18 Tumours of Female

Reproductive System I
TLO

1. Discuss the aetiology, pathogenesis, diagnosis, and morphology of

cancer cervix.

2. Discuss the aetiology, pathogenesis, diagnosis, and morphology of

tumours of endometrium (polyps and carcinoma) and myometrium
(leiomyoma and leiomyosarcoma)
Tumours of the cervix
Classification of the cervical tumours

Epithelial Metastatic tumour

•Squamous cell tumors and Mixed Epithelial-mesenchymal

Germ cell tumour
precursors tumour
•Glandular tumors and Carcinosarcoma
precursors
Lymphoma
Mesenchymal
Benign
Example : Leiomyoma
Malignant Melanocytic
Example : tumourd
Leiomyosarcoma
Cervix – Squamous cell tumours
• Benign squamous cell lesion
• Condyloma acuminatum
• Squamous papilloma

• Squamous intraepithelial lesions

• Low-grade squamous intraepithelial lesion
• High-grade squamous intraepithelial lesion

• Squamous cell carcinoma

Condyloma acuminatum
• HPV 6 and 11
• HPV-6 and HPV-11 are
categorized as low-risk HPVs,
meaning that the risk for cervical
cancer from these viruses is
lower compared to other high-
risk HPVs (such as HPV-16 or 18)
• Microscopic: Papillomatosis,
hyperkeratosis, acanthosis,
koilocytes
Cervix – Squamous cell tumours
aetiopathogenesis
1. Squamous neoplasia of the cervix is associated with sexual activity;
a. Early age of first intercourse,
b. Frequency of intercourse
c. Number of sexual partners

2. Cigarette smoking- carcinogenic

3. Human papilloma virus (HPV)

4. Cervical intraepithelial neoplasia (Squamous intraepithelial lesions)

• Low-grade squamous intraepithelial lesion
• High-grade squamous intraepithelial lesion
HPV 16 and 18
Cervix – Squamous cell tumours
aetiopathogenesis
4. Cervical
intraepithelial neoplasia
(Squamous
intraepithelial lesions)
• Low-grade
squamous
intraepithelial
lesion (CIN1)
• High-grade
squamous
intraepithelial
lesion (CIN2 and
CIN3)
Squamous cell carcinoma of
cervix

• 90% of cervical cancer

• Arise at squamocolumnar junction
• Grading:
1. Well differentiated – abundant
keratin pearl
2. Moderately differentiated-non
keratinizing
3. Poorly differentiated
Spread

1. Extend to the vagina

2. Lateral extension

3. Anterior and posterior extension

4. Lymphatic spread (paracervical, obturator, external iliac, common

iliac or Sacral internal iliac ,common iliac )
STAGING OF SQUAMOUS
CELL CARCINOMA OF CERVIX
SCC OF CERVIX – CLINICAL FEATURES

1. Vaginal bleeding after intercourse, between periods or after

menopause

2. Watery, bloody vaginal discharge that may be heavy and have a foul
odor

3. Pelvic pain or pain during intercourse

Treatment
1. Surgery
2. Radiation therapy
3. Chemotherapy
4. Targeted therapy
5. Immunotherapy
Glandular tumors and precursors of the cervix

• Benign
1. Endocervical polyp
2. Endometriosis

• Adenocarcinoma in situ

• Adenocarcinoma

• Neuroendocrine tumors

• Undifferentiated carcinoma
Classification of the tumours of the uterus

Epithelial Metastatic tumour

•Benign – Endometrial Mixed Epithelial-mesenchymal

MISC tumour
polyp tumour
•Precursor – Endometrial Carcinosarcoma
hyperlasia
•Malignant - Endometrial Lymphoma
Mesenchymal
adenocarcinoma
Benign
Example : Leiomyoma
Malignant Gestational
Example : trophoblastic
Leiomyosarcoma Disease
Endometrial polyps
• Common in perimenopausal and
postmenopausal
• Single or multiple
• Pathogenesis is due to
inappropriate reaction of a focus
of endometrium to estrogen
• Microscopic : variably sized
gland with endometrial stroma
and thick walled blood vessels
Endometrial adenocarcinoma
Aetiopathogenesis
1. Oestrogenic stimulation
a. Endogenous overproduction-PCOS, oestrogen secreting ovarian
tumours
b. Exogenous estrogen therapy
c. Obesity
2. Atypical endometrial hyperplasia
3. Atrophic endometrium – post menopausal
Endometrial hyperplasia
• Hyperplasia due to unopposed estrogen stimulation
• Types
1. Simple hyperplasia
2. Complex hyperplasia
3. Atypical hyperplasia
Type 1 : Endometrioid adenocarcinoma Type 2 : Serous adenocarcinoma
(FIGO Grading 1,2,3) (grade 3)
Spread
Local extension Metastasis
1. Along the fallopian tube 1. Lymphatics
2. Cervix and vaginal spread 2. Blood vessels
3. Penetration of the uterine wall 3. Via fallopian tube to the
into the parametrium ovaries and peritoneal cavity
4. Anteriorly invade the urinary 4. Distant metastasis to the liver,
bladder lung and bones
Mesenchymal uterine tumours-
Smooth muscle tumours
Range from benign (leiomyoma) to malignant (leiomyosarcoma)
Clinical features
• Abdominal mass • Obstetric complications
• Abnormal uterine bleeding • Pregnancy related
• Infertility 1. Myoma growth
• Urinary problems due to 2. Red degeneration
pressure on the urinary bladder 3. Pain
• Pelvic mass 4. Spontaneous abortion
• Pelvic pain
Diagnostic differentiating features
Leiomyoma
• Most common benign tumour of
the uterine corpus
• Arise from uterine smooth muscle
• Small to large
• Can be multiple
• Based on site
1. Submucosal -polyp
2. Intramural
3. Sub serosal -polyp
Leiomyoma
• Microscopy
 Leiomyosarcoma

• Large tumour
• Necrosis
• Haemorrhage
• Degeneration
 Leiomyosarcoma

Pleomorphic cell with tumour giant cells

Thank you