Diseases of the Female Genital Tract and Breast

8/8/2019 Diseases of the Female Genital Tract and Breast

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DISEASES OF THE FEMALE

GENITAL TRACT AND BREAST

Section 13


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Case 1. MATURE CYSTIC TERATOMA,

Ovary 25 year old female

Complaint: Gradual abdominal enlargement

PE: palpable right adnexal mass

Ultrasound: solid cystic mass with teethand bone-like structures

Underwent salpingoophorectomy

Gross:

Cyst measured 10 cm

Smoothgrayish white surface

Upon opening: filled with cream yellow amorphousgreasy material admixed with

hair

Protuberant mass was noted along the inner wall with fat, teethand bone-like

structures

Microscopically:

Cyst wall was composed of ovarian stroma

Lined by stratified squamous epithelium with dermal appendages

Otherareas: fat, smooth muscle, blood vessels, cartilage, and glandular tissues

Note: Please referto youratlas orotherreferences forclearerimage and distinction of parts.


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MATURE CYSTIC TERATOMA, Ovary

LPO


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MATURE CYSTIC TERATOMA, Ovary

HPO


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Case 2. ECTOPIC TUBAL PREGNANCY

30 year old female

Sudden left lowerquadrant pain

History of delay in menses for 8 weeks with positive pregnancy test

Ultrasound:

no gestational sac in uterus

Dilated left fallopian tube

Exploratory laparotomy: showed ruptured left fallopian tube withhemoperitoneum

amounting to 1 liter

Left fallopian tube:

edematousand hemorrhagic with friable blood clots

contained cream white soft to spongy placental tissues upon sectioning

Microscopic exam:

Placental tissuesalong the tubal mucosa partially obscured by blood clots

Immature villi with loose central stromal tissue containinga few blood vesselsand

surrounded by trophoblasts

Numerousacute inflammatory cellsand red blood cells within lumen and wall of

fallopian tube


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ECTOPIC TUBAL PREGNANCY

LPO

Muscular

wall

ChorionicVilli

RBCs


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ECTOPIC TUBAL PREGNANCY

LPOHPO

Trophoblasts


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Case 3. HYDATIDIFORM MOLE

25 year old G4P3

History ofabortion five monthsago and wasamenorrheic since then

Abdomen enlarged to 5 monthsgestational age

Profuse vaginal bleeding

Passed out a mass ofgrape-like structures

PE: enlarged uterus with no palpable fetus

Urine and blood levels ofHCG markedly elevated

Specimen: consisted of multiple vesicles, admixed withsoft hemorrhagic

tissuesamounting to5

cm in aggregate diameter Microscopically:

Large and distended chorionic villi without blood vessels

Central of villi composed of loose myxomatousstroma covered by

chorionic cilli, chorionic epithelium, cytotrophoblastsand syncitial

trophoblasts


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HYDATIDIFORM MOLE

Chorionic Villi

Avascular Stroma

Trophoblasts

LPO


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Case 4. SEROUS CYSTADENOMA,

Ovary

30 year old nulligravid female

Complaint: vague abdominal pain and gradual abdominalenlargement 5 months prior to consult

PE: distended abdomen and palpable right adnexal mass

Ultrasound: large cystic ovary filled with fluid

Gross exam: 5x5x3 cm ovary withsmooth pinkish cream surface with prominent vascular

markings

Uniloculated and filled with clear light yellow serous fluid

Smoothand glistening internal surface

No solid nodules or papillary masses

Microscopic exam: benign cuboidal to columnar epithelium(some ciliated) lining the cyst


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SEROUS CYSTADENOMA

LPO


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SEROUS CYSTADENOMA

HPO

Lining

epitheliumCyst wall


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Case 5. FIBROCYSTIC CHANGES OF THE

BREAST

20 year old female

Complaint: lump on breast

PE: 3 cm ill-defined slightly tender, movable breast mass just below areola

Gross: specimen was irregular withseveral brown to bluish colored cysts

containingsemi-translucent turbid fluid surrounded by dense fibrous

tissue

Microscopic:

Small cysts lined with cuboidal to columnar epithelium (some

multilayered)

Larger cysts with flattened epithelium

Some were lined with cells withabundant granular eosinophilic

cytoplasm withsmall round deeply chromatic nuclei

Stroma composed of fibrous tissue infiltrated with lymphocytes


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FIBROCYSTIC CHANGES OF THE BREAST

LPO


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FIBROCYSTIC CHANGES OF THE BREAST

HPO

Lining

epithelium

Cystic ducts

Stroma


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Case 6. FIBROADENOMA

30 year old female

Movable left breast mass of2 mos. duration

Mass: 4cm; firm; slightly tender; movable

Gross:

masswas well-circumscribed, lobulated withrubbery consistency

4x3x3cm

Cut sections: yellowishwhite slightly bulgingsurfaces withseveral slit-

like spaces

Microscopically:

Glandularand cystic spaces lined by heaped up and compressed

cuboidal epithelium surrounded by large irregular loose spindle cells

and fine wavy connective tissue fibers

Thin rim of fibrinous connective tissue separated the normal breast

parenchyma


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FIBROADENOMA

Fibroblastic stroma

LPO


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FIBROADENOMA

Glandularandcystic spaces

HPO


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Case 7. INVASIVE DUCTAL CARCINOMA

60 year old female Non-healing left breast ulcer

Began two yearsago asasmall firm non-tender, fixed nodule in the left upper

outerquadrant

PE: 3cm superficial ulcer with erythematousskin ulcer withan underlying palpable

fixed massbelow the nipple

Underwent radical mastectomy with lymph node dissection

Gross exam:

4cm fairly circumscribed hard reddish cream massbeneath ulcer

Had gritty solid cut surface withsmall pinpoint foci of chalk white necrotic

mass

Microscopically: Tumor composed of irregular nestsand cords of polyhedral cells withhyperchromatic

nuclei, prominent nucleoli, and ample eosinophilic cytoplasm

Dilated ducts were filled with necrotic material

Dense sclerotic connective tissue surrounded the tumor nests

Some glands exhibited cribriform pattern


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INVASIVE DUCTAL CARCINOMA

LPO

Fatty

tissue

Stroma

Malignant

glandular cells


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INVASIVE DUCTAL CARCINOMA

HPO

Malignantglandular

cells

Diseases of the Female Genital Tract and Breast

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