Female Reproductive System by hetal vithalani

Anatomicaly includes the skin and mucosa of the female genitalia external to the hymen labia majora labia minora mons pubis and vesibule Lined by squamous epithelium

Bartholin Cystone bartholin gland is present on each side of the vaginal canal and produces mucus like fluid that drains via ducts in to the lower vestibule. common in women at reproductive age painful cystiv lesion at the lower vestibule adjacent to the vaginal canal

Condyloma Neoplasm of vulvar skin often large Due to HPV 6 or 11 -koilocytesSyphlis (condyloma latum) Sexually transmited

Lichen Sclerosis Thining of epidermis and fibrosis of the dermis Present with white patch common in post menopausal womenautoimune etiology benign but associated with a slightly increased risk for squamous cell carcinoma

Lichen Simplex Chronicus hyperplasis of the vulvar squamous epithelium presents as leukoplakia with thick leathery vulvar skin due to cronic irritation and scraching no reisk of suqmous cell carcinoma

Vulvar carcinoma Carcinoma arising from suqmous epithelioum lining the vulva -Rare cancer Leukoplakia - Biopsy may be required to distinguish carcinoma from other causes of leukoplakia Posibility of HPV - 16 & 18 none HPV exist too -due to cronic inflamation and irritation eventually lead to carcinoma -women >70Arises from Vulvar intraepithelial neoplasis dysplastic precursor lesion - kilocytic change nuclear atypia increase mitotic activity

malignant epithelial cells in the epidermis of the vulva pruritic ulcerated valvar skin carcinoma in situ - no underlining nipples are also associated paget cells are PSA +Keratin + and s100_melanoma is PSA + Keratin and S100+

canal leading to the cervix mucosa is lined by non keratinizing squamous epithlium

Adenosis young women exposed diethylstibestol (DES) in utero focal presistence of columnar epithelium in the uper 1/3 of vagina during developent squamous epithelium from the lower 2/3 of the vaginal grow upward to replace the columnar epithelium lining of the uper 1/3 of the vagina

Malignat proliferation of glands with clear cytoplasm rare but feared, complication of DES vaginal adenosis Discovery of the complication -abnomality of gynecologic tract due to DES uses

Embryonal Rhabdomyosarcoma malgnant Mesenchymal proliferation of immature skeletal muscle Rare presents as bleeding and a grape like mas protruding from the vagina or penis of a chold usaly <5 year of age also known as sarcoma botryoides cell exhibits cytoplasmic cross striatrions and positive immunohistochemical staining for desmin and myogenin

Vaginal Carcinoma carcinomaarising from squamous epithelium lining vaginal mucosa usally related to high -risk HPVprecursor lesion is vaginal intraepithelial neoplasia (VAIN) when spread to regional lymph nodes occurs cancer from the lower 2/3 of vagina goes to inguinal nodes and cancer from the uper 1/3 goes to reginonal iliac nodes

Neck of the uterus devides in to the exocervix and endocervix endocervix is lined by single layer of columnar cells junction between the exocervix and endocervix is called the transformation zone

Endometrium is the mucosal lining of the Uterine cavityMyometrium is the smooth muscle wall underlying the endomerium Endometrium is hormonally sensitive growth of the endometrium is estrogen driven preparation of the endometrium for implantation is progestrone driven shedding occurs with loos of progestrone support

ASHERMAN SYNDROMESecondary amenorrhea due to loss of the basalis and scarring result of overaggressive dilation and curettage ( D&C)

Lake of ovulation Results in an estrogen driven proliferative phase without a subsequent progestrone driven secretory phase proliferative glands break down and shed resulting in uterine bleeding reprsents a common couse of dysfunctional uterine bleeding especially during menarche and menopose

Acute endometritis bacterial infection of the endometrium usally due to retained product of conception ex after baby or miscarriage presents as fever abnomal utrerine bleeding and pelvic pain

Cronic Endometritis cronic inflamation of the endometrium lymphocytes and plasma cell plasma cells are necessary for the diagnosis of chronic endometritis given that lymphocytes are normally found in the endometrium causes includes relained products of conception chronic pelvic inflammatory disease such as chlamydia IUD and TB abnormal utrine bleed, Pain, and infertility

Endometrial polyp Hyperplastic protrusion of endometrium presents as abonormal uterine bleeding can arise as a effect of tamoxifen, which has anti estrogenic effects on the breast but week pro estrogenic effects on the endomerium

