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Tumor of

reproductive
organs and
breast
Budiningsih S
Department of Anatomic
Pathology FMUI

Indonesia (BRK,2000)
cervix
3277
payudara 2398
ovarium 878
prostat
392

Tumors of female
reproductive
organs

Benign tumor

Leiomyoma/uterine fibroid
Commonest benign tumor
Commonly present in later repro
ductive life & around menopause
Associated with infertility
precise aetiology is unknown
clinically may present with
- abdominal mass
- urinary problems
- abnormal uterine bleeding

MACROSCOPIC
Multiple, round 5 200 mm
well circumscribed
cut section white,whorled

MICROSCOPIC
Complex interlacing
bundles of smooth muscle
fibers

Ovarian tum

Ovarian tumors
Solid / cystic
Benign / malignant
Borderline lesions have low risk of
malignant
behaviour
Nomenclature based on cellular origin
Commonest fatal gynaecological
malignancy in
many countries

Malignant tumor

Cervical cancer

Cervical cancer
Risk factors
Early age at first intercourse
Frequency of i c
Number of partners
HPV postulated as main causative
factor
Precancer can be detected by
cytology
(Paps smear)

CIN 2

CIN I

CIN 3

Cervical carcinoma

Tumor
of the
breast

Clinical features of breast


lesions
Distinguish physiological
changes from pathological
lesions
Many breast lesions present as a
lump/s
Note the characteristic of the
lump and the age of patient
Discharge from nipple occurs
with some conditions

Diagnostic methods
Immagingmammography &
ultrasound
Fine needle aspiration cytology
Core biopsy

Benign tumor

Fibroadenoma
Duct papilloma
Adenoma
Connective tissue tumor

fibroadenoma

Commonest type
Clinically mobile on palpation
Mainly in young woman
Arises from connective tissue &
epithelium

fibroadenoma
Macroscopic
Well circumscribed & lobulated
1 4 cm in diameter
Cut surface: solid, firm

Microscopic
Admixture of stromal &
glandular epithelial pro
liferation

Breast cancer
20% of all cancers in woman (Ind : 2
nd rank)
Occur in pre & post menopausal
woman
Commonest cause of death in 35
55
age group
Prognosis is good if detected at
early stage

Breast cancer
Aetiological mechanism
Overexposure to estrogens &
underexposure
to progesterone important
Some tumors contain ER & PR &
respond to hormone
manipulation
No good evidence for viral
involvement

Peau dorange

Nipple retraction
Nipple eczema

Major prognostic factor


Invasive / insitu disease
Distant metastases
(lungs,bones,liver)
Lymph node metastases (axillary
LN!!)
Tumor size
Locally advanced
Inflammatory ca

Minor prognostic factor

Histologic subtype
Tumor grade
Estrogen & progesterone receptor
HER 2/neu
Lymphovascular invasion
Proliferative rate
DNA content

Frequency of Histologic Subtypes of Invasive


Breast Cancer
Subtype

Frequency (%)

Invasive ductal carcinoma


pure
mixed with other types (incl lobular)

55
25

Invasive lobular carcinoma

10

Medulary carcinoma

<5

Mucinous carcinoma

Other pure types

Other mixed types

Ductal invasive
carcinoma
Macroscopic
irregular/stellate
outline/nodular
Ill defined edge
Cut surface : gray
white+yellow streaks
Microscopic
Tumor cells aranged in
cords,cluster,trabeculae
cytoplasm often
abundant
&
eosinophilic
nuclei regular /pleomor
phic

Predictive marker

ER

HER 2

HER 2

Tumor of male
reproductive
organs

Prostate cancer
Commonest

malignant tumor
second leading cause of male deaths
from ca
peak incidence is 60 85 years
unknown aetiology hormonal?
two clinicopathological types
clinical (symptomatic)
latent (incidental)

Clinical features
Urinary symptoms difficulty
/increase frequency micturition,
urinary retention
Rectal examination revealing hard
craggy
Bone metastases presenting with
pain,pathological fracture,anaemia
Lymph node metastases

Clinical / symptomatic
cancer
Arises in posterior subcapsular area
Adenocarcinoma
Invasion of stroma and perineural
spaces
Asymmetric firm enlargement may
palpable
per rectum
Metastasises especially to bone

Latent (incidental) ca
Microscopic focus of tumor found
incidentally
Common, incidence high in old
age
Dormant lesions
Metastases in 30% after 10 years

diagnosis
Digital rectal examination
Imaging ultrasound(TRUS), skeletal x
rays, isotop
bone scan
Cystoscopy including transurethral
resection
serologicserum acid & alkaline
phosphatase & Prostate Spesific Antigen
Haematologyleukoerythroblastic anemia
Biopsytransurethral
resection,needle,fine needle aspiration
cytology

Mode of spread
Direct stromal invasion,
capsule,urethra,
bladder base, seminal
vesicle
Via lymphatic to sacral,
iliac,paraaortic nodes
Via blood bone
(pelvis,lumbosacral spine,
femur), lungs, liver

Tumor of the penis


3 rd rank of penile lesion frequency
after venereal infection & congenital
malformation
2 types
intraepidermal carcinoma
(Bowens disease)
invasive squamous cell carcinoma
Occurs in uncircumcised men
HPV may be an aetiological factor

Testis tumor

< 1% of adult males malignancy


Diagnosis between 25 45 years
90% germ cell origin
Curable by combination of
surgery & chemotherapy
Metastize first to periaortic
abdominal LN
Most (65%) release markers
detectable in blood

Practical guide for pathology


anatomy of reproductive
organ

Disease of
pregnancy

Ectopic pregnancy

endometriosis

endometriosis

Pathology
of the Male
Reproductiv
e organs

Condyloma acuminatum

Condyloma accuminata

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