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General Pathology

FGT & Breast (Dr. Sionzon)

2nd wk ng 4th shift (silent ‘f’)

Female Genital Tract Infections of the Female Genital Tract
Vulva - usually affects the lower genital tract but may
- lined with keratinized squamous epithelium infect ovaries and peritoneum
- non keratinized stratified squamous epithelium 1. HSV
Uterus - vulva, vagina, cervix
- divided into 3 segments - common in teenagers, young women
1. cervix
- HSV 2 = sexually transmitted
2. lower uterine segment
- HSV 1 = oral
3. corpus
- lined by columnar epithelium - ⅓ will have signs and symptoms
- layers: - painful red papule that progress to vesicles
1. endometrium: contains basal cells  ulcers
2. myometrium: smooth muscle - fever, malaise, tender vaginal nodes
3. serosa: outermost portion - pap smear = viral inclusions and multi-
* leiomyomas are called based on their location nucleated giant cells
i.e. submucosal, intramural, subserosal
Cervix 2. Yeast (Candida)
- ectocervix: stratified squamous epithelial lining - 10% of women
- Squamo-columnar junction - enhanced by DM, OCP, pregnancy
: important site for the development of
cervical Ca - leukorrhea, pruritus
: pre-neoplastic changes usually occur here
: aka transformation zone 3. Trichomonas
- flagellated protozoa
- 15% of referrals to STD clinics
- purulent vaginal discharge
- fever, malaise or systemic manifestations
- bright red appearance “strawberry cervix”

4. Mycoplasma
- spontaneous abortion and chorioamnionitis
- associated with preterm deliveries if mild
5. Gardnerella
- part of the flora
- may have a problem if there is over growth
- Gr (-) small bacilli

- Endocervix: columnar Pelvic Inflammatory Disease

mucus secreting - etiologic agent has reached upper part of female
epithelium genital tract
: varies - pelvic pain, adnexal tenderness, fever and vaginal
with age discharge
: may - puerperal infection: Staphylococcus,
extend Streptococcus, Clostridia, coliform bacteria
outside the - Common: Gonococcus, Chlamydia and enteric
cervical os bacteria
: during o acute salpingitis: lined by columnar
late epithelium with abundant inflammatory
adulthood infiltrates
this o salpingoophoritis: fibrous adhesions of ovary
migrates to
and fallopian tube
the inner
part of
o tuboovarian abscesses: cavity is filled with
cervical os purulent material

joyce + MR (kung alam ko lang, sana di na ko nagnotes!) 1 of 5

Patholab – FGT & Breast by Dr. Sionzon Page 2 of 5

o pyosalpynx / hydrosalpynx: presence of Premalignant:

serous fluid 1) Vulvar intraepithelial neoplasm
- Complications: peritonitis, intestinal obstruction - dysplastic or paraneoplastic change
from adhesions of epithelial lining
- carcinoma in situ
Vulva - atypia of nuclei, proliferation, ↑
mitoses, ↓ surface differentiation
1. Bartholin’s Cyst 2) Carcinoma of the vulva
- obstruction of Bartholin’s duct, usually by an - rare, 5% of genital carcinoma
infection - 85% = SCCA, 15% = BCCA,
adenocarcinoma, melanoma
- may dilate to 3-5 cm in diameter
3) Malignant melanoma
- lined by transitional epithelium of the
- > 5% of vulvar varcinoma, 2% of all
melanomas in women
normal duct with some squamous
4) Paget’s disease
- pruritic, red, crusted, sharply
2. Vestibular adenitis demarcated, map like area,
occurring usually in the labia majora
- inflammation of the serosa of the vulva
- tumor cells infiltrate between
- vulvadynia: pain in the vulva epithelial cells of epidermis
- may require surgical excision

