1. Female Genital System - II
Organ Pathology
Female Genital System - II
Pathology of ovaries, tubes, breast, pregnancy
Jaroslava Dušková
Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague

2. Diseases of the Fallopian Tubes
inborn – malformations:
aplasia (Müllerian duct disorders)
bilateral incl. uterus & vagina
unilateral incl. kidney
partial atresia
acquired

3. 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

4. Diseases of the Fallopian Tubes
PID – pelvic inflammatory disease (chronic salpingooophoritis)
tubar sterility

5. Diseases of the Ovaries
inborn
acquired
atrophy (involution)
stromal hyperplasia (stromal)
inflammation (salpingooophoritis, PID, tuboovarian absess. Actinomycosis, tbc.)
(cont.)

6. Diseases of the Ovaries
inborn – malformations:
aplasia (incl. kidney, uterus & vagina)
hypoplasia (e.g. in adrenogenital syndrome –pseudohermafroditismus femininus)
acquired (cont.)

7. Diseases of the Ovaries
inborn
acquired
atrophy
hyperplasia
inflammation
pseudotumours
TUMOURS (cont.)

8. POLYCYSTIC OVARIES (Stein- Leventhal syndrome)
Ovary - cysts
follicle
luteal
inclusion
endometrial („chocolate“)
POLYCYSTIC OVARIES (Stein- Leventhal syndrome)
obesity
hirsutism
infertility
oligo- or amenorrhea

9. Diseases of the Ovaries
inborn
acquired
pseudotumours (stromal hyperplasia, dif. dg CYSTS)
TUMOURS

10. Ovary malignant neoplasms
Czech Rep new cases 2002
Czech Rep. 25,3/ women
Europe 20,6/ women
World 15,1/ women

11. TUMOURS of the Ovary 119 (!) 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

12. Surface epithelial stromal 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% (!!!)

13. Surface epithelial stromal tumours - macroscopy
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

14. 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

15. TUMOURS of the Ovary 119 (!) 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

16. Sex cord stromal tumours
TUMOURS of the Ovary
Sex cord stromal tumours
Granulosa-stromal cell tumours
Thecoma-fibroma group
Sertoli- Leydig cell group
Others…..

17. Sex cord stromal tumours
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

18. TUMOURS of the Ovary 119 (!) 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

19. TUMOURS of the Ovary Germ cell Tumours
dysgerminoma (= seminoma ovarii)
embryonal carcinoma
teratoma (mature, immature)
yolc sac tumour
choriocarcinoma
95% mature teratomas

20. 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 +

21. 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

22. 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.

23. 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

24. Teratoma coetaneous – differentiated -cystic
embryonal – nondifferentiated solid

25. 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

26. Diseases of the Breast acquired
inborn – malformations:
amastia, polymastia (mamma accessoria), aberant mammary tissue, polythelia
acquired

27. Diseases of the Breast TUMOURS inborn acquired
degenerations: amyloid, mastitis: acute puerperal, chronic
Pseudotumours (& precanceroses) : fibrocystic disease, lipophagic granuloma, silicon granuloma, suture granuloma….
TUMOURS

28. Fibrocystic Breast Disease
Def:
dyshormonal changes of the breast tissue with variably increased risk of breast cancer according to the type of epithelial proliferation

29. Fibrocystic Breast Disease - symptoms
palpable lump
fluctuating cysts
(pain)

30. Fibrocystic Breast Disease - morphology
fibrosis
cysts
epithelial hyperplasia
ductal, lobular – adenosis :simple, florid, sclerosing, microglandular
usual, atypical
papillary

31. 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

32. Tumours of the Breast symptoms
early stage – asymptomatic – mammography – (microcalciffication)
palpable lump
nipple discharge
breast configuration change
ulceration
metastases

33. Benign epithelial tumours
intraductal papilloma central peripheral
tubular adenoma

34. 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/ to 15,8/

35. Ductal ca in situ DCIS Histopathology
solid, papillary, cribriform, comedo
cytology (grading) G1-3

36. Lobular carcinoma in situ LCIS
85% multicentric, 30% bilateral
precursor of invasive ca
Histopathology:
preserved lobular architecture, TDLU involvement, small monomorphous cells, regular nuclei

37. 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..)

38. Breast cancer – increased risk
menarche prior 11 & menopause after 55 yrs
nuliparity late first delivery let
higher socioeconomic group
obesity
radiation

39. Breast cancer – increased risk
etanol abuse
oral contraceptives uncertain
HRT following yrs administration

40. Breast cancer -prognosis
typing
grading
staging
hormonal receptors (ER & PR- immunohistochemistry)
c-erbB-2 receptoru (immunohistochemistry, FISH)
proliferation activity (immunohistochemistry Ki-67 index)
angioinvasion

41. 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

42. Fibroadenoma young age (30yr) firm circumscribed, painles
mostly up to 30 mm
solitary
stromal & epithelial component

43. Phyllodes tumor middle age (50yrs) mostly benign, recidives
painless, up to 50 mm
more cellular stromal component