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HUMAN REPRODUCTION

♀ ♂
Irene Maria Elena, MD
Obstetrics and Gynecology Department
FK UKRIDA
Reproductive Health
• The WHO defines reproductive health as a state
of complete physical, mental and social well-
being, and not merely the absence of
reproductive disease or infirmity.
• Reproductive health involves all of the
reproductive processes, functions and systems at
all stages of human life.
• This definition implies that people are able to
have a satisfying and safe sex life and that they
have the capability to reproduce and the freedom
to decide if, when and how often to do so.
• Kesehatan Reproduksi , adalah kondisi sehat
menyangkut sistem, fungsi, dan proses alat
reproduksi yang dimiliki .

• Sehat tidak semata-mata berarti bebas


penyakit atau bebas dari kecacatan,
melainkan juga sehat secara mental, sosial
dan kultural
Male VS Female

What’s the different?


Female Reproductive System
• Female reproductive organs are for
intercourse, reproduction, urination
pregnancy and childbirth.

• The female reproductive pathway is


comprised of the vagina, uterus, fallopian
tubes, and ovaries.
• Ovaries – where egg is produced
• Oviduct (Fallopian tube) – where fertilization
takes place
• Uterus – where the embryo grows and
develops
• Vagina – birth canal
Male Reproductive System
• Sperm are the male reproductive cells
• The penis is the male organ used in sexual
intercourse
• The testes are where sperm are produced
• The scrotum contains the testes and controls
temperature for sperm development
WHO : The Different Components of
Reproductive Health Research
INFERTILITY
• Infertility is a disease of the reproductive
system defined by the failure to achieve a
clinical pregnancy after 12 months or more of
regular unprotected sexual intercourse
• Primary infertility
When a woman is unable to ever bear a child,
either due to the inability to become pregnant
or the inability to carry a pregnancy to a live
birth
• Thus women whose pregnancy spontaneously
miscarries, or whose pregnancy results in a
still born child, without ever having had a live
birth would present with primarily infertility.
• Secondary infertility
When a woman is unable to bear a child,
either due to the inability to become pregnant
or the inability to carry a pregnancy to a live
birth following either a previous pregnancy or
a previous ability to carry a pregnancy to a live
birth, she would be classified as having
secondary infertility
Increase Risk
• Age
• Stress
• Poor diet
• Smoking
• Alcohol
• STDs
• Overweight
• Underweight
• Caffeine intake
• Too much exercise
Infertility
ETIOLOGY DIAGNOSIS
OVULATORY DISFUNCTION PCOS
HYPOTALAMIC PITUITARY
AGE RELATED
PREMATURE OVARIAN FAILURE
TUBAL DISEASE PELVIC INFLAMMATORY DISEASE
UTERINE ABNORMALITIES CONGENITAL
LEIOMYOMA
ASHERMAN SYNDROME
OTHER ENDOMETRIOSIS
Polycystic Ovarian Disease
• Short-term consequences
1. Irregular menses
2. Hirsutism/acne/androgenic alopecia
3. Infertility
4. Obesity
5. Metabolic disturbances
6. Abnormal lipid levels/glucose intolerance
• Long-term consequences
1. Diabetes mellitus
2. Cardiovascular disease
3. Endometrial cancer
Signs and Symptoms
• Menstrual dysfunction : amenorrhea to
oligomenorrhea to episodic
menometrorrhagia with anemia
• Hyperandrogenism : hirsutism, acne, and/or
androgenic alopecia
Premature Ovarian Failure
• The term hypergonadotropic hypogonadism
refers to any process in which ovarian function is
decreased or absent (hypogonadism)
• Due to a lack of negative feedback, the
gonadotropins, LH and FSH, have increased levels
(hypergonadotropic)
• This category of disorders implies primary
dysfunction at the level of the ovary, rather than
centrally at the hypothalamus or pituitary
• Premature ovarian failure is defined as loss of
oocytes and the surrounding support cells
prior to age 40 years
• The diagnosis is determined by two serum FSH
levels greater than 40 mIU/mL that are
obtained at least 1 month apart
Pelvic Inflammatory Disease
• Pelvic inflammatory disease (PID) is an infection of the
upper reproductive tract organs
• Another diagnosis given to this disease is acute salpingitis
• Is usually the result of infection ascending from the
endocervix. Includes any combination of endometritis,
salpingitis, oophoritis, myometritis, parametritis,
tuboovarian abscess and pelvic peritonitis.
• While sexually transmitted infections (STIs) such as
Chlamydia trachomatis and Neisseria gonorrhoeae have
been identified as causative agents, additional STIs
including Mycoplasma genitalium, anaerobes and other
organisms may also be implicated
• Approximately 85% of infections are spontaneous in
sexually active females
• 15% develop following procedures that break the
cervical mucus barrier, allowing the vaginal flora the
opportunity to colonize the upper genital tract which
includes endometrial biopsy, curettage, IUD insertion,
HSG and hysteroscopy
• If found in the postmenopausal woman associated
conditions such as genital malignancies, diabetes,
and/or concurrent intestinal diseases such as
diverticulitis, appendicitis, or carcinoma are usually
