Transcript Female genital I

Organ Pathology
Female Genital
System - I
Pathology of vulva,
vagina, uterus
Jaroslava Dušková
Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague
http://www1.lf1.cuni.cz/~jdusk/
Diseases of the Vulva

inborn – hymen imperforatus
haematocolpos

acquired
– non neoplastic : atrophy, degeneration, infection…
– neoplastic: precanceroses –VIN, condyloma,
carcinoma, melanoma
Vulva – regressive changes

simple atrophy

leukoplakia
coexistent in
LICHEN SCLEROSUS
(et atrophicus)
Vulvar Dystrophies
LICHEN SCLEROSUS
(et atrophicus)

whittish glistening plaques or papules
 atrophy of epidermis
 basophillic degeneration of the dermis
 chronic inflammatory infiltrate
constriction of the orifice
Leukoplakia
white spot – merely a
descriptive term giving no
indication about the
underlying nature (!)
Vulvar Infections



bacterial: folliculitis & furunculosis,
Bartholin gland abscess (staphylococcus),
ulcus durum, tbc, gonorrhea (neisseria),
chancroid (haemophillus ducreyi)
viral: herpes genitalis, molluscum contag.
(poxvirus),.. HPV
mycotic: candida, intertrigo (dermatophyta)
esp. in DM
Vulvar Pseudotumours

retention cysts

elephantiasis

varicose veins
endometriosis

Condyloma accuminatum
HPV papilloma with koilocytes
and mild dysplasia
Vulvar Precanceroses
VIN I, II, III
HPV 16
manifesting mostly as LEUKOPLAKIA
warty or basaloid type. Increasing incidence
in women 20-35 yrs.
Vulvar Tumours (WHO 2003)
lists more than 50 primary malignant &
benign neoplasms classified into:
 epithelial
– squamous
– glandular
 soft
tissue
tumours
 melanocytic
 miscelaneous
 haematopoietic
lymphoid
 secondary
&
Squamous tumours of vulva

sq.cell ca
–
–
–
–
–
keratinizing
non-keratinizing
basaloid
warty
verrucous HPV6
basal cell ca
 VIN 3 CIS
 vestibular papilloma

Glandular tumours of vulva
 Paget
disease
 Bartholin gland tumours
 other adenocarcinomas and adenomas
Mesenchymal tumours of vulva
 Sarcoma
botryoides – embryonal
rhabdomyosarcoma – under 10 yrs + vagina
„bunch of grapes“ appearance there. Alveolar
histology pattern – unfavourable prognosis
 other
sarcomas –lmsa, lpsa, dfsa protub…
Diseases of vagina


inborn – vagina duplex –failure of the müllerian duct to fuse
acquired
– non neoplastic :

atrophy,

degeneration, infection (ulcus durum - chancre, bacterial
mixed, mycotic, trichomonas)…

pseudotumours:hernia-like lesions cystocele, rectocele, cysts
– neoplastic: precanceroses –VAIN, condyloma, carcinoma, sarcoma
botryoides, melanoma
Vaginal Pseudotumours

retention cysts of Gardner´s duct

endometriosis
rectocele, cystocele

Vaginal Tumours (WHO 2003)
lists more than 44 primary malignant &
benign neoplasms classified into:
 epithelial
– squamous
– glandular
 mesenchymal
tumours
 mixed
 melanocytic
miscelaneous
 haematopoietic &
lymphoid
 secondary
Condyloma accuminatum
HPV papilloma with koilocytes
and mild dysplasia
Vagina Precanceroses
VAIN I, II, III
(HG)
HPV 16
manifesting mostly as LEUKOPLAKIA
Glandular tumours of the vagina
 adenocarcinoma
 clear
cell adenocarcinoma
 endometrioid carcinoma
 mucinous carcinoma
 adenomas
DES
with enteric differentiation
Diseases of the Uterus

inborn – malformations: duplex, septus, bicornis, unicornis…,

acquired
– non neoplastic : atrophy, descensus, prolapse,
infection
– hyperplasias - pseudotumours…
– neoplastic: precanceroses –CIN, condyloma,
carcinoma,
Uterine Pseudotumours
retention cysts of cervical
glands
 hyperplastic polyps
 endometriosis
 (pregnancy!)

Ectopia, ectropium (pseudoerosion)
 red
rim of ext. orificium
 endocervical type of mucose
 ectopy- in newborn, no relation to
delivery
 ectropium- eversion of the endocervical
mucose related to delivery laceration
Cervix Precanceroses
CIN I, II, III (HG)
HPV 16
manifesting mostly as LEUKOPLAKIA
ECCIN 1,2,3… AIS
HPV infection
cervical ca cause
 HPV DNA present in 99,7% squamous cell &
94-100% adenoca
 high risk HPV (hrHPV)- 16,18,33,45
(oncogens E6/E7 integrate into the genom
 E6 protein interaction with p53 preventing
the cells from p53 induced apoptosis)
 E7 protein interfering with the
oncosupresoric protein pRb (cell cycle )

HPV infection
 80%
women infected with HPV
 spontaneous resolution or transitory L
SIL/ CIN1
 80% hrHPV transitory, no SIL H
 hrHPV- on average 12-15 yrs to
invasive ca
 immune status (HLA…)
Uterine Cervix Tumours
(WHO 2003)
lists more than 60 primary malignant &
benign neoplasms classified into:
 epithelial
– squamous
– glandular
 mesenchymal
tumours
 mixed
 melanocytic
miscelaneous
 haematopoietic &
lymphoid
 secondary

Cervix ca
 2002
Czech Rep. 1082 new cases
 Czech
Rep. 20,7/ 100 000 women
 Europa
 World
18,5/ 100 000 women
incidence 15,1/ 100 000 women
zdroj: ÚZIS
Diseases of the Uterus

inborn – malformations: duplex, septus, bicornis, unicornis…,

acquired
– non neoplastic : atrophy, descensus, prolapse,
infection
– hyperplasias - pseudotumours…
– neoplastic: precanceroses –CIN, condyloma,
carcinoma,
Uterine Pseudotumours

retention cysts of cervical
glands

hyperplastic polyps

endometriosis

(pregnancy!)
Uterine Corpus Tumours
(WHO 2003)
lists more than 50 primary malignant &
benign neoplasms classified into:
 endometrial
– endometrioid
– mucinous
– serous
– clear cell…
 mesenchymal
 mixed
 miscelaneous
 gestational
 haematopoietic
lymphoid
 secondary
&
Uterine Corpus Pseudotumours &
Precanceroses
hyperplasia
simple
complex
atypical
atypical complex
Prognostic Factors in Uterine Ca
 staging
– most important
 grading
– no influence in sq. ca
 typing
- good prognosis (verrucous, villoglandullar ca)
– bad prognosis (serous, adenoid cystic,
neuroendocrine ca)
Uterine Leiomyomas
WHO 2003
lists 13 variants of uterine smooth muscle neoplasms
– benign and malignant

typical
atypical
 cellular
 epithelioid
 myxoid
 lipoleiomyoma

leimyosarcoma

epithelioid
 myxoid

Mixed Tumours
Def.:
Tumours (benign or malignant)
composed of two or more
different cell lines that are
normally present in the place
of tumour origin
Uterus – „mixed“ tumours





carcinosarcoma
adenosarcoma
carcinofibroma
adenofibroma
adenomyoma
Uterus – „mixed“ tumours
carcinosarcoma (malignat mixed
müllerian neoplasm, malignant
mesodermal mixed tumour, ..
metaplastic carcinoma
( monoclonal with the diff. into epith.
& mesench. structures)