common gyn disease

8/14/2019 Common Gyn Disease

1/67

Common

gynecologicaldiseases

Wang Jingwen (CathyWang)

Department of Gynecology


2/67

Cervical diseases:

Uterine diseases: Ovarian diseases

Flloping tube disease:Ectopic

pregnancy

Outline


3/67

Learning objectives Learning common terms of Ob &

Gyn

Understanding clinicalappearance of common diseases

Knowing the treatmentprinciples of common diseases


4/67

Normal uterine, cervix, falloping tube, ovary

in

Different age of women


5/67

Here is the gross appearance of

a normal uterus, cervix, vaginal

cuff, fallopian tube, and ovary

young woman

The ovaries are somewhat smaller thanthe left picture but have a similar tan-

white bosselated appearance.

perimenopausal woman


6/67

An older postmenopausal woman. The uterus and

ovaries are smaller and have a fairly smooth tan-white

appearance.

postmenopausal woman


7/67

Here is a normal cervix with a smooth, glistening

mucosal surface. There is a smallrim ofvaginal cuff from thishysterectomy specimen. The cervical os is small and

round, typical for a nulliparous woman.The os will have a fish-mouth shape after one or

more pregnancies.

normal cervix


8/67

Cervical diseases Inflammations

Cervical cancer


9/67

The normal adult

vaginal mucosa with awrinkled appearancethat is seen in women ofreproductive yearsappears at the left.

The cervix has been

opened to reveal anendocervical canalleading to the lower

uterine segmentAn erythematous

appearanceextending to the cervicalos consistent withchronic inflammation.


10/67

The normal cervical squamous epithelium at

the left transforms to dysplastic changes on the

right.


11/67


12/67

This is the gross appearance of a cervical squamous cell

carcinoma that is still limited to the cervix (stage I).


13/67

Here is another cervical squamous cell carcinoma. Note

the IUD string protruding from the cervix.


14/67

At high magnification, nests of neoplastic squamous cells

are invaded through a chronically inflamed stroma. Thiscancer is well-differentiated, as evidenced by keratin pearl.


15/67

Self-assessment

Q:Markedevery organsname,please.


16/67

Self-assessment

Q: Suspecteddiagnosisfurther

examinationhow to manage


17/67

Answers Cervical squamous cell carcinoma

Biopsy and pathological examination Surgery: radical hysterectomy and

pelvic lymphodenectomy


18/67

Endometrial diseases

HyperplasiaAdenocarcinomamyoma


19/67

The endometrial cavity is opened to reveal lush fronds ofhyperplastic endometrium. Endometrial hyperplasia can

lead to metrorrhagia (uterine bleeding at irregular

intervals), menorrhagia (excessive bleeding with menstrual

periods), or menometrorrhagia .

hyperplastic endometrium


20/67

High in the

fundus and

projecting into

the endometrial

cavity is a small

endometrial

polyp.Such benign

polyps may

cause uterine

bleeding.

It can be

treated with

Hysteroscopy .

endometrial polyp


21/67

There is an irregularmass in the upper fundus

that proved to be

endometrial

adenocarcinoma on

biopsy.Such carcinomas are

more likely to occur in

postmenopausal women.

Any postmenopausal

bleeding should make yoususpect that this lesion

may be present.

adenocarcinoma


22/67

In the upper fundus of the

uterus protruding into theendometrial cavity is a nodule

that proved to be aleiomyoma.

a submucosal leiomyoma.

Such benign smooth muscle

tumors of the myometrium are

very common, perhaps 1 in 5

women has one.

They may be the cause of

irregular bleeding if placed

submucosally.

leiomyoma


23/67

Uterine myoma Myomas are the most common uterine

tumors

Benign smooth muscle tumor

(leiomyomata)

Prevalence :20%-40% women Sensitive to ovarian hormones(grow in

pregnancy, regress after menopause)


24/67

Types

Smooth muscle

tumors of theuterus are often

multiple.

Submucosa

Intramural

Subserosal


25/67

"red degeneration".

Such an appearance

might make you think

that it could bemalignant.

Remember that

malignant tumors do not

generally arise frombenign tumors


26/67

symptoms Most myomas do not case any symptoms Enlarge or distort uterine

cavity:Menorrhagia and anaemia Large mass pressure bladder:frequency of

micturition

Infertility pelvic pain Abdominal swelling


27/67

Diagnosis Age

Medical history:mass,

menorrhagia Pelvic examination:enlarge

uterine

B Ultrasound


28/67

Treatment Small myoma, asymptomatic:

following-up

Perimenopausual women:medicaltreatment.

Any large pelvic mass of uncertain

nature requires removal to excludemalignancy and relieve pressuresymptoms: surgery.


29/67

Indications of surgery The size of uterine: more than 10

weeks(pregnancy)

Heavy bleeding results in anaemia

Submucasal, cervical myoma

Infertility

Suspected malignancy


30/67

Surgerys

Myomectomy

preserve fertility or uterus Enucleation of myoma

Remove all myomas as possible as you can

Recurrence soon (if more than 3 mass)


31/67


32/67

Hysterectomy More than 40 year-old

Multiple myomas

With cervical inflammation

Preserve ovarian function

Avoid recurrence


33/67


34/67


35/67

case 31 years old, marriage 2yrs,G0P0

Found abdominal mass 6 months

Felling abdominal swelling

Mass size: look-like 7 months pregnancy

Tumor markers: CA125,CP2 normal B ultrasound: uterine mass, cannot

excluded ovarian tumor.


