GYNECOLOGICAL ONCOLOGY INTRAEPITHELIAL NEOPLASIA OF THE LOWER GENITAL
- Slides: 51
GYNECOLOGICAL ONCOLOGY
INTRAEPITHELIAL NEOPLASIA OF THE LOWER GENITAL TRACT
HISTOPATHOLOGICAL DEGREES OF INTRAEPITHELIAL NEOPLASIA That depends on measurement of the depth of affection from the basement membrane to the surface epithelium. - Class I (Mild dysplasia = basal cell hyperplasia): [CIN I, VAIN I] The dysplastic cells are only in the lower deep 1/3. - Class II (Moderate dysplasia): [CIN II, VAIN II] The affected cells are in the lower deep 2/3 of the epithelium. - Class III (Severe dysplasia = carcinoma in situ): [CIN III, VAIN III] The affected cells are in the whole thickness of the epithelium. CIN III
CORRELATION BETWEEN: - CIN. - DYSPLASIA - THE BETHESDA TERMINOLOGY CIN 1 CIN 2 CIN 3 MILD DYSPLASIA MODERATE DYSPALSIA SEVERE DYSPLASIA (CARCINOMA IN SITU) CIS LOW GRADE HIGH GRADE SQUAMOUS INTRAEPITHELIAL SQUAMOUS LESION(HSIL) INTRAEPITHELIAL LESION(LSIL)
CERVICAL CYTOLOGY
SAMPLE COLLECTION FROM ENDOCERVICAL CANAL Specimen needs to include endocervical cells. Therefore a cytobrush can be used when appropriate. To obtain exfoliated cells from other areas of the genital tract, scraping of the lateral vaginal walls and aspiration from the posterior vaginal fornix are also included.
Lichen sclerosis
Mixed Dystrophy (hypertrophic in some areas, and lichen sclerosis in other areas. )
COLPOSCOPY
CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) COLPOSCOPY Indications of colposcopy: The value is especially significant with lesions of the cervix. 1) Suspected malignancy of the cervix, the vagina or the vulva. other accessible areas: the perineum and peri-anal areas. 2) Diagnosis of intraepithelial neoplasia 3) Follow-up of cases treated for pre-malignant and malignant conditions.
CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) COLPOSCOPY
LOCATION OF THE SQUAMOCOLUMNAR JUNCTION IN THE EARLY REPRODUCTIVE YEARS Columnar epithelium ectropion external os OSCJ 1 original squamous epithelium the OSQJ is located far away from the external os. The columnar epithelium is everted occupying a large portion of the ectocervix (ectropion).
LOCATION OF THE SQUAMOCOLUMNAR JUNCTION DURING THE REPRODUCTIVE YEARS metaplastic squamous epithelium new SQJ Columnar epithelium external os The new SQJ has moved closer to the external os. It appear as distinct white line after application of 5 % acetic acid (immature squamous metaplastic epithelium adjacent to the new SQJ. 2
LOCATION OF THE SQUAMOCOLUMNAR JUNCTION PERIMENOPAUSAL WOMAN mature metaplastic squamous epithelium external os the new SQJ is at the external os. new SQJ 3
4 LOCATION OF THE SQUAMOCOLUMNAR JUNCTION IN POSTMENOPAUSAL WOMEN external os mature metaplastic squamous cells The new SQJ is not visible and has receded into the endocervix. Mature metaplastic squamous epithelium has occupied most of the ectocervix.
Terminal vessels seen by colposcope (A) hairpin capillaries (B) punctuation of the terminal vessels (C) Mosaic pattern of the terminal vessels
MALIGNANT DISEASES OF THE BODY OF THE UTERUS
PATHOLOGY OF ADENOCARCINOMA OF THE ENDOMETRIUM Macroscopic appearance 1 - Proliferative type: [fungating mass]. - may become polypoidal. - may fill the uterine cavity. 2 - Ulcerative type: [malignant ulcer]. 3 - Diffuse type: [warty friable growth]. - may spreads over the entire cavity. PROLIFERATIVE POLYPOIDAL
ADENOCARCINOMA OF THE ENDOMETRIUM TRANSVAGINAL ULTRASOUND
MANAGEMENT OF CARCINOMA OF THE ENDOMETRIUM Postoperative adjuvant intra-vaginal vault irradiation vaginal cuff brachytherapy: - Low-dose-rate (LDR) brachytherapy, to the vaginal wall. - It entails hospitalization, immobilization and bed-confinement for 50 to 60 hours.
MANAGEMENT OF CARCINOMA OF THE ENDOMETRIUM Ovoids and cylinders are used as vaginal applicators in HDR brachytherapy
UTERINE SARCOMA • The uterus has been opened. • There is a neoplasm replacing & destroying the normal tissues of the posterior endometrium and myometrium. • Lesion: Yellow tan. Focally necrosis & hemorrhage. • Endocervix and cervix (normal).