Endometriosis Endometrial glands and stroma outside of the uterine endometrial lining most likely due to retrograde menstrauation with implantation at ectopic site presents as dymenorrhea and pelvic pain may cause infertility. endometriousis cycles just like normal endometrium most common site of involvment is the overy, which classically results in formation of a chocolate cyst other sites of involvement include the uterine ligament (pelvic pain ) pouch of abdominal pain and adhesion) , fallopian tube mucosa (scarring increases risk for ectopic tubal pregnancy) implants classically appear as yellow brown "gun powder" nodules involvement of the uterine myometrium is called adenomyosis increassed risk of carcinoma at the site of endometriosis (overy)

Endometrial hyperplasia hyperplasia of endometrial glands relative to stroma occurs as consequence of unpopposed estrogen - Post menopausal uterine bleeding architectural growth pattern absence of cellular atypia -> precursure to carcinoma cellular atypia inverse relationship to carcinoma

Endometrial carcinoma - malignant -most commen of female -Postmenopausal bleeding -via two different pathway 1. Hyperplasia - (75% ) cases, estrogen exposure late menopause, nuliparity, infertility with anovulatory cycles and obesity -around 60 year of age. 2. Sporadic (25%) carcinoma arises in an atropic endometrium with no evident precursor lesion - age is around 70 - papillary structure with psammoma body formation - p53 mutation is common and the tumore exhibits agrresive behavior

-Benign neoplastic profliferation of smooth muscle arising from myometrium most common tumore in female -prementopausal women often multiple enlarge during pregnancy shrink after menopause asymptomatic The cause of uterine fibroids is unknown, but evidence suggests that their growth is tied to estrogen.

Leiomyosarcoma - maligant smooth muscle arising from the myometrium arises de novo - does not come from liomyomas in post monoposal women gross exam often shows a single lesion with areass of necrosis and hemorrhage mitotic activity and cellular atypia

Ovary functional uinit - folicle follicle consists of an an oocyte surrounded by granulosa and theca cells - LH acts on THECA cells to induce androgen production -FSH stimulates granulosa cell to converst androgen to estadiol -Estradiol surge induces an LH surge which lead to ovulation after ovulation the ressidul folicle becomes a corpus leteum primary secretes progesterone homorrhage in to a corpus luteum -> cyst degeneration of follicales results in follicular cysts small numbers of follicular cysts are common in women and have no clinical significance.

- multiple ovarian folicular cysts due to hormone imbalance -reproductive age- high LH and Low FSH (LH :FSH >2) Increased LH induces excess androgen production from theca cells resulting in hirsusim ( hair like man) - androgen is converted to estrone in adipose tissue - estrone feedback decrese FSH resulting in cystic degenration of folicles -high levels of circulating estrone increase risk for endometrila carcinoma - obbies young women, infertility, oligomenorrhea and hirsutism - some have insulin resistance and may develop type 2 diabetes in later life

- most commen overian tumor (70%) derived from coelomic ( overy line ) - two kinds (both can be benign or maligant or borderline) 1. serous tumors are full of watery fluid 2. Mucinous tumors are full of mucus like fluid benign tumors (cystadenomas ) are composed of a single cyst - all benin tumore symptoms )Maligant tumors (cystaadenocarcinomas) are composed of complex cysts with a think , shaggy lining most commen in post menopausal women clinically presentation vague abdominal symptoms or signs of compression (urinary frequency) borderline tumors have both kind of characteristic BRCAI mutation carriers have an increased risk for serous carcinoma of the overy and fallopian tube

GERM CELL TUMORSin women of reproductive age Tumor subtyes mic tissues normally produced by germ cells. Fetal tissue - cystic teratoma and embryonal carcinoma Oocytes - dysgerminoma Yolk sac - endodermal sinus tumor placental tissue - choriocarcinoma cystic teratoma 1. cystic tumor composed of fetal tissue derived from two or three embryologic layers 2. benign, but presence of immature tissue or somatic maliganacy indicates maligant potential. struma ovarii is a teratoma composed primarily of thyroid tissue. dysgerminoma 1. tumor composed of large cells with clear cytoplasm and central nuclei most common malignant germ cell tumor 2. testicular counterpart is called seminoma, which is a relatively common germ cell tumor in males. good prognosis reponds to radiotherapy serum LDH may be elevated Endomdermal sinus tumor Malignant tumor that mimics the yolk sac most common germ cell tumor in children serum AFP is often elevated schiller - duval bodies are classically seen on histolgy Choriocarcinoma malignnt tumor composed of trophoblasts and syncytiotropoblasts mimics placental tissue but villi are absent small hemorrhagic tumor with early hematogenous spread High b-hcg is characteristic s may lead to thecal cysts in the ovary poor response to chemotheraphy Embryonal carcinoma malignant tumor composed of large primitive cells aggressive with early metastasis