Female Genital Tract
description
Transcript of Female Genital Tract
Female Genital Tract1-Vulva
2-Vagina3-Cervix
4-Uterine corpus5-Ovary
6-Placenta
Vulva
Vulva1-Vulvitis
2-Non-neoplastic epithelial disorders
3-Tumor
Vulvar Leukoplaki
aCauses of vulvar leukoplakia:
1-Vitiligo (loss of pigment)2-Inflammatory dermatosis: e.g. psoriasis
3-Squamous intraepithelial neoplasms of the vulva (VIN) and invasive carcinoma4-Paget’s disease
3-Vulvar Tumors1-Condyloma
2-Intaepithelial V. Neoplasia3--Vulvar carcinoma
4-Extramammary Paget’s disease5-Melanoma
Vulvar Intraepithelial
Neoplasia (VIN)
VIN I: mild dysplasia, lower third.
VIN II: moderate dysplasia, lower two thirds.
VIN III (CIS): Severe dysplasia, full thickness.
Vulvar CarcinomaStromal invasion.
1-3% of all female genital cancers, > 60 years of age.
2-Increasing Incidence of VIN (40-60 y).
3-90% of malignancies are squamous cell carcinomas, 10%: adenocarcinomas, basal cell carcinomas, and melanomas.
Vulvar CarcinomaInitially a leukoplakia-type lesion, progresses to overt exophytic (elevated) or endophytic (ulcerated) lesion.
Management and prognosis depend on size of tumor, depth of invasion, lymphatic
involvement , and presence of metastasis .STAGE
5 year survival :Stage I (tumor < 2 cm): 60-80%
Larger tumor with metastasis: 10%
Vulvar CarcinomaSurgery: treatment of choice for early stage lesions
Local excision, radical vulvectomy, groin/pelvic LN dissection
Radiotherapy: stage III and IV tumorsChemotherapy: Metastatic disease (low response rate)
Vaginal Intraepithelial Neoplasia (VAIN) and
CarcinomaUncommon, VAIN are graded I, II, and III (~VIN)Elderly females (>60 y)Preexisting or concurrent cervical or vulvar Neoplasia or carcinoma is sometimes present.
Endocervical polypInflammatory polypoid masses.
Smooth surface composed of columnar mucus-secreting cells (endocervical epithelium) with underlying cystically dilated glands filled with mucus. Stromal edema inflammatory mononuclear cells.
Squamous metaplasia and ulceration.
Cervical Intraepithelial Neoplasia (CIN) and
CarcinomaImportance of early detection, adequate follow up and management.Histologic grading of precursor lesions:CIN I: Mild dysplasiaCIN II: Moderate dysplasiaCIN III : Severe dysplasia/carcinoma in situ
Cervical Intraepithelial Neoplasia (CIN) and
Carcinoma
Cytologic grading of precursor lesions
1 )LOW GRADE SQUAMOUS INTRAEPITHELIAL LESIONS
[CIN I and Condylomas (koilocytosis)]
2 )HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESIONS
[CIN II, CIN III/CIS]
Cervical Intraepithelial Neoplasia (CIN) and
CarcinomaPeak incidenceCIN : 30 YInvasive carcinoma: 45 yRisk factors
1-Early age at first intercourse2-Multiple sexual partners
3-A male partner with multiple previous sexual partners
Invasive Carcinoma of the Cervix
80-95% :Squamous cell carcinomasMultifactorial disease
PreventableGross (macroscopic appearance)
Fungating (exophytic)Ulcerative (endophytic)
Infiltrative