Download - 2 Tumor Genital Wanita
TUMOR GENITAL WANITATUMOR GENITAL WANITA
FEMALE REPRODUCTIVE SYSTEM
Condyloma acuminatum (VIN)Condyloma acuminatum (VIN)
Numerous condylomas encircling the introitus
Venereal warts(condyloma acuminatum)
Condyloma acuminatum (VIN)Condyloma acuminatum (VIN)
Condyloma acuminatum (VIN)Condyloma acuminatum (VIN)
Condyloma acuminatum (VIN)Condyloma acuminatum (VIN)
Acantosis, hyperkeratosis, and cytoplasmic vacuolization (koilocytosis)
VINVIN
•Diffuse cellular atypia•Nuclear crowding•Pathologic mitosis
PAGET’S DISEASE of the VULVAPAGET’S DISEASE of the VULVA
EXTRAMAMMARY PAGET’S DISEASEEXTRAMAMMARY PAGET’S DISEASE
PAGET’S DISEASE of the VULVAPAGET’S DISEASE of the VULVA
SQUAMOUS CELL CASQUAMOUS CELL CA
SQUAMOUS CELL CASQUAMOUS CELL CA
SQUAMOUS CELL CASQUAMOUS CELL CA
CLEAR CELL ADENOCACLEAR CELL ADENOCA
SARCOMA BOTRYIOIDES SARCOMA BOTRYIOIDES (embryonal rhabdomyosarcoma)(embryonal rhabdomyosarcoma)
SARCOMA BOTRYOIDESSARCOMA BOTRYOIDES
SARCOMA BOTRYOIDESSARCOMA BOTRYOIDES
SARCOMA BOTRYOIDESSARCOMA BOTRYOIDES
CERVIKCERVIK
ANATOMYANATOMY
CERVIXCERVIX
Colposcopy: dotted line is transformation zone
Post-menopausal cervix
ANATOMY (TRANSFORMATION ZONE)ANATOMY (TRANSFORMATION ZONE)
ANATOMY ANATOMY (TRANSFORMATION (TRANSFORMATION
ZONE)ZONE)
ANATOMY (TRANSFORMATION ZONE)ANATOMY (TRANSFORMATION ZONE)
ANATOMY (TRANSFORMATION ANATOMY (TRANSFORMATION ZONE)ZONE)
ANATOMY (TRANSFORMATION ZONE)ANATOMY (TRANSFORMATION ZONE)
Cervical epithelial cells (Papanicolaou smear)
Flat condyloma (uterine cervix)
Cervicitis - metaplasiaCervicitis - metaplasia
SQUAMOUS METAPLASIASQUAMOUS METAPLASIA
ENDOCERVICAL POLYPENDOCERVICAL POLYP
POLYPPOLYP
Condyloma Condyloma
Carcinoma: pathophysiologyCarcinoma: pathophysiology
EXPOSURE TO HPVEXPOSURE TO HPV
Carcinoma: pathophysiologyCarcinoma: pathophysiology
Carcinoma: pathophysiologyCarcinoma: pathophysiology
Carcinoma: pathophysiologyCarcinoma: pathophysiology
Spectrum of CINSpectrum of CIN
Cervical Intraepithelial Neoplasia (CIN)
Cytology: normal Cytology: normal CIN III CIN III
In Situ & Invasive Ca of the CervixIn Situ & Invasive Ca of the Cervix
Invasive Ca of CervixInvasive Ca of Cervix
CIN IIICIN III
CIN III with micro-invasionCIN III with micro-invasion
SCCSCC
MICROINVASIVE SCCMICROINVASIVE SCC
SCCSCC
SCC, keratinizedSCC, keratinized
SCCSCC
StagingStaging
Stage 0Stage 0 Carcinoma in situCarcinoma in situ
Stage IaStage Ia Microinvasive and confined to cervixMicroinvasive and confined to cervix
Stage IbStage Ib Invasive and confined to cervix Invasive and confined to cervix
Stage IIaStage IIa Extends to upper vagina but not to para-Extends to upper vagina but not to para-
metriummetrium
Stage IIbStage IIb Involve parametrium Involve parametrium
Stage IIIStage III Extension to pelvis sidewall or lower vagina Extension to pelvis sidewall or lower vagina
Stage IVStage IV Beyond the pelvis or involvement of rectal Beyond the pelvis or involvement of rectal or or
bladder mucosabladder mucosa
U T E R U S
ENDOMETRIAL HYPERPLASIAENDOMETRIAL HYPERPLASIA
Simple/Swiss cheese
Atypical hyperplasia
Complex hyperplasia
Squamous metaplasia
II. II. ENDOMETRIAL ENDOMETRIAL
GLANDULAR GLANDULAR TUMORSTUMORS
Endome-Endome-trioid trioid
Carcino-Carcino-mama
Relations among proliferation hyperplasia, atypical hyper-plasia, and endometrial Ca.
