Female Reproductive System PDF

Female Reproductive System  Site Specific Objectives Vagina and Vulva: 1. Describe the microorganisms affecting this system, including papovavirus, herpes simplex, candida, trichomonas, gonococcus, chlamydia and describe their local pathological results....

Female Reproductive System  Site Specific Objectives Vagina and Vulva: 1. Describe the microorganisms affecting this system, including papovavirus, herpes simplex, candida, trichomonas, gonococcus, chlamydia and describe their local pathological results. 2. Describe diseases of the vagina and vulva. 3. Discuss various treatment methods for cancer of the vagina and vulva. Cervix: 1. Describe the effects of radiation, hormones, and infections on the epithelial tissues of the cervix. 2. Describe the microorganisms, including papovavirus, herpes simplex, trichomonas, candida, gonococcus, and describe their local pathological results. 3. Describe the features of cysts and polyps of the cervix. 4. Describe precancerous change and carcinoma, including correlation of cytology with histology. 5. Compare the various terminologies related to these processes. 6. Describe the risk factors related to carcinoma of the cervix. 7. Discuss various treatment methods for carcinoma of the cervix. 11/10/2023 2  Site Specific Objectives Endometrium: 1.Describe the effects of radiation, hormones, and infections on the epithelial tissues of the endometrium. 2.Describe the microorganisms, including gonococcus, tuberculosis, and describe their local pathological results. 3.Describe the features of cysts and polyps of the endometrium. 4.Describe the main features of Dysfunctional Uterine Bleeding (DUB), hyperplasia, and carcinoma. 5.Describe the pathology of endometriosis/adenomyosis. 6.Describe pathology of myometrium. 7.Discuss various treatment methods for carcinoma of the endometrium. Ovary: 1.Classify various benign and malignant tumours including dysgerminoma. 2.Discuss various treatment methods for cancer of the ovary. Gestational disease: 1.Describe the basic pathology of hydatidiform mole and choriocarcinoma. 11/10/2023 3  General Overview Obstetrics Many aspects of this area involve knowledge around conception, pregnancy and post-natal care Pathology Abnormalities not directly related to the above (Obstetrics) form the other large part of discussion around the female reproductive system. Bleeding and pain are the usual symptoms. Infectious organisms, simple benign causes or benign and malignant tumours generate main headings Treatment Canadian Cancer Society has a good general overview of Treatment http://www.cancer.ca/en/cancer-information/diagnosis-and- treatment/treatment/?region=on You should have already looked at this in last weeks session. If you didn’t get to it, look at it now, as we will be covering specific 11/10/2023 treatment for each area. 4  General Overview (con’t) The World Health Organization (WHO) handouts include a chart on the Classification of Tumours for each area we will discuss. This is generally an extensive list, so use my headings under each section of FRS to determine how far down the list you need to go. This documents contain a great deal of information that will further your understanding. Hence, I would recommend this reading during your clinical rotation, prior to the National exam. WHO handouts – The links are posted on BB. You will be responsible for a basic knowledge of TNM and FIGO classification for Cervix and Endometrium Pathology and Genetics of Tumours of the Breast and Female Genital Organs Chapter 1. Tumours of the ovary and peritoneum (p12-14) Chapter 3. Tumours of the fallopian tube and uterine ligaments (p104- 105) Chapter 5. Tumours of the uterine corpus (p122-123) Chapter 6. Tumours of the uterine cervix (p170-171) Chapter 8. Tumours of the vagina (p208-209) Chapter 9. Tumours of the vulva (p230-231) 11/10/2023 5  Vulva Many conditions located here are similar to Skin diseases. We will not spend much time on these here but will revisit the information when we cover Skin disease in the Winter term. Infections (common symptom – pruritis) STD’s –HPV (leukoplakia), Herpes, Gonorrhea Bartholin gland cysts commonly associated with infections Hyperplastic conditions Contact Dermatitis Lichen sclerosus (leukoplakia) Melanotic lesions –benign nevi Benign conditions – cysts, papillomas (condylomas –warty lesions, usually due to HPV 6, 11) Malignant tumours Vulvar Intraepithelial Neoplasia (VIN) - leukoplakia 6 11/10/2023  Vagina Infections –(common