lab ii Flashcards
Enfermedad fibroquistica de la mama
- son hallazgos casuales en mamographia
- bilateral y multicentricas
- con cuadros de remision y exacerbacion
- mas frecuente en px de 25-40 anos (@ pico de la perimenoupausia)
The importance of fibrocystic disease lies in its ability to mimic clinical, radiographic, gross, and microscopic features of carcinoma.
SE CLASIFICAN EN 3 TIPOS:
- Mastopatia no proliferativa con cambios mamarios minimos …( masas/bultos….3 varientes: lesiones quisticas, proliferaction estromal fibrosa, adenosis)
- Mastopatia proliferativa con cambios mamarios sin atipia:…( calcificaciones, secrecciones @ pezon, proliferacion epitelial/estromal)..Tipos:
…..hiperplasia epitelial moderado o florida
….Adenosis esclerosante
….Papilomatosis
….Lesiones esclerosantes complejas
….Fibroadenoma con caracteristicas complejas - Mastopatia proliferativa con cambios mamarios con atipia …(2 varientes: hiperplasia ductal atipica (HDA en 17% de biopsias) y Hiperplasia lobulilar atipica (HLA en menos de 5% de biopsias) ….las dos varientes se parecen a CA lobular o ductal in situ)
IMAGE CLUES:****
The image shows numerous variably sized cysts surrounded by foci of adenosis (benign lobulocentric proliferative process in which lobules are enlarged and increased in number). Some of the larger cysts in fibrocystic disease may have a bluish appearance from outside (blue-domed cysts). The cyst lining is flattened or absent in some cases. Apocrine metaplasia is a frequent finding in fibrocystic disease. The lining cells have abundant eosinophilic granular cytoplasm, prominent nucleolus and apocrine snouts
Fibroadenoma
- el tumor benigno mas frecuente en mama
- origen monoclonal del TC fibroso intralobulillar
- en jovenes menor de 30 anos
- mas frecuente en cuadrante superoexterno
- unicos o multiples
- masas circunscritas blanquecinas bien definidas, ovoides con superficie lisa (1-7cm de longitud)
- estrogen dependent
2 componentes:
1, Mesenquimal (que origina del TC intralobulillar)
2. Proliferacion de las celulas epiteliales en los conductos
3 patrones histologicos:
- Intracanalicular (TC comprime conductos=**slits)
- Pericanalicular (no comprime full aka se preserva la luz)
- Mixtos (el mas frecuente
IMAGE CLUES *******
Look for fibrous stroma and slit-like/compressed glandular spaces = in it
loose fibrous stroma surrounding ducts
hypercellular stroma
The tubules and glands in a fibroadenoma are lined by cuboidal or low columnar epithelium with uniform nuclei and surrounded by a myoepithelial layer. The stroma is made up of loose connective tissue
Carcinoma Ductal Infiltrante
- tumor ue rompio lamina basal de los canaliculos
- se presenta como masa duro y palpable , fijas @ pared, y con linfedema
2 Tipos:
- sin otras especificaciones = ESCIRROSO es el mas comun (79% de los infiltrantes…..se subdividen en Luminal A, Luminal B, Similar a celulas basales, y Her2+)
- con otras especificacion
IMAGE CLUES**:
tumor cells are arranged in cords, nests, and as individual cells
tumor cells are highly pleomorphic and are arranged singly or in small clusters.
may see necrosis
Cistoadenoma Papilar Seroso aka Tumor Seroso
- tumor ovarico mas comun del epitelio celomico
- representa 30% de todos los tumores ovaricos
- masas quisticas de consistencia remitente (approx. 15cm) con superficia lisa y de aspecto perlado
- pueden ser unilateral o bilateral
- 60% benigna, 25% maligna, 15% limirofe
- hay epitelio cilindrico ciliado @ pared del quiste con multiples papilas y proliferacion de celulas indiferenciadas
- cuerpos de psamoma (calcificaciones distroficas en el estroma)
Factores que predispnen:
- nuliparas
- disgenesia gonadal
- x BRCA1/2
- x p53
- sobreexpresion de Kras
IMAGE CLUES****:
papilas estromales with epitelio columnar and cilias
irregularly branching papillae without much stroma lined by highly atypical nuclei.
psammoma bodies infiltrating the ovarian stroma.