IV.IV. ENDOMETRIAL POLYPSENDOMETRIAL POLYPS
-Often pedunculated, may be solitary or multiple
-Commonly composed of hyperplastic endometrium with cystically dilated glands, cellular stroma, and thick walled vessels
-May cause intermittent bleeding, 3% harbor adenocarcinoma
Endometrial PolypEndometrial Polyp
A single polyp extent into endometrialcavity. The necrotic (arrow) tip is res-ponsible for clinical bleeding.
Slightly dilated endometrialglands embedded in markedlyfibrous stroma.
Adenocarcinoma of the EndometriumAdenocarcinoma of the Endometrium
Histological GradingHistological Grading
II. ENDOMETRIAL GLANDULAR TUMORSII. ENDOMETRIAL GLANDULAR TUMORS
Endometrioid CarcinomaEndometrioid Carcinoma
Endometrioid adenoca + squamous differentiation (well Endometrioid adenoca + squamous differentiation (well differentiated) differentiated) ADENOACANTHOMAADENOACANTHOMA
Variants of endometrial adenocarcinoma:Variants of endometrial adenocarcinoma:
Serous adenocarcinoma Clear cell adenocarcinomaSerous adenocarcinoma Clear cell adenocarcinoma
Endometrial Stromal SarcomaEndometrial Stromal Sarcoma
The myometrium is irregularly invaded by the tumor, which displays a rich vascular network.
MYOMETRIAL TUMORSMYOMETRIAL TUMORS
POSSIBLE LOCATION OF LEIOMYOMAPOSSIBLE LOCATION OF LEIOMYOMA
LEIOMYOMALEIOMYOMA
A. Well demarcated white appearance mass bulging into the uterine cavityB. Well differentiated spindle shaped cells in interlacing bundles
Bland spindle cells of leiomyoma Bland spindle cells of leiomyoma
LEIOMYOSARCOMALEIOMYOSARCOMA
A. Large hemorrhagic tumor mass distends to the lower corpus and flankedby two leiomyomas
B. The tumor cells are irregular in size & shape, with hyperchromatic nuclei
LEIOMYOSARCOMALEIOMYOSARCOMA
Leiomyoma
Leiomyosarcoma
Mitosis
Necrosis: uterine sarcoma
ECTOPIC PREGNANCYECTOPIC PREGNANCY
- Most ectopic pregnancies involve the fallopian tube (90%)- Predisposing factors include that inhibit tubal transport: chronic salpingitis, peritubal adhesion, large cyst, tumors, etc.- After 2-6 weeks growing rupture hematosalpinx (in tube), 12 weeks in isthmus
ECTOPIC PREGNANCYECTOPIC PREGNANCY
GESTATIONAL TROPHOBLASTIC DISEASEGESTATIONAL TROPHOBLASTIC DISEASE
A. Complete Hydatidiform MoleA. Complete Hydatidiform Mole
- content all of hydropic villi- content all of hydropic villi- etiology: lost or inactivation of maternal chromosome in the fertilized egg- etiology: lost or inactivation of maternal chromosome in the fertilized egg- bleeding and high hCG level in the urine- bleeding and high hCG level in the urine
B. Incomplete (Partial) MoleB. Incomplete (Partial) Mole
- admixture of normal and hydropic villi- admixture of normal and hydropic villiC. Invasive Mole (chorioadenoma destruen)C. Invasive Mole (chorioadenoma destruen)
- invasion of molar villi & trophobastic tissue into / through myometrium- invasion of molar villi & trophobastic tissue into / through myometriumD. ChoriocarcinomaD. Choriocarcinoma
- arise from normal pregnancy (20%) and abnormal pregnancy (50%- arise from normal pregnancy (20%) and abnormal pregnancy (50% hydatidiform mole)hydatidiform mole)-very high level of urine hCG-very high level of urine hCG
Fertilization pattern of compete & partial moleFertilization pattern of compete & partial mole
Triploidy: partial hydatiform mole
HYDATIDIFORM MOLEHYDATIDIFORM MOLE
Numerous swollen villi (hydropic degeneration)
Triploidy: partial hydatiform mole(HE) x 50
HYDATIDIFORM MOLEHYDATIDIFORM MOLE
Partial mole Complete mole
Normal-lookingvilli
INVASIVE MOLEINVASIVE MOLE
The mole invade into myometrium
CHORIOCARCINOMACHORIOCARCINOMA
!-HCG: choriocarcinoma(IH) x 200
OVARYOVARYNON-NEOPLASTICNON-NEOPLASTIC
OVARIAN ENLARGMENTOVARIAN ENLARGMENT
NEOPLASTICNEOPLASTIC OVARIAN OVARIAN ENLARGEMENTENLARGEMENT (80% are (80% are
benign)benign)
NON-NEOPLASTIC NON-NEOPLASTIC OVARIAN ENLARGMENTOVARIAN ENLARGMENT
