Female Genital Tract

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Female Genital Tract

• 1-Vulva
• 2-Vagina
• 3-Cervix
• 4-Uterine corpus
• 5-Ovary
• 6-Placenta

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Vulva
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Vulva

• 1-Vulvitis
• 2-Non-neoplastic epithelial disorders
• 3-Tumor

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Vulvar Leukoplakia

• Causes of vulvar leukoplakia
• 1-Vitiligo (loss of pigment)
• 2-Inflammatory dermatosis e.g. psoriasis
• 3-Squamous intraepithelial neoplasms of the vulva
  (VIN) and invasive carcinoma
• 4-Pagets disease

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3-Vulvar Tumors

• 1-Condyloma
• 2-Intaepithelial V. Neoplasia
• 3--Vulvar carcinoma
• 4-Extramammary Pagets disease
• 5-Melanoma

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Vulvar Intraepithelial Neoplasia (VIN)

• VIN I mild dysplasia, lower third.
• VIN II moderate dysplasia, lower two thirds.
• VIN III (CIS) Severe dysplasia, full thickness.

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Vulvar Carcinoma

• Stromal invasion.
• 1-3 of all female genital cancers, gt 60 years of
  age.
• 2-Increasing Incidence of VIN (40-60 y).
• 3-90 of malignancies are squamous cell
  carcinomas, 10 adenocarcinomas, basal cell
  carcinomas, and melanomas.

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Vulvar Carcinoma

• Initially a leukoplakia-type lesion, progresses
  to overt exophytic (elevated) or endophytic
  (ulcerated) lesion.
• Management and prognosis depend on size of tumor,
  depth of invasion, lymphatic involvement , and
  presence of metastasis.
• STAGE
• 5 year survival
• Stage I (tumor lt 2 cm) 60-80
• Larger tumor with metastasis 10

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Vulvar Carcinoma

• Surgery treatment of choice for early stage
  lesions
• Local excision, radical vulvectomy, groin/pelvic
  LN dissection
• Radiotherapy stage III and IV tumors
• Chemotherapy Metastatic disease (low response
  rate)

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Vaginal Intraepithelial Neoplasia (VAIN) and
Carcinoma

• Uncommon, VAIN are graded I, II, and III (VIN)
• Elderly females (gt60 y)
• Preexisting or concurrent cervical or vulvar
  Neoplasia or carcinoma is sometimes present.

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Endocervical polyp

• Inflammatory polypoid masses.
• Smooth surface composed of columnar
  mucus-secreting cells (endocervical epithelium)
  with underlying cystically dilated glands filled
  with mucus. Stromal edema inflammatory
  mononuclear cells.
• Squamous metaplasia and ulceration.

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Cervical Intraepithelial Neoplasia (CIN) and
Carcinoma

• Importance of early detection, adequate follow up
  and management.
• Histologic grading of precursor lesions
• CIN I Mild dysplasia
• CIN II Moderate dysplasia
• CIN III Severe dysplasia/carcinoma in situ

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Cervical Intraepithelial Neoplasia (CIN) and
Carcinoma

• Cytologic grading of precursor lesions
• 1) LOW GRADE SQUAMOUS INTRAEPITHELIAL LESIONS
• CIN I and Condylomas (koilocytosis)
• 2) HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESIONS
• CIN II, CIN III/CIS

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Cervical Intraepithelial Neoplasia (CIN) and
Carcinoma

• Peak incidence
• CIN 30 Y
• Invasive carcinoma 45 y
• Risk factors
• 1-Early age at first intercourse
• 2-Multiple sexual partners
• 3-A male partner with multiple previous sexual
  partners

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Invasive Carcinoma of the Cervix

• 80-95 Squamous cell carcinomas
• Multifactorial disease
• Preventable
• Gross (macroscopic appearance)
• Fungating (exophytic)
• Ulcerative (endophytic)
• Infiltrative