2 Tumor Genital Wanita

TUMOR GENITAL WANITATUMOR GENITAL WANITA

FEMALE REPRODUCTIVE SYSTEM

Condyloma acuminatum (VIN)Condyloma acuminatum (VIN)

Numerous condylomas encircling the introitus

Venereal warts(condyloma acuminatum)


Acantosis, hyperkeratosis, and cytoplasmic vacuolization (koilocytosis)

VINVIN

•Diffuse cellular atypia•Nuclear crowding•Pathologic mitosis

PAGET’S DISEASE of the VULVAPAGET’S DISEASE of the VULVA

EXTRAMAMMARY PAGET’S DISEASEEXTRAMAMMARY PAGET’S DISEASE

PAGET’S DISEASE of the VULVAPAGET’S DISEASE of the VULVA

SQUAMOUS CELL CASQUAMOUS CELL CA

CLEAR CELL ADENOCACLEAR CELL ADENOCA

SARCOMA BOTRYIOIDES SARCOMA BOTRYIOIDES (embryonal rhabdomyosarcoma)(embryonal rhabdomyosarcoma)

SARCOMA BOTRYOIDESSARCOMA BOTRYOIDES

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 ANATOMY (TRANSFORMATION ZONE)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

Spectrum of CINSpectrum of CIN

Cervical Intraepithelial Neoplasia (CIN)

Cytology: normal Cytology: normal CIN III CIN III

In Situ & Invasive Ca of the CervixIn Situ & Invasive Ca of the Cervix

Invasive Ca of CervixInvasive Ca of Cervix

CIN IIICIN III

CIN III with micro-invasionCIN III with micro-invasion

SCCSCC

MICROINVASIVE SCCMICROINVASIVE SCC

SCCSCC

SCC, keratinizedSCC, keratinized

SCCSCC

StagingStaging

Stage 0Stage 0 Carcinoma in situCarcinoma in situ

Stage IaStage Ia Microinvasive and confined to cervixMicroinvasive and confined to cervix

Stage IbStage Ib Invasive and confined to cervix Invasive and confined to cervix

Stage IIaStage IIa Extends to upper vagina but not to para-Extends to upper vagina but not to para-

metriummetrium

Stage IIbStage IIb Involve parametrium Involve parametrium

Stage IIIStage III Extension to pelvis sidewall or lower vagina Extension to pelvis sidewall or lower vagina

Stage IVStage IV Beyond the pelvis or involvement of rectal Beyond the pelvis or involvement of rectal or or

bladder mucosabladder mucosa

U T E R U S

ENDOMETRIAL HYPERPLASIAENDOMETRIAL HYPERPLASIA

Simple/Swiss cheese

Atypical hyperplasia

Complex hyperplasia

Squamous metaplasia

II. II. ENDOMETRIAL ENDOMETRIAL

GLANDULAR GLANDULAR TUMORSTUMORS

Endome-Endome-trioid trioid

Carcino-Carcino-mama

Relations among proliferation hyperplasia, atypical hyper-plasia, and endometrial Ca.

IV.IV. ENDOMETRIAL POLYPSENDOMETRIAL 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 PolypEndometrial Polyp

A single polyp extent into endometrialcavity. The necrotic (arrow) tip is res-ponsible for clinical bleeding.

Slightly dilated endometrialglands embedded in markedlyfibrous stroma.

Adenocarcinoma of the EndometriumAdenocarcinoma of the Endometrium

Histological GradingHistological Grading

II. ENDOMETRIAL GLANDULAR TUMORSII. ENDOMETRIAL GLANDULAR TUMORS

Endometrioid CarcinomaEndometrioid Carcinoma

Endometrioid adenoca + squamous differentiation (well Endometrioid adenoca + squamous differentiation (well differentiated) differentiated) ADENOACANTHOMAADENOACANTHOMA

Variants of endometrial adenocarcinoma:Variants of endometrial adenocarcinoma:

Serous adenocarcinoma Clear cell adenocarcinomaSerous adenocarcinoma Clear cell adenocarcinoma

Endometrial Stromal SarcomaEndometrial Stromal Sarcoma

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

MYOMETRIAL TUMORSMYOMETRIAL TUMORS

POSSIBLE LOCATION OF LEIOMYOMAPOSSIBLE LOCATION OF LEIOMYOMA

LEIOMYOMALEIOMYOMA

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

Bland spindle cells of leiomyoma Bland spindle cells of leiomyoma

LEIOMYOSARCOMALEIOMYOSARCOMA

A. Large hemorrhagic tumor mass distends to the lower corpus and flankedby two leiomyomas

B. The tumor cells are irregular in size & shape, with hyperchromatic nuclei

LEIOMYOSARCOMALEIOMYOSARCOMA

Leiomyoma

Leiomyosarcoma

Mitosis

Necrosis: uterine sarcoma

ECTOPIC PREGNANCYECTOPIC 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 PREGNANCYECTOPIC PREGNANCY

GESTATIONAL TROPHOBLASTIC DISEASEGESTATIONAL TROPHOBLASTIC DISEASE

A. Complete Hydatidiform MoleA. Complete Hydatidiform Mole

- content all of hydropic villi- content all of hydropic villi- etiology: lost or inactivation of maternal chromosome in the fertilized egg- etiology: lost or inactivation of maternal chromosome in the fertilized egg- bleeding and high hCG level in the urine- bleeding and high hCG level in the urine

