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Tumors of Cervix

Tumors of Cervix. BENIGN Adenoma Myoma Papilloma and angioma MALIGNANT Primary Carcinoma Sarcoma Mesodermal mixed tumor Secondary From any source. Adenoma (Mucous Polyp). Clinical Features Asymptomatic Vaginal discharge Vaginal bleeding Mass at the introitus

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Tumors of Cervix

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  1. Tumors of Cervix

  2. BENIGN • Adenoma • Myoma • Papilloma and angioma • MALIGNANT Primary • Carcinoma • Sarcoma • Mesodermal mixed tumor Secondary • From any source

  3. Adenoma (Mucous Polyp) Clinical Features • Asymptomatic • Vaginal discharge • Vaginal bleeding • Mass at the introitus Differential Diagnosis • Carcinoma of the cervix • Cervical ectopy • Endometrial polyp • Products of conception and blood clot • Ectropion • Cervical tags

  4. Adenoma (Mucous Polyp) Treatment • Asymptomatic must be removed and examined by the histopathologist • Adenoma may be avulsed easily without anaesthesia • Base of the polyp should be cauterized to avoid recurrence • Perform curettage

  5. Myomas of Cervix Arise from body of uterus, rarely from cervix Polypoidal Protrude through cervical canal Types Subserous Intramural submucous

  6. Myomas of Cervix Clinical Features • Prone to trauma • Ulceration • Infection • Vaginal discharge • Irregular vaginal bleeding • Mass at the introitus Treatment Vagival myomectomy or hysterectomy

  7. Papilloma and Angioma Clinical features • Small papillomas • Single or multiple associated with vulva and vaginal papillomas • Angioma forms superficial growth Treatment • Surgical removal

  8. Pre Malignant Conditions of Cervix

  9. Cervical Intraepithelial Neoplasia (CIN)or Dysplasia • Spectrum of disordered growth and abnormal microscopic changes confined to epithelium • May be • Mild (CIN I) • Moderate (CIN II) • Severe or carcinoma in situ (CIN III) • Spontaneous regression of mild and moderate types possible • Severe dysplasia may be irreversible • May progress into invasive carcinoma

  10. Cervical Intraepithelial Neoplasia (CIN)or Dysplasia • CIN I (mild) Involves deeper 3rd of epithelium • CIN II (moderate) Involves more than half thickness of epithelium • CIN III (severe) Whole thickness of epithelium shows abnormal changes

  11. Screening • Screening programme • Cervical smear • Repeated every 3 y up to 60 y Normal cervix, transition zone

  12. Invasive carcinoma of cervix, Pap smear anaplastic cancer cells show marked variation in size, in comparison with neutrophils

  13. Treatment • Cryocautry • Electrocuatry • Surgery • Conization • LEEP • Hysterectomy • Follow up

  14. Malignant Tumours of Cervix

  15. Ca cervix One of the most common cancers in the world Incidence: USA 10/1000000 UK 15/1000000 Peak incidence at 35 and 55

  16. Etiology • Number of partners • Age of first coitus • Grand multi parity • Social status • Race and religion • Circumcision • Smoking • Viruses herpes simplex type 2 / human papulama virus type 16 & 18 • Atypical squamous metaplasia

  17. Pathology • SQ cell carcinoma 90 % • Adeno 5% • Mixed 5% Gross • Polypoidal • Ulcerative • Infiltrative

  18. Squamous cell carcinoma cervix Tumour extends to anterior and posterior lips, appears granular and hemorrhagic, cervix surrounding by narrow vaginal cuff

  19. Squamous cell carcinoma in-situ of cervix Normal epithelium lack of maturation, altered cell polarity, nuclear pleomorphism and increased nuclear / cytoplasmic ratio, confined to the epithelial layer, epithelial basement membranenot invaded, submucosal stroma contains chronic inflammatory cells

  20. Spread • Direct • Lymphatic • Blood born

  21. Diagnosis • History • Asymtpomatic • Irregular vaginal bleeding IMB, PCB, PMB • Pain • Vaginal discharge • Examination • Normal cervix • Hard cervix • Ulcer • Growth

  22. Carcinoma Cervix

  23. Diagnosis • Cytology • Schiller test • Colposcopy • Biopsy of cervix • Punch biopsy • Wedge biopsy • Ring biopsy • Cone biobsy

  24. Treatment • Assessment • Radiotheraphy • Surgery young, pelvic sepsis, UV prolapse, fibroid, ovarian tumor, recurrence, pregnancy • Combined

  25. Case History Age 36, mass at endocervical os which thickens the barrel of the cervix and fixes the cervix to the surrounding soft tissue Pap smear shows

  26. Case History biopsy showed invasive nests of abnormal squamous epithelium extending under the surface mucosa, extending all the way through the cervical wall and out into the surrounding paracervical soft tissue

  27. Case History The patient underwent a hysterectomy. The gross specimen shows thickened area representing the cervix. Tumour has extended through the wall. cervix was fixed to the soft tissues of the paracervical area

  28. Thank You

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