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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