High-grade tumor cells arranged in nests and clusters infiltrating the ovarian stroma.
Cistoadenocarcinoma papilar endometriode aka Tumor Endometroide
- el 20% de tumores ovaricos
- originado del epitelio celomico
- en px jovenes
- masas solidas y quisticas
- uni o bilateral
- 15% –> adenocarcinoma del endometrio
- por mutaciones en PTEN, p53, o K-ras
IMAGE CLUES*****:
parenquima con estructuras glandulares
areas solidas y quisticas, estructuras tubulares
similar al endometrio
glands resemble normal endometrium. Stroma is moderately cellular. Many of these tumors arise from endometriosis.
glandular areas are lined by stratified columnar epithelium.
Malignant glands are separated by abundant stroma.
Tumor de Brenner
- tumor ovarico originado del epitelio celomico
- benino (mas en infancia), maligno (mas en envejecientes)
- solido o quistico
- tiene differenciacion urotelial aka parenquima de celulas epiteliales transicionales similar a la vejiga
IMAGE CLUES****:
transitional cells with mucin cells in center
solid and cystic nests of epithelium resembling transitional epithelium in a dense fibroblastic stroma.
transitional epithelial cells have sharply defined outlines, oval nuclei with longitudinal grooves, and small or inconspicuous nucleoli.
Endometriosis
- estructuras glandulares o estroma endometrial fuera del utero
- @ jovenes –> infertilidad
3 teorias de etiologia:
- metaplasia @ celulas epiteliales
- regurgitacion menstrual
- disminacion por estructuras vasculares/linfaticas
Manifestaciones incluyen:
- hemorragia
- rectorragia
- dismenorrea
- dispareuria
IMAGE CLUES**:
epithelial cells lining the cyst may sometimes show abundant eosinophilic cytoplasm and atypical nuclei.
abundant hemosiderin-laden macrophages and fresh hemorrhage in endometrial stroma
Adenocarcinoma del Endometrio
- tumor maligno mas comun del aparato reproductivo femenino
- @ muj entre 65-70 anos posmenopausica
- presenta sangrados @ etapas iniciales
- 80% se diagnostican en etapa I
2 TIPOS: I: - el 85% de los casos - en edad 55-65 - morfologia endometroide por hiperplasia - comportamiento endolene
II:
- 15%
- 65-75
- agresivo
- morfologia serosa, de celulas claras, o tumor mulleriano mixto
- precursor es carcinoma intrapitelial endometrial
so remember we can have carcinosarcoma uterino o mulleriano:
- homologo o heterologo
- es una adenocarcinoma con mesenquima maligna
- tiene componentes sarcomatosas, musculares, estraidos, carilagainosos, adiposos, y oseosos
IMAGE CLUES***:
clear cells or hobnail cells in papillary, tubular, or solid growth patterns (shown here). The cytoplasm ranges from clear to eosinophilic
hyalinization
polygonal cells with abundant clear cytoplasm (due to glycogen content). It has distinct cytoplasmic borders and moderate cytologic atypia. The histologic features are similar to its counterpart seen in ovary
similar to cistoAdenoCA seroso papilar
case of MMMT shows both heterologus bone and cartilage elements
Adenocarcinoma de celulas claras
- tumor maligno
- @ envejecientes
- origina de los restos embriologicos del conducto de Muller y del epitelio celomico
- tiene differenciacion mesonefroide
- dx en etapas avancadas
- dx differencial con ACACC de rinon
- un variante de tumores endometroides
IMAGE CLUES***:
sabanas de celulas con citoplasma vacuolado
tubulo-cystic, papillary, and solid growth patterns. The cytoplasm of tumor cells is clear or oxyphilic. This tumor is often associated with endometriosis and is regarded by many as a subtype of endometrioid carcinoma.
Cytoplasmic clearing of the tumor cells is largely due to glycogen content.
may be hyalinized
Prominent vacuoles within tumor cells create a signet-ring cell appearance in this clear cell carcinoma of the ovary.
