Pathology of the Female Reproductive System

Question 1

Benign Breast Disease

Answer 1

• Benign breast diseases constitute a heterogeneous group of lesions including developmental abnormalities, inflammatory lesions, epithelial and stromal proliferations, and neoplasms.

Question 2

when does Benign Breast Disease most frequently occur

Answer 2

• Increases in frequency towards menopause

then decreases.

Question 3

Adolescent breast

Answer 3

arge and intermediate-size ducts are seen within a dense fibrous stroma. No lobular units are present.

Question 4

Postpubertal breast.

Answer 4

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.

Question 5

Lactating breast Postmenopausal breast.

Answer 5

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.

Question 6

D. Postmenopausal breast.

Answer 6

The terminal duct lobular units are absent. The remaining intermediate ducts and larger ducts are commonly dilated.

Question 7

Fibrocystic Change (FCC)

Answer 7

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.

Question 8

FCC and cancer

Answer 8

• 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.

Question 9

Proliferative Breast Disease

Answer 9

• 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.

Question 10

Men can also develop benign breast conditions and the most common in men is

Answer 10

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.

Question 11

most common cause of Gynaecomastia

Answer 11

drugs (cardiovascular and prostate drugs in older patients and cannabis, anabolic steroids and anti ulcer drugs, antidepressants in younger men)

Question 12

Benign Breast Tumours.

Answer 12

• Fibroadenoma • Duct papilloma • Adenoma

* Connective tissue tumours

Question 13

Fibroadenomas

Answer 13

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.

Question 14

Phyllodes tumours

Answer 14

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.

Question 15

Fat Necrosis.

Answer 15

• 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.

Question 16

Non-invasive Precursors for breast cancer

Answer 16

• 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.

Question 17

Paget’s Disease of the nipple.

Answer 17

• Leads to erosion of the nipple that resembles eczema

* Associated with underlying in situ or invasive carcinoma

Question 18

Prognostic Factors

Answer 18

• Tumour type
• Tumour grade (A) • Tumour stage
– Tumour size
– Node metastasis (B) – Other metastases
• Oestrogen receptor (C)
• HER-2 amplification

Question 19

Screening Strategies for Breast Cancer.

Answer 19

• Breast self examination.
• Clinical breast examination.
• Mammography.
• Ultrasonography.
• Magnetic Resonance Imaging (MRI).

Question 20

Cervical Squamous Neoplasia

Answer 20

• The commonest cervical cancer is an invasive tumour of epithelial origin with squamous differentiation.
• Human papillomavirus main aetiological factor. • Immune modulation: smoking, HIV infection

Question 21

testing and classification of Cervical Squamous Neoplasia

Answer 21

• 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.

Question 22

Human papillomavirus is the main aetiological factor of Cervical Squamous Neoplasia

Answer 22

• 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.

Question 23

Cytology.

Answer 23

• The first stage in cervical screening is taking a cervical sample using liquid based cytology (LBC), which has replaced the conventional Pap smear

Question 24

Treatment of invasive Squamous cell carcinoma of the Cervix.

Answer 24

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.