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8/14/2019 Common Gyn Disease
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Common
gynecologicaldiseases
Wang Jingwen (CathyWang)
Department of Gynecology
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Cervical diseases:
Uterine diseases: Ovarian diseases
Flloping tube disease:Ectopic
pregnancy
Outline
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Learning objectives Learning common terms of Ob &
Gyn
Understanding clinicalappearance of common diseases
Knowing the treatmentprinciples of common diseases
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Normal uterine, cervix, falloping tube, ovary
in
Different age of women
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Here is the gross appearance of
a normal uterus, cervix, vaginal
cuff, fallopian tube, and ovary
young woman
The ovaries are somewhat smaller thanthe left picture but have a similar tan-
white bosselated appearance.
perimenopausal woman
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An older postmenopausal woman. The uterus and
ovaries are smaller and have a fairly smooth tan-white
appearance.
postmenopausal woman
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Here is a normal cervix with a smooth, glistening
mucosal surface. There is a smallrim ofvaginal cuff from thishysterectomy specimen. The cervical os is small and
round, typical for a nulliparous woman.The os will have a fish-mouth shape after one or
more pregnancies.
normal cervix
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Cervical diseases Inflammations
Cervical cancer
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The normal adult
vaginal mucosa with awrinkled appearancethat is seen in women ofreproductive yearsappears at the left.
The cervix has been
opened to reveal anendocervical canalleading to the lower
uterine segmentAn erythematous
appearanceextending to the cervicalos consistent withchronic inflammation.
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The normal cervical squamous epithelium at
the left transforms to dysplastic changes on the
right.
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This is the gross appearance of a cervical squamous cell
carcinoma that is still limited to the cervix (stage I).
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Here is another cervical squamous cell carcinoma. Note
the IUD string protruding from the cervix.
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At high magnification, nests of neoplastic squamous cells
are invaded through a chronically inflamed stroma. Thiscancer is well-differentiated, as evidenced by keratin pearl.
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Self-assessment
Q:Markedevery organsname,please.
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Self-assessment
Q: Suspecteddiagnosisfurther
examinationhow to manage
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Answers Cervical squamous cell carcinoma
Biopsy and pathological examination Surgery: radical hysterectomy and
pelvic lymphodenectomy
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Endometrial diseases
HyperplasiaAdenocarcinomamyoma
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The endometrial cavity is opened to reveal lush fronds ofhyperplastic endometrium. Endometrial hyperplasia can
lead to metrorrhagia (uterine bleeding at irregular
intervals), menorrhagia (excessive bleeding with menstrual
periods), or menometrorrhagia .
hyperplastic endometrium
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High in the
fundus and
projecting into
the endometrial
cavity is a small
endometrial
polyp.Such benign
polyps may
cause uterine
bleeding.
It can be
treated with
Hysteroscopy .
endometrial polyp
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There is an irregularmass in the upper fundus
that proved to be
endometrial
adenocarcinoma on
biopsy.Such carcinomas are
more likely to occur in
postmenopausal women.
Any postmenopausal
bleeding should make yoususpect that this lesion
may be present.
adenocarcinoma
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In the upper fundus of the
uterus protruding into theendometrial cavity is a nodule
that proved to be aleiomyoma.
a submucosal leiomyoma.
Such benign smooth muscle
tumors of the myometrium are
very common, perhaps 1 in 5
women has one.
They may be the cause of
irregular bleeding if placed
submucosally.
leiomyoma
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Uterine myoma Myomas are the most common uterine
tumors
Benign smooth muscle tumor
(leiomyomata)
Prevalence :20%-40% women Sensitive to ovarian hormones(grow in
pregnancy, regress after menopause)
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Types
Smooth muscle
tumors of theuterus are often
multiple.
Submucosa
Intramural
Subserosal
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"red degeneration".
Such an appearance
might make you think
that it could bemalignant.
Remember that
malignant tumors do not
generally arise frombenign tumors
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symptoms Most myomas do not case any symptoms Enlarge or distort uterine
cavity:Menorrhagia and anaemia Large mass pressure bladder:frequency of
micturition
Infertility pelvic pain Abdominal swelling
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Diagnosis Age
Medical history:mass,
menorrhagia Pelvic examination:enlarge
uterine
B Ultrasound
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Treatment Small myoma, asymptomatic:
following-up
Perimenopausual women:medicaltreatment.
Any large pelvic mass of uncertain
nature requires removal to excludemalignancy and relieve pressuresymptoms: surgery.
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Indications of surgery The size of uterine: more than 10
weeks(pregnancy)
Heavy bleeding results in anaemia
Submucasal, cervical myoma
Infertility
Suspected malignancy
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Surgerys
Myomectomy
preserve fertility or uterus Enucleation of myoma
Remove all myomas as possible as you can
Recurrence soon (if more than 3 mass)
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Hysterectomy More than 40 year-old
Multiple myomas
With cervical inflammation
Preserve ovarian function
Avoid recurrence
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case 31 years old, marriage 2yrs,G0P0
Found abdominal mass 6 months
Felling abdominal swelling
Mass size: look-like 7 months pregnancy
Tumor markers: CA125,CP2 normal B ultrasound: uterine mass, cannot
excluded ovarian tumor.
