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Female Reproductive System Pathology: Disorders and Neoplasms, Study notes of Pathology

An in-depth analysis of various disorders and neoplasms related to the female reproductive system. Topics covered include the structure and function of the female reproductive system, endometrial hyperplasia, neoplasms of the lower reproductive tract, and neoplasms of the uterus and ovaries. The document also discusses infertility, diseases of pregnancy, and breast pathology.

Typology: Study notes

2021/2022

Uploaded on 09/12/2022

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Female reproductive system pathology
Female reproductive system
Structure
[Fig. 15-1, 15-2]
vulva (labia majora, labia minora, clitoris, urethral orifice)
vagina
cervix
uterus
fallopian tubes
ovaries
Function
[Fig. 15-1]
reproduction
Histology
stratified squamous mucosa (vulva, vagina, ectocervix)
glandular epithelium (endocervix, endometrium, fallopian tube
germ cells (ovary)
Menstrual Cycle
Female reproductive system pathology
Developmental abnormalities
Hermaphroditism
discordance between genotypic and phenotypic sex
True hermaphroditism
have both male and female gonads
Male pseudohermaphroditism
genotypically male, phenotypically female
Female pseudohermaphroditism
genotypically female, phenotypically male
Infectious diseases
[Fig. 15-5]
Sexually transmitted diseases
common (HSV, Chlamydia, HPV)
present with vaginal discharge, lesions, pelvic pain, dyspareunia
Genital herpes (Herpes Simplex virus 2)
vesicles on genitalia that coalesce and ulcerate
appear 3-7 days after exposure (only 30% develop lesions)
remains dormant in nerves, reactivation
important to be aware because don’t want vaginal delivery if active
Human papilloma virus (HPV)
labial, vaginal and cervical warts (condyloma)
certain types associated with carcinoma (see below)
condyloma acuminatum is large vulvar wart (HPV 6,11)
Sexually transmitted diseases
Chlamydia (Chlamydia trachomatis)
present with urethritis or cervicitis with discharge, PID
Gonorrhea (Neisseria gonorrheae)
urethritis or cervicitis with discharge, PID
Syphilis (Treponema pallidum)
vulvar ulcers
Bacterial vaginoses
Candida
Trichomonas
Gardnerella
pf3
pf4
pf5
pf8

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Female reproductive system

Structure [Fig. 15-1, 15-2]

  • vulva (labia majora, labia minora, clitoris, urethral orifice)
  • vagina
  • cervix
  • uterus
  • fallopian tubes
  • ovaries

Function [Fig. 15-1]

  • reproduction

Histology

  • stratified squamous mucosa (vulva, vagina, ectocervix)
  • glandular epithelium (endocervix, endometrium, fallopian tube
  • germ cells (ovary)

Menstrual Cycle

Female reproductive system pathology

Developmental abnormalities

Hermaphroditism

  • discordance between genotypic and phenotypic sex True hermaphroditism
    • have both male and female gonads Male pseudohermaphroditism
    • genotypically male, phenotypically female Female pseudohermaphroditism
    • genotypically female, phenotypically male

Infectious diseases [Fig. 15-5]

Sexually transmitted diseases

  • common (HSV, Chlamydia, HPV)
  • present with vaginal discharge, lesions, pelvic pain, dyspareunia Genital herpes (Herpes Simplex virus 2)
    • vesicles on genitalia that coalesce and ulcerate
    • appear 3-7 days after exposure (only 30% develop lesions)
    • remains dormant in nerves, reactivation
    • important to be aware because don’t want vaginal delivery if active Human papilloma virus (HPV)
    • labial, vaginal and cervical warts (condyloma)
    • certain types associated with carcinoma (see below)
    • condyloma acuminatum is large vulvar wart (HPV 6,11)

Sexually transmitted diseases

Chlamydia (Chlamydia trachomatis)

