FACULTY of MEDICINE in ENGLISH

PATHOLOGY OF THE
URINARY TRACT AND MALE
GENITAL SYSTEM
Discipline: Pathology
Year of study: 3rd

Teacher: Prof. Simona Gurzu, MD, Phd

Date: March 2021
 Pathology of the lower urinary tract and male
genital system
• Pathology of the penis, scrotum, testis and epididymis 691-697
• Pathology of the prostate 697-701
• Pathology of the ureter, urinary bladder and urethra 701-704
 Inflammations – p. 701-702

Acute: uretritis, cystitis, ureteritis (induced by E.coli, chemotherapics, etc.)

Chronic uretritis/cystitis/ureteritis: infections, stones, trauma, radio-/chemotherapy

Complications:
✓ ascending infection, septicaemia
✓ urothelial carcinoma
✓ squamous metaplasia with further squamous cell carcinoma
✓ malakoplakia – proliferation of macrophages with Michaelis-Gutmann bodies

Specific inflammations:
Candida
Tuberculosis
Acute and chronic cystitis
Acute cystitis
Pseudomembranous cystitis

Hemorrhagic cystitis

Acute cystitis
after urinary stent
Ureteritis and cystic cystitis
7 cm-sized bladder stone
 Tumors - p. 701-704

Benign
- Papilloma
- “Papillary urothelial neoplasm of low malignant potential”

Malignant
Urothelial carcinoma (90%): bladder > renal pelvis > ureter > urethra
- multifocally tumor !
Causes: smoking, aromatic amines (dye), genetic factors
Morphology: papillary or solid tumor, from in situ to invasive carcinoma
Staging: pT1 – invasion of the lamina propria; pT2 – internal muscularis layer
pT3 – perivesical; pT4 – other organs
Metastases: lymph nodes, bones, lungs
Prognosis: good in papillary type, unfavorable in invasive forms
Therapy: BCG instillation, cystectomy, chemotherapy

Squamous cell carcinoma

Adenocarcinoma
Urothelial carcinoma of the renal pelvis
Urothelial carcinoma of the renal pelvis
Urothelial carcinomas – urinary bladder
 Pathology of the lower urinary tract and male
genital system
• Pathology of the penis, scrotum, testis and epididymis 691-697
• Pathology of the prostate 697-701
• Pathology of the ureter, urinary bladder and urethra 701-704
• Sexually transmited diseases-classification 705 (Table 18.3)
• Syphilis 705-708
 Pathology of the penis – p. 691-692

Phimosis: narrowing of prepuce orifice

Hypospadiasis, epispadiasis: opening of the urethra on the ventral/dorsal penis

Balanitis: inflammation of the glans penis

Posthitis: inflammation of the inner surface of prepuce

Peyronie ‘s disease (fibromatosis)

a penile fibromatosis → painful curvature of the penis on erection

Tumors
Premalignant: Queyrat erythroplakia (dysplasia)
Bowen’s disease (in situ carcinoma)
Benign: papilloma, condyloma
Malignant: squamous cell carcinoma
– more frequent on the glans (head)
- good prognosis in early stages (without invasion of the uretra, without lymph node metastasis)
Phimosis
Congenital anomalies

dorsal

ventral

hypospadias
epispadias
Balanitis,
posthitis
Hermaphroditism
Adrenal hyperplasia – ambigous genitalia – 46XX karyotype
3-year-old – Congenital adrenal hyperplasia
Adrenal hyperplasia – neovulva and vaginoplasty

2-year follow-up
 Pathology of scrotum

Inflammations

Squamous cell carcinoma

Swelling:
hydrocele/hematocele
inguino-scrotal hernia
testicular tumors
orchiepididymitis
testicular torsion
varicocele
hypoalbuminaemic edema
elephantiasis

Scrotal edema and edema of the preputium

39-year-old man
- right scrotal swelling for two years
- hydrocelectomy
-recurred swelling after 6 months
- CT: enlarged testis and paraaortic lymph nodes → testicular tumor???
- orchidectomy
1A. enlarged testis; 1B, C – lymph vessels containing Filaria bancrofti
Hydrocele
Pathology of spermatic cord
and seminal vesicles

