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/

Diseases of the Vulva

inborn – hymen imperforatus

haematocolpos

acquired

– non neoplastic : atrophy, degeneration, infection…

– neoplastic: precanceroses –VIN, condyloma,

carcinoma, melanoma

Vulva – regressive changes

simple atrophy leukoplakia

coexistent in

LICHEN SCLEROSUS (et atrophicus)

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

Leukoplakiawhite spot – merely a descriptive term giving no indication about the underlying nature (!)

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

Vulvar Pseudotumours retention cysts

elephantiasis

varicose veins endometriosis

Condyloma accuminatum

HPV papilloma with koilocytes

and mild dysplasia

Vulvar Precanceroses

VIN I, II, IIIHPV 16manifesting mostly as LEUKOPLAKIAwarty or basaloid type. Increasing incidence

in women 20-35 yrs.

Vulvar Tumours (WHO 2003)

epithelial– squamous– glandular

soft tissue tumours melanocytic

miscelaneous haematopoietic &

lymphoid secondary

lists more than 50 primary malignant & benign neoplasms classified into:

Squamous tumours of vulva

sq.cell ca– keratinizing– non-keratinizing– basaloid– warty– verrucous HPV6

basal cell ca VIN 3 CIS vestibular papilloma

Glandular tumours of vulva

Paget disease Bartholin gland tumours other adenocarcinomas and adenomas

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…

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)…

pseudotumours:hernia-like lesions cystocele, rectocele, cysts

– neoplastic: precanceroses –VAIN, condyloma, carcinoma, sarcoma

botryoides, melanoma

Vaginal Pseudotumours

retention cysts of Gardner´s duct

endometriosis rectocele, cystocele

Vaginal Tumours (WHO 2003)

epithelial– squamous– glandular

mesenchymal tumours

mixed

melanocytic miscelaneous

haematopoietic & lymphoid

secondary

lists more than 44 primary malignant & benign neoplasms classified into:

Condyloma accuminatum

HPV papilloma with koilocytes

and mild dysplasia

Vagina Precanceroses

VAIN I, II, III (HG)

HPV 16manifesting mostly as LEUKOPLAKIA

Glandular tumours of the vagina

adenocarcinoma clear cell adenocarcinoma DES endometrioid carcinoma mucinous carcinoma

adenomas with enteric differentiation

Diseases of the Uterus inborn – malformations: duplex, septus, bicornis, unicornis…,

acquired

– non neoplastic : atrophy, descensus, prolapse,

infection

– hyperplasias - pseudotumours…

– neoplastic: precanceroses –CIN, condyloma,

carcinoma,

Uterine Pseudotumours

retention cysts of cervical glands

hyperplastic polyps endometriosis (pregnancy!)

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

Cervix Precanceroses

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

ECCIN 1,2,3… AIS

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 )

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…)

Uterine Cervix Tumours (WHO 2003)

epithelial– squamous– glandular

mesenchymal tumours

mixed

melanocytic miscelaneous haematopoietic &

lymphoid secondary

lists more than 60 primary malignant & benign neoplasms classified into:

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

Diseases of the Uterus inborn – malformations: duplex, septus, bicornis, unicornis…,

acquired

– non neoplastic : atrophy, descensus, prolapse,

infection

– hyperplasias - pseudotumours…

– neoplastic: precanceroses –CIN, condyloma,

carcinoma,

Uterine Pseudotumours

retention cysts of cervical

glands hyperplastic polyps endometriosis (pregnancy!)

Uterine Corpus Tumours (WHO 2003)

endometrial– endometrioid– mucinous– serous– clear cell…

mesenchymal mixed

miscelaneous gestational haematopoietic &

lymphoid secondary

lists more than 50 primary malignant & benign neoplasms classified into:

Uterine Corpus Pseudotumours & Precanceroses

hyperplasia simple

complexatypical

atypical complex

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)

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

typical atypical cellular epithelioid myxoid lipoleiomyoma

leimyosarcoma

epithelioidmyxoid

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

Uterus – „mixed“ tumours

carcinosarcoma adenosarcoma carcinofibroma adenofibroma adenomyoma

Uterus – „mixed“ tumours

carcinosarcoma (malignat mixed müllerian neoplasm, malignant mesodermal mixed tumour, ..

metaplastic carcinoma( monoclonal with the diff. into epith.

& mesench. structures)