Diseases of female genital system and the breast Diseases of female genital system and the breast Xuemei jiang Department of Pathology Basic Medical School

Anatomy of female genital system

Ovary (gross)

1 上皮 2 不同发育阶段的卵泡 follicle 3 ，间质

Histological Classification and tumor orign Most tumors arise from the ovarian stroma and germinal epithelium. Most tumors arise from the ovarian stroma and germinal epithelium. The embryonic coelom ( from which that epithelium develops also gives rise to the Mullerian ( duct from which develop the structures of the genital tract, and it is this common origin which explains the great variety of epithelial patterns which are met with. The embryonic coelom ( 胚体腔 ) from which that epithelium develops also gives rise to the Mullerian ( 苗勒 ( 氏 ) duct from which develop the structures of the genital tract, and it is this common origin which explains the great variety of epithelial patterns which are met with.

epithelial tumors Sex cord-stromal tumors,SST Germ cell tumors Tumors of the ovary

General Introduction Ovarian tumors are commonest between 30 and 60 years old. Ovarian tumors are commonest between 30 and 60 years old. They are particularly liable to be or to become malignant. They are particularly liable to be or to become malignant. In their early stages, they are asymptomatic and painless. In their early stages, they are asymptomatic and painless. They may grow to a large size. They may grow to a large size. 1.4% lifetime risk of ovarian cancer 1.4% lifetime risk of ovarian cancer

Risk Factors Family history –Ovarian cancer –Breast cancer –Colon cancer Genetic factors Older age Caucasian More menstrual circles during lifetime ( Ovulation induction )

Incidence Nearly 25% of all ovarian neoplasm are malignant. Approximately 80 ％ of them are primary growths of the ovary. The remainder being secondary ， usually carcinomata.

The most widely accepted theory for the derivation of müllerian epithelial tumors is through the transformation of coelomic mesothelium. The most widely accepted theory for the derivation of müllerian epithelial tumors is through the transformation of coelomic mesothelium. This view is based on the embryologic pathway by which the müllerian ducts are formed and evolve into serous (tubal), endometrioid (endometrium), and mucinous (cervix) epithelia present in the normal female genital tract (see the section on anatomy). epithelial tumors

Ovary (low power) Cortical inclusion cysts of the ovary. These cysts appear to arise from the overlying mesothelium and are presumed to be the site of origin for many ovarian epithelial neoplasms. Another source of ovarian epithelium neoplasia is endometriosis

Primary Epithelial Tumor Mucinous cystadenoma or cystadencarcinoma (of. Cervical epithelium). (of. Cervical epithelium). Serous cystadenoma or cystadenocarcinoma (of. Tubal ( epithelium). (of. Tubal ( 输卵管的 ) epithelium). Endometrioma or Endometrioid carcinoma (of. Endometrium). (of. Endometrium). Clear cell carcinoma. Brenner tumour.

Regardless of their specific origin(s), ovarian epithelial tumors composed of serous, mucinous, and endometrioid cell types are emblematic of the plasticity of müllerian epithelium and range from clearly benign, to tumors of borderline malignancy, to malignant tumors Regardless of their specific origin(s), ovarian epithelial tumors composed of serous, mucinous, and endometrioid cell types are emblematic of the plasticity of müllerian epithelium and range from clearly benign, to tumors of borderline malignancy, to malignant tumors

serous cystadenoma Serous mucinous mucinous cystadenoma borderline serous cystadenoma serous cystadenocarcinoma Borderline mucinous cystadenoma mucous cystoadenocarcinoma 一、 epithelial tumour epithelial tumour (types) content

1 、 Serous 1 、 Serous epithelial tumour （ 30% of all ovarian tumors ） 1)serous cystadenoma 2) 2) borderline serous cystadenoma 3) 3) serous cystadenocarcinoma (25%) (75%)

They are the most common benign epithelial tumors and form 20% of all ovarian neoplasm. They are the most common benign epithelial tumors and form 20% of all ovarian neoplasm. In 10% of cases they are bilateral. In 10% of cases they are bilateral. It is uncommon to find them large than a fetal head. It is uncommon to find them large than a fetal head. 1)OVARIAN SEROUS CYSTADENOMA

Gross: Benign tumors typically present with a smooth glistening cyst wall with no epithelial thickening A unilocular or multilocular cyst A unilocular or multilocular cyst lined by epithelium similar to the fallopian tube. lined by epithelium similar to the fallopian tube. These common cystic neoplasms are filled with clear serous fluid ovarian serous cystadenoma Unilocular cyst multilocular cyst

Papillary serous cystadenoma a cyst cavity lined by more thick papillary tumor growths Benign tumors typically present with with small papillary projections ，

Histological appearance of serous cystadenoma LM: the lining epithelium of cystic neoplasms is composed of short columnar epithelium with abundant cilia in benign tumors

serous Papillary cystadenoma stromal papilla LM ： Papillary serous cystadenoma revealing stromal papillae with a columnar epithelium.

