Diseases of the Female Reproductive System

Diseases of the Female Reproductive System

Female sex organs develop from the same primitive structures as male sex organs. The ovary evolves from the embryonic urogenital ridge, and the Wolffian (mesonephric) duct remains vestigial without male stimulation. Paramesonephric ducts (müllerian ducts) form the anlage of the fallopian tubes, uterus, and vagina. External genitalia are essentially female in design and develop male features only when stimulated by dihydrotestosterone.

Common diseases of the female reproductive system are discussed in the following chapter according to their anatomical sites. They comprise congenital alterations, inflammation, and infections (Table 8-1); benign and malignant tumors; and pregnancy-related disorders.



Conditions Causes
Dermatoses of the vulva  
  Folliculitis and furunculosis Staphylococcus aureus, mixed organisms
  Herpes genitalis (progenitalis) Herpes simplex virus type 2
  Intertrigo Chafing plus dermatophytosis (fungal infection)
  Tinea cruris Ringworm of the groin, usually Epidermophyton floccosum
  Molluscum contagiosum Poxvirus
  Psoriasis Systemic noninfectious inflammatory disorder
Infections and other lesions of the vulva, vagina, and cervix  
  Diabetic vulvitis Mycotic (fungal) infection
  Gonorrhea Neisseria gonorrhoeae
  Syphilis Treponema pallidum
  Chancroid Haemophilus ducreyi
  Lymphogranuloma venereum Chlamydia trachomatis types L1, L2, L3
  Granuloma inguinale Calymmatobacterium granulomatis (originally Donovania species)
  Bartholin gland cyst and abscess Neisseria gonorrhoeae, other pathogenic bacteria
  Common vulvovaginitis, urethritis, and cervicovaginitis Candida albicans (moniliasis), Chlamydia trachomatis (serotypes D-K), Trichomonas vaginalis, other organisms, including gram-positive and -negative bacteria (nonspecific vaginitis)
  Genital (venereal) warts (condylomata acuminata) Human papillomaviruses, especially types 6, 11, 42, and 44 (low risk for cervical cancer)
  Tuberculosis Mycobacterium tuberculosis
  Chemical vaginitis Douches (high-concentration chemicals)
  Traumatic vaginitis Foreign bodies, pessaries
Pelvic inflammatory disease  
  Vulvitis, cervicitis, endometritis, salpingitis, oophoritis Neisseria gonorrhoeae, Chlamydia trachomatis, polymicrobial puerperal infections—staphylococci, streptococci, coliform bacteria, Clostridium perfringens
Puerperal infections  
  Endometritis, vaginitis, sepsis Streptococcus species, Staphylococcus species, gram-negative bacteria

Diseases of the Uterus

The uterus is subdivided for diagnostic and therapeutic reasons into the uterine cervix, the endometrium, and the myometrium. Common diseases include functional disturbances, inflammation, and neoplasia. Cervicitis, which often results from sexually transmitted disease (STD), is common, whereas endometritis is rather rare. STDs include infections by papilloma virus, herpes simplex virus type II, syphilis, and gonorrhea (also see chapter 7). Chlamydia species cause infections of the female reproductive system with increasing frequency.

Cervical intraepithelial neoplasia (CIN) is a common atypical proliferation of squamous epithelium, frequently related to infection with certain papilloma viruses (human papillomaviruses [HPVs] 16 and 18), which carries the risk of progressing to SCC. Early diagnosis of CIN by exfoliative cytology (PAP smear) followed by appropriate treatment has helped to decrease the annual incidence of SCC by 50% to 85%.

Squamous cell carcinoma of the cervix is the second or sixth most common tumor of females (depending on the efficiency of cervical cytologic screening). There are 15 new cases annually per 100,000 women in the United States. The chief clinical feature of SCC is vaginal bleeding after intercourse or douching; it may be silent in sexually inactive women. The 5-year survival after treatment is stage-dependent and ranges from 90% in patients diagnosed in International Federation of Gynecology and Obstetrics (FIGO) stage I to 10% in those diagnosed in stage IV.

Endometrial hyperplasia and endometrial adenocarcinoma (EAC) represent a continuum of proliferative diseases (hyperplasias) that start as a benign disturbance and proceed stepwise to malignancy. Atypical hyperplasia with complex glandular crowding and cytologic atypia signals the transition to carcinoma. Afflicting approximately 34,000 women per year in the United States, EAC is the fourth most frequent cancer in women. The incidence decreased recently when the administration of menopausal estrogens was reduced, suggesting that prolonged estrogenic stimulation may support its pathogenesis. The essential clinical feature of EAC is perimenopausal or postmenopausal bleeding. The prognosis for patients with EAC depends on the tumor stage and additional risk factors; the 10-year survival rate is approximately 65%.

Diseases of the Ovary

Besides various endocrinopathies, ovarian tumors are the most important diseases in this region. There are more than 25 types of ovarian tumors and many subtypes. They are classified into major groups: tumors of the germinal epithelium (e.g., serous and mucinous cystadenoma/carcinoma), tumors of the germ cell (dysgerminoma, teratoma, choriocarcinoma), tumors of the gonadal stroma (granulosa cell tumor, Sertoli-Leydig cell tumor, thecoma), and benign hilus cell tumors (composed of Leydig cells). The most common, serous cyst-adenocarcinoma (SAC), occurs in approximately 1% of women, favoring older women. SAC does not secrete hormones and usually causes symptoms of pain and abdominal distention only as it increases in size. It spreads readily by lymphatic channels and peritoneal dissemination. The prognosis is poor, with an overall 5-year survival of 35%.

Pathology of the Mammary Gland

The female breast, like the endometrium and the cervical-vaginal epithelium, responds sensitively and with varying histology to alterations in female sex hormones during adolescence, the menstrual cycle, pregnancy, and menopause. Knowledge of the normal histologic reaction patterns in the breast gland is essential for the interpretation of pathologic changes. The most frequent disorders today are various forms of hyperplasia (fibrocystic disease) and mammary carcinoma (MCa). MCa is the most frequent tumor in females of the Western world, with a lifetime incidence of approximately 1 woman in 9. Approximately one third of patients die of the disease.

Genetic factors play a significant role in breast cancer, and its risk is significantly increased among first-degree relatives of affected individuals. Several genes, including BRCA1 and 2, have been implicated. In addition, there are obvious hormonal and environmental influences on the pathogenesis of MCa. Because the initial growth of the tumor usually remains clinically inapparent or is camouflaged by preexistent fibrocystic disease, regular breast examination is essential for early diagnosis and survival.

Figure 8-1 Dermatoses
The skin of the vulva can be involved by the same spectrum of dermatoses that affect the skin of the rest of the body. Some common dermatoses are shown here, and the causes are listed in Table 8-1. Folliculitis is a papular or pustular inflammation involving the apertures of the hair follicles, and furuncles are larger and more deeply seated lesions with a central core of purulent exudate. Herpes genitalis or progenitalis is a recurring, localized condition, beginning as groups of vesicles on an edematous, erythematous base and subsequently forming small ulcers that dry, crust, and heal. Intertrigo and tinea cruris are superficial dermatoses associated with fungal infection. Vulvar lesions of psoriasis, a systemic noninfectious inflammatory disorder, are typically pruritic, red, and covered with silvery-white scales. The presence of similar lesions on the scalp and extensor surfaces of the extremities and nail changes help to establish the diagnosis.

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Jun 28, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Diseases of the Female Reproductive System

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