Common

gynecological
diseases

Wang Jingwen (Cathy

Wang)

Department of Gynecology
 Outline
 Cervical diseases:
 Uterine diseases:
 Ovarian diseases
 Flloping tube disease:Ectopic
pregnancy
Learning objectives
 Learning common terms of Ob &
Gyn
 Understanding clinical
appearance of common diseases
 Knowing the treatment
principles of common diseases
Normal uterine, cervix, falloping tube, ovary
in
Different age of women
 young woman perimenopausal woman

Here is the gross appearance of The ovaries are somewhat smaller than
a normal uterus, cervix, vaginal the left picture but have a similar tan-
cuff, fallopian tube, and ovary white bosselated 有圆 凸的 appearance.
 postmenopausal woman

An older postmenopausal woman. The uterus and

ovaries are smaller and have a fairly smooth tan-white
appearance.
 normal cervix

Here is a normal cervix with a smooth, glistening

闪光 的 mucosal 粘膜的 surface. There is a small
rim of vaginal cuff 阴道残端 from this
hysterectomy specimen. The cervical os is small and
round, typical for a nulliparous 未经产的 woman.
The os will have a fish-mouth shape after one or
more pregnancies.
 Cervical diseases
 Inflammations
 Cervical cancer
•The normal adult
vaginal mucosa with a
wrinkled appearance
that is seen in women of
reproductive years
appears at the left.
•The cervix has been
opened to reveal an
endocervical canal
leading to the lower
uterine segment 节段
•An erythematous 红斑
的 appearance
extending to the cervical
os consistent with
chronic inflammation.
The normal cervical squamous epithelium at
the left transforms to dysplastic changes on the
right.
This is cervical squamous dysplasia at high magnification 高倍放
大 extending from the center to the right. The epithelium is
normal at the left. Note how the dysplastic cell nuclei are larger
and darker, and the dysplastic cells have a disorderly
arrangement 排列 .
This is the gross appearance of a cervical squamous cell
carcinoma that is still limited to the cervix (stage I).
Here is another cervical squamous cell carcinoma. Note
the IUD string protruding from the cervix.
At high magnification, nests of neoplastic squamous cells
are invaded through a chronically inflamed stroma. This
cancer is well-differentiated, as evidenced by keratin 角
蛋白 pearl.
Self-assessment

Q:Marked
every organ’s
name,please.
Self-assessment

Q: Suspected
diagnosis
further
examination
how to manage
 Answers
 Cervical squamous cell carcinoma
 Biopsy and pathological examination
 Surgery: radical hysterectomy and
pelvic lymphodenectomy
Endometrial diseases
•Hyperplasia 增生

•Adenocarcinoma
•myoma
 hyperplastic endometrium

The endometrial cavity is opened to reveal lush fronds of

hyperplastic endometrium. Endometrial hyperplasia can
lead to metrorrhagia (uterine bleeding at irregular
intervals), menorrhagia (excessive bleeding with menstrual
periods), or menometrorrhagia 月经 频多 .
 •High in the
fundus and
projecting into
the endometrial
cavity is a small
endometrial polyp endometrial
polyp.
•Such benign
polyps may
cause uterine
bleeding.
•It can be
treated with
Hysteroscopy 宫
腔镜检 查 .
 •There is an irregular
mass in the upper fundus
that proved to be
endometrial
adenocarcinoma on
biopsy.
•Such carcinomas are
more likely to occur in
adenocarcinoma
postmenopausal women.
•Any postmenopausal
bleeding should make you
suspect that this lesion
may be present.
 •In the upper fundus of the
uterus protruding into the
endometrial cavity is a nodule
结节 that proved to be a
leiomyoma.
leiomyoma •a submucosal leiomyoma.
•Such benign smooth muscle
tumors of the myometrium are
very common, perhaps 1 in 5
women has one.
•They may be the cause of
irregular bleeding if placed
submucosally.
 Uterine myoma
 Myomas are the most common uterine
tumors
 Benign smooth muscle tumor
(leiomyomata)
 Prevalence 患病 率 :20%-40% women
 Sensitive to ovarian hormones(grow in
pregnancy, regress after menopause)
 Types
•Smooth muscle
tumors of the
uterus are often
multiple.
•Submucosa
•Intramural
•Subserosal
"red degeneration".
•Such an appearance
might make you think
that it could be
malignant.
•Remember that
malignant tumors do not
generally arise from
benign tumors
 symptoms
 Most myomas do not case any symptoms
 Enlarge or distort uterine
cavity:Menorrhagia and anaemia 贫血
 Large mass pressure bladder:frequency of
micturition 排尿
 Infertility
 pelvic pain
 Abdominal swelling
 Diagnosis
 Age
 Medical history:mass,
menorrhagia 月经过多
 Pelvic examination:enlarge
uterine
 B Ultrasound
 Treatment
 Small myoma, asymptomatic:
following-up
 Perimenopausual women:medical
treatment.
 Any large pelvic mass of uncertain
nature requires removal to exclude
malignancy and relieve pressure
symptoms: surgery.
 Indications of surgery
 The size of uterine: more than 10
weeks(pregnancy)
 Heavy bleeding results in anaemia
 Submucasal, cervical myoma
 Infertility
 Suspected malignancy
 Surgerys

Myomectomy
 preserve fertility or uterus

 Enucleation 剜除术 of myoma

 Remove all myomas as possible as you can

 Recurrence soon (if more than 3 mass)

