Pathology of the Female Reproductive System PDF

PATHOLOGY OF FEMALE REPRODUCTIVE DR IZATUS SHIMA TAIB  OUTLINE Menstrual Disorder Menopause Endometriosis Benign Reproductive Tumor : Leiomyomas, PCOS Cancers of Female Reproductive System MENSTRUAL DISORDERS 1) Premenstrual Syndrome (PMS) Why is PMS know...

PATHOLOGY OF FEMALE REPRODUCTIVE DR IZATUS SHIMA TAIB  OUTLINE Menstrual Disorder Menopause Endometriosis Benign Reproductive Tumor : Leiomyomas, PCOS Cancers of Female Reproductive System MENSTRUAL DISORDERS 1) Premenstrual Syndrome (PMS) Why is PMS know as a syndrome and not a disease? a group of physiological and psychological symptoms  What are the symptoms? these can vary from month to month?  Treatment Stress Reduction Techniques naturally Initiation of an Exercise Program Diet Therapy – Avoid caffeine and alcohol – Eat complex carbohydrates, high-fiber – Reduce salt intake – Increase vitamin B12 , calcium and magnesium  Treatment Drug Therapy – Selective Serotonin reuptake inhibitors Prozac Zoloft – Diuretics - spironolactone – Prostaglandin inhibitors - ibuprofen – Antidepressants, antianxiety - Xanax – Oral contraceptives  2) Dysmenorrhea Painful cramps that may occur immediately before or during the menstrual period – period pain 2 types: primary (common), secondary (disorder of female repro organ) Cause - excessive prostaglandins * What is the action of prostaglandins on smooth muscles? interineto must contract - lead cramp  Signs and Symptoms – In addition to aching pain in the abdomen, what will the patient complain of? Pressure in the abdomen Pain in the hips, lower back and inner thighs Upset stomach (severe) Vomiting (severe) Diarrhoea (severe)  Treatment – Drug Therapy NSAIDS/ Prostaglandin blockers - Oral Contraceptives – Relaxation Techniques – Heat Therapy – Exercise – Other Acupuncture Transcutaneous nerve stimulation 3) Abdominal Vaginal Bleeding Abdominal Vaginal Definition ⑭ Bleeding Oligomenorrhea light or infrequent menstrual periods (> 35 days interval, 4 – 9 times per year) Amenorrhea absence of menses Menorrhagia prolonged menstrual bleeding Metrorrhagia Bleeding from the uterus between menstrual periods Complications of Vaginal Bleeding Anemia Lab investigation– CBC, Hb, Hct Assess for excessive fatigue Monitor vital signs Provide for safety with the weak patient Toxic Shock Syndrome (TSS) Assess for high fever, vomiting, diarrhea, weakness, myalgia, and sunburn-like rash Avoid use of superabsorbent tampons and pads (change pads and tampons frequently) Treatment of Vaginal Bleeding – Drug Therapy Oral Contraceptives – Balloon Thermotherapy – Myomectomy  Endometrial Ablation A resectoscope is a special type of telescope inserted inside the uterus. It has a built in wire loop that uses high- frequency electrical energy to cut or coagulate or ablate tissue. The resectoscope has the advantage of being able to remove polyps and some fibroids at the time of ablation.  MENOPAUSE CESSATION OF MENSES  Menopause Absence of menstrual periods for 12 months. Function of ovary ceases. Stages: 1) Premenopause 2) Perimenopause 3) Menopause 4) Postmenopause  Causes of Menopause Natural decline of reproductive hormones Hysterectomy, bilateral oophorectomy Chemotherapy and radiation therapy Primary ovarian Hysterectory insufficiency Pophoteretu  Treatment of Menopause Drug Therapy – NO longer encourage the use of Hormone Replacement Therapy – related to increase in risk for development of breast cancer, stroke, heart disease, Deep Vein Thrombosis, pulmonary emboli – Antidepressants – Selective estrogen receptor modulators raloxifene (Evista) Relatifent – Bisphosphonates – treat osteoporosis Fosamax or Actonel  Non-hormonal Therapy – Cool environment – Loose fitting clothing – Moisturizing soaps and lotions – Healthy diet with vitamin D – Vitamin and mineral supplements – Exercise. L PELVIC INFLAMMATORY DISEASE INFECTION OF UTERUS, FALLOPIAN TUBES, OVARIES, AND PERITONEAL CAVITY Pelvic Inflammatory Disease (PID) Cause – gonorrhea and chlamydial infections spread up the reproductive system into the peritoneal cavity Manifestation – Abdominal pain – Fever – Vaginal discharge Diagnosis – Vaginal culture Complication & Treatment Pelvic Inflammatory of PID Disease Complications – Septic Shock – Infertility – Ectopic pregnancy Treatment – Drug Therapy – Force fluids – Heat to abdomen or Sitz bath – Patient teaching – prevention of re-infection  ENDOMETRIOSIS Presence of normal Endometrial Tissue outside the uterine cavity  Endometriosis It is characterized by endometrial glands and stroma in a location outside the endomyometrium. It may present as a pelvic mass filled with degenerating blood. Menstrual backflow through the fallopian tubes with subsequent implantation. Indeed, menstural endometrium is viable and survives when injected into the anterior abdominal wall. Clinical Manifestation & Diagnosis of Endometriosis Clinical manifestation  Dysmenorrhea, pelvic pain  Dyspareunia (painful intercourse), dysuria (painful urination)  Infertility  Chocolate cysts in ovaries Diagnosis  Pelvic exam  Ultrasound  Laparoscopy Treatment of Endometriosis Ibuprofen (Advil) Oral contraceptives Medroxyprogesterone (Depo-Provera) Danazol - Danocrine Gonadotropin-releasing hormone agonists –Leuprolide (Lupron) –Nafarelin (Synarel)  Surgical Therapy – Conservative Laparoscopic laser surgery / laparotomy Used in women who desire to bear children – Definitive Hysterectomy Used in women who no longer desire children  myshe tel Politic BENIGN REPRODUCTIVE SYSTEM TUMORS Laimyomis Leiomyomas Polycystic ovary Uterine Fibroids (Leiomyomas) Benign smooth muscle tumors in uterus diagnosed - with Hysteroscopy Signs and Symptoms of Leiomyomas – Most do NOT have symptoms If they do: – Abnormal uterine bleeding- menorrhagia and metrorrhagia – Pain, pelvic pressure  Diagnosis and Treatment of Leiomyomas Diagnosis – Enlarged uterus distorted with nodular masses Treatment – Myomectomy, Myolysis – Hysterectomy – Cryosurgery  Answer this… A 26 y/o woman who wishes to have children is diagnosed with uterine fibroids (leiomyoma). Which of the following is likely to be the treatment of choice? a. A hysterectomy will be necessary to remove the tumor b. A myomectomy may be performed c. Aspirin and NSAID’s will be used to control the pain d. Hormonal therapy will be used to shrink the tumor and maintain sterility Polycystic Ovarian Syndrome (PCOS) bilateral enlarged ovaries multiple outer follicular cysts (fluid-filled sacs) absence corpora lutea failed ovulation hyperplastic ovarian stroma + thickening capsule  Insulin directly and independently  stimulates androgen secretion by ovarian stroma  reduces serum sex hormone-binding globulin (SHBG) Hyperinsulinemia plays a key role in androgen excess, anovulation and pathogenesis of PCOS Hyperinsulinemia ↓ SHBG ↑ ovarian ↑ LH/ ↓ FSH production androgen secretion production Hyperandrogenism Anovulation (↑ free testosterone) PCOS  Estrogen (N) ↑ testosterone Small cysts ↓progesterone develop in No egg released ovaries  from ovary failure to release egg ↑ LH, ↓ FSH high LH-to-FSH ratio Signs and Symptoms and Diagnosis of PCOS Signs and Symptoms – Irregular menstrual periods – infrequent or absent – Hirsutism – Obesity – Acne – No ovulation – Long