Female Reproductive System Kristine Krafts, M.D
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- Female Reproductive System Kristine Krafts, M.D.
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- Female Reproductive System Outline Cervix Uterus Ovaries
Breast
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- Female Reproductive System Outline Cervix Cervical
carcinoma
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- Cervical Carcinoma Once the most common cancer in women now not
even in top 10. Decrease due to Pap test! At the same time,
precursor lesions are increasing (early detection)
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- Cervical Intraepithelial Neoplasia (CIN) Precursor to carcinoma
Almost all carcinomas arise in CIN; but not all cases of CIN
progress to carcinoma! Three grades: CIN I: mild dysplasia (half
regress, 20% progress) CIN II: moderate dysplasia CIN III: severe
dysplasia (30% regress, 70% progress) The higher the grade, the
more likely the lesion will progress to carcinoma
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- Cervical Carcinoma Risk Factors Early age at first intercourse
Multiple sexual partners A male partner with multiple previous
partners Persistent infection with high-risk HPV Smoking
Immunodeficiency
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- Cervical Carcinoma and HPV HPV is detectable in almost all CIN
and cancer. High-risk types: 16, 18, 45, 31 Found in carcinomas
Integrate into genome, inactivate p53, RB Low-risk types: 6, 11
Found in condylomas (benign lesions) Do not integrate into
genome
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- Development of transformation zone
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- Normal cervix, young adult Transformation zone
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- Spectrum of cervical intraepithelial neoplasia (CIN)
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- Normal turning into CIN
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- normalCIN ICIN IICIN III Cytology of CIN (Pap smear)
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- normalCIN ICIN IICIN III Low-grade dysplasia High-grade
dysplasia
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- Invasive Cervical Carcinoma Most cases are squamous, arising
from CIN Small number are adenocarcinomas Peak age: 45 (10-15 years
after CIN develops!) Spreads slowly Most cases are diagnosed early
Mortality is related to stage Stage 0 (preinvasive): 100% 5 year
survival Stage 4: 10% 5 year survival
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- Cervical carcinoma
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- Female Reproductive System Outline Cervix Uterus Endometriosis
Endometrial hyperplasia Tumors
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- Endometriosis Location of endometrial glands outside uterus
Usually peritoneum, rarely lymph nodes Endometrium undergoes cyclic
bleeding Causes scarring, pain, sometimes sterility How does
endometrium get out?
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- Endometriosis in ovary (chocolate cyst)
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- Endometrial Hyperplasia Proliferation of endometrium due to
estrogen excess Risk factors: anovulatory cycles, obesity,
estrogen- producing ovarian tumors, exogenous hormone use Three
categories: simple, complex, and atypical The more severe the
hyperplasia, the greater the chance that it will evolve into
carcinoma
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- Normal endometrium
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- Endometrial hyperplasia SimpleComplexAtypical
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- Leiomyoma Fibroid Benign tumor of smooth muscle Common!
Stimulated by estrogen Menorrhagia, metrorrhagia, or
asymptomatic
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- Leiomyosarcoma Malignant tumor of smooth muscle Necrotic, with
atypical cells and lots of mitoses Often recur after surgery Many
metastasize, especially to lungs 5 year survival = 40%
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- LeiomyomaLeiomyosarcoma
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- LeiomyomaLeiomyosarcoma
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- Endometrial Carcinoma Peak age: 55-65 (not before 40)
Frequently arises in endometrial hyperplasia Risk factors: obesity,
nulliparity, estrogen replacement Symptoms: leukorrhea, irregular
bleeding Metastasizes late
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- Endometrial adenocarcinoma
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- Female Reproductive System Outline Cervix Uterus Ovaries
Tumors
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- Surface epithelial tumors Cystadenoma Cystadenocarcinoma Germ
cell tumors Teratoma Dysgerminoma Yolk sac tumor Choriocarcinoma
Granulosa-theca cell tumor Sertoli-Leydig cell tumor Sex
cord-stromal tumors Origin of Ovarian Tumors
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- Cystadenoma Benign tumor derived from surface epithelium
Repeated ovulation, scarring, infolding of epithelium leads to
cysts, which can undergo neoplastic transformation Typically large,
occasionally bilateral
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- Patient with ovarian cystadenoma
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- Ovarian cystadenoma
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- Teratoma Benign tumor with differentiation along all three germ
cell layers (ectoderm, endoderm, mesoderm) Usually cystic, with
skin inside (dermoid cyst) Sebaceous material, matted hair, teeth,
bone Malignant variant has immature tissues
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- Teratoma
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- Ovarian Cancer 22,000 new cases / 14,000 deaths predicted in
2014 5 th commonest, 5 th most deadly cancer in women Danger: no
definitive signs until advanced Peak age: 50 Most are
cystadenocarcinomas
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- Papillary cystadenocarcinoma
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- Ovarian Cancer Symptoms Feeling of fullness or bloating Pelvic
pain Back pain Abnormal menses Risk factors Nulliparity Family
history (BRCA gene mutation) NOT using oral contraceptives!