B. Incomplete (Partial) MoleB. Incomplete (Partial) Mole

- admixture of normal and hydropic villi- admixture of normal and hydropic villiC. Invasive Mole (chorioadenoma destruen)C. Invasive Mole (chorioadenoma destruen)

- invasion of molar villi & trophobastic tissue into / through myometrium- invasion of molar villi & trophobastic tissue into / through myometriumD. ChoriocarcinomaD. Choriocarcinoma

- arise from normal pregnancy (20%) and abnormal pregnancy (50%- arise from normal pregnancy (20%) and abnormal pregnancy (50% hydatidiform mole)hydatidiform mole)-very high level of urine hCG-very high level of urine hCG

Fertilization pattern of compete & partial moleFertilization pattern of compete & partial mole

Triploidy: partial hydatiform mole

HYDATIDIFORM MOLEHYDATIDIFORM MOLE

Numerous swollen villi (hydropic degeneration)

Triploidy: partial hydatiform mole(HE) x 50

HYDATIDIFORM MOLEHYDATIDIFORM MOLE

Partial mole Complete mole

Normal-lookingvilli

INVASIVE MOLEINVASIVE MOLE

The mole invade into myometrium

CHORIOCARCINOMACHORIOCARCINOMA

!-HCG: choriocarcinoma(IH) x 200

OVARYOVARYNON-NEOPLASTICNON-NEOPLASTIC

OVARIAN ENLARGMENTOVARIAN ENLARGMENT

NEOPLASTICNEOPLASTIC OVARIAN OVARIAN ENLARGEMENTENLARGEMENT (80% are (80% are

benign)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 cystfollicle 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

Stromal HyperthecosisStromal Hyperthecosis

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

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. Serous cystadenomaa. Serous cystadenomab. Serous cystadenocarcinomab. Serous cystadenocarcinomac. Serous borderline tumorc. Serous borderline tumor

2. 2. Mucinous TumorsMucinous Tumorsa. Mucinous cystadenomaa. Mucinous 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

Serous tumor of borderline malignancySerous tumor of borderline malignancy

Borderline Serous Cystadenoma & CystadenocarcinomaBorderline Serous Cystadenoma & Cystadenocarcinoma

Delicate papillary tumor growth Large, bulky tumor mass

Borderline Serous CystadenomaBorderline Serous Cystadenoma

Increased architectural complexity and epithelial cell stratification

Serous cystadenocarcinomaSerous cystadenocarcinoma

Mucinous cystadenocarcinomaMucinous cystadenocarcinoma

Brenner TumorBrenner Tumor

Brenner tumorBenign 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 tumorBrenner tumor


B. TUMORS DERIVED FROM SEX B. TUMORS DERIVED FROM SEX CORD/STROMACORD/STROMA1. Granulosa-Theca Cell Tumors1. Granulosa-Theca Cell Tumors2. Fibroma 2. Fibroma 3. Sertoli-Leydig Cell Tumor3. Sertoli-Leydig Cell Tumor4. Hilus (hilar) Cell Tumor4. Hilus (hilar) Cell Tumor5. Sertoli Cell Tumors5. Sertoli Cell Tumors

Granulosa cell tumorGranulosa 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 TumorGranulosa Cell Tumor

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

Fibroma -- fibrothecomaFibroma -- 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 (Meig’s syndrome)

Sertoli-Leydig cell tumorSertoli-Leydig cell tumor

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

Sertoli Cell TumorSertoli Cell Tumor

Well differentiated Sertoli cell tubulesGolden yellow appearances of the tumor cut surface.

Fibroma ovariiFibroma ovarii

Meig syndrome


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

Immature teratomaImmature teratoma

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

Immature teratoma(HE) x 25

Immature TeratomaImmature Teratoma

Primitive neuroepithelium

Yolk-sac CarcinomaYolk-sac Carcinoma

Schiller-Duval bodies

Yolk sac carcinomaYolk sac carcinoma

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

Dysgerminoma ovariiDysgerminoma ovarii

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

DYSGERMINOMA 0VARIIDYSGERMINOMA 0VARII

Metastatic TumorsMetastatic Tumors

Krukenberg tumorKrukenberg tumor

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

infiltrating the ovary

Pseudomyxoma Peritonei Pseudomyxoma Peritonei (( from appendix) from appendix)

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

OVARYOVARY

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