discovered
• Upper tract infection is believed to be caused by
bacteria from the lower reproductive tract that
ascend into the upper tract
• It is assumed that ascension of bacteria into the
upper tract is enhanced during menstruation due
to loss of endocervical barriers
• The gonococcus can cause a direct inflammatory
response in the human endocervix,
endometrium, and fallopian tube and is one of
the true pathogens of human fallopian tube
epithelial cells.
Criteria for Diagnosis
• bilateral lower abdominal tenderness (sometimes
radiating to the legs)
• abnormal vaginal or cervical discharge
• fever (greater than 38°C)
• abnormal vaginal bleeding (intermenstrual, postcoital
or ‘breakthrough’)
• deep dyspareunia
• cervical motion tenderness on bimanual vaginal
examination
• adnexal tenderness on bimanual vaginal examination
(with or without a palpable mass).
Uterine Abnormalities
Uterine Abnormalities
• unicornuate uterus represents a uterine
malformation where the uterus is formed
from one only of the paired Müllerian ducts
while the other Müllerian duct does not
develop or only in a rudimentary fashion
(sometimes called hemi-uterus)
• Uterine didelphys results when there is failed
fusion of the paired müllerian ducts
– This anomaly is characterized by the presence of two
endometrial cavities, each with a uterine cervix
– A longitudinal vaginal septum runs between the two
cervices in most cases
– Uterine didelphys should be suspected if a
longitudinal vaginal septum or if two separate cervices
are discovered
– The didelphic uterus has the best reproductive
prognosis
• Bicornuate uterus is caused by incomplete
lateral fusion of the müllerian ducts
– It is characterized by two separate but
communicating endometrial cavities and a single
uterine cervix
– Failure of fusion may extend to the cervix,
resulting in a complete bicornuate uterus, or may
be partial, causing a milder abnormality
• Septate Uterus, after lateral fusion of the
müllerian ducts, failure of their medial
segments to regress can create a permanent
septum within the uterine cavity
• Arcuate uterus is only a mild deviation from
the normally developed uterus
• Asherman's syndrome is a condition
characterized by adhesions and/or fibrosis of
the endometrium  intrauterine adhesions,
intrauterine synechiae
• Leiomyomas are benign smooth muscle
neoplasms that typically originate from the
myometrium
• They are often referred to as uterine myomas
Endometriosis
• Is a common benign gynecologic disorder
defined as the presence of endometrial glands
and stroma outside of the normal location
• Endometriosis is most commonly found on the
pelvic peritoneum but may also be found on
the ovaries, rectovaginal septum, ureter, and
rarely in the bladder, pericardium, and pleura
• Endometriosis is a hormonally dependent
disease and as a result is chiefly found in
reproductive-aged women.
• Endometrial tissue located within the
myometrium is termed adenomyosis
• Symptoms of endometriosis are pain and
infertility. The pain often is worse with the
menstrual cycle and is the most common
cause of secondary dysmenorrhea.
Genital Tract Infection
VULVITIS, is inflammation of the external genital
organs of the female (the vulva)
• Bagian-bagian vulva : mons veneris, labia
mayora/minora, klitoris, vestibulum dengan
orifisium eksternum uretra, kelenjar bartholin,
kelenjar parauretralis
• Vulvitis may be caused by a number of different
infections
• Because the vulva is also often inflamed when
there is inflammation of the vagina, vaginitis is
sometimes referred to as vulvovaginitis.
Herpes Simplex
• Terbagi 2 jenis : HSV-1  penyakit orofasial; dan
HSV-2  penyakit kelamin
• HSV (tipe 1&2) merupkan keluarga herpesviridae dan
subfamili alphaherpesvirinae; ini adalah virus DNA
yang mempunyai sifat-sifat biologis unik berikut:
1. Neurovirulence (kapasitas untuk menyerang dan
meniru dalam sistem saraf)
2. Latency (pembentukan dan pemeliharaan infeksi
laten di ganglia sel saraf proksimal ke lokasi infeksi)
• HSV ditularkan oleh kontak pribadi yang dekat,
dan infeksi terjadi melalui inokulasi virus ke
permukaan mukosa rentan (mis orofaring,
serviks, konjungtiva) atau melalui celah kecil di
kulit
• Tipe penyakit : Herpes gingivostomatitis akut,
faringotonsilitis akut, labialis, genital
VAGINITIS
• Bacterial Vaginosis, a syndrome of unknown cause
characterized by the decrease in the concentration of
lactobacilli and overgrowth of an anaerobic organism
associated with loss of vaginal acidity
• The species commonly isolated:
– Gardnerella vaginalis 90 %
– Gram negative rods 50-70%
– Peptostreptococcus 30-60%
– Mycoplasma hominis 60-75%
– Mobiluncus sp 50%
• Trichomonas vaginalis, is an anaerobic
protozoan parasites, hardy organism that can
survive for up to 24 hours on a wet towel and
up to 6 hours on a moist surface
• Resides in paraurethral glands
• The classic signs :
– Frothy yellow copious discharge
– Vaginal erythema
– Strawberry cervix
• Vulvovaginal Candidiasis
• The species commonly isolated :Candida albicans 85%,
Candida glabrata, Candida tropicalis, Candida parapsilosis, Candida krusie

