Keywords: Chapter 18, Female Reproductive System
Adenocarcinoma of the cervix
A mucinous malignant epithelial tumor. It accounts for a minority (10%) of malignant cervical tumors.
Adenomyosis
Myometrial lesion composed of endometrial glands and stroma. It has no clinical significance, but must not be confused with invasive carcinoma upon histologic examination.
Apocrine metaplasia
A change of the ductal breast epithelium from simple cuboidal into tall cylindrical with abundant eosinophilic cytoplasm and apical blebbing reminiscent of apocrine gland. Apocrine metaplasia occurs in breasts showing fibrocystic change.
Atypical hyperplasia of the endometrium
The hyperplastic endometrium shows cytologic atypia. It has an increased risk for progression to adenocarcinoma and is usually treated by hysterectomy.
Borderline ovarian tumors (tumors of low malignant potential)
A group of ovarian epithelia tumors characterized by moderate to marked epithelial proliferation, forming solid cellular buds and papillae and by absence of destructive stromal invasion by the tumor. They share an excellent prognosis, despite certain histologic features that suggest malignancy.
Brenner tumor
A rare ovarian neoplasm composed of solid nests of transitional-like (urothelium-like) cells encased in a dense, fibrous stroma. The majority of these tumors are benign occurring in the fourth to eighth decade of life.
Call-Exner bodies
Characteristic follicular pattern formed by tumor cells in granulosa cell tumor of the ovary.
Carcinoma in situ
A malignant lesion that involves the entire thickness of the epithelium without stromal invasion.
Carcinoma in situ of the breast
A preinvasive form of breast carcinoma. It can exhibit several histologic types; intraductal, lobular and papillary types.
Cathepsin D
A proteolytic enzyme that is overexpressed in some breast cancers. This enzyme presumably enables tumor cells to invade into host's tissues. Tumor expressing higher levels of Cath D have a poorer prognosis than those that have lower levels of this enzyme.
Cervical intraepithelial neoplasm (CIN)
A spectrum of intraepithelial changes that begins with minimal atypia and progresses through stages of more marked intraepithelial abnormalities to invasive squamous cell carcinoma. Multiple sexual partners and early age at first coitus are the most important factors in the pathogenesis. Pathologically, it is classified as follows: CIN-1 (mild dysplasia) )Abnormal cells in the lower third of the epithelium CIN-2 (moderate dysplasia)Abnormal cells in the lower and middle thirds of the epithelium CIN-3 (severe dysplasia)Abnormal cells diffusely involve more than two thirds of the epithelium.Treatment varies occording to the disease stage, from close follow up in CIN I to cryosurgery, cervical conization, laser vaporization and hysterectomy in more severe lesions.
Choriocarcinoma
A highly malignant tumor, composed of neoplastic cytotrophoblastic and syncytiotrophoblastic cells. These cells, like their placental equivalents are highly invasive causing hemorrhage and necrosis of tissue into which they spread. Choriocarcinoma can be derived from the placenta, hence the name gestational choriocarcinoma or as a component of teratocarcinoma of the ovary. The choriocarcinoma cells secrete human chorionic gonadotropin, which serves a as marker for these tumors.
Comedocarcinoma
A variant of intraductal carcinoma of the breast. It is composed of large, pleomorphic cells with arranged around areas of central necrosis. The intraductal material can be expressed upon compression like sebum from comedos, which accounts for the name of the tumor.
Condyloma acuminatum
A sexually transmitted, virally-induced, benign exophytic, verrucous (wart-like) squamous lesions that occur on the vulva, perianal region, perineum, vagina, cervix and other sites. A characteristic feature is the koilocytic changes of epithelial cells with a perinuclear halo and a wrinkled nucleus containing the human papilloma virus. HPV infection is involved in the pathogenesis of CIN and cervical cancer.
Ductal epithelial hyperplasia
Intraluminal proliferation of cells lining the dilated terminal ducts. It is he most common proliferative change in fibrocystic disease. The morphologic spectrum ranges from cytologically benign hyperplasia to atypical hyperplasia to carcinoma in situ. The more severe and atypical the hyperplasia the hyperplasia, the greater the risk of cancer.
Dysgerminoma
A germ cell tumor of the ovary, composed of primordial germ cells with clear glycogen-filled cytoplasm that are arranged in large nests. It is the ovarian counterpart of testicular seminoma. It is a tumor that occurs in younger women with a very good prognosis.
Dysplasia
Is the loss in the uniformity of individual cells as well as in their architectural orientation. It is an alteration that carries with it the potential of development of cancer.
