Pathology of the Female Reproductive System Flashcards
Benign Breast Disease
• Benign breast diseases constitute a heterogeneous group of lesions including developmental abnormalities, inflammatory lesions, epithelial and stromal proliferations, and neoplasms.
when does Benign Breast Disease most frequently occur
• Increases in frequency towards menopause
then decreases.
Adolescent breast
arge and intermediate-size ducts are seen within a dense fibrous stroma. No lobular units are present.
Postpubertal breast.
The terminal duct lobular unit consists of small ductules arrayed around an intralobular duct. The two- cell-layered epithelium shows no secretory or mitotic activity. The intralobular stroma is dense and confluent with the interlobular stroma.
Lactating breast Postmenopausal breast.
The terminal duct lobular units are conspicuously enlarged, with inapparent interlobular and intralobular stroma. The individual terminal ducts, now termed acini, show prominent epithelial secretory activity (cytoplasmic vacuolization). The acinar lumina contain secretory material.
D. Postmenopausal breast.
The terminal duct lobular units are absent. The remaining intermediate ducts and larger ducts are commonly dilated.
Fibrocystic Change (FCC)
is an exaggerated physiologic response.
• Fibrocystic change is a nonproliferative change that includes gross and microscopic cysts, apocrine metaplasia, mild epithelial hyperplasia, adenosis and an increase in fibrous stroma.
FCC and cancer
• FCC doesn’t increase the risk of getting breast cancer, but it can make it more difficult to identify potentially cancerous lumps during breast examination and on mammograms.
Proliferative Breast Disease
- Proliferative disease without atypia entails a 2 fold increased risk of developing carcinoma over 5–15 years and is classified simply as proliferative breast disease.
- Proliferative lesions with atypia involve even greater relative risk (5 fold). Such patients require close clinical monitoring.
Men can also develop benign breast conditions and the most common in men is
Gynaecomastia.
• Gynaecomastia is hyperplasia of the male breast stromal and ductal tissue.
• It is usually caused by are lative increase in the oestrogen to androgen ratio in the circulation or breast tissue.
most common cause of Gynaecomastia
drugs (cardiovascular and prostate drugs in older patients and cannabis, anabolic steroids and anti ulcer drugs, antidepressants in younger men)
Benign Breast Tumours.
- Fibroadenoma • Duct papilloma • Adenoma
* Connective tissue tumours
Fibroadenomas
Fibroadenomas
• Fibroadenomas arise from breast lobules and are composed of fibrous and epithelial tissue.
• They are well circumscribed and highly mobile, because of the encapsulation and pliability of young breast tissue.
• Clinically, fibroadenomas are difficult to differentiate from Phyllodes Tumours, which is a distinct pathology.
Phyllodes tumours
are sarcomas which rapidly enlarge and have variable degrees of malignant potential.
• They are larger than fibroadenomas and tend to occur in an older age group.
Fat Necrosis.
- Fat necrosis presents as a soft, indistinct lump that develops a few weeks after a traumatic incident, and often in older women with fatty breasts.
- On imaging, some are difficult to distinguish from breast cancer and a core biopsy is often indicated.
Non-invasive Precursors for breast cancer
• Usually identified coincidentally. • Tumour cells confined to ducts or acini. • Two forms. – Ductal carcinoma in situ. • Often unilateral. – Lobular carcinoma in situ. • Often bilateral, can be multifocal.
Paget’s Disease of the nipple.
- Leads to erosion of the nipple that resembles eczema
* Associated with underlying in situ or invasive carcinoma
Prognostic Factors
• Tumour type • Tumour grade (A) • Tumour stage – Tumour size – Node metastasis (B) – Other metastases • Oestrogen receptor (C) • HER-2 amplification
Screening Strategies for Breast Cancer.
- Breast self examination.
- Clinical breast examination.
- Mammography.
- Ultrasonography.
- Magnetic Resonance Imaging (MRI).
Cervical Squamous Neoplasia
- The commonest cervical cancer is an invasive tumour of epithelial origin with squamous differentiation.
- Human papillomavirus main aetiological factor. • Immune modulation: smoking, HIV infection
testing and classification of Cervical Squamous Neoplasia
• Pre-invasive phase detectable by cervical cytology.
• Grading systems for pre invasive disease:
- Bethesda classification:
- ‘Low grade squamous intraepithelial
neoplasia’ LSIL versus ‘high grade’ HSIL.
Human papillomavirus is the main aetiological factor of Cervical Squamous Neoplasia
- If infection is persistent the virus may incorporate its DNA into the host cell’s genome.
- Once incorporated, the production of viral oncoproteins can go on unchecked, and the host’s genes that suppress tumours (p53 and pRb) can be inactivated.
- Damaged DNA is replicated without being checked and repaired, and malignantly transformed cells proliferate uncontrollably.
Cytology.
• The first stage in cervical screening is taking a cervical sample using liquid based cytology (LBC), which has replaced the conventional Pap smear
Treatment of invasive Squamous cell carcinoma of the Cervix.
Radical hysterectomy is favoured for localized tumour, especially in younger women.
For tumours larger than 4 cm or spread beyond the cervix, radiotherapy with concurrent platinum based chemotherapy is the mainstay of treatment.