• Symptoms (none of this spec for VVC) :


– Pruritus
– Erythema
– Edema
– Excoriation
– Tenderness
– Discharge is thick, white, curdy and attached on the vaginal walls
– Vaginal pH is acidic (<4.5)
MUCOPURULENT CERVICITIS
• Gonococcal infection, caused by Neisseria
gonorrhea which is a gram-negative diplococcus
• Non-pregnant : urethritis, cervicitis, PID
• Infection during pregnancy is primary concern 
Gonorrheal ophthalmia neonatorum
• Amniotic infection, PROM, chorioamnionitis,
prematurity, IUGR, neonatal sepsis, postpartum
endometritis
• Chlamydial infection, caused by Chlamydia
trachomatis
• Is a major cause of mucopurulent cervicitis
(MPC)
Syphilis, Chronic infection usually involved the
mucous membrane, caused by Treponema
pallidum
 PRIMARY SYPHILIS
 Painless papule appear at the site of inoculation 
ulcerate (CHANCRE)  heal spontaneously within
3 to 8 weeks
 SECONDARY SYPHILIS
 Develops between 6 weeks after chancre
 The cutaneous and mucousmembrane manisfestations :
macular, papular, pustular, not irritated, pleomorfik,
bilateral symmetry, cooper in color, moth eaten (alopesia
rambut kepala yang tidak merata) at the occipital erea of
the head
 Classic rash: red macules and papules over the palms of the
hands and soles of the feet
 Genital lesions (vulva&anal) are called mucous patches and
condyloma latum, both of witch are moist and highly
infectious and easily diagnosed by darkfield exam
 LATENT SYPHILIS
 After 2-3weeks
 Early and late latent syphilis (WHO early less than
2yr)
 Late latent stage, patient has agreater risk
progressing to tertiary or neurosyphilis
 This stage is not infectious by sexual transmission,
however the spirochetes may still be
transplacentally transmitted to the fetus at any
AOG
• LATE or TERTIARY SYPHILIS
Characterized by the presence of gumma, aortitis,
meningovascular disease, paresis, optic neuritis, argyll-
robertson pupil and tabes dorsalis

