Laboratory Manual of Anatomical Pathology

BLOK 18 (REPRODUKSI)

dr. Indrayanti, Sp.PA

endometrial hyperplasia
hyperplasia endometrial gland

U T E R U S

FEMALE REPRODUCTIVE SYSTEM

ENDOMETRIAL HYPERPLASIA

Simple/Swiss cheese

Complex hyperplasia

Atypical hyperplasia

Squamous metaplasia

Cervical Intraepithelial Neoplasia (CIN) II

Middle displasi of cervix uteri

CERVIK

ANATOMY

CERVIX

Colposcopy: dotted line is transformation zone

Post-menopausal cervix

ANATOMY (TRANSFORMATION ZONE)

ANATOMY
(TRANSFORMATION ZONE)

ANATOMY (TRANSFORMATION ZONE)

ANATOMY (TRANSFORMATION ZONE)

ANATOMY (TRANSFORMATION ZONE)

Cervical epithelial cells (Papanicolaou smear)

Flat condyloma (uterine cervix)

Cervicitis - metaplasia

SQUAMOUS METAPLASIA

ENDOCERVICAL POLYP

POLYP

Condyloma

Carcinoma: pathophysiology

EXPOSURE TO HPV

Carcinoma: pathophysiology

Carcinoma: pathophysiology

Carcinoma: pathophysiology

Spectrum of CIN

Cervical Intraepithelial Neoplasia (CIN)

Cytology: normal CIN III

Endometrial Atrophy
Atrophy (endometrial)

Uterin prolapse

Uterin prolapse

Normal uterin endometrium & miometrium

Normal uterin endometrium

atrophy

Fibrocystic Change page II

Lesi fibrocystic page II

A. Normal B. Laktasi

A. Premenopause B. Pascamenopause

FREKUENSI LESI PAYUDARA

GAMBARAN KLINIS LESI PAYUDARA

Tabel. Kemungkinan sebab lesi patologis beserta gejala dan tanda klinis pada berbagai umur Gejal klinis Sebab patologis 25 tahun 25-35 tahun 35-55 tahun . 55 tahun Benjolan mobil Fibroadenoma Fibroadenoma Fibroadenoma Tumor filodes Tumor filodes Benjolan berbatas Jarang Fibroadenosis Perubahan fibro- Jarang tidak tegas Sclerosing adenosis kistik Benjolan Jarang Karsinoma Karsinoma Karsinoma padat/keras Nekrosis lemak Discharge puting: 1. Jernih Jarang Jarang Ektasia duktus Ektasia duktus 2. Berdarah Jarang Jarang Papilloma duktus Papilloma duktus Ulserasi, eksema Adenoma puting Adenoma puting Penyakit Paget Penyakit Paget puting Adenoma puting Adenoma puting

MAKROSKOPIS PERUBAHAN FIBROKISTIK BLUE DOME CYST

GAMBARAN HISTOLOGIS PERUBAHAN FIBROKISTIK

Perubahan fibrokistik
A, Hiperplasi sedang (florid) B. Hiperplasi atipik

Perubahan fibrokistik

Sclerosing adenosis

Fibroadenoma
Fibroadenoma

Enucleated fibroadenoma of the breast

GAMBAR MAKROSKOPIS DAN MIKROSKOPIS FIBROADENOMA MAMMAE

Fibroadenoma

Fibroadenoma

Fibroadenoma

Fibroadenoma (HE) x 25

INVASIVE DUCTAL CARCINOMA

Carcinoma ductile

Karsinoma inflamasi

PENYAKIT PAGET

umur lebih tua karsinoma intraduktal mengenai duktus ekskretorius utama meluas dan infiltasi ke kulit putting dan areola kering, pecah, ulserasi, hiperemia, edema gambaran khas: invasi epidermis sel Paget sel Paget: sel besar, tunggal atau berkelompok, inti hiperkhromatik dan pleomorfik, dikelilingi halo morfologi sel Paget = sel karsinoma duktal invasif/ non invasif

Skin ulceration: breast cancer

KARSINOMA DUKTAL INVASIF, NOS

A. Gambaran potongan makroskopis

B. Gambaran mikroskopis

OVARY
NON-NEOPLASTIC OVARIAN ENLARGMENT NEOPLASTIC OVARIAN ENLARGEMENT (80% are benign)

NON-NEOPLASTIC OVARIAN ENLARGMENT

A. Germinal Inclusion Cyst - common cyst in pre-menopausal period, result of down growth and entrapment of the surface epithelium into the ovarian cortex B. Physiologic or Functional Cyst - follicle cyst - corpus luteum cyst - theca lutein cyst C. Polycystic ovaries D. Stromal Hyperplasia stromal hyperthecosis

FOLLICLE CYST
OF THE OVARY

The rupture of the thin walled follicular cyst led to abdominal hemorrhage

POLYCYSTIC 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 OVARIES
(polycystic disease of the ovary)

Cut section of the ovary show numerous cysts embedded in sclerotic stroma

Pathogenesis

Polycystic Ovary Syndrome

NEOPLASTIC OVARIAN ENLARGEMENT (1)

A. TUMORS DERIVED FROM SURFACE (GERMINAL) EPITHELIUM 1. Serous Tumors a. Serous cystadenoma b. Serous cystadenocarcinoma c. Serous borderline tumor 2. Mucinous Tumors a. Mucinous cystadenoma b. Mucinous cystadenocarcinoma c. Mucinous borderline tumor 3. Endometrioid Tumors 4. Brenner Tumors 5. Serous surface papilloma, cystadenofibroma, etc.

ovarian epithelial-stromal tumors

Histogenesis of

Serous Tumor

Serous epithelial tumor growth from the surface of the ovary

Serous cystadenoma of the ovary

Huge unilocular tumor

The cyst is lined by a single layered cyliated tubal-type epithelium

Mucinous Cystadenoma

Mucinous cystadenoma with multicystic

Columnar cell lining

Mucinous Cystadenoma of the Ovary

Numerous cysts filled with thick, Viscous fluid

A single layer of mucinous epithelial cells lines th cyst

Leiomyoma
Leiomyoma

MYOMETRIAL TUMORS

POSSIBLE LOCATION OF LEIOMYOMA

Leiomyoma (uterus)

Leiomyoma (uterus)

Leiomyoma

Moderate cellular lesion, composed of spindle cells with an elongated nucleus with rounded ends (blunt-ended, cigar-shaped). Note the Perinuclear vacuolization and perpendicular crossing

Leiomyoma

LEIOMYOMA

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

dermoid cyst
dermoid cyst

NEOPLASTIC OVARIAN ENLARGEMENT (3)

C. TUMORS DERIVED FROM GERM CELLS 1. Teratoma - Mature Cystic Teratoma - Immature (Malignant) Teratoma 2. Dysgerminoma 3. Endodermal Sinus (Yolk sac) Tumors 4. Embryonal Carcinoma 5. Choriocarcinoma
D. METASTATIC TUMORS

Histogenesis and inter-relationship of tumors of germ cell origin

Dermoid cyst

Mature Cystic Teratoma (dermoid cyst)

A mixture of tissues

Hair intermingled with butter-like substance

Brain tissue is layered by skin tissue

Mature cystic teratoma

Mature teratoma (HE) x 25