Vagina_vulva _cervix by bvishaal

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									     DISEASES
       OF
FEMALE GENITAL TRACT
Endometrium
Myometrium
Perimetrium
          Pathology of vulva
 Diseases   of vulva constitute small fraction
  of gynecologic practice
 Diseases of skin that affect skin of other
  parts of the body: psoriasis,skin infections
  Few specific disorders:
 Bartholins cyst
 Lichen sclerosis et atrophicus
               Bartholins cyst
 Occurs from obstruction
  of the Bartholin duct by
  inflammatory process
 Relatively common
 May be large : 3-5 cm
 May cause pain and local
  discomfort
 Lined by squamous
  epithelium
 Treatment : surgical
  excision
    Lichen sclerosis et atrophicus
   Smooth white
    parchment like
    plaques that in time
    may extend and
    coalesce : constricting
    vaginal orifice
   Commonly seen in
    postmenopausal
    women
   ?? Auto-immune
                      LSEA
   Microscopy : Thinning
    of epidermis and
    dermal sclerosis
                         VULVA
Extramammary Pagets
  disease
 presents as erythematous
 plaque on vulva
 Features of intraepidermal
 carcinoma – nests of clear
 malignant cells in the
 epidermis
 Sometimes extension of an
 underlying malignancy
       Condyloma Acuminatum

-  warty lesions involving
   the
   perineum,vulva,vagina or
   cervix
- Single or multiple
 - HPV induced 6,11
Condyloma acuminatum
             Branching tree like
              projections of
              squamous epithelium
             Koilocytic atypia :
              nuclear enlargement
              and atypia and
              perinuclear
              cytoplasmic halo :
              diagnostic of HPV
              infection
        Diseases of Vagina
 Vaginaladenosis and clear cell
  adenocarcinoma
 Embryonal rhabdomyosarcoma
                       Vagina
Embyonal
    rhabdomyosarcoma
(sarcoma botryoides)
- infants and children less
    than 4 years
    grape like mass
    protruding from vagina
Microscopically
    Spindle shaped cells
    Cambium layer +
(concentration of cells under
    the epithelium seen)
         MICROSCOPY



EPITHELIUM




                      CAMBIUM LAYER
    Vaginal Adenosis and Clear cell
           adenocarcinoma


- rare
 increased risk in women exposed to
 Diethystilbesterol (DES) in utero
   CLEAR CELL
ADENOCARCINOMA
Infections of female genital tract
      Pelvic inflammatory disease
- ascending infection (sexually transmitted disease) from
  cervix to uterus,fallopian tubes and the pelvic cavity
- Organisms –usually gonococcus /and or chlamydia
- Puerperal infections : polymicrobial :
  staph,strepto,coliform,clostridium perfringens
Distribution of the disease
    Endocervix: endocervicitis
    Endometrium-Endometritis
    Fallopian tubes- Salphingitis
    Pelvic cavity- Peritonitis and pelvic abscess
    Perihepatitis – characterised by violin string adhesions
    between the liver and fallopian tube
         Clinical symptoms
Cervicitis: vaginal discharge
Endometritis: abnormal bleeding or mid
 abdominal pain
Salphingitis:Bilateral lower abdominal pain
Peritonitis: Abdominal pain and tenderness
Perihepatitis:right upper quadrant pain
             Complications
-   tubo-ovarian abscess




- Tubal scarring - leading to infertility
- Peritonitis – leads to adhesions –intestinal
  obstruction
Carcinoma
of cervix
Risk Factors for development of
           Ca Cervix

Early age at first intercourse
Multiple sexual partners
Increased parity
A male partner with multiple previous
sexual partners
Presence of HPV infection
Use of oral contraceptives,Cigarette
smoking
  Evidence linking HPV with
       cervical cancer
HPV DNA detected in 95% of cervical
cancers
Specific HPV types linked with cervical
cancer (high risk- 16, 18, 31, 33, 35, 39,
45, etc.) versus condylomata (low risk- 6,
11, 42, 44, 53, 54, 62 and 66).
Vaccines against HPV can prevent
infection and development of
precancerous lesions
  Human Papilloma Virus
High risk types:16,18,33,35

E6 and E7 genes of the HPV bind to the
 pRB and P53 genes in the host cell
 (Cervical epithelium)

This integration causes degardation of the
 pRB and p53 tumor suppression genes

              CANCER CERVIX
Pathogenesis of Ca Cervix
CERVICAL INTRAEPITHELIAL
       NEOPLASIA
  CERVICAL INTRA EPITHELIAL
       NEOPLASIA (CIN)
 Dysplasia
 Precancers

Graded into CIN-I
            CIN- II
            CIN-III
A
      Squamous cell carcinoma
  Age:40-45 years of age
Morphology:
Grossly, they can be 1)Exophytic
                     2)Infiltrative
                     3)Ulcerating
Spreads by contiguous spread to adjacent
  structures
Lymph node metastasis
Distant metastasis to lungs,liver and other
  structures
Other types


Adenocarcinoma
Adenocarcinoma

  • Arisein endocervical
  glands and often
  preceded by
  intraepithelial glandular
  neoplasm

  •Adenocarcinomas
  appear grossly and
  behave like squamous
  cancers
Investigations and treatment
Prevention and control with the help of
PAP smears
Colposcopic examination with biopsy.
Treatment
– For CIN I PAP smear follow up
– CIN II or III cryotherapy, laser, LEEP and
  cone biopsy
– Invasive cancer – hysterectomy with lymph
  node dissection, radiation.

								
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