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Pathology of Reproductive system, Appears as a Gray, crusted, papular…
Pathology of Reproductive system
Male Reproductive system Pathologies
Inflammaatory Lesions
Balanitis and balanoposthitis
Refer to local inflammation of the glans penis and overlying prepuce.
Agents
: Candida albicans, anaerobic bacteria, Gardnerella and pyogenic bacteria
Phimosis
Prepuce cannot be retracted easily over glans penis. Scarring of prepuce caused by balanoposthitis.
Neoplasms
Squamous cell carcinoma in situ of the penis (Bowen
disease)
occurs in older uncircumcised males.
Appears grossly as a
solitary plaque on the shaft
of the penis.
Dysplastic cells
throughout the epidermis with
no invasion
of the underlying stroma.
Gives rise to invasive squamous cell carcinoma.
Invasive Squamous cell carcinoma
Verrucous
carcinoma
non-HPV–related
variant of squamous cell carcinoma.
-characterized by
papillary architecture
no cytologic atypia
, and
rounded
, pushing deep
margins.
locally invasive but
do not
metastasize
More than 95 percent of penile neoplsms arise on squamous epithelium
SCROTUM, TESTIS, AND EPIDIDYMIS
Cryptorchidism and Testicular Atrophy
Complications
Germ cell neoplasia in-situ
Precursor
of subsequent Germ cell tumors
Treatment
Orchioplexy
by 18 months of age
Inflammatory Lesions
Nonspecific epididymitis and orchitis
begin as a primary urinary tract infection.
spreads to the testis through the
vas deferens
or the
lymphatics of the spermatic cord.
testis is
swollen and tender
histologic examination reveals
numerous neutrophils
Mumps infection
Affected testes are
edematous
and
congested
.
Contain a
lymphoplasmacytic inflammatory infiltrate
.
Severe Mumps orchitis
May lead to
extensive necrosis, loss of seminiferous epithelium,
tubular atrophy, fibrosis,
and
sterility
Tuberculosis
Testicular tuberculosis generally begins as an
epididymitis
.
secondary involvement of the testis.
Histologically-
granulomatous inflammation
and
caseous necrosis
identical to that seen in active tuberculosis in other sites
Most Common
Vascular Disturbances
Torsion
obstruction of testicular venous drainage
while leaving
the thick-walled and more resilient arteries patent.
leads to intense
vascular engorgement and infarction
unless the torsion is relieved.
Neonatal Torsion
occurs either in
utero
or shortly
after birth
Adult torsion
results from a
bilateral congenital anomaly
the testis is
abnormally anchored in the scrotal sac
rise to
increased mobility (bell clapper abnormality
)
Testicular Neoplasms
Heterogenous
Includes Germ cell tumors and sex cord- stromal tumors
Germ Cell Neoplasia In Situ
Precursor Lesions include,
Cryptorchidism
Dysgenetic Gonads
Testicular Germ cell tumors
Differentiated into -
Seminomas
-
Non-Seminomatous germ cell tumors
Seminomas
soft, well-demarcated, gray-white tumor.
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Remain confined to the testis for long time.
Metastases -
Iliac and paraaortic lymph nodes
( Upper lumbar region).
Hematogenous Metastases occur late in course
Nonseminomatous germ cell neoplasms
Tend to
metastasize earlier
, by
lymphatic
as well as
hematogenous
routes.
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Assay of tumor markers,
HCG
is always elevated in patients with
choriocarcinoma
.
Increased
AFP
in the setting of a
testicular neoplasm
indicates a
yolk sac tumor
component.
**The levels of lactate dehydrogenase (LDH) correlate with
the tumor burden. **
PROSTATE
Prostatis
Acute bacterial prostatis
Sudden onset of
fever, chills, perineal pain
and
bladder outlet obstruction
. - Complicated by
Sepsis
.- > Treated by
antibiotics
Chronic bacterial prostitis
Occurs from
recurrent UTI
.