•Spermatocele – seminal vesicles

•Varicocele
•Deferentitis
•Atresia of the spermatic cord
•Torsion of the spermatic cord
•Spermatocystitis
 Hydrocele

Spermatocele
Pathology of the testis and epididymis – p. 693-697
 Pathology of testis and epididymis – p. 693-697

Cryptorchidism (undescended testis)

- Diagnosis in children over 12 months (1%)
- Uni- or bilateral (10%)
- Complications: atrophy, germ cell tumors

Ectopy – development outside the abdominal cavity

Monoorchidism - one testis
Normal testis
Atrophy
- Causes: cryptochidism, radio-/chemotherapy,
cirrhosis, trauma, ischemia

Hypogonadism
- decreasing of spermatogenesis
- primary: dysgenesia or
Klinefelter syndrome
- secondary: liver cirrhosis Atrophy
hyperestrogenism
 Inflammations of testis and epididimis:
Orchitis, epididymitis

Acute: trauma, viruses, ascending bacterial infections, septicaemia

serous orchitis (mumps)
purulent
complications: periorchitis, fibrosis, atrophy

Chronic: fibrosis
Particular type: idiopathic granulomatous orchitis

Specific:
tuberculosis – the commonest location of TB in male genital organs
syphilis diffuse inflammation or gumma
Purulent orchiepididimitis with abscess Tuberculous orchiepididimitis

epididymis

testis
Endometriosis in paratesticular tissue after hormonal therapy for
prostatic carcinoma
TUMORS

Germ cell

Embryonal carcinoma
Seminoma

Extraembryonic Trophoblast Embryonic

tissues tissues

Yolk sac tumor Chorio- Teratoma

carcinoma
 TUMORS

GERM CELL TUMORS – pure or, more frequent (60%), mixed types!!! 95% are malignant

Seminoma (30-50%): 40-50 years males

very good prognosis in the pure type (classic seminoma) – 95% are radiosensitive!!!
Embryonal carcinoma (15-20%): 20-30 years males
5 year survival 25-30%, metastases in lungs and liver
Teratomas (25-30%):
Teratocarcinoma
Choriocarcinoma – can secrete hCG (human Choriogonadothropin)
Yolk sac tumor – can secrete alpha-fetoprotein (AFP)

SEX-CORD/STROMAL TUMORS – rare tumors, usually benign

Leydig cell tumor: benign, secretes androgens

Sertoli cell tumor: benign

ADENOMATOID TUMOR: epididymal rare benign tumor

Seminoma, embryonal carcinoma, choriocarcinoma and teratoma
Adenomatoid tumor Seminoma Teratoma
Pure (classic) seminoma
Embryonal carcinoma
Dermoid cyst
Bilateral Sertoli cell tumor – β catenin

34-year-old male patient with history of FAP had subtotal colectomy at age of 15. Since then, he
has been followed by yearly endoscopy, which, on multiple occasions, showed tubular adenoma
polyps in the sigmoid colon and rectum. There is no other significant past medical history. His
mother has FAP. His two siblings are without disease
 Pathology of the lower urinary tract and male
genital system
• Pathology of the penis, scrotum, testis and epididymis 691-697
• Pathology of the prostate 697-701
• Pathology of the ureter, urinary bladder and urethra 701-704
 Pathology of the prostate gland – p. 697-701
Prostatitis
- non-specific – acute, bacterian (2-5%)
- non-specific – chronic (the main cause of infertility; it can induce chronic pelvian pain)
- Granulomatous prostatitis (after BCG instillation)
- Specific: tuberculosis (rare)

Benign nodular hyperplasia

= nodular hyperplasia of the transition (central) zone of prostate, due to hyperandrogenism

1. hyperplasia of the peri-urethral gland (below bladder)

2. hyperplasia surrounding the internal urethral meatus (intravesical)

Complications:
compression of the prostatic urethra → atrophy of the remnant prostate
hypertrophy of the bladder muscle fibers
bilateral hydroureter and hydronephrosis
ascending inflammations (cystitis, pyelonephritis)
malignant transformation (adenocarcinoma)
septicemia
nicturia, polakiuria
Prostatitis and nodular hyperplasia
Benign hyperplasia
 Prostatic carcinoma - p. 697-701

- usually originates from peripheral prostate

- serum: high level of PSA - over 4 ng/ml (it might be also elevated in prostatitis!!!)