Embryonal rhabdomyosarcoma (sarcoma botryoides)
A rare malignant vaginal neoplasm occurring exclusively in infants and young children, composed of primitive embryonal rhabdomyoblasts. It presents as confluent polypoid masses resembling a bunch of grapes, protruding from the vagina. The tumor has a good prognosis with only conservative surgery followed by chemotherapy.
Endodermal sinus tumor (yolk sac carcinoma)
A malignant germ cell tumor of the ovary that resembles the mesenchyme of primitive yolk sac. Schiller-Duval bodies resembling fetal glomeruli are often present. The tumor cells secrete AFP. The tumor has an excellent prognosis and surgery is curative. Similar yolk sac tumor elements can be found in teratocarcinomas.
Endometrial adenocarcinoma
The most common cancer of the female genital tract in American women. The tumor has a polypoid or a diffuse growth pattern involving the endometrium and oftently show areas with hemorrhage and necrosis. Several microscopic patterns can be seen including; endometrioid (most common), endometrioid with squamous differentiation, serous, clear cell and secretory carcinomas. Endometrial carcinoma is linked to prolonged estrogenic stimulation. The tumor typically occurs in peri-menopausal and post-menopausal women who primarily complain of abnormal uterine bleeding
Endometrial hyperplasia
A morphologic continuum that ranges from simple glandular crowding to a conspicuous proliferation of atypical glands that are difficult to distinguish from early carcinoma. It be either simple or complex with or without cytologic atypia based on the complexity and crowding of the glands and the degree of cytologic atypia. Hyperestrinism is related to its pathogenesis.
Endometrial polyp
A benign localized overgrowth of the endometrium composed of endometrial glands, fibromatous stroma, and thick-walled, dilated blood vessels. Patients usually present with inter-menstrual bleeding.
Endometrioid adenocarcinoma of the ovary
A malignant epithelial tumor of the ovary that is histologically identical to adenocarcinoma of the endometrium. It is the second most common ovarian cancer, accounting for 20% of the cases. The overall survival in this tumor is considerably better than that for serous cystadenocarcinoma.
Endometriosis
Presence of endometrial glands and stroma outside the uterus. Most common sites are pelvic organs, such as ovaries, tubes, broad ligaments. Pathogenesis include several theories; retrograde menstruation through fallopian tubes and implantation on the various pelvic organs, hematogenous spread of the endometrium, and celomic metaplasia of the peritoneum. Patients are of reproductive age and usually complain of dysmenorrhea, dyspareunia and infertility.
Extramammary Paget disease
A rare vulvar neoplasm in which malignant, large, pale vacuolated cells (Paget cells) are found scattered throughout the epidermis. Wide local excision is usually curative
Fibroadenoma
Benign tumor composed of elongated ducts and hyperplastic stroma resembling intralobular connective tissue. This is the most common benign neoplasm of the breast. Fibroadenoma occurs in post pubertal girls and young women (15-45 years) and usually presents as a freely mobile sharply circumscribed spherical nodule.
Fibrocystic change of the breast
Complex ductal and stromal changes related to the cumulative effects of normal cyclic hormonal changes and aging. It is characterized by (1) cystic dilatation of terminal ducts, (2) a relative increase in fibrous stroma, and (3) a variable proliferation of terminal duct epithelial elements.
Germ cell tumors
Tumors derived from the germ cells of the ovary, testis or in extragonal sites. Irrespective of their origin, these tumors show histologic homology.
Gestational trophoblastic diseases
A spectrum of trophoblastic disorders characterized by abnormal proliferation and maturation of trophoblast and neoplasms derived from the trophoblast.
Gonorrhea
A sexually transmitted disease caused by Neisseria gonorrheae. It frequently causes acute salpingitis and pelvic inflammatory disease.
Granulosa cell tumor
A sex cord/stromal ovarian tumor that is yellow solid to cystic tumors composed of lipid-laden lutinized granulosa cells arranged in a diffuse, insular or trabecular patterns. The cells typically have a cleaved, elongated nucleus (coffee-bean appearance). The majority of these tumors secrete estrogen, consequently endometrial hyperplasia is common in those patients
Gynecomastia
Enlargement of the adult male breast usually caused by an excess of estrogenic hormones in circulation, as in cirrhosis or hormonally active tumors of the testis and adrenals.
Herpes virus
A double stranded DNA type 2 virus that is a common cause of sexually transmitted genital infections. Histologically, the lesion show intraepithelial vesicles with several multinucleated epithelial cells having large nuclei with eosinophilic inclusions and ballooning degeneration of epithelial cells. It causes painful vesicles and ulcers on the vulva, vagina and cervix.
