2/9/2015

Vulva: Bartholin Squamous “skin”

Vagina: Squamous epithelium “mucosa”

Cervix: Ectocervix: squamous Endocervix: glandular

Slide courtesy of Dr. Lodge‐Rigal

Slide courtesy of Dr. Lodge‐Rigal

Lichen sclerosus et atrophicus Lichen simplex chronicus Squamous epithelial

Figure 18‐1

Figure 18‐1

1 2/9/2015

Condylomata lata Secondary syphilis Condylomata acuminata

HPV 6, 11 low risk

Koilocytes Figure 18‐2

Extramammary Paget Disease

Sir James Paget

DYSPLASIA (VIN3) VULVAR BASALOID SQUAMOUS Figure 18‐3 CELL Slide courtesy of Dr. Lodge‐Rigal

Embryology of female lower genital tract Vulvar

2 2/9/2015

Embryology of female lower genital tract

Arcuate Septate Didelphic

Candida albicans on Pap smear

Larry Cochard. Netter’s Atlas of Human Embryology 1st ed. Saunders. 2012.

Strawberry cervix Trichomonas vaginalis on wet mount slide Trichomonas cervicitis

http://www.youtube.com/watch?v=UJ3yjJmBhY8

3 2/9/2015

Gardnerella vaginalis “clue cell” on Pap test VAGINOSIS/VAGINITIS PANEL DNA‐hybridization

Molluscum contagiosum

Vaginal clear cell

Embryonal rhabdomyosarcoma () Cervical/endocervical polyp

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Nabothian

Cervical dilated mucinous

Figure 18‐4

Dr. George Papanicolaou PAP TESTS

Figure 18‐5 Convenonal smears → liquid based monolayer Thin Prep

Cervical cytology on Pap test

Figure 18‐7

Cervical histology on /excision

Figure 18‐6

5 2/9/2015

Cervical carcinoma 80% Adenocarcinoma 15%

SCCa in situ Adenocarcinoma in situ

Microinvasive SCCa Invasive SCCa Invasive adenocarcinoma

Loop Electrosurgical Excision Procedure (LEEP)

Endometritis

Adenomyosis Retained POC IUD STDs

Endometriosis Histology of the endometrial cycle

Chocolate cyst

Images courtesy of Dr. Lodge‐Rigal

6 2/9/2015

Larry Cochard. Netter’s Atlas of Human Embryology

1st ed. Saunders. 2012.

Simple hyperplasia without atypia Complex hyperplasia without atypia Endometrial polyps

Complex hyperplasia with atypia

Leiomyomata Endometrial carcinoma Type I

Figure 18‐13

7 2/9/2015

Endometrial carcinoma type II Malignant Mixed Müllerian Tumor (serous carcinoma) (Triple MT, Carcinosarcoma)

Endometrial carcinoma + malignant mesenchymal elements (sarcoma)

Papillary serous carcinoma

Hydrosalpinx Salpingitis

Gabriello Tubo‐ovarian abscess Fallopio Cervical motion tenderness

Larry Cochard. Netter’s Atlas of Human Embryology 1st ed. Saunders. 2012.

Luteinized cells Corpus luteum

Larry Cochard. Netter’s Atlas of Human Embryology

1st ed. Saunders. 2012.

8 2/9/2015

Torsion of Polycystic ovary Stein‐Leventhal syndrome Anovulatory hyperandrogenism

String of pearls

Ovarian tumors

Figure 18‐5

Ovarian serous

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Serous tumor of low malignant potential Serous Serous adenocarcinoma with psammoma bodies

Ovarian

Figure 18‐17 Figure 18‐17

Pseudomyxoma peritonei

Krukenberg tumor

Omental “caking”

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Ovarian benign (mature) cystic

Endometrioid cystadenoma Brenner tumor

Ovarian germ cell tumors

Dysgerminoma

Malignant (immature) teratoma “Seminoma counterpart”

Yolk sac (endodermal sinus) tumor Schiller‐Duval body α‐fetoprotein

Choriocarcinoma Syncytiotrophoblasts Cytotrophoblasts β‐hCG

Figure 18‐21

Ovarian sex cord‐stromal tumors

Granulosa cell tumor Estrogenic Call‐Exner bodies

Fibroma‐

Meigs syndrome

Sertoli cells Sertoli‐Leydig cell tumor

Androgenic

Leydig cells

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Day 8

Day 7

Before We Are Born : Essentials of Embryology and Birth Defects . Keith L. Moore, T.V.N. Persaud, Mark G. Torchia.—8th ed. Elsevier 2013. Figure 3‐4 Before We Are Born : Essentials of Embryology and Birth Defects . Before We Are Born : Essentials of Embryology and Birth Defects . Keith L. Moore, T.V.N. Persaud, Mark G. Torchia.—8th ed. Keith L. Moore, T.V.N. Persaud, Mark G. Torchia.—8th ed. Elsevier 2013. Elsevier 2013. Figures 2‐2

Villus cross section Day 21 Chorionic villus at 10 weeks

Villus cross section at term

Before We Are Born : Essentials of Embryology and Birth Defects . Keith L. Moore, T.V.N. Persaud, Mark G. Torchia.—8th ed. Before We Are Born : Essentials of Embryology and Birth Defects . Elsevier 2013. Figure 8‐6 Keith L. Moore, T.V.N. Persaud, Mark G. Torchia.—8th ed. Elsevier 2013. Figure 5‐11

Fetal aspect Maternal aspect

Before We Are Born : Essentials of Embryology and Birth Defects . Keith L. Moore, T.V.N. Persaud, Mark G. Torchia.—8th ed. Elsevier 2013. Figure 8‐13

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Single umbilical artery Trivascular cord Cord prolapse Nuchal cord

Umbilical knot

Amniotic band syndrome Placental infarction

Before We Are Born : Essentials of Embryology and Birth Defects . Keith L. Moore, T.V.N. Persaud, Mark G. Torchia.—8th ed. Elsevier 2013.

Placental abruption Placenta accreta/increta/percreta

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Membrane

Amnion

Chorion

Dividing membrane Diamnionic monochorionic

Dividing membrane Diamnionic dichorionic

Monochorionic = Monozygosity

Larry Cochard. Netter’s Atlas of Human Embryology 1st ed. Saunders. 2012. Figures 2‐17 and 2‐18

Acute villitis Twin‐Twin Transfusion Syndrome

Chorioamnionitis

O T R

H C

Larry Cochard. Netter’s Atlas of Human Embryology 1st ed. Saunders. 2012.

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Complete mole

Ultrasound snowstorm of molar pregnancy

Figures 18‐19, 18‐20

Gestational (non‐gonadal)

Table 18‐4

Figure 18‐21

Altered uteroplacental blood flow in preeclampsia

Proteinuria

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HELLP in Eclampsia

Hemolysis with schistocytes Elevated Liver enzymes

Low Platelets

16