TUMOR GENITAL WANITA

FEMALE REPRODUCTIVE SYSTEM

Condyloma acuminatum (VIN)

Numerous condylomas encircling the introitus

Condyloma acuminatum (VIN)

Condyloma acuminatum (VIN)

Condyloma acuminatum (VIN)

Acantosis, hyperkeratosis, and cytoplasmic vacuolization (koilocytosis)

VIN
Diffuse cellular atypia Nuclear crowding Pathologic mitosis

PAGETS DISEASE of the VULVA

EXTRAMAMMARY PAGETS DISEASE

PAGETS DISEASE of the VULVA

SQUAMOUS CELL CA

SQUAMOUS CELL CA

SQUAMOUS CELL CA

CLEAR CELL ADENOCA

(embryonal rhabdomyosarcoma)

SARCOMA BOTRYIOIDES

SARCOMA BOTRYOIDES

SARCOMA BOTRYOIDES

SARCOMA BOTRYOIDES

CERVIK

ANATOMY

CERVIX

Colposcopy: dotted line is transformation zone

Post-menopausal cervix

ANATOMY (TRANSFORMATION ZONE)

ANATOMY
(TRANSFORMATION ZONE)

ANATOMY (TRANSFORMATION ZONE)

ANATOMY (TRANSFORMATION ZONE)

ANATOMY (TRANSFORMATION ZONE)

Cervical epithelial cells (Papanicolaou smear)

Cervicitis - metaplasia

SQUAMOUS METAPLASIA

ENDOCERVICAL POLYP

POLYP

Condyloma

Carcinoma: pathophysiology

EXPOSURE TO HPV

Carcinoma: pathophysiology

Carcinoma: pathophysiology

Carcinoma: pathophysiology

Spectrum of CIN

Cervical Intraepithelial Neoplasia (CIN)

Cytology: normal CIN III

In Situ & Invasive Ca of the Cervix

Invasive Ca of Cervix

CIN III

CIN III with micro-invasion

SCC

MICROINVASIVE SCC

SCC

SCC, keratinized

SCC

Staging
Stage 0 Stage Ia Stage Ib Stage IIa Carcinoma in situ Microinvasive and confined to cervix Invasive and confined to cervix Extends to upper vagina but not to parametrium Involve parametrium Extension to pelvis sidewall or lower vagina Beyond the pelvis or involvement of rectal or bladder mucosa

Stage IIb Stage III Stage IV

U T E R U S

ENDOMETRIAL HYPERPLASIA

Simple/Swiss cheese

Complex hyperplasia

Atypical hyperplasia

Squamous metaplasia

Endometrioid Carcinoma
Relations among proliferation hyperplasia, atypical hyperplasia, and endometrial Ca.

II. ENDOMETRIAL GLANDULAR TUMORS

IV.

ENDOMETRIAL 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 Polyp

A single polyp extent into endometrial cavity. The necrotic (arrow) tip is responsible for clinical bleeding.

Slightly dilated endometrial glands embedded in markedly fibrous stroma.

Adenocarcinoma of the Endometrium

Histological Grading

Endometrioid Carcinoma

II. ENDOMETRIAL GLANDULAR TUMORS

Endometrioid adenoca + squamous differentiation (well differentiated) ADENOACANTHOMA

Variants of endometrial adenocarcinoma: Serous adenocarcinoma Clear cell adenocarcinoma

Endometrial Stromal Sarcoma

The myometrium is irregularly invaded by the tumor, which displays a rich vascular network.

MYOMETRIAL TUMORS

POSSIBLE LOCATION OF LEIOMYOMA

LEIOMYOMA

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

LEIOMYOSARCOMA

A. Large hemorrhagic tumor mass distends to the lower corpus and flanked by two leiomyomas B. The tumor cells are irregular in size & shape, with hyperchromatic nuclei

LEIOMYOSARCOMA
Leiomyosarcoma

Leiomyoma

Mitosis

ECTOPIC 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 PREGNANCY

GESTATIONAL TROPHOBLASTIC DISEASE

A. Complete Hydatidiform Mole - content all of hydropic villi - etiology: lost or inactivation of maternal chromosome in the fertilized egg - bleeding and high hCG level in the urine B. Incomplete (Partial) Mole - admixture of normal and hydropic villi C. Invasive Mole (chorioadenoma destruen) - invasion of molar villi & trophobastic tissue into / through myometrium D. Choriocarcinoma - arise from normal pregnancy (20%) and abnormal pregnancy (50% hydatidiform mole) -very high level of urine hCG

Fertilization pattern of compete & partial mole

HYDATIDIFORM MOLE

Numerous swollen villi (hydropic degeneration)

HYDATIDIFORM MOLE
Normal-looking villi

Partial mole

Complete mole

INVASIVE MOLE

The mole invade into myometrium

CHORIOCARCINOMA

OVARY
NON-NEOPLASTIC OVARIAN ENLARGMENT NEOPLASTIC OVARIAN ENLARGEMENT (80% are
benign)