A. “Germinal” Inclusion CystA. “Germinal” Inclusion Cyst- common cyst in pre-menopausal period, result of down growth - common cyst in pre-menopausal period, result of down growth and entrapment of the surface epithelium into the ovarian cortexand entrapment of the surface epithelium into the ovarian cortex
B. Physiologic or Functional CystB. Physiologic or Functional Cyst- follicle cyst- follicle cyst- corpus luteum cyst- corpus luteum cyst- theca lutein cyst- theca lutein cyst
C. Polycystic ovariesC. Polycystic ovariesD. Stromal Hyperplasia D. Stromal Hyperplasia stromal hyperthecosis stromal hyperthecosis
FOLLICLE CYSTFOLLICLE CYSTOF THE OVARYOF THE OVARY
The rupture of the thin walled follicular cyst led to abdominal hemorrhage
POLYCYSTIC OVARIESPOLYCYSTIC OVARIES
-Bilateral and multiple cyst, as one of the more common cause of infertility, dulu disebut sindroma Stein-Leventhal, ditemukan pada 3-6% wanita usia reproduksi-Lined by granulosa-theca cells (may be luteinized & androgen secreting)-Symptom: varies from hyperestrinism (abnormal bleeding) to virilization (amenorrhea, hirsutism)
POLYCYSTIC OVARIESPOLYCYSTIC OVARIES(polycystic disease of the ovary)(polycystic disease of the ovary)
Cut section of the ovary show numerous cysts embedded in sclerotic stroma
Pathogenesis Pathogenesis
Polycystic Ovary SyndromePolycystic Ovary Syndrome
Stromal HyperthecosisStromal Hyperthecosis
Focal luteinization of ovarian stromal cells nest of luteinized stromal cells often functional virilization
NEOPLASTIC OVARIAN ENLARGEMENT NEOPLASTIC OVARIAN ENLARGEMENT (1)(1)
A. TUMORS DERIVED FROM SURFACE (GERMINAL) EPITHELIUMA. TUMORS DERIVED FROM SURFACE (GERMINAL) EPITHELIUM1. 1. Serous TumorsSerous Tumors
a. Serous cystadenomaa. Serous cystadenomab. Serous cystadenocarcinomab. Serous cystadenocarcinomac. Serous borderline tumorc. Serous borderline tumor
2. 2. Mucinous TumorsMucinous Tumorsa. Mucinous cystadenomaa. Mucinous cystadenomab. Mucinous cystadenocarcinomab. Mucinous cystadenocarcinomac. Mucinous borderline tumorc. Mucinous borderline tumor
3. Endometrioid Tumors3. Endometrioid Tumors4. Brenner Tumors4. Brenner Tumors5. Serous surface papilloma, cystadenofibroma, etc.5. Serous surface papilloma, cystadenofibroma, etc.
Histogenesis of Histogenesis of
ovarian epithelial-stromal tumorsovarian epithelial-stromal tumors
Serous TumorSerous Tumor
Serous epithelial tumor growth from the surface of the ovary
Serous cystadenoma of the ovarySerous cystadenoma of the ovary
Huge unilocular tumor The cyst is lined by a single layeredcyliated tubal-type epithelium
Mucinous CystadenomaMucinous Cystadenoma
Mucinous cystadenoma with multicystic Columnar cell lining
Mucinous Cystadenoma of the OvaryMucinous Cystadenoma of the Ovary
Numerous cysts filled with thick, Viscous fluid
A single layer of mucinous epithelialcells lines th cyst
Serous tumor of borderline malignancySerous tumor of borderline malignancy
Borderline Serous Cystadenoma & CystadenocarcinomaBorderline Serous Cystadenoma & Cystadenocarcinoma
Delicate papillary tumor growth Large, bulky tumor mass
Borderline Serous CystadenomaBorderline Serous Cystadenoma
Increased architectural complexity and epithelial cell stratification
Serous cystadenocarcinomaSerous cystadenocarcinoma
Mucinous cystadenocarcinomaMucinous cystadenocarcinoma
Brenner TumorBrenner Tumor
Brenner tumorBenign cystic teratoma
Characteristic epithelial nest within ovarial stroma
Tumor jinak pada berbagai umur, separo timbul pada umur > 50 th.Nama lain: tumor sel transisional
Brenner tumorBrenner tumor
NEOPLASTIC OVARIAN ENLARGEMENT NEOPLASTIC OVARIAN ENLARGEMENT (2)(2)
B. TUMORS DERIVED FROM SEX B. TUMORS DERIVED FROM SEX CORD/STROMACORD/STROMA1. Granulosa-Theca Cell Tumors1. Granulosa-Theca Cell Tumors2. Fibroma 2. Fibroma 3. Sertoli-Leydig Cell Tumor3. Sertoli-Leydig Cell Tumor4. Hilus (hilar) Cell Tumor4. Hilus (hilar) Cell Tumor5. Sertoli Cell Tumors5. Sertoli Cell Tumors
Granulosa cell tumorGranulosa cell tumor
Penampang melintang menunjukkan tumor solid dengan perdarahan. Bagian kuning menunjukkan kelompok sel-sel granulosa berlipid.
