tumors of cervix. benign –adenoma –myoma –papilloma and angioma malignant primary –carcinoma...
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Tumors of Cervix
•BENIGN– Adenoma– Myoma– Papilloma and angioma
•MALIGNANTPrimary – Carcinoma– Sarcoma– Mesodermal mixed tumor
Secondary – From any source
Adenoma (Mucous Polyp)Clinical Features
– Asymptomatic– Vaginal discharge– Vaginal bleeding– Mass at the introitus
Differential Diagnosis– Carcinoma of the cervix– Cervical ectopy– Endometrial polyp– Products of conception
and blood clot– Ectropion– Cervical tags
Adenoma (Mucous Polyp)
Treatment– Asymptomatic must be removed and
examined by the histopathologist– Adenoma may be avulsed easily without
anaesthesia– Base of the polyp should be cauterized
to avoid recurrence– Perform curettage
Myomas of Cervix
Arise from body of uterus, rarely from cervixPolypoidalProtrude through cervical canal Types
SubserousIntramuralsubmucous
Myomas of CervixClinical Features
– Prone to trauma– Ulceration– Infection– Vaginal discharge– Irregular vaginal bleeding– Mass at the introitus
TreatmentVagival myomectomy or hysterectomy
Papilloma and Angioma
Clinical features– Small papillomas– Single or multiple associated with
vulva and vaginal papillomas– Angioma forms superficial growth
Treatment– Surgical removal
Pre Malignant Conditions of
Cervix
Cervical Intraepithelial Neoplasia (CIN)
or Dysplasia• Spectrum of disordered growth and
abnormal microscopic changes confined to epithelium
• May be– Mild (CIN I)– Moderate (CIN II) – Severe or carcinoma in situ (CIN III)
• Spontaneous regression of mild and moderate types possible
• Severe dysplasia may be irreversible• May progress into invasive carcinoma
Cervical Intraepithelial Neoplasia (CIN)
or Dysplasia•CIN I (mild)
Involves deeper 3rd of epithelium
•CIN II (moderate)Involves more than half thickness of epithelium
•CIN III (severe)Whole thickness of epithelium shows abnormal changes
Screening
• Screening programme• Cervical smear• Repeated every 3 y up to 60 y
Normal cervix, transition zone
anaplastic cancer cells show marked variation in size, in comparison with neutrophils
Invasive carcinoma of cervix, Pap smear
Treatment
• Cryocautry• Electrocuatry• Surgery
– Conization– LEEP– Hysterectomy
• Follow up
Malignant Tumours of
Cervix
Ca cervix
One of the most common cancers in the worldIncidence:
USA 10/1000000UK 15/1000000
Peak incidence at 35 and 55
Etiology
• Number of partners • Age of first coitus • Grand multi parity• Social status• Race and religion • Circumcision • Smoking• Viruses herpes simplex type 2 / human
papulama virus type 16 & 18• Atypical squamous metaplasia
Pathology
• SQ cell carcinoma 90 %• Adeno 5%• Mixed 5%Gross• Polypoidal • Ulcerative• Infiltrative
Squamous cell carcinoma cervix
Tumour extends to anterior and posterior lips, appears granular and hemorrhagic, cervix surrounding by narrow vaginal cuff
lack of maturation, altered cell polarity, nuclear pleomorphism and increased nuclear / cytoplasmic ratio, confined to the epithelial layer, epithelial basement membrane not invaded, submucosal stroma contains chronic inflammatory cells
Normal epithelium
Squamous cell carcinoma in-situ of cervix
Spread
• Direct • Lymphatic• Blood born
Diagnosis
• History• Asymtpomatic• Irregular vaginal bleeding IMB, PCB,
PMB• Pain• Vaginal discharge• Examination• Normal cervix• Hard cervix• Ulcer• Growth
Carcinoma Cervix
Diagnosis
• Cytology• Schiller test• Colposcopy• Biopsy of cervix
• Punch biopsy• Wedge biopsy• Ring biopsy• Cone biobsy
Treatment
• Assessment• Radiotheraphy• Surgery young, pelvic sepsis, UV
prolapse, fibroid, ovarian tumor, recurrence, pregnancy
• Combined
Case HistoryAge 36, mass at endocervical os which thickens the barrel of the cervix and fixes the cervix to the surrounding soft tissue Pap smear shows
Case Historybiopsy showed invasive nests of abnormal squamous epithelium extending under the surface mucosa, extending all the way through the cervical wall and out into the surrounding paracervical soft tissue
Case HistoryThe patient underwent a hysterectomy. The gross specimen shows thickened area representing the cervix. Tumour has extended through the wall. cervix was fixed to the soft tissues of the paracervical area
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