Chapter 13 Female Genital System and Breast
Female Genital Tract – Anatomy and Physiology
The following diagrams summarise normal anatomy and physiology:
Cyclical Endometrial Changes
Diseases of the Endometrium
Endometriosis
This consists of deposits of endometrium outside the uterine cavity.
In most cases, the disease is confined to the pelvis and the genital tract.
Other sites: Caecum and appendix, bladder, rectum, umbilicus laparotomy scar.
Endometrial Hyperplasia
Endometrial hyperplasia occurs in 3 forms: Simple hyperplasia, complex hyperplasia and atypical hyperplasia. Of these, atypical hyperplasia is most important as it is associated with an increased risk of malignancy. Progressive molecular genetic alterations occur on the pathway to cancer.
Endometrial Carcinoma
This common gynaecological cancer particularly affects postmenopausal patients, who typically present with vaginal bleeding.
Carcinoma
This growth may form a localised plaque or polyp.
Most growths are well-differentiated adenocarcinomas (endometrioid). These are graded from I – III
The endometrium possesses no lymphatics and invasion of the myometrium takes place slowly.
Local extension: this may take place in several directions.
Metastases
Diseases of the Myometrium
Tumours of the myometrium are extremely common.
Leiomyoma (Fibroid)
This is a circumscribed growth derived from uterine muscle.
The cells are typical long spindle muscle cells, arranged in interlacing bundles
They vary in size from tiny (mm) growths to several cm in diameter and are frequently multiple.
Fibroids may be found in any part of the uterus.
Diseases of the Cervix
The cervix constitutes the lower one third of the uterine body.
It is in two parts: endocervical and ectocervical with different lining epithelium.
Cervical Intraepithelial Neoplasia (CIN)
The Transformation Zone
From puberty onwards and particularly in pregnancy the squamo-columnar junction presents on the vaginal surface of the external os. This is the area where squamous metaplasia occurs. It is important because cervical squamous carcinoma and its precursor cervical intraepithelial neoplasia (CIN) begin there. Within this metaplastic epithelium, dysplastic changes may develop. They are graded as CIN I, II and III. Later, in some cases, invasive squamous carcinoma develops.
Carcinoma of Cervix
Carcinoma
This is the most common malignant tumour of the female genital tract, even where there is a vigorous screening campaign for early diagnosis and eradication of dysplasia. The tumour is a squamous carcinoma in 90% of cases, and an adenocarcinoma in 10%. Most squamous carcinomas arise at the squamo-columnar junction: most adenocarcinomas arise within the endocervical canal.
The cervix becomes indurated with necrosis and ulceration
Later, a large fungating mass is produced