Hydatidiform mole
A gestational trophoblastic disorder in which the placenta have has grossly swollen chorionic villi, resembling a bunch of grapes, with varying degrees of trophoblastic proliferation and absence of embryo. Most complete moles are homozygous, XX 46 and all the chromosomes are of paternal origin. Patients with complete mole present during the second trimester of pregnancy with abnormal uterine bleeding, excessive uterine enlargement and high serum human chorionic gonadotropin concentration. The most important complication is the development of choriocarcinoma.
Inflammatory carcinoma of the breast
Occurs secondary to dermal lymphatic invasion by the malignant cells, blocking the lymphatic drainage of the skin leading to lymphedema and thickening of the skin (French- Peau d'orange - orange peal). With a more extensive dermal lymphatic involvement, there will be acute swelling, redness, and tenderness of the breast (inflammatory carcinoma).
Intraductal carcinoma of the breast
A preinvasive carcinoma of the breast arising in the terminal duct-lobular unit that occurs either as comedocarcinoma or papillary carcinoma. These tumors have a more favorable prognosis than invasive cancer.
Invasive (infiltrating) ductal carcinoma of the breast
Adenocarcinoma of ductal origin. It is usually scirrhous (desmoplastic) which accounts for its "rock hard" consistency. It is the most common form of invasive breast cancer and accounts for 65-80% of all breast cancers.
Invasive lobular carcinoma of the breast
Carcinoma originating from lobular epithelium. It is the second most common form of invasive breast cancer. In its classic form, the tumor cells are arranged in single file or strands infiltrating the breast stroma (so-called "Indian filing").
Krukenberg tumor
A metastatic tumor to the ovary. The tumor appear as nests of mucin-filled "signet-ring" cells within a cellular stroma. The stomach is the primary site in 75% of cases. Krukenberg tumors are often bilateral.
Leiomyoma
A benign tumor of smooth muscle origin. Grossly, leiomyomas are firm, pale gray, well circumscribed whorled lesions that can be subserosal, submucosal or intramural in location. They are composed of bundles of benign smooth muscle fibers similar to the myometrium. They can be asymtomatic or may cause abnormal uterine bleeding and pain requiring hysterectomy. It is the most common tumor of the female genital tract.
Leiomyosarcoma
A malignant tumor of smooth muscle origin in the myometrium, composed of malignant smooth muscle fibers with abundant mitosis and nuclear atypia. Patients present with the same symptoms as those with fibroids (leiomyomas). The tumor is rare compared to leiomyoma. Treatment of choice is radical hysterectomy.
Lichen sclerosus
Painful white plaques on the vulva with atrophy. Histologically, there is hyperkeratosis, blunting of rete ridges and a homogenous, acellular zone in the upper dermis with a band of chronic inflammatory infiltrate. Itching and dyspareunia are frequent.
Lobular carcinoma in situ
A type of in situ breast cancer arising in the terminal duct lobular unit. The cells tend to be smaller and more monotonous than those of the ductal type.
Microinvasive squamous cell carcinoma
A squamous cell carcinoma in which the malignant cells only minimally invaded the underlying stroma without vascular or lymphatic invasion. Invasion is usually
Mucinous cystadenocarcinoma
A malignant epithelial tumor of the ovary with multilocular cysts lined by malignant mucin producing tall columnar cells. It is one of the largest ovarian tumors and constitutes 10% of all ovarian cancers.
Ovarian fibroma
Solid, firm benign ovarian stromal tumor, composed of well-differentiated fibroblasts and collagen stroma. Half of these tumor are associated with ascitis and pleural effusion causing a syndrome called Meigs syndrome. Fibroma is the most common ovarian stromal tumor.
Papillary-cribriform carcinoma
A variant of intraductal (non invasive, in situ) carcinoma of the breast. As the name indicates, the tumor cells grow in papillary structures and form fenestrations within the distended ducts.
Pelvic inflammatory disease
Infection of pelvic organs secondary to ascending infection causing pain, fever and adenxal tenderness. N. gonorrheae is the most common cause of PID. Complications include infertility, peritonitis, and intestinal obstruction.
Phyllodes tumor (cystosarcoma phyllodes)
A tumor composed of proliferating stromal and ductal elements, accompanied by a benign growth of ductal structures. It resembles fibroadenoma with an over abundant stromal component and is therefore referred to as giant fibroadenoma. They can be benign or malignant.