3. Non-neoplastic epithelial disorder Vagina

- precursor of carcinoma
A. Lichen Sclerosus 1. Congenital anomalies
- aka chronic atrophic vulvitis - i.e. absence, fusion
- atrophy, fibrosis and scarring - Gartner duct cyst = lesion in gartner duct
1) atrophy of the epidermis with which is an embryonic remnant in vaginal
disappearance of rete pegs wall
2) hydyropic degeneration of the basal
cells 2. Malignant and Non-malignant Neoplasm
3) replacement of dermis by dense A. VIN
collagenous fibrous tissue - atypia, mitoses
4) monoclonal bandlike lymphocytic B. SCC
infiltrate - 95%
- thinning of epidermis - HPV associated
- common in the upper, posterior vagina
B. Lichen Simplex Chronicus - associated with SCCA of cervix
- hyperkeratosis (proliferation of - irregular spotting or development of
keratin) and acanthosis (proliferation frank vaginal discharge (leukorrhea)
of squamous epithelial cells) C. Adenocarcinoma
- inflammation of epidermis, thinning of - usually clear cell type
the dermis - 0.14% of women whose mothers where
- proliferation of collagenous exposed to DES (tx for threatened
connective tissue abortion)
D. Embryonal Rhabdomyosarcoma
4. Neoplasms of the vulva - sarcoma botyroides
- similar to tumors of the skin - polypoid, rounded, bulky masses
A. Benign - grape like clusters
1) Papillary hydradenoma - malignant tumor arising from skeletal
- labia majora or interlabial folds muscle
- identical to intraductal papilloma of - common in children
the breast - tumor cells are crowded in a so-called
- proliferation of apocrine glands cambium layer
2) Condyloma acuminata - thick rounded cells within a
- verrucous fibromyxomatous stroma
- koilocytic atypia (anuclear atypia Tx: excision with chemotherapy
and perinuclear vacuolization) –
considered a viral cytopathic effect oops break muna… FYI, from this point forward, me na ang nagtype,
imagine… notes ko na me pa magttype, (and formatting + editing) ndi
- keratosis, parakeratosis naman me ang trans!  kasi naman, meant for my eyes only ang notes
ko! - MR
B. Neoplasms
Patholab – FGT & Breast by Dr. Sionzon Page 3 of 5

Cervix basal cells: cells with larger nuclei

1. Acute cervicitis a. CIN I

- characterized by acute inflammatory cells, - cells with irregular cellular borders
erosions and reactive cellular changes - koilocytic atypia, perinuclear
- may have atypia vacuolization
- nuclear atypia, increased mitotic activity
2. Chronic cervicitis b. CIN II
- little clinical significance except if it causes - enlarged nuclei
systemic infection - irregular borders, dense nuclear
- inflammation usually mononuclear with chromatin
lymphocytes and macrophages, plasma cells - cells are larger
- Causes: - atypia occupies 2/3 of epithelial layer
o HSV: epithelial ulcers c. CIN III
o C. trachomatis: lymphoid germinal - irregular borders
centers - very darkly staining
o T. vaginalis: epithelial spongosis - marked pleiomorphism
- dysplastic in all layers
3. Endocervical polyp - may have invasion of mucosa
- small and sessile to large lesions (microinvasive SCCA)
- spotting, bleeding, which may occur after
sexual contact
- may protrude thru cervical os
- protrusions are polypoid, columnar
endocervical glands with inflammatory

4. Intraepithelial Neoplasia
- pre-neoplastic changes of the cervix, may
progress to cervical cancer
- risk factors 5. Invasive cervical cancer
early age at 1st intercourse - usually occurs during late adulthood
multiple sexual partners (brim =p) - patterns: fungating, ulcerating or infiltrative
increased parity - spreads by;
HPV o direct spread (to peritoneum, urinary
OCPs and nicotine bladder, ureter, rectum)
genital infections o lymphatics (to inguinal or iliac nodes)
- Evidences linking HPV to cervical cancer o hematogenous spread
a. HPV DNA is detected in by hybridization - histologic patterns:
technique in 95% of cases o large keratinizing cells (well
b. Specific HPV types are associated with differentiated)
cervical cancer o non keratinizing cells (moderately
* HPV 6, 11, 42, 44, 53, 54, 62, 66 – low differentiated)
risk group, associated with condylomata o small cell squamous (poorly
* HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, differentiated)
56, 68, 69 – high risk group associated o small cell undifferentiated
with cervical cancer (neuroendocrine or oat cell carcinoma)
c. presence of viral oncogenes based on stain via Chromogranin (visualize
experimental data neuroendocrince cells)
d. physical state of virus differs in different - associated with HPV 18
lesions - Staging
integrated in host DNA in cancer Stage 0: CIN III
free (episomal) viral DNA in Stage 1: confined to cervix
condylomata Stage 1a: preclinical disease diagnosed by
e. chromosome abnormalities microscopy
f. vaccines directed against HPV prevent Stage 1a1: stromal invasion
development of precancerous lesions Stage 2: extends beyond cervix but not onto
- Grading: pelvic wall
CIN I = low grade intraepithelial lesion (LSIL) Stage 3: extended into pelvic wall
CIN II = high grade intraepithelial lesion Stage 4: extended beyond true pelvis
CIN III = carcinoma in situ, carcinoma noted Uterus – Endometrium
on entire epithelium
- pap smear: peripheral cells – superficial
Patholab – FGT & Breast by Dr. Sionzon Page 4 of 5

