BLOK REPRO II

PATHOLOGY ANATOMIC

LESI BENIGN
MALIGNANT

Female Tract

2021
1.Ca Cervix (Squamous vs Adeno) (tumor ganas)
2.Ca Endometrium vs Ca Serosum (tumor ganas)
3.Chorio Ca (tumor ganas)
4.Leiomyoma Uteri (tumor jinak)
5.Cystadenoma mucinosum, serosum (tumor jinak)
6. Serosum Ca, Mucinosum Ca (tumor ganas)
1. Ca cervix type Squamous dan Adeno
An invasive epithelial tumor composed of neoplastic cells with
varying degrees of squamous differentiation

90-99%- high risk human papillomavirus (HPV) and arise from a

precursor lesion, high grade squamous intraepithelial lesion
(HSIL)

HPV 16 and HPV 18

More common in low resource countries and women without
adequate cytologic screening

Variable morphology with several histologic variants described

Most common type of cervical carcinoma (> 90% of cases)

Ages 40 - 54 years old
• Younger age at first intercourse and higher lifetime number of sexual partners (Br J Cancer
2003;89:2078, Br J Cancer 2000;83:1565)
• Single contact with infected partner may result in infection and risk plateaus with many contacts
(Sex Transm Dis 2000;27:438)
• Immunodeficiency, including human immunodeficiency virus (HIV) infection, transplantation and
medications (J Natl Cancer Inst 2000;92:1500)
• Cigarette smoking > 20 years (Br J Cancer 2003;89:2078, Br J Cancer 2000;83:1565, Cancer Causes
Control 2002;13:839)
• Multiparity and early age at first birth (Br J Cancer 2003;89:2078, Lancet 2002;359:1093)
• Long term oral contraceptive use (Br J Cancer 2003;89:2078, Lancet 2003;361:1159)
• Chronic inflammation or concurrent sexually transmitted diseases, such as chlamydia
• Positive family history
• No circumcision in male partner (N Engl J Med 2002;346:1105)
Squamous epitelial

Adeno

Squamous Metaplasia
 Nesting: epitel bertatah
Horn pearl
Pola infiltrative

https://webpath.med.utah.edu/FEMHTML/FEM011.html
https://www.glowm.com/section-view/heading/pathology-of-
cervical-carcinoma/item/230
https://en.wikipedia.org/wiki/Villoglandular_adenocarcinoma_of_the_cervix
https://www.nature.com/articles/modpathol2015138.pdf?origin=ppub
 Ca Endometrium: type Endometrioid dan Serous
Mean age is sixth decade, with a range from the third to ninth
decades (Am J Clin Pathol 2008;129:110)
No definitive race predilection
Increased circulating estrogen:
Body Mass Index (BMI): dose response relationship of BMI ≥ 25
and increased risk of hyperplasia / carcinoma (Am J Obstet
Gynecol 2016;214:689.e1)
Nulliparous females (Cancer 1985;56:403, Am J Epidemiol
2008;168:563)
Endometrioid histotype constitutes approximately 80% of all
endometrial carcinomas, most of which are low grade (FIGO
grade 1 - 2) (Int J Gynecol Pathol 2019;38:S25)

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)67063-8/references

Primary cervical endometrioid adenocarcinomas are extraordinarily rare and likely develop from cervical
endometriosis (Histopathology 2020;76:112)
Technically, any tissue involved by endometriosis
Ectopic endometrial glands / stroma are responsive to estrogen stimulation and can also develop an
endometrioid-like hyperplasia and subsequently carcinoma
https://www.webpathology.com/image.asp?case=569&n=20

Abnormal, dysfunctional or postmenopausal uterine bleeding http://eknygos.lsmuni.lt/springer/117/208-248.pdf

Pelvic pain or mass / compression effect on adjacent structures
Abdominal bloating
Dyspareunia, dysuria
General stigmata of malign
 High grade carcinoma arising in
postmenopausal women
Often arises within endometrial
polyps; background
endometrium often atrophic
Immunohistochemistry shows
mutational pattern of p53
expression (strong and diffuse
or complete absence)
Associated with worse
prognosis than endometrioid
carcinoma and can present at
high stage

https://www.pathologyoutlines.com/topic/uterusserous.html

•Postmenopausal bleeding is common

Architecture:
Papillary with or without
appreciable fibrovascular
cores; micropapillary
Gland-like spaces may be
observed (but luminal
borders are not sharp as
seen in endometrioid
carcinoma)
Solid growth
Psammoma bodies may
be present in up to 33%
of cases
https://www.webpathology.com/image.asp?case=525&n=80
 3. Chorio Ca
Arises from trophoblastic cells of previous pregnancy, most
commonly after complete hydatidiform mole (Int J Gynaecol
Obstet 2018;143:79)
Intraplacental choriocarcinoma can occur after nonmolar
pregnancies, usually in the third trimester or postpartum
Also arises less commonly after nonmolar miscarriages and
ectopic pregnancies (Int J Gynaecol Obstet 2018;143:79, Case
Rep Obstet Gynecol 2018;2018:4705192)