• NEUROSYPHILIS
 No single testing technique has been able to diagnose
 All adults with latent syphilis be evaluated clinically for aortitis,
neurosyphilis, gumma, iritis (CDC recommended)
 Lumbar puncture for cerebrospinal fluid analysis should be done
in any patient with latent syphilis of unknown or greater than 1 yr
durationin specific situatuons
Condyloma Acuminatum, Sexually
transmitted disease of the vulva, vagina and
cervix; Etiologic agent: Human papillomavirus
• High risk: HPV 16 and 18; Benign: HPV 6 and
11
Penyakit Radang Panggul
• Infeksi dan peradangan pada organ-organ di
saluran genital wanita bagian atas
• Inflamasi yang terjadi merupakan suatu
rangkaian kesatuan yang terdiri dari uterus
(endometritis), tuba falopii (salpingitis),
ovarium (ooforitis), miometrium,
parametrium (parametritis), rongga pelvis
(peritonitis)
• RPR merupakan infeksi polimikrobial dan
biasanya disebabkan oleh mikroorganisme
N.gonorrhoeae dan C.trachomatis
• Bakteri masuk melalui vagina dan serviks
(kolonisasi pada endoserviks) dan menjalar ke
rahim lalu ke tuba falopii.
• Dapat juga ditemukan virus, jamur
(actinomyces israeli) dan parasit
(skistosomiasis)
• Infeksi ini jarang terjadi sebelum siklus
menstruasi pertama, setelah menopause
maupun selama kehamilan
• Penularan yang utama terjadi melalui
hubungan seksual, tetapi bakteri juga bisa
masuk ke dalam tubuh setelah prosedur
kebidanan/kandungan (mis pemasangan IUD,
persalinan, keguguran, aborsi dan biopsi
endometrium)
Organisme penyebab
Penyakit Radang Panggul
Aerob Anaerob Virus
Neisseria gonorrheae Bacteroides sp Herpes simplex
Chlamydia trachomatis Peptostreptococcus sp Echovirus
Ureaplasma urelyticum Clostridium bifermentans Coxsackie
Gardneralla vaginalis Fusobacterium sp
Strptococcus pyogenes
Coagulase negative
staphylococci
Escherichia coli
Haemophillus influenzae
Mycoplasma hominis
Streptococcus pneumoniae
Mycobacterium
tuberculosis
Infeksi Traktus Urinarius
• Etiologi : E.coli (80%), Proteus, Klebsiella dan
Pseudomonas, Enterobacter, Streptococcus
faecalis, Staphylococcus saprophyticus,
Enterococcus dan Chalamydia
• Infeksis dari uretra (uretritis) dan kandung
kencing (sistitis)
• Gejala : kombinasi frekuensi, urgensi, disuria,
piuria, hematuria, nyeri pelvik akut atau
kronik, nyeri punggung dan demam
HUMAN IMMUNODEFICIENCY
VIRUS
• HIV infection is caused by an RNA retrovirus
• HIV is a RNA retrovirus that attches to the CD4
receptor of the target cell and integrates into
the host genome
• When the CD4 all count falls below 200
cells/µL, patients are at high risk for Aquired
Immunodeficiency Syndrome (AIDS)
• In females: Coexisting infections may have damaged normal
anatomy and function of pelvic organs
• In males: HIV effects on semen
• Safe reproduction in couples with HIV
• Safe reproduction recommendations:
– Infected man + normal woman: semen washing + Assisted
Reproductive Technology (ART)
– Normal man + infected woman: Intarauteriane
Insemination (IUI)
– Both HIV+: semen washing
– Anti-retrovirals, elective CS, no breastfeeding
Induced Abortion
• Abortus dipakai untuk menunjukan ancaman
atau pengeluaran hasil konsepsi sebelum janin
dapat hidup diluar kandungan, dan sebagai
batasan digunakan kehamilan kurang dari 20
minggu atau berat anak kurang dari 500 gram.
• Abortus buatan (Induced Abortion) ialah
pengakhiran kehamilan sebelum 20 minggu
akibat tindakan (The delibrate termination of
pregnancy in a manner that ensures that the
embryo or fetus will not survive)
• Komplikasi :
- Perdarahan
- Perfosi
- Infeksi
- Syok
Kontrasepsi
• Perencanaan Keluarga

