2/9/2015
Vulva: Bartholin Cyst Squamous epithelium “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 hyperplasia
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 CARCINOMA Slide courtesy of Dr. Lodge‐Rigal
Embryology of female lower genital tract Vulvar melanoma
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 adenocarcinoma
Embryonal rhabdomyosarcoma (Sarcoma botryoides) Cervical/endocervical polyp
4 2/9/2015
Nabothian cysts
Cervical dilated mucinous glands
Figure 18‐4
Dr. George Papanicolaou PAP TESTS
Figure 18‐5 Conven onal smears → liquid based monolayer Thin Prep
Cervical cytology on Pap test
Figure 18‐7
Cervical histology on biopsy/excision
Figure 18‐6
5 2/9/2015
Cervical carcinoma Squamous cell 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 ovary Polycystic ovary Stein‐Leventhal syndrome Anovulatory hyperandrogenism
String of pearls
Ovarian tumors
Figure 18‐5
Ovarian serous cystadenoma
9 2/9/2015
Serous tumor of low malignant potential Serous cystadenocarcinoma Serous adenocarcinoma with psammoma bodies
Ovarian mucinous cystadenoma
Figure 18‐17 Figure 18‐17
Pseudomyxoma peritonei
Krukenberg tumor
Omental “caking”
10 2/9/2015
Ovarian benign (mature) cystic teratoma
Endometrioid cystadenoma Brenner tumor
Ovarian germ cell tumors
Dysgerminoma
Malignant (immature) teratoma Struma ovarii “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‐thecoma
Meigs syndrome
Sertoli cells Sertoli‐Leydig cell tumor
Androgenic
Leydig cells
11 2/9/2015
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
12 2/9/2015
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
13 2/9/2015
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.
14 2/9/2015
Complete mole
Ultrasound snowstorm of molar pregnancy
Figures 18‐19, 18‐20
Gestational (non‐gonadal) choriocarcinoma
Table 18‐4
Figure 18‐21
Altered uteroplacental blood flow in preeclampsia
Proteinuria
15 2/9/2015
HELLP in Eclampsia
Hemolysis with schistocytes Elevated Liver enzymes
Low Platelets
16