Salale University

Pathophysiology Of Female Reproductive

Tract disorders for medical students

By Getnet D/MD/
 Out line

• Gestational and Placental Disorders

• Ectopic Pregnancy

• Hypertensive disorders of px
• Gestational trophoblastic disease
• Breast disorders
Gestational and Placental Disorders

• Diseases of pregnancy and pathologic conditions

of the placenta are important causes of fetal

intrauterine or perinatal death, congenital

malformations, intrauterine growth restriction,

maternal death, and morbidity for both the mother

and child.
 Gesta and placental dis….

 Understanding placental disorders requires a

working knowledge of normal placental anatomy.

 The placenta is composed of chorionic villi that

sprout from the chorion to provide a large

contact area between the fetal and maternal

circulations.
 Ectopic Pregnancy

 Ectopic pregnancy refers to implantation of the fetus in a

site other than the normal intrauterine location includes:

 fallopian tube (approximately 90% of cases).

 ovary, cornual

 abdominal cavity,

 Ectopic pregnancies account for 2% of confirmed

pregnancies.

 predisposing condition,

 prior pelvic inflammatory , previous hx, ART

Epx
 Tubal pregnancy is the most common
cause of hematosalpinx (blood-filled
fallopian tube) and should always be
suspected when a tubal hematoma is
present.
 DISORDERS OF EARLY PREGNANCY

Abortion

Spontaneous vs induced

Clinical classifications of Abx

 Spontaneous abortion, or “miscarriage,” is defined as

pregnancy loss before 20 weeks of gestation.

 Most of these occur before 12 weeks.

 Ten to fifteen percent of clinically recognized

pregnancies terminate in spontaneous abortion.

Hypertensive disorders of pregnancy

Preeclampsia and Eclampsia

 Preeclampsia is a systemic syndrome characterized by

widespread maternal endothelial dysfunction that

presents during pregnancy with hypertension, edema,

and proteinuria.

 It occurs in about 3% to 5% of pregnant women,

usually in the last trimester and more commonly in

women pregnant for the first time (primiparas).

Pathogenesis

 The placenta plays a central role in the

pathogenesis of preeclampsia, as symptoms

disappear rapidly after delivery of the placenta.

 The critical abnormalities in preeclampsia are

diffuse endothelial dysfunction, vasoconstriction

(leading to hypertension), and increased vascular

permeability (resulting in proteinuria and edema).

 Patho….

 The precipitating events in preeclampsia are abnormal

trophoblastic implantation and a failure of physiologic
remodeling of the maternal vessels, which is required for
adequate perfusion of the placenta.
 At the implantation site of a normal pregnancy, fetal
extravillous trophoblasts (cells not associated with chorionic
villi) invade the maternal decidua and decidual vessels,
destroy the vascular smooth muscle, and replace the
maternal endothelial cells with fetal trophoblastic cells,
forming hybrid fetomaternal blood vessels.
GESTATIONAL TROPHOBLASTIC DISEASE

 Gestational trophoblastic disease encompasses

a spectrum of tumors and tumor like conditions
characterized by proliferation of placental
tissue, either villous or trophoblastic includes:
 hydatidiform mole (complete and partial),
invasive mole,
 choriocarcinoma, and placental site
trophoblastic tumor (PSTT).
 Hydatidiform Mole
• Hydatidiform moles are important to recognize because

they are associated with an increased risk of persistent

trophoblastic disease (invasive mole) or choriocarcinoma.

• Moles are characterized histologically by cystic swelling of

the chorionic villi and variable trophoblastic proliferation.

• Molar pregnancy can develop at any age, but the risk is

higher at the two ends of reproductive life, in teenagers

and between 40 and 50 years of age.

