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Organ Pathology

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

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Organ Pathology

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  1. 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/

  2. Diseases of the Vulva • inborn – hymen imperforatus haematocolpos • acquired • non neoplastic : atrophy, degeneration, infection… • neoplastic: precanceroses –VIN, condyloma, carcinoma, melanoma

  3. Vulva – regressive changes • simple atrophy • leukoplakia coexistent in LICHEN SCLEROSUS (et atrophicus)

  4. 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

  5. Leukoplakia white spot – merely a descriptive term giving no indication about the underlying nature (!)

  6. 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

  7. Vulvar Pseudotumours • retention cysts • elephantiasis • varicose veins • endometriosis

  8. Condyloma accuminatum HPV papilloma with koilocytes and mild dysplasia

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

  10. epithelial squamous glandular soft tissue tumours melanocytic miscelaneous haematopoietic & lymphoid secondary Vulvar Tumours (WHO 2003) lists more than 50 primary malignant & benign neoplasms classified into:

  11. Squamous tumours of vulva • sq.cell ca • keratinizing • non-keratinizing • basaloid • warty • verrucous HPV6 • basal cell ca • VIN 3 CIS • vestibular papilloma

  12. Glandular tumours of vulva • Paget disease • Bartholin gland tumours • other adenocarcinomas and adenomas

  13. 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…

  14. 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

  15. Vaginal Pseudotumours • retention cysts of Gardner´s duct • endometriosis • rectocele, cystocele

  16. epithelial squamous glandular mesenchymal tumours mixed melanocytic miscelaneous haematopoietic & lymphoid secondary Vaginal Tumours (WHO 2003) lists more than 44 primary malignant & benign neoplasms classified into:

  17. Condyloma accuminatum HPV papilloma with koilocytes and mild dysplasia

  18. Vagina Precanceroses VAIN I, II, III (HG) HPV 16 manifesting mostly as LEUKOPLAKIA

  19. Glandular tumours of the vagina • adenocarcinoma • clear cell adenocarcinoma DES • endometrioid carcinoma • mucinous carcinoma • adenomas with enteric differentiation

  20. Diseases of the Uterus • inborn – malformations: duplex, septus, bicornis, unicornis…, • acquired • non neoplastic : atrophy, descensus, prolapse, infection • hyperplasias - pseudotumours… • neoplastic: precanceroses –CIN, condyloma, carcinoma,

  21. Uterine Pseudotumours • retention cysts of cervical glands • hyperplastic polyps • endometriosis • (pregnancy!)

  22. 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

  23. Cervix Precanceroses CIN I, II, III (HG) HPV 16 manifesting mostly as LEUKOPLAKIA ECCIN 1,2,3… AIS

  24. 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 )

  25. 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…)

  26. epithelial squamous glandular mesenchymal tumours mixed melanocytic miscelaneous haematopoietic & lymphoid secondary Uterine Cervix Tumours (WHO 2003) lists more than 60 primary malignant & benign neoplasms classified into:

  27. 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

  28. Diseases of the Uterus • inborn – malformations: duplex, septus, bicornis, unicornis…, • acquired • non neoplastic : atrophy, descensus, prolapse, infection • hyperplasias - pseudotumours… • neoplastic: precanceroses –CIN, condyloma, carcinoma,

  29. Uterine Pseudotumours • retention cysts of cervical glands • hyperplastic polyps • endometriosis • (pregnancy!)

  30. endometrial endometrioid mucinous serous clear cell… mesenchymal mixed miscelaneous gestational haematopoietic & lymphoid secondary Uterine Corpus Tumours (WHO 2003) lists more than 50 primary malignant & benign neoplasms classified into:

  31. Uterine Corpus Pseudotumours & Precanceroses hyperplasia simple complex atypical atypical complex

  32. 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)

  33. typical atypical cellular epithelioid myxoid lipoleiomyoma leimyosarcoma epithelioid myxoid Uterine Leiomyomas WHO 2003lists 13 variants of uterine smooth muscle neoplasms – benign and malignant

  34. 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

  35. Uterus – „mixed“ tumours • carcinosarcoma • adenosarcoma • carcinofibroma • adenofibroma • adenomyoma

  36. Uterus – „mixed“ tumours • carcinosarcoma (malignat mixed müllerian neoplasm, malignant mesodermal mixed tumour, .. metaplasticcarcinoma ( monoclonal with the diff. into epith. & mesench. structures)

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