  • present with urethritis or cervicitis with discharge, PID Gonorrhea (Neisseria gonorrheae)
  • urethritis or cervicitis with discharge, PID Syphilis (Treponema pallidum)
  • vulvar ulcers

Bacterial vaginoses

  • Candida
  • Trichomonas
  • Gardnerella

Infections

Pelvic inflammatory disease

  • chronic, extensive infection of upper reproductive tract
  • usually secondary to STD (Neisseria, Chlamydia)
  • salpingitis, tubo-ovarian abscess,peritonitis
  • complications
    • chronic non-specific infection [fever, malaise, fatigue]
    • infertility secondary to scarring of fallopian tubes
    • pelvic mass with pain
    • spread of infection

Endometrial hyperplasia

  • normal menstrual cycle requires normal functioning of the hypothalamic-pituitary-ovarian axis (figure 15-5)
  • endometrial hyperplasia is thickening of the endometrial mucosa due to continued estrogen stimulation with inadequate progesterone
  • anovulatory cycles (no ovulation therefore no progesterone secretion)
    • functional causes
      • puberty, anxiety, athlete
    • organic
      • excess estrogen (OCP, tumors) Complex vs. simple hyperplasia
  • atypical hyperplasia
    • increased risk of endometrial adenocarcinoma

Neoplasms of lower reproductive tract

Carcinoma of vulva

  • squamous cell carcinoma
  • raised or ulcerated lesion
  • pre-neoplastic change may present as white or red patch
  • biopsy to assess
  • surgical excision +/- adjuvant therapy

Carcinoma of vagina

  • squamous cell carcinoma
  • clear cell carcinoma
    • women born to mothers on DES during pregnancy

Carcinoma of cervix

  • reduced mortality due to Pap test (early diagnosis)
  • risk factors
    • sexual intercourse at early age, multiple partners, HPV infection (certain types), other venereal diseases
    • environmental component and other factors
  • squamous cell carcinoma
    • precursor lesion = dysplasia (Cervical intra-epithelial neoplasia) [Fig. 15-6]
    • lack of normal maturation of squamous epithelium
    • occurs at transition zone
    • graded mild, moderate, severe
    • cells shed into vagina (Pap smear)
    • HPV types 16, 18, 31, 33, 34, 35 associated
    • koilocytic change refers to characteristic changes due to HPV

Ovarian neoplasms

Surface epithelial tumors

  • 70 % of ovarian neoplasms
  • spectrum of histologic types
    • serous, mucinous, endometrioid, clear cell and transitional cell types

Serous epithelial tumors

  • most common
  • typically cystic, filled with clear fluid
  • benign, borderline malignant, and malignant tumors
  • 25 % of benign tumors and 50 % of malignant tumors are bilateral
  • distinction of benign versus malignant requires histologic examination

Mucinous epithelial tumors

  • also typically cystic, filled with viscus fluid
  • benign, borderline malignant, and malignant tumors
  • 25 % of benign tumors and 50 % of malignant tumors are bilateral
  • distinction of benign versus malignant requires histologic examination

Endometrioid epithelial tumors

  • typically solid
  • malignant

Germ cell tumors

  • 20 % of ovarian tumors, occur in young females

Teratoma

  • most common ovarian neoplasm in young females
  • cystic, contain hair, sebaceous material (dermoid cysts)
  • may contain teeth, bone cartilage
  • benign
    • may undergo malignant transformation (malignant teratoma)

Immature teratoma

  • teratoma that contains immature neural tissue
  • may behave malignantly

Fibroma

  • benign neoplasm of fibroblasts

Thecoma

  • benign, solid and firm neoplasm of spindle cells (theca cells)
  • produce estrogens

Granulosa cell tumor

  • neoplasm of granulosa cells
  • benign or malignant,may produce estrogen

Metastases

Infertility

  • ovum related
  • sperm related
  • genital organ factors
    • PID
    • Asherman’s syndrome
  • systemic factors