Fase menunda Fase Fase tidak


kehamilan menjarangkan hamil lagi
kehamilan

2-4 tahun

KB pil KB pil KB pil


AKDR AKDR AKDR
Kontrasepsi Kontrasepsi Kontrasepsi
sederhana sederhana sederhana
Implan Implan Kontrasepsi
KB suntik KB suntik mantap
Minipil KB suntik
Kontrasepsi
• Metode kontrasepsi :
Alamiah
– Metode kalender (orgino-knaus)
– Metode suhu basal (termal)
– Metode lendir serviks (billings)
– Koitus interuptus

Sederhana dengan alat


- Kondom pria
- Barier intra-vagina (diafragma, kap serviks, spons,
kondom wanita)
Kontrasepsi kimiawi
- spermisida

Alat kontrasepsi dalam rahim (AKDR)/ intra uterine device


(IUD) : lippes loop, self T-coil, Dana Cu, Copper-T, Copper-7,
multiload, progesterone AKDR

Kontrasepsi Hormonal : oral, suntik, subkutis/implan, cincin


vagina, transdermal/koyo

Sterilisasi : Tubektomi (perempuan); vasektomi (laki-laki)


Condom
• 98% effective
• Protects against some
Male STDs
Condom

Diafragma

Male
Condom
Spermisida
CARCINOMA
CERVIX
CERVIX
third most frequent malignancy
 Risk Factors:
- early and frequent sexual contact
- cervical viral infection particularly HPV
CERVICAL INTRAEPITHELIAL
NEOPLASIA (CIN)

CIN 1
 Mild atypia
 Atypical changes involve
lower third of
epithelium

Cervix
CERVICAL INTRAEPITHELIAL
NEOPLASIA

CIN 2
 Moderate atypia
 Atypical changes involve
1/3 – 2/3 of epithelium
CERVICAL INTRAEPITHELIAL
NEOPLASIA

CIN 3
 Severe atypia
 Atypical changes involve
>2/3 or full thickness of
the epithelium
CERVIX
Two types of malignancy:
1. Squamous cell CA – 80–85%
2. Adenocarcinoma – 15-20%
Degree of Differentiation of Tumors
G1 = well differentiated
G2 = intermediate
G3 = undifferentiated
CERVIX
Verrucous Carcinoma
- a rare type of squamous cell carcinoma
- warty tumors appear as large bulbous masses
- rarely metastasize
Adenocarcinoma
- do not appear to be affected by sexually factors
associated with squamous cell CA
CERVIX
Adenoma malignum
- microscopically innocuous appearing tumors
consist of well-differentiated mucinous gland
that vary in size and shape and infiltrate the
stroma
- deeply invasive and metastasize early
CERVIX
Clear Cell Carcinoma
- histologically identical to ovary
- uncommon in cervix
- associated with intrauterine DES exposure
Adenoid Cystic Carcinoma
- rare; less aggressive
- resemble Basal Cell CA of skin
CARCINOMA of the CERVIX

