Transcript Female genital II

Organ Pathology
Female Genital
System - II
Pathology of ovaries,
tubes, breast,
pregnancy
Jaroslava Dušková
Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague
http://www1.lf1.cuni.cz/~jdusk/
Diseases of the Fallopian Tubes

inborn – malformations:
– aplasia (Müllerian duct disorders)
 bilateral
 unilateral
incl. uterus & vagina
incl. kidney
– partial atresia
 acquired
Diseases of the Fallopian Tubes

inborn

acquired
– non neoplastic : atrophy, infection – pyosalpinx,
hydrosalpinx, tbc salpingitis, synechiae
– salpingitis isthmica nodosa
– pseudotumours – cysts, ectopic pregnancy,
– neoplastic: adenocarcinoma
Diseases of the Fallopian Tubes

PID – pelvic inflammatory disease
(chronic salpingooophoritis)

tubar sterility
Diseases of the Ovaries

inborn

acquired
–atrophy
(involution)
–stromal hyperplasia
(stromal)
–inflammation
(salpingooophoritis, PID,
tuboovarian absess. Actinomycosis, tbc.)
(cont.)
Diseases of the Ovaries

inborn – malformations:
– aplasia (incl. kidney, uterus & vagina)
– hypoplasia (e.g. in adrenogenital
syndrome –pseudohermafroditismus
femininus)
 acquired
(cont.)
Diseases of the Ovaries

inborn

acquired
– atrophy
– hyperplasia
– inflammation
– pseudotumours
–TUMOURS
(cont.)
Ovary - cysts
 follicle
 luteal
 inclusion
 endometrial
(„chocolate“)
POLYCYSTIC OVARIES
(Stein- Leventhal syndrome)
– obesity
– hirsutism
– infertility
– oligo- or amenorrhea
Diseases of the Ovaries

inborn

acquired
– pseudotumours (stromal hyperplasia,
dif. dg.
–TUMOURS
CYSTS)
Ovary malignant neoplasms

Czech Rep. 1323 new cases 2002

Czech Rep. 25,3/ 100 000 women

Europe 20,6/ 100 000 women

World 15,1/ 100 000 women
TUMOURS of the Ovary
119 (!) coded nosology units ICD-O
Classification groups
Surface
epithelial stromal
Sex cord stromal
 Germ cell


Mixed germ cell sex cord-stromal
Tumour of the rete ovarii
Miscelaneous, tumour like lesions

Lymphomas & leukemias


 Secondary

tumours of the ovary
Peritoneal tumours
TUMOURS of the Ovary
Surface epithelial stromal tumours








30% of fem. gen. neoplasms
middle & old age
risk factors: longer HRT, obesity
protective factors: high parity, oral
contraceptives
precursors: inclusion cyts, endometriosis
lack of early warning symptoms
70% dg. at a late stage – ca peritonitis
mean 5-year survival in Europe 32% (!!!)
TUMOURS of the Ovary
Surface epithelial stromal tumours
- macroscopy





small to more than 20cm
two thirds bilateral
solid & cystic with intracystic papillae
confluent papillae, softer
borderline
necroses & haemorrhage
susp. malignancy
TUMOURS of the Ovary
stromal tumours
Surface epithelial
- microscopy
 serous
- endosalpigeoma
 mucinous – endocervicoma
 mixed
 endometrioid (coinciding with endometrial ca)

Brenner tumour
----------------------- papillary cystadenoma
 papillary borderleine
 papillary cystadenocarcinomas
TUMOURS of the Ovary
119 (!) coded nosology units ICD-O
Classification groups
Surface
epithelial stromal
Sex cord stromal
 Germ cell


Mixed germ cell sex cord-stromal
Tumour of the rete ovarii
Miscelaneous, tumour like lesions

Lymphomas & leukemias


 Secondary

tumours of the ovary
Peritoneal tumours
TUMOURS of the Ovary
Sex cord stromal tumours

Granulosa-stromal cell tumours

Thecoma-fibroma group

Sertoli- Leydig cell group

Others…..
TUMOURS of the Ovary
Sex cord stromal tumours
Granulosa-stromal cell tumours

manifesting mostly as a solid or cystic
mass or with steroid hormones production
E/A
effects
– adult
– juvenile
– bleeding disorders, virilisation,
– isosexual precoccious puberty
TUMOURS of the Ovary
119 (!) coded nosology units ICD-O
Classification groups
Surface

epithelial stromal
Sex cord stromal
 Germ
cell

Mixed germ cell sex cord-stromal
Tumour of the rete ovarii
Miscelaneous, tumour like lesions

