Pathology of the Reproductive System

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Pathology of the Reproductive System

• DMI 56
• Marilyn Rose

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The Female Reproductive System

• Uterus and Adnexa
• Breasts

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Imaging of the Female Reproductive System

• Hysterosalpingogram
• Pelvic Sonography
• Mammography

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Hysterosalpingogram
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Pelvic Ultrasound
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Mammogram
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Congenital Abnormalities

• Bicornuate Uterus
• Paired uterine horns that extend to the uterine
  tubes
• Unicornuate Uterus
• The uterine cavity is elongated and has one
  uterine tube
• Often the kidney on that side is missing
• Uterus Didelphys
• Complete duplication of the uterus, cervix, and
  vagina
• The most serious complication with these
  abnormalities is with reproduction
• Most can be corrected surgically

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Didelphic Uterus
there is a double uterus with two separate
cervices, and often a double vagina as well. Each
uterus has a single horn linked to the
ipsilateral fallopian tube that faces its ovary.
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double uterus with two separate cervices, and
often a double vagina as well. Each uterus has a
single horn linked to the ipsilateral fallopian
tube that faces its ovary.
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Unicornuate Uterus
A unicornuate uterus is a type of congenital
uterine abnormality (müllerian duct abnormality).
A unicornuate uterus is smaller than a typical
uterus and usually has only one functioning
fallopian tube. The other side of the uterus may
have what is called a rudimentary horn.
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Retroverted Uterus
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A retroverted uterus (tilted uterus, tipped
uterus) is a uterus that is tilted backwards
instead of forwards.
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Inflammatory Diseases

• PID
• A bacterial infection
• Gonococcus, staphylococcus, or streptococcus
  bacterias
• Unsterile abortion, IUD insertion, or pathogens
  from other sources
• The inflammationbilateral and spreads to the
  peritoneum
• Abcesses may form (risk sterility)
• Sing abdominal and pelvic pain, along with fever
• Antibiotic therapy is used to treat this disorder
• Increased risk of ectopic pregnancy

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Inflammatory Diseases

• Mastitis
• Caused by staphylococcus aureus
• Occurs in the breast of lactating females
• Bacteria invades through cracks in the skin
  surrounding the nipple
• Patient will experience pain, redness, swelling
  and fever
• Antibiotics and heat application are used for
  treatment

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Neoplastic Diseases

• Cystadenocarcinoma
• A malignant neoplasm of the ovary
• Occurs in women over age 40
• It is the most lethal with a very poor prognosis
• The tumors often spread to other pelvic organs
  and the digestive system
• Treatment includes surgery, radiation and
  chemotherapy

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Neoplastic Diseases

• Carcinoma of the uterus
• One of the most common female cancers
• More common in nulliparous(?) females
• Stage 0 is curable by hysterectomy
• Stage 1 or 2 are usually treated by surgery and
  radiation therapy
• 5 year survival rate is 80

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Neoplastic Diseases

• Breast Carcinoma
• Second leading cause of female cancer deaths in
  the US
• The etiology is unknown
• Early detection increases the chance of survival
• Mammography is the method of choice for detection
• Treatment includes surgery, radiation or
  chemotherapy

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Breast Carcinoma
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Disorders During Pregnancy

• Ectopic Pregnancy
• Development of a fetus outside the uterine cavity
• The most common site is the uterine tube
• If the condition remains untreated, the blood
  vessels can rupture as the tissue stretches
• The treatment is surgical removal of the embryo
  and uterine tube

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Disorders During Pregnancy

• Placenta Previa
• The placenta develops in the lower half of the
  uterus
• Causes obstruction of the internal cervical os
• The mother may experience bleeding in the late
  stages of pregnancy
• Hemorrhage can occur, which can be
  life-threatening for both mother and fetus
• Ultrasound is helpful in diagnosis
• Normal delivery cannot occur
• A cesarean section is normally performed

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The Male Reproductive System

• Paired Testicles
• Prostate gland
• Imaging is limited to urethrograms, IVU, and CT
• Sonography is used to evaluate the testicles and
  prostate
• Ultrasound can differentiate between epididymitis
  and testicular torsion

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Congenital Anomalies

• Cryptorchidism
• A condition of undescended testes
• The rate of malignancy is much greater with this
  condition
• Testicles are usually brought down and fixed into
  position
• Sonography is used to locate the testicle

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Neoplastic Diseases

• Prostatic Hyperplasia BPH
• A common benign enlargement
• Usually affects men over 50
• Patients will experience difficulty with
  urination
• Patients may be treated with a TURP
• Hyperplastic changes are easily visualized on CT
  and sonography
• Prostatic calculi can be seen on plain abdominal
  films

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Benign Prostatic Hypertrophy
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Neoplastic Diseases

• Adenocarcinoma of the prostate
• Affects older males, incidence increases with age
• The disease is usually diagnosed by physical
  examination
• Acid phosphatase levels will be elevated
• Patients may often experience urinary tract
  obstructions
• Treatment includes surgical excision, hormone
  treatment, or radioactive seeds to prostate
• Skeletal metastases may occur in about 75 of the
  cases
• It is the third leading cause of cancer deaths
• It has a five year survival rate of about 33

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Carcinoma of the Prostate
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Neoplastic Diseases

• Testicular masses
• Seminomas
• Arise from the seminiferous tubules
• Accout for about 40 of testicular tumors
• These tend to grow rapidly but remain localized
• These neoplasms are very radiosensitive
• The prognosis is excellent with radiation therapy
• 10 year survival rate is about 90

• Teratomas
• Composed of different cell types
• Very poor prognosis
• Highly malignant
• Metastasize via lymphatic and hematogenous spread
• 10 year survival rate is about 50 - 75

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Inflammatory Diseases

• Testicular Torsion
• Results from a testicle twisting upon itself
• Reduced surgically- can cause severe compromise
  of vascularity (6hours until testicle dies)
• Ultrasound/Nuclear medicine scans will
  demonstrate decreased uptake on the affected side
• Scrotal pain and swelling is usually present

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Inflammatory Diseases

• Epididymitis
• Inflammation of the epididymis
• Also leads to scrotal swelling
• The increased blood flow can be seen on
  sonography and on nuclear medicine scans
• The affected side will demonstrate increased
  uptake

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Inflammatory Diseases

• Gonorrhea
• Most common and widespread
• venereal bacterial infection
• Symptoms occur within days after infection
• Men experience acute urethritis with pus
  discharge
• Women are usually asymptomatic
• Usually responds to antibiotic therapy
• If untreated
• urethral strictures in men
• pelvic inflammatory disease in women.
• Fibrous scarring in the fallopian tubes causing
  sterility or increased risk of ectopic pregnancy
  occurs as a serious complication
• May also cause septic arthritis

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Urethral Strictures From Gonorrheal Infection
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Inflammatory Diseases

• Syphillis
• Chronic sexually transmitted disease
• Caused by the spirochete Treponema pallidum
• Babies can be born with congenital syphillis
• Chancre sores develop on the genitalia
• Antiobiotics are successful in treating syphillis
• Lack of treatment can lead to destruction of bone
  
• Osteomyelitis
• Neuropathic joint disease
• Mental disorders, deafness, blindness

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Syphilitic Changes In Bone