Microscopy: adenocarcinoma – Gleason grading system

immunohistochemical positivity for PSA

Spread:
- direct spread: seminal vesicles, urinary bladder, pelvic wall
- lymphatic spread – sacral, ilac, para-aortic nodes
- systemic spread:
commonest in bones (Batson’s veins → vertebras) – osteoblastic lesions

Staging:
Stage 0 - in situ carcinoma
Stage I - incidentally diagnosis, clinical undetectable
Stage II - tumor limited to prostate
Stage III - tumor direct invasion in other structures, without metastases
Stage IV - distant metastases

Evolution: usually long overal survival, especially in elderly patients (occult carcinoma)
Carcinoma of the prostate
 Gleason grading

1+2 = 3
3+4 = 7
4+3 = 7
Kuala-Lumpur, Malayesia
Hibiscus
FACULTY of MEDICINE in ENGLISH

PATHOLOGY OF THE
FEMALE GENITAL SYSTEM

Discipline: Pathology
Year of study: 3rd

Teacher: Prof. Simona Gurzu, MD, Phd

Date: March 2021
 Pathology of female genital system

• Pathology of the vulva and vagina 714-717

• Pathology of the uterine cervix 717-721
• Pathology of the uterine corpus 721-726
• Pathology of the ovaries and fallopian tubes 726-732
 Pathology of female genital system

• Pathology of the vulva and vagina 714-717

• Pathology of the uterine cervix 717-721
• Pathology of the uterine corpus 721-726
• Pathology of the ovaries and fallopian tubes 726-732
 Pathology of the vulva – p. 714-716

Edema - hypoalbuminaemia

Varices - pregnancy, pelvic tumors

Trauma - delivery

Vulvitis: acute, chronic

• non-infective: poor hygiene, diabetes, uremia, allergic/contact dermatitis (spray, etc.)
• infective: Trichomonas, Candida, bacteria (gonhorea, cocci), oxyuris,
Herpes-virus, HPV (condyomata accuminata), syphilis (chancre, condylomata lata)
Tumors:
premalignant:
✓ kraurosis = lichen sclerosus (atrophy) or chronic (hyperplasia+hyperkeratosis)+leukoplakia
✓ dysplastic nevi
✓ condyloma accuminata (risk for HPV-positive squamous cell carcinoma)
benign: papilloma, condyloma, papillary hidradenoma, fibroma, lipoma
intraepithelial: vulvar intraepithelial neoplasia (VIN) and extra-mammary Paget’s disease
malignant: squamous cell carcinoma, adenocarcinoma, basal cell carcinoma, melanoma

Bartholin’s glands: bartholinitis, cysts, abscesses, adenoma, adenocarcinoma

Vulvar fibroma
Condylomata accuminata – HPV Condylomata lata –
secondary syphylis
 Intraepithelial Invasive
squamous cell carcinoma squamous cell
Premalignant lesions
(VIN) carcinoma

leukoplakia
 Pathology of vagina – p. 716-717
Hematocolpos - himenal atresia
Atrophy
Trauma: delivery, sexual abuse

Vaginitis:
risk factors: diabetes, prolonged antibiotherapy, low estrogen level (menopausal period)
acute: purulent (Trichomonas vaginalis, Gardnerella vaginalis)
mycoses (Candida albicans - moniliasis)
chronic: senile atrophy – related
malakoplakia (E. coli – chronic inflammation)

Tumors
papilloma, fibroma, hemangioma
vaginal intraepithelial neoplasia (VIN)
carcinoma 1% of genital tumors;
squamous cell carcinoma (HPV-related), adenocarcinoma
botryoid sarcoma (embryonal rhabdomyosarcoma)
metastases or direct infiltration of cervical carcinoma
Botryoid sarcoma Squamous cell carcinoma
Battlo house – Antonio Gaudi
Barcelona, Spain
 Pathology of female genital system

