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Pathology - Pelvic Inflammatory Disease
Common causes are Chlamydia trachomatis (subacute), Neisseria gonorrhoeae (acute), Gardnerella vaginalis, and Trichomonas vaginalis.
Typically seen in young women who have not given birth and are sexually active with several partners.
The Fallopian tubes exhibit swelling of the outer layer with fibrin covering, pus inside the tube, which can lead to the formation of a pyosalpinx or a hydrosalpinx.
Infection can also affect the ovaries and other pelvic structures.
Symptoms include high fever, lower abdomen pain, cervical motion soreness (chandelier sign), purulent cervical discharge, and right upper quadrant (RUQ) pain indicating perihepatitis (Fitz-Hugh-Curtis syndrome).
Sequelae of previous pelvic inflammatory disease (PID) may involve subsequent ectopic pregnancy, infertility, chronic pelvic pain, and adhesions.
Antibiotics are efficient against the organism that causes the infection.
Ectopic pregnancy commonly happens in the fallopian tubes but can also occur in the ovary, abdominal cavity, or cervix. Risk factors include of a history of salpingitis, endometriosis, or tubal ligation. Symptoms include abdominal pain occurring 6 weeks after the previous menstruation, vaginal bleeding, and increased levels of hCG, which are below the typical range for the stage of pregnancy.
Common causes are Chlamydia trachomatis (subacute), Neisseria gonorrhoeae (acute), Gardnerella vaginalis, and Trichomonas vaginalis.
Typically seen in young women who have not given birth and are sexually active with several partners.
The Fallopian tubes exhibit swelling of the outer layer with fibrin covering, pus inside the tube, which can lead to the formation of a pyosalpinx or a hydrosalpinx.
Infection can also affect the ovaries and other pelvic structures.
Symptoms include high fever, lower abdomen pain, cervical motion soreness (chandelier sign), purulent cervical discharge, and right upper quadrant (RUQ) pain indicating perihepatitis (Fitz-Hugh-Curtis syndrome).
Sequelae of previous pelvic inflammatory disease (PID) may involve subsequent ectopic pregnancy, infertility, chronic pelvic pain, and adhesions.
Antibiotics are efficient against the organism that causes the infection.
Ectopic pregnancy commonly happens in the fallopian tubes but can also occur in the ovary, abdominal cavity, or cervix. Risk factors include of a history of salpingitis, endometriosis, or tubal ligation. Symptoms include abdominal pain occurring 6 weeks after the previous menstruation, vaginal bleeding, and increased levels of hCG, which are below the typical range for the stage of pregnancy.
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Pathology - Placental Attachment Abnormalities (Abruptio Placentae, Placenta Previa, Placenta Accreta)
Abruptio placentae can be linked to disseminated intravascular coagulation (DIC) and has a higher risk when combined with smoking, cocaine use, and hypertension.
Placenta accreta is more likely to occur in individuals with previous C-section scars or endometrial irritation.
Placenta previa is more likely to occur in individuals with previous C-section scars.
Abruptio placentae refers to the premature detachment of the placenta.
Placenta accreta occurs when a faulty decidual layer enables the placenta to connect directly to the myometrium.
Placenta previa is when the placenta attaches to the lower part of the uterus or cervix, potentially blocking the cervical opening, and it can occur alongside placenta accreta.
Abruptio placentae is characterized by painful uterine bleeding typically occurring in the third trimester and may lead to fetal death.
Placenta accreta leads to significant bleeding following childbirth.
Placenta previa is characterized by painless bleeding during any trimester and can lead to premature childbirth.
Abruptio placentae requires immediate delivery of the fetus and management of maternal hemorrhage.
Hysterectomy may be required to halt bleeding in cases with placenta accreta.
Placenta previa may need bed rest and potential hospitalization.
Abruptio placentae can be linked to disseminated intravascular coagulation (DIC) and has a higher risk when combined with smoking, cocaine use, and hypertension.
Placenta accreta is more likely to occur in individuals with previous C-section scars or endometrial irritation.
Placenta previa is more likely to occur in individuals with previous C-section scars.
Abruptio placentae refers to the premature detachment of the placenta.
Placenta accreta occurs when a faulty decidual layer enables the placenta to connect directly to the myometrium.
