Tumor Genital Wanita
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TUMOR GENITAL WANITATUMOR GENITAL WANITA
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FEMALE REPRODUCTIVE SYSTEM
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Condyloma acuminatum (VIN)Condyloma acuminatum (VIN)
Numerous condyloms enc!rcl!n" #$e !n#ro!#us
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Venereal warts
%condylom cum!n#um&
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Condyloma acuminatum (VIN)Condyloma acuminatum (VIN)
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Flat condyloma %u#er!ne cer'!(&
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CondylomCondylom
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Condyloma acuminatum (VIN)Condyloma acuminatum (VIN)
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Condyloma acuminatum (VIN)Condyloma acuminatum (VIN)
Acn#os!s) $y*er+er#os!s) nd
cy#o*lsm!c 'cuol!,#!on %+o!locy#os!s&
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VINVIN
-D!..use cellulr #y*!-Nucler cro/d!n"-P#$olo"!c m!#os!s
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PAGET0S DISEASE o. #$e VULVAPAGET0S DISEASE o. #$e VULVA
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EXTRAMAMMARY PAGET’S DISEASEEXTRAMAMMARY PAGET’S DISEASE
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PAGET0S DISEASE o. #$e VULVAPAGET0S DISEASE o. #$e VULVA
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S1UAMOUS CELL CAS1UAMOUS CELL CA
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S1UAMOUS CELL CAS1UAMOUS CELL CA
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S1UAMOUS CELL CAS1UAMOUS CELL CA
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CLEAR CELL ADENOCACLEAR CELL ADENOCA
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SARCOMA 2OTRYIOIDESSARCOMA 2OTRYIOIDES(embryonal rhabdomyosarcoma)(embryonal rhabdomyosarcoma)
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SARCOMA 2OTRYOIDESSARCOMA 2OTRYOIDES
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SARCOMA 2OTRYOIDESSARCOMA 2OTRYOIDES
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SARCOMA 2OTRYOIDESSARCOMA 2OTRYOIDES
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CERVI3CERVI3
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ANATOMY ANATOMY
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CERVIXCERVIX
Col*osco*y4 do##ed l!ne !s
#rns.orm#!on ,one
Pos#5meno*usl cer'!(
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ANATOMY (TRANSFORMATION ZONE)ANATOMY (TRANSFORMATION ZONE)
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ANATOMY ANATOMY
(TRANSFORMATION(TRANSFORMATIONZONE)ZONE)
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ANATOMY (TRANSFORMATION ZONE)ANATOMY (TRANSFORMATION ZONE)
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ANATOMY (TRANSFORMATIONANATOMY (TRANSFORMATION
ZONE)ZONE)
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ANATOMY (TRANSFORMATION ZONE)ANATOMY (TRANSFORMATION ZONE)
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Cervcal e!t"elal cells
(P*n!colou smer&
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Cer'!c!#!s 5 me#*ls!Cer'!c!#!s 5 me#*ls!
