Fgt uterus and cervix

FGT

1. FEMALE GENITAL TRACT

2. FGT IS COMPOSED OF VULVA VAGINA CERVIX UTERUS FALLOPIAN TUBE OVARY

3. CERVIX

4. OVERVIEW CIN SQUAMOUS INTRA-EPITHELIAL LESION CARCINOMA CERVIX

5. CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) CIN I : Less than one third involvement of the thickness of lower 1/3 rd of epidermis CIN 2 : one third to two third involvement. CIN 3 : full thickness involvement ( carcinoma in situ)

6. SQUAMOUS INTRAEPITHELEIAL LESION ( SIL ) L-SIL (low grade) - corresponds to CIN 1 H-SIL (high grade) – CIN 2 and CIN 3

7. RISK FACTORS E arly onset of sexual activity Multiple sexual partners Women with HPV infection : 16, 18, 31, 33, 35 High risk male sexual partner Multiparous women Use of OCP Cigarette smoking HIV infection

8. PAP SCREENING: Annual c ervical pap smear in all sexually active women having any high risk factors. if negative in 3 consecutive smears, then the frequency of PAP screening is reduced.

9. INVASIVE CERVICAL CARCINOMA Gross: 3 types fungating , ulcerative and infiltrative.

10. INVASIVE CERVICAL CARCINOMA Microscopy: 1. Sq cell carcinoma - composed of nests and tongues of malignant sq epithelium invading the underlying cervical stroma. 2. Adenocarcinoma – proliferation of glandular endocervical glands 3. Adenosquamous carcinoma- malignant glandular and sq epithelium.

11. S quamous cell carcinoma moderately differentiated non- keratinising carcinoma .

12. UTERUS

13. OVERVIEW ENDOMETRIAL HYPERPLASIA ENDOMETRIAL CARCINOMA LEIOMYOMA

14. Endometrial hyperplasia Characterized by increased proliferation of endometrial glands relative to stroma resulting in an increased gland to stroma ratio when compared with normal proliferative endometrium

15. Causes: P rolonged estrogenic stimulation with absence of progestational activity. A novulation, obesity, menopause, PCOD, functioning granulosa cell tumour, adrenocortical hyperfunction , estrogen replacement therapy

16. Classification of endometrial hyperplasia Simple hyperplasia (cystic hyperplasia) presence of glands of various sizes and irregular shape with cystic dilatation mild increase in gland to stroma ratio

17. Complex hyperplasia( adenomatous hyperplasia) increase in no. of endometrial glands with variation in size & shape marked glandular crowding (back to back glands) epithelial glands remain cytologically normal (no loss of basal polarity no atypia ) stroma is dense cellular & compact

18. Atypical hyperplasia Presence of atypical cells in the hyperplastic epithelium Extent of cytological atypia might be mild, moderate or severe. Glandular crowding with eosinophilic cytoplasm and nuclear enlargement ,loss of polarity and prominent nucleoli. Stroma diminished,but remains present It is a precancerous condition.

19. Tumours of endometrium Endometrial carcinoma Most common invasive cancer of FGT Clinical features is abnormal bleeding Type 1 Type 2

20. TYPE 1 ENDOMETRIAL CARCINOMA Most common type ( reproductive age group) Referred as endometrioid carcinoma Associated with obesity, diabetes, hypertension & unopposed estrogen stimulation ASSOCIATED WITH ENDOMETRIAL HYPERPLASIA

21. TYPE 1 ENDOMETRIAL CARCINOMA Gross : 2 patterns – localized polypoidal tumour diffuse tumour Extension of growth into myometrium by direct invasion, periuterine structures by direct continuity, lymphatic metastasis, haematogenous metastasis

22. TYPE 1 ENDOMETRIAL CARCINOMA M/E : most endometrial carcinomas are endometrioid adenocarcinomas Depending on the pattern of glands & cell changes they are well differentiated, moderately differentiated or poorly differentiated

23. TYPE 2 ENDOMETRIAL CARCINOMA Arise in atrophied endrometrium Age group 65-75 yrs ( post-menopausal age group) Poorly differentiated tumours Aggressive tumours

24. Tumours of myometrium Leiomyoma Most common uterine tumour Benign smooth muscle neoplasm Gross types: Sub-mucosal, intramural, sub-serosal

25. LEIOMYOMA Gross : round, well circumscribed, well encapsulated, firm, homogenous grey white masses of variable sizes showing whorled appearance. M/E: smooth muscle cells arranged in fascicles and bundles admixed with fibrous tissue. individual smooth muscle cells are uniform in size & shape with abundant cytoplasm & central oval nucleus.

26. LEIOMYOMA

27. Leiomyosarcoma Uncommon malignant neoplasm of myometrium C/F : uterine enlargement, abnormal uterine bleeding Gross: bulky fleshy mass that invade the uterine wall or polypoid mass projecting into lumen M/E: whorled arrangement of spindle cells with large hyperchromatic nuclei(nuclear atypia), No. of mitosis per HPF(mitotic index) = 10 or more

28. Thankyou

29. Adenomyosis Presence of endometrial tissue within the myometrium Clinical features: menorrhagia , dysmennorhoea , pelvic pain

30. Adenomyosis Gross : uterus enlarged C/S: areas of hemorrhage M/E: irregular nests of endometrial stroma & glands arranged within myometrium separated from basal endometrium by 2-3mm

31. Endometriosis Presence of endometrial glands & stroma outside the uterus Site : Ovary uterine ligaments rectovaginal septum cul -de –sac pelvic peritoneum mucosa of cervix, vagina fallopian tubes large& small bowel & appendix

32. Endometriosis Clinical Features : infertility, dysmennorhoea , pelvic pain, dyspareunia Seen only in reproductive years of life

33. ENDOMETRIOSIS SEEN IN THE MUCOSA OF COLON

34. Two theories of development of endometriosis Metastatic theory : retrograde menstruation through fallopian tube Metaplastic theory : metaplasia of coelomic epithelium

35. Gross : foci of endometriosis appear blue or brownish black in the sites mentioned When disease is extensive organizing hemorrhages causes extensive fibrous adhesions Ovaries show numerous cysts filled with dark brown blood called as chocolate cysts

36. Microscopy: Presence of endometrial glands & stroma, areas of hemorrhage, haemosiderin laden macrophages, surrounding zone of inflammation & fibrosis

37. ENDOCERVICAL POLYP Benign exophytic growths Gross appearance: Small or sessile or may protrude throught the external os . Microscopic appearance: Soft , mucoid lesions composed of loose fibromyxomatous stroma , mucus secreting endocervical glands and variable dergee of inflammatory infitrate .

38. ENDOCERVICAL POLYP