Placenta previa is when the placenta attaches to the lower part of the uterus or cervix, potentially blocking the cervical opening, and it can occur alongside placenta accreta.
Abruptio placentae is characterized by painful uterine bleeding typically occurring in the third trimester and may lead to fetal death.
Placenta accreta leads to significant bleeding following childbirth.
Placenta previa is characterized by painless bleeding during any trimester and can lead to premature childbirth.
Abruptio placentae requires immediate delivery of the fetus and management of maternal hemorrhage.
Hysterectomy may be required to halt bleeding in cases with placenta accreta.
Placenta previa may need bed rest and potential hospitalization.
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Pathology - Preeclampsia and Eclampsia
Risk factors include of underlying hypertension, diabetes, chronic renal illness, autoimmune disorders, or twin gestation.
Occurs in 5%-10% of pregnant women, typically in the third trimester of their first pregnancy.
Evidence of infarction, retroplacental hematomas, reduced vascularity, and fibrinoid necrosis observed in the placenta.
Pathophysiology: An inherent flaw in the invading cytotrophoblast causes the restructuring of the uterine vasculature, resulting in placental ischemia. Reduced placental perfusion triggers vasoconstrictive effects that contribute to toxemic hypertension in vulnerable women.
Preeclampsia is characterized by a triad of hypertension, proteinuria, and edema, along with symptoms such as headache, hazy vision, and stomach pain.
Eclampsia is characterized by the presence of seizures, impaired mental state, hyperreflexia, and perhaps disseminated intravascular coagulation (DIC) in addition to the triad of symptoms seen in preeclampsia.
Laboratory results indicate thrombocytopenia, increased liver function tests, hyperuricemia, and hemolytic anemia.
Therapy
Treatment for preeclampsia includes delivering the fetus promptly, bed rest, limiting salt intake, and managing hypertension.
Eclampsia is a medical emergency that requires treating seizures with intravenous magnesium sulfate and diazepam, followed by delivering the fetus.
HELLP syndrome is a severe form of preeclampsia characterized by hemolysis, increased liver function tests, and low platelet count.
Risk factors include of underlying hypertension, diabetes, chronic renal illness, autoimmune disorders, or twin gestation.
Occurs in 5%-10% of pregnant women, typically in the third trimester of their first pregnancy.
Evidence of infarction, retroplacental hematomas, reduced vascularity, and fibrinoid necrosis observed in the placenta.
Pathophysiology: An inherent flaw in the invading cytotrophoblast causes the restructuring of the uterine vasculature, resulting in placental ischemia. Reduced placental perfusion triggers vasoconstrictive effects that contribute to toxemic hypertension in vulnerable women.
Preeclampsia is characterized by a triad of hypertension, proteinuria, and edema, along with symptoms such as headache, hazy vision, and stomach pain.
Eclampsia is characterized by the presence of seizures, impaired mental state, hyperreflexia, and perhaps disseminated intravascular coagulation (DIC) in addition to the triad of symptoms seen in preeclampsia.
Laboratory results indicate thrombocytopenia, increased liver function tests, hyperuricemia, and hemolytic anemia.
Therapy
Treatment for preeclampsia includes delivering the fetus promptly, bed rest, limiting salt intake, and managing hypertension.
Eclampsia is a medical emergency that requires treating seizures with intravenous magnesium sulfate and diazepam, followed by delivering the fetus.
HELLP syndrome is a severe form of preeclampsia characterized by hemolysis, increased liver function tests, and low platelet count.
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Pathology - Hydatidiform Mole and Gestational Choriocarcinoma
Hydatidiform mole (HM) occurs as a result of embryonic chromosomal anomalies. A complete mole has a chromosomal makeup of 46, XX, with all chromosomes originating from the sperm. A partial mole is triploid (69, XXY) or tetraploid, typically resulting from the fertilization of an ovum by several sperm.
Gestational choriocarcinoma (GC) is more common in Asia and Africa and is typically preceded by a complete hydatidiform mole, abortions, or ectopic or normal pregnancies.
HM: Features include edematous chorionic villi with cystic swelling forming grapelike clusters, hyperplasia of trophoblastic cells, honeycombed appearance of the uterus, and lack of fetal components. Partial findings include swollen villi and the presence of embryonic body components.
