Organ Pathology

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

Diseases of the Fallopian Tubes

inborn malformations:
aplasia (Mllerian duct disorders)
bilateral
unilateral

incl. uterus & vagina

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 & Ovaries

PID pelvic inflammatory disease

(chronic salpingooophoritis)

tubar sterility

Diseases of the Ovaries

inborn

acquired

non-neoplastic
pseudotumours
neoplastic
benign
BORDERLINE
malignant

(cont.)

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.)

Diseases of the Ovaries

inborn

acquired

non-neoplastic

atrophy - involution, inflammation PID,

actinomycosis, tbc

pseudotumours
neoplastic
benign
BORDERLINE
malignant

(cont.)

Diseases of the Ovaries

inborn
acquired

non-neoplastic
pseudotumours
stromal hyperplasia
CYSTS

neoplastic
benign
BORDERLINE
malignant

(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.

TUMOURS

CYSTS)

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

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 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

stromal tumours

Surface epithelial
- microscopy

serous

- endosalpigeoma
mucinous endocervicoma
mixed
endometrioid (coinciding with endometrial ca)

Brenner tumour

----------------------- papillary cystadenoma

papillary borderline
papillary cystadenocarcinomas

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

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 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

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

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
-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

epithelial

75 ICD-O coded nosology units

myoepithelial
mesenchymal
fibroepithelial
tumours

WHO 2003

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

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..)

Breast cancer increased risk

menarche

prior 11 & menopause

after 55 yrs
nuliparity late first delivery 30-35 let
higher socioeconomic group
obesity
radiation

Breast cancer increased risk

etanol
oral

abuse

contraceptives uncertain

HRT

following 10-15 yrs

administration

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

Histopathology
solid, 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 -prognosis

typing
grading
staging
hormonal

receptors (ER & PRimmunohistochemistry)

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
firm

age (30yr)

circumscribed, painles

mostly

up to 30 mm

solitary
stromal

& epithelial component

Phyllodes tumor
middle

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