Pathology of the cervix and the uterus

Pathology of the cervix and the uterus. Alia al- mohtaseb , md frcpath.

Cervix:. Exocervix . Endocervix .. S01871-022-f016.

Development of the transformation zone. S01871-022-f002.

Cervicitis:. Extremely common. Vaginal discharge. Infectious & noninfectious . Specific or nonspecific. Acute or chronic..

Pap smear:. The most successful cancer screening test ever developed. Reported according to Bethesda system..

Normal pap smear.

Cervical cancer dropped from second cancer of females to 2% of all new cases of cancer in women in US nowadays. Cervical cancer mortality reduced by as much as 99%..

Squamous Intraepithelial Lesions. Koiolocytosis LSIL Mild dysplasia CIN I LSIL Moderate dysplasia CIN II HSIL Severe dysplasia CIN III HSIL Cacinoma in-situ CIN III HSIL.

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Risk factors for development of CIN and invasive carcinoma:.

HPV role in cervical carcinoma. Consistent presence of certain strains in carcinoma. Not all patients infected with the virus develop carcinoma. HPV can be detected in 85-90% of precancerous lesions and invasive malignancies. HPV may act as an initiator, other factors may act as promoters, these may include: HSV oncogenes smoking …etc..

Pathogenesis of HPV infection. Latent infection (dormant). Intranuclear replication, episomal (extrachromosomal). Chromosomal integration leading to expression of large amounts of E6-E7 proteins... E7 interacts with ras and inactivates Rb . E6 inhibits TP53 either by inactivation or point mutation..

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Nearly all invasive cervical SCC arise from CIN. Not all cases of CIN progress to invasive cancer. Progression of a lower grade to a higher grade is not inevitable. The higher the grade of CIN, the greater the likelihood of progression, BUT in many cases even the higher grade lesions DO NOT progress to cancer. Detection of precursor lesions by cytological examination and their eradication is most effective method of cancer prevention..

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Carcinoma of the Cervix. Microinvasive : depth of invasion is <3 mm. Invasive: exophytic (papillary) ulcerative (infiltrative) nodular SCC 80% Adenoca . 10% Mixture and rare types 10%.

Carcinoma of the Cervix. Modes of spread: Direct spread to contiguous sites, may produce: hydronephrosis, pyelonephritis, renal failure. Lymphatic spread to regional pelvic nodes. Vascular to lungs and liver.

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FEM012. Stage I cervical squamous cell carcinoma.

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FEM016. Pelvic exenteration for cervical squamous cell carcinoma.

Body of uterus. Endometritis. Adenomyosis. Endometriosis. DUB & endometrial hyperplasia. Tumors..

Endometrial cycle. Menstrual (~4 days). Proliferative: glandular proliferation with mitoses and pseudostratification - Early - Mid - Late Secretory: vacuolation (early, ~ days17-19) Secretions (days 19-20) Stromal edema (days 21, 22) Decidual changes (days 23-27) Necrosis (day 28).

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ENDOMETRITIS. Fever, abdominal pain, menstrual abnormalities, infertility and ectopic pregnancy. Acute infections are usually limited to bacterial infections after delivery or miscarriages. Frequently due to N. gonorrhea or C. trachomatis. Chronic endometritis occurs in the following settings: Chronic gonorrheal pelvic disease Tuberculosis Postpartal or postabortal endometrial cavities IUCDs Spontaneously in 15% of patients.

Endometritis:.

Adenomyosis:. Growth of basal cell layer of endometrium down into the myometrium… no cyclical bleeding. menorrhagia, dysmenorrhea, pelvic pain before onset of menstruation. Reactive hypertrophy of myometriumm leading to thickened uterine wall. Stroma, glands, or both..

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Endometriosis. Presence of endometrial tissue (functional) in remote sites: Ovaries, Douglas pouch, uterine ligaments, tubes, peritoneal cavity, umbilicus. Uncommonly in lymph nodes, lungs, heart, and bone. Clinically: Pain on defecation, infertility, dyspareunia, dysuria. In almost all cases ; severe dysmenorrhea and pelvic pain Abdominal discomfort..

S01871-022-f029. Potential Origins OF Endometrial Implants.

Endometriosis:. Red blue to yellow brown implants. Variable in size. Chocolate cyst. Fibrosis, adherance of pelvic structures, seeling of tubal fimbiriated ends..

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DUB & endometrial hyperplasia:. The most common problem for which women seek medical attention. Menorrhagia; profuse or prolonged bleeding at the time of the period. Metrorrhagia; irregular bleeding between the periods. Ovulatory ; intermenstrual. Postmenopausal; bleeding after menopause. Common causes include polyps, leiomyomas, endometrial carcinoma, endometrial hyperplasia, and endometritis..

Dysfunctional Uterine Bleeding Abnormal bleeding in the absence of organic uterine lesion.

Causes of abnormal uterine bleeding:. Prepuberty : - Precocious puberty (hypothalamic, pituitary, or ovarian origin) Adolescence: Anovulatory cycle Postmenopause : - Organic lesions (carcinoma, hyperplasia, polyps) - Endometrial atrophy.

Reproductive age: - Complications of pregnancy (abortion, trophoblastic disease, ectopic pregnancy) - Organic lesions (leiomyoma, adenomyosis , polyps, endometrial hyperplasia, carcinoma) - Anovulatory cycle Ovulatory dysfunctional bleeding (e.g., inadequate luteal phase) Perimenopause: - Anovulatory cycle - Irregular shedding - Organic lesions (carcinoma, hyperplasia, polyps).

Endometrial hyperplasia. Etiology: Excess unopposed estrogen seen in: Anovulatory cycles Polycystic ovarian disease Prolonged administration of estrogenic steroids. Estrogen producing tumors( granulosa-theca cell tumors, cortical stromal hyperplasia ) Obesity Classification.

Tumors of the Endometrium and Myometrium. Endometrial polyps Leiomyoma Leiomyosarcoma Endometrial carcinoma Mesodermal tumors and others.

Endometrial Adenocarcinoma. A disease of menopausal and postmenopausal women. The most frequent cancer of FGT. Ages of 55-65 years. Predisposing factors: Increased estrogen stimulation endometrial hyperplasia obesity Infertility (single and nulliparous ) late menopause diabetes hypertension.

Endometrial Adenocarcinoma. Endometrioid (>80%) Estrogen related Associated with hyperplasia Younger perimenopausal women Low grade Microsatellite instability and PTEN gene mutations.

Sydromes with increased risk of endometrioid cancer:.

CLINICAL COURSE. Irregular bleeding and marked leukorrhea Enlarged uterus and palpable, fixation to surroundings . With therapy, stage I carcinoma has 90% 5 YSR Stage III & IV have less than 20% 5 YSR. Serous and clear cell carcinoma are of high grade and bad prognosis by definition..