1. Female Genital Tract 1-Vulva 2-Vagina 3-Cervix 4-Uterine corpus
5-Ovary
6-Placenta

2. Vulva

4. Vulva
1-Vulvitis
2-Non-neoplastic epithelial disorders
3-Tumor

7. Vulvar Leukoplakia Causes of vulvar leukoplakia:
1-Vitiligo (loss of pigment)
2-Inflammatory dermatosis: e.g. psoriasis
3-Squamous intraepithelial neoplasms of the vulva (VIN) and invasive carcinoma
4-Paget’s disease

8. 3-Vulvar Tumors 1-Condyloma 2-Intaepithelial V. Neoplasia
3--Vulvar carcinoma
4-Extramammary Paget’s disease
5-Melanoma

9. Vulvar Intraepithelial Neoplasia (VIN)
VIN I: mild dysplasia, lower third.
VIN II: moderate dysplasia, lower two thirds.
VIN III (CIS): Severe dysplasia, full thickness.

10. Vulvar Carcinoma Stromal invasion.
1-3% of all female genital cancers, > 60 years of age.
2-Increasing Incidence of VIN (40-60 y).
3-90% of malignancies are squamous cell carcinomas, 10%: adenocarcinomas, basal cell carcinomas, and melanomas.

11. Vulvar Carcinoma
Initially a leukoplakia-type lesion, progresses to overt exophytic (elevated) or endophytic (ulcerated) lesion.
Management and prognosis depend on size of tumor, depth of invasion, lymphatic involvement , and presence of metastasis.
STAGE
5 year survival:
Stage I (tumor < 2 cm): 60-80%
Larger tumor with metastasis: 10%

12. Local excision, radical vulvectomy, groin/pelvic LN dissection
Vulvar Carcinoma
Surgery: treatment of choice for early stage lesions
Local excision, radical vulvectomy, groin/pelvic LN dissection
Radiotherapy: stage III and IV tumors
Chemotherapy: Metastatic disease (low response rate)

13. Vaginal Intraepithelial Neoplasia (VAIN) and Carcinoma
Uncommon, VAIN are graded I, II, and III (~VIN)
Elderly females (>60 y)
Preexisting or concurrent cervical or vulvar Neoplasia or carcinoma is sometimes present.

15. Endocervical polyp Inflammatory polypoid masses.
Smooth surface composed of columnar mucus-secreting cells (endocervical epithelium) with underlying cystically dilated glands filled with mucus. Stromal edema inflammatory mononuclear cells.
Squamous metaplasia and ulceration.

16. Cervical Intraepithelial Neoplasia (CIN) and Carcinoma
Importance of early detection, adequate follow up and management.
Histologic grading of precursor lesions:
CIN I: Mild dysplasia
CIN II: Moderate dysplasia
CIN III : Severe dysplasia/carcinoma in situ

19. Cervical Intraepithelial Neoplasia (CIN) and Carcinoma
Cytologic grading of precursor lesions
1) LOW GRADE SQUAMOUS INTRAEPITHELIAL LESIONS
[CIN I and Condylomas (koilocytosis)]
2) HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESIONS
[CIN II, CIN III/CIS]

20. Cervical Intraepithelial Neoplasia (CIN) and Carcinoma
Peak incidence
CIN : 30 Y
Invasive carcinoma: 45 y
Risk factors
1-Early age at first intercourse
2-Multiple sexual partners
3-A male partner with multiple previous sexual partners

22. Invasive Carcinoma of the Cervix
80-95%: Squamous cell carcinomas
Multifactorial disease
Preventable
Gross (macroscopic appearance)
Fungating (exophytic)
Ulcerative (endophytic)
Infiltrative