• Pathology of the vulva and vagina 714-717

• Pathology of the uterine cervix 717-721
• Pathology of the uterine corpus 721-726
• Pathology of the ovaries and fallopian tubes 726-732
 Pathology of the uterine cervix
Cervicitis
Acute: catarrhal, suppurative
- infective (bacteria, chlamidii, mycoplasma, Herpes-virus)
- non-infective (trauma, irritative substances)
Chronic: squamous metaplasia, retention Naboth’s cysts
glandular hyperplasia (contraceptive drugs, pregnancy)
Chronic exocervicitis

HPV-related lesions
Low oncogenic potential: types 6, 11, 42, 43, 44, 53
High oncogenic potential: types 16, 18, 45, 56, 58
Intermediary oncogenic risk: types 31, 33, 35, 39, 51
1. Koilocytosis
2. Metaplasia (squamous metaplasia of columnar epithelium – transition zone)
3. Dysplasia – Cervical Intraepithelial Neoplasia (CIN)
Squamous intraepithelial lesion (SIL)
dysplasia grade I,II,III also-called CIN I,II,III
L-SIL - low grade squamous intraepithelial neoplasia (CIN I)
H-SIL - high grade squamous intraepithelial lesion (CIN II, III)
4. Condyloma acuminatum (genital warts)
Cervicitis
 Cervicitis

erosive cervicitis
 HPV-related lesions

dysplasia + metaplasia
Condyloma accuminatum
 Cervical Intraepithelial neoplasia (CIN)

CIN I (L-SIL)

CIN 2 (H-SIL) CIN 3 (H-SIL)

 Tumors of the uterine cervix
Benign: endocervical polyp, condyloma accuminatum, leiomyoma

Carcinoma of the uterine cervix – young females (35-50 years)

Macroscopy: - exophytic-ulcerated or endophytic

Microscopy: - squamous cell carcinoma (90%)

(microinvasive → invasive – below or over 3 mm)
- adenocarcinoma

pTNM, FIGO staging: pTis – in situ carcinoma (CIN III)

pT1: uterine cervix (Ia,Ib)
pT2: uterine body + vagina (IIa,IIb)
pT3: pelvic wall
pT4: bladder, rectum, etc.

5-year survival: 90-95% → 50-65% → 30%

adenocarcinomas: 50-65%
Complications: hemorrhages, superinfection
fistula → rectum, vagina, bladder
uretheral compression – hydronephrosis, pyelonephritis
 Carcinoma

Endocervical polyps
Carcinoma
Carcinom
 Pathology of female genital system

• Pathology of the vulva and vagina 714-717

• Pathology of the uterine cervix 717-721
• Pathology of the uterine corpus 721-726
• Pathology of the ovaries and fallopian tubes 726-732
 Pathology of the uterine corpus – p. 721-723
Endometritis
acute: - post-abortion, post-delivery
- purulent, necrotizing, hemorrhagic
- complications: myometritis, salpingitis
peritonitis, septicemia
chronic: - senile-atrophic
- IUD
- might induce salpingitis and infertility
tuberculous: spread from fallopian tubes (might induce chronic pelvian pain)

Myometritis – inflammation of myometrium

Endometriosis – abnormally located islands of ”endometrium”, which is usually functional, in:

➢ genital organs: ovary – ”chocolate cysts”, fallopian tubes, uterin ligaments, rectovaginal
septa, etc; might induces infertilty
➢ intra-abdominal organs
➢ extra-abdominal organs

Adenomyiosis – ”endometriosis” of myometrium, usually non-functional

– it might associates menorrhagia, dysmenorrhea and pelvian pain

Abnormal beeding: menorrhagia, metrorrhagia

Intrauterine contraceptive device (IUD)
 Queen Victoria

Susan Sarandon
ENDOMETRIOSIS
adenomyosis

ovarian
endometriosis

origins
peri-fallopian tubes
endometriosis
 extra-genital
endometriosis

appendix

abdominal wall
Endometriosis – Douglas pounch
Endometriosis – peritoneal wall (with scarring)
Endometriosis – Peri-sciatic nerve
 Pathology of the uterine corpus
Proliferative lesions – p. 723-726

