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Femail Genital, mamary gl., HPV neg , older women , imm & mechnical…
Femail Genital
Ovary
Sex Cord Stromal
Granulosa cell : M (ass w/ Est)
Adult : endometrial hyperplasia → Ca - U/L - solid
Juvenile : < 30 yo, pseudopubertas praecox
Leyding : ass w/ Androgen(steroidogenic) - yellowish, hirsutism, virilization - Micro - Reinke crystals
Thecoma : B , (spindle cell w/ lipid droplets, ass w/ Est, U/L , calcification, necrosis)
Fibroma : B , Fibroblast, w/out hormonal activity
Sertoli +Leyding : Rare, may be ass w/ virilization
Germ Cell
Primitive GC
Yolk Sac: Solid cystic w/ haemorrhage, dg = AFP
Emb Ca : large , solid , mix w/ other
Dysgerminoma : Solid, encap, U/L, regressive changes, M but good prog - Micro: cells w/ watery cytoplasm, lymphocytes
non ges choriCa : Solid, bloody, mixed with others, poor prog, dg = B-hCG
Teratoma
Mature (dermoid cyst) = B, most common, homunculus , Ovarian goiter (monodermal)
Immature = M, mostly neuroectodermal undiff, Peritoneal gliomatosis - spread of glial cells to peritoneum
Epithelium
Mucinous
Borderline
: GIT type cells w/ atypia, tens of cm, 100% benign ,
non invasive peritoneal implants
Ca : rare, U/L, large, KRAS , precursor = mucinous cystadenoma
B : mucinous cystadenoma, the largest tumors (even tens of cm)
Endometroid
B : cystadenoma, adenofibroma
M : precursor = endometriosi - Solid/cystic, bloody - early dg, good prog - HNPCC gene
Serous
Borderline
: cystic with papillary growths, uncertain behavior,
non invasive peritoneal implants
HGSC "type2" : 70% - BRCA1 , A2 , p53 - precursor > STIC - B/L - poor prog - spread to abdo cavity
B : serous cystadenoma, serous adenofibroma, superficial serous papilloma
LGSC "type1" : 5% - BRAF , KRAS - papillary structure - invasive - only removed surgically
Clear cell
B : cystadenoma, very rare
M : precursor = endometriosis , HG , prog dep on dg time .
Carcinoma: RF = endometriosis,nulliparity, previous menarche, (BRCA1, BRCA2, P53, Lynch syndrome), smoking, obesity
tumor marker = Ca-125 - protective fac = hormonal contraception - peritonial dissemination - ascites - lymph mts - poor pro
2ndary
Krukenburg Tumor : B/L mts of Mucinous/ring cell carcinoma from the Stomach
most commonly Breast, Pan, GIT (may look like borderline mucinous carcinoma)
Endometriosis > chocolate cysts" (endometriomas)
Cervix
Cancerous
Squa Cell Ca (80%) : mostly exophytic , ulcerated
AdenoCa (10-15%): most common > AdenoCa , from endocervical gl. (Ass w/ HPV)
--------------------------- rarely > Clear cell Ca , Mucinous, Serous (not Ass w/ HPV)
NET : rare
PreCancer
CIN1, (LSIL): mild, up to 1/3 of the thickness , HPV 6 - 11
CIN2, (HSIL): moderate 2/3 of thickness , HPV 16- 18- 31- 45
CIN3, (HSIL): sever , in situ , HPV 16- 18- 31- 45
Mesenchy: very rare
PseudoTumor
Polyp : exophytic growth of endocervical mucosa
Ovulosis (Nabothi Ovulus) - retention cysts
Endometriosis
Vulva
Non Tumor Epi Lesion
Lichen Sclerosus
Lichen Simplex Chronicus
p53 mut
d-VIN
Tumor
Mesen
B
lipoma, leiomyoma, hemangioma
M
leiomyosarcoma, rhabdomyosarcoma in children
Melanoma
Epi
B
vestibular papilloma, papillary hidradenoma
M
u-VIN
Squa Cell Ca
Basiloma : on vulva minor
Paget: eczematous and erythematous lesions, intraEpi of adenocarcinoma
(1.from apocrine gl. 2.from adenocarcinom of internal organs 3. de novo
Inflamm
non
Infec
Infec
Mycotic - candidiasis
Viral - HPV 6,11 (condylomata accuminata (genital wart) /HSIL ), HSV (painful blisters)
Bacterial
Gonorrhea
Ulcus Molle (Chancroid) > H.duceri - painfull