Clinical Considerations
- abnormal bleeding/brownish discharge following
intercourse or douching occurring spontaneously
between menstrual periods
- back pain
- loss of appetite
- weight loss
- age 40-60s (median 32 years)

Cervix
CARCINOMA of the CERVIX
Staging:
- pelvic exam
- general physical exam
- chest radiographic exam
- IVP
- CT Scan
Natural History and Spread
- initially a locally infiltrating carcinoma that spreads
from cervix to the vagina and paracervical and
parametrial areas

Cervix
CARCINOMA of the CERVIX

Forms:
- ulcerated
- exophytic
- endophytic
Spread:
- lymphatic
- hematogenous (lung, liver, bone)

Cervix
UTERUS
UTERUS
 Most common malignancy
Epidemiology:
- affects women in perimenopausal and
postmenopausal years
- diagnosed between 50 – 65 years
- younger than 40 (5%)
- younger than 50 (10%)
 Complex Atypical Hyperplasia
- results from increased estrogen stimulation of the
endometrium and is a precursor to endometrioid
endometrial carcinoma
ENDOMETRIAL CARCINOMA
RISK FACTORS
Increases the Risk Decreases the Risk
Unopposed estrogen stimulation Ovulation
Unopposed menopausal estrogen Progestin therapy
replacement therapy (4-8x) Combined OCP
Menopause after 52 yrs (2.4x) Menopause before 49 years
Obesity (2-5x) Normal weight
Nulliparity (2-3x) Multiparity
Diabetes (2.8x)
Feminizing ovarian tumors
Polycystic ovarian syndrome
Tamoxifen therapy for breast
cancer
ENDOMETRIAL
HYPERPLASIA
 Results from excess of estrogen or an excess of
estrogen relative to progestin, such as occurs with
anovulation
Types:
1. Simple Hyperplasia
2. Complex Hyperplasia without atypia
3. Complex Hyperplasia with atypia
Simple Hyperplasia

 Endometrium with dilated


glands that may contain
some outpouching and
abundant endometrial
stroma
 Considered weakly
premalignant

Uterus
Complex Hyperplasia
w/o Atypia
 Glands are crowded with
very little endometrial
stroma and a very complex
gland pattern and
outpouching formation
 Considered low
premalignant potential

Uterus
Complex Hyperplasia
w/ Atypia

Hyperplasia that contain glands with cytologic


atypia
Increase in nuclear/cytoplasmic ration w/
irregularity in size and shape of nuclei
Considered premalignant

Uterus
ENDOMETRIAL
HYPERPLASIA
Natural History
- the rate at which endometrial hyperplasia progresses to
endometrial carcinoma has not been accurately
determined
 Rate of Progression to Cancer
- complex atypical hyperplasia – 29%
- simple hyperplasia – 1%
- complex hyperplasia w/o atypia – 3%

Uterus
ENDOMETRIAL CARCINOMA

 Symptoms:
- postmenopausal and perimenopausal bleeding
 Diagnosis:
- endometrial sampling
- Fractional D&C
- Pap smear – detect endometrial CA (50%)
 Histologic Types:
G1 = well differentiated (<6% solid components)
G2 = intermediate (6-50% solid components)
G3 = poorly intermediate (>50% solid components)

Uterus
ENDOMETRIAL PRIMARY
CARCINOMA

Endometrial Primary Adenocarcinomas


Typical Endometrioid Adenocarcinoma
Adenocarcinoma with squamous elements
Clear Cell Carcinoma
Serous Carcinoma
Secretory Carcinoma
Mucinous Carcinoma
Squamous Carcinoma