GC :A tumor including necrotic and hemorrhagic patches made up of cells resembling syncytiotrophoblasts and cytotrophoblasts, with potential endometrial penetration.
HM: may manifest as nausea and vomiting, painless vaginal bleeding typically occurring in the first trimester, enlarged uterus for gestational age, and maybe hypertension in the first trimester.
Ultrasound shows a snowstorm look without detection of fetal or placental components.
GC:Excessive vaginal bleeding following the removal of a mole or after giving birth/miscarriage; hemoptysis caused by early spread of the condition to the lungs through the blood.
Laboratory results: Elevated serum hCG levels for the stage of pregnancy (HM and GC).
Performing immediate uterine evacuation via suction.
GC: Surgical excision; chemotherapy.
Hydatidiform mole (HM) occurs as a result of embryonic chromosomal anomalies. A complete mole has a chromosomal makeup of 46, XX, with all chromosomes originating from the sperm. A partial mole is triploid (69, XXY) or tetraploid, typically resulting from the fertilization of an ovum by several sperm.
Gestational choriocarcinoma (GC) is more common in Asia and Africa and is typically preceded by a complete hydatidiform mole, abortions, or ectopic or normal pregnancies.
HM: Features include edematous chorionic villi with cystic swelling forming grapelike clusters, hyperplasia of trophoblastic cells, honeycombed appearance of the uterus, and lack of fetal components. Partial findings include swollen villi and the presence of embryonic body components.
GC :A tumor including necrotic and hemorrhagic patches made up of cells resembling syncytiotrophoblasts and cytotrophoblasts, with potential endometrial penetration.
HM: may manifest as nausea and vomiting, painless vaginal bleeding typically occurring in the first trimester, enlarged uterus for gestational age, and maybe hypertension in the first trimester.
Ultrasound shows a snowstorm look without detection of fetal or placental components.
GC:Excessive vaginal bleeding following the removal of a mole or after giving birth/miscarriage; hemoptysis caused by early spread of the condition to the lungs through the blood.
Laboratory results: Elevated serum hCG levels for the stage of pregnancy (HM and GC).
Performing immediate uterine evacuation via suction.
GC: Surgical excision; chemotherapy.
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Pathology- Varicocele, Hydrocele and Spermatocele
Varicocele
Definition: Enlargement of the network of veins in the scrotum known as the pampiniform venous plexus.
Clinical symptoms: Linked to infertility due to elevated heat from blood collection, potentially harming sperm; some individuals may have scrotal soreness.
Treatment: Surgery for infertility causes
Varicocele
Definition: Enlargement of the network of veins in the scrotum known as the pampiniform venous plexus.
Clinical symptoms: Linked to infertility due to elevated heat from blood collection, potentially harming sperm; some individuals may have scrotal soreness.
Treatment: Surgery for infertility causes
Hydrocele
Hydrocele is a condition characterized by the accumulation of fluid in the tunica vaginalis of the scrotum, typically found on the front and side of the testicle. It occurs when there is a continuous passage between the processus vaginalis and the scrotum, allowing peritoneal fluid to enter. In some cases, hydrocele can also be a result of infection by Wuchereria bancrofti.
Clinical presentation: Appears as a painless swelling of the scrotum that is transparent when examined with a flashlight.
Treatment: Monitoring.
Spermatocele
Spermatocele is the accumulation of sperm within the testes, typically located near the head of the epididymis on the superior surface of the testicle.
Clinical manifestations: Usually asymptomatic; transparent upon flashlight examination.
Treatment: Monitoring.
Failure of a scrotal anomaly to transilluminate is suggestive of a solid lesion and requires further investigation with ultrasonography.
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Pathology - Testicular Germ Cell Tumors
Risk factors comprise cryptorchidism, genetic factors, and testicular dysgenesis.
Seminoma(S) is the most prevalent type and is similar to ovarian dysgerminoma.
Embryonal carcinoma (EC) is the second most prevalent kind.
Endodermal sinus tumor (yolk sac tumor) (EST) is more prevalent in newborns and children.
Teratoma (T) accounts for 30% of all testicular tumors.
Choriocarcinoma (CC) is the most aggressive kind of cancer.
Seminoma consists of uniform cells with well-defined cell membranes, transparent cytoplasm, and a prominent nucleus.
