Pathology of the Female Reproductive System Lecture 2

Question 1

Congenital Uterine Abnormalities

Answer 1

• The uterus, tubes, and upper vagina develop from the Müllerian ducts in the absence of anti Müllerian hormone.
• This development requires the prior existence of mesonephric ducts that will give rise to the renal system.

Question 2

The fusion of the Müllerian ducts will form

Answer 2

the tubes, uterus, and upper vagina around the tenth week of gestation.

Question 3

Müllerian malformations

Answer 3

Müllerian malformations are frequently associated with abnormalities of the renal and axial skeletal systems, and they are often the first encountered when patients are initially examined for associated conditions.

• recognised after puberty

Question 4

Vulval Cancers.

Answer 4

• The vulva is essentially epithelial skin; therefore the main tumour types that affect the vulva are skin-related cancers.

Question 5

what is the most common vulval cancer

Answer 5

squamous cell carcinomas, which typically develop at the edges of the labia majora/ minora or in the vagina.

Question 6

Squamous hyperplasia –

Answer 6

hyperkeratosis, irregular thickening of ridges. Some neoplastic potential

Question 7

Lichen Sclerosus –

Answer 7

hyperkeratosis, flattening of ridges, oedema in connective tissue with chronic inflammation.
Some neoplastic potential

• Causes pruritis
• Excoriation makes
things worse
• Treated with potent topical corticosteroids

Question 8

• Adenomyosis

Answer 8

– Endometrial glands and stroma within
the myometrium
– Causes menorrhagia / dysmenorrhoea

is a benign disease of the uterus due to the presence of ectopic endometrial glands and stroma, deep within the myometrium with adjacent reactive myometrial hyperplasia. The disease can be diffuse or focal (adenomyoma).

Question 9

• Smooth muscle tumours

Answer 9

• Very common

* Associated with menorrhagia, infertility

Question 10

Leiomyoma

Answer 10

• Benign smooth
muscle tumour
• Very common cause of uterine
enlargement
• May undergo degeneration

Question 11

Endometriosis

Answer 11

• Endometrial glands and stroma outside
the uterine body
• May cause
– Pelvic inflammation
– Infertility
– Pain • Sites
– Ovary (‘chocolate’ cyst)
– Pouch of Douglas
– Peritoneal surfaces, including uterus
– Cervix, vulva, vagina – Bladder, bowel etc

Question 12

Ovarian Cysts

Answer 12

• Ovarian cysts are commonly encountered in gynaecological imaging, and vary widely in aetiology, from physiologic, to complex benign, to neoplastic

Question 13

Polycystic ovary syndrome

Answer 13

• It is a heterogeneous condition whose pathophysiology appears to be multifactorial and polygenic.
• Women may initially present with symptoms of hyperandrogenism (such as hirsutism, acne, alopecia), menstrual disturbance, infertility, or obesity

• The combined oral contraceptive pill may be prescribed to women with PCOS

Question 14

how do you diagnose PCOS

Answer 14

• A transvaginal ultrasound should be considered in the absence of withdrawal bleeds or in the presence of abnormal uterine bleeding.

Question 15

Hydatidiform mole, or molar pregnancy, results from

Answer 15

too much production of the tissue that is supposed to develop into the placenta.
• Trophoblast = the peripheral cells of the BLASTOCYST, which attach the ZYGOTE (fertilized OVUM) to the uterine wall and become the PLACENTA and the membranes that nourish and protect the developing organism.

Question 16

• A complete hydatidiform mole

Answer 16

most often develops when either 1 or 2 sperm cells fertilize an egg cell that contains no nucleus or DNA (an “empty” egg cell). All the genetic material comes from the father’s sperm cell. Therefore, there is no foetal tissue.

Question 17

A partial hydatidiform mole

Answer 17

develops when 2 sperm fertilize a normal egg. These tumours contain some foetal tissue, but this is often mixed in with the trophoblastic tissue. It is important to know that a viable foetus is not being formed.

Question 18

Invasive hydatidiform mole

Answer 18

• An invasive mole is a hydatidiform mole that has grown into the muscle layer of the uterus.

Question 19

The risk of developing an invasive mole in these women increases if

Answer 19

• there is a long time (more than 4 months) between the last menstrual period and treatment.
• the uterus has become very large.
• the woman is older than 40 years.
• the woman has had gestational trophoblastic disease in the past.

Question 20

Choriocarcinoma

Answer 20

• Choriocarcinoma is a malignant form of gestational trophoblastic disease (GTD).

Question 21

Ectopic Pregnancy

Answer 21

• Implantation of a conceptus outside the endometrial cavity.
• Commonest site is Fallopian tube.