Patient presents with
Low back pain, dysuria, perineal
and
suprapubic discomfort
-> Treated with
Antibiotics
Chronic Pelvic pain syndrome
Characterized by
chronic pain
localized to the
perineum, suprapubic area, and penis
Benign Prostatic Hyperplasia
Caused by proliferation of
stromal
and
glandular
components. Its an
androgen dependent growth (DHT)
Virtually always occurs in the
inner transition zone
of the prostate
Most common manifestations are related to
lower urinary tract obstruction
Adenocarcinoma of Prostate
Most common form of cancer in men
Advanced lesions appear as
firm, gray-white lesions
with
ill-defined margins
that infiltrate the adjacent gland.
Most prostate cancers are
moderately differentiated adenocarcinomas that produce well-defined glands
.
Prostate cancer is graded by the Gleason system
PSA Assay is the most widely used test in the
diagnosis and management of prostate cancer.
not cancer-specific.
BPH, prostatitis, prostatic infarcts, instrumentation of the prostate, and ejaculation
all may increase serum PSA levels.
The most common treatments for clinically localized
prostate cancer are
radical prostatectomy and radiotherapy
URETER, BLADDER, AND URETHRA
Urinary Bladder
Non- Neoplastic
Bacterial Cystitis
Hemorrhagic Cystitis
Interstitial Cystitis
Malakoplakia
Polypoid Cystitis
Neoplastic
Carcinoma
of bladder is more common in men.
Squamous cell carcinoma
is related to
Schistosoma haematobium
Clinical Features
Commonly present with
painless hematuria
. Patients with urothelial tumors whatever the grade have a tendency to develop new tumors after excision.
High Grade Papillary urothelial carcinomas
are associated with
concurrent or subsequent invasive urothelial carcinoma
, lower grade papillary urothelial neoplasms often recur but infrequently invade.
Treatment:
depends oon tumor grade and stage and whether the lesion is
flat or papillary
Ureter
Ureteropelvic junction (UPJ) obstruction
Malignant tumors -> Most are
Urothelial Carcinomas
Retroperitoneal fibrosis
Urethra?
Female Reproductive System Pathologies
Ovarian Tumors
Epithelial Tumors
Benign Tumors
Serous/ Mucinous Cystadenoma
Uni or multilocular smooth walled cyst -> with or without papillary projections
Usually without necrosis
Microscopic View: Papillary adenoma with Cystic Dlation
Complications: Rupture, torsion, Super-infection, Malignant transformation
Brenner Tumor
Solid tumors with Cystic Areas
Borderline tumors
Serous/ Mucous Borderline tumors
Macroscopic:
Cystic tumor with Serous or Mucin filled Cavities
Intracystic Papillary Projections and Surface Papillary Excrements
Uni or Bilateral tumor
Microscopic:
Serous Boderline tumor -> Pappilae lined with stratified cuboidal or columnar epithelium with nuclear atypia
Mucinous Borderline tumor -> Papillae lined with stratified intestinal type epithelium with nuclear atypia
Complications:
Non- invasive or Invasive peritoneal implants,
Invasive implants
Cystadenocarcinoma
Malignant Epithelial tumors
Serous/ Mucinous Cystadenocarcinoma
Ovarian Sex- Cord / Stromal Tumors
Arise from ovarian stromal and sex cord cells ( most are benign)
Clinical features:
Uterine bleeding, endometrial hyperplasia/ Adenocarcinoma, hirsutism
Tumor cells secrete Estrogen, Progesterone or androgen ( 30%)
Germ cell tumors
Teratoma
Mature Teratoma
Derived from Endoderm, ectoderm and mesoderm
Struma Ovrii
Variant composed of thyroid tissue
Immature teratoma
Potentially malignant tumor composed of Neural and mesenchymal tissue
Dygerminoma
Choriocarcinoma
Yolk Sac tumor
Fallopian Tubes
Tubal Ectopic Pregnancy
Localization: Ampulla(80%), Isthmus( 10%), Infundibulum(5%)
Complications:
Tubal Abortion-> Hematosalpinx,
Rupture of Fallopian Tubes -> Hemoperitoneum
Clinical Features: Acute Lower abdominal Pain, Pelvic Pain, Vaginal Bleeding
Salpingitis
Acute Salpingitis
Catarrhal or purulent inflammation
Complications: Pyosalpinx
Chronic Salpingitis
Fibrous or obstructive inflammation
Complications: Tubuloovearian cyst, infertility, ectopic pregnancy, hydro/ pyosalpinx
Tuberculous Salpingits
Fallopian tubes are the most common female genital organs affected by tuberculosis.
