Praktikum KBK semester V

Blok
Female Reproductive System

Departemen Patologi Anatomi

Fakultas Kedokteran USU
Medan
Pembentukan kista
luteum & kista folikel

Normal folicle & corpus

luteum
 Cystic structure
 Retention cyst develop
 Corpus luteum cyst &
follicular cyst

Follicular cyst from :

• Benign granulosa cell
• Theca cell

Corpus luteum cyst from :

• Luteinized granulosa
cells
• Luteinized theca cell
NEOPLASMA PADA OVARIUM
CASE -1
 A 23-year old female presents with pelvic pain and is
found to have an ovarian mass of left ovary that
measures 3 cm in diameter. Grossly, the mass consist of
multiple cystic spaces. Histologically, these cyst are lined
by columnar epitelium, with some of cells being ciliated.
What is your diagnosis of this ovarian tumor. Which
histologically recapitulates the histology of the fallopian
tubes ?
A. Serous tumor
B. Mucinous tumor
C. Endometrioid tumor
D. Clear cell tumor
E. Brenner tumor
Answer
 Answer : (A) Serous Tumor
 Serous tumor  ciliated columnar serous epithel 
similar to the lining cells of the fallopian tubes.
 Endometrioid ovarian tumor  non-ciliated columnar
cells  similar to the endometrium
 Mucinous ovarian  mucinous non-ciliated columnar
cells similar to the endocervical gland.
 Brenner tumor  transitional lining
Surface epithelial tumor

 Serous
 Mucinous
 Brenner
 Endometrioid
 Typical
 Clear cell tumor
 Mixed mullerian tumor
Kista Adenoserosum ovari
Benign serous cystadenoma
Serous cystadenocarcinoma.
The tumor is predominantly solid,
with necrotic and hemorrhagic
areas.
KISTA ADENOMUSINOSUM OVARI
Fig. 19.245 Lining of
mucinous cystadenoma.
Goblet cells are evident.
This subtype, which is by
far the most common, is
referred to as intestinal.

Fig. 19.247 Complex

architecture & obvious
nuclear atypia in mucinous
cystadenocarcinoma.
Germ cell tumor

 Dysgerminoma
 Embryonal carcinoma
 Yolk sac tumor
 Choriocarcinoma
 Teratoma
Immatur (malignan and grow rapidly )
Matur : solid and cystic (dermoid cyst )  >>>
benign
Kista dermoid
 Fig. 19.291. Well-developed
teeth in ovarian mature cystic
teratoma.

Fig. 19.290. Admixture of

sebum & hair within the
cavity of an ovarian mature
cystic teratoma.
Case 2
 A 32-year old female presents with the recent onset of
oligomenorrhea followed by amenorrhea, and then the
loss of female secondary characteristic. She also
developed acne, deepening of her voice, and temporal
balding. Which one of the following ovarian tumors would
most likely produce these symptom ?
A. Epithelial tumor
B. Stromal tumor
C. Germ cell tumor
D. Surface tumor
E. Metastasis
Answer :

 (B). Stromal tumor

 Thecoma, granulosa cell tumor 
produce steroid hormon (estrogen)
 Sertoly leydig cell tumor (Androblastoma)
 produce androgen  loss of
secondary female sex characteristic
SEX CORD STROMAL TUMOR

Sertoli-Leydig cell
Granulosa cell Leydig cell tumor
tumors
tumor of the ovary of the ovary
(androblastomas)

Sertoli cell tumor of Thecoma of the Fibroma of the

the ovary ovary ovary

Sex cord tumor

Steroid (lipid) cell Gynandroblastoma
with annular
tumors of the ovary
tubules
Feminizing
Effect
Masculinizing
effect
Payudara
Mammary Glands
 Parenchyma Stroma

 Essential parts of an
organ that are
concerned with its
function
 Stroma
 Framework/Supporting
tissue of an organ;
 Contains connective
tissue& blood vessels
 Opposite of
Parenchyma
parenchyma
Anatomy of the Breast
Interlobular duct

