Female Genital System Basic Robbins Chapter 18, pages 681-704 Big Robbins Chapter 22 M.E. Bauman, MD
Slides for review: 22, 34, 37, 94, 104, 153, 163, 181, 192, 198, 223 and normal uterus slide.
One online clinical case: #12 A woman with vaginal bleeding
Note: The material presented below generally follows the outline of Chapter 18 of Basic Robbins. Occasionally the order of the material presented below differs from that of the text; additional material not in the text is also presented.
Vulva
Labium minus/labia majora
Vulvitis
Contact irritant dermatitis
Contact allergic dermatitis
Infectious dermatitis
Bartholin gland duct obstruction
Non-neoplastic Epithelial Disorders
Lichen Sclerosus et atrophicus (figure 18-1)
Leukoplakia
Lichen simplex chronicus (squamous epithelial hyperplasia) (figure 18-1)
Tumors
Condyloma (condylomas/condylomata) (figure 18-2)
Condylomata lata
Condylomata acuminata
Vulvar carcinomas Female reproductive page 2
1. HPV16 and 18 associated
VIN/VAIN/CIN
2. Non-HPV associated
Extramammary Paget disease
Vagina
Embryology and developmental anomalies
Müllerian ducts
Mesonephric (wolffian) ducts
Arcuate/septate/bicornuate/didelphic uterus
Vaginitis
Candida albicans
Trichomonas vaginalis
Gardnerella vaginalis
Vaginosis panel
Molluscum contagiosum
Female reproductive page 3
Malignant neoplasms
Squamous cell carcinoma
Clear cell carcinoma
Vaginal adenosis
Sarcoma botryoides (embryonal rhabdomyosarcoma)
Cervix
Cervicitis
Chlamydia trachomatis Neisseria gonorrhea Ureaplasma urealyticum HSV-2
Neoplasia of the cervix
Transformation zone (figure 18-4)
Risk factors for CIN
HPV Vaccines
Low risk and high risk HPV (Figure 18-5)
Pap tests
Female reproductive page 4
CIN/LSIL/HSIL (Figure 18-6, 18-7)
Colposcopy/LEEP
Cervical carcinoma
Body of Uterus (Corpus uteri) Uterus/uteri
Endometritis
Infection: N. gonorrhea, C. trachomatis, mycobacteria
Retained products of conception
Intrauterine device
Complications
Adenomyosis
Complications
Endometriosis
Possible etiologies (figure 18-9)
Complications
Female reproductive page 5
Histology of the endometrial cycle
Menorrhagia
Metrorrhagia
Oligomenorrhea/Amenorrhea
Menopause/postmenopause
Abnormal uterine bleeding
Female reproductive page 6
AUB secondary to organic uterine lesions
AUB secondary to functional etiologies (= dysfunctional uterine bleeding)
Proliferative lesions of the endometrium and myometrium
Endometrial hyperplasia
Endometrial polyps
Leiomyoma (leiomyomas, leiomyomata)
Leiomyosarcoma
STUMP
Endometrial carcinoma
Type I
Type II
Female reproductive page 7
Malignant Mixed Müllerian Tumor (Triple MT)
Fallopian Tubes
Gabriello Fallopio
Salpinx
Salpingitis
Tubo-ovarian abscess
Pelvic inflammatory disease (PID)
Ovaries
Gonadotropic hormones from the hypothalamus cause the anterior lobe of the pituitary gland (pars distalis) to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones stimulate the development of ovarian follicles, which in turn secrete estrogen. Rising estrogen levels trigger a surge of LH. This results in ovulation and the development of the corpus luteum, which begins to secrete progesterone and estrogen. Progesterone builds up the endometrial wall in preparation for implantation (pregnancy). Progesterone also inhibits LH, so if no pregnancy occurs, the corpus luteum causes its own demise. If a pregnancy occurs, the placenta produces human chorionic gonadotropin (hCG) to maintain the corpus luteum and pregnancy.
Cochard. Netter's Atlas of Human Embryology: Updated Edition. Saunders, 062012.
Follicular and luteal cysts
Corpus luteum/corpora lutea
Corpus albicans/corpora albicantia
Polycystic ovarian disease (PCOD)
Female reproductive page 8
Torsion of ovary
Tumors of the ovary
1.
2.
3.
4.
1. Surface epithelial tumors
Serous Cystadenoma Mucinous Cystadenofibroma Endometrioid Tumor of low malignant potential Brenner/transitional/urothelial Cystadenocarcinoma Carcinoma
Serous tumors
Psammoma bodies
Low malignant potential
Mucinous tumors
Pseudomyxoma peritonei
Omental “caking”
Female reproductive page 9
Endometrioid tumors
Brenner/transitional/urothelial tumors
2. Germ cell tumors
Teratomas
Benign (mature) cystic teratoma/dermoid cyst
Malignant (immature) teratoma
Specialized teratoma, e.g. struma ovarii
Dysgerminomas
Yolk sac (endodermal sinus) tumor
Schiller-Duval body
α-fetoprotein
Choriocarcinoma
Syncytioblasts and cytotrophoblasts
β-hCG
3. Sex cord-stromal tumors
Derivation
Granulosa cell tumor (granulosa-theca cell tumor)
Juvenile granulosa cell tumor
Call-Exner bodies
Fibroma-thecoma
Female reproductive page 10
Meigs syndrome
Sertoli-Leydig cell tumor (androblastoma)
4. Metastatic tumors to the ovary
Müllerian origin
Extra-Müllerian origin
Krukenberg tumor
Diseases of Pregnancy
Placentation
Female reproductive page 11
Single umbilical artery
Umbilical knot
Umbilical cord prolapse
Nuchal cord
Amniotic band syndrome
Placental infarction
Placental abruption
Placenta accreta/increta/percreta
Succenturiate lobe
Velamentous insertion of cord
Placenta previa
Female reproductive page 12
Twin gestations
Monozygotic/dizygotic
Monoamnionic Monochorionic (MoMo)
Diamnionic Monochorionic (DiMo)
Diamnionic Dichorionic (DiDi), fused or separate
Monochorionic =
Twin-twin transfusion syndrome
Placental infections
Ascending (transcervical) infections
PPROM, PROM
Chorioamnionitis
Funisitis
Hematogenous (transplacental) infections
T O R C H
Ectopic pregnancy
Female reproductive page 13
Gestation trophoblastic disease
Hydatidiform mole (Table 18-4, Figures 18-19, 18-20)
Complete mole
Partial mole
Invasive mole
Choriocarcinoma (Figure 18-21)
Gestational
Nongestational/Gonadal
Preeclampsia/Eclampsia (toxemia of pregnancy)
Preeclampsia
1. 2. 3.
3-5% of pregnancies, 3rd trimester, primigravida
Eclampsia
≠ gestational hypertension
Decreased uteroplacental blood flow
Female reproductive page 14
Altered circulating endothelial factors
Placenta
Maternal endothelial dysfunction
End organ failure
HELLP in 10% of eclamptic patients
H EL LP
Rx
End of Handout