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The Reproductive System MIS311 Imaging Pathology 2 Prepared by S. Beatty 1998 The Reproductive System • • • • • Infection and Inflammation Benign Growth & Proliferative Growth Female Infertility Disorders of the Male Reproductive System Disorders of the breast Infection & Inflammation Pelvic Inflammatory Disease (PID) • Any inflammatory condition of the female pelvic organs. • Usually caused through bacterial infection • Symptoms include: – fever, foul-smelling vaginal discharge, lower abdominal pain, pain with coitus. – If an abscess has developed then a fluid-filled mass may be palpated. PID • Fibrosis associated with PID may cause uterine tube blockage infertility. • Ultrasound is often used with diagnosis of PID and associated pelvic abscesses. • Hysterosalpingogram is still performed in checking uterine tube patency. PID • May involve any organ, or combinations of organs, of the upper genital tract: – uterus, fallopian tubes or ovaries – in severe form the entire peritoneal cavity. • Usually PID is caused by sexually transmitted microorganisms that migrate from the vagina to the uterus, fallopian tubes and the ovaries. PID Under Ultrasound PID Under Ultrasound PID Under Hysterosalpingogram PID Under Hysterosalpingogram Benign Growth and Proliferative Condition Benign Ovarian Cysts Benign Ovarian Cysts • Simple ovarian cysts are usually follicular or corpus luteum in origin. • Follicular cysts – Develops from a fominant ovarian follicle that does not release its own ovum but remains active – Not usually systematic – Usually require no treatment – They either regress or rupture spontaneously. Benign Ovarian Cysts • Symptoms include (if any): – Painful intercourse, chronic lower abdominal pain and menstrual irregularities. • Corpus Luteum Cysts – Develops from a mature corpus luteum - persists abnormally and continues to secrete progesterone. – The cyst contains blood or fluid that accumulates in the corpus luteum cavity. Benign Ovarian Cysts • Symptoms if any include: – Dull pelvic pain, delayed menstruation followed by irregular or heavier than normal bleeding. – Rupture can cause excruciating pain levels and requires immediate surgery – Oral contraceptives may be used to prevent cysts in the future Dermoid Cysts • The teratoma is the most common germ cell tumour and it contains a varying mixture of skin, hair, fatty elements and calcified teeth. Dermoid Cyst Dermoid Cyst Leiomyomas (Uterine Fibroids) • Benign tumours that develop from smooth muscle cells in the myometrium. • Most common benign tumours of the uterus. • Size of the tumour relates to hormonal fluctuations. Leiomyomas (Uterine Fibroids) Leiomyomas (Uterine Fibroids) • Characteristic mottled, mulberry, or popcorn type of appearance. • Able to be seen on plain abdominal x-ray as smooth or lobulated nodules with a stippled appearance. • A large Fibroid adenoma may occupy the entire pelvis. Leiomyomas (Uterine Fibroids) • I.V.P. – Persistent uterine opacification is seen in patients with underlying fibroid tumour. – The tumour typically presses on the fundus of the bladder, causing a lobulated impression usually seen with ovarian cysts. – Extension of a fibroid into the adjacent tissues may cause medial displacement of the pelvic ureter or ureteral compression leading to hydronephrosis. Leiomyomas (Uterine Fibroids) • Ultrasound shows a hypoechoic, solid contour-deforming mass in an enlarged inhomogenous uterus. Endometriosis • Most lesions are small and difficult to distinguish from normal tissue even when using modalities like CT and MRI. • This is the presence of normal appearing endometrium in sites other than their normal location inside the uterus. – Usually the ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum are most frequent, but the GI and Urinary tracts may also become affected. Endometriosis • Symptoms – Abdominal cramps, diarrhoea during menstruation and may appear either as single or multiple masses in the colon. – Endometriosis involving the urinary tract most commonly produces ureteral obstruction below the level of the pelvis brim. Cervical Cancer • May be detected in the early, curable stage by Pap test. • Increased manifestations may occur due to: – early age coitus, many sexual partners, genital herpes virus infections, poor obstetric and gynaecological care. – May be watery vaginal discharge or occasional spotting of blood. Cervical Cancer • Advanced lesions may have the following symptoms: – foul smelling vaginal discharge, leaking from bladder or rectal fistulas, anorexia, weight loss, back and leg pains. Cervical Cancer • Ultrasound usually demonstrates a cervical carcinoma as a solid echogenic mass behind the bladder. Cervical Cancer Cervical Cancer • CT is more accurate in detecting pelvic sidewall invasion and therefore is usually the initial staging procedure in patients in whom there is a clinical suspicion of advanced disease. • May show bladder invasion of carcinoma. Cervical Cancer Cervical Cancer Cervical Cancer • MRI can allow the cervix to be distinguished from the uterus and vagina. Cervical Cancer Endometrial Cancer • A malignant disease of the endometrium of the uterus • Most commonly occurs in the 5th or 6th decade of life. • Abnormal vaginal bleeding is the most common sign especially in a post menopausal woman • Endometrial lesions may invade the cervix but rarely the vagina. Endometrial Cancer • Typical Ultrasound appearance is an enlarged uterus with irregular areas of lowlevel echoes and bizarre clusters of highintensity echoes. Endometrial