1. Female reproductive system and breast 303Endometriosis 308Ectopic (tubal) pregnancy 92Hydatidiform mole 93Choriocarcinoma 94Fibrocystic breast change 22Hyaline degeneration of the fibrous tissue 66Fibroadenoma 159Phyllodes tumor 95Invasive breast carcinoma flashback

2. Endometriosis Three elements usually present: - benign endometrial glands, - endometrial stroma, - evidence of recent or remote hemorrhage (blood, siderophages) Any two of the three elements are sufficient to make the diagnosis. Exceptions: - in vagina, endometrial stroma must be seen to rule out adenosis of endometrial type - same histology within myometrium is diagnosed as adenomyosis

3. Endometriosis

5. Ectopic (tubal) pregnancy - villi and fetal tissue present within the tubal lumen -trophoblastic cells infiltrating the muscular wall of the fallopian tube - usually minimal decidual tissue - hemorrhage

6. Ectopic (tubal) pregnancy

8. Hydatidiform mole - villi are edematous and enlarged - many villi display central cistern formation characterized by a prominent central space that is entirely acellular - trophoblastic proliferation is variable, but is always circumferentially distributed rather than polarized - villi are usually avascular - trophoblast may show cytologic atypia

9. Hydatidiform mole

11. Choriocarcinoma - sheets of trophoblastic cells without chronic villi invading surrounding tissues and permeating vascular spaces - a mixture of cytotrophoblast, intermediate trophoblast, and syncytiotrophoblast - cytologic atypia usually pronounced with abnormal mitotic figures - hemorrhage and necrosis (- cytotrophoblast consists of polygonal cells with distinct cell membranes and clear cytoplasm, with round nuclei with prominent nucleoli - syncytiotrophoblast consists of multinucleated tumor cells with eosinophilic to basophilic cytoplasm - intermediate trophoblast is similar to cytotrophoblast but has larger more atypical nuclei)

12. Choriocarcinoma

14. Fibrocystic breast change There are three principal patterns of morphologic change: - cyst formation, often with apocrine metaplasia (Cysts are lined either by a flattened atrophic epithelium or by cells altered by apocrine metaplasia. Metaplastic cells have an abundant granular, eosinophilic cytoplasm, with round nuclei, resembling the apocrine epithelium of sweat glands. Papillary projections may be present in cysts and calcifications are common. - fibrosis (chronic inflammation and fibrous scarring contribute to the palpable firmness of the breast) - adenosis (An increase in the number of acini per lobule. A normal physiologic adenosis occurs during pregnancy throughout the breast. In nonpregnant women, adenosis can occur as a focal change. The acini are often enlarged (blunt duct adenosis) and are not distorted as is seen in sclerosing adenosis. Calcifications are occasionally present within lumens.)

15. Fibrocystic breast change

17. Hyaline degeneration of the fibrous tissue flashback

18. Fibroadenoma - well demarcated nodule of small, round or slit-like, evenly spaced acini and ducts, usually forming a branching, canalicular pattern - the stroma is usually delicate, cellular, and often myxoid, resembling intralobular stroma, enclosing glandular and cystic spaces lined by epithelium - the epithelium may be surrounded by stroma or compressed and distorted by it

19. Fibroadenoma

21. Phyllodes tumor - similar to fibroadenoma, but with increase in either abundance or cellularity (or both) of stromal component, and possibly dilation of the canalicular network of epithelium - this can produce the classical low-power appearance of a cabbage leaf-like structure extending into a cyst-like space

22. Phyllodes tumor

24. Invasive breast carcinoma Poorly differentiated invasive carcinoma of no special type: - ragged sheets of pleomorphic cells without or with poor tubule formation infiltrating the adjacent stroma

25. Invasive breast carcinoma