Embryonal Carcinoma : Glandular or tubular cell patterns with papillary folds.
There is a mesodermal core with layers that resemble those found in primitive glomeruli (Endodermal sinus ( yolk tumor /EST)
Teratoma (T): Teratomas derived from many embryonic layers are usually malignant, unlike ovarian dermoid cysts.
Choriocarcinoma (CC): Sheets/cords of cells resembling syncytiotrophoblasts and cytotrophoblasts with transparent cytoplasm.
Symptom and Signs
Seminoma: Pain-free testicular swelling or lump that does not allow light to pass through upon inspection with a flashlight.
Embryonal Carcinoma : Painful testicular tumor frequently associated with metastases.
Endometrial Sinus Tumor :Testicular mass appears before the age of 3.
Teratoma :Symptoms include a painful bulge in the testes and gynecomastia.
Choriocarcinoma:Chief Complaint: Pain-free, nodular swelling in the testicles; development of breast tissue in males; presence of enlarged lymph nodes above the collarbone (if cancer has spread). Laboratory results show elevated levels of hCG in (S,EC,T,CC) samples, as well as elevated levels of AFP in (EST and T)
Therapy
Treatment options include radiotherapy, chemotherapy, and radical inguinal orchectomy. Testicular cancers predominantly affect Caucasian males aged 15 to 34.
Risk factors comprise cryptorchidism, genetic factors, and testicular dysgenesis.
Seminoma(S) is the most prevalent type and is similar to ovarian dysgerminoma.
Embryonal carcinoma (EC) is the second most prevalent kind.
Endodermal sinus tumor (yolk sac tumor) (EST) is more prevalent in newborns and children.
Teratoma (T) accounts for 30% of all testicular tumors.
Choriocarcinoma (CC) is the most aggressive kind of cancer.
Seminoma consists of uniform cells with well-defined cell membranes, transparent cytoplasm, and a prominent nucleus.
Embryonal Carcinoma : Glandular or tubular cell patterns with papillary folds.
There is a mesodermal core with layers that resemble those found in primitive glomeruli (Endodermal sinus ( yolk tumor /EST)
Teratoma (T): Teratomas derived from many embryonic layers are usually malignant, unlike ovarian dermoid cysts.
Choriocarcinoma (CC): Sheets/cords of cells resembling syncytiotrophoblasts and cytotrophoblasts with transparent cytoplasm.
Symptom and Signs
Seminoma: Pain-free testicular swelling or lump that does not allow light to pass through upon inspection with a flashlight.
Embryonal Carcinoma : Painful testicular tumor frequently associated with metastases.
Endometrial Sinus Tumor :Testicular mass appears before the age of 3.
Teratoma :Symptoms include a painful bulge in the testes and gynecomastia.
Choriocarcinoma:Chief Complaint: Pain-free, nodular swelling in the testicles; development of breast tissue in males; presence of enlarged lymph nodes above the collarbone (if cancer has spread). Laboratory results show elevated levels of hCG in (S,EC,T,CC) samples, as well as elevated levels of AFP in (EST and T)
Therapy
Treatment options include radiotherapy, chemotherapy, and radical inguinal orchectomy. Testicular cancers predominantly affect Caucasian males aged 15 to 34.
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Pathology - Testicular Sex Cord–Gonadal Stroma Tumors
Primarily benign tumors originating from sex cord stroma.
Similar to Sertoli-Leydig cell ovarian cancers.
Typically observed in individuals aged 20 to 60.
Pathology
Leydig cell tumor is characterized by small yellowish-brown nodules made up of polygonal cells with eosinophilic cytoplasm and round nucleus. It also contains distinctive intracytoplasmic Reinke crystals, which are rod-shaped crystalloids. These tumors typically generate androgens and estrogens.
Sertoli cell tumor is a solid mass made up of tumor cells organized in trabeculae and cord structures resembling seminiferous tubules.
Clinical Symptoms and Signs
Testicular swelling or nodule that does not show light passing through during a flashlight examination.
Leydig cell tumors can cause early puberty in children or breast enlargement in adults.
Therapy
Treatment options include radiotherapy, chemotherapy, and radical inguinal orchectomy.
Testicular lymphomas make about 5% of testicular neoplasms and are the most prevalent type of testicular cancer in men over the age of 60.