Terminal duct
Duct cells

Lobules

Alveolar
Secretory
cells gland
Tubular gland
Case 1
 A 35-year-old with normal menstrual cycles,
whose last child was born 5 years ago, feels a
poorly defined lump in her right breast. The lump
is not painful, and it does not feel hard. If a right
breast were to be performed, the most probable
finding would be :
A. Fibrocystic changes
B. Lobular carcinoma
C. Acute mastitis
D. Fibroadenoma
Fibrocystic Changes
(Mammary dysplasia fibrocystic disease)

 Hormonal imbalance
 Short menstruation cycle(21-24days)
 Estrogen >>  Hyperestrism.
 50% cases in reproductive periode
 Premenstrual pain+lumpy breast
 Stromal & terminal ducts epithelial proliferation
Profibrocystic Changes

 Proliferation of
small ducts &
myoepithelial
cells in terminal
duct lobular
unit.
Case 2

 A 25-year-old woman palpates a lump in her right

breast. Her physician determines that there is a
firm, circumscribed, 2-cm, lower outer quadrant
mass. The most likely diagnosis is :
A. Phylloydes tumor
B. Fibrocystic changes
C. Fibroadenoma
D. Fat necrosis
E. Infiltrating ductal carcinoma
Fibroadenoma Mammae
 Benign neoplasm
 Composed of : epithelial & stromal elements
 Originate from : terminal duct lobular unit.
 Ages : 20-30 years
 Sign :
 Round, rubbery tumor, soliter / multiple,
sharply demarcated, freely moveable, upper
lateral quadrant >>
 Macros : encapsulated, gray white
 Micros : proliferation of glands & fibrous stroma.
… Fibroadenoma Mammae
… Fibroadenoma Mammae

 Intracanaliculare
 fibrous tissue
form tumor
 compress
proliferated ducts
 curvilinear slits.
… Fibroadenoma Mammae

 Pericanalicular 
round glands
dispersed within
fibrous stroma.
Case 3

 A 51-year-old female develops a 7-cm area of

tender, firm, erythematous skin with swelling of
the right breast, accompanied by nipple retraction
and right axillary lymphadenopathy.
A biopsy of this right breast is most likely to show :
A. Atypical epithelial hyperplasia
B. Phylloides tumor
C. Fibrocystic changes
D. Infiltrating ductal carcinoma
 CARCINOMA OF THE BREAST

EPIDEMIOLOGY  the most common

malignancy of women after cervix cancer.
PATHOGENESIS :
- Genetic Factor  history of breast ca in first
line degree relatives (mother,sister,daughter).
Mutations of p53 tumor suppressor gene;
BRCA 1 gene (breast ca 1) located at
chromosome 17 (17q21) and BRCA 2 gene
located on chromosome 13q.
Hormonal status  early menarch, late
menopause and older age at first term
pregnancy  increased risk.
PATHOGENESIS

 Environmental Influences  high fat intake.

 Radiation.
 Fibrocystic Change.
 Previous cancer.
 Viruses.
 Genomic alterations  gene amplification,
overexpression & allelic deletion.
 1

MAMMOGRAM
 4

Hematogenous
metastasis

Lymphatogenou
s metastasis

Mechanism of metastasis
Breast Self-Examination
The American Cancer Society recommends that women
perform a breast self-examination once a month.

The best time to do a breast self-exam is one week after

your period so that your breasts will be less tender and you
will be more likely to notice any changes in their look or
feel.

After menopause, do breast self-exams on the first day

of each month.
 Visual Inspection
Standing or sitting in front of a mirror as
illustrated. In each position look for :

Changes in color or shape of breast

Changes in color or texture of the skin
Changes in nipple shape or texture
Evidence of nipple discharge
Dimpling or puckering anywhere on chest
If your eyesight is limited, making it difficult for you to do the
visual inspection yourself perhaps a close friend, spouse, an
attendant or family member could help you with this.
Thank You