Gross Unknowns

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Gross Unknowns

• Audrea Williams, MD
• Department of Pathology
• Howard University Hospital

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A. Mammograms of young women are typically
"dense" or white in appearance difficult to
detect lesions B. Young woman's breast
predominance of fibrous interlobular stroma and
the paucity of adipose tissue C. Pregnancy,
branching of terminal ducts results in more
numerous TDLUs, and the number of acini per TDLU
increases. D. Increasing age TDLUs decrease in
size and number, and the interlobular stroma is
replaced by adipose tissue E. Mammograms become
more radiolucent (darker) with age secondary to
small ducts and atrophic lobules in adipose
tissue.
Robbins and Cotran p.1120
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Robbins and Cotran p.1120
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Multiple masses in the breast of a 40-year-old
woman. Excision was performed, what is the best
diagnosis? A. Fibrocystic changes B. Ductal
carcinoma in situ with apocrine change C.
Apocrine carcinoma E. None of the above
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Multiple masses in the breast of a 40-year-old
female. Excision was performed, what is the best
diagnosis? A. Fibrocystic changes B. Ductal
carcinoma in situ with apocrine change C.
Apocrine carcinoma E. None of the above
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Multiple masses in the breast of a 40-year-old
female. Excision was performed, what is the best
diagnosis? A. Fibrocystic changes B. Ductal
carcinoma in situ with apocrine change C.
Apocrine carcinoma E. None of the above
Fibrocystic changes
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64F bilateral skin/breast changes secondary to
implants
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Left breast lobular carcinoma insitu (E-cadherin
negative)
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Rigt breast Invasive moderately differentiated
ductal carcinoma
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Uterus is hollow, pear shaped, 40-80 g, 7-8 cm
Histology of the menstrual cycle
early proliferative (days 4-7)
days 20-21 maximal secretion
post-ovulatory day 2
Robbins and Cotran p.1120
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24 year old woman with polycystic ovarian
syndrome (prolonged estrogenic stimulation with
reduced progestational activity) and abnormal
uterine bleeding
Endometrial hyperplasia
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47 year old woman with abnormal uterine
bleeding DDx Endometrial Carcinoma
Endometrial polyps Leiomyomas(Fibroids)
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47 year old woman with abnormal uterine
bleeding DDx Endometrial Carcinoma
Endometrial polyps Leiomyomas(Fibroids)
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47 year old woman with abnormal uterine
bleeding DDx Endometrial Carcinoma
Endometrial polyps Leiomyomas(Fibroids)
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Robbins and Cotran p.1094
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27 year old woman with severe abdominal pain
this is the ovary Hint endometrial glands and
stroma outside the uterus
Endometriosis of Ovary Dx 2 of 3 are
required endometrial glands, stroma
hemosiderin-laden macrophages
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27 year old woman with severe abdominal pain this
is the ovary Hint endometrial glands and stroma
outside the uterus
Endometriosis of Ovary Dx 2 of 3 are
required endometrial glands, stroma
hemosiderin-laden macrophages
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29 year old woman with a cystic ovarian mass
benign serous cystadenoma
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49 year old woman with a cystic ovarian mass
Papillary serous cystadenocarcinoma
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30 cm retroperitoneal cystic mass in 55 year old
woman
mucinous cystadenoma fluid to viscous material of
mucoid nature in lumen
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mucinous ovarian neoplasm that had borderline
features at the microscopic level
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mucinous cystadenocarcinoma
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DIAGNOSIS

• Total abdominal hysterectomy, bilateral
  salpingo-oophorectomy
• - Invasive moderately differentiated
• endometrioid carcinoma, Grade 2 showing
• - Endocervical stromal invasion (Pathologic
• Stage pT2 pN0 pMX)
• - Sertoliform differentiation
• - Extension up to 78 through the myometrium
• - Leiomyomas

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Clinical Summary

• 65 year old lady with endometrial carcinoma
  stage IV
• Hospice care at home
• Admitted 10 June 2007 for management of
  respiratory failure and sepsis
• Diagnosed in November 2006 with endometrial
  carcinoma, she completed 5 cycles of chemotherapy
  with carboplatin, taxol, and cyclophosphamide
  as well as alternative medical therapy
• Daughter noted a continued decline in her health
  and worsening shortness of breath. One week of
  ongoining diarrhea , nausea and vomiting were
  also noted prior to admission.
• During hospitalization received supportive
  management IV fluids, transfusion, antibiotic
  therapy and noninvasive ventilation
• After a family meeting supporting her wishes she
  was placed Do Not Resuscitate (DNR)
• She expired a day later 6/12/2007 at 715PM.

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Final Autopsy Diagnosis

• Malignant mixed mullerian tumor of uterus with
  metastasis to
• Serosal surfaces of abdominal viscera including
• Spleen
• Colon with extension into mucosa
• Small intestine
• Liver
• Stomach
• Uterus, ovaries, and oviducts
• Liver parenchyma
• Lungs
• Left adrenal gland
• Lymph nodes, intrathoracic, cervical, and
  intraabdominal
• Adventitia of esophagus

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• 65 year old lady with stage IV malignancy
• uterus700grams

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A07-25
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(No Transcript)
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epithelial component
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necrosis