Polycystic ovary syndrome
A syndrome complex characterized by persistent anovulation, many small subcapsular ovarian cysts and clinical manifestations secondary to the secretion of excess androgenic hormones, such as amenorrhea, hirsutism and obesity. The treatment is mostly hormonal, to block the excess androgen production.
Psammoma bodies
Laminated calcified concretions that are noted in a variety of neoplasms, such as serous cystadenocarcinoma of the ovary.
Pseudomyxoma peritonei
Multiple peritoneal implants composed of mucus containing columnar cells causing massive accumulation of gelatinous material in the abdominal cavity. It can be associated with mucinous tumors of the ovary or mucoceles of the appendix. Treatment is surgical, and usually requires repeated operations.
Schiller-Duval bodies
Characteristic structures seen in endodermal sinus tumors that resemble endodermal sinuses of rodent placenta and are composed of papillae that protrudes into a space lined by tumor cells.
Sclerosing adenosis
It is a variant of proliferative fibrocystic change that is characterized by proliferation of small ducts and myoepithelial cells in the region of the terminal duct lobular unit (adenosis). It is commonly associated with fibrosis (sclerosis).
Serous cystadenocarcinoma of the ovary
A malignant multicystic epithelial ovarian tumor composed of invasive papillary adenocarcinoma oftenly with laminated calcified concretions (psammoma bodies). It is the most common malignant ovarian cancer, accounting for 1/3 of all ovarian cancers. By the time the tumor is discovered it oftenly has already metastasized beyond the ovary and seeded the peritoneum. The prognosis is usually poor for these tumors because of the spread by the time they are discovered.
Sertoli-Leydig tumor (arrhenoblastoma, androblastoma)
A rare mesenchymal neoplasm of the ovary of low malignant potential, that resembles the embryonic testis and often secretes androgens. The tumor is yellow due to the presence of large steroid filled leydig cells. Patients with functioning tumors have signs of virilization such as hirsutism, deep voice and clitoral enlargement
Squamous cell carcinoma of the uterine cervix
Malignant tumor of the cervix arising from the squamous epithelium. It presents as an exophytic, ulcerating or infiltrative lesion. Microscopically, malignant cells can be either keratinizing or non-keratinizing. The tumor usually evolves from the precursor CIN, and is the most common malignant tumor of the cervix. Patients complain of vaginal bleeding and discharge. The tumor spreads by direct extension and through lymphatics. Radical hysterectomy is the treatment of choice for localized tumors.
Squamous cell carcinoma of the vagina
Malignant tumor of the vagina arising from the squamous epithelium. It is a disease of alder women and is the most common malignant tumor of the vagina (90%), that is usually preceded by vaginal intraepithelial neoplasia.
Squamous cell carcinoma of the vulva
Malignant tumor of the vulvar squamous epithelium. It can be exophytic, ulcerative or endophytic. Histologically, it is graded based on the degree of cellular anaplasia from well to poorly differentiated. It is the most common cancer of the vulva (85%) and accounts for 3% of all genital cancers in women.
Teratoma
Benign tumor of germ cell origin, compose of nonproliferating somatic tissues. In the ovary, teratomas account for 1/4 of all ovarian tumors with a peak incidence in the third decade. The majority of these tumors are mature forming cysts with more than 90% contain skin, sebaceous glands and hair follicles. Immature teratomas contain embryonic tissues in addition, more solid and have a poorer prognosis.
Thecoma
A benign yellowish solid functional ovarian tumor, composed of lipid-laden theca cells that arises in postmenopausal women. In the majority of cases it produces signs of estrogen production with breast enlargement and irregularity in menstrual cycles.
Toxemia of pregnancy (preeclampsia and eclampsia)
A symptom complex of hypertension, proteinuria and pathologic edema and in its most advanced stage, convulsions that occur in 6% of pregnant women during the last trimester. The pathogenesis is not exactly known, but is related to reduced blood flow with widespread ischemic changes in the placenta and other organs. The placenta shows extensive infarction throughout. Treatment includes anti-hypertensive and anti-platelet drugs, but the definitive therapy is the removal of the placenta.
Verrucous carcinoma
A variant of well differentiated squamous cell carcinoma that presents as a large fungating mass resembling a giant condyloma. HPV type 6 is commonly identified in this tumor. The tumor invades locally and typically does not metastasize. Local surgical excision is the treatment of choice.
Vulvar vaginosis
Replacement of normal squamous epithelium by a glandular epithelium. History of DES exposure in the early prenatal life.