Organ Pathology

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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/
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Diseases of the Fallopian Tubes

• inborn malformations
• aplasia (Müllerian duct disorders)
• bilateral incl. uterus vagina
• unilateral incl. kidney
• partial atresia
• acquired

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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

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Diseases of the Fallopian Tubes Ovaries

• PID pelvic inflammatory disease (chronic
  salpingooophoritis)
• tubar sterility

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Diseases of the Ovaries

• inborn
• acquired
• non-neoplastic
• pseudotumours
• neoplastic
• benign
• BORDERLINE
• malignant (cont.)

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Diseases of the Ovaries

• inborn malformations
• aplasia (incl. kidney, uterus vagina),
• hypoplasia/dysplasia (e.g. in adrenogenital
  syndrome pseudohermafroditismus femininus,
  Turner sy (45X0, or 45X0/46XX)
• acquired (cont.)

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Diseases of the Ovaries

• inborn
• acquired
• non-neoplastic
• atrophy - involution, inflammation PID,
  actinomycosis, tbc
• pseudotumours
• neoplastic
• benign
• BORDERLINE
• malignant (cont.)

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Diseases of the Ovaries

• inborn
• acquired
• non-neoplastic
• pseudotumours
• stromal hyperplasia
• CYSTS
• neoplastic
• benign
• BORDERLINE
• malignant (cont.)

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Ovary - cysts

• follicle
• luteal
• inclusion
• endometrial (chocolate)
• POLYCYSTIC OVARIES (Stein- Leventhal syndrome)
• obesity
• hirsutism
• infertility
• oligo- or amenorrhea

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Diseases of the Ovaries

• inborn
• acquired
• pseudotumours (stromal hyperplasia, dif.
  dg. CYSTS)
• TUMOURS

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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

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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

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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 (!!!)

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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

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TUMOURS of the Ovary Surface epithelial stromal
tumours - microscopy

• serous - endosalpigeoma
• mucinous endocervicoma
• mixed
• endometrioid (coinciding with endometrial ca)
• Brenner tumour
• ------------------------
• papillary cystadenoma
• papillary borderline
• papillary cystadenocarcinomas

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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

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TUMOURS of the Ovary

• Sex cord stromal tumours
• Granulosa-stromal cell tumours
• Thecoma-fibroma group
• Sertoli- Leydig cell group
• Others..

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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

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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

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TUMOURS of the Ovary Germ cell Tumours

• dysgerminoma ( seminoma ovarii)
• embryonal carcinoma
• teratoma (mature, immature)
• yolc sac tumour
• choriocarcinoma

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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

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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

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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.

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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

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Teratoma

• coetaneous differentiated -cystic
• embryonal nondifferentiated -
  solid

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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

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Diseases of the Breast

• inborn malformations
• amastia, polymastia (mamma accessoria), aberant
  mammary tissue, polythelia
• acquired

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Diseases of the Breast

• inborn
• acquired
• degenerations amyloid, mastitis acute
  puerperal, chronic
• Pseudotumours ( precanceroses) fibrocystic
  disease, lipophagic granuloma, silicon granuloma,
  suture granuloma.
• TUMOURS

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Fibrocystic Breast Disease

• Def
• dyshormonal changes of the breast tissue with
  variably increased risk of breast cancer
  according to the type of epithelial proliferation

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Fibrocystic Breast Disease - symptoms

• palpable lump
• fluctuating cysts
• (pain)

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Fibrocystic Breast Disease - morphology

• fibrosis
• cysts
• epithelial hyperplasia
• ductal, lobular adenosis simple, florid,
  sclerosing, microglandular
• usual, atypical
• papillary

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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

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Tumours of the Breast symptoms

• early stage asymptomatic mammography
  (microcalciffication)
• palpable lump
• nipple discharge
• breast configuration change
• ulceration
• metastases

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Benign epithelial tumours

• intraductal papilloma
  - central
  - peripheral
• tubular adenoma

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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..)

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Breast cancer increased risk

• menarche prior 11 menopause after 55 yrs
• nuliparity late first delivery 30-35 let
• higher socioeconomic group
• obesity
• radiation

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Breast cancer increased risk

• etanol abuse
• oral contraceptives uncertain
• HRT following 10-15 yrs administration

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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

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Ductal ca in situ DCIS

• Histopathology
• solid, papillary, cribriform, comedo
• cytology (grading) G1-3

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Lobular carcinoma in situ LCIS

• 85 multicentric, 30 bilateral
• precursor of invasive ca
• Histopathology
• preserved lobular architecture, TDLU involvement,
  small monomorphous cells, regular nuclei

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Breast cancer -prognosis

• typing
• grading
• staging
• hormonal receptors (ER PR- immunohistochemistry)
  
• c-erbB-2 receptoru (immunohistochemistry, FISH)
• proliferation activity (immunohistochemistry
  Ki-67 index)
• angioinvasion

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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

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Fibroadenoma

• young age (30yr)
• firm circumscribed, painles
• mostly up to 30 mm
• solitary
• stromal epithelial component

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Phyllodes tumor

• middle age (50yrs)
• mostly benign, recurrences
• painless, up to 50 mm
• more cellular stromal component