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S1UAMOUS METAPLASIAS1UAMOUS METAPLASIA
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ENDOCERVICAL POLYPENDOCERVICAL POLYP
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POLYPPOLYP
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Crc!nom4 *#$o*$ys!olo"yCrc!nom4 *#$o*$ys!olo"y
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EXPOSURE TO HPVEXPOSURE TO HPV
C ! #$ $ ! lC ! #$ $ ! l
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Crc!nom4 *#$o*$ys!olo"yCrc!nom4 *#$o*$ys!olo"y
Crc!nom4 *#$o*$ys!olo"yCrc!nom4 *#$o*$ys!olo"y
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Crc!nom4 *#$o*$ys!olo"yCrc!nom4 *#$o*$ys!olo"y
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Crc!nom4 *#$o*$ys!olo"yCrc!nom4 *#$o*$ys!olo"y
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Spectrum of CINSpectrum of CIN
Cervical Intraepithelial Neoplasia (CIN)
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Cytolo#y$ normalCytolo#y$ normal CIN IIICIN III
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In S!#u 6 In's!'e C o. #$e Cer'!(In S!#u 6 In's!'e C o. #$e Cer'!(
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In's!'e C o. Cer'!(In's!'e C o. Cer'!(
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CIN IIICIN III
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CIN III /!#$ m!cro5!n's!onCIN III /!#$ m!cro5!n's!on
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SCCSCC
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MICROINVASIVE SCCMICROINVASIVE SCC
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SCCSCC
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SCC) +er#!n!,edSCC) +er#!n!,ed
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SCCSCC
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S#"!n"S#"!n"
S#"e 7S#"e 7 Carcinoma in situCarcinoma in situ S#"e IS#"e I Microinvasive and confned to cervixMicroinvasive and confned to cervix
S#"e I8S#"e I8 Invasive and confned to cervix Invasive and confned to cervix
S#"e IIS#"e II Extends to upper vagina but not to para-Extends to upper vagina but not to para-
metriummetrium
S#"e II8S#"e II8 Involve parametrium Involve parametrium
S#"e IIIS#"e III Extension to pelvis sidewall or lower vagina Extension to pelvis sidewall or lower vagina
S#"e IVS#"e IV Beyond the pelvis or involvement o rectal orBeyond the pelvis or involvement o rectal or
bladder mucosabladder mucosa
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U T E R U S
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ENDOMETRIAL HYPERPLASIAENDOMETRIAL HYPERPLASIA
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S!m*le9S/!ss c$eese
A#y*!cl $y*er*ls!
Com*le( $y*er*ls!
S:umous me#*ls!
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II.II.
ENDMETRIA!ENDMETRIA!
G!AND"!ARG!AND"!ART"MRST"MRS
Endome-Endome-
trioidtrioid
Carcino-Carcino-mama
Rel#!ons mon" *rol!.er#!on
$y*er*ls!) #y*!cl $y*er5
*ls!) nd endome#r!l C;
IVIV
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IV.IV.
ENDOMETRIAL POLYPSENDOMETRIAL POLYPS
5O.#en *eduncul#ed) my 8e sol!#ry
or mul#!*le
5Commonly com*osed o. $y*er*ls#!c
endome#r!um /!#$ cys#!clly d!l#ed
"lnds) cellulr s#rom) nd #$!c+
/lled 'essels
5My cuse !n#erm!##en# 8leed!n")
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Endome#r!l Poly*Endome#r!l Poly*
A s!n"le *oly* e(#en# !n#o endome#r!l
c'!#y; T$e necro#!c %rro/& #!* !s res5
*ons!8le .or cl!n!cl 8leed!n";
Sl!"$#ly d!l#ed endome#r!l
"lnds em8edded !n mr+edly
.!8rous s#rom;
Ad ! . #$ E d # !Ad ! . #$ E d # !
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Adenocrc!nom o. #$e Endome#r!um Adenocrc!nom o. #$e Endome#r!um
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Histological radingHistological rading
II ENDMETRIA! G!AND"!AR T"MRS
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II. ENDMETRIA! G!AND"!AR T"MRSII. ENDMETRIA! G!AND"!AR T"MRS
Endometrioid CarcinomaEndometrioid Carcinoma
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Endome#r!o!d denoc > s:umous d!..eren#!#!on %/ellEndome#r!o!d denoc > s:umous d!..eren#!#!on %/ell
d!..eren#!#ed&d!..eren#!#ed& A%ENOACANT&OMAA%ENOACANT&OMA
Vr!n#s o. endome#r!l denocrc!nom4Vr!n#s o. endome#r!l denocrc!nom4
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Vr!n#s o. endome#r!l denocrc!nom4Vr!n#s o. endome#r!l denocrc!nom4
Serous denocrc!nom Cler cell denocrc!nomSerous denocrc!nom Cler cell denocrc!nom
E d t i l St l SE d t i l St l S
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Endometrial Stromal SarcomaEndometrial Stromal Sarcoma
The myometrium is irregularly invaded y the tumor!"hich displays a rich vascular net"or#$
A S
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MYMETRIA! T"MRSMYMETRIA! T"MRS
POSSI!LE LOCATION O" LEIOMYOMAPOSSI!LE LOCATION O" LEIOMYOMA
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POSSI!LE LOCATION O" LEIOMYOMAPOSSI!LE LOCATION O" LEIOMYOMA
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LEIOMYOMALEIOMYOMA
A; Well demrc#ed /$!#e **ernce mss 8ul"!n" !n#o #$e u#er!ne c'!#y2; Well d!..eren#!#ed s*!ndle s$*ed cells !n !n#erlc!n" 8undles
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!EIMYSARCMA!EIMYSARCMA
A; Lr"e $emorr$"!c #umor mss d!s#ends #o #$e lo/er cor*us nd .ln+ed8y #/o le!omyoms
2; T$e #umor cells re !rre"ulr !n s!,e 6 s$*e) /!#$ $y*erc$rom#!c nucle!