2)Borderline serous cystadenoma Bilateral Borderline tumors contain an increased number of papillary projections low potential malignancy a cyst cavity lined by more delicate papillary tumor growths

borderline Serous cystadenoma LM ： Tumors of borderline malignancy contain increased complexity of the stromal papillae with stratification of the epithelium （ 2-3layer ） and nuclear atypia. but destructive infiltrative growth into the stroma is not seen 5-year survival rate of about 90% 。 5-year survival rate of about 90% 。

borderline Serous cystadenoma Microscopy （ LP) papillary projections of epithelium extending into the lumen of the tumor. There is no invasion of the stroma or capsule.

( 三级乳头 --- 交界性 细胞有异型性 ) borderline Serous cystadenoma ( 三级乳头 --- 交界性 细胞有异型性 ) increased complexity of the stromal papillae --- papillae of three-stage branch

HM(HP): ( 1)exhibiting increased architectural complexity ( 1)exhibiting increased architectural complexity (2) epithelial cell stratification(2- 3layers), (2) epithelial cell stratification(2- 3layers),papillae of many-stage, atypia (3)Cell andnuclearatypia,mitotic figure appear. destructive infiltrative growth into the stroma is not seen (4)destructive infiltrative growth into the stroma is not seen borderline Serous cystadenoma

3)Serous cystadenocarcinoma 3)Serous cystadenocarcinoma -- common This is by far the commonest primary carcinoma, accounting for 60% of all cases, This is by far the commonest primary carcinoma, accounting for 60% of all cases, and over half the cases is bilateral. and over half the cases is bilateral. Ascites is always present. Ascites is always present. 5-year survival rate of about 5-year survival rate of about 20-30%

Gross appearance of serous cystadenocarcinoma The cysts are always of papillary type Larger amounts of solid( fragile,easily blood and necrosis) or papillary tumor mass, Larger amounts of solid( fragile,easily blood and necrosis) or papillary tumor mass, irregularity in the tumor mass, irregularity in the tumor mass, and fixation or nodularity of the capsule are all important indicators of probable malignancy and fixation or nodularity of the capsule are all important indicators of probable malignancy

Larger amounts of solid or papillary tumor mass Larger amounts of solid or papillary tumor mass the epithelium the epithelium burrowing through the capsule produces papillary processes papillary processes 乳 on the serous 头突 on the seroussurface. Gross appearance of serous cystadenocarcinoma

Cystadenocarcinoma growth on the ovarian surface （ left ） Extension of the growth to the pelvis and adjacent organs fixes the tumor. frozen pelvis

HM ： Papillary serous cystadenocarcinoma of the ovary with invasion of underlying stroma According to the differentiation of papillae or gland ： well \moderated\poorly differentiated adenocarcinoma Serous cystadenocarcinoma

the malignant papillae penetrate into the cystic wall. Ovarian papillary serous cystadenocarcinomas may contain small concretions called psammomma bodies, as purplish rounded and laminated objects. They are essentially just a form of dystrophic calcification in neoplasms. Concentric calcifications (psammoma bodies)

Serous cystadenocarcinoma at low power The individual tumor cells in the carcinomatous esions display the usual features of all malignant more complex gland and papillae more complex growth with infiltration solid papillae gland

Serous cystadenocarcinoma at high power HM:The individual tumor cells in the carcinomatous lesions display the usual features of all malignant neoplasia with the more extreme degrees of atypia, the cells may become undifferentiated More than 3 layers

prognosis Consequently, careful pathologic classification of the tumor, even if it has extended to the peritoneum, is relevant to both prognosis and selection of therapy Consequently, careful pathologic classification of the tumor, even if it has extended to the peritoneum, is relevant to both prognosis and selection of therapy The 5-year survival rate for borderline and malignant tumors confined within the ovarian mass is, respectively, 100% and 70%, The 5-year survival rate for borderline and malignant tumors confined within the ovarian mass is, respectively, 100% and 70%, whereas the 5-year survival rate for the same tumors involving the peritoneum is about 90% and 25%, respectively. whereas the 5-year survival rate for the same tumors involving the peritoneum is about 90% and 25%, respectively. Because of their protracted course (, borderline tumors may recur after many years, and 5-year survival is not synonymous with cure Because of their protracted course ( 迁延疗程 ), borderline tumors may recur after many years, and 5-year survival is not synonymous with cure

2 、 ( ) 2 、 mucinous epithelial tumour (about 25% of all ovarian neoplasms ) 1 ） mucinous cystadenoma 2 ） borderline mucinous cystadenoma 3 ） mucous cystoadenocarcinoma (about15- 20%) These tumors closely resemble their serous counterparts. They are somewhat less common They are somewhat less common 80%

1)OVARIAN MUCINOUS CYSTADENOMA It is usually large and may reach immense proportions, occupying the whole peritoneal cavity and compressing other organs. It is usually large and may reach immense proportions, occupying the whole peritoneal cavity and compressing other organs. some have been recorded with weights of more than 25 kg some have been recorded with weights of more than 25 kg. They are less frequently bilateral They are less frequently bilateral It may occur at any age

