Organ Pathology

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Organ Pathology

• Female Genital System - I

Pathology of vulva, vagina, uterus
Jaroslava Dušková Inst. Pathol. ,1st Med.
Faculty, Charles Univ. Prague http//www1.lf1.cuni
.cz/jdusk/
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Diseases of the Vulva

• inborn hymen imperforatus
• haematocolpos
• acquired
• non neoplastic atrophy, degeneration,
  infection
• neoplastic precanceroses VIN, condyloma,
  carcinoma, melanoma

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Vulva regressive changes

• simple atrophy
• leukoplakia
• coexistent in
• LICHEN SCLEROSUS
• (et atrophicus)

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Vulvar Dystrophies

• LICHEN SCLEROSUS (et atrophicus)
• whittish glistening plaques or papules
• atrophy of epidermis
• basophillic degeneration of the dermis
• chronic inflammatory infiltrate
• constriction of the orifice

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Leukoplakia

• white spot merely a descriptive term giving no
  indication about the underlying nature (!)

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Vulvar Infections

• bacterial folliculitis furunculosis,
  Bartholin gland abscess (staphylococcus), ulcus
  durum, tbc, gonorrhea (neisseria), chancroid
  (haemophillus ducreyi)
• viral herpes genitalis, molluscum contag.
  (poxvirus),.. HPV
• mycotic candida, intertrigo (dermatophyta)
  esp. in DM

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Vulvar Pseudotumours

• retention cysts
• elephantiasis
• varicose veins
• endometriosis

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Condyloma accuminatum

• HPV papilloma with koilocytes and mild dysplasia

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Vulvar Precanceroses

• VIN I, II, III
• HPV 16
• manifesting mostly as LEUKOPLAKIA
• warty or basaloid type. Increasing incidence in
  women 20-35 yrs.

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Vulvar Tumours (WHO 2003)
lists more than 50 primary malignant benign
neoplasms classified into

• epithelial
• squamous
• glandular
• soft tissue tumours
• melanocytic

• miscelaneous
• haematopoietic lymphoid
• secondary

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Squamous tumours of vulva

• sq.cell ca
• keratinizing
• non-keratinizing
• basaloid
• warty
• verrucous HPV6
• basal cell ca
• VIN 3 CIS
• vestibular papilloma

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Glandular tumours of vulva

• Paget disease
• Bartholin gland tumours
• other adenocarcinomas and adenomas

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Mesenchymal tumours of vulva

• Sarcoma botryoides embryonal rhabdomyosarcoma
  under 10 yrs vagina bunch of grapes
  appearance there. Alveolar histology pattern
  unfavourable prognosis
• other sarcomas lmsa, lpsa, dfsa protub

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Diseases of vagina

• inborn vagina duplex failure of the müllerian
  duct to fuse
• acquired
• non neoplastic
• atrophy,
• degeneration, infection (ulcus durum - chancre,
  bacterial mixed, mycotic, trichomonas)
• pseudotumourshernia-like lesions cystocele,
  rectocele, cysts
• neoplastic precanceroses VAIN, condyloma,
  carcinoma, sarcoma botryoides, melanoma

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Vaginal Pseudotumours

• retention cysts of Gardners duct
• endometriosis
• rectocele, cystocele
• (unwanted urine leakage and incomplete emptying
  of the bladder)

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Vaginal Tumours (WHO 2003)
lists more than 44 primary malignant benign
neoplasms classified into

• epithelial
• squamous
• glandular
• mesenchymal tumours
• mixed

• melanocytic miscelaneous
• haematopoietic lymphoid
• secondary

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Condyloma accuminatum

• HPV papilloma with koilocytes and mild dysplasia

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Vagina Precanceroses

• VAIN I, II, III (HG)
• HPV 16
• manifesting mostly as LEUKOPLAKIA

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Glandular tumours of the vagina

• adenocarcinoma
• clear cell adenocarcinoma DES
• endometrioid carcinoma
• mucinous carcinoma
• adenomas with enteric differentiation

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Diseases of the Uterus

• inborn malformations duplex, septus,
  bicornis, unicornis,
• acquired
• non neoplastic atrophy, descensus, prolapse,
  infection
• hyperplasias - pseudotumours
• neoplastic precanceroses CIN, condyloma,
  carcinoma,

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Uterine Pseudotumours

• retention cysts of cervical glands
• hyperplastic polyps
• endometriosis
• (pregnancy!)

