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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