Female
Reproductive
System
TOPICS
• TODAY (Part I) • NEXT CLASS (Part II)
– Vulva
– Vagina
– Cervix, uterus
– Body, uterus
– Tubes
– Ovaries
– Placenta
VULVA
• Synonymous with EXTERNAL genitalia
• Everything ANTERIOR to the INTROITUS
• Usual classification of Degen., Inflam.,
Neopl.
• Common Diseases:
– BARTHOLIN Cyst
– Vulvar Vestibulitis
– Deg./Inflam. Epithelial: LICHEN diseases
– BENIGN tumors: Condyloma(ta)
– MALIGNANT tumors: VIN, SCC
The types of lichen lesions
which show HYPER-plastic
mucosal changes are often
regarded as being
“potentially” pre-malignant
CONGENITAL
• Imperforate hymen
(hematocolpos)
• Atresia
• Absence (agenesis)
• Septate
• Double vag/uterus (didelphys)
VAGINAL NEOPLASIA
• VIN
• INFILTRATING SCC
• ADENOSIS (D.E.S.) 
• ADENOCARCINOMA
(Di-Ethyl-Stilbestrol)
SCC
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CERVIX
NORMAL
METAPLASIA
INFLAMMATION
POLYPS
DYSPLASIA
CIN
INFILTRATING SCC
DYSPLASIA / CIN / SIL
INFILTRATION
How have we “CURED” Cervical Carcinoma?
ENDOMETRIUM
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•
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FUNCTIONAL HISTOLOGY
D.U.B. (Dysfunctional Uterine Bleeding)
INFLAMMATION
ADENOMYOSIS/ENDOMETRIOSIS
POLYPS/HYPERPLASIA
ADENOCARCINOMA and/or STROMAL
LEIOMYOMYOMAS, -SARCOMAS
• MITOSES differentiate benign from malignant
MITOSES (Glandular and Stromal) =
VACUOLES/SECRETION =
PRE-ovulatory
POST-ovulatory
DYSFUNCTIONAL UTERINE
BLEEDING (DUB)
• Anovulatory Cycle
• Inadequate Luteal Phase
• Oral Contraceptives
• Menopause
• Post-Menopause
ENDOMETRITIS
•PID
•Post-partum Sepsis
•BCP’s
•TB
•IUD’s
ADENOMYOSIS
• Defined as normal endometrial glands
deep within the myometrium
ENDOMETRIOSIS
Defined as normal endometrial glands OUTSIDE
the confines of the myometrium
Reverse menstruation vs. Embryologic “rest”
theories
EXTREMELY common cause of cyclical
abdominal/pelvic pain
Broad Ligament, Ovary (“chocolate cysts”),
Peritoneum, Bowel, Umbilicus
“CHOCOLATE”
CYST
GRADING and STAGING
• GRADING
– 1, 2, 3
– Well, Moderate, Poor
• STAGING
– (I) Corpus
– (II) Corpus + Cervix
– (III) Beyond uterus,
but inside true pelvis
– (IV) Outside true
pelvis or involving
bladder or rectal
mucosa
Fallopian Tubes
•Inflammation
•Cysts
•Neoplasms
SALPINGITIS/PID
GC and
CHLAMYDIA
PYOSALPINX
PERITONITIS
TUBO-OVARIAN
ADHESIONS
STERILITY
INFERTILITY
CHAPTER 22
DISEASES of
OVARIES
PREGNANCY
PLACENTA
DISEASES of
OVARIES
• DEGENERATIVE?
• INFLAMMATORY?
• CYSTS
• TUMORS
–
–
–
–
Müllerian (“Germinal”)
Germ Cell
Sex Cord/Stromal
Metastatic
DISEASES of
PREGNANCY
•EARLY Pregnancy
•LATE Pregnancy
DISEASES of
PLACENTA
• ANOMALIES
• “BENIGN” tumors (MOLES)
• MALIGNANT tumors
(CHORIOCARCINOMA)
6 WEEKS
GENITAL RIDGE
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TERMS
“Germinal” Epithelium (Mesothelium)
Ovum (Oocyte)
Tunica Albuginea
Primordial Follicle
Primary Follicle
Mature “Graffian” follicle (antral or secondary)
Granulosa cells ( Estrogen)
Thecal cells ( Estrogen)
Corpus luteum ( Progesterone)
“Atretic” follicle
Corpus Albicans
“Stroma”
ESTROGEN
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•
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Controlled by FSH and LH
Develop, Lactate Breast Lobules
Proliferate Endometrial Glands
“Cardioprotective”
“Bone Mass” protective
PROGESTERONE
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Controlled by FSH and LH
SECRETE Endometrial Glands
IMPLANTATION of the blastocyst
Lactation
DISEASES of
OVARIES
• CYSTS:
–Follicular
–Luteal
FOLLICULAR CYST
MOST COMMON
POLY-Cystic Ovarian Disease
(Stein-Leventhal syndrome)
5% Prevalence
Anovulation
Oligomenorrhea
Obesity
Hirsutism
Polycystic Ovaries
OVARIAN TUMORS
• MÜLLERIAN (MAJORITY)
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Serous (Benign, Borderline, Malignant)
Mucinous (Benign, Borderline, Malignant)
Endometroid (Benign, Borderline, Malignant)
Adenosarcoma (Carcinoma AND Sarcoma)
Mesodermal Mixed (MULTIPHASIC Sarcoma)
Clear Cell
Brenner (almost always benign)
Transitional (almost always look like Brenner)
• Germ Cell (Not surprisingly, like males)
• SEX-CORD/STROMAL
• METASTATIC
OVARIAN TUMORS
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•
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Solid vs. Cystic
Functional vs. NON-functional
Benign vs. Malignant
First clinical presentation may be ascites,
in carcinomas.
• Malignant ascites in a woman is ovarian
cancer until proven otherwise
• CA-125 is THE important tumor marker in
ovarian cancer, especially as a follow up.
SEROUS, BENIGN
MUCINOUS, BENIGN
Dysgerminoma:Female::Seminoma:Male
CHORIOCARCINOMA,
Just like testis or placenta
DISEASES of
PREGNANCY
•EARLY Pregnancy
•LATE Pregnancy
EARLY PREGNANCY
• SPONTANEOUS ABORTION
• ECTOPIC PREGNANCY
Ectopic Pregnancy
• Chiefly TUBAL, but ovarian or
abdominal rare
•1% OF NORMAL WOMEN
•35%-50% OF WOMEN with
previous SALPINGITIS/PID
• + HCG, Abdominal pain, 1st
trimester, ultrasound
CIRCUMVALLATE
PLACENTA ACCRETA
NO DECIDUA BETWEEN VILLI AND MYOMETRIUM
Placental Infections
• Villitis vs. chorionamnionitis vs. funisitis
• ASCENDING vs. hematogenous
• ASCENDING are usually bacterial,
and chorionamnionitis
• HEMATOGENOUS
are often TORCH,
and villitis
Placental Neoplasms,
i.e. gestational trophoblastic disease
• Benign: MOLES (Hydatidiform moles)
• Malignant: CHORIOCARCINOMA
• BOTH are associated with increased or
persistent levels of the placental
hormone HCG
(Hydatid)-iform Mole
• 1/1000 in USA
• 1% in Indonesia
• Also called NON-invasive mole in
its most common benign variant,
but can also be “invasive”
• Complete (2% chorioCA incidence)
or partial (0% incidence)
• Grapelike clusters, i.e., swollen villi