Atrophy of endometrium – post-menopausal period (physiologic)

Endometrial hyperplasia
Causes: hyperestrogenism: hormonal disorders, pre-menopausal period
obesity
polycystic ovaries
sex-cord tumors of ovaries
hormonal therapy of breast or ovarian cancer

Types: simple / complexe – with/without atypia

Morphology: endometrial thickening

Evolution:
- complexe hyperplasia with atypia is a pre-malignant status → endometrial carcinoma

Therapy: curettage followed by hysterectomy (in cases with atypia)

Simple hyperplasia

Complex hyperplasia,
no atypia

Complex hyperplasia,
with atypia
 Benign tumors of the uterine corpus – p. 723-726

Leiomyoma:
- intramural, submucosal, subserosal
- solitary or multiple
Consequences: uterine bleeding, disorders of placental implantation, abortion
Particular types: intravenous leiomyomatosis
adenomyoma
Evolution: contraceptive pills and hyperestrogenism stimulates their growth
regression aftere menopausal period

Endometrial polyps:
- more frequent in perimenopausal period
- complications: hemorrhages
ulcerations, superinfection, infarction
malignization (very rare)
Leiomyomas
Leiomyomas of the uterus
Intramural
leiomyoma
 Malignant tumors of the uterine corpus – p. 723-726

Endometrial carcinoma:
- nulipars, diabetes, obesity, hypertension, late menopause, hyperestrogenism
Type I (endometrioid): 80-90% of cases, 55-65 years, hyperplasia-related, PTEN gene
long survival (90% - 5-year survival rate)

Type II (non-endometrioid): 10-15% of cases, 65-75 years

within atrophic endometrium, p53 gene
poor survival in advanced stages

Staging: pT1: endometrium + ½ of myometrium; pT2: cervix;

pT3: salpinx, ovary, vagina, peritoneum; pT4: other organs

Leiomyosarcoma: usually de novo tumors, 5 year survival 20-40% (rare tumors)

Endometrial stromal sarcoma: - low grade (80% survival), high grade (poor survival)

Carcinosarcoma: highly malignant

Endometrial carcinoma
Leiomyosarcoma
Congenital anomalies and displacements of the uterus
Displacements and
prolapse of the
uterus
Barcelona, Spain
 Pathology of female genital system

• Pathology of the vulva and vagina 714-717

• Pathology of the uterine cervix 717-721
• Pathology of the uterine corpus 721-726
• Pathology of the ovaries and fallopian tubes 726-732
 Pathology of the fallopian tubes – p. 726

Ectopic pregnancy tubar abortion, hematosalpinx, hemoperitoneum

Salpingitis (salpingo-oophoritis)

Acute: catarrhal, purulent

pyosalpinx, tubo-ovarian abscess, peritonitis
Chronic: fibrous, obstructive
pyosalpinx, hydrosalpinx, tubo-ovarian cyst
infertility (bilateral), ectopic pregnancy
Tuberculous salpingitis
Salpingitis isthmica nodosa
→ smooth muscle+glandular hyperplasia – isthmus → infertility

Tumors very rare

Adenomatoid tumor (mesothelioma)
Adenocarcinoma – serous or endometrioid (BRCA1 mutant)
Metastases
Normal pregnancy
Ectopic pregnancy
Acute salpingitis and pyosalpinx Pelviperitonitis and Douglas abscess
Hydrosalpinx, pyosalpinx
Tuberculous salpingitis Salpingitis isthmica nodosa and
Carcinoma
Peri-salpingian cysts
Montserrat, Spain
Ovary - histology
 Pathology of the ovary – p. 726-732

Circulatory disorders: - hemorrhagic infarction

- hemorrhages in graafian follicles or corpus luteum

Atrophy: - senile involution, post-radiotherapy

Endometriosis – “chocolate cysts”

Oophoritis + salpingitis (Adnexitis)

Acute: ascending purulent inflammation
complications: tubo-ovarian abscess, peritonitis