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LEIOMYOSARCOMALEIOMYOSARCOMA
Le!omyom
Le!omyosrcom
M!#os!s
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Necross$ u#er!ne srcom
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ECTOPIC PRENANCYECTOPIC PRENANCY
5 Mos# ec#o*!c *re"nnc!es !n'ol'e #$e .llo*!n #u8e %?7=&5 Pred!s*os!n" .c#ors !nclude #$# !n$!8!# #u8l #rns*or#4 c$ron!c sl*!n"!#!s)
*er!#u8l d$es!on) lr"e cys#) #umors) e#c;5 A.#er @5 /ee+s "ro/!n" ru*#ure $em#osl*!n( %!n #u8e&) B@ /ee+s !n
!s#$mus
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ECTOPIC PRENANCYECTOPIC PRENANCY
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GESTATIONAL TROPHOBLASTIC DISEASEGESTATIONAL TROPHOBLASTIC DISEASE
A; Com*le#e yd#!d!.orm Mole A; Com*le#e yd#!d!.orm Mole
- content all of hydropic villi- content all of hydropic villi
- etiology: lost or inactivation of maternal chromosome in the fertilized egg- etiology: lost or inactivation of maternal chromosome in the fertilized egg
- bleeding and high hCG level in the urine- bleeding and high hCG level in the urine
2; Incom*le#e %Pr#!l& Mole2; Incom*le#e %Pr#!l& Mole
- admixture of normal and hydropic villi- admixture of normal and hydropic villi
C; In's!'e Mole %c$or!odenom des#ruen&C; In's!'e Mole %c$or!odenom des#ruen&
- invasion of molar villi trophobastic tissue into ! through myometrium- invasion of molar villi trophobastic tissue into ! through myometrium
D; C$or!ocrc!nomD; C$or!ocrc!nom
- arise from normal pregnancy "#$%& and abnormal pregnancy "'$%- arise from normal pregnancy "#$%& and abnormal pregnancy "'$% hydatidiform mole&hydatidiform mole&
-very high level of urine hCG-very high level of urine hCG
. 6F #!l! #! ## . # 6 #! l l
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Fer#!l!,#!on *##ern o. com*e#e 6 *r#!l moleFer#!l!,#!on *##ern o. com*e#e 6 *r#!l mole
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Tr!lody$ *r#!l $yd#!.orm mole
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YDATIDIFORM MOLEYDATIDIFORM MOLE
Numerous s/ollen '!ll! %$ydro*!c de"ener#!on&
Tr!lody$ *r#!l $yd#!.orm mole
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Tr!lody$ *r#!l $yd#!.orm mole
%E& ( 7
YDATIDIFORM MOLEYDATIDIFORM MOLE
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YDATIDIFORM MOLEYDATIDIFORM MOLE
Pr#!l mole Com*le#e mole
Norml5loo+!n"
'!ll!