Complete Mole
• Complete mole results from fertilization of an
egg that has lost its female chromosomes, and
as a result the genetic material is completely
paternally derived .
• Ninety percent have a 46,XX karyotype
stemming from the duplication of the genetic
material of one sperm (a phenomenon called
androgenesis).
Partial Mole
• Partial moles result from fertilization of an egg
with two sperm .
• In these moles, the karyotype is triploid (e.g.,
69,XXY) or occasionally tetraploid (92,XXXY).
Fetal tissues are typically present.
• Partial moles have an increased risk of persistent
molar disease but are not associated with
choriocarcinoma
Invasive Mole

• Invasive mole is an infiltrative lesion that

penetrates or even perforates the uterine wall.
• There is invasion of the myometrium by
hydropic chorionic villi, accompanied by
proliferation of both cytotrophoblasts and
syncytiotrophoblasts.
Choriocarcinoma

 Gestational choriocarcinoma is a malignant

neoplasm of trophoblastic cells derived from a
previously normal or abnormal pregnancy, such
as an extrauterine ectopic pregnancy.
 Gestational choriocarcinoma is an uncommon
condition that arises in 1 in 20,000 to 30,000
pregnancies in the
Breast disorders
• The breast is distinguished from other organs by three

important characteristics.

 provide for the nutritional support and survival of

another individual, the infant.

 dynamic structural changes throughout life: expansion

of the lobular system after menarche;

 symbols of femininity, breasts have social, cultural, and

personal importance that is unique from other organs

Acute Mastitis
• Acute bacterial mastitis typically occurs during the
first month of breastfeeding and is caused by a local
infection when the breast is most vulnerable due to
cracks and fissures in the nipples.
• From this portal of entry, Staphylococcus aureus or,
less commonly, streptococci invade the breast tissue.
• The breast is erythematous and painful, and fever is
often present.
Squamous Metaplasia of Lactiferous Ducts
• Squamous metaplasia of lactiferous ducts is
known by a variety of names, including
recurrent subareolar abscess, periductal
mastitis, and Zuska disease.
• Women, and sometimes men, present with
a painful erythematous subareolar mass
that mimics a bacterial abscess
Duct Ectasia
• Duct ectasia presents as a palpable
periareolar mass that is often associated
with thick, white nipple secretions and
occasionally with skin retraction.
• Pain and erythema are uncommon.
Fat Necrosis

• The presentations of fat necrosis are protean

and may closely mimic cancer.
• It may present as a painless palpable mass,
skin thickening or retraction, or
mammographic densities or calcifications.
• About half of affected women have a history of
breast trauma or surgery
 Lymphocytic Mastopathy (Sclerosing Lymphocytic Lobulitis

 This condition presents with single or multiple hard

palpable masses or mammographic densities.

 The masses are associated with areas of densely

collagenized stroma, a feature that may make it difficult

to obtain lesional tissue by needle biopsy.

 This condition is most common in women with type 1

(diabetes or autoimmune thyroid disease and is

hypothesized to have an autoimmune basis.

Granulomatous Mastitis

• Granulomatous inflammation of the breast

may be a manifestation of systemic
granulomatous diseases (e.g., granulomatosis
with polyangiitis, sarcoidosis, tuberculosis) or
of inflammatory or infectious disorders that
are localized to the breast.
Gynecomastia
• Gynecomastia (enlargement of the male breast) is the

only benign lesion seen with any frequency in the

male breast.

• It presents as a button-like subareolar enlargement

and may be unilateral or bilateral.

• Microscopically, there is an increase in dense

collagenous connective tissue associated with

epithelial hyperplasia .
CARCINOMA OF THE BREAST
• Breast carcinoma is the most common and deadly

malignancy of women globally; each year, 1.7 million

women are diagnosed, and one in three of those afflicted

die of disease.

• Although the incidence of breast cancer is four to seven

times higher in the United States and Europe than

elsewhere, the worldwide incidence and mortality is

increasing at an alarming rate, and by 2020 it is estimated

that 70% of cases will be in lower income countries.

Breast…

• The factors underlying this trend are thought to

be social changes that increase breast cancer risk
—specifically
 delayed childbearing,

 fewer pregnancies, and reduced breastfeeding—

 combined with a lack of access to optimal health

care
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Thank you