PATHOLOGY FEMALE GENITAL SYSTEM - PowerPoint Presentation

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PATHOLOGY FEMALE GENITAL SYSTEMPart 2Noushin Afshar Moghaddam (MD/Professor of Pathology/Shahid Beheshti University)

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Endometrium Myometrium

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Body of the uterus

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Menstrual phase : day1- 4Proliferative phase : day 5 – 14Secretory phase : day 15 - 28

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Endometrium

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The endometium is relatively resistant to infectionAcute endometritis Chronic endometritis

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Endometritis

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Bacterial infecions after parturition or miscarriageAcute endometritis

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1- Chronic gonorrhea2-Clamidia Trachomatis3-Tuberculosis4- In postpartal or postabortal endometrium5- IUD6- In 15% without apparent causeChronic endometritis

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Irregular proliferation of endometrial glands presence of chronic inflammatory cells : plasma cells, macrophages and lymphocytes in the stroma

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Endometritis

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AdenomyosisEndmetriosis

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Adenomyosis occurs when endometrial glands and stroma are found in the myometrium, not just in the endometrium where they belong. This condition leads to uterine enlargement and irregular bleeding

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OvariesPouch of DouglasUterine ligamentsFallopian TubesRectovaginal septum

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Endometriosis

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Regurgitation TheoryMetaplastic TheoryVascular or lymphatic dissemination Theory

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Endometriosis

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Endometrial glandsEndometrial stromaHemosiderin pigment

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Endometriosis

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Endometrial glands and stroma are seen at high magnification in the wall of the colon. Endometriosis is symptomatic during reproductive years when patients may present with dysmenorrhea, pelvic pain, and infertility

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Endometriosis

Hemosiderin pigment

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This is a section through an enlarnged 12 cm ovary to demonstrate cystic cavity filled with old blood typical for endometriosis with formation of an endometriotic, or "chocolate", cyst. The hemorrhage from endometriosis into the ovary may give rise to a large "chocolate cyst" so named because the old blood in the cystic space formed by the hemorrhage is broken down to produce much hemosiderin and a brown to black color

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Menorrhagia : Profuse or prolonged bleeding at the time of periodMetrorrhagia : Irregular bleeding between the periods or ovulatory (intermenstrual) bleedingPostmenopausal Bleeding

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Abnormal Uterine Bleeding (AUB)

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Common causes include: PolypsLeiomyomasendometrial or cervical carcinoma, endometritis Endometriosis DUB endometrial hyperplasia

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Abnormal Uterine Bleeding (AUB)

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Failure of ovulation(1) Hypothalamicpituitary axis, adrenal, or thyroid dysfunction(2) functional ovarian lesions producing excess estrogen(3)malnutrition, obesity, or debilitating disease(4)severe physical or emotional stressInadequate luteal phaseContraceptive-induced bleedingEndomyometrial disorders

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Abnormal uterine Bleeding

AUB

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An excess of estrogen relative to progestin, if sufficiently prolonged or marked , will induce Endometrial hyperplasia

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Endometrial hyperplasia

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Failure of ovulation prolonged administration of estrogenic steroids without counter balancing progestin PCODGranulosa – theca cell tumors of the ovaryObesity

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Endometrial hyperplasia

potential factors

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Simple (Cystic) HyperplasiaComplex HyperplasiaAtypical HyperplasiaAtypical hyperplasia : 20% -25% progression to adenocarcinoma

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Endometrial hyperplasia

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endometrial cystic hyperplasia

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The amount of endometrium is abnormally increased and not cycling as it shouldenlarged and irregular gland with columnar cells that have some atypia. Simple endometrial hyperplasias are not thought to be premalignant. adenomatous hyperplasia is premalignant.endometrial cystic hyperplasia

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Endometrium, hyperplasia -Atypical

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Tumors of the Endometrium and Myometrium

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Benign = Polyp Malignant = Adenocarcinoma

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Tumors of the endometrium

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May occur at any age ,but more commonly at the time of menopauseUsually sessile0.5 to 3 cm in diameterClinical significance : AUBMalignant change , Rare

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Endometrial polyp

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Endometrial polyp

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Endometrial polyp

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Adenocarcinoma

of the

endometrium

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Obesity :Increased synthesis of estrogens in fat depots and from adrenal and ovarian precursorsDiabetesHypertension Infertility : Women tend to be single and nulliparous ,and they often have nonovulatory cycles

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Risk factors

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Endometriod carcinomaPapillary serous carcinoma

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Adenocarcinoma of the endometrium

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Gross:Resemble normal endometriumExophytic infiltrativeMicroscopy :Grade 1 to 3

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Endometriod

carcinoma

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Uterus, endometrioid adenocarcinoma - Gross

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endometrial adenocarcinoma :invading into the smooth muscle bundles of the myometrial wall of the uterus. This neoplasm has a higher stage than a neoplasm that is just confined to the endometrium or is superficially invasive

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Endometrial adenocarcinoma

with squamous metaplasia

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About 20% 0f Adenocarcinoma of the endometrium Do not appear to be associated with hyperstrinism or preexisting hyperplasia.Arise at later stage in lifePoor prognosis

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Papillary serous

carcinoma

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Nearly all cases have mutations in the TP53 tumor suppressor genemutations in DNA mismatch repair genes and PTEN are rarePapillary serous carcinoma of endometrium

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Papillary serous carcinoma of endometrium

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Immunohistochemical (IHC) staining for P53

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LeiomyomaLeiomyosarcoma

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Tumors of the myometrium

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The most common benign tumor in females , 30% - 50% of women during reproductive lifeGenetic influences are involved More frequent in blacks than in whites Estrogen and possibly oral contraceptives stimulate their growthMonoclonalChromosomal abnormalities in about 40%60% normal karyotype

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Leiomyoma

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May be asymptomatic The most frequent manifestation , when present is menorrhagia , with or without metrorrhagiaMalignant transformation is extremely rare

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Leiomyoma

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Sharply circumscribed , firm , gray – white massesWhorled cut surfaceMay occur singly, but most often multiple

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Leiomyoma

Gross

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IntramuralSubmucosalSubserosal parasitic leiomyoma

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Leiomyoma

Gross

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Multiple uterine leiomyomas.

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Leiomyoma

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benign leiomyoma: Normal myometrium is at the left, and the neoplasm is well-differentiated so that the leiomyoma at the right hardly appears different. Bundles of smooth muscle are interlacing in the tumor mass.

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Arise directly from myometriumAlmost always solitary

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Leiomyosarcoma

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tumor necrosiscytologic atypia mitotic activity.Since increased mitotic activity is sometimes seen in benign smooth muscle tumors, particularly in young women, an assessment of all three features is necessary to make a diagnosis of malignancy.Leiomyosarcoma

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As with sarcomas in general, leiomyosarcomas have spindle cells. Several mitoses are seen here, just in this one high power field.

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