Pathology Laboratory

FGT & Breast (Doc Amata)

28 January 2008

DISEASES OF THE FGTDISEASES OF THE FGT

MATURE CYSTIC TERATOMA

CLINICAL Gradual abdominal enlargement w/ moderste pain PE- Right adnexal mass Ultrasound – solid cystic mass w/ teeth & bone-like

structures Rt salpingo-oophorectomy

GROSS Cyst is smooth grayish white and globular and

measures 10 X 10 X 5 cm Cavuty filled w/ cream yellow amorphous greasy

material admixed w/ hair Protuberant mass – along the inner wall w/ fat, teeth

and bone like structuresMICROSCOPIC

Cyst wall – ovarian stroma Cyst lining – stratified squamous epithelium w/

dermal appendages underneath Fat smooth ms, BVs, thyroid tissue, cartilage

WHAT ARE THE POSSIBLE COMPLICATIONS OF A MATURE CYSTIC TERATOMA? Torsion of a dermoid tumor on its pedicle Higher than usual rate of sterility Malignant transformation (SSCA, thyroid CA,

malignant melanoma, Sarcoma)

ECTOPIC TUBAL PREGANANCY

CLINICAL G1P0 female- left lower quadrant pain Hx of a delay in menses for 1 month Ultrasound – no gestational sac in the uterus, rt

fallopian tube dilated Pregnancy test – (+) Explaratory laparotomy – ruptured fallopian tube w/

hemoperitoneum amounting to 2 litersGROSS

Left fallopian tube- edematous and hemorrhagic w/ adherent friable irregular blood clots

Cream white soft to spongy placental tissuesMICROSCOPIC

Placental tissues implanted along the tubal mucosa partially obscured by blood clots

Villi- immature w/ loose central stromal tissue containing a few blood vessels w/ trophoblast

Acute inflammatory cells

GIVE THE PREDISPOSING FACTORS IN THE DEVELOPMENT OF ECTOPIC PREGNANCIES. Predisposing factors include PID w/ chronic salpingitis

& peritubular adhesions, but 50% occur in apparently normal tubes

HYDATIDIFORM MOLE

CLINICAL G4P3-hx of abortion 5 months ago Amenorrheic Enlarged abdomen about 5 months gestation size Profuse vaginal bleeding Mass of grape-like structures Enlarged fetus w/ no fetus HCG – blood and urine

Brim, leu, virns 1 of 4

Patholab – FGT & Breast by Doc Amata Page 2 of 4

Suction curettageGROSS

Multiple vesicles admixed w/ soft and hemorrhagic tissues – 5cm in dm

MICROSCOPIC Chorionic villi – large & distended w/o BVs Center of villi – loose, myxomatous stroma covered by

chorionic epithelium Cytotrophoblasts & synctial trophoblasts Trophoblasts & avascular stroma

GIVE THE FEATURES OF COMPLETE VERSUS PARTIAL HYDATIDIFORM MOLE.

Feature Complete mole PartialKaryotype 46, XX (46, XY) TriploidVillous edema All villi Some villiTrophoblast proliferation

Diffuse, circumferential

Focal, slight

Atypia Often present AbsentSerum HCG Elevated Less elevatedHCG in tissue ++++ +Behavior 2% chorioCA Rare chorioCA

SEROUS CYSTADENOMA OVARY

CLINICAL Nulligravid F- vague abdominal apin Gradual enlargement 5 months ago Distended abdmen Palapabe rt adenxal mass US– cystically enlarged ovary w/ no solid areas Salpingo-oophorectomy

GROSS 5 X 5X 3 cm ovary – smooth, pinkidh cream w/

prominrt vascular markings Uniloculated and filled w/ serous fluid Cyst – smooth & glistening w/ no epithelial thickening

or papillary projectionsMICROSCOPIC

Lining epithelium – benign cuboidal to columnar epithelium

Some ciliated Cyst wall

WHAT IS A KRUKENBERG TUMOR? Krukenberg tumor refers to metastatic ovarian cancer

(usually bilateral) composed of mucin- producing signet cells that metastasize from the gastrointestinal tract, mostly the stomach.