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Q:
What is the probablydiagnosis?
What treatment can we
suggest?
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Answers Suspected diagnosis: uterine
myomas
ovarian tumor
pregnancy
Laparotomy:
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More than 20 myomas
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Pathological examination: benign leiomyoma.
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Surgery actually is a wonderfulart
--- wang Jianliu
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Fallopian tube diseases
(ectopic pregnancy)
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Fertilization Ovulation releases an egg from an ovarian follicle . The egg is swept into the fallopian tube and begins to
descend.
Spermatozoa (millions are represented here by one)begin ascending.
Fertilization of the egg by a single sperm occurs inthe ampullary portion of the fallopian tube
about a day after ovulation. The fertilized egg begins to develop into the blastocyt on descent into the endometrial cavity, whereimplantation occurs on the wall of the fundus about aweek after ovulation
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.
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This is a second trimester 3fetus and uterus
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Here is the sizeof the uterus in
the thirdtrimester 3 .Note how itdisplaces thebowelsuperiorly andfills the lowerabdomen.
Thisunfortunate
woman diedaccidentally,and the babydied too.
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This is a normal postpartum uterus 5 daysfollowing delivery. Note how quickly the uterus is
returning to its normal non-pregnant size.
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Ectopic pregnancy Ectopic pregnancies occur when the fertilized
ovum implants outside of theuterine fundus. About 1 in 150 pregnancies results in ectopic.
Most cannot be sustained at extrauterine
sites.
A tubal ectopic pregnancy may proceed forseveral weeks.
The enlargement can rupture and lead to
acute, life-threatening bleeding.
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Half of ectopic pregnancies occur because of an
identifiable lesion
chronic salpingitis frompelvic inflammatorydisease
adhesions from appendicitis, endometriosis
, or previous laparotomy .
However, in half of cases no cause can be found.
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This is a ruptured tubal ectopic pregnancy. Note the twin
fetuses at the lower right adjacent to the blood clot at the
left.
twin
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Here is another ectopic pregnancy in a fallopian tube.
This is a medical emergency because of the sudden rupture with
hemoperitoneum .Ectopic pregnancy should be considered in the differential diagnosis of
acute abdominal pain in a woman ofchildbearing age.
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Self-assessmentRegarding ectopic pregnancy: A it can always be detected by laparoscopy
B it may co-exist with an intra-uterine device insitu
C It cannot survive beyond 16 wks
D it is declining in frequency E the IUD confers protection against ectopic
pregnancy.
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Answers A.False. Laparoscopy occasionally fails
to detect a very early ectopic
pregnancy. B. true.it is extremely rare.
C. False. Peritoneal cavity pregnancymay survive to term .
D. False. Incidence is increasing.
E. False. IUD does not confer protectionagainst ectopic pregnancy.
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Ovarian tumorTumor-like conditions
Benign tumor
Cancer
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This is an adult ovary with two corpora lutea .The larger one is a hemorrhagic corpus luteum ofmenstruation.The smaller one is involuting from a previous menstrual period.Of 400,000 ovarian follicles present at birth, only about 400 will mature
to the point of ovulation during childbearing.
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A benign paratubal cyst.
They are filled with clear serous fluid and lined byflattened cuboidal epithelium.
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Benign epithelial tumors of the ovary.
The serous cystadenoma seen here fills a
surgical pan and dwarfs the 4 cmruler.
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A ovarian papillary cystadenocarcinoma, with
papillations seen over the surface.Many of these ovarian tumors have metastasized.
These neoplasms characteristically spread by "seeding"
along peritoneal surfaces.
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Here are bilateral fibrothecomas--benign ovarian
tumors.A right-sided hydrothorax in association with
this tumor is known as Meig's
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Here is an ovarian stromal tumor that is
hard and white and is a fibroma
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Benign serous cystadenoma
Multiloculation . the inner surface is, smooth, with only asolitary papillation at the upper right.
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A papillary serous cystadenocarcinoma.
Many papillations on the inner surface.
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A granulosa cell tumor of ovary.These tumors are derived from the ovarian stroma.
They are often hormonally active
The patient may initially present with bleeding from
endometrial hyperplasia .
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A large unilateral mature cystic teratoma
The uterus has an intramural and a subserosal
leiomyoma.
The other ovary is replaced by a fibroma.
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Metastatic tumors to ovary are uncommon. "Krukenberg" tumor of ovary: a signet ring histologic
pattern and usually is metastatic from gastrointestinal tract.
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Self-assessment
Q: probably diagnosis?
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Self-assessment
Q: describe each partsgive your suspected diagnosis