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Ectopia, ectropium (pseudoerosion)

• red rim of ext. orificium
• endocervical type of mucose
• ectopy- in newborn, no relation to delivery
• ectropium- eversion of the endocervical mucose
  related to delivery laceration

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Cervix Precanceroses

• CIN I, II, III (HG)
• HPV 16
• manifesting mostly as LEUKOPLAKIA

ECCIN 1,2,3 AIS
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HPV infection

• cervical ca cause
• HPV DNA present in 99,7 squamous cell
  94-100 adenoca
• high risk HPV (hrHPV)- 16,18,33,45 (oncogens
  E6/E7 integrate into the genom
• E6 protein interaction with p53 preventing the
  cells from p53 induced apoptosis)
• E7 protein interfering with the oncosupresoric
  protein pRb (cell cycle )

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HPV infection

• 80 women infected with HPV
• spontaneous resolution or transitory L SIL/ CIN1
• 80 hrHPV transitory, no SIL H
• hrHPV- on average 12-15 yrs to invasive ca
• immune status (HLA)

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Uterine Cervix Tumours (WHO 2003)
lists more than 60 primary malignant benign
neoplasms classified into

• epithelial
• squamous
• glandular
• mesenchymal tumours
• mixed

• melanocytic
• miscelaneous
• haematopoietic lymphoid
• secondary

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Cervix ca

• 2002 Czech Rep. 1082 new cases
• Czech Rep. 20,7/ 100 000 women
• Europa 18,5/ 100 000 women
• World incidence 15,1/ 100 000 women

zdroj ÚZIS
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Diseases of the Uterus

• inborn malformations duplex, septus,
  bicornis, unicornis,
• acquired
• non neoplastic atrophy, descensus, prolapse,
  infection
• hyperplasias - pseudotumours
• neoplastic precanceroses CIN, condyloma,
  carcinoma,

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Uterine Pseudotumours

• retention cysts of cervical glands
• hyperplastic polyps
• endometriosis
• (pregnancy!)

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Uterine Corpus Tumours (WHO 2003)
lists more than 50 primary malignant benign
neoplasms classified into

• endometrial
• endometrioid
• mucinous
• serous
• clear cell
• mesenchymal
• mixed

• miscelaneous
• gestational
• haematopoietic lymphoid
• secondary

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Uterine Corpus Pseudotumours Precanceroses

• hyperplasia
• simple
• complex
• atypical
• atypical complex

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Prognostic Factors in Uterine Ca

• staging most important
• grading no influence in sq. ca
• typing
  - good prognosis
  (verrucous, villoglandullar ca)
  
• bad prognosis (serous, adenoid cystic,
  neuroendocrine ca)

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Uterine Leiomyomas WHO 2003lists 13 variants of
uterine smooth muscle neoplasms benign and
malignant

• typical
• atypical
• cellular
• epithelioid
• myxoid
• lipoleiomyoma

• leimyosarcoma
• epithelioid
• myxoid

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Mixed Tumours

• Def.
• Tumours (benign or malignant) composed of two or
  more different cell lines that are normally
  present in the place of tumour origin

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Uterus mixed tumours

• carcinosarcoma
• adenosarcoma
• carcinofibroma
• adenofibroma
• adenomyoma

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Uterus mixed tumours

• carcinosarcoma (malignat mixed müllerian
  neoplasm, malignant mesodermal mixed tumour,
  .. metaplastic carcinoma
• ( monoclonal with the diff. into epith.
  mesench. structures)