Case. Questions Diseases of the Genital System and the Breast
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1 Diseases of the Genital System and the Breast Case 邓红浙江大学医学院病理学系 Pathology for 7yr (DH) 1 hongdeng@zju.edu.cn Pathology for 7yr (DH) 2 A 54-year-old woman notes a 6-month history of progressive vaginal discharge with an odor. She also has noted vaginal spotting after intercourse. She had gone through menopause 2 years earlier and took an oral contraceptive for 10 years. She has smoked one pack of cigarettes per day for 20 years. She denies a cough or dyspnea. She complains of right back pain and right leg swelling. The speculum examination shows a 4- cm irregular fungating mass arising from the cervix. Questions What is the most likely diagnosis? What is the next step? What is the likely pathophysiology for this condition? Pathology for 7yr (DH) 3 Pathology for 7yr (DH) 4 Diseases of the Cervix Diseases of the Uterus Gestational Trophoblastic Diseases Ovarian Tumors Carcinoma of the Breast Diseases of the Prostate Penis and Testicular Tumors Pathology for 7yr (DH) 5 Pathology for 7yr (DH) 6 1
2 Diseases of the Cervix Diseases of the Uterus Gestational Trophoblastic Diseases Ovarian Tumors Carcinoma of the Breast Diseases of the Prostate Penis and Testicular Tumors Diseases of the Cervix Diseases of the Uterus Gestational Trophoblastic Diseases Ovarian Tumors Carcinoma of the Breast Diseases of the Prostate Penis and Testicular Tumors Pathology for 7yr (DH) 7 Pathology for 7yr (DH) 8 Diseases of the Cervix Chronic Cervicitis Chronic Cervicitis Cervical Epithelial Intraepithelial Neoplasia Cervical erosion Cervical Nabothian cyst Endocervical polyp Pathology for 7yr (DH) 9 Pathology for 7yr (DH) 10 Chronic Cervicitis CIN Cervical Intraepithelial Neoplasm (CIN) Cervical epithelial dysplasia (precursor of cancer) Carcinoma in situ Pathology for 7yr (DH) 11 Pathology for 7yr (DH) 12 2
3 CIN Grade and Pathological change CIN CIN CIN I: mild dysplasia CIN II: moderate dysplasia CIN III: severe dysplasia & Carcinoma in situ Pathology for 7yr (DH) 13 Pathology for 7yr (DH) 14 CIN One of the most common tumors in the female reproductive system Age: 40~60 yr Site: cervix carcinoma in situ involving endocervical glands Pathology for 7yr (DH) 15 Pathology for 7yr (DH) 16 Etiology Sexually transmitted agent early age at coitus multiple sexual partners early pregnancy lack of circumcision: smegma Infection human papilloma virus, HPV (16,18) Pathology for 7yr (DH) 17 Pathology for 7yr (DH) 18 3
4 NE Eroding pattern Fungating pattern Ulcerative pattern Infiltrating pattern Pathology for 7yr (DH) 19 Pathology for 7yr (DH) 20 cervical carcinoma: eroding pattern Pathology for 7yr (DH) 21 cervical carcinoma: fungating pattern Pathology for 7yr (DH) 22 LM Squamous cell carcinoma early invasive carcinoma, < 5 mm invasive carcinoma, > 5 mm Adenocarcinoma cervical carcinoma: infiltrating pattern Pathology for 7yr (DH) 23 well differentiated moderately differentiated poorly differentiated Pathology for 7yr (DH) 24 4
5 Pathology for 7yr (DH) 25 Pathology for 7yr (DH) 26 Dysplasia Spread Carcinoma in situ Early invasive Carcinoma Direct spread Lymphatic metastasis Hematogenous metastasis Invasive carcinoma Pathology for 7yr (DH) 27 Pathology for 7yr (DH) 28 Clinicopathological correlations Answers Clinical presentations Irregular vaginal bleeding Leukorrhea Dysuria Prognosis depending on the stage death from urethral obstruction Summary: A 54-year-old postmenopausal woman has a 6-month history of an odiferous vaginal discharge and postcoital spotting. She has smoked one pack of cigarettes per day for 20 years. She also complains of right back pain and right leg swelling. The speculum examination shows a 4-cm irregular fungating mass arising from the cervix. Most likely diagnosis: Cervical cancer Next step: Biopsy of the lesion to confirm the diagnosis, followed by staging to assess the extent of the disease Likely pathophysiology: Human papillomavirus Pathology for 7yr (DH) 29 Pathology for 7yr (DH) 30 5
