specimen spotters in obstetrics and gynecology.pptx

few slides containing some pathological spotter specimens shown in obstetrics and gynecology including cervical cancer, ovarian cancer/ tumor, fibroid, polyp, adenomyosis, hydatiform mole

1. Specimens

2. Serous cystadenoma Gross findings – Benign ovarian epithelial cell tumor Smooth, glistening, Thin walled cyst, clear watery fluid Unilocular or multilocular BRCA-1, BRCA-2 Microscopic findings – Single layer of epithelium resembling fallopian tube Complications – Rupture, infection, pseudomyxoma, malignant change

3. Mucinous cystadenoma of ovary Gross - Unilateral > Bilateral Septate, multilocular cyst Gelatinous mucinous fluid KRAS mutation Slow growing, mobile adnexal mass, smooth surface Microscopic – Single layer of tall columnar epithelium with goblet cells resembling endocervical lining

4. Papillary serous cystadenocrcinoma Features: Malignant ovarian tumor Causes: TP53 mutations are common. Gross Pathology: Complex cystic mass with solid areas and papillary projections. May show areas of necrosis and hemorrhage. Microscopic Findings: Atypical epithelial cells with papillary formations, nuclear atypia, and increased mitotic activity. Invasion into surrounding stroma. CA 125 increased

5. FIGO classification of ovarian tumors s tage I:    tumor limited to the ovaries stage Ia : ​ tumor limited to one ovary stage Ib : ​ tumor involves both ovaries stage II :  tumor involves one or both ovaries with pelvic extension or primary peritoneal cancer (below pelvic brim) stage III :  tumor involves one or both ovari es or fallopian tubes with cytologically or histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes stage IIIa:  positive retroperitoneal lymph nodes and /or microscopic metastasis beyond the pelvis stage IIIb :  macroscopic peritoneal metastasis beyond the pelvis up ≤2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes stage IIIc:  macroscopic extra pelvic peritoneal metastases >2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes (includes extension of tumor to the capsule of liver and spleen) stage IV :  consists of distant metastasis, excluding peritoneal metastases , and includes the following: stage IVa :  pleural effusion with positive cytology stage IVb :  distant metastases

6. Fibroid uterus Uterine Fibroid/ Leiomyoma Benign, arises from uterine smooth muscle Estrogen, Progesterone dependant Well circumscribed, firm mass Microscopic – whorled bundles of smooth muscle cells Types – Submucosal, Intramural, Subserosal Pseudo fibroid – broad ligament

7. FIGO Type Description Location in relation to Endometrium & Serosa Pedunculated Intracavitary Entirely within the uterine cavity, attached by a stalk 1 Submucosal < 50% intramural (within the uterine wall) 2 Submucosal ≥ 50% intramural 3 Intramural 100% intramural, but in contact with the endometrium 4 Intramural Completely within the uterine wall 5 Subserosal ≥ 50% intramural 6 Subserosal < 50% intramural 7 Subserosal Pedunculated Entirely outside the uterine wall, attached by a stalk 8 Other Cervical Feature Fibroids Adenomyosis C omplaints Pain, Pressure symptoms M menorrhagia, Dyspareunia Growth Distinct, globular mass Diffusely enlarged uterus Composition Smooth muscle and fibrous tissue Endometrial tissue in myometrium Uterus Size Irregularly enlarged, >16wk 12wk enlarged Rx GnRH, OCPs, Myomectomy, UAE, HIFU, hysterectomy NSAIDs, Progesterone, UAE, hysterectomy

8. Hydatid mole Features: Abnormal pregnancy with trophoblastic proliferation, no fetal development. High risk of gestational trophoblastic neoplasia. Gross Pathology: Uterus enlarged, Passing of grape like vesicles, 1 st trimester bleed, no FHS, no quickening Microscopic Findings: Hydropic swelling of chorionic villi, absence of fetal tissue, and trophoblastic hyperplasia. Rx – Spontaneous, D&C, Hysterectomy