36/67

Q:

What is the probablydiagnosis?

What treatment can we

suggest?


37/67

Answers Suspected diagnosis: uterine

myomas

ovarian tumor

pregnancy

Laparotomy:


38/67

More than 20 myomas


39/67

Pathological examination: benign leiomyoma.


40/67

Surgery actually is a wonderfulart

--- wang Jianliu


41/67

Fallopian tube diseases

(ectopic pregnancy)


42/67

Fertilization Ovulation releases an egg from an ovarian follicle . The egg is swept into the fallopian tube and begins to

descend.

Spermatozoa (millions are represented here by one)begin ascending.

Fertilization of the egg by a single sperm occurs inthe ampullary portion of the fallopian tube

about a day after ovulation. The fertilized egg begins to develop into the blastocyt on descent into the endometrial cavity, whereimplantation occurs on the wall of the fundus about aweek after ovulation


43/67

.


44/67

This is a second trimester 3fetus and uterus


45/67

Here is the sizeof the uterus in

the thirdtrimester 3 .Note how itdisplaces thebowelsuperiorly andfills the lowerabdomen.

Thisunfortunate

woman diedaccidentally,and the babydied too.


46/67

This is a normal postpartum uterus 5 daysfollowing delivery. Note how quickly the uterus is

returning to its normal non-pregnant size.


47/67

Ectopic pregnancy Ectopic pregnancies occur when the fertilized

ovum implants outside of theuterine fundus. About 1 in 150 pregnancies results in ectopic.

Most cannot be sustained at extrauterine

sites.

A tubal ectopic pregnancy may proceed forseveral weeks.

The enlargement can rupture and lead to

acute, life-threatening bleeding.


48/67

Half of ectopic pregnancies occur because of an

identifiable lesion

chronic salpingitis frompelvic inflammatorydisease

adhesions from appendicitis, endometriosis

, or previous laparotomy .

However, in half of cases no cause can be found.


49/67


50/67

This is a ruptured tubal ectopic pregnancy. Note the twin

fetuses at the lower right adjacent to the blood clot at the

left.

twin


51/67

Here is another ectopic pregnancy in a fallopian tube.

This is a medical emergency because of the sudden rupture with

hemoperitoneum .Ectopic pregnancy should be considered in the differential diagnosis of

acute abdominal pain in a woman ofchildbearing age.


52/67

Self-assessmentRegarding ectopic pregnancy: A it can always be detected by laparoscopy

B it may co-exist with an intra-uterine device insitu

C It cannot survive beyond 16 wks

D it is declining in frequency E the IUD confers protection against ectopic

pregnancy.


53/67

Answers A.False. Laparoscopy occasionally fails

to detect a very early ectopic

pregnancy. B. true.it is extremely rare.

C. False. Peritoneal cavity pregnancymay survive to term .

D. False. Incidence is increasing.

E. False. IUD does not confer protectionagainst ectopic pregnancy.


54/67

Ovarian tumorTumor-like conditions

Benign tumor

Cancer


55/67

This is an adult ovary with two corpora lutea .The larger one is a hemorrhagic corpus luteum ofmenstruation.The smaller one is involuting from a previous menstrual period.Of 400,000 ovarian follicles present at birth, only about 400 will mature

to the point of ovulation during childbearing.


56/67

A benign paratubal cyst.

They are filled with clear serous fluid and lined byflattened cuboidal epithelium.


57/67

Benign epithelial tumors of the ovary.

The serous cystadenoma seen here fills a

surgical pan and dwarfs the 4 cmruler.


58/67

A ovarian papillary cystadenocarcinoma, with

papillations seen over the surface.Many of these ovarian tumors have metastasized.

These neoplasms characteristically spread by "seeding"

along peritoneal surfaces.


59/67

Here are bilateral fibrothecomas--benign ovarian

tumors.A right-sided hydrothorax in association with

this tumor is known as Meig's


60/67

Here is an ovarian stromal tumor that is

hard and white and is a fibroma


61/67

Benign serous cystadenoma

Multiloculation . the inner surface is, smooth, with only asolitary papillation at the upper right.


62/67

A papillary serous cystadenocarcinoma.

Many papillations on the inner surface.


63/67

A granulosa cell tumor of ovary.These tumors are derived from the ovarian stroma.

They are often hormonally active

The patient may initially present with bleeding from

endometrial hyperplasia .


64/67

A large unilateral mature cystic teratoma

The uterus has an intramural and a subserosal

leiomyoma.

The other ovary is replaced by a fibroma.


65/67

Metastatic tumors to ovary are uncommon. "Krukenberg" tumor of ovary: a signet ring histologic

pattern and usually is metastatic from gastrointestinal tract.


66/67

Self-assessment

Q: probably diagnosis?


67/67

Self-assessment

Q: describe each partsgive your suspected diagnosis

common gyn disease

Documents