5. CERVICAL INTRAEPITHELIAL
NEOPLASIA (CIN)
CIN I : Less than one third involvement of the
thickness of lower 1/3 rd of epidermis
CIN 2: one third to two third involvement.
CIN 3: full thickness involvement ( carcinoma in
situ)
7. RISK FACTORS
Early onset of sexual activity
Multiple sexual partners
Women with HPV infection : 16, 18, 31, 33, 35
High risk male sexual partner
Multiparous women
Use of OCP
Cigarette smoking
HIV infection
8. PAP SCREENING:
◦ Annual cervical pap smear in all sexually active women
having any high risk factors.
◦ if negative in 3 consecutive smears, then the frequency
of PAP screening is reduced.
16. Endometrial hyperplasia
Characterized by increased proliferation of endometrial
glands relative to stroma resulting in an increased gland to
stroma ratio when compared with normal proliferative
endometrium
18. Classification of endometrial
hyperplasia
Simple hyperplasia (cystic hyperplasia)
◦ presence of glands of various sizes and irregular shape
with cystic dilatation
◦ mild increase in gland to stroma ratio
19. Complex hyperplasia(adenomatous hyperplasia)
◦ increase in no. of endometrial glands with variation in
size & shape
◦ marked glandular crowding (back to back glands)
◦ epithelial glands remain cytologically normal (no loss of
basal polarity no atypia)
◦ stroma is dense cellular & compact
20. Atypical hyperplasia
◦ Presence of atypical cells in the hyperplastic epithelium
◦ Extent of cytological atypia might be mild, moderate or severe.
• Glandular crowding with eosinophilic cytoplasm and nuclear
enlargement ,loss of polarity and prominent nucleoli.
• Stroma diminished,but remains present
◦ It is a precancerous condition.
21.
22. Tumours of endometrium
Endometrial carcinoma
Most common invasive cancer of FGT
Clinical features is abnormal bleeding
1. Type 1
2. Type 2
23. TYPE 1 ENDOMETRIAL
CARCINOMA
◦ Most common type (reproductive age group)
◦ Referred as endometrioid carcinoma
◦ Associated with
obesity,
diabetes,
hypertension &
unopposed estrogen stimulation
ASSOCIATED WITH ENDOMETRIAL HYPERPLASIA
24. TYPE 1 ENDOMETRIAL
CARCINOMA
◦ Gross: 2 patterns –
localized polypoidal tumour
diffuse tumour
◦ Extension of growth into
myometrium by direct invasion,
periuterine structures by direct continuity,
lymphatic metastasis,
haematogenous metastasis
25. TYPE 1 ENDOMETRIAL
CARCINOMA
◦ M/E:
most endometrial carcinomas are endometrioid
adenocarcinomas
Depending on the pattern of glands & cell changes they
are
well differentiated,
moderately differentiated or
poorly differentiated
26. TYPE 2 ENDOMETRIAL
CARCINOMA
◦ Arise in atrophied endrometrium
◦ Age group 65-75 yrs (post-menopausal age group)
◦ Poorly differentiated tumours
◦ Aggressive tumours
31. LEIOMYOMA
Gross :
round, well circumscribed, well encapsulated, firm, homogenous grey
white masses of variable sizes showing whorled appearance.
M/E:
•smooth muscle cells arranged in fascicles and bundles admixed with
fibrous tissue.
•individual smooth muscle cells are uniform in size & shape with
abundant cytoplasm & central oval nucleus.
35. Leiomyosarcoma
Uncommon malignant neoplasm of myometrium
C/F :
uterine enlargement, abnormal uterine bleeding
Gross:
bulky fleshy mass that invade the uterine wall or polypoid mass projecting into
lumen
M/E:
whorled arrangement of spindle cells with large hyperchromatic nuclei(nuclear
atypia),
No. of mitosis per HPF(mitotic index) = 10 or more
40. Adenomyosis
Gross : uterus enlarged
C/S: areas of hemorrhage
M/E:
◦ irregular nests of endometrial stroma & glands arranged within
myometrium
◦ separated from basal endometrium by 2-3mm
41.
42. Endometriosis
Presence of endometrial glands & stroma outside the uterus
Site:
Ovary
uterine ligaments
rectovaginal septum
cul-de –sac
pelvic peritoneum
mucosa of cervix, vagina fallopian tubes
large& small bowel & appendix
45. Two theories of development of endometriosis
Metastatic theory: retrograde menstruation through fallopian tube
Metaplastic theory: metaplasia of coelomic epithelium
46. Gross: foci of endometriosis appear blue or brownish black in the sites
mentioned
When disease is extensive organizing hemorrhages causes extensive
fibrous adhesions
Ovaries show numerous cysts filled with dark brown blood called as
chocolate cysts
47. Microscopy:
Presence of endometrial glands & stroma, areas of hemorrhage,
haemosiderin laden macrophages, surrounding zone of inflammation &
fibrosis
48.
49. ENDOCERVICAL POLYP
◦ Benign exophytic growths
◦ Gross appearance: Small or sessile or may protrude
throught the external os.
◦ Microscopic appearance:
Soft , mucoid lesions composed of loose
fibromyxomatous stroma ,
mucus secreting endocervical glands and
variable dergee of inflammatory infitrate.