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