6 Diseases of the Cervix Diseases of the Uterus Gestational Trophoblastic Diseases Ovarian Tumors Carcinoma of the Breast Diseases of the Prostate Penis and Testicular Tumors Pathology for 7yr (DH) 31 Pathology for 7yr (DH) 32 Diseases of the Cervix Diseases of the Uterus Gestational Trophoblastic Diseases Ovarian Tumors Carcinoma of the Breast Diseases of the Prostate Penis and Testicular Tumors Pathology for 7yr (DH) 33 Pathology for 7yr (DH) 34 the most common carcinoma in women 1992 年 10 月在美国发起的 粉红丝带 活动发展成为全球性乳腺癌防治活动 每年 10 月成为世界乳腺癌防治月或警示月 10 月的第三个星期五定为 粉红丝带关爱日 Pathology for 7yr (DH) 35 Pathology for 7yr (DH) 36 6
7 Etiology hormonal influence long duration of reproductive life nulliparity late age at first child functioning ovarian tumor fibrocystic disease radiation exposure obesity genetic predisposition virus Pathology for 7yr (DH) 37 Pathology for 7yr (DH) 38 inner upper quadrant 10% Site Central zone 20% outer upper quadrant 50% 10% inner lower quadrant 10% outer lower quadrant Pathology for 7yr (DH) 39 Pathology for 7yr (DH) 40 Non-invasive carcinoma Intraductal carcinoma Comedocarcinoma Noncomed intraductal carcinoma Paget s disease of the nipple Lobular carcinoma in situ Invasive carcinoma Invasive ductal carcinoma Invasive lobular carcinoma Special types Pathology for 7yr (DH) 41 Pathology for 7yr (DH) 42 7
8 Pathology for 7yr (DH) 43 Pathology for 7yr (DH) 44 Pathology for 7yr (DH) 45 Pathology for 7yr (DH) 46 Pathology for 7yr (DH) 47 Pathology for 7yr (DH) 48 8
9 Pathology for 7yr (DH) 49 Pathology for 7yr (DH) 50 Spread Direct spread Lymphatic metastasis Hematogenous metastasis Pathology for 7yr (DH) 51 1, 锁骨上淋巴结 2, 锁骨下淋巴结 3, 腋窝淋巴结 4, 胸肌内淋巴结 5, 乳内淋巴结 Pathology for 7yr (DH) 52 Clinicopathological correlations Clinical presentations Solitary, painless mass Spread to axillary or other LNs Pathology for 7yr (DH) 53 Clinicopathological correlations Prognostic factors Tumor size Histological subtypes Histological grade ER,PR Proliferative rate & ploidy Lymphatic & vascular invasion Oncogenes & tumor-suppressor genes Others Pathology for 7yr (DH) 54 9
10 Diseases of the Cervix Diseases of the Uterus Gestational Trophoblastic Diseases Ovarian Tumors Carcinoma of the Breast Diseases of the Prostate Penis and Testicular Tumors Pathology for 7yr (DH) 55 Pathology for 7yr (DH) 56 Diseases of the Prostate Benign Prostatic Hyperplasia (Nodular Prostatic Hyperplasia) Pathology for 7yr (DH) 57 Pathology for 7yr (DH) 58 Benign Prostatic Hyperplasia (BPH) Introduction age: over age 50 Etiology hormonal influence BPH NE Enlargement with multiple nodules On cut surface: Pathology for 7yr (DH) 59 Pathology for 7yr (DH) 60 10
11 BPH BPH LM Proliferation of glands, smooth muscle cells and stromal fibroblasts hyperplasia of the prostate Pathology for 7yr (DH) 61 Pathology for 7yr (DH) 62 BPH Clinicopathological Correlations Compression of the urethra Frequency, nocturia, overflow, drippling, dysuria Retention of urine Hypertrophy of the bladder, cystitis, hydronephrosis, renal failure, death The most common form of cancer in men (followed closely by lung cancer). Age: increase from 20% to 70% between 50yr to 70&80 yr Incidence: 69 per 100, 000 in US 1 per 100, 000 in China Pathology for 7yr (DH) 63 Pathology for 7yr (DH) 64 Etiology Age Race Family history Environmental influences Hormone level (androgen) NE Commonly multicentric In the peripheral zones On cut surface: Pathology for 7yr (DH) 65 Pathology for 7yr (DH) 66 11
12 LM Adenocarcinoma Gleason score Pathology for 7yr (DH) 67 Pathology for 7yr (DH) 68 Gleason score Gleason score Pathology for 7yr (DH) 69 Pathology for 7yr (DH) 70 Spread Clinicopathological Correlations Direct spread: the seminal vesicles the base of the bladder Lymphatic metastasis Hematogenous metastasis (the bone) Asymptomatic Prostate-specific antigen (PSA) Treated by surgery, radiotherapy & hormonal manipulations Pathology for 7yr (DH) 71 Pathology for 7yr (DH) 72 12
13 Pathology for 7yr (DH) 73 Pathology for 7yr (DH) 74 13
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