symptom –Leukorrhea) STD’s – spread from Vulva or Cervix Non-STD’s – Candida Toxic shock Adenosis (Diethylstilbestrol exposure -DES) DES is a synthetic form of estrogen given to pregnant women during 1938- 1971 to prevent miscarriages Concerns for the offspring range from increased risk of Vaginal Adenocarcinoma, Breast cancer, Epididymal cysts. Anyone born during this timeframe is high-risk for neoplasia. Third generation risks have not been confirmed Tumours Vaginal Intraepithelial Neoplasia (VAIN) Sarcoma botryoides (embryonal tumour affecting age 5days with no known lesion present 11/10/2023 12  Endometrium (Uterus) con’t Hyperplasia Excessive growth due to unopposed estrogen Simple (Cystic) Hyperplasia –no link with Uterine cancer Complex Hyperplasia Atypical (Adenomatous) Hyperplasia – significant cellular atypia present, higher risk for progression to malignancy Carcinoma Occurs predominantly in post-menopause Endometrioid type Serous type Myometrium (leiomyoma, leiomyosarcoma) Leiomyoma commonly referred to as fibroids, most common symptom is menorrhagia Leiomyosarcoma does not arise from leiomyomas 13 11/10/2023  Endometrium (Uterus) con’t WHO Classification of Tumours Chapter 5 –Tumours of the Uterine Corpus Click on hyperlink in Week 10 BB for this WHO document Treatment – main method is Surgery Go to the following link for general treatment for cancer of the Uterus: https://cancer.ca/en/cancer-information/cancer-types/uterine/treatment (click on left-hand side of screen to change the stage of the tumour). High-risk groups – conditions resulting in unopposed estrogen (estrogen- replacement therapy, polycystic ovarian disease, granulosa cell tumours of ovary, obesity 14 11/10/2023  Fallopian Tubes Salpingitis STD’s Non-STD’s Ectopic pregnancy Carcinoma - Adenocarcinoma 15 11/10/2023  Ovary Using knowledge gained from the Microanatomy of this area, you should have a basi understanding of tumours that will arise in the ovary. Cysts Very common, often source of pelvic pain Polycystic Ovarian Disease (Stein-Leventhal syndrome) –appearance is as name suggests –multiple cysts Epithelial (surface) tumours –same tumour suppressor gene mutations associated with Breast cancer can occur here – BRCA1 and BRCA2 Serous – can be benign or malignant Mucinous – can be benign or malignant Endometrioid – resembles endometrium Sex cord (stroma) tumours – thecomas, granulosa cell tumours Germ cell tumours Cystic teratoma Solid teratoma Metastatic tumours to ovary – referred to as Krukenberg tumours 11/10/2023 16  Treatment – Surgery is main option, but other methodologies may be necessary Go to the following link for general treatment for cancer of the ovary: https://cancer.ca/en/cancer-information/cancer- types/ovarian/treatment Go to the following link for more specific treatment based on staging (click on left-hand side of screen to change the stage of the tumour). High-risk groups – Obesity, familial mutations such as BRCA1, BRCA2 11/10/2023 17  Gestational Disease Awareness of the names, origin and basic pathology of these tumours is all that is required. Hydatidiform mole Choriocarcinoma –often these aggressive gestational tumours are diagnosed in distant body sites as metatstatic tumours 18 11/10/2023  Images and Diagrams WebPath https://webpath.med.utah.edu/FEMHTML/FEMIDX.html Look at a few examples of each area of female reproductive in Images #1 – 89. A list of images will be posted on BB Please note: the term dysplasia is still being used in these images instead of SIL. 19 11/10/2023  References Anderson, P. Basic Medical Pathology Series. The University of Alabama, Department of Pathology. (2020) Retrieved from: http://peir.path.uab.edu/library/index.php?/category/53 Canadian Cancer Society (2021) Cancer Treatment Information. Retrieved from: http://www.cancer.ca/Canada- wide/About%20cancer/Treatment.aspx?sc_lang=en Kumar, V., Abbas, A.K., Aster, J.C. Robbins Basic Pathology, 11th Edition, Philadelphia: Elsevier Saunders, 2022. Webpath –The Internet Pathology Laboratory. The University of Utah Eccles Health Sciences Library. (2021) Retrieved from: https://webpath.med.utah.edu/NEOHTML/NEOPLIDX.html World Health Organization. (2021) International Agency for Cancer. Retrieved from: http://publications.iarc.fr/Book-And-Report-Series/Who-Iarc-Classification- Of-Tumours/WHO-Classification-Of-Tumours-Of-Female-Reproductive-Organs- 2014 Young, B., Stewart, W., O’Dowd, G. Wheater’s Basic Pathology. 5th ed. China: Churchill Livingstone Elsevier; 2011. 11/10/2023 20