 Hysterectomy
 More than 40 year-old
 Multiple myomas
 With cervical inflammation
 Preserve ovarian function
 Avoid recurrence
 case
 31 years old, marriage 2yrs,G0P0
 Found abdominal mass 6 months
 Felling abdominal swelling
 Mass size: look-like 7 months pregnancy
 Tumor markers: CA125,CP2 normal
 B ultrasound: uterine mass, cannot
excluded ovarian tumor.
 Q:
 What is the probably
diagnosis?
 What treatment can we
suggest?
 Answers
 Suspected diagnosis: uterine
myomas
ovarian tumor
pregnancy
 Laparotomy: 剖腹术
More than 20 myomas
Pathological examination: benign leiomyoma.
Surgery actually is a wonderful
art
--- wang Jianliu
Fallopian tube diseases
(ectopic pregnancy)
 Fertilization
 Ovulation releases an egg from an ovarian follicle 卵泡 .
 The egg is swept into the fallopian tube and begins to
descend.
 Spermatozoa (millions are represented here by one)
begin ascending.
 Fertilization 受精 of the egg by a single sperm occurs in
the ampullary portion 壶腹部 of the fallopian tube
about a day after ovulation.
 The fertilized egg begins to develop into the blastocyt 胚
细胞 on descent into the endometrial cavity, where
implantation occurs on the wall of the fundus about a
week after ovulation
.
This is a second trimester 妊娠期 3 月
fetus and uterus
•Here is the size
of the uterus in
the third
trimester 妊娠
末 3月 .
•Note how it
displaces the
bowel
superiorly and
fills the lower
abdomen.
•This
unfortunate
woman died
accidentally,
and the baby
died too.
This is a normal postpartum 产后的 uterus 5 days
following delivery. Note how quickly the uterus is
returning to its normal non-pregnant size.
 Ectopic pregnancy
• Ectopic pregnancies occur when the fertilized
ovum 受精卵 implants outside of the
uterine fundus.
• About 1 in 150 pregnancies results in ectopic.
• Most cannot be sustained at extrauterine
sites.
• A tubal ectopic pregnancy may proceed for
several weeks.
• The enlargement can rupture and lead to
acute, life-threatening bleeding.
Half of ectopic pregnancies occur because of an
identifiable lesion
• chronic salpingitis from pelvic inflammatory
disease
• adhesions from appendicitis, endometriosis 内异
症 , or previous laparotomy 剖腹术 .
However, in half of cases no cause can be found.
 twin

This is a ruptured tubal ectopic pregnancy. Note the twin

fetuses at the lower right adjacent to the blood clot at the
left.
•Here is another ectopic pregnancy in a fallopian tube.
•This is a medical emergency because of the sudden rupture with
hemoperitoneum 腹腔 积血 .
•Ectopic pregnancy should be considered in the differential diagnosis of
acute abdominal pain in a woman of childbearing age.
Self-assessment
Regarding ectopic pregnancy:
 A it can always be detected by laparoscopy
 B it may co-exist with an intra-uterine device in
situ
 C It cannot survive beyond 16 wks
 D it is declining in frequency
 E the IUD confers protection against ectopic
pregnancy.
 Answers
 A.False. Laparoscopy occasionally fails
to detect a very early ectopic
pregnancy.
 B. true.it is extremely rare.
 C. False. Peritoneal cavity pregnancy
may survive to term 终止 .
 D. False. Incidence is increasing.
 E. False. IUD does not confer protection
against ectopic pregnancy.
 Ovarian tumor
 Tumor-like conditions
 Benign tumor
 Cancer
•This is an adult ovary with two corpora lutea 黄体 .
•The larger one is a hemorrhagic corpus 血体 luteum of menstruation.
•The smaller one is involuting 退化 from a previous menstrual period.
•Of 400,000 ovarian follicles present at birth, only about 400 will mature
to the point of ovulation during childbearing.
•A benign paratubal cyst.
•They are filled with clear serous fluid 浆液 and lined by
flattened cuboidal 立方形的 epithelium.
•Benign epithelial tumors of the ovary.
•The serous cystadenoma seen here fills a
surgical pan and dwarfs 使变 矮 the 4 cm
ruler.
•A ovarian papillary cystadenocarcinoma, with
papillations seen over the surface.
•Many of these ovarian tumors have metastasized.
•These neoplasms characteristically spread by "seeding"
along peritoneal surfaces.
•Here are bilateral fibrothecomas--benign ovarian
tumors.
•A right-sided hydrothorax 胸水 in association with
this tumor is known as Meig's
Here is an ovarian stromal tumor that is
hard and white and is a fibroma
•Benign serous cystadenoma
•Multiloculation 多房 的 . the inner surface is, smooth, with only a
solitary papillation 单乳头 的 at the upper right.
•A papillary serous cystadenocarcinoma.
•Many papillations on the inner surface.
•A granulosa 颗粒 cell tumor of ovary.
•These tumors are derived from the ovarian stroma.
•They are often hormonally active
•The patient may initially present with bleeding from
endometrial hyperplasia 增生 .
•A large unilateral mature cystic teratoma
•The uterus has an intramural and a subserosal
leiomyoma.
•The other ovary is replaced by a fibroma.
•Metastatic tumors to ovary are uncommon.
• "Krukenberg" tumor of ovary: a signet ring histologic
pattern and usually is metastatic from gastrointestinal tract.
 Self-assessment

Q: probably diagnosis?
 Self-assessment

Q: describe each parts

give your suspected diagnosis