organ pathology female genital system - ii pathology of ovaries, tubes, breast, pregnancy jaroslava...
TRANSCRIPT
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 incl. uterus & vagina
unilateral 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.
CYSTS)
–TUMOURS
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 Ovary119 (!) 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 Surface epithelial stromal tumours - microscopy
serous - endosalpigeoma mucinous – endocervicoma mixed endometrioid (coinciding with endometrial ca) Brenner tumour------------------------ papillary cystadenoma papillary borderleine papillary cystadenocarcinomas
TUMOURS of the Ovary119 (!) 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 tumoursGranulosa-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 Ovary119 (!) coded nosology units ICD-O Classification groups
Surface epithelial stromal Sex cord stromalGerm 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 Krukenberg tumour – metastatic signet
ring cell ca originating mostly in the stomach or colon
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
early stage – asymptomatic – mammography – (microcalciffication)
palpable lump nipple discharge breast configuration change ulceration metastases
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
Histopathologysolid, 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 50developed countries USA, Europepositive family historyatypical hyperplasiaBRCA1 gen (40-50%), BRCA2 gen,
+ other ca (bowel, ovary, prostate, stomach, pankreas..)
Breast cancer – increased riskmenarche prior 11 & menopause
after 55 yrsnuliparity late first delivery 30-35 lethigher socioeconomic groupobesityradiation
Breast cancer – increased risk
etanol abuse
oral contraceptives uncertain
HRT following 10-15 yrs
administration
Breast cancer -prognosis typing grading staging hormonal receptors (ER & PR-
immunohistochemistry) 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 age (30yr)
firm circumscribed, painles
mostly up to 30 mm
solitary
stromal & epithelial component
Phyllodes tumor
middle age (50yrs)mostly benign, recidivespainless, up to 50 mm more cellular stromal component