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Female Reproductive System
Izuddin Fahmy Abu | March 29th, 2010
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Female Reproductive System
Cervix
Uterus
Ovaries
Breast
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1) Cervical Carcinoma
CIN is the potentially premalignant transformation andabnormal growth (dysplasia) of squamous cells on the
surface of the cervix.
Almost all carcinomas arise in CIN; but not all cases of CIN
progress to carcinoma.
Three grades:
CIN I: mild dysplasia CIN II: moderate dysplasia
CIN III: severe dysplasia
The higher the grade, the more likely the lesion will progress
to carcinoma.
Cervical intraepithelial neoplasia (CIN)
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Cervical Carcinoma
Persistent infection with high-risk HPV
integrate into genome, inactivate p53, RB Early age at first intercourse
Multiple sexual partners
A male partner with multiple previous partners
Smoking
Immunodeficiency
Risk Factors
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Spectrum of cervical intraepithelial neoplasia (CIN)
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Cytology of CIN (Pap smear)
normal CIN I CIN II CIN III
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Cytology of CIN (Pap smear)
normal CIN I CIN II CIN III
Low-grade dysplasia High-gradedysplasia
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Cervical Carcinoma
Most cases are squamous, arising from CIN
Peak age: 45 (10-15 years after CIN develops!)
Spreads slowly
Mortality is related to stage:
stage 0 (preinvasive): 100% 5 year survival
stage 4: 10% 5 year survival
Invasive cervical carcinoma
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2) Endometriosis
A medical condition in which endometrial like cells
appear and flourish in areas outside the uterine cavity.
These endometrial-like cells in areas outside the uterus
are influenced by hormonal changes and respondsimilarly as do those cells found inside the uterus.
Endometrium undergoes cyclic bleeding
Causes scarring, pain, sometimes sterility.
How does endometrium get out?
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Endometriosis in ovary (chocolate cyst)
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Endometrial Hyperplasia
Proliferation of endometrium due to estrogen excess
Risk factors: anovulatory cycles, obesity, estrogen-
producing ovarian tumors, exogenous hormone use
Three categories: simple, complex, and atypical
The more severe the hyperplasia, the greater the
chance that it will evolve into carcinoma
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Normal endometrium
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Endometrial hyperplasia
Simple Complex Atypical
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3) Uterine Tumors
Fibroid
Benign tumor of smooth muscle
Common!
Stimulated by estrogen
Menorrhagia, metrorrhagia, or asymptomatic
Leiomyoma
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Uterine Tumors
Malignant tumor of smooth muscle
Necrotic, with atypical cells and lots of mitoses
Often recur after surgery
Many metastasize, especially to lungs
5 year survival = 40%
Leiomyosarcoma
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Leiomyoma Leiomyosarcoma
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Leiomyoma Leiomyosarcoma
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Uterine Tumors
Peak age: 55-65 (not before 40)
Frequently arises in endometrial hyperplasia
Risk factors: obesity, nulliparity, estrogen replacement
Symptoms: leukorrhea, irregular bleeding
Metastasizes late
Endometrial carcinoma
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Endometrial adenocarcinoma
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4) Benign Ovarian Tumors
Benign tumor derived from surface epithelium Repeated ovulation, scarring, infolding of
epithelium leads to cysts, which can undergo
neoplastic transformation
Typically large
Cystadenoma
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Patient with ovarian cystadenoma
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Ovarian cystadenoma
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Ovarian cystadenoma
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Benign Ovarian Tumors
Benign tumor with differentiation along all three
germ cell layers (ectoderm, endoderm, mesoderm)
Usually cystic, with skin inside (dermoid cyst)
Contain sebaceous material, hair, teeth, bone
Malignant variant has immature tissues
Teratoma
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Teratoma
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Teratoma
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5) Ovarian Cancer
23,000 new cases / 15,000 deaths in 2007
5th most deadly cancer in women
Danger: produces no signs until advanced
Peak age: 50
Symptoms:
feeling of fullness or bloating
pelvic pain back pain
abnormal menses
Treatment: surgery, radiation, chemotherapy
cystadenocarcinomas
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Papillary cystadenocarcinoma
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Papillary cystadenocarcinoma
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Breast
Many breast diseases present as lumps
Most lumps represent benign things, howeverit still needs to be evaluated