Uterus
ENDOMETRIAL PRIMARY
CARCINOMA
Adenosquamous Carcinoma
- squamous epithelium that co-exists with glandular
elements of endometrial carcinoma
Uterine Papillary Serous Carcinoma
- highly virulent and uncommon
Clear Cell Carcinoma
- less common (5%)
- tend to develop in postmenopausal women
and carry a prognosis much worse than typical
endometrial carcinoma
Uterus
STAGING of ENDOMETRIAL
CARCINOMA
Stages CHARACTERISTICS
Stage IA Tumor limited to the endometrium
IB Invasion to less than half of the myometrium
IC Invasion to more than half of the myometrium
Stage IIA Endocervical glandular involvement only
IIB Cervical stromal invasion
Stage IIIA Tumor invades serosa and/or adnexae and/or positive
peritoneal cytology
IIIB Vaginal metastases

IIIC Metastases to pelvic and/or paraaortic lymph nodes

Stage IVA Tumor invasion of bladder and/or bowel mucosa

IVB Distant metastases including intraabdominal and/or


inguinal lymph node
PATTERN OF SPREAD

 Pelvic and paraaortic nodes are most important


clinically
 Direct peritoneal spread of tumor can occur through
the uterine wall or via the lumen of fallopian tube

Uterus
OVARY
OVARIAN CARCINOMA
Second most common malignancy
Major contributing factor:
- detection of disease after metastatic spread
Incidence increase with age

Ovary
RISKS OF
OVARIAN CARCINOMA
Increases Decreases
Age Breastfeeding
Diet Oral contraceptives
Family history Pregnancy
Industrialized country Tubal ligation and
Infertility hysterectomy with ovarian
Nulliparity preservation
Ovulation
Ovulatory drugs
Talc?

Ovary
CLASSIFICATION OF
OVARIAN CARCINOMA
CLASS FREQUENCY
Epithelial Stromal 65
Germ Cell 20 – 25
Sex Cord-Stromal 6
Lipid Cell < 0.1
Gonadoblastoma < 0.1
Soft tissue tumors
Unclassified tumors
Secondary (metastatic)
Tumor-like conditions

Ovary
WHO Classification of Ovarian
Neoplasm
CLASSIFICATION OF
OVARIAN CARCINOMA
Epithelial Stromal Tumors
- most frequent
- arise from coelomic epithelium
 Germ Cell Tumor
- second most common
- most common in young women
- composed of extraembryonic elements or 3 embryonic layers
(ectoderm, mesoderm or endoderm)
- main cause of ovarian malignancy particularly in young
women – teens

Ovary
CLASSIFICATION OF
OVARIAN CARCINOMA
 Sex Cord-Stromal Tumors
- 3rd most common
- contain elements that recapitulate the constituents of the
ovary and testis
- secrete sex steroid hormones or may be hormonally inactive
 Lipid Cell Tumor
- extremely rare; histologically resemble the adrenal gland
 Gonadoblastoma
- consists of germ cell and sex-cord stromal elements
- occur in individuals with dysgenetic gonads
particulary when Y chromosome is present

Ovary
CLASSIFICATION OF
OVARIAN CARCINOMA
Soft Tissue Tumor
- not specific to the ovary
- hemangioma or lipoma
Unclassified
- Small Cell CA – highly virulent affecting young women
Secondary Metastatic Tumors
Tumor-like conditions

Ovary
Serous Cystadenocarcinoma

Fine papillary structures with


marked stratification

Ovary
Mucinous Cystadenocarcinoma

Papillary structures with abundant


apical cytoplasmic mucin and small
basal nuclei

Ovary
Endometriod Tumors

Tumors composed of tubular


glands arranged in a cribriform
pattern
Ovary
STAGES CHARACTERISTICS
Stage IA Growth limited to 1 ovary, no ascites, capsule intact

IB Growth limited to both ovaries, no ascites, capsule intact

IC Tumor either IA or IB but with tumor on surface of one or both


ovaries, or w/ capsule ruptured or if w/ ascites
Stage IIA Extension and/or metastases to the uterus and/or tubes