Diseases of pregnancy

Ectopic pregnancy

  • implantation of fertilized ovum outside the uterine cavity
  • usually occurs in fallopian tube
  • trophoblast cells of placenta invade wall of tube, begins enlarging
  • may rupture
    • surgical emergency

Placenta accreta

  • abnormally deep penetration of placental villi into wall of uterus

Placenta previa

  • abnorma placental implantation site in lower uterine segment

Toxemia of pregnancy

  • disease of pregnancy of unknown pathogenesis resulting in characteristic symptom complex in the mother

Preeclampsia

  • presents with hypertension, edema, and proteinuria
  • occurs in third trimester
  • may progress to eclampsia

Eclampsia

  • hypertension, edema, proteinuria and seizures
  • life threatening, must treat seizures, deliver baby

Gestational trophoblastic disease

  • abnormalities of placentation resulting in tumor-like changes or malignant transformation

Hydatidiform mole

  • developmental abnormality of placenta
  • trophoblastic proliferation, hydropic degeneration of chorionic villi
  • enlarged uterus with no fetal movement, high HCG Complete mole
  • no identifiable fetus, abnormal fertilization (46XX, all paternal) Incomplete mole
  • usually some fetal parts, abnormal fertilization (69 chromosomes)

Choriocarcinoma

  • rare highly malignant tumor of placental origin, treat with methotrexate

Breast pathology

Normal Breast

Function

  • function is to produce milk (nourish newborn)

Structure [Figs. 16-1, 16-3]

  • modified apocrine sweat gland
  • lobules (ducts + terminal buds) drain into larger duct system hormonally influenced changes
  • males, pre-pubertal females have nipple + ducts
  • post-pubertal female
    • proliferation of ducts and early acini
  • pregnant female
    • terminal buds develop into acini
    • prolactin released in response to infant’s suck
    • milk produced

Breast pathology

Inflammation

Acute mastitis

  • acute inflammation of the breast
  • lactating female
  • bacterial infection
  • abscess may develop

Chronic mastitis

  • rare disease of unknown etiology
  • may mimic breast cancer

Fibrocystic change

  • benign changes in breast tissue due to various factors including hormonal influences and age
  • females of reproductive age
  • fibrosis of intralobular stroma
  • cystic dilation of epithelial ducts
  • epithelial hyperplasia
  • various symptoms

Gynecomastia

  • increased proliferation of male breast due to various factors

Breast pathology

Breast neoplasms

Fibroadenoma

  • benign neoplasm of breast epithelial and stromal elements
  • well circumscribed, firm, mobile mass
  • young females

Breast cancer

  • most common cancer in females
  • second most common cause of cancer related deaths in females
  • hormonal, environmental and genetic influences
    • familial breast cancers
      • BRCA-1, BRCA-2 tumor suppressor genes
      • increased incidence of other cancers
  • risk factors
    • female sex (100x males)
    • genetic predisposition
    • hormonal factors
      • prolonged estrogen exposure » early menarche, late menopause » nulliparous
    • other malignancies
      • contralateral breast carcinoma
      • endometrial carcinoma
    • premalignant changes
      • carcinoma in situ, atypical hyperplasia
    • Age
    • Race
  • there are different forms of breast cancer
  • most common breast cancer is infiltrating ductal carcinoma
    • adenocarcinoma
    • desmoplastic response of stroma
    • lymphatic spread (axillary nodes drain most of the breast)
    • presents as mass
    • early detection
      • breast self-examination
      • mammography [Fig. 16-10]
    • fine needle aspiration
    • incisional biopsy
  • therapy
    • Surgical resection
      • lumpectomy
      • mastectomy
      • axillary dissection
    • radiation
    • chemotherapy
      • tamoxifen
      • herceptin
  • Prognosis
    • staging most important [Fig. 16-8]
    • histologic subtypes
    • histological grading
    • estrogen receptor status