Ultrasound, mammography, fine needleaspiration, and biopsy are the usual methods
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Most breast lumps are benign
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6) Fibroadenoma Breast Tumor
Most common benign breast tumor
Stimulated by estrogen
Peak incidence 20s
Solitary, discrete, moveable mass
Fibrous tissue with compressed ducts and lobules
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Fibroadenoma
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Fibroadenoma
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7) Breast Carcinoma
180,00 new cases / 40,000 deaths in 2007
Second most common type of cancer
75% of patients are >50
Rate was increasing but now stable
Risk Factors
Age
Family History
Increased estrogen exposure
Obesity
Alcohol consumption
High-fat diet
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Breast Carcinoma
5-10% of all cases are hereditary
Worry if first degree relative with breast cancer Most have BRCA-1 or BRCA-2 mutations
Tumor suppressor genes; help repair DNA
Most carriers get cancer by age 70
Family History
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Size of typical palpable breast lump
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Advanced breast carcinoma: fixation to skin
C
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Breast Carcinoma
Neoplastic cells fill ducts (DCIS) or lobules (LCIS) but donot breach basement membrane
Incidence has increased with mammography
If untreated, over 1/3 will develop invasive carcinoma
With treatment, prognosis is excellent
Non-Invasive Breast Carcinoma
Ductal (or not otherwise specified) carcinoma, lobular
carcinoma
Inflammatory carcinoma - breast looking red and swollen.Often does not present with a lump, often not detected by
mammography or ultrasound.
Invasive Breast Carcinoma
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Normal breast
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Lobular carcinoma in situ
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Invasive breast carcinoma
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Invasive ductal breast carcinoma low grade
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Invasive ductal breast carcinoma high grade
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Inflammatory breast carcinoma
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Inflammatory breast carcinoma
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Breast Carcinoma
Size of tumor
Lymph node involvement
Distant metastases
Grade of tumor
Histologic type of tumor
Prognostic Factors
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Male Reproductive SystemIzuddin Fahmy Abu | March 29th, 2010
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Male Reproductive System
Testis
Prostate
Sexually transmitted diseases
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1) Testis: Cryptorchidism
Incomplete testicular descent into scrotum
Present in 3% of newborns; most descend by 6
months.
Associated with sterility and malignancy
Orchiopexy - move an undescended testicle
into the scrotum and permanently fix it there
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2) Testis: Neoplasms
The most common cancer in men aged 15-35
5 cases per 100,00 males
Firm, painless enlargement of the testis
Seminomas and non-seminomas
Some present with metastases Treatable curable! - if detected early
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Testis: Neoplasms
Small, painless lump
Enlarged testicle
Feeling of heaviness intesticle or groin
Change in the way thetesticle feels
Accumulation of fluid
Testicular self-examination
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Testis: Neoplasms
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Testis: Neoplasms
Half of all testicular cancers
Seminomas develop from the sperm-producing germ cellsof the testicle.
Arise from germinal epithelium of seminiferous tubules
Tumor classification - i) Seminoma
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Seminoma
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Testis: Neoplasms
A group of testicular cancers that begin in the germcells (cells that give rise to sperm)
Embryonal tumor (undifferentiated stem cells)
Yolk sac tumor (yolk sac cells) Choriocarcinoma (immature placental cells)
Teratoma (somatic tissue cells)
ii) Nonseminomas
Tumor classification
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Embryonal carcinoma
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Embryonal carcinoma
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Choriocarcinoma
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Teratoma
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Teratoma
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Testis: Neoplasms
Important for staging and follow-up.
Human chorionic gonadotropin (hCG) Normally made by placental cells
in choriocarcinoma; sometimes in seminoma
Alpha-fetoprotein (AFP)
Normally made by fetal yolk sac and other cells in yolk sac tumors and embryonal carcinoma
Tumor markers
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Testis: Neoplasms
Overall, prognosis is good If detected early, 90% cure rate
8000 new cases a year, only 400 deaths.