Complications: Infertility
Cervicitis
Acute Cervicitis
Caused by bacteria, Chlamydia, Mycoplasma, herpes virus, trauma
Chronic Cervicitis
Consequences: Squamous metaplasia (Endocervix) -> Dysplasia -> Squamous cell carcinoma
Retention Naboth Cysts
HPV related epithelial lesions
Koilocytosis
Metaplasia
Dysplasia
Synonyms:
Cervical Intraepithelial Neoplasia( CIN),
Squamous Intraepithelial lesion( SIL) : :
Morphological classification:
Mild Dysplasia( CIN1, LGSIL- Low grade) - 1/3 of epithelium
Moderate Dysplasia ( CIN 2, HGSIL - High Grade SIL) - 2/3 of the epithelium
Severe Dysplasia or in situ Carcinoma ( CIN 3, HGSIL) Entire thickness of the epithelium -> Basically its carcinoma
Tumors of the Uterine Cervix
Benign Tumors
Endo-cervical Polyp -> Simple polyp lind by columnar mucinous Epithelium
Condyloma Accuminatum - HPV related Disease
Malignant Tumors
Risk Factors: HPV infections, multiple partners, Poor hygiene, Sexually transmitted dieases
Invasive Squamous Cell carcinoma
Microinvasive
Stromal invasion <5mm in depth and <7mm horzontal spread
Invasive Carcinoma
Stage 1(pT1): Tumor limited to Cervix - 5 year survival.
Stage 2 (pT2): Invasion beyond uterus, but not to pelvic wall or lower third of Vagina- 5 Year srvival rate
Stage 3 (pT3) Invasion of the pelvic wall and to the lower third of vagina or associated with hydronephrosis or renal failure.
Stage 4 (pT4) invasion of urinary bladder or rectum. Distant metastases - lung, liver, bone, peritoneal spread, supraclavicular/ mediastinal, paraaortic lymph nodes
Complications:
Hemorrhages, Superinfection,
Fistula that opens into rectum, vagina, bladder. compression of the surrounding organs
invasion of the ureters-> Hydronephrosis, pyelonephritis
Pathology of Uterine Corpus
Endometrial hyperplasia
Macroscopic: Thickening of endometrium
Microscopic:
Simple hyperplasia without atypia -> Proliferation of endometrial glands and stroma, without atypia
Complex hyperplasia without atypia -> hyperplasia of the endometrial glands with reduced stroma, without atypia.
Simple or complex atypical hyperplasia -> atypia also present
Complications: -Complex atypical hyperplasia -> endometrial carcinoma
Clinical features: Aysymtomatic or abnormal uterina bleeding
Treatment:
Simple/complex hyperplasia without atypia
Progestative drugs, complex atypical hyperplasia- Hysterectomy
Endometritis:
Acute Endometritis:
Etiology: Post- Delivery, Post- Abortion, ascending bacterial infection
Morphology: Purulent, Necrotizing or hemorrhagic Endmetritis
Tuberculous Endometritis -> Direct Spread from fallopian Tubes
Endometriosis:
Endometriosis: Endometrial islets( Glands and stroma) in other gential ( Ovary parametrium, Vagina, Vulva) or Extragenital organs ( Abdomina wall , Douglas Pouch, Urinary bladder, intestines, skin, nasal mucosa etc
Adenomyosis: Endometrial islets in the Myometrium.
Consequences: During menstrual cycle the endometrial islets can present the same transformations as the normal endometrium, including bleeding
Complications: Cystic Diltions ( ' Chocolate cysts' in the ovary) Pelvic inflammation, Pelvic pain, infertility, maliganant transformation( Endometriod Carcinoma)
Endometrial Carcinoma **
Clinico- Pathological classification
Type- 1- Endometriod adenocarcinoma -> Malignant transformation of Atypical endometrial hyperplasia
Type- 2 Non- Endometriod adenocarcinoma -> Atrophic epithelium
Stage 1(pT1)- tumor confined to corpus uteri.
