Female genital tractFemale genital tract

InfectionsInfections

Lower genital tract (Lower genital tract (STDSTD – HSV, – HSV, molluscum contagiosum, HPV, molluscum contagiosum, HPV, trichomonas, chancroid, granuloma trichomonas, chancroid, granuloma inguinale; inguinale; endogenousendogenous – candida) – candida)

Entire genital tract (Entire genital tract (STDSTD – – gonorrhea, chlamydia, mycoplasma, gonorrhea, chlamydia, mycoplasma, syphilis; syphilis; endogenousendogenous – enteric – enteric bacteria), may end in PIDbacteria), may end in PID

Causes of female infertility

HSV

Syphilitic chancre

SyphilisSyphilis

secondary stage – early secondary stage – early generalisationgeneralisation

Acute salpingoophoritis

PID - torsion

Ovarian cystsOvarian cysts

non-neoplastic non-neoplastic – – inclusion c.inclusion c. (mesothelial, epithelial)(mesothelial, epithelial)

functional c.functional c. (follicular, luteal, polycystic (follicular, luteal, polycystic ovary syndrome, ovarian hyperstimulation ovary syndrome, ovarian hyperstimulation syndrome)syndrome)

endometriosisendometriosis neoplastic neoplastic ((surface epithelial tumors, surface epithelial tumors,

germ cell tu, germ cell tu, sex-cord stromal tu, metastatic sex-cord stromal tu, metastatic tu, etc.)tu, etc.)

Follicle cyst

EndometriosisEndometriosis

Ovarian tumors

Serous cystadenoma

Serous cystadenoma

Serous papillary cystadenoma

Serous papillary tumor of low malignant potential (papillary cystadenoma of borderline malignancy)

serous cystadenocarcinoma

ovarian adenocarcinoma – stromal invasion

Malignant cell clusters in ascitesMalignant cell clusters in ascites

Mucinous cystadenoma

Mucinous papillary cystadenoma

Mucinous cystic tumor of low malignant potential

Germ cell tumorsGerm cell tumors

dysgerminomadysgerminoma (ovarian counterpart of (ovarian counterpart of seminoma)seminoma)

embryonal carcinomaembryonal carcinoma yolk sac tumor yolk sac tumor (endodermal sinus tumor)(endodermal sinus tumor) choriocarcinomachoriocarcinoma teratoma teratoma (mature – benign: dermoid cyst,(mature – benign: dermoid cyst,

immature – malignant,immature – malignant,

malignisation in a mature malignisation in a mature teratoma)teratoma)

Embryonal carcinoma

Choriocarcinoma

Dermoid cyst

Sex-cord stromal tumorsSex-cord stromal tumors Granulosa cell tumors Granulosa cell tumors (potentially (potentially

malignant, possible estrogen production malignant, possible estrogen production – risk of abnormal uterine bleeding, – risk of abnormal uterine bleeding, endometrial hyperplasia or ca)endometrial hyperplasia or ca)

Thecoma-fibroma Thecoma-fibroma (most common, (most common, usually benign, possible association with usually benign, possible association with ascites, rarely estrogen production) ascites, rarely estrogen production)

Sertoli-Leydig cell tumors Sertoli-Leydig cell tumors (possible (possible masculinisation)masculinisation)

Granulosa cell tumorGranulosa cell tumor

Granulosa cell tumorGranulosa cell tumor

Ovarian fibroma

Sertoli-Leydig cell tumor

Metastatic tumorsMetastatic tumors

GITGIT (stomach, colorectal, commonly (stomach, colorectal, commonly mucinous adenocarcinoma)mucinous adenocarcinoma)

breastbreast ! synchronnous primary endometrial ! synchronnous primary endometrial

ca + primary endometroid ovarian ca + primary endometroid ovarian caca

Krukenberg tumor

Fallopian tubes diseasesFallopian tubes diseases

inflammationinflammation cystcyst tumorstumors GEU (ectopic pregnancy)GEU (ectopic pregnancy)

Chronic salpingitis

Hydrosalpinx

Pathology of uterine Pathology of uterine corpuscorpus

congenital anomaliescongenital anomalies inflammationinflammation functional endometrial disordersfunctional endometrial disorders polyps (endometrial etc.)polyps (endometrial etc.) adenomyosis adenomyosis endometrial hyperplasiaendometrial hyperplasia tumors tumors