INVASIVE MOLEINVASIVE MOLE
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INVASIVE MOLEINVASIVE MOLE
T$e mole !n'de !n#o myome#r!um
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CORIOCARCINOMACORIOCARCINOMA
'&C$ c$or!ocrc!nom
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&C$ c$or!ocrc!nom
%I& ( @77
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O#ARYO#ARYNON-NEOPLASTICNON-NEOPLASTIC
O#ARIAN ENLARMENTO#ARIAN ENLARMENT
NEOPLASTICNEOPLASTIC O#ARIANO#ARIAN
ENLAREMENTENLAREMENT $%&' are$%&' are(enign)(enign)
NON-NEOPLASTICNON-NEOPLASTIC
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O#ARIAN ENLARMENTO#ARIAN ENLARMENT
() *Germinal+ ,nclusion Cyst() *Germinal+ ,nclusion Cyst- common cyst in pre-menopausal period result of do.n gro.th- common cyst in pre-menopausal period result of do.n gro.th
and entrapment of the surface epithelium into the ovarian cortexand entrapment of the surface epithelium into the ovarian cortex
/) Physiologic or 0unctional Cyst/) Physiologic or 0unctional Cyst
- follicle cyst- follicle cyst- corpus luteum cyst- corpus luteum cyst
- theca lutein cyst- theca lutein cyst
C) Polycystic ovariesC) Polycystic ovaries
1) 2tromal 3yperplasia1) 2tromal 3yperplasia stromal hyperthecosisstromal hyperthecosis
"OLLICLE CYST"OLLICLE CYST
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"OLLICLE CYST"OLLICLE CYSTO" THE O#ARYO" THE O#ARY
T*e r+,t+re o t*e t*in .alled ollic+lar c/st led to a(dominal *emorr*age
%&'CSTIC &VRIES%&'CSTIC &VRIES
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*+ilateral and multiple cyst! as one of the more common cause ofinfertility! dulu diseut sindroma Stein*'eventhal! ditemu#an
pada ,*-. "anita usia reprodu#si
*'ined y granulosa*theca cells (may e luteini/ed 0 androgen secreting)*Symptom1 varies from hyperestrinism (anormal leeding) to virili/ation (amenorrhea! hirsutism)
POLYCYSTIC O#ARIESPOLYCYSTIC O#ARIES
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POLYCYSTIC O#ARIESPOLYCYSTIC O#ARIES$,ol/c/stic disease o t*e o0ar/)$,ol/c/stic disease o t*e o0ar/)
Cut section of the ovary sho" numerous cysts emedded in sclerotic stroma
Pat*ogenesisPat*ogenesis
Polycys#!c O'ry SyndromePolycys#!c O'ry Syndrome
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Polycys#!c O'ry SyndromePolycys#!c O'ry Syndrome
Stromal H/,ert*ecosisStromal H/,ert*ecosis
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Stromal H/,ert*ecosisStromal H/,ert*ecosis
2ocal luteini/ation of ovarian stromal cells nest of luteini/edstromal cells often functional virili/ation
NEOPLASTIC O#ARIAN ENLAREMENTNEOPLASTIC O#ARIAN ENLAREMENT
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NEOPLASTIC O#ARIAN ENLAREMENTNEOPLASTIC O#ARIAN ENLAREMENT
$1)$1)
() 456O72 187,981 07O6 2570(C8 "G876,(L& 8P,438L,56() 456O72 187,981 07O6 2570(C8 "G876,(L& 8P,438L,56
1.1. 2erous 4umors2erous 4umors
a. Serous cystadenomaa. Serous cystadenoma
b. Serous cystadenocarcinoma b. Serous cystadenocarcinoma
c. Serous borderline tumor c. Serous borderline tumor
2.2. 6ucinous 4umors6ucinous 4umors
a. Mucinous cystadenomaa. Mucinous cystadenoma
b. Mucinous cystadenocarcinoma b. Mucinous cystadenocarcinoma
c. Mucinous borderline tumor c. Mucinous borderline tumor ;) 8ndometrioid 4umors;) 8ndometrioid 4umors
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o0arian e,it*elial-stromal t+morso0arian e,it*elial-stromal t+mors
Serous TumorSerous Tumor
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Serous Tumor
Serous e*!#$el!l #umor "ro/#$ .rom #$e sur.ce o. #$e o'ry
S # d . #$S # d . #$
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Serous cys#denom o. #$e o'rySerous cys#denom o. #$e o'ry
u"e un!loculr #umor T$e cys# !s l!ned 8y s!n"le lyeredcyl!#ed #u8l5#y*e e*!#$el!um
Muc!nous Cys#denomMuc!nous Cys#denom
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yy
Muc!nous cys#denom /!#$ mul#!cys#!c Columnr cell l!n!n"
Muc!nous Cys#denom o. #$e O'ryMuc!nous Cys#denom o. #$e O'ry
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Muc!nous Cys#denom o. #$e O'ryMuc!nous Cys#denom o. #$e O'ry
Numerous cys#s .!lled /!#$ #$!c+)V!scous .lu!d
A s!n"le lyer o. muc!nous e*!#$el!lcells l!nes #$ cys#
S # . 8 d l! l!S # . 8 d l! l!
