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SITUATIONAL ANALYSIS

PATHOLOGY OF THE FEMALE


GENITAL TRACT

by

Mary Ann O. Cabrera, M.D.


Emmanuel R. de la Fuente, M.D.
Rosella L. Montano, M.D.
Objectives :
4. Recognize the non-neoplastic and
neoplastic disorders of the female genital
tract
5. Correlate the morphologic lesions with the
clinical signs and symptoms of the disease
6. Discuss the etiopathogenesis of the disease
Situation 1

A 45 y/o female consults a physician because of


post-coital bleeding. On physical examination her
cervix shows a cauliflower-like mass on the right
side. Pelvic examination reveals a normal sized
uterus. There are no adnexal masses.
Shown below are 2 pictures of the cervix.

A B

1. Which among the two best describes the patients’ cervix?


2. What is the nature of the mass based on its gross appearance?
LPO HPO

Briefly describe the histologic appearance of the lesion and give the
final diagnosis.
1. Discuss the risk factors in the
development of this lesion
2. Discuss the pathogenesis of the
lesion
3. Discuss the outcome of the lesion if
untreated.
4. What factors determine the
prognosis of the lesion and
response to treatment modalities?
The Paps smear of the patient done a week before consultation
shows the following cells. Describe the diagnostic cells. What is
the use of paps smear?
SITUATION 2

A 48-year-old woman has noted menstrual


periods that have been exceptionally heavy
lasting 6 to 8 days for 4 months. She has also
noted inter-menstrual bleeding. On physical
examination her uterine cervix appears normal,
and a Pap smear shows no abnormal cells.
Pelvic examination shows a normal-sized
uterus. There are no adnexal masses.
Pelvic ultrasound shows the lesion indicated by the
short arrow. The long arrow indicates the uterine
cavity. Describe the lesion.
Which of the above pictures probably corresponds to the
lesion in the ultrasound? Explain.
Which of the following
histology probably
corresponds to the
gross in the previous
slide? Which of these
two lesions is
malignant? Explain
Discuss the two lesions as to:

3. Pathogenesis
4. Clinical manifestations
5. Possible complications
SITUATION 3

For the past year, a 50-year-old woman has noted


that her menstrual periods have been exceptionally
heavy, lasting 7 to 9 days. She has also noted
occasional minor inter-menstrual bleeding. On pelvic
examination the uterine cervix appears normal, but
the uterus is enlarged to twice normal size.
Indicate and describe the lesion/s
Describe the lesion. Is the lesion benign or malignant?
Discuss the pathogenesis of the lesion.

Discuss the role of hormones in the growth


and development of the lesion.
SITUATION 4

A 23-year-old woman is brought to the


emergency room because of the sudden onset of
lower abdominal pain. Pelvic examination reveals
a normal sized uterus and normal appearing
cervix and vagina. However, there is marked
tenderness upon palpation of the left adnexal
region. Culdocentesis yields bloody fluid.
Exploratory laparotomy shows a hemorrhagic
dilated and ruptured left fallopian tube. The right
fallopian tube is noted to be slightly dilated.
Which of the following histologic pictures corresponds to the right
and left fallopian tube? Indicate and describe the lesions.

A B
Discuss the pathogenesis of both lesions.
SITUATION 5

A 44-year-old woman has experienced pelvic


discomfort for over a month along with a 4 kg
weight loss, nervousness, and diaphoresis. A
pelvic examination reveals a large left adnexal
mass that on transvaginal ultrasound appears
as a discrete 10 cm cystic mass. The uterus
appears normal in size. A Pap smear is normal.
An ovarian mass was removed. Describe the gross findings.
Based on the above histology, how would you classify the
lesion? Discuss the pathogenesis.
THE END