Female Genital TractLab

Dr. Nisreen Abu ShahinAssistant Professor of Pathology

University of Jordan

Ovarian Pathology

• A 20-year-old female presented with vague left pelvic pain. Pelvic exam revealed a large adnexal mass. Ultrasound showed a large, heterogenous, cystic mass replacing much of the left ovary. The contents of the cystic mass included hair, sebaceous material and a tooth. What is your diagnosis?

• What is the expected clinical behavior of this tumor?

•What is the key microscopic feature of these tumors? • Above are different microscopic fields from this neoplasm. Mention the tissues you can recognize.

•A 36 y/o woman complained of pelvic pain, her U/S examination in clinic revealed a unilateral right ovarian cystic mass. Grossly, the cyst has a smooth and glistening surface, and a thin multilocular wall. It contained thin serous fluid. Shown here are sections from the cystic mass wall. What is your diagnosis?

•Is it benign or malignant?

•Describe the typical microscopic features of these lesions.

• What are the microscopic features of serous borderline tumors?

Diseases of the fallopian tubes

•A 20-year-old woman abruptly developed RLQ abdominal pain in the absence of fever. Last menstrual period was several weeks ago. The right fallopian tube was obtained during emergent exploratory laparotomy. What is the diagnosis?

•What is the clinical significance?

• Above is a cross-section of the dilated, hemorrhagic mid-level of the fallopian tube. What are those structures (arrows?• Name some known predisposing conditions.

•In this context, what will the endometrium look like?

Uterine Pathology

• Describe the myometrial lesions you see in these pictures. Do you have the names for the lesions based on their locations?•How common are (fibroids) leiomyomata ? In what age group are they most prevalent?•Are they malignant?•What are the presenting symptoms?

Leiomyoma

• What are the microscopic features of leiomyoma that highlight its benign behavior?

• A 57 year-old lady, presented to GYN clinic complaining of postmenopausal bleeding, and underwent hysterectomy. Cut section of the enlarged uterus showed this lesion. What is the likely diagnosis?

• What gross features you

see favor a malignant neoplasm?

Leiomyosarcoma

Leiomyosarcoma

What are the microscopic features needed to make the correct diagnosis of leiomyosarcoma?

Endometrial Adenocarcinoma

Describe the endometrial tumor you see here.

What is the diagnosis? Endometrioid carcinoma

Describe the endometrial tumor you see here.

What is the diagnosis? Serous carcinoma

• Describe the most distinct microscopic feature of this vulvar lesion at low microscopic power. What is the corresponding gross lesion?

• What is your diagnosis?

• Do you see viral induced cytologic changes? What are those cells called?

Breast pathology:fibroadenoma

Fibroadenoma • how frequent are fibroadenomas? The most common benign

neoplasm of the female breast. • Describe the lesion clinically? a discrete, solitary, freely movable

nodule, (1 to 10 cm).• What are the effects of estrogen hormones? may enlarge late in

the menstrual cycle and during pregnancy. • What is the rate of malignant transformation? Fibroadenomas

almost never become malignant.• What is the neoplastic cell types in fibroadenomas? The stromal

cells.• Histologically loose fibroblastic stroma containing ductlike,

epithelium-lined spaces of various forms and sizes

Comedo DCIS

Comedo DCIS

• The comedo subtype: cells with high-grade nuclei distending ducts with extensive central necrosis. (The name derives from the toothpaste-like necrotic tissue).

• Calcifications are frequently associated with DCIS• The neoplastic cells express ER and PR. • Current treatment strategies: surgery and radiation,

tamoxifen• Significance: adjacent invasive CA; recurrence; become

invasive if untreated