Chronic: - hydrosalpinx, pyosalpinx

- periovarian adherences
- sterility (in bilateral processes!)
- tubo-ovarian cyst
72 year old woman, benign tumor of the right ovary
ovarian torsion
hemorrhagic shock
 Non-tumor cysts – p. 726-732

Follicle cysts (cystic follicles)

hyperestrogenism

Polycystic ovarian disease

(Stein-Leventhal syndrome)
oligomenorrhea, anovulation, obesity, hirsutism, virilism

Luteal cysts

Inclusion cysts

Endometriotic cysts
OVARIAN TUMORS - carcinogenesis
 Benign and borderline epithelial tumors of ovary – p. 726-732

Serous/mucinous cystadenoma/borderline tumor

- 20-45 years
- sometimes bilateral (only 25%, especially serous neoplasm)
- 15-20% are borderline tumors – with low malignant potential
- can produce peritoneal implants (pseudomyxoma peritonei)
- can be transformed in acystadenocarcinomas (serous/mucinous)

Brenner tumor (Transitional cell tumor)

- 10-20% are bilateral, 1% malignant
- transitional cells

Endometrioid cystadenoma/borderline tumor

Epithelial tumors
Simple and papillary serous cystadenomas
Mucinous cystadenomas
Pleural metastases from a borderline tumor
with invasive peritoneal implants
Brenner tumor and benign teratoma
 Malignant epithelial tumors of the ovary

Serous/mucinous cystadenocarcinoma: 40-65 years; bilateral tumors (~ 65%/10%)

- primary (de novo) or secondary, low or high malignant potential (p53 index)
- staging: I, II: ovary/pelvis; III, IV: intra-abdominal/distant metastases
- 5 year survival: stage I -90%; stage II -60%; stage III -10-30%
- BRCA1 mutations – 30% familial risk, lower for BRCA2 (anti-BRCA drugs)
- only 8-10% of sporadic carcinomas show BRCA mutations
- follow-up: CA125 serum level (tumor marker)
Endometrioid adenocarcinoma: 20% - on the background of endometriosis
- solitary or bilateral (~ 15%)
- good prognosis but can associate endometrioid carcinoma of the uterine body

Other tumors: clear cell carcinomas (3%); carcinosarcoma, undifferentiated carcinomas

Metastases: Krukenberg’s tumor, appendix, breast, uterus

Cystic and solid malignant ovarian tumors
 uterus
X
X

Douglas pouch
 Mucinous
adenocarcinoma

Endometrioid
adenocarcinoma

Serous Brenner tumor

adenocarcinomas
 Staging

ovarian tumor - AIDS

invasion of appendix
Metastases

- Krukenberg’s tumor

Endometrial carcinoma
Rambla street, Barcelona
 Ovarian sex-cord/stromal tumors

Granulosa cell tumors

Thecoma

Sertoli-Leydig cell tumors

-they are usually benign

- they secrete estrogen, progesteron, androgens
 Ovarian sex-cord/stromal tumors

Granulosa cell tumors

- menopausal women
- adult type (95%): 20% - malignant, they secret estrogen, androgen or progesteron
- juvenile type: 5% - malignant

Thecoma
- peri- and post-menopausal
- benign tumor which secretes estrogens
- lipid-containing cells

Sertoli-Leydig cell tumors (0.3%)

- 20-30 years
- from well to poorly differentiated
- usually benign, secrete androgens

Fibroma
- Meigs syndrome
Sex-cord ovarian tumors

Granulosa cell tumors

Alfa-inhibin

Thecoma
Granulosa cell tumor

Thecoma
Fibroma
Leydig solitary tumor
Madrid, Spain
OVARIAN GERM CELL TUMORS
 Germ cell

Embryonal carcinoma
Seminoma
(Dysgerminoma)
Extraembryonic Trophoblast Embryonic
tissues tissues

Yolk sac tumor Chorio- Teratoma

carcinoma

- 10-20% of ovarian tumors

- children and young females
- usually malignant
 OVARIAN GERM CELL TUMORS

Teratomas
- dermoid cyst
- ovarian goitre (struma ovarii)
- immature teratoma – especially in young females

Dysgerminoma (ovarian seminoma):