term  INFERTILITY Diagnosis – Ultrasound & laparoscopy  Treatment of PCOS  Medication oral contraceptives, spironolactone (Aldactone), leuprolide (Lupron), Metformin (glucophage), clomiphene (Clomid)  Surgery Oophorectomy  Additional treatment Weight management, Exercise, Monitor lipid profile, Monitor glucose levels  CANCERS OF FEMALE REPRODUCTIVE SYSTEM Cervical Cancer, Endometrial Cancer, Ovarian Cancer, Vaginal Cancer, Vulva Cancer  Cervical cancer Early changes in cervical epithelial tissue consist of dysplasia Mild then becomes severe (takes 10 yrs) Occurs at junction of columnar cells and squamous cells of external of cervix Etiology Strongly linked to STDs – Herpes simplex virus type 2 (HSV-2) – Human papilloma virus (HPV) Virus exerts direct effects on host cell or may cause antibody reaction – Increased antibodies have been assoc with increasing dysplasia High risk factors – Multiple sex partners – Sexual intercourse in early teen years – Pt history of STDs Environmental factors such as smoking can predispose women  Staging of Cervical cancer Cervical intraepithelial neoplasia (CIN) graded from I to III Based on amount of dysplasia and cell differentiation 1. Grade I (minimal dysplasia) 2. Grade II (moderate) 3. Grade III - Carcinoma in situ - Many disorganized, undifferentiated, abnormal cells present (severe dysplasia) Staging and Treatment of Cervical Staging and Treatment Cancer  Endometrial Cancer Major Risk factor – Prolonged exposure to Estrogen Other Risk factors – Age - >60 – Infertility – Diabetes – Family history, other cancers – Lifestyle – obesity, smoking Diagnosed – Endometrial biopsy Treatment: Surgical Therapy – Hysterectomy – first choice of treatment Chemotherapy Radiation - brachytherapy  Brachytherapy Internal radiation implantation which delivers a high dose of radiation to a localized area. The radiation device is placed near the tumor (in vagina) seeds, needles, catheters Radioisotopes are loaded into the device after correct placement.  Ovarian Cancer Ovarian Cancer Greatest risk factor is family history Other risk factors include – Age – High-fat diet – Greater number of ovulatory cycles – Hormone replacement therapy – Use of infertility drugs 90% of ovarian cancers are epithelial carcinomas from malignant transformation of surface epithelial cells  Clinical Manifestations – Increase in abdominal girth – Bowel and bladder dysfunctions – Persistent pelvic or abdominal pain – Menstrual irregularities – Ascites Diagnosis - Screening for high risk women should include CA- 125, ultrasound, and yearly pelvic examination - CA-125 is positive in 80% of women with ovarian cancer Treatment options for all Cancers Surgery – Oophorectomy, Panhysterectomy – Pelvic Exenteration Chemotherapy Radiation – External – Brachytherapy BREAST CARCINOMA  Benign FIBROADENOMA The most common benign breast tumor, Occurs at any time during reproductive life, – most often under age 30. It presents a small, sharply circumscribed, freely movable nodule within the breast substance. A loose stroma surrounds ducts that are often crushed flat. Fibroadenoma  Malignant This is the most common cancer in women It is rare before age 25, – more common with increasing age. Around 1 in 9 women will develop breast cancer during their life. Breast cancer usually presents as a dominant, painless mass. Nowadays it is often found on mammography long before symptoms appear. Ductal Carcinoma In Situ LEP: luminal epithelial MEP: myoepithelial  Ductal carcinoma in situ (DCIS) https://www.bcna.org.au/understanding- breast-cancer/what-is-breast-cancer/ductal- carcinoma-in-situ/ Invasive carcinoma