Female Clinical Correlations

Question 1

what diseases need to be considered for cervix

Answer 1

HPV

cervical intraepithelial

squamous cell carcinoma

Question 2

uterus diseases

Answer 2

leiomyoma

leiomyosarcoma

endometrial andenocarcinoma

Question 3

ovarian diseases

Answer 3

cystic lesions

• cystadeoma
• cystadenocarcinoma

stromal tumor
- granulosa cell tumor

germ cell tumor
- benign cystic teratoma

Question 4

breast diseases

Answer 4

fibroadenoma

intraductal carcinoma

infiltrating ductal carcinoma

lobular carcinoma

Question 5

normal cervix

Answer 5

non keratinizing squamous epithelium

squamous cells show maturation from basal layer to surface

mucosa of the endocervical canal is composed of a single layer of mucin-secreting columnar epithelium
–> lines both the surface and the underlying glandular structures

cerical glands are deep, cleft like infolding of the surface epithelium into the underlying stroma

Question 6

HPV

Answer 6

DNA detected in 85% of cervical cancers and 90% of pre-cancer lesions

Types 6, 11 = low risk

high risk = 16, 18

precancerous changes (dysplasia) associated with HPV exposure, but HPV does not mean eventual progression to carcinoma

Question 7

Squamous cell carcinoma of cervix

Answer 7

highly irregular cellular and nuclear shapes, prominent nucleoli, cytoplasmic density, chromatin granularity

keratinized cells are orange
- often with squamous pearls

nonkeratinized cells = dense, basophilic cytoplasm

tumor diathesis in background

Question 8

endometriosis

Answer 8

presence of endometrial tissue outside of the uterus

usually both endometrial glands and stroma

occurs in the following sites, in descending order of frequency

• ovaries
• uterine ligaments
• rectovaginal septum
• cul de sac
• pelvic peritoneum
• large and small bowel and appendix
• mucosa of the cervix, vagina, and fallopian tubes
• laparotomy scars

associated with pelvic pain, dysmenorrhea, and infertility

Question 9

uterine leiomyoma / leiomyosarcoma

Answer 9

multiple tumors in submucosal (bulging into the endometrial cavity), intramural, and subserosal locations

well differentiated, regular, spindle-shaped SmM cells
- high number of cell divisions

Question 10

endometrial adenocarcinoma

Answer 10

present in the luminal surface of uterus usually

can be seen invading the SmM bundles of the myometrium

malignant glands are often abck to back and complex cribiform patterns

intraluminal necrotic tissue may be seen

Question 11

cystadenoma

Answer 11

derived from surface epithelium

most common of the benign ovarian tumors

lined by tall, columnar ciliated and nonciliated epithelial cells and filled with clear serous fluid

histologically = serous cystadenoma is seen with papillary projections of epithelium extending into lumen of the tumor

no invasion of stroma or capsule

Question 12

grey zone of borderline lesions lie between

Answer 12

benign cystaadenos and malignant cystadenocarcinomas

Question 13

granulosa cell tumors

Answer 13

ovary

derived from stroma and often have a component of thecoma

they are often hormonally active and can produce large amounts of estrogen such that the patient may intially present with bleeding from endometrial hyperplasia

Question 14

Call Exner Bodies

Answer 14

distinct feature of granulosa cell tumors

nests of cells which are forming primative follicles

most of these are histologically benign

Question 15

benign teratomas

Answer 15

cystic masses better known as dermoid cysts

usually found in young women during the active reproductive yers

3 embyronic cells lines - ecto, meso, and endo

46,XX

1% may undergo malignant transformation

Question 16

fibrocysts in breast tissue

Answer 16

lined by apocrine cells with round nuclei and abundant granular cytoplasm

luminal calcifications with form on secretory debris

Question 17

fibroadenoma

Answer 17

most common benign breast tumor

2nd-3rd decade usually

has an expansile margin that compesses surroudning breast tissue

composed of a proliferation of attentuated ducts in a loose, myxoid CT

Question 18

low grade ducatal carcinoma in situ (DCIS)

Answer 18

intraductal carcinoma

malignant cells have completely filled the lumen of the duct, have regular looking nuclei, and show no evidence of invasion into surrounding breast tissue

microcalcifications

Question 19

infiltrating (invasive) carcinoma of breast

Answer 19

absence of mammographic secreeing…invasive carcinoma almost always presents as a palpable mass

larger ones may be fixed to the chest wall of cause dimpling of the skin

lymphatics may become so involved as to block th local area of skin drainage and cause lymphedema and thickening of the sking (orange peel skin)

tumor cells are arranged in slender linear strands one to two cell across

“Indian filing”