- unilaterally, good prognosis after radiotherapy

Choriocarcinoma: very rare, hCG secretion

Embryonal carcinoma: highly malignant, hCG, α-FP

Yolk sac tumor: children, α-FP, poor prognosis

Teratocarcinomas: poor prognosis

Dermoid cyst and ovarian goitre
Dermoid cyst

Solid teratoma
Mature and immature teratomas - ovary
Yolk sac tumor
Blue Lagoon - Malta
FACULTY of MEDICINE in ENGLISH

PATHOLOGY OF THE
MAMMARY GLAND AND
PREGNANCY
Discipline: Pathology
Year of study: 3rd

Teacher: Prof. Simona Gurzu, MD, Phd

Date: March 2021
 Pathology of the pregnancy and breast

• Diseases of pregnancy 732-735

• Pathology of the breast 736-747
Pathology of pregnancy – p. 732, 735

Infections: TORCH sdr. (Toxoplasma, Other, Rubella, CMV, Herpes simplex virus)
Abortion: misscariage before 28th weeks
complete / incomplete / retained
complications: endometritis, myometritis, septicaemia

Ectopic pregnancy
= ovular implantation in fallopian tubes, ovary, abdominal cavity

Pregnancy-related toxemia (dysgravidia)

preeclampsia – arterial hypertension, albuminuria, edema
eclampsia – associated seizures
Consequences of eclampsia:
infarction of placenta, high blood pressure, hypercoagulability
hepato-renal failure: HELLP sdr. (10%) – Hemolysis, elevated Liver Enzymes,
Low Platelets level
 Ectopic pregnancy
Abortion
 Normal and ectopic pregnancy

Litopedion (lytos, gr.=stone)

• 31-year-old African woman, gravida 2 Para 0 (left
tubal pregnancy in 2011), farmer
• presented from a rural district of Burundi at 37 weeks
gestation for a first gynecological examination
• Abdominal pregnancy – placental insertion in
Douglas pouch
• After removal of placenta – complications???
• At 3 months - baby and mother in good condition
• the baby died at the age of eight months due to
cerebral malaria infection

• Congenital abnormalities: neck webbing,

torticollis, kyphosis, lumbar skin lesion, talipes
equinovarus, facial asymmetry

Muroni M, et al. Int J Surg Case Rep. 2021

Placenta
Pathology of placenta – p. 732-735
- disorders of placentation: placenta accreta, placenta praevia (low implantation)
accesory lobe
extrachorial placentation (small chorionic plate, underweight baby)
- villitis, chorioamnionititis, funisits (umbilical cord)
- hemorrhages

Trophoblastic (gestational) diseases

Hydatiform mole (partial or complete, simpe or invasive) – followed by:
abortion and even
choriocarcinoma – high level of HCG (serum and urine)

Complications of delivery
Uterine rupture
Uterine atonia
Retention of placenta
Maternal death
Baby death
Hydatiform mole and choriocarcinoma
Güell park-Barcelona
 Pathology of the pregnancy and breast

• Diseases of pregnancy 732-735

• Pathology of the breast 736-747
 Pathology of the breast – p.736-747

Malformations polymastia, polythelia, amastia, micromastia/hypoplasia, inverted nipples

Inflammations:
Acute mastitis: mammary abscess – lactations, inferior quadrants
Chronic mastitis:
Mamary duct ectasia (periductal mastitis)
Fat necrosis (steatonecrosis)
Galactocel

Fibrocystic change
- proliferation of mamary ducts + fibrosis
- non-tumor lesion!!!
Inverted nipple Amastia
Acute mastitis Chronic mastitis
A 34 year-old patient presented for revision breast surgery following three previous
augmentation mammaplasty operations and revisions that failed due to infection, severe
capsular contracture and implant exposure. At presentation there was a subglandular implant
on the right, and a contracted breast without an implant on the left.

Medical tourism in plastic surgery: Ethical guidelines and practice standards for perioperative care. Aesthetic plastic
surgery. In review. 2014.
A 57 year-old patient presented six weeks following bilateral breast implant explantation and
mastopexy. At the time of presentation, there was fulminant mastitis with fat necrosis and a
draining abscess.

