Organ Pathology Female Genital System I Pathology of

Organ Pathology Female Genital System - I Pathology of vulva, vagina, uterus Jaroslava Dušková Inst. Pathol. , 1 st Med. Faculty, Charles Univ. Prague http: //www 1. lf 1. cuni. cz/~jdusk/

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

Vulva – regressive changes v simple atrophy v leukoplakia coexistent in LICHEN SCLEROSUS (et atrophicus)

Vulvar Dystrophies LICHEN SCLEROSUS (et atrophicus) v whittish glistening plaques or papules atrophy of epidermis v basophillic degeneration of the dermis v chronic inflammatory infiltrate constriction of the orifice v

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

Vulvar Infections v bacterial: folliculitis & furunculosis, Bartholin gland abscess (staphylococcus), ulcus durum, tbc, gonorrhea (neisseria), chancroid (haemophillus ducreyi) v viral: herpes genitalis, molluscum contag. (poxvirus), . . HPV v mycotic: candida, intertrigo (dermatophyta) esp. in DM

Vulvar Pseudotumours v retention cysts v v v elephantiasis varicose veins endometriosis

Condyloma accuminatum HPV papilloma with koilocytes and mild dysplasia

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

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

Squamous tumours of vulva v sq. cell ca – – – keratinizing non-keratinizing basaloid warty verrucous HPV 6 basal cell ca v VIN 3 CIS v vestibular papilloma v

Glandular tumours of vulva v Paget disease v Bartholin gland tumours v other adenocarcinomas and adenomas

Mesenchymal tumours of vulva v Sarcoma botryoides – embryonal rhabdomyosarcoma – under 10 yrs + vagina „bunch of grapes“ appearance there. Alveolar histology pattern – unfavourable prognosis v other sarcomas –lmsa, lpsa, dfsa protub…

Diseases of vagina v v inborn – vagina duplex –failure of the müllerian duct to fuse acquired – non neoplastic : v atrophy, v degeneration, infection (ulcus durum - chancre, bacterial mixed, mycotic, trichomonas)… v pseudotumours: hernia-like lesions cystocele, rectocele, cysts – neoplastic: precanceroses –VAIN, condyloma, carcinoma, sarcoma botryoides, melanoma

Vaginal Pseudotumours v retention cysts of Gardner´s duct v v endometriosis rectocele, cystocele

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

Condyloma accuminatum HPV papilloma with koilocytes and mild dysplasia

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

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

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

Uterine Pseudotumours retention cysts of cervical glands v hyperplastic polyps v endometriosis v (pregnancy!) v

Ectopia, ectropium (pseudoerosion) v red rim of ext. orificium v endocervical type of mucose v ectopy- in newborn, no relation to delivery v ectropium- eversion of the endocervical mucose related to delivery laceration

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

HPV infection cervical ca cause v HPV DNA present in 99, 7% squamous cell & 94 -100% adenoca v high risk HPV (hr. HPV)- 16, 18, 33, 45 (oncogens E 6/E 7 integrate into the genom v E 6 protein interaction with p 53 preventing the cells from p 53 induced apoptosis) v E 7 protein interfering with the oncosupresoric protein p. Rb (cell cycle ) v

HPV infection v 80% women infected with HPV v spontaneous resolution or transitory L SIL/ CIN 1 v 80% hr. HPV transitory, no SIL H v hr. HPV- on average 12 -15 yrs to invasive ca v immune status (HLA…)

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

Cervix ca v 2002 Czech Rep. 1082 new cases v Czech Rep. 20, 7/ 100 000 women v Europa v World 18, 5/ 100 000 women incidence 15, 1/ 100 000 women zdroj: ÚZIS

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

Uterine Pseudotumours v retention cysts of cervical glands v hyperplastic polyps v endometriosis v (pregnancy!)

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

Uterine Corpus Pseudotumours & Precanceroses hyperplasia simple complex atypical complex

Prognostic Factors in Uterine Ca v staging – most important v grading – no influence in sq. ca v typing - good prognosis (verrucous, villoglandullar ca) – bad prognosis (serous, adenoid cystic, neuroendocrine ca)

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

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

Uterus – „mixed“ tumours v v v carcinosarcoma adenosarcoma carcinofibroma adenomyoma

Uterus – „mixed“ tumours vcarcinosarcoma (malignat mixed müllerian neoplasm, malignant mesodermal mixed tumour, . . metaplastic carcinoma ( monoclonal with the diff. into epith. & mesench. structures)