MALIGNANT DISEASES OF THE OVARIES
CANCER OVARY • Benign cysts (right) have smooth linings. Malignant cysts (left) have epithelial proliferations that form tufted papillations. Initally, the papillations are internal but neoplastic papillations may also form on the external surface. These tumors are subclassified as serous or mucinous based on the microscopic appearance of the lining cells.
CANCER OVARY • This is the cut surface of a large (about 15 cm diameter) mostly "solid" ovarian carcinoma indicating that it is high grade or poorly differentiated. The yellowish areas indicate necrosis. Lower grade carcinomas are usually predominantly cystic masses.
PAPILLARY SEROUS CYSTADENOCARCINOMA Note the many papillations on the inner surface. Between benign cystadenomas and malignant cystadenocarcinomas lies the grey zone of "borderline" lesions that are not clearly malignant, but are treated as though they could be.
OVARIAN PAPILLARY CYSTADENOCARCINOMA solid tissue and has invaded outside of the ovary, with papillations seen over the surface. Because there are no early signs or symptoms with masses in the ovary, many of these ovarian tumors have metastasized by the time they are detected with abdominal enlargement. These neoplasms characteristically spread by "seeding" along peritoneal surfaces.
Early (stage I) ovarian cancer Advanced (stage III) ovarian cancer
CANCER OVARY - 52 -year-old woman with postmenopausal bleeding. - Ultrasound: 12 -cm cystic ovarian mass with polypoid intracystic mass. - Surgery & histopathology: a papillary serous cystadenocarcinoma. The tumor arise in a serous tumor containing benign and borderline areas.
CT SCAN OF THE LOWER ABDOMEN a massive amount of ascites Ovarian malignancy
CT scan series of the lower abdomen - ovarian cancer. - metastasis to the peritoneum.
ULTRASOUND: ENLARGED ABDOMINAL LYMPH NODES
CT scan of chest in ovarian cancer with calcified nodes and pleural deposits
CANCER OVARY compression fractures of the L 2 and L 3 vertebral bodies. sagittal mr image of the vertebral column
"KRUKENBERG" TUMOR OF OVARY The tumor is extending out of the pelvis. Autopsy: large right ovarian mass. Metastases: in the lower right portion of liver.
MALIGNANT DUSEASES OF THE CERVIX
Early cervical cancer
CLINICAL INSPECTION Nabothian follicles (chronic cervicitis) Cancer cervix
Ectocervical cancer Endocervical cancer
Squamous cell carcinoma of the cervix • Opened uterine cavity. • Endocervical canal ["ecc“]. • Large fungating, granular, friable mass replacing entire ectocervix and most of endocervix.
CANCER CERVIX
INVASIVE CANCER CERVIX (COLPOSCOPY) large, thick area in the cervix irregular, nodular surface
Squamous Cell Carcinoma of Cervix small intramural, bulging leiomyoma. • Opened uterus • Endometrial cavity (em) is normal. bulging, fungating cervical carcinoma, protruding through the cervical os.
squamous cell carcinoma of the cervix Stage I: still limited to the cervix. The tumor is a fungating red to tan to yellow mass.
MALIGNANT DISEASES OF THE VULVA
MALIGNANT VULVAR ULCER
malignant melanoma of the vulva
RADICAL VULVECTOMY: REMOVAL OF THE ENTIRE VULVA the skin incision is wide to include all the draining lymphatic vessels + LEFT AND RIGHT INGUINAL LYMPH NODE CHAINS. Arrows highlight a large, hard carcinoma distorting the right labia majora.
OTHERS
Sarcoma botryoides (embryonal carcinoma) RADICAL SURGERY
Hydatidiform Mole:
- Vulvar intraepithelial neoplasia (vin) grade 3
- Low grade squamous intraepithelial lesion
- Neoplasia
- Que es una neoplasia
- Malignancy
- Que es una neoplasia
- Clinical features of neoplasia
- Neoplasia literally means
- Neoplasia
- Fap
- Neoplasia
- Vaginal neoplasia
- Atrofia testicular
- Metaplasia displasia e neoplasia
- Multiple endocrine neoplasia type 2
- Patologia
- New growth meaning
- Male reproductive system
- Female genital mutilation
- Testicul histologie
- Ciclo vital de la familia
- Appareil génital souris femelle
- What is.fgm
- Fijaciones de la etapa genital
- Male reproductive organs
- Aparelho reprodutor feminino
- How to determine the gender of a fetal pig
- Erkek genital sistem histolojisi
- Cestides
- Tricomoníase fotos
- Function of fallopian tube
- Tubuli recti
- Genital hijyen nedir
- Aparatul genital masculin referat
- Std from oral
- Ciclo de vida familiar duvall
- Latency stage
- Dogfish shark internal anatomy
- Etapa incorporativa
- Amber blumling
- What is fgm
- Monogenia
- Sistema reproductor femenino y sus partes
- Schema du sexe masculin
- Prolapsplastik
- Salphagitis
- External genitalia of female
- Cara posterior de la vejiga
- Herpes genital glande
- Genital infections
- Historia natural de la enfermedad herpes
- Papilomavírus humano