Cancer Endometrial Cancer • CT demonstrates focal or diffuse enlargement of the body of the uterus. Endometrial Cancer Endometrial Cancer • MRI allows differentiation of the endometrium (inner layer) from the myometrium (muscle layer) of the uterus and has been useful in demonstrating focal or diffuse endometrial tumours. Endometrial Cancer Ovarian Cancer • Asymptomatic in early stages and therefore it is often not detected until it has metastasised. • Cystadenocarcinoma of the ovary often shows on ultrasound examination as a large cystic mass with internal septa. • Difficult to distinguish from Cystadenoma. • They often calcify. Ovarian Cancer Ovarian Cancer Ovarian Cancer Disorders of the Male Reproductive System Penis Scrotum Testis Epididymis Disorders of the Penis • Phimosis – condition where the foreskin cannot be pulled back because it is too tight Phimosis Paraphimosis • This is where the foreskin cannot be moved forward to cover the glans Paraphimosis Peyronie Disease • Bent nail syndrome – fibrotic condition that causes lateral curvature of the penis during erection. – It develops slowly and is characterised by fibrous thickening of the fascia in the erectile tissue of the penis. – May cause pain on erection and intercourse. Peyronie Disease Priaprism • Prolonged penile erection – usually painful and not associated with arousal. Priaprism Balanitis • Inflammation of the Glans penis. • Associated with poor hygiene and phimosis. • Circumcision may prevent further recurrence. Balanitis Penile Cancer • Very rare 1% of all malignancies. • Usually occurs in unhygienic people who are not circumcised. • Unknown origin. • Thought to develop as a result of chronic irritation caused by smegma beneath a phimotic foreskin. • Velvety, ulcerative lesions to large scaly growths. • Usually affects the penile shaft. Penile Cancer • 30% of penis cancers spread to lymph nodes before diagnosis. • Distant metastases occur in less than 10% of cases. Cancer of the Testis • One of the most curable cancers. (95%) • The most common tumour of young men (15 to 34 years of age). • Cause is unknown – trauma and infection-related testicular atrophy have been associated with testicular tumours. Cancer of the Testis Epididymitis • Inflammation of the epididymitis – Usually occurs in sexually active males. – The usual case is a sexually transmitted disease which causes Epididymitis. Epididymitis Carcinoma of the prostate • More than 95% of prostatic neoplasms are adenocarcinomas, and most occur in the periphery of the prostate. • 42% of all cancer in men. • Cause is not well understood. – Genetic predisposition – Diet related Carcinoma of the prostate Carcinoma of the prostate Carcinoma of the prostate Carcinoma of the prostate Metastatic Carcinoma of Prostate Metastatic Carcinoma of the prostate Disorders of the Breast Breast Cancer Benign Breast Disease Breast Cancer • Most Common malignancy among women. • Mammograms providing compression and magnification techniques greatly improve the diagnostic value of an image. • Typically the malignant tumour mass is poorly defined, has irregular margins, and demonstrates numerous fine linear strands radiating out from the mass. Breast Cancer As Opposed to Benign Breast Masses Breast Cancer • May appear as numerous tiny calcifications with linear, curvilinear, and branching forms of malignancy. Breast Cancer Breast Cancer • Ultrasound can differentiate a benign cyst from a solid mass. • Ultrasound however is not good in detecting nonpalpable cancers, particularly with those presenting with calcifications alone. Breast Cancer Sexually Transmitted Infections •Bacterial Infections –Gonorrhoea – Syphilis •Hepatitis B •AIDS Gonorrhoea • Bacterial infection which is the most common bacterial infection that is one of the most widespread of the venereal diseases. • Symptoms usually include acute urethritis with copious discharge of pus in men. • In women they may get urethral or cervical inflammation and usually symptoms are minimal. Gonorrhoea Gonorrhoea • Gonorrhoeal infection can cause septic arthritis leading to articular erosion and joint space narrowing. • Infection may lead to stenosis or stricture of the urethra. Gonorrhoea Syphilis • Chronic sexually transmitted systemic infection caused by the spirochaete bacterium. • May be passed on to newborn baby. • In the primary stage of the disease – a chancre or ulceration develops on the genitals. Syphilis Syphilis • If untreated with antibiotics, the second phase appears as a non-itching rash on any part of the body. (6 weeks) Syphilis Syphilis • Condylomata lata lesions may appear also which are watery, flat, moist, wartlike lesions. – These lesions are highly contagious. Syphilis Syphilis Syphilis • Cardiovascular Syphilis primarily involves the ascending aorta (tertiary phase). • Syphilis is major cause of neuropathic joint disease in which bone resorption and total disorganisation of the joint with associated with calcification and bony debris. Syphilis Syphilis Syphilis Genital herpes (Viral Infection) • Causes blisters (cold sores) is the most common infectious genital infection. • Transmitted through intimate contact. • May be transmitted through a secreting lesion or mucosal surface. Genital herpes Condylomata Acuminata • Genital Warts. • Caused by the human papilloma virus (HPV). • HPV infection is closely associated with multiple sexual partners and early onset of sexual activity. • These warts are quite contagious. Condylomata Acuminata Topics covered previously: • HIV Virus • Hepatitis B Infections THE END OF THE REPRODUCTIVE SYSTEM