Uterus bicornis

Uterus didelphys

Uterus unicornis with rudimentary horn

Acute endometritis

Chronic endometritis

Disordered early secretion - Disordered early secretion - ovulationovulation

Hypersecretion

Stromoglandular Stromoglandular dissociationdissociation

Epithelial changes – Epithelial changes – metaplasiametaplasia

squamous cellsquamous cell

Epithelial changes – Epithelial changes – metaplasiametaplasia

Epithelial changes – Epithelial changes – metaplasiametaplasia

PolypsPolyps Endometrial polypEndometrial polyp Polypoid hyperplasiaPolypoid hyperplasia Hyperplasia and polyps in tamoxifenem Hyperplasia and polyps in tamoxifenem

ther. ther. Polypoid tumors – adenomyoma, carcinoma, Polypoid tumors – adenomyoma, carcinoma,

submucosal leiomyoma, stromal tumors, submucosal leiomyoma, stromal tumors, etc.etc.

Pathological pregnancy (trofoblastic Pathological pregnancy (trofoblastic lesions, decidua etc.)lesions, decidua etc.)

Pseudotumors –pathol. material Pseudotumors –pathol. material accumulation etc.accumulation etc.

Endometrial polypEndometrial polyp

Endometrial polypEndometrial polyp

Endometrial polypEndometrial polyp

Atypical polypoid Atypical polypoid adenomyomaadenomyoma

Mixed tumor, stromal smooth muscle + glands (appearance of complex hyperplasia, epithelial atypias)

AdenomyosisAdenomyosis

irregular bleeding, dysmenorrhea, irregular bleeding, dysmenorrhea, pelvialgiapelvialgia

more common in perimenopause after more common in perimenopause after repeated births („diverticulosis“)repeated births („diverticulosis“)

may predispose to uterine prolaps into may predispose to uterine prolaps into vaginavagina

myometrial reaction incl. hyperplasiamyometrial reaction incl. hyperplasia possible origo of endometrial tu possible origo of endometrial tu

in myometrium (! x ca invasion into in myometrium (! x ca invasion into myometrium)myometrium)

Adenomyosis

Adenomyosis

Adenomyosis + Adenomyosis + leiomyomaleiomyoma

Uterine corpus tumors – Uterine corpus tumors – WHOWHO Epithelial tu and related lesionsEpithelial tu and related lesions: :

EndometrialEndometrial carcinoma carcinoma – endometrioid – endometrioid (type 1, estrogen-dependent; type 2 -non (type 1, estrogen-dependent; type 2 -non estrogen-dependent) mucinous, serous, estrogen-dependent) mucinous, serous, clear cell, squamous cell, metaplastic clear cell, squamous cell, metaplastic (carcinosarcoma = malignant mixed (carcinosarcoma = malignant mixed müllerian tumor), othersmüllerian tumor), others

Endometrial hyperplasia Endometrial hyperplasia (+ (+ endometrial endometrial intraepithelial neoplasiaintraepithelial neoplasia) )

Endometrial polypsEndometrial polyps

Tamoxifen related lesionsTamoxifen related lesions

Uterine corpus tumors – Uterine corpus tumors – WHOWHO

Mesenchymal tumors:Mesenchymal tumors:

endometrial stromal lesions: endometrial stromal lesions: endom. stromal endom. stromal nodule (benign), low grade endom. stromal nodule (benign), low grade endom. stromal sarcoma, undifferentiated endom. stromal sarcoma, undifferentiated endom. stromal sarcomasarcoma

smooth muscle tumors: smooth muscle tumors: leiomyoma (+ variants), leiomyoma (+ variants), tu of uncertain malignant potential, tu of uncertain malignant potential, leiomyosarcoma (+ variants)leiomyosarcoma (+ variants)

tumors from perivascular epitheloid cells tumors from perivascular epitheloid cells (PECom)(PECom)

other mesenchymal tumorsother mesenchymal tumors

Uterine corpus tumors – Uterine corpus tumors – WHOWHO

Mixed epithelial and mesenchymal Mixed epithelial and mesenchymal tumorstumors: adenomyoma, adenofibroma, : adenomyoma, adenofibroma, adenosarcoma etc.adenosarcoma etc.