NON-NEOPLASTIC OVARIAN ENLARGMENT

A. Germinal Inclusion Cyst - common cyst in pre-menopausal period, result of down growth and entrapment of the surface epithelium into the ovarian cortex B. Physiologic or Functional Cyst - follicle cyst - corpus luteum cyst - theca lutein cyst C. Polycystic ovaries D. Stromal Hyperplasia stromal hyperthecosis

FOLLICLE CYST
OF THE OVARY

The rupture of the thin walled follicular cyst led to abdominal hemorrhage

POLYCYSTIC 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 OVARIES
(polycystic disease of the ovary)

Cut section of the ovary show numerous cysts embedded in sclerotic stroma

Pathogenesis

Polycystic Ovary Syndrome

Stromal Hyperthecosis

Focal luteinization of ovarian stromal cells nest of luteinized stromal cells often functional virilization

NEOPLASTIC OVARIAN ENLARGEMENT (1)

A. TUMORS DERIVED FROM SURFACE (GERMINAL) EPITHELIUM 1. Serous Tumors a. Serous cystadenoma b. Serous cystadenocarcinoma c. Serous borderline tumor 2. Mucinous Tumors a. Mucinous cystadenoma b. Mucinous cystadenocarcinoma c. Mucinous borderline tumor 3. Endometrioid Tumors 4. Brenner Tumors 5. Serous surface papilloma, cystadenofibroma, etc.

ovarian epithelial-stromal tumors

Histogenesis of

Serous Tumor

Serous epithelial tumor growth from the surface of the ovary

Serous cystadenoma of the ovary

Huge unilocular tumor

The cyst is lined by a single layered cyliated tubal-type epithelium

Mucinous Cystadenoma

Mucinous cystadenoma with multicystic

Columnar cell lining

Mucinous Cystadenoma of the Ovary

Numerous cysts filled with thick, Viscous fluid

A single layer of mucinous epithelial cells lines th cyst

Serous tumor of borderline malignancy

Borderline Serous Cystadenoma & Cystadenocarcinoma

Delicate papillary tumor growth

Large, bulky tumor mass

Borderline Serous Cystadenoma

Increased architectural complexity and epithelial cell stratification

Serous cystadenocarcinoma

Mucinous cystadenocarcinoma

Brenner Tumor

Brenner tumor Benign 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 tumor

NEOPLASTIC OVARIAN ENLARGEMENT (2)

B. TUMORS DERIVED FROM SEX CORD/STROMA 1. Granulosa-Theca Cell Tumors 2. Fibroma 3. Sertoli-Leydig Cell Tumor 4. Hilus (hilar) Cell Tumor 5. Sertoli Cell Tumors

Granulosa 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 Tumor

The tumor cells are arranged in sheets punctuated by small follicle-like structures (Call-Exner bodies)

Fibroma -- 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 (Meigs syndrome)

Sertoli-Leydig cell tumor

Immature solid tubules of embryonic Sertoli cells are adjacent to clusters of aleydig cells that exhibit abundant eosinophilic cytoplasm.

Sertoli Cell Tumor

Golden yellow appearances of the tumor cut surface.

Well differentiated Sertoli cell tubules

Fibroma ovarii

Meig syndrome

NEOPLASTIC OVARIAN ENLARGEMENT (3)

C. TUMORS DERIVED FROM GERM CELLS 1. Teratoma - Mature Cystic Teratoma - Immature (Malignant) Teratoma 2. Dysgerminoma 3. Endodermal Sinus (Yolk sac) Tumors 4. Embryonal Carcinoma 5. Choriocarcinoma
D. METASTATIC TUMORS

Histogenesis and inter-relationship of tumors of germ cell origin

Mature Cystic Teratoma (dermoid cyst)

A mixture of tissues

Hair intermingled with butter-like substance

Brain tissue is layered by skin tissue

Mature cystic teratoma

Immature teratoma

Immature neural tissue exhibit rossette (R ) with multilayered nuclei Embryonal glia (G) display densely packed atypical nuclei

Immature Teratoma

Primitive neuroepithelium

Yolk-sac Carcinoma

Schiller-Duval bodies

Yolk sac carcinoma

Tumor cells are arrayed in reticular pattern Schiller-Duval bodies: papilla protruding into the lumen lined by tumor cells

Dysgerminoma ovarii

Polyhedral tumor cells with central round nuclei and adjacent inflammation. The neoplastic cells have clear, glycogen filled cytoplasm.

Krukenberg tumor

Metastatic Tumors

The ovary is enlarged and partially hemorrhagic. A microscopic section reveals mucinous (signet-ring) cells infiltrating the ovary

Pseudomyxoma Peritonei
( from appendix)

Ovarian tumor with extensive mucinous ascites, cystic epithelial implants on the peritoneal surfaces, and adhesions intestinal obstruction & death

OVARY