Medical tourism in plastic surgery: Ethical guidelines and practice standards for perioperative care. Aesthetic plastic
surgery. In review. 2014.
Fibrocystic change
Fibrocystic change
Benign proliferative lesions (pseudotumors)
Ductal hyperplasia: with/without atypia
Sclerosing adenosis: lobular and ductal proliferation
proliferation of epithelium and myoepithelium
fibrosis and calcification
Radial scar: stellate scarring tissue + ductal epithelium proliferation
Gynecomastia: dilated ducts and epithelial proliferation

Benign tumors
Fibroadenoma:
- it occurs around 30 years old, no malignant transformation
Phyllodes tumor: larger tumor with laminated structure
-15% of cases → phyllodes sarcoma
Adenoma: rare, around nipples
Intraductal papilloma: central
peripheral
Myofibroblastoma
 Ductal hyperplasia

solid
Papillary, cribriform

cribriform
 Fibroadenoma Sclerosing adenosis
Central papilloma
Peripheral papillomatosis
Fibroadenoma
Gynecomastia
Eva Erkvall – 17 years – miss Venezuela
21 years – miss Univers
26 years – breast cancer (mother and a noon with breast cancer)
28 years – death (2011)
 Malignant tumors
Carcinoma:
Localization: 45-50% supero-extern, 20-25% central
10% supero-intern, 5-10% lower quadrant
Risk factors: genes BRCA1,2, p53
nulipars, early menarche, late menopause, hyperestrogenism
atypical pseudotumors

In situ carcinomas: 5-30% of cases

Tipuri: - ductal carcinoma in situ (DCIS) – 95%
solid, papillary, cribriform pattern, calcifications
Paget’s disease of the nipple - tumor cells within epidermis (ulcerations)

- lobular carcinoma in situ (LCIS) – 5%. bilateral or multifocally

Ductal carcinoma in situ (DCIS)

Comedocarcinoma
Paget disease
Lobular carcinoma in situ (LCIS)
 Invasive carcinomas

1. Invasive ductal carcinoma (80%)

schirrhous, glandular structures
- particular types (30-40%): medullary carcinoma
tubular carcinoma
papillary carcinoma

2. Infiltrating lobular carcinoma : 10-15%

- schirrhous tumor
- small cells arranged in linear files of single cells (`Indian files`)
- dense stroma

3. Other tumors – better prognosis:

- mucinous carcinoma
- medullary carcinoma
- tubular carcinoma
 Malignant infiltrative carcinomas

scirrhous tumor medullary tumor

mucinous tumor inflammatory

Lt. Breast Benign Phylloides tumour in a 16 year
old girl with necrosis of the skin. Figure 3. Advanced breast
cancer with fungating
ulcerative mass of the Rt.
Phylodes tumor – malignant variant
Granulocyte-colony stimulating
factor-producing malignant phyllodes
tumor of the breast: a rare case.
Mizoguchi et al. Surg Case Rep (2021)

Hyperreactivity of the bone marrow

Differential diagnosis:
Leukemia
Metastases
Invasive ductal carcinoma, NOS
Infiltrating lobular carcinoma
Medullary carcinoma
 MUCINOUS CARCINOMA

PAS- HE NOS + mucinous

 Invasive mammary carcinomas
Spread: direct spread: muscles, skin, thoracic wall
lymphatic spread: axillary, subclavicullary and mediastinal nodes
systemic spread: bone, lungs, liver, brain, adrenal glands

Staging: pT1: < 2 cm; pT2: 2-5 cm; pT3: > 5 cm

pT4: thoracic wall, skin, muscles

Prognostic factors:
- tumor stage
- tumor histologic type (unfavorable in infiltrating ductal or lobular carcinomas)
- histological grade (well, moderately or poorly differentiated)
- hormonal status (estrogen and progesteron receptors)
- gender: more agressive in males
- mutation of HER-2 gene (good results with Herceptin in mutated cases)

Other malignant tumors

Sarcomas: liposarcoma, leiomyosarcoma, rabdomiosarcoma, angiosarcoma

Malignant lymphomas
Skin invasion
Male breast rhabdomyosarcoma with relapse
Hodgkin lymphoma