Chapter 22: Female Genital Pathology

Female Genital Pathology begins with vulvar conditions, including inflammatory dermatoses like lichen sclerosis and lichen simplex chronicus, as well as infectious lesions such as condylomata acuminata caused by Human Papillomavirus (HPV). The text distinguishes between benign tumors like papillary hidradenoma and malignancies such as squamous cell carcinoma and extramammary Paget disease. Vaginal pathology is explored through congenital anomalies like Gartner duct cysts, infectious vaginitis caused by Candida, Gardnerella, and Trichomonas, and rare malignancies like clear cell adenocarcinoma associated with in utero diethylstilbestrol (DES) exposure and embryonal rhabdomyosarcoma (sarcoma botryoides) in infants. A significant portion of the chapter is dedicated to the cervix, detailing the progression of cervical intraepithelial neoplasia (CIN) to invasive squamous cell carcinoma driven by high-risk HPV subtypes (16, 18, 31, 33), alongside the pathology of Pelvic Inflammatory Disease (PID) and its complications like Fitz-Hugh-Curtis syndrome. Uterine disorders are categorized into inflammatory states (endometritis), ectopic growth (endometriosis and adenomyosis), benign tumors (leiomyomas or fibroids), and endometrial hyperplasia leading to adenocarcinoma, with specific reference to PTEN and TP53 mutations. Ovarian pathology is broadly classified into surface epithelial tumors (serous and mucinous), germ cell tumors (teratomas and dysgerminomas), and sex cord-stromal tumors (granulosa cell tumors and fibromas associated with Meigs syndrome), while also addressing endocrine disorders like Polycystic Ovarian Disease (PCOS). The chapter concludes with gestational trophoblastic disease, differentiating between complete and partial hydatidiform moles and choriocarcinoma, and examines obstetric complications including ectopic pregnancy, placental abruption, placenta previa, placenta accreta, and preeclampsia.