https://www.pathologyoutlines.com/topic/placentachoriocarcinoma.html

Vaginal bleeding is the most common symptom

Can also present initially with metastatic disease, especially after nonmolar pregnancies, in the lungs
(dyspnea, hemoptysis), lower genital tract (violet nodules located in the vulva, vagina or cervix), liver
(abnormal liver function, intraabdominal hemorrhage) and brain (neurologic symptoms, e.g. convulsion,
altered mental status)
 Triphasic neoplasm (syncytiotrophoblast,
cytotrophoblast and intermediate trophoblast
components)
Arises from previous pregnancies, more
commonly after complete hydatidiform mole
Aggressive behavior
Serum human chorionic gonadotropin (hCG) is
a reliable tumor marker
High cure rates with chemotherapy

https://www.pathologyoutlines.com/topic/
placentachoriocarcinoma.html
https://www.webpathology.com/image.asp?case=302&n=52
 4. Leiomyoma Uteri
Most common uterine tumor (Mod Pathol 2016;29:S104)
Benign mesenchymal tumor derived from smooth muscle

Benign mesenchymal tumor derived from smooth muscle

90% of leiomyomas are the conventional type:
Conventional / usual leiomyoma:
Monotonous spindle cells with indistinct borders arranged in
intersecting fascicles

https://www.stepwards.com/?page_id=2886

25% symptomatic; remainder asymptomatic

Symptoms depend on size and location
Menorrhagia and pelvic pain in 33% of patients
Reference: Nat Rev Dis Primers 2016;2:16043
https://www.pathologyoutlines.com/topic/uterusleiomyoma.html
https://www.pathologyoutlines.com/caseofweek/case345.htm
https://www.webpathology.com/image.asp?case=570&n=13
 5. Cystadenoma serosum ovarii
Patients present over a broad age range
Most often found in adult women of reproductive age

Benign; > 1 cm in size (< 1 cm signifies a cortical inclusion cyst);

composed of cells resembling fallopian tube epithelium
Presents over a broad age range and are generally
asymptomatic
https://medicine.tamu.edu/class-files/webpath16/femhtml/Usually small, uni to multilocular cysts lined by a single layer of
fem052.htm tall, columnar, ciliated cells

Generally asymptomatic
Symptoms related to an ovarian mass
One of the more common ovarian tumors to undergo torsion
 https://www.humpath.com/spip.php?article4514

https://medicine.tamu.edu/class-files/webpath16/femhtml/
fem052.htm

https://www.nature.com/articles/3800307
https://librepathology.org/wiki/Serous_cystadenoma_of_the_ovary
5B. Serous Ca

Mean age: 63 years

Abdominal distension /
bloating / pain
Nausea
Anorexia / early satiety
Back pain
Urinary incontinence
Advanced disease at
presentation in ~80% of
cases
 Often bilateral, solid and cystic
ovarian masses
Solid, pseudoendometrioid,
transitional cell carcinoma-like
(appearance more common in
BRCA1 mutations; need to refer
to genetic testing
3 patterns of aberrant p53
expression correlate with TP53
mutation

https://www.pathologyoutlines.com/topic/ovarytumorserouscarcinomahg.html
 6. Mucinosum Cystadenoma

Accounts for 80% of primary ovarian mucinous neoplasms

Mucinous cystadenoma > adenofibroma (Int J Gynecol Pathol
2005;24:4, Cancer 1985;55:1958)
Median age 50 years (range 13 - 79) (Cancer 1985;55:1958)

Abdominal distention with or without palpable mass

Abdominal or pelvic pain
Other symptoms related to abdominal / pelvic mass
Rarely, estrogenic or androgenic manifestations secondary to
stromal luteinization (Int J Gynecol Pathol 2005;24:4)
https://www.webpathology.com/image.asp?case=526&n=8

https://www.webpathology.com/image.asp?case=526&n=7
 Simple nonstratified mucinous epithelium resembling
Müllerian, intestinal or gastric foveolar type epithelium
> 80% are intestinal type containing goblet cells
Epithelium may be undulating but usually no epithelia
stratification or tufting
Columnar, cuboidal to flat nonciliated cells
Variable amounts of mucinous cytoplasm
Small basally located nuclei lacking cytological

https://www.pathologyoutlines.com/topic/ovarytumormucinousbenign.html
https://en.wikipedia.org/wiki/Ovarian_mucinous_tumor
Referensi:
• Pathology outlines
• Web pathology
• the lancet
• eknygos.lsmuni.lt/springer
• Librepathology
• Nature.com
• Glown.