Benign Mucinous cystadenoma Benign ovarian Mucinous cystadenoma Gross ： the cut surface of the cyst is multilocular more cysts of variable size the surface of the cyst is completely smooth but may be slightly nodular due to projecting loculi the surface of the cyst is completely smooth but may be slightly nodular due to projecting loculi multilocular cyst

cysts filled with sticky, gelatinous fluid rich in glycoproteins Mucinous cystadenoma ovarian Mucinous cystadenoma

HM: A unilocular or multilocular cyst of ovary lined by tall columnar epithelium resembling that of the cervix or large intestine HM: A unilocular or multilocular cyst of ovary lined by tall columnar epithelium resembling that of the cervix or large intestine Cell without atypia Cell without atypia Mucinous cystadenoma

HM ： multilocular cyst lined by tall columnar epithelium, multilocular cyst lined by tall columnar epithelium with apical mucin and the absence of cilia, nuclear located basilar part ， Cell without atypia Mucinous cystadenoma

Borderline Mucinous cystadenoma  1 ）上皮 ≤3 层，轻度异型，核大，有少量 核分裂像， 2 ）增生上皮向腔内突出形成乳 头分支短而粗。 3 ）没有间质的浸润  The feature of borderline mucinous cystadenoma is the same with borderline serous cystadenoma 。 Only different with the content in the cyst （ 1 ） increased complexity of the stromal papillae with stratification of the epithelium （ 2-3 layer ） （ 1 ） increased complexity of the stromal papillae with stratification of the epithelium （ 2-3 layer ） （ 2 ） nuclear atypia （ 2 ） nuclear atypia. （ 3 ） but destructive infiltrative growth into the stroma is not seen

5-year survival rate of about 5-year survival rate of about 40-50% The feature of mucinous cystadenocarcinoma is the same with borderline serous cystadenocarcinoma ， Mainly different with the content in the cyst 。 Mucinous cystadenocarcinoma （ 10% ）

Mucinous cystadenocarcinoma half big ， Cystadenocarcinomas contain more solid growth Larger amounts of solid(fragile,easily blood and necrosis) or papillary tumor mass Larger amounts of solid(fragile,easily blood and necrosis) or papillary tumor mass solid tumor mass papillary tumor mass cyst papillary tumor mass

HM: conspicuous epithelial cell atypia and stratification （ More than 3 layers ） gland architecture ---well differentated less stroma Without Concentric calcifications (psammoma bodies) Mucinous cystadenocarcinoma

Teratoma ( 良 / 恶性畸胎瘤 ) Desgeminoma ( 无性细胞瘤 ) endodermal sinus tumor ( 内胚窦瘤 ) embryonal carcinoma ( 胚胎性癌 ) Ovarian Germ cell tumors yolk sac tumor （卵黄囊瘤）

teratoma blastodermblastoderm arise from germ cell,havethe potentiality of forming body cell differentiation,most. tumors contain at least bis-blastoderm or tris- blastoderm tissue 。 blastoderm mature tissue of tris- blastoderm : ectoderm: skin ;hair ;sebum; tooth;brain endoderm: respiratory tract; digestive tract ; thyroid gland mesoderm:connective tissue; cartilage( 软骨 ); bone; blood vessel

Type according todifferentiation :Cystic teratoma or dermoid mature teratoma:Cystic teratoma or dermoid benign (common) benign (common) :Solid teratoma immature teratoma:Solid teratoma malignant

1 、 mature teratoma : cystic nature of a mature teratoma of ovary. The most common tissue element of these teratomas is skin, so large amounts of hair and sebum are produced, gross ： HM mature tissue ectoderm: skin ;hair ;sebum; tooth;brain endoderm: respiratory tract; digestive tract ; thyroid gland mesoderm: connective tissue; blood vessel cartilage( 软骨 ); bone;

a form of ovarian germ cell tumor. These tumors are often called "dermoid cysts" because they are mostly cystic. mature cystic teratomas of the ovary

mature teratoma

1. 成熟性畸胎瘤：良性

TEETH

皮脂腺 角化的鳞状上皮 Histologically, a variety of mature tissue elements may be found.

squamous epithelium Sebaceous gland

hairs Colonic gland cartilaginous tissue （ ectoderm ） （ entoderm ） （ mesoderm ） mature teratoma

sebaceous gland skin mature teratoma--- Dermoid cysts

thyroid tissue struma ovarii ： Microscopically, this teratoma has cartilage, adipose tissue, and intestinal glands at the right, while at the left is a lot of thyroid tissue. This condition can be termed struma ovarii. Rarely, a struma ovarii can even be a cause for hyperthyroidism.( 以甲状腺组织为主的单胚层畸胎瘤 ) struma ovarii cartilage, tissue adipose tissue intestinal glands

thyroid tissue

immature teratoma these tumors are mostly solid, then they are often "immature" teratomas with less differentiated tissue and are more aggressive.

2 、 immature teratoma tumors are mostly solid with part Of cyst gross ： malignant, primitive neural tube

immature teratoma primitive neural tube Like chrysanthemum -shape

Teratoma

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