Gambaran mikroskopik bentuk folikular spesifik (Call-Exner bodies).
Granulosa Cell TumorGranulosa Cell Tumor
The tumor cells are arranged in sheets punctuated by small follicle-like structures (Call-Exner bodies)
Fibroma -- fibrothecomaFibroma -- fibrothecoma
-Most (90%) are unilateral, solid, round, firm, white masses 5-10 cm in size-Some time a thecal component may be present fibrothecoma-When the size >6cm 40% patients will develop ascites and right-sided pleural effusion (Meig’s syndrome)
Sertoli-Leydig cell tumorSertoli-Leydig cell tumor
Immature solid tubules of embryonic Sertoli cells are adjacent to clusters of aleydig cells that exhibit abundant eosinophilic cytoplasm.
Sertoli Cell TumorSertoli Cell Tumor
Well differentiated Sertoli cell tubulesGolden yellow appearances of the tumor cut surface.
Fibroma ovariiFibroma ovarii
Meig syndrome
NEOPLASTIC OVARIAN ENLARGEMENT NEOPLASTIC OVARIAN ENLARGEMENT (3)(3)
C. TUMORS DERIVED FROM GERM CELLSC. TUMORS DERIVED FROM GERM CELLS1. Teratoma1. Teratoma
- Mature Cystic Teratoma- Mature Cystic Teratoma- Immature (Malignant) Teratoma- Immature (Malignant) Teratoma
2. Dysgerminoma2. Dysgerminoma3. Endodermal Sinus (Yolk sac) Tumors3. Endodermal Sinus (Yolk sac) Tumors4. Embryonal Carcinoma4. Embryonal Carcinoma5. Choriocarcinoma5. Choriocarcinoma
D. METASTATIC TUMORSD. METASTATIC TUMORS
Histogenesis and inter-relationship of Histogenesis and inter-relationship of tumors of germ cell origintumors of germ cell origin
Dermoid cyst
Mature Cystic TeratomaMature Cystic Teratoma(dermoid cyst)(dermoid cyst)
Hair intermingled with butter-like substance
A mixture of tissues
Brain tissue is layered byskin tissue
Mature cystic teratomaMature cystic teratoma
Mature teratoma(HE) x 25
Immature teratomaImmature teratoma
Immature neural tissue exhibit rossette (R ) with multilayered nucleiEmbryonal glia (G) display densely packed atypical nuclei
Immature teratoma(HE) x 25
Immature TeratomaImmature Teratoma
Primitive neuroepithelium
Yolk-sac CarcinomaYolk-sac Carcinoma
Schiller-Duval bodies
Yolk sac carcinomaYolk sac carcinoma
Tumor cells are arrayed in reticular patternSchiller-Duval bodies: papilla protruding into the lumen lined by tumor cells
Dysgerminoma ovariiDysgerminoma ovarii
Polyhedral tumor cells with central round nuclei and adjacent inflammation.The neoplastic cells have clear, glycogen filled cytoplasm.
DYSGERMINOMA 0VARIIDYSGERMINOMA 0VARII
Metastatic TumorsMetastatic Tumors
Krukenberg tumorKrukenberg tumor
The ovary is enlarged and partially hemorrhagic.A microscopic section reveals mucinous (signet-ring) cells
infiltrating the ovary
Pseudomyxoma Peritonei Pseudomyxoma Peritonei (( from appendix) from appendix)
Ovarian tumor with extensive mucinous ascites, cystic epithelial implants on the peritoneal surfaces, and adhesions intestinal obstruction & death
OVARYOVARY