DISEASES OF THE BREASTDISEASES OF THE BREAST

FIBROCYSTIC CHANGES OF THE BREAST

CLINICAL Enlarging left breast mass for 4 months 3cm dm mass, slightly tender, movable, firm w/

indistinct bordersGROSS

Irregular w/ several brown to bluish colored cysts Semitranslucent turbid fluid Dense fibrous tissue

MICROSCOPIC Smaller cyst – lined by cuboidal to columnar

epithelium, multilayering Larger cysts – flattened lining, abundant granular

eosinophilic cytoplasm, small rounded deeply chromatic nuclei

Apocrine metaplasia Stroma- fibrous tissue infiltrated w/ lymphocytes Lining epithelium & cystic ducts

GIVE THE ROLE OF ESTROGEN IN THE DEVELOPMENT OF THIS CONDITION The excess of estrogens may represent an absolute

increase, as in the rarely associated functioning ovarian tumors, or may be related to a deficiency of progesterone, as seen in anovulatory women.

Estrogen injections induce mammary cysts & hyperplastic lesions experimentally.

Hyperestrinism are considered to be basic to the development of this multipatterned disorder.

FIBROADENOMA

Patholab – FGT & Breast by Doc Amata Page 3 of 4

CLINICAL Movable left breast mass in a month Mass- firm, tender & movable Excision biopsy

GROSS Well circumscribed mass, lobulated w/ rubbery

consistency 3X 3X 2 cm Yellowish white, slightly bulging surfaces – w/ slit-like

spaces

MICROSCOPIC Large irregular loosely arranged spindle cells and fine

wavy connective tissue fibers enclosing glandular & cystic spaces

Lined by heaped-up and compressed cuboidal epithelium

Periphery – thin rim of fibroid connective tissue separating the normal breast parenchyma

Fibroblastic stroma

WHAT ARE THE HISTOLOGIC TYPES OF FIBROADENOMA? Pericanalicular fibroadenoma

o Intact, round-to-oval gland spaces may be present, lined by single or multiple layers of cells

Intracanalicular Fibroadenomao Glandular lumina are collapsed or compressed into

slitlike, irregular clefts & the epithelial elements then appear as narrow strands or cords of epithelium lying within the fibrous stroma

Lactating adenomao Connective tissue element is scant in amount, the

entire tumor may be composed of fairly densely packed glandular & acinar spaces lined by a single or double layers of cells

o Most often encountered in the lactating breast

INVASIVE DUCTAL CARCINOMA

CLINICAL Non-healing ulcer in left breast 2 yrs ago -Small firm non tender nodule in upper outer

quadrant Mass excised – biopsy – severe epithelial hyperplasia

w/ atypia 3cm superficial ulcer w/ erythematous borders above

the nipple Firm palpable lymp nodes in left axilla Left modified radical mastectomy w/ lymph node

dissedtionGROSS

8X6X4 cm breast tsissue w/ ulcerated skin flap & attached axillary fat

2cm – circumscribed hard reddish cream mass beneath ulcer

Retracted below the cut surface & gritty Small pinpoint foci – chalky white necrotic areas

MICROSCOPICALLY Irregular nests & cords of polyhedral cells w/

hyperchromatic nuclei Prominent nucleoli Ample eosinophilic cytoplasm Tumor cells – dilated ducts containing central

necrosis Dense connective tissue – surround tumor nests Cribiform pattern 8/10- lymph nodes positive for

malignant cells Desmoplastic stroma & malignant glandular

cells

WHAT IS THE CLINICAL STAGE OF THIS TUMOR?Stage CA Lymph

Node Metastatis

Distant Metastasis

5 Yr Survival Rate

0 DCIS/ LCIS

Absent Absent 92%

I Invasive Abent Absent 87% 2cm <0.02cm

II Invasive 5cm

1-3 present Absent 75%

>5cm AbsentIII Invasive

5 cm 4 present

Absent 46%

> 5cm > 1 present

Any size 10 present

Locally PresentAdvanced Absent

IV Any size Present/ absent

Present 13%

Ewan ko ba kung bkit ko to’ tinoxic.. tinype ko pa. prang parehas lang naman,, o well, pra mareview din cguro ako..

Patholab – FGT & Breast by Doc Amata Page 4 of 4

Anyways, yung mga highlighted na red yung pinahanap microscopically.

Thanks sa mga ngupload ng pix, malta & ate candz? –kaw ba yung empress cea? Gastos nanaman sa ink nito. Sma na ko sa nanlilimos ng ink..

O bsta ayun.. goodluck!Namimiss ko ng gumawa ng detox..Pero ala e,, tamad na ko.. knya kanya ng hanap ng detox. Haha!

-brim