IIB Extension to other pelvic tissues

IIC Tumor either IIA or IIB, but w/ tumor on surface of one or both
ovaries, or w/ capsule ruptures, or if w/ ascites
Stage IIIA Tumor grossly limited to the pelvis w/ negative nodes but w/
microscopic seeding to the abdominal peritoneal surface
IIIB Tumor of one or both ovaries w/ histologically confirmed
implants of abdominal peritoneal surfaces, none exceeding 2
cm, nodes are negative
IIIC Abdominal implants greater than 2 cm and/or positive
retroperitoneal or inguinal nodes
Stage IVA Parenchymal liver metastasis
Teratoma
• Mature Teratoma (Dermoid)
• Most common type of ovarian
teratoma/ovarian neoplasms; and most
common neoplasm diagnosed during
pregnancy
• Composed of fully/well differentiated mature
tissues from 3 germs cell layers, usually
ectodermal (skin, hair, sebaceous glands, glia)
but also mesodermal and endodermal
derivatives
• Occuring in woman ages 20-30 years
• Complications: torsion, rupture, infection,
malignant transformation (2%)
Teratoma
• Immature Teratoma
• The malignant counterpart of mature cystic
teratoma or dermoid
• 2nd most common germ cell malignancy
• Proliferation of meiotic germ cell
• Neural elements that makes it malignant
• The amount of undifferentiated neural tissues
(immature neural tissue present) is prognostic
importance and guidelines for chemotherapy
• They are usually unilateral, although the
contralateral may contain a mature teratoma
• These tumors often secrete ά fetoprotein
(AFP)
Torsion Cyst
• Adnexal torsion may be suspected in the
woman with an adnexal mass who
experiences the sudden onset of pelvic pain
• Torsion of the adnexae can involve the ovary,
tube, and ancillary structures, either
separately or together
• Commonly associated with a cystic neoplasm
• Symptoms include :
Abdominal pain and tenderness, that usually
are sudden in onset and result from occlusion
of the vascular supply to the twisted organ
Ruptured Cyst
• A ruptured ovarian cyst is a common
phenomenon, with presentation ranging from
no symptoms to symptoms mimicking an
acute abdomen
• Each month, a mature ovarian follicle
ruptures, releasing an ovum so the process of
fertilization can begin
• Occasionally, these follicles may bleed into the
ovary, causing cortical stretch and pain, or at
the rupture site following ovulation
• Similarly, a corpus luteum cyst may bleed
subsequent to ovulation or in early pregnancy.
• As blood accumulates in the peritoneal cavity,
abdominal pain and signs of intravascular
volume depletion may arise.
• The etiology of this increased bleeding is
unknown, although abdominal trauma and
anticoagulation treatments may increase the
risk.
• Nonphysiologic cysts, such as cystadenomas
and mature cystic teratomas (dermoid cysts),
may, in rare cases, rupture and cause
symptoms
• a diffuse chemical peritonitis can accompany
rupture of a dermoid cyst, presumably from
spillage of sebaceous fluid
Torsion and Ruptured Cyst
• These symptoms :
- severe or sharp pelvic pain
- fever
- faintness or dizziness
- rapid breathing
can indicate a ruptured cyst or an ovarian
torsion. Both complications can have serious
consequences if not treated early.
• Williams obstetrics
• Williams gynecologic
• Clinical gynecologic oncology (De Saia)
• Medscape
• Current obstetrics and Gynecology Ed 11
• WHO : Introduction to Reproductive Health and The Environtment
• Panduan penatalaksanaan infeksi pada traktus genitalis dan urinarius
• Buku ajar kependudukan dan pelayanan KB
• At a glance sistem Reproduksi Ed 2
• Panduan pelayanan klinik Kanker Ginekologi Ed 3-2013 (Himpunan
Onkologi Ginekologi indonesia)
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