Primarily benign tumors originating from sex cord stroma.
Similar to Sertoli-Leydig cell ovarian cancers.
Typically observed in individuals aged 20 to 60.
Pathology
Leydig cell tumor is characterized by small yellowish-brown nodules made up of polygonal cells with eosinophilic cytoplasm and round nucleus. It also contains distinctive intracytoplasmic Reinke crystals, which are rod-shaped crystalloids. These tumors typically generate androgens and estrogens.
Sertoli cell tumor is a solid mass made up of tumor cells organized in trabeculae and cord structures resembling seminiferous tubules.
Clinical Symptoms and Signs
Testicular swelling or nodule that does not show light passing through during a flashlight examination.
Leydig cell tumors can cause early puberty in children or breast enlargement in adults.
Therapy
Treatment options include radiotherapy, chemotherapy, and radical inguinal orchectomy.
Testicular lymphomas make about 5% of testicular neoplasms and are the most prevalent type of testicular cancer in men over the age of 60.
Sertoli Cell Tumor
Leydig Cell Tumor
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Pathology - Acute Bacterial Prostatitis
Primarily caused by gram-negative rods such as E. coli, Proteus mirabilis, Klebsiella, or Enterobacter, as well as N. gonorrhoeae or Enterococcus.
Risk factors comprise urinary tract infection, Foley catheterization, and recent transurethral surgery or cystoscopy.
Pathology: The prostate gland is enlarged due to edema and congestion.
Microscopic examination reveals an inflammatory infiltration, typically lymphocytic, in the prostate stroma that may extend into the glandular regions.
Manifests with fever, dysuria, and perineal discomfort. Experiencing pain with a noticeable sensitive prostate upon examination. May sometimes be linked to urinary retention.
Possible complications involve the formation of a prostatic abscess or the presence of chronic prostatitis.
Laboratory results: Leukocytes detected in urinalysis; urine culture shows positive results.
Antibiotic treatment targeting the responsible bacterium often lasts for 30 days to prevent problems.
Chronic bacterial prostatitis can occur as a consequence of inadequate treatment of acute bacterial prostatitis. Patients exhibit genitourinary discomfort, dysuria, frequent urination, and recurring UTIs. Diagnosis is confirmed by detecting bacteria in produced prostatic secretions or urine culture following prostatic massage, comparable to those found in acute bacterial prostatitis. Treatment involves a 4- to 12-week regimen of antibiotics.
Primarily caused by gram-negative rods such as E. coli, Proteus mirabilis, Klebsiella, or Enterobacter, as well as N. gonorrhoeae or Enterococcus.
Risk factors comprise urinary tract infection, Foley catheterization, and recent transurethral surgery or cystoscopy.
Pathology: The prostate gland is enlarged due to edema and congestion.
Microscopic examination reveals an inflammatory infiltration, typically lymphocytic, in the prostate stroma that may extend into the glandular regions.
Manifests with fever, dysuria, and perineal discomfort. Experiencing pain with a noticeable sensitive prostate upon examination. May sometimes be linked to urinary retention.
Possible complications involve the formation of a prostatic abscess or the presence of chronic prostatitis.
Laboratory results: Leukocytes detected in urinalysis; urine culture shows positive results.
Antibiotic treatment targeting the responsible bacterium often lasts for 30 days to prevent problems.
Chronic bacterial prostatitis can occur as a consequence of inadequate treatment of acute bacterial prostatitis. Patients exhibit genitourinary discomfort, dysuria, frequent urination, and recurring UTIs. Diagnosis is confirmed by detecting bacteria in produced prostatic secretions or urine culture following prostatic massage, comparable to those found in acute bacterial prostatitis. Treatment involves a 4- to 12-week regimen of antibiotics.
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Pathology - Benign Prostatic Hyperplasia
Resulting from elevated estradiol levels associated with aging.
Prevalent in males over 50 years old (impacts 90% of men by age 70).
Pathophysiology: Elevated estradiol levels stimulate the expression of receptors for DHT, resulting in prostate enlargement.
Prostate enlargement characterized by a rubbery, nodular growth in the periurethral and transurethral zones (middle and lateral lobes).
Microscopic: Both glandular and fibromuscular stromal components exhibit hyperplasia.
