Dr Sanjiv Manek Oxford. Oxford Pathology Course 2010 for FRCPath Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

Transcription

1 Dr Sanjiv Manek Oxford Oxford Pathology Course 2010 for FRCPath Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

2 Ovarian Endometrial Vulvo-vaginal Cervical Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

3 Primary Germ cell tumours Sex-cord/stromal tumours Epithelial/stromal tumours Metastatic Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

4 Young Dirty-messy, haphazard growth pattern Bizarre cells Haemorrhage and necrosis Inflammatory background Often no organoid structure Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

5 Specific features Schiller Duvall bodies (yolk sac tumour) Eosinophilic droplets (yolk sac tumour) Lacey pattern (yolk sac tumour) Nodules (dysgerminoma) Lymphocytic background (dysgerminoma) Dark tubules (immature teratoma) Thyroid-like follicles (struma ovarii) Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

6 Generally uniform and diffuse Often spindly appearance Occasionally nodular and/or organoid Rare haemorrhage and necrosis Atypia not readily apparent Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

7 Specific features Call-Exner bodies (granulosa cell tumours) Macro and micro -follicles (granulosa cell tumours) Nuclear grooves (granulosa cell tumours) Mosaic/moire-silk pattern (granulosa cell tumours) Tubules and eosinophilic cells (Sertoli-Leydig cell tumours) Large irregular follicles with secretions (juvenile granulosa cell tumours) Atypia and mitoses (poorly differentiated Sertoli- Leydig cell tumours) Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

8 Many subtypes Glandular with various growth patterns Soild or cystic Variable amounts of stroma (+/- desmoplasia) Haemorrhage and necrosis Lymphovascular invasion often obvious Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

9 Specific features slit-like gland spaces = serous papillary = serous tubulo-cystic, cystic, solid = clear cell carcinoma clear or pink cells with hob-nail appearance and dark nuclei = clear cell carcinoma nests = Brenner papillomatous = TCC rounded glands = endometrioid (often sertoliform) bizzare cells = serous small atypical moulding cells with cystic areas = small cell carcinoma Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

10 Borderline Ovarian Tumours Cellular atypia Proliferation (glandular crowding and back to back arrangement, papillae, solid islands, multiple small cords and trabeculae, hyperplastic features) No stromal invasion Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

11 Bilaterality Surface tumour Nodular pattern Lymphatic invasion Desmoplasia +++ Necrosis ( especially colorectal = garland effect ) Single cell infiltration (e.g.signet ring cells or lobular carcinoma cells) Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

12 Granulosa cell tumours Carcinoid tumours Carcinomas (small cell, endometrioid) Sertoli-Leydig cell tumours Fibro-thecoma Endometrioid carcinoma Sertoli-Leydig cell tumours Clear cell carcinoma Dysgerminoma Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

13 Carcinomas Papillary serous, endometrioid, clear cell or mixed Background hyperplasia Metaplasias Mixed-Mullerian Stromal lesions Nodular and proliferative stroma-like = Stromal Nodule or ESS Lymphatic invasion = ESS For ESN or ESS - look for small arterioles and foam cells Mast cells in leiomyomas with larger blood vessels Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

14 Leiomyomas and variants Mitotically active leiomyomas Symplastic leiomyomas Leiomyosarcomas Look for cytological atypia, coagulative tumour necrosis and excess mitotic activity and look at the margins Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

15 Villoglandular adenocarcinoma - well differentiated Mesonephric adenocarcinoma - dense secretions in glands lined by cuboidal cells on a background of hyperplasia Endocervical adenocarcinoma and background CGIN and/or CIN Small cell carcinoma (neuroendocrine features and large cell variant) Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

16 Soft tissue lesions (see vulva) Carcinomas and VAIN Melanomas Endometriosis or adenosis related carcinomas GISTs Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

17 Paget s (large clear cells in epithelium). Look out for invasion or underlying adenocarcinoma Melanoma Verrucous carcinoma VIN +/- Lichen sclerosus Soft tissue lesions aggressive angiomyxoma (watery, scanty cellularity, arterioles, infiltrative) cellular angiofibroma (thick vessels with hyalinised walls, spindled cells intrlacing, mitotic angiomyofibroblastoma (clustered cells, cellular and acellular areas) Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

18 CK7 (with CK20), EMA, SMO47, CA-125, WT1, p53 and PTEN. Inhibin, Vimentin, CD10, CD99, Calretinin, H- caldesmon,, Chromogranin, CD56, Desmin, Smooth muscle actin, AFP, PLAP, HCG, p57 Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust

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