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Pathology – Ectopic Pregnancy
Definition: When a fertilized ovum implants abnormally outside of the uterus. Almost all of them take place in the ampullary region of the Fallopian tubes. Rarely, other locations include the abdominal cavity and ovaries.
The study of epidemiology • The incidence is 12 per 1000 pregnancies annually and is on the rise. The cause • The most frequent risk factor is tubal scarring from prior PID episodes. • Endometriosis and prior tubal surgery are additional risk factors. • Roughly half happen for no apparent reason.
The pathogenesis • There is severe bleeding into the Fallopian tube when trophoblasts are implanted there. • The tubal wall may rupture abruptly or gradually; the embryo may become dislodged and be absorbed by the wall or shed.
Presentation: • Sudden rupture results in an acute abdomen with peritonism and shock; • Typical presentation is progressively growing stomach discomfort and vaginal bleeding. 2. If a woman of reproductive age experiences stomach pain, take the diagnosis into consideration. Macroscopy • There is a noticeable dilatation and congestion of the affected Fallopian tube. • Friable material and blood fill the tubal lumen. Histopathology: The Fallopian tube contains chorionic villi and infiltrating extravillous trophoblasts.
Prognosis: If the diagnosis is made and the proper treatment is administered, the prognosis is favorable. • A increased risk of subsequent ectopic pregnancies is linked to having one ectopic pregnancy.
Definition: When a fertilized ovum implants abnormally outside of the uterus. Almost all of them take place in the ampullary region of the Fallopian tubes. Rarely, other locations include the abdominal cavity and ovaries.
The study of epidemiology • The incidence is 12 per 1000 pregnancies annually and is on the rise. The cause • The most frequent risk factor is tubal scarring from prior PID episodes. • Endometriosis and prior tubal surgery are additional risk factors. • Roughly half happen for no apparent reason.
The pathogenesis • There is severe bleeding into the Fallopian tube when trophoblasts are implanted there. • The tubal wall may rupture abruptly or gradually; the embryo may become dislodged and be absorbed by the wall or shed.
Presentation: • Sudden rupture results in an acute abdomen with peritonism and shock; • Typical presentation is progressively growing stomach discomfort and vaginal bleeding. 2. If a woman of reproductive age experiences stomach pain, take the diagnosis into consideration. Macroscopy • There is a noticeable dilatation and congestion of the affected Fallopian tube. • Friable material and blood fill the tubal lumen. Histopathology: The Fallopian tube contains chorionic villi and infiltrating extravillous trophoblasts.
Prognosis: If the diagnosis is made and the proper treatment is administered, the prognosis is favorable. • A increased risk of subsequent ectopic pregnancies is linked to having one ectopic pregnancy.
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Pathology - Pelvic inflammatory disease
Definition: An infection of the upper female vaginal canal.
Epidemiology • The majority of instances occur in young sexually active women aged 15 to 25. The true incidence is challenging to ascertain due to numerous undiagnosed instances.
Aetiology • The majority of cases result from ascending infections caused by either Chlamydia (C.) trachomatis or Neisseria (N.) gonorrhoeae. Both organisms are sexually transmitted microorganisms. • Cases not linked to sexually transmitted infections are frequently connected with intrauterine devices or retained products of conception following childbirth or miscarriage.
Presentation • Typically, there are enduring symptoms of pelvic discomfort, dyspareunia, and post-coital or intermenstrual bleeding. • Severe instances may result in an acute illness characterized by fever, abdominal pain, and peritonitis. 2 It is important to recognize that numerous women remain asymptomatic and consequently undetected.
Complications • Infertility: the likelihood of infertility escalates with each occurrence of infection. Women who experience three or more bouts of pelvic inflammatory disease (PID) have a 40% likelihood of infertility. • Ectopic pregnancy: the chance is increased sixfold, perhaps due to deformation and scarring of the fallopian tubes. • Persistent pelvic pain and painful intercourse
Definition: An infection of the upper female vaginal canal.
Epidemiology • The majority of instances occur in young sexually active women aged 15 to 25. The true incidence is challenging to ascertain due to numerous undiagnosed instances.