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Serous #umor o. 8orderl!ne ml!"nncySerous #umor o. 8orderl!ne ml!"nncy
/orderline 2erous Cystadenoma Cystadenocarcinoma/orderline 2erous Cystadenoma Cystadenocarcinoma
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/orderline 2erous Cystadenoma Cystadenocarcinoma/orderline 2erous Cystadenoma Cystadenocarcinoma
Del!c#e **!llry #umor "ro/#$ Lr"e) 8ul+y #umor mss
/orderline 2erous Cystadenoma/orderline 2erous Cystadenoma
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Incresed rc$!#ec#url com*le(!#y nd e*!#$el!l cell s#r#!.!c#!on
S # d !Serous cys#denocrc!nom
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Serous cys#denocrc!nomSerous cys#denocrc!nom
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!renner T+mor!renner T+mor
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2renner #umor 2en!"n cys#!c #er#om
C$rc#er!s#!c e*!#$el!l nes# /!#$!n o'r!l s#rom
Tumor 3ina# pada eragai umur! separo timul pada umur 4 56 th$Nama lain1 tumor sel transisional
2renner #umor2renner #umor
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2renner #umor 2renner #umor
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NEOPLASTIC O#ARIAN ENLAREMENTNEOPLASTIC O#ARIAN ENLAREMENT
$2)$2)
!3 TUMORS DERI#ED "ROM SE4!3 TUMORS DERI#ED "ROM SE4CORD5STROMACORD5STROMA
B; Grnulos5T$ec Cell TumorsB; Grnulos5T$ec Cell Tumors
@; F!8rom@; F!8rom
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ran+losa cell t+morran+losa cell t+mor
%enampang melintang menun3u##an tumor solid dengan perdarahan$+agian #uning menun3u##an #elompo# sel*sel granulosa erlipid$
7amaran mi#ros#opi# entu# foli#ular spesifi# (Call*E8ner odies)$
l C ll Tran+losa Cell T+mor
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ran+losa Cell T+morran+losa Cell T+mor
The tumor cells are arranged in sheets punctuated ysmall follicle*li#e structures (Call*E8ner odies)
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F!8rom 55 .!8ro#$ecomF!8rom 55 .!8ro#$ecom
*9ost (:6.) are unilateral! solid! round! firm! "hite masses 5*;6 cm in si/e*Some time a thecal component may e present firothecoma*
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Sertoli Le/dig cell t+mor/ g
Immature solid tuules of emryonic Sertoli cells are ad3acent to clustersof aleydig cells that e8hiit aundant eosinophilic cytoplasm$
Ser#ol! Cell TumorSer#ol! Cell Tumor
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Ser#ol! Cell Tumor Ser#ol! Cell Tumor
Well d!..eren#!#ed Ser#ol! cell #u8ulesGolden yello/ **ernces o. #$e #umor
cu# sur.ce;
F!8rom o'r!!F!8rom o'r!!
