female genital tract presentation of pathology

female genital tract

1. Female Genital System

2. NORMAL ANATOMY Uterus has three anatomical and functional regions: 1. Cervix 2. Lower uterine segment 3. Corpus 9/29/2024 2

3. Cervix Cervix is further divided into: • Ectocervix (vaginal portion): It is the part of cervix that is visible from the vaginal canal. Ectocervix is lined by nonkeratinizing stratified squamous epithelium continuous with the vagina. The squamous epithelium converges centrally at a small opening called external os , which is closed in nulliparous women . • Endocervix : It is lined by columnar mucous secreting epithelium , which meets the squamous epithelial covering at the squamocolumnar junction. The endocervical stroma contains endocervical glands . The portion of the columnar epithelium ultimately replaced by the squamous epithelium is termed the transformation zone, which is important clinically because this is where the precancerous and cancerous lesions develop 9/29/2024 3

4. Lower Uterine Segment and Corpus Uterus has two main components—the endometrium and the myometrium . Endometrium is composed of glands embedded in a stroma and the myometrium is composed of interwoven smooth muscle bundles . Ovaries • Surface is lined by germinal epithelium and the average size is 4 cm x 1.5 cm x 1.5 cm. • It is divided into cortex and medulla . Cortex consists of closely packed stromal cells with a thin covering of collagen. 4

5. Fallopian Tube • Average size is 10 cm x 1 mm; it is divided into four anatomical regions, namely, isthmus, ampulla , fimbriae and abdominal opening. • Mucosa is lined by three cell types—ciliated columnar, nonciliated columnar and intercalated cells (inactive secretory cells). 9/29/2024 5

6. Cervical intraepithelial neoplasia (CIN ). CIN is a precancerous lesion frequently associated with HPV infection. HPV is a sexually transmitted DNA virus which can lead to CIN as well as invasive squamous cell carcinoma . According to Bethesda system, precancerous lesions of cervix are divided into two groups : Low-grade squamous intraepithelial lesion or LSIL (CIN I): Associated with HPV types 6, 11, 42 and 44 (also known as HPV types with low oncogenic potential ). • High-grade squamous intraepithelial lesion or HSIL (CIN II and III): Associated with HPV types 16, 18, 31, 33 and 45 (also known as HPV types with high oncogenic potential ). 9/29/2024 6

7. CIN I: • Dysplasia is present in lower one-third of stratified squamous epithelium .• May be raised (as in condyloma acuminatum ) or macular (flat condyloma ). • Abundant HPV nucleic acid of low-risk HPV type is present. • Koilocytic atypia or viral cytopathic effect is seen ( koilocytosis is seen as nuclear abnormalities with perinuclear halo). 9/29/2024 7

8. CIN II: • Dysplasia is limited to basal two-thirds of stratified squamous epithelium. • Increased number of atypical cells in lower layers (increased N/C ratio, anisokaryosis , loss of polarity, mitotic figures and hyperchromasia ) • Upper layer cells appear differentiated • Associated with high-risk HPV types 9/29/2024 8

9. CIN III/Carcinoma In Situ: Dysplasia spreads to the entire thickness of the epithelium. Note : A low-grade lesion does not always progress to a high-grade lesion. Most low-grade lesions regress spontaneously; whereas, most high-grade lesions progress. 9/29/2024 9

10. 9/29/2024 10 Spectrum of cervical intraepithelial neoplasia with normal stratified squamous epithelium for comparison. LSIL (CIN I/mild dysplasia); HSIL (CIN II and CIN III/severe dysplasia and carcinoma in situ)

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