Seminomas Often remain localized until large Metastasize locally first, then later, distantly
VERY sensitive to radiation and chemotherapy Nonseminomas
Metastasize earlier, farther Worse prognosis
Treatment
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Testis: Neoplasms
At age 25 (in 1996), diagnosed with aggressive
testicular cancer Already metastatic to brain, abdomen, lungs
Treated with surgery, chemotherapy
Victories in 1999-2005 Tours de France!
Lance Armstrong
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Prostate
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4) Prostate: Nodular Hyperplasia
Very common! 90% of men have it by their 70s.
Caused by excessive androgens
Benign proliferation of glands and stroma Large
prostate
Usually affects central zone of the prostate
Symptoms (in 10% of patients): hesitancy, urgency,nocturia, poor urinary stream.
Symptoms of urinary obstruction
Cause: excessive androgen stimulation
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Nodular hyperplasia
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Nodular hyperplasia
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5) Prostate: Carcinoma
Common, deadly cancer
Early on asymptomatic, detected by PSA test
Later: hard nodule by rectal exam
Much later: local pain and obstructive symptoms
Develops in peripheral zones of prostate
Peak incidence: 65-75
Treatment, prognosis depend on stage, grade
Some come to attention because of metastases
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Prostatic carcinoma
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Prostatic carcinoma
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Prostatic carcinoma
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Prostatic carcinoma
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Prostate: Carcinoma
Enzyme made by prostatic epithelial cells
Malignant cells make more PSA than benign cells Used as a screening and monitoring test
PSA 10 suggests cancer
But PSA can go up in benign disorders too (nodularhyperplasia, prostatitis)!
So: elevated PSA doesnt always mean cancer.
Prostate-specific antigen (PSA)
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Prostate: Carcinoma
Hormonal influences males castrated before puberty dont get it
treatment with orchiectomy/estrogens works
Genetic contributions increased risk in first-degree relatives earlier onset in blacks
Environmental influences in Scandinavian countries, in Asia
Cause
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Prostate: Carcinoma
Prognosis depends on stage (and grade)
Treatment: surgery, radiation, hormonal therapy
Limited disease: 90% survive 10+ years
Metastatic disease: 10-40% survive 10+ years
Prognosis
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STDs
15 million cases per year worldwide
Most in 15-24 year olds
5 of the top 10 infectious diseasesrequiring notification are STDs: chlamydia,
gonorrhea, AIDS, syphilis, hepatitis B
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1) Syphilis
Caused by Treponema pallidum
33,000 cases/year
Primary: painless chancre (ulceration)
Secondary: rash, lymphadenopathy
Tertiary: proximal aortitis, brain lesions
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Syphilitic plaques
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Syphilitic ulceration
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Syphilitic chancre
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Syphilitic rash
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Condylomata lata (rash becomes flat,
broad, whitish lesions)
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2) Gonorrhea
Caused by Neisseria gonorrhoeae
300,000 cases/year
Males: severe, purulent urethritis (can spreadto prostate, testis)
Females: cervicitis (can spread to tubes,ovaries)
Can be transmitted during birth
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Gonorrhea
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3) Non-Gonococcal Urethritis and Cervicitis
Caused by Chlamydia (mostly) and other bugs
Chlamydia: 900,000 cases/year
Symptoms indistinguishable from gonorrhea
Reiter syndrome
Occurs mostly in people who are HLA-B27 +
Urethritis, arthritis, conjunctivitis,mucocutaneous lesions
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4) Genital Herpes Simplex
50 million affected people in US
Most cases caused by HSV-2 (HSV-1 more oral)
Painful, erythematous vesicles on genital
skin/mucosa
Primary: lesions plus lymphadenopathy, fever
Recurrences: milder, shorter
May be fatal in immunocompromised patients andin neonates
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5) Human Papillomavirus
Causes squamous proliferations in genital tract:
condylomata acuminata (venereal warts)
precancerous lesions
carcinomas
Condylomata: HPV 6, 11
Carcinomas: HPV 16, 18, others
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Condylomata acuminata (small rough tumor)
Thank You
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Thank You
Now go home & do your self examination!!