Lymphogranuloma Venereum (LGV) > Ch. trachomatis - 1.painless 2.buboes (painful lymphoadenopathy) 3. fibrotic disease
Siphilis > T.pallidum - 1. chancre 2. chondylomata lata 3. gumma (soft tumor like growth)
Granuloma Inguinale > Kleb - beefy red appearance
Vagina
Pseudotumor
Cyst: after childbirth, surgery - lined by squa cell epi - inclusion / Gartner (rem of Wolffian) / Bartolin
Endometriosis: retrograde mens, Iatrogenic implantation (after C-sec)
Fibroid Polyp : due to Est overproduction (preg, hormonal therapy)
Tumor
Epithe
B
Squamous cell papilloma, micropapillomatosis (rare)
M
SCC = VaIN = HSIL : upper third of the vagina
Clear cell Ca = Vaginal Adenosis (glandular epi in vaginal squa epi ) = adenocarcinoma
Mesench
M - Embryonal RhabdoMyoSarcoma < 5yo
Melonoma
Vaginitis / Colpitis : Bac vaginus (dysmicrobial of lactobaccilus which is maintain the acidic enviroment ph<4.5) ,
------------------------- S.agal, Tricho, Candida
Uterine body
Inflam
Salpingitis
Chronic: after acute > tubes become Fibrotic, Scarred w/ Adhensions - Hydrosalpinx (filled w/ serous fluid)
Granulomatous: by Tuberc - may lead to complete obstruction and infertility - caseous necrosis
Acute : N. gono, Ch. trachomatis, E. coli - Pyosalpinx, tuboovarian abscess
Oophoritis
2ndary to Salpingitis - Tubo-Ovarian Abcess
Endometritis
Preg: Aseptic / Septic (S.pyogenes, S.aureus, E.coli )
Non Preg
Infec (PID) : N.gono - Chlamydia, A.israelii
Non Infec : IU corpus luteum. chronic inflam
Tumor
Epithelium
Endometrial Ca
T2 ; low/norm Est , post menopausal, atrophic corporal endomethrium > p53 mut
----- HG / Serous / Clear Cell Ca (deep invasion, poor prog , 15%)
T1 ; high Est > proliferative endomet > laten phase (y) > Atypical Endometrial Hyperplasia (precancer) > EIN
----- LG / Mucinous (superficial invasion, good prog, 85%)
Mesenchy
Endometrial Stromal Node : B, well cicum
Endometrial Stromal Sarcoma
LeioMyoSarcoma : one large dominant w/out margine, Acute (necrosis, hemorrhage, edema) , postmenopausal growth
STUMP "smooth m. tumor of uncertain malig potential"
LeioMyoma: multi various nodules, sharp margin, chronic regression change (fibrosis, hyalinization, calcification)
--------------- Intramural/submucosal/subserous,
Mix
MMMT (CarcinoSarcoma) " M Mix Mull Tu" : mix of epi & mesen - Epithelial origin - not true mix, is metaplastic HG carcinoma
mamary gl.
Non-tumor
Fibrocystic : premeno, nodular proliferation, Ductal/Lobular
Adenosis : muliplication of Acinar Structures , "caricature of lobules"
Iatrogenic changes after implant placement : Giant cell inflam
Radial scar : idiopathic , star-shaped, central scar
Infarction of gl. : rapid breast enlargement (pregnancy) or thrombophilic conditions
Lipophagic granuloma : fat necrosis (trauma) → pseudocysts (oil cysts)
Mastitis
Chronic inflam: aseptic, asymp
Granulomatous inflam : Infectious (rarely) / Idiopatic(related to pregnancy, lactation - painless
Acute suppurative : mostly initiation of lactation (puerperal mastitis), Staph, Abscess - Painful red and warm
developmental
Supernumerary nipple
Hypoplasia/aplasia
Ectopic
Benign
Lactational adenoma
Papilloma
Fibroadenoma and tubular adenoma
Carcinoma
acc to behaviour and therapy
Hormone-dependent luminal
Triple negative
HER2 positive
acc to morphology
Lobular carcinoma in situ (LCIS)
Invasive
Ductal carcinoma in situ (DCIS)
Phyllodes : Fibroepi tumour, 50 yo, branching slits - like maple leaf
Paget's disease of the nipple: intraepithelial spread of ductal carcinoma
HPV neg , older women ,
imm & mechnical fac
vuvlvar dermatosis
vulvar dystroohies
65-70 %
M = 90%
Adult
20 %
M = 3-5%
more in young women
5-10 %
M = 2-3%
Adult
Tz , SCJ