praktikum reproduksi 2

7/25/2019 praktikum reproduksi 2

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MateriMateri

praktikumpraktikum

patologi anatomipatologi anatomiModul reproduksiModul reproduksi


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Learning Objectives1. Define the cervical transformation zone

.2. Review the endometrial and ovarian changes that occur during themenstrual cycle.3. List three ris factors for the develo!ment ofcervical carcinoma.

". #$!lain the role of human !a!illoma viruses in the !athology ofbenign and malignant cervical tumors.

%. Recognize the mor!hologic and biologic s!ectrum of cervicalintrae!ithelial neo!lasia and the various terminologies used indescribing &a! smears and tissue sections' such as dys!lasia'cervical intrae!ithelial neo!lasia ()*+,' and s-uamous intrae!itheliallesion.

. Define &*D (!elvic inflammatory disease,/ describe its common!resentation and se-uelae.

0. Describe the following genital infections as they affect the femalegenital tracta. sy!hilisb. gonorrheac. chancroidd. Chlamydiae.Trichomonasf. her!esg. human !a!illoma virusList the infectionsthat can affect fetal outcome.

. )om!are condyloma acuminatum and condyloma latum.


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cenario

4 335year5old lawyer who !ost!oned !regnancy in her 26s has now beentrying to get pregnantfor several years. 7er husband had a son duringa !rior marriage.

he !resents to her gynecologist for woru! of her infertility. &ertinent

history includes menarche' age 12/ coitarche' age 1%/ eight lifetimese$ual !artners/ cyclic menses regularly every 2 days/ no birth controlfor 2 years/ no !elvic e$amination in % years. +o *8 drug use. &ertinente$amination and !rocedure findings include a friable' vascular lesion onthe anterior uterine cervi$' a Pap smeardiagnosis of 79*L (high gradesquamous intraepithelial lesion, (*mage 1,' an 7&8 (human !a!illomavirus, assay !ositive for high5ris 7&8 seroty!es' a cervical bio!sy

diagnosis of severe dys!lasia ()*+ ***, (*mage 2, with flat condyloma(*mage 3,' bloced (non!atent, fallo!ian tubes on hysterosal!ingogram'and a microimmunofluorescence test on her cervical mucus that is!ositive for Chlamydia trachomatis. he is 7*8 (humanimmunodeficiency virus, negative.


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:terine cervical cytology' &a!anicolaou stain (&a! smear,

7igh !ower

*n com!arison to the normal cervical s-uamous cells' the dys!lastic cells have increasednuclearcyto!lasmic ratios with enlarged nuclei and coarsely granular chromatin. ;he!resence of endocervical cells indicates that an ade-uate s!ecimen was obtained

+ormal s-uamus cells Dys!lastic s-uamous

cells' 7igh grade

#ndocervical cells


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;he &a! smear is considered a screening test. ince its

introduction' has it altered the incidence of cervical

carcinomaedium !ower

(9lass slide 133,

+ote loss of cellular !olarity and

differentiation. *n situ meansthat it has not yet invaded

through the basementmembrane and thereforecannot yet metastasize.7owever' an invasive

s-uamous cell carcinoma

may arise from this !recursorlesion

>itotic figure

?asement membrane

high5grade s-uamous

intrae!ithelial lesion ()*+ ***, 5

>edium &ower

@8irtually the entire thicness of the cervicale!ithelium is affected by dys!lastic changes.

+ote the cellular and nuclear !leomor!hism'failure of normal and orderly differentiation'hy!erchromatic nuclei' and several mitotic

figures e$tending toward the surface. Only thevery su!erficial cells a!!ear to differentiate and

flatten. 4lthough most of the basementmembrane is not com!letely visible in this

image' it is intact


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Ahat are the ris factors for the develo!ment of cervical

dys!lasiaulti!le lifetime se$ual !artners (five or

more,' high5ris se$ !artners (those with

condyloma' !enile carcinoma' multi!lese$ual !artners' !artners who have

condyloma' dys!lasia' or cervical

carcinoma,' early coitarche


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)ervi$' low5grade s-uamous intrae!ithelial lesion (flat

condyloma, 5 Low !ower

Blat condyloma' or human !a!illoma virus infection' is characterizedby the !resence of oilocytes' which are s-uamous cells withenlarged' wrinled' dar (CraisinoidC, nuclei surrounded by a halo.;he cells are usually found in the su!erficial half of the e!ithelium

Ahich human !a!illoma virus

(7&8, seroty!es are associated

with high5grade dys!lasia and

carcinoma< 7&8 seroty!es 1' 1'

31' 33' and 3%

oilocytes

?asement membrane


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)ervi$' carcinoma 5

9ross

;his !in5tan' friable' fungating lesionon the anterior cervical li! is

characteristic of cervicalcarcinoma.

Ahy can we consider s-uamous cell

carcinoma ())4, of the cervi$ ase$ually transmitted disease

:terine cervi$' s-uamous

carcinoma 5 8ery low !ower

+odules of tumor have

invaded the wall of the

uterine cervi$.


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-uamous carcinoma of the cervi$ is the end !oint of a !rogressionof lesions that begins with infection by human !a!illoma virus(7&8,' !robably in tandem with environmental cofactors. Aomenwho are se$ually active can become infected/ women who are not

se$ually active generally dont get ))4 of the cervi$. ;he risfactors that !redis!ose se$ually active women to develo! ))4 areyoung age at first se$ual intercourse' es!ecially before age 1 (thehormonal interactions on the changing cervi$ of menarche render itsusce!tible to infection,/ multi!le lifetime se$ual !artners (the more!artners' the higher the !robability of infection,/ male se$ual!artners who are high ris themselves (they have had condyloma or!enile cancer' other !artners with cervical cancer or dys!lasia' ormulti!le se$ual !artners,/ and cigarette smoing.


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)ervi$' s-uamous cell carcinoma 5

Low !ower

4t low !ower' the abru!t transition between thenormal s-uamous e!ithelium and the s-uamouscell carcinoma (in situ and invasive, can bea!!reciated

+ormal s-uamous cell

e!ithelium

*n situ and invasive scc


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)arcinoma in situ is confined to thee!ithelium' while invasive carcinoma infiltrates

the underlying stroma. ;his young woman had two disease

!rocesses infertility as a se-uela of)hlamydia trachomatis infection' untreated

and asym!tomatic for a long time' ands-uamous cell carcinoma in situ of the cervi$'a se-uela of 7&8 infection.


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7ow does it transform cells

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