Gestational trophoblastic disease Gestational trophoblastic disease Other tumors: adenomatoid tumor Other tumors: adenomatoid tumor

(mesothelial), …(mesothelial), … Secondary tumorsSecondary tumors

Hyperplasia, intraepithelial Hyperplasia, intraepithelial neoplasianeoplasia

Non-physiological non-invasive proliferation Non-physiological non-invasive proliferation of endometrium, benign lesion (reactive) → of endometrium, benign lesion (reactive) → premalignant condition (monoclonal)premalignant condition (monoclonal)

Hormone dysbalanceHormone dysbalance - persistent estrog. - persistent estrog. stimulation without secretory stimulation without secretory transformation, incl. relative (progestin transformation, incl. relative (progestin inssuf.). inssuf.). ~~ endometr. ca type 1. endometr. ca type 1.

endogennousendogennous: path. ovarian regulation, : path. ovarian regulation, polycystic ovaries, hormon. active processes polycystic ovaries, hormon. active processes (tu), obesity with hyperestrinism etc.(tu), obesity with hyperestrinism etc.

exogennousexogennous: hormon. therapy (pure : hormon. therapy (pure estrogens)estrogens)

Classification of endometrial hyperplasis SimpleComplexAtypical (specify architecture: simple or complex)

Endometrial intraepithelial Endometrial intraepithelial neoplasia (EIN)neoplasia (EIN) ~~ to complexní to complexní atyp. hyperplasia atyp. hyperplasia >> 1 mm, different 1 mm, different from surrounding tissuefrom surrounding tissue

intraglandular or superficialintraglandular or superficial

Simple hyperplasiaSimple hyperplasia

Complex hyperplasiaComplex hyperplasia

Endometrioid carcinomaEndometrioid carcinoma

Endometrioid. ca – cervical Endometrioid. ca – cervical invasioninvasion

EIN in polypEIN in polyp

Metaplastic carcinomaMetaplastic carcinoma

Carcinosarcoma = metaplastic carcinoma

ESS - HGESS - HG

LeiomyomaLeiomyoma

Leiomyosarcoma

AdenosarcomaAdenosarcoma

Breast ca metastasisBreast ca metastasis

Pathology of the cervixPathology of the cervix

cervicitiscervicitis polypspolyps physiological and pre-neoplastic physiological and pre-neoplastic

epithelial changes – metaplasia, epithelial changes – metaplasia, dysplasia (CIN)dysplasia (CIN)

tumorstumors

Endocervical polyp

Endocervical polyp with squamous metaplasia

Cervical intraepithelial Cervical intraepithelial neoplasianeoplasia

flat HPV condyloma (without dysplasia)flat HPV condyloma (without dysplasia) mild dysplasia (CIN I)mild dysplasia (CIN I) moderate dysplasia (CIN II)moderate dysplasia (CIN II) severe dysplasia (CIN IIIa)severe dysplasia (CIN IIIa) carcinoma in situ (CIS, CIN IIIb)carcinoma in situ (CIS, CIN IIIb)

Cytology:Cytology:Low grade squamous intraepithelial lesion Low grade squamous intraepithelial lesion

(LSIL): condyloma + CIN I(LSIL): condyloma + CIN IHigh grade SIL (HSIL): CIN II + CIN IIIHigh grade SIL (HSIL): CIN II + CIN III

Sexual activity ↓ HPV exposure ↓ cervical transformation zone ↓ ↓ squamous differentiation glandular ↓ ↓ ↓ CIN low grade high ECCIN, AIS (low- or high-risk HPV) (high-risk HPV) (low- or high-risk HPV) ↓ ↓ ↓ ↓ ↓ ↓ ↓ regression progression progression regression progression (rare) smoking, high parity, oral contraceptives, immunity, time ↓ ↓ ↓ invasive squamous ca invasive adenoca

HPV – koilocytosis - LSIL

HPV - immunohistochemistry

HPV CIN II.

Invasive squamous cell carcinoma

Cervical squamous cell carcinoma

Endocervical (glandular) intraepithelial neoplasia – ECCIN

Adenosquamous carcinoma – alcian blue staining

Vaginal pathologyVaginal pathology

inflammationinflammation polyps, cystspolyps, cysts vaginal squamous intraepithelial vaginal squamous intraepithelial

neoplasia (VaIN)neoplasia (VaIN) vaginal adenosis (glands)vaginal adenosis (glands) tumorstumors

vaginal adenosis

Vulvar pathologyVulvar pathology

inflammatory disorders (infectious, inflammatory disorders (infectious, noninfectious)noninfectious)

cystscysts vulvar intraepithelial neoplasia (VIN)vulvar intraepithelial neoplasia (VIN) tumorstumors

Extensive HPV condylomatosis

Lichen sclerosus

Vulvar squamous carcinoma