Stage 2(pT2)- invasion of-the stromal connective tissue ofthe cervix.
Stage 3 (pT3) - invasion ofthe salpinx, vagina or parameters
Stage 4(pT4) - invasion of the intestinal and/or bladder mucosa (pT4) ± distant metastases (pMl): lung, liver, bone, etc
Pathology of Vagina
Acute vaginits
bacterial, fungal or parasitic infections: Gardnerella vaginalis, Neisseria gonorrhea, Candida albicans, Trichomonas vaginalis
Chronic vaginitis
etiology: senile atrophy, radiotherapy
Tumors of Vagina
Malignant tumors
squamous cell carcinoma , adenocarcinoma - mainly in elderly women
botryoid sarcoma: mainly in girls, good prognosis after radiotherapy
Pathology of Vulva
Infective vulvitis
Etiology:
bacterial, viral or fungal infections (e.g. Herpes virus, Candida)
Syphilis - primary chancre and secondary syphilis (condyloma latum)
Non-infective vulvitis:
Predisposing factors:
diabetes, uremia, poor hygiene, psoriasis
intimate lotions (irritant contact dermatitis)
Lichen Planus
Idiopathic Disease
Presence of purple pruritic papules on skin
Bartholinitis
inflammations of the Bartholin's glands - cyst formation, abscess
Tumors
Benign tumors
Papilloma, condyloma acuminatum (HPV-related), fibroma, lipoma | - tumors of the Bartholins glands -> adenoma
Premalignant lesions
Kraurosis vulvae - pruritic leukoplakia + vulvar atrophy
Malignant tumors
Invasive squamous cell carcinoma, adenocarcinoma, melanoma, etc.
Pathology of Pregnancy
Spontaneous abortion
Definition: Miscarriage before the 28th week of intrauterine life
Classification:
Complete Abortion
- complete Expulsion of fetus and placenta in 3 months. |
Incomplete Abortion
- Incomplete expulsion of fetus and placenta in 3 months of pregnancy. |
Retained Abortion
- Spontaneous intrauterine death of fetu, without his natural expulsion
Compllications: Risk factor for gestational trophoblastic disease ( Tumor developing from gestational cells.| Endometritis, myometritis and septicemia
Ectopic Pregnancy
ovular implantation in the fallopian tubes, ovary or abdominal cavity. Risk factor being Chronic Salpingitis
Toxemia in Pregnancy
Preeclampsia
maternal hypertension, albuminuria and edema (nephropathy)
Eclampsia
maternal hypertension, albuminuria , edema, convulsions ± DIC
Appears as
a Gray, crusted, papular lesion
, commonly in the
glans penis or prepuce
.
-infiltration of the underlying connective tissue produces an
indurated, ulcerated lesion
with
irregular margins
.
tumor is most often a
typical keratinizing squamous cell carcinoma
.
if untreated:-
testicular atrophy, infertility, and testicular
cancer.
Tubular atrophy begins
to appear by 5 to 6 years of age
Should be
fixed within 6 hours
In postpubertal males,
95%
of testicular tumors arise from
germ cells
, and almost all are malignant
Sex -Cord Stromal Tumors derived from
Sertoli or Leydig
cells
are uncommon and usually benign.
Most Hyperplastic lesions arise in the
inner transition zone
Most carcinomas (70%–80%) arise in the
peripheral zones
.
Hyperplasia
causes
urinary obstruction
normal prostate contains two cell types
a.
Flat basal cell layer
b.
Overlying columnar secretory cell layer
Most of the cases are serous type
Risk Factors Include: BRCA1/BRCA2 gene mutations, Lynch Syndrome.
Metastases: Lymph Nodes, Peritoneal Cavity, Lung, Liver and Pleura
-Inflammation of the Fallopian Tubes,
Etiology: Ascending Bacterial Infection
Predisposing Factors: Endometrial Infection
Large cells with vaculoated cytoplasm and pyknotic nuclei in the cervical epithelium, observed in pap smears and biopsies
Endocervical columnar epithelium is replaced by squamous epithelium. - Mainly involves the transformation zone of the cervix
Disorder of cell proliferation and differentiation of squamoous metaplastic epithelium and/or of the exocervical squamous epithelium
Inflammation
