Transcript The Reproductive System

The Reproductive System
MIS311 Imaging Pathology 2
Prepared by S. Beatty 1998
The Reproductive System
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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