Manifests with frequent urination, nighttime urination, painful urination, and challenges initiating and stopping urine flow due to nodules compressing the urethra.
Complications may involve urinary blockage resulting in kidney failure, enlarged bladder, kidney swelling, ureter swelling, and urinary tract infections.
Laboratory results: Elevated total prostate-specific antigen (PSA) levels with a corresponding rise in the percentage of free PSA.
Treatment includes finasteride, a 5-alpha-reductase inhibitor; tamsulosin, a 1 blocker; and transurethral resection of the prostate (TURP) for severe instances.
Benign prostatic hyperplasia (BPH) is the most common cause of urinary tract blockage in men and is not considered a condition that leads to cancer.
Resulting from elevated estradiol levels associated with aging.
Prevalent in males over 50 years old (impacts 90% of men by age 70).
Pathophysiology: Elevated estradiol levels stimulate the expression of receptors for DHT, resulting in prostate enlargement.
Prostate enlargement characterized by a rubbery, nodular growth in the periurethral and transurethral zones (middle and lateral lobes).
Microscopic: Both glandular and fibromuscular stromal components exhibit hyperplasia.
Manifests with frequent urination, nighttime urination, painful urination, and challenges initiating and stopping urine flow due to nodules compressing the urethra.
Complications may involve urinary blockage resulting in kidney failure, enlarged bladder, kidney swelling, ureter swelling, and urinary tract infections.
Laboratory results: Elevated total prostate-specific antigen (PSA) levels with a corresponding rise in the percentage of free PSA.
Treatment includes finasteride, a 5-alpha-reductase inhibitor; tamsulosin, a 1 blocker; and transurethral resection of the prostate (TURP) for severe instances.
Benign prostatic hyperplasia (BPH) is the most common cause of urinary tract blockage in men and is not considered a condition that leads to cancer.
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Pathology - Endometrial Carcinoma
Risk factors comprise unopposed estrogen use, obesity, diabetes, hypertension, nulliparity, and late menopause.
The highest occurrence is often observed between the ages of 55 and 65.
Endometrial carcinoma is the most prevalent gynecologic malignancy.
Usually occurs after endometrial hyperplasia.
Gross: Either a localized polypoid tumor or a widespread tumor affecting the entire uterine surface.
Adenocarcinoma is identified by distinct gland patterns formed by malignant stratified columnar epithelial cells, with the possibility of observing some squamous cells.
Manifests as postmenopausal vaginal bleeding, facilitating early detection; can result in cervical blockage with accumulation of pus (pyometra) or blood (hematometra), leading to lower abdomen pain.
Therapy
Complete removal of the uterus, fallopian tubes, and ovaries; treatment with radiation therapy and chemotherapy for symptom relief.
Endometrial hyperplasia is the abnormal growth of endometrial glands due to an excess of estrogen, which can be caused by conditions such as polycystic ovarian syndrome, estrogen-secreting ovarian tumors, or estrogen replacement treatment. It presents clinically with postmenopausal vaginal bleeding and can result in endometrial cancer based on the level of atypia.
Risk factors comprise unopposed estrogen use, obesity, diabetes, hypertension, nulliparity, and late menopause.
The highest occurrence is often observed between the ages of 55 and 65.
Endometrial carcinoma is the most prevalent gynecologic malignancy.
Usually occurs after endometrial hyperplasia.
Gross: Either a localized polypoid tumor or a widespread tumor affecting the entire uterine surface.
Adenocarcinoma is identified by distinct gland patterns formed by malignant stratified columnar epithelial cells, with the possibility of observing some squamous cells.
Manifests as postmenopausal vaginal bleeding, facilitating early detection; can result in cervical blockage with accumulation of pus (pyometra) or blood (hematometra), leading to lower abdomen pain.
Therapy
Complete removal of the uterus, fallopian tubes, and ovaries; treatment with radiation therapy and chemotherapy for symptom relief.
Endometrial hyperplasia is the abnormal growth of endometrial glands due to an excess of estrogen, which can be caused by conditions such as polycystic ovarian syndrome, estrogen-secreting ovarian tumors, or estrogen replacement treatment. It presents clinically with postmenopausal vaginal bleeding and can result in endometrial cancer based on the level of atypia.