Teratoma
- tumores de celulas germinales (el 95%) mas frecuentes
- un tumor benigno constituido por elementos heteroloos que originan de 3 capas germinales
Clasifiacion:
teratoma maduro, quistico, dermoide (differenciacion ectodermica de celulas totipotenciales y epitelio plano estratificado queratinizado con anexos de la piel)
teratoma monodermico/ especializado (estroma ovarico y tumor carcinide)
teratoma inmaduro/maligno
IMAGE CLUES:***
stratified epitelio with glandulas sebaceas, foliculos pilosos, glandulas sudoriparas
ectodermal derivatives are predominant in most cases. They consist of epidermis, hair follicles, sweat and sebaceous glands and neuroectodermal derivatives.
bone (mesodermal derivative) adjacent to keratinized epidermis (ectodermal derivative).
Coriocarcinoma
- tumor de celulas germinales (de celulas pluripotenciales)
- differenciacion extraembrionaria
- @ px jovenes
- frecuentemente hay metastasis hacia pulmones
- raro
- masas disminuitas irregulares con necrosis @superficie
- exression de gCH
- cel. indiferenciadas polimorficas del citotrofoblasto y sincitiotrofoblasto
IMAGE CLUES:***
more color, necrosis
Disgerminoma
- tumor de celulas germinales (30% de estos)
- 1% de todos los tumores ovaricos
- en adolecentes y px con disgenesia gonadal y pseudohemafroditismo
- lo mismo que seminoma en hombres
-expresa receptor de tirosina cinasa y c-kit - expresa factores de transcripcion (OCT3, OCT4, NANOG, gcH)
0 masas solidas con necrosis - sabanas de celulas tumorales con citoplasma vaculado
- 20% bilateral
- excellent proignosis
IMAGE CLUES**:
celulas dispersas en hojas/cordones seperated by fibrous stroma
lots of linfocites and granulomas
maybe calcification
Adenomiosis
- estructuras glandulares del endometrio infiltran miometrio
- @ mujeres perimenopausicas
- ## forma engrosamiento del uteroMANIFESTACIONES:
- dismenorrea
-menorragia
-metrorragia
-dispareunia
IMAGE CLUES**:
Adenomyosis is defined as the presence of endometrial tissue within the myometrium
The surrounding myometrium is usually hyperplastic
Leiomioma
- tumor benigno mas comun en aparato reproductivo femenino
- 75% of giros have mostly 20-40 years old
- asintomatico normalmente
- es circunscrita sin capsula
- mas en bolacks
- aumenta de tamano en embarazo aka sensitivo a estrogeno
- proliferacion de celulas fusiformes
- 60% tienen carotipo normal
- 40% no (translocacion 12,14 o trisomia 12)
- multiples masas
IMAGE CLUES **: Whorled pattern of smooth muscle bundles with well-demarcated borders
significantly more cellular than the normal myometrium but lack nuclear atypia, tumor cell necrosis or increased mitotic activity
cells are small and round to spindle shaped.
Tumor cells resemble normal cells (uniform, elongated, spindle-shaped, with a cigar-shaped nucleus) and form bundles with different directions (whirled). The tumor may present areas of fibrosis, calcification and / or hemorrhage. The tumor is well circumscribed, but not encapsulated.
Condiloma Acuminado o Cresta de gallo
- infeccion de transmission sexual
- lesiones exofisticas que afectan mucosa, surco balano prepucial, perianal, perine, labios, cuerdas boales, labios mayores
- mm–>cm
- por VPH 6 y 11
- @ hombres promiscous, homosexuales
- tx quirurgico
IMAGE CLUES***:
- hiperqueratosis, acantosis, papilomatosis, atipia coliocitica (vascuoliacion aka celulas con halo claro @ nucleo)
papilarry
Enfermedad pelvica inflamatoria
- por microorganismos (mayoria de gonocco y chlamydia trachomatis)
- un trastorno inflmatorio supurativo
- dolor pelvico, fiebre, exudado prulato
- en jovenes, promiscuidad
- @ trompas = salpingitis incipiente
- complicaciones por diseminacion incluyen pericarditis, meningitis, artritis septica, infertilidad por fibrosis de trompas (obstruction)
IMAGE CLUES**:
just like salpingitis
