RiskfactorsforcervicalcarcinomaarerelatedtoHPVexposure,suchasearlyageatfirstintercourse,multiplesexualpartners,andotherfactorsincludingcigarettesmokingandimmunodeficiency.
NearlyallcervicalcarcinomasarecausedbyHPVinfections,particularlyhigh-riskHPVtypes16,18,31,and33; http://ebooksmedicine.net theHPVvaccineiseffectiveinpreventinginfectionresultingfromtheHPVtypesmostcommonlyassociatedwithcarcinoma.
•HPVexpressesE6andE7proteinsthatinactivatethep53andRBtumorsuppressors,respectively,resultinginincreasedcellproliferationandsuppressionofDNAdamage–inducedapoptosis.
Incervicalcancer,high-riskHPVisintegratedinthehostgenome,aneventthatincreasestheexpressionofE6andE7andcontributestoprogressiontocancer.
ThePapsmearisahighlyeffectivescreeningtoolforthedetectionofSILandcarcinomaandhassignificantlyreducedtheincidenceofcervicalcarcinoma.HPVtestingiscurrentlybeingusedinconjunctionwiththePapsmear.
The body (corpus) of the uterus is composed of the endometrium, consisting of glands and stroma, and the myometrium, made up of smooth muscle. The more frequent and significant disorders of the uterus are considered here.
Inflammation of the endometrium is classified as acute or chronic depending on whether a neutrophilic or a lymphoplasmacytic infiltrate predominates, respectively. The diagnosis of chronic endometritis generally requires the presence of plasma cells, as lymphocytes are present even in the normal endometrium.
Endometritis is a component of pelvic inflammatory disease and is frequently a result of N. gonorrhoeae or C. trachomatis infection. Histologic examination shows a neutrophilic infiltrate in the superficial endometrium coexisting with a stromal lymphoplasmacytic infiltrate. Prominent lymphoid follicles may be seen, particularly in chlamydial infection. Tuberculosis causes granulomatous endometritis, frequently with associated tuberculous salpingitis and peritonitis. Although seen in the United States mainly in immunocompromised persons, tuberculous endometritis is common in countries in which tuberculosis is endemic, and it should be included in the differential diagnosis for pelvic inflammatory disease in women who have recently emigrated from endemic areas.
Endometritis also may be a result of retained products of conception subsequent to miscarriage or delivery or the presence of a foreign body such as an intrauterine device. Retained tissue or foreign bodies act as a nidus for ascending infection by vaginal or intestinal tract flora. Removal of the offending tissue or foreign body typically results in resolution.
Clinically, all forms of endometritis manifest with fever, abdominal pain, and menstrual abnormalities. In addition, there is an increased risk of infertility and ectopic pregnancy due to damage and scarring of the fallopian tubes.
Adenomyosis refers to the presence of endometrial tissue in the myometrium. Nests of endometrial stroma, glands, or both are found deep in the myometrium interposed between the muscle bundles. This endometrial tissue induces reactive hypertrophy of the myometrium, resulting in an enlarged, globular uterus, often with a thickened uterine wall. Extensive adenomyosis may produce menorrhagia, dysmenorrhea, and pelvic pain, particularly just prior to menstruation, and can coexist with endometriosis.