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Me!" syndrome
NEOPLASTIC O#ARIAN ENLAREMENTNEOPLASTIC O#ARIAN ENLAREMENT
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NEOPLASTIC O#ARIAN ENLAREMENTNEOPLASTIC O#ARIAN ENLAREMENT
$6)$6)
C3 TUMORS DERI#ED "ROM ERM CELLSC3 TUMORS DERI#ED "ROM ERM CELLS
B; Ter#omB; Ter#om
5 M#ure Cys#!c Ter#om5 M#ure Cys#!c Ter#om
5 Imm#ure %Ml!"nn#& Ter#om5 Imm#ure %Ml!"nn#& Ter#om@; Dys"erm!nom@; Dys"erm!nom
-
8/17/2019 Tumor Genital Wanita
111/125
t+mors o germ cell origint+mors o germ cell origin
%ermod cyst
-
8/17/2019 Tumor Genital Wanita
112/125
%ermod cyst
Mat+re C/stic TeratomaMat+re C/stic Teratoma
$dermoid c/st)$dermoid c/st)
-
8/17/2019 Tumor Genital Wanita
113/125
$dermoid c/st)$dermoid c/st)
!r !n#erm!n"led /!#$
8u##er5l!+e su8s#nce
A m!(#ure o. #!ssues
2r!n #!ssue !s lyered 8y
s+!n #!ssue
Mat+re c/stic teratomaMat+re c/stic teratoma
-
8/17/2019 Tumor Genital Wanita
114/125
Mat+re c/stic teratomaMat+re c/stic teratoma
Matre teratoma
-
8/17/2019 Tumor Genital Wanita
115/125
%E& ( @
Immat+re teratomaImmat+re teratoma
-
8/17/2019 Tumor Genital Wanita
116/125
Immat+re teratomaImmat+re teratoma
Imm#ure neurl #!ssue e($!8!# rosse##e %R & /!#$ mul#!lyered nucle!
Em8ryonl "l! %G& d!s*ly densely *c+ed #y*!cl nucle!
Immatre teratoma
% &
-
8/17/2019 Tumor Genital Wanita
117/125
%E& ( @
I T
-
8/17/2019 Tumor Genital Wanita
118/125
Immat+re TeratomaImmat+re Teratoma
Pr!m!#!'e
neuroe*!#$el!um
-
8/17/2019 Tumor Genital Wanita
119/125
Yol7-sac CarcinomaYol7-sac Carcinoma
Sc$!ller5Du'l 8od!es
Yol7 sac carcinomaYol7 sac carcinoma
-
8/17/2019 Tumor Genital Wanita
120/125
Tumor cells are arrayed in reticular patternSchiller*?uval odies1 papilla protruding into the lumen lined y tumor cells
D/sgerminoma o0ariiD/sgerminoma o0arii
-
8/17/2019 Tumor Genital Wanita
121/125
%olyhedral tumor cells "ith central round nuclei and ad3acent inflammation$The neoplastic cells have clear! glycogen filled cytoplasm$
DYSGERMINOMA 7VARIIDYSGERMINOMA 7VARII
-
8/17/2019 Tumor Genital Wanita
122/125
DYSGERMINOMA 7VARIIDYSGERMINOMA 7VARII
Metastatic T+morsMetastatic T+mors
8r+7en(erg t+mor8r+7en(erg t+mor
-
8/17/2019 Tumor Genital Wanita
123/125
8r+7en(erg t+mor8r+7en(erg t+mor
The ovary is enlarged and partially hemorrhagic$ microscopic section reveals mucinous (signet*ring) cells
infiltrating the ovary
Pse+dom/9oma PeritoneiPse+dom/9oma Peritonei$$ rom a,,endi9)rom a,,endi9)
-
8/17/2019 Tumor Genital Wanita
124/125
&varian tumor "ith e8tensive mucinous ascites! cystic epithelial implantson the peritoneal surfaces! and adhesions intestinal ostruction 0 death
O#ARYO#ARY
-
8/17/2019 Tumor Genital Wanita
125/125