breast

77 Fibrocystic change Related hormonal fluctuation Clinical : breast pain, lump with firm breast There are three principal patterns of morphologic change: 1. Cyst formation, often apocrine cyst 2. Fibrosis 3. Adenosis

78 Fibrocystic changes

79 Fibrosis Cysts frequently rupture, with release of secretory material into adjacent stroma Resulting chronic inflammation and fibrous scarring contribute to palpable firmness of breast

80 Adenosis Increase in number of acini per lobule Often enlarged acini May be calcifications

81 Fibroadenoma Most common benign tumor of breast More common before age 30 Frequently multiple mass and bilateral Cure by excision Rare carcinoma arising in it

82 Fibroadenoma Gross: well-circumscribed, rubbery, gray white mass, variable in size

83 Fibroadenoma

84 Carcinoma of breast Risk factors Age Age at menarche Age at first live birth First-degree relatives with breast cancer Estrogen exposure Breast-feeding Environment toxins

85 Carcinoma of breast Risk factors Breast density Radiation exposure Carcinoma of contralateral breast or endometrium Diet Obesity Exercise Genetic

86 Invasive ductal carcinoma Almost presents as a palpable mass More 50% of case have axillary lymph node metastases Larger carcinomas may be fixed to chest wall or cause dimpling of the skin

87 Invasive ductal carcinoma firm to hard, gray-white mass with irregular border

88 Prognosis and predictive factors Major prognostic factors Invasive carcinoma Distant metastases Lymph node metastases Tumor size Locally advanced disease Inflammatory carcinoma

89 Ectopic pregnancy การต งครรภ นอกมดล ก พบบ อยท ท อน าไข Tubal pregnancy ป จจ ยเส ยง -PID - การใส ห วงค มก าเน ด (intrauterine device) ม กม การแท งภายในอาย ครรภ 3 เด อน

91 Hydatidiform mole Classified 2 type - complete hydatidiform mole - partial hydatidiform mole

92 Complete hydatidiform mole Diploid karyotype from only sperm No fetal part

93 Partial hydatidiform mole Triploid karyotype from egg and sperm Presence of fetal part

94 Feature Karyotype Villous edema Trophoblast proliferation Atypia Serum hcg HCG in tissue Behavior Complete Mole Diploid (46XX, 46XY) All villi Diffuse; circumferential Often present Elevated % choriocarcinoma Partial Mole Triploid (69xxx, 69xxy) Some villi Focal; slight Absent Less elevated + Rare choriocarcinoma

95 Male disease

96 Gynecomastia Enlargement of male breast Presents as a subareolar enlargement Imbalance between estrogen, which stimulate breast tissue, and androgens Condition of elevated estrogen : - cirrhosis of the liver - increase in adrenal estrogen - drugs : alcohol, heroin, steroid - functioning testicular tumor

97 Gynecomastia Gynecomastia Normal

99 Paraffinoma of penis Injection foreign body (paraffin) to penis result as enlarged penis Inflammation or abscess of penis

100 Carcinoma of penis Most of squamous cell carcinoma Occurs in years Clinical : mass, ulcer at penis Risk factor : smoking and HPV infection (type 16, 18)

101 Carcinoma of penis

102 Seminoma Germ cell tumor of testis Occurs in years Predisposing factors: - cryptorchidism (undescended testis) - genetic factor Clinical : testicular mass Radiosensitive

103 Seminoma

104 Benign prostate hyperplasia (BPH) Common in > 50 year Hyperplasia of prostate gland result as enlarged prostate compress urethra cause to obstruction Clinical : urinary retention, frequency, flow dribbling, dysuria, urinary infection

105 Benign prostate hyperplasia (BPH)

106 Prostate carcinoma Most of adenocarcinoma Common in old men Increase level of serum PSA (prostate specific antigen) Localized cancer : no symptom Advance cancer : dysuria, hematuria, back pain (bone metastasis)

107 Prostate carcinoma

108 THE END

Gynaecological Malignancies

Gynaecological Malignancies Dr Rodney Itaki Lecturer Anatomical Pathology Discipline University of Papua New Guinea Division of Pathology School of Medicine & Health Sciences Overview Genital tract tumors