Laboratory Manual of Laboratory Manual of Anatomical PathologyAnatomical Pathology

BLOK 18 (REPRODUKSI)BLOK 18 (REPRODUKSI)

dr. Indrayanti, Sp.PAdr. Indrayanti, Sp.PA

endometrial hyperplasiaendometrial hyperplasia

hyperplasia endometrial glandhyperplasia endometrial gland

U T E R U S

FEMALE REPRODUCTIVE SYSTEM

ENDOMETRIAL HYPERPLASIAENDOMETRIAL HYPERPLASIA

Simple/Swiss cheese

Atypical hyperplasia

Complex hyperplasia

Squamous metaplasia

Cervical Intraepithelial Neoplasia (CIN) II

Middle Middle displasidisplasi of cervix uteri of cervix uteri

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

Endometrial AtrophyEndometrial Atrophy

Atrophy (endometrial)Atrophy (endometrial)

Uterin prolapseUterin prolapse

Uterin prolapseUterin prolapse

Normal uterin endometrium & miometriumNormal uterin endometrium & miometrium

Normal uterin endometriumNormal uterin endometrium

atrophyatrophy

Fibrocystic Change Fibrocystic Change page IIpage II

Lesi Lesi fibrocystic page IIfibrocystic page II

A. NormalB. Laktasi

A. PremenopauseB. Pascamenopause

FREKUENSI LESI PAYUDARAFREKUENSI LESI PAYUDARA

GAMBARAN KLINIS LESI PAYUDARAGAMBARAN KLINIS LESI PAYUDARA

Tabel. Kemungkinan sebab lesi patologis beserta gejala dan tanda klinis pada berbagai umur Sebab patologis Gejal klinis

25 tahun 25-35 tahun 35-55 tahun . 55 tahun Benjolan mobil Benjolan berbatas tidak tegas Benjolan padat/keras Discharge puting: 1. Jernih 2. Berdarah Ulserasi, eksema puting

Fibroadenoma Jarang Jarang Jarang Jarang Adenoma puting

Fibroadenoma Fibroadenosis Sclerosing adenosis Karsinoma Jarang Jarang Adenoma puting

Fibroadenoma Tumor filodes Perubahan fibro-kistik Karsinoma Ektasia duktus Papilloma duktus Penyakit Paget Adenoma puting

Tumor filodes Jarang Karsinoma Nekrosis lemak Ektasia duktus Papilloma duktus Penyakit Paget Adenoma puting

MAKROSKOPIS MAKROSKOPIS PERUBAHAN FIBROKISTIK PERUBAHAN FIBROKISTIK ””BLUE DOME CYSTBLUE DOME CYST””

GAMBARAN HISTOLOGIS PERUBAHAN FIBROKISTIKGAMBARAN HISTOLOGIS PERUBAHAN FIBROKISTIK

AA, , Hiperplasi sedang (florid)Hiperplasi sedang (florid)B. Hiperplasi atipikB. Hiperplasi atipik

Perubahan fibrokistik …Perubahan fibrokistik …

Sclerosing adenosisSclerosing adenosis

Perubahan fibrokistik …Perubahan fibrokistik …

FibroadenomaFibroadenoma

FibroadenomaFibroadenoma

Enucleated fibroadenoma of the breast

GAMBAR MAKROSKOPIS DAN GAMBAR MAKROSKOPIS DAN MIKROSKOPIS FIBROADENOMA MIKROSKOPIS FIBROADENOMA MAMMAE MAMMAE

FibroadenomaFibroadenoma

FibroadenomaFibroadenoma

FibroadenomaFibroadenoma

Fibroadenoma(HE) x 25

INVASIVE INVASIVE DUCTAL CARCINOMADUCTAL CARCINOMA

Carcinoma ductileCarcinoma ductile

Karsinoma inflamasiKarsinoma inflamasi

PENYAKIT PAGETPENYAKIT PAGET

umur lebih tuaumur lebih tua karsinoma intraduktal karsinoma intraduktal

mengenai duktus ekskretorius mengenai duktus ekskretorius utama meluas dan infiltasi ke utama meluas dan infiltasi ke kulit putting dan areola kulit putting dan areola kering, pecah, ulserasi, kering, pecah, ulserasi, hiperemia, edemahiperemia, edema

gambaran gambaran khaskhas: invasi : invasi epidermis sel Pagetepidermis sel Paget

sel Paget: sel besar, tunggal sel Paget: sel besar, tunggal atau berkelompok, inti atau berkelompok, inti hiperkhromatik dan pleomorfik, hiperkhromatik dan pleomorfik, dikelilingi dikelilingi halohalo

morfologi sel Paget = sel morfologi sel Paget = sel karsinoma duktal invasif/ non karsinoma duktal invasif/ non invasif invasif

Skin ulceration: breast cancer

KARSINOMA DUKTAL INVASIF, NOSKARSINOMA DUKTAL INVASIF, NOS

A. Gambaran potongan makroskopis

B. Gambaran mikroskopis

OVARYOVARYNON-NEOPLASTICNON-NEOPLASTIC

OVARIAN ENLARGMENTOVARIAN ENLARGMENT

NEOPLASTICNEOPLASTIC OVARIAN OVARIAN ENLARGEMENTENLARGEMENT (80% are benign)(80% are 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

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. a. Serous cystadenomaSerous cystadenomab. Serous cystadenocarcinomab. Serous cystadenocarcinomac. Serous borderline tumorc. Serous borderline tumor

2. 2. Mucinous TumorsMucinous Tumorsa. a. Mucinous cystadenomaMucinous 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

LeiomyomaLeiomyoma

LeiomyomaLeiomyoma

MYOMETRIAL TUMORSMYOMETRIAL TUMORS

POSSIBLE LOCATION OF LEIOMYOMAPOSSIBLE LOCATION OF LEIOMYOMA

Leiomyoma Leiomyoma (uterus)(uterus)

Leiomyoma Leiomyoma (uterus)(uterus)

LeiomyomaLeiomyoma

Moderate cellular lesion, composed of spindle cells with an elongated nucleus with rounded ends (blunt-ended, cigar-shaped). Note the

Perinuclear vacuolization and perpendicular crossing

LeiomyomaLeiomyoma

LEIOMYOMALEIOMYOMA

A. Well demarcated white appearance mass bulging into the uterine cavityB. Well differentiated spindle shaped cells in interlacing bundles

dermoid dermoid cystcyst

dermoid dermoid cystcyst

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