9. Cervical Cancer Features Most common type: Squamous cell carcinoma (arising from the epithelial lining of the cervix). Less common types: Adenocarcinoma Precursor lesions: Cervical intraepithelial neoplasia Chief complaints Early stages: Often asymptomatic. As the cancer progresses: Abnormal vaginal bleeding Vaginal discharge (may be watery, bloody, or foul-smelling) Pelvic pain Post-coital bleed >> Dyspareunia Weight loss and fatigue Gross Findings Early stage: May appear as a small, ulcerated area or a growth on the cervix. Later stages: Large, dirty, exophytic mass Microscopic Findings Squamous cell carcinoma: Atypical squamous cells with invasion into the cervical stroma. Adenocarcinoma: Atypical glandular cells with invasion.. Diagnosis Screening: Pap smear (cytology) to detect abnormal cells. HPV DNA Testing Diagnostic tests: Colposcopy (magnified examination of the cervix) with biopsies. Endocervical curettage (ECC) to sample cells from the cervical canal. Cone biopsy to remove a larger tissue sample for diagnosis and treatment. Imaging studies (CT, MRI, PET) to assess the extent of the disease. Treatments Early stage: Surgery (cone biopsy, hysterectomy. trachelectomy) Radiation therapy Locally advanced stage: Concurrent chemoradiation (radiation therapy combined with chemotherapy) Advanced stage: Palliative care to manage symptoms and improve quality of life.

10. FIGO Staging Stage Description Stage I Cancer confined to the cervix (extension to the uterine corpus is disregarded) IA: Carcinoma diagnosed only by microscopy, with maximum depth of invasion ≤ 5 mm IA1: Measured invasion of stroma ≤ 3 mm in depth IA2: Measured invasion of stroma > 3 mm and ≤ 5 mm in depth IB: Measured deepest invasion of > 5 mm with lesion limited to the cervix IB1: Lesion > 5 mm deep and ≤ 2 cm in largest dimension IB2: Lesion > 2 and ≤ 4 cm in largest dimension IB3: Lesion > 4 cm in largest dimension Stage II Extension beyond the uterus but not to the pelvic wall or to the lower third of the vagina IIA: Limited to the upper 2/3 of the vagina without parametrial involvement IIA1: Lesion ≤ 4 cm in largest dimension IIA2: Lesion > 4 cm in largest dimension IIB: Parametrial involvement but not up to the pelvic wall Stage III Extension to the pelvic wall and/or involves the lower third of the vagina and/or causes hydronephrosis or a nonfunctioning kidney IIIA: Extension to lower third of the vagina but not to the pelvic wall IIIB: Extension to the pelvic wall and/or causes hydronephrosis or a nonfunctioning kidney IIIC: Involves pelvic and/or para-aortic lymph nodes IIIC1: Only metastasis to pelvic lymph nodes IIIC2: Metastasis to para-aortic lymph nodes Stage IV Extension beyond the true pelvis or biopsy-proven involvement of the bladder or rectal mucosa IVA: Spread to adjacent pelvic organs IVB: Spread to distant organs In brief: Stage I is limited to the cervix. Stage II extends beyond the cervix but not to the pelvic wall or lower vagina. Stage III involves the pelvic wall, lower vagina, or nearby organs. Stage IV extends beyond the pelvis or involves the bladder or rectum.

11. Anencephaly Features: Severe neural tube defect, absence of a major portion of the brain, skull, and scalp. Fatal. Causes: folic acid deficiency, MTHFR gene variants may increase risk. Gross Pathology: Open skull defect with absent brain tissue.

12. All women of reproductive age group – 0.4mg/day of folic acid Aka to prevent NTD occurrence = 0.4mg/day Previous history of NTD/ to prevent NTD recurrence – 4mg/day (1 month preconceptionally and continued till 1 st trimester then switch to 0.4mg/day)