- composed of islands of stroma and glands in

muscle layer
- causes severe bleeding (menorrhagia),
dysmenorrhea, dyspneuria, and pelvic pain

5. Endometrial Polyps
- may protrude into uterine cavity
- may be single or multiple
- sessile masses
- responsive to estrogen
- may be functional or hyperplastic

6. Endometrial hyperplasia
- pre cancerous lesion
- increase number of glands compared to
- cystic dilatation
- lined by pseudostratified hyperplastic
epithelium with atypia or presence of
stratification of epithelium and mitoses
- inactivation of PTEN tumor suppressor gene
- Patterns:
a. Simple hyperplasia without atypia
- glands are compressed and laid
1. Dysfunctional uterine bleeding back to back
- most common cause: anovulation with b. Simple hyperplasia with atypia
estrogenic stimulation c. Complex hyperplasia with atypia
- excessive prolonged estrogen stimulation - leads to adenocarcinoma
with decreased progesterone
- lack of ovulation probably due to the 7. Carcinoma of the endometrium
following causes: - most common invasive cancer of the genital
o endocrine disorders tract
o ovarian lesions
- peak incidence in the 55 to 65 year old
o metabolic disturbances
- associated with anovulatory endometrium - associated with obesity, DM, hypertension,
with stromal breakdown infertility
- 85% are adenocarcinoma
2. Endometritis - may protrude or occupy entire endometrial
- not common surface
- usually only in patients with - Grading
a. chronic PID (i.e. gonococcus) 1: well differentiated adenoCa, with
b. postabortal/postpartal endometrial glandular pattern
cavities usually related to retained 2: easily recognizable glandular patterns;
gestational tissue with well-formed glands mixed with solid
c. intrauterine contraceptive devices sheets of malignant cells
d. tuberculosis 3: solid sheets of malignant cells with barely
recognizable glands with high degree of
3. Endometriosis atypia and mitoses, cribriform pattern
- presence of endometrial glands or stroma in
abnormal locations outside the uterus 8. Other Tumors
- most common locations: ovaries, lower part
of genital tract
a. Carcinosarcomas
- mesenchymal tumor
- important cause of dysmenorrhea, pelvic - mixed tumor with malignant
pain, infertility and other problems mesodermal components differentiating
- responds to hormonal changes in the into muscle, cartilage, osteiod
menstrual cycle b. Adenocarcinoma
- may form hemorrhagic cyst (chocolate cyst) - large, broad based polypoid masses
in ovaries - endometrial glands are benign but
- presence of RBCs and lining of endometrium stroma is malignant
in abnormal locations
c. Stromal tumors
4. Adenomyosis - either (1) benign stromal tumor or (2)
- presence of endometrial tissue in uterine endometrial stromal sarcoma (invades
wall (myometrium) muscle tissue)
Patholab – FGT & Breast by Dr. Sionzon Page 5 of 5

Uterus - Myometrium

1. Leiomyoma
- occurs in 75% of women in the reproductive
- well circumscribed tumors; discreet, round,
firm, gray white tumors
- common cause of bleeding
- produces whorled pattern of smooth muscle
- described based on location as: submucosal,
intramural, subserosal

2. Leiomyosarcoma
- uncommon, bulky fleshy masses on
- not well differentiated
- invades uterine wall
- high degree of atypia, mitotic index and
zonal necrosis
- >10 mitoses per HPO field
- peak incidence 40 to 60 years old
- metastasize to different organs i.e. lungs,
brains and bones

End of transcription

Tip lang, yung lecture nya as in librong libro. Kasi yung

ppt nya, as in outline lang talaga.

Gamitin ang book, huwag lang gawing paper weight at

pang straighten ng gusot na trans (me yun)

Yun lang.