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- Ovarian Cancer Treatment: surgery, radiation, chemotherapy
Prognosis depends on stage Cancer confined to the ovary: 5y
survival 70% Cancer through ovarian capsule: 5y survival 13%
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- Female Reproductive System Outline Cervix Uterus Ovaries Breast
Fibrocystic change Tumors
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- Breast Many breast diseases present as lumps Most lumps
represent benign things but a lump always needs to be evaluated
Ultrasound, mammography, fine needle aspiration, and biopsy are the
usual methods
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- Most breast lumps are benign
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- Fibrocystic Change Two kinds: nonproliferative and
proliferative change Cause: exaggeration of normal breast cycles
Rarely associated with increased cancer risk Very common (present
in most women at autopsy) Called fibrocystic change, not
fibrocystic disease
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- Fibrocystic Change Nonproliferative fibrocystic change
Increased stroma Dilation of ducts, formation of cysts
Proliferative fibrocystic change Hyperplasia of breast epithelium
If epithelium shows atypia, 5x risk of cancer
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- Fibrocystic change
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- Normal breast
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- Nonproliferative fibrocystic change
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- Proliferative fibrocystic change
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- Fibroadenoma Most common benign breast tumor Stimulated by
estrogen Peak incidence in 20s Solitary, discrete, moveable mass
Fibrous tissue with compressed ducts and lobules
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- Fibroadenoma
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- Breast Carcinoma 233,000 new cases / 40,000 deaths predicted in
2014 Most common, 2 nd deadliest cancer in women Lifetime risk: 1
in 8 75% of patients are >50 Rate was increasing but now
stable
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- Breast Carcinoma Risk Factors Age Family history Increased
estrogen exposure Obesity Alcohol consumption High-fat diet
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- Breast Carcinoma Family History 5-10% of all cases are
hereditary Worry if first degree relative with breast cancer Most
have BRCA-1 or BRCA-2 mutations Tumor suppressor genes; help repair
DNA Genetic testing difficult Most carriers get cancer by age
70
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- Breast Carcinoma Clinical Findings If discovered by palpation
Solitary, painless, moveable mass 2-3 cm in diameter Axillary nodes
positive in 50% of patients If discovered by mammography 1 cm in
size Axillary nodes positive in only 15% of patients As disease
progresses Fixation to chest wall Adherence to overlying skin Peau
dorange
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- Advanced breast carcinoma: fixation to skin
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- Peau dorange
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- Inflammatory breast carcinoma
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- Breast Carcinoma Histologic Types Non-invasive Ductal carcinoma
in situ (DCIS) Lobular carcinoma in situ (LCIS) Invasive Ductal
Lobular Inflammatory Others
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- Normal breast
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- Lobular carcinoma in situ
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- Invasive breast carcinoma
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- Low-grade invasive ductal carcinoma
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- High-grade invasive ductal carcinoma
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- Inflammatory breast carcinoma
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- Breast Carcinoma Prognostic Factors Size of tumor Lymph node
involvement Distant metastases Grade of tumor Histologic type of
tumor
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- Sentinel node biopsy
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- Stage 0 Stage I Stage II Stage III Stage IV TNM* staging system
for breast cancer DCIS