Lymphomas & leukemias


 Secondary

tumours of the ovary
Peritoneal tumours
TUMOURS of the Ovary
Germ cell Tumours
–dysgerminoma (= seminoma ovarii)
– embryonal carcinoma
– teratoma (mature, immature)
– yolc sac tumour
– choriocarcinoma
Embryonal carcinoma
 composed
of primitive anaplastic-appearing
epithelial cells
 pure rare, mostly in combined germ cell
tumours
 peak incidence 30 years
 swelling, 2/3 patients with metastases at
diagnosis
 macro : tan/gray, necroses, hemorrhages
 micro: solid, tubular, PLAP, CK +
Mesoblastoma vitellinum- yolc sac
tumour –endodermal sinus tumour
 80%
of prepubertal germ cell tumours
 in postpubertal as admixture
 painless mass, serum AFP elevated
 macro: gray/tan nonencapsulated
 micro: many variants – microcystic,
solid,festoon-like, hepatoid, spindle cell…
 AFP+, alpha1-Antitrypsin
Choriocarcinoma (non gestational)
 rare
 admixture
in many germ cell tumours
 malignant
 children
& young adults
 presents with bleeding and precoccious
pseudopuberty
 ß-HCG +
morphologicall identical with gestational ch.
Teratomas
Def.:
Tumours (benign, borderline or
malignant) composed of two or
more different cell lines that are
NOT normally present in the
place of tumour origin
Teratoma

coetaneous –
differentiated -cystic

embryonal –
nondifferentiated solid
TUMOURS of the Ovary
Secondary tumours of the ovary
 metastatic

- advanced stage
poor prognosis
tumour – metastatic signet
ring cell ca originating mostly in the
stomach or colon
 Krukenberg
Diseases of the Breast

inborn – malformations:
– amastia, polymastia (mamma
accessoria), aberant mammary tissue,
polythelia
 acquired
Diseases of the Breast


inborn
acquired
– degenerations: amyloid, mastitis: acute
puerperal, chronic
– Pseudotumours (& precanceroses) : fibrocystic
disease, lipophagic granuloma, silicon granuloma,
suture granuloma….
–TUMOURS
Fibrocystic Breast Disease
Def:
dyshormonal changes of the breast
tissue with variably increased risk
of breast cancer according to the
type of epithelial proliferation
Fibrocystic Breast Disease - symptoms

palpable lump

fluctuating cysts

(pain)
Fibrocystic Breast Disease - morphology

fibrosis

cysts

epithelial hyperplasia
– ductal, lobular – adenosis :simple,
florid, sclerosing, microglandular
– usual, atypical
– papillary
Tumours of the Breast
WHO 2003
75 ICD-O coded nosology units
 epithelial
 myoepithelial
 mesenchymal
 fibroepithelial
 tumours
of the nipple
 malignant lymphoma
 metastatic tumours
 tumours of the male breast
Tumours of the Breast symptoms
stage – asymptomatic –
mammography – (microcalciffication)
 palpable lump
 nipple discharge
 breast configuration change
 ulceration
 metastases
 early
Benign epithelial tumours
intraductal
papilloma
- central
- peripheral
tubular adenoma
Ductal ca in situ DCIS
TDLU, seldom larger ducts
 precursor of invasive ca
 microcalcification on mammography
85% of cases detected with imaging
techniques

screening introduction
incidence from 2,4/ 100 000 to 15,8/ 100 000
Ductal ca in situ DCIS
Histopathology
solid, papillary, cribriform,
comedo
 cytology (grading) G1-3
Lobular carcinoma in situ LCIS


85% multicentric, 30% bilateral
precursor of invasive ca
Histopathology:
 preserved lobular architecture, TDLU
involvement, small monomorphous
cells, regular nuclei
Breast cancer – high risk
 age
more than 50
 developed countries USA, Europe
 positive family history
 atypical hyperplasia
 BRCA1 gen (40-50%), BRCA2 gen,
+ other ca (bowel, ovary, prostate,
stomach, pankreas..)
Breast cancer – increased risk
menarche
prior 11 & menopause
after 55 yrs
nuliparity late first delivery 30-35 let
higher socioeconomic group
obesity
radiation
Breast cancer – increased risk
etanol
oral
abuse
contraceptives uncertain
HRT
following 10-15 yrs
administration
Breast cancer -prognosis
 typing
 grading
 staging
 hormonal
receptors (ER & PRimmunohistochemistry)
 c-erbB-2 receptoru (immunohistochemistry,
FISH)
 proliferation activity (immunohistochemistry
Ki-67 index)
 angioinvasion
Mixed Tumours
Def.:
Tumours (benign or malignant)
composed of two or more
different cell lines that are
normally present in the place
of tumour origin
Fibroadenoma
young
firm
age (30yr)
circumscribed, painles
mostly
up to 30 mm
solitary
stromal
& epithelial component
Phyllodes tumor
middle
age (50yrs)
mostly benign, recidives
painless, up to 50 mm
more cellular stromal component