Aetiology • The majority of cases result from ascending infections caused by either Chlamydia (C.) trachomatis or Neisseria (N.) gonorrhoeae. Both organisms are sexually transmitted microorganisms. • Cases not linked to sexually transmitted infections are frequently connected with intrauterine devices or retained products of conception following childbirth or miscarriage.
Presentation • Typically, there are enduring symptoms of pelvic discomfort, dyspareunia, and post-coital or intermenstrual bleeding. • Severe instances may result in an acute illness characterized by fever, abdominal pain, and peritonitis. 2 It is important to recognize that numerous women remain asymptomatic and consequently undetected.
Complications • Infertility: the likelihood of infertility escalates with each occurrence of infection. Women who experience three or more bouts of pelvic inflammatory disease (PID) have a 40% likelihood of infertility. • Ectopic pregnancy: the chance is increased sixfold, perhaps due to deformation and scarring of the fallopian tubes. • Persistent pelvic pain and painful intercourse
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Pathology - Ovarian carcinomas
Definition: A collection of malignant epithelial tumors originating in the ovary.
Epidemiology • Rare, however a predominant cause of cancer-related mortality owing to its delayed presentation.
Aetiology • High parity and the utilization of oral contraceptives are consistently linked to a diminished risk of ovarian cancer. • Post-menopausal women using oestrogen replacement treatment have an elevated risk. • Emerging evidence indicates that obesity correlates with an increased risk.
Carcinogenesis • Recent morphological and genetic evidence indicates that ovarian carcinomas can be classified into several types based on their probable origin and behavior. One group (low-grade serous, mucinous, Brenner) has indolent behavior and infrequently demonstrates TP53 mutations. Certain workers hypothesize that these tumors originate from paraovarian Müllerian epithelium via a progression from benign cystadenoma to borderline neoplasm to invasive carcinoma. The second category, comprising high-grade serous, high-grade endometrioid, and undifferentiated carcinomas, represents highly aggressive malignancies that often exhibit TP53 mutations. Certain workers hypothesize that these tumors may originate in other pelvic organs, such as the Fallopian tubes, and subsequently affect the ovaries. Endometrioid and clear cell ovarian carcinomas are believed to develop from ovarian endometriosis.
Presentation: stomach pain, tiredness, abdominal distension, and diarrhea. The ambiguous and nonspecific characteristics of the symptoms frequently lead women to attribute them to stress or menopause. Women who pursue medical care are frequently misdiagnosed with benign gastrointestinal or urinary disorders. Most women present with advanced disease at the time of diagnosis. Macroscopy The ovary is hypertrophied and substituted by a neoplastic tumor that is frequently both solid and cystic. Mucinous tumors may comprise gelatinous substances. Histopathology Serous carcinomas consist of malignant epithelial cells that proliferate in irregular branching papillae and create slit-like glandular gaps. Psammoma bodies may be observed.
Endometrioid carcinomas consist of malignant epithelial cells that create round or oval glands similar to those found in endometrial carcinomas. Regions of squamous differentiation are prevalent. Mucinous carcinomas consist of malignant epithelial cells characterized by mucinous cytoplasm that forms glandular structures. Differentiating original ovarian mucinous carcinoma from metastatic mucinous carcinoma originating in the gastrointestinal tract can be quite challenging. transparent cell carcinomas consist of malignant epithelial cells characterized by transparent cytoplasm and hobnailing, which proliferate in tiny tubules and papillae. Transitional cell carcinomas exhibit morphological similarities to urothelial carcinomas; however, their immunophenotypic characteristics align more closely with serous carcinomas.
Prognosis: Generally unfavorable, as the majority of women arrive with advanced disease (FIGO III and IV), correlating with a 5-year survival rate of 25–30% (in contrast to 80–90% for FIGO I or II).
FIGO staging of ovarian carcinomas
IA: tumour limited to one ovary; capsule intact, no tumour on the
ovarian surface; no malignant cells in ascites or peritoneal washings.
IB: tumour limited to both ovaries; capsule intact, no tumour on the
ovarian surface; no malignant cells in ascites or peritoneal washings.
IC: tumour limited to one or both ovaries with any of the following:
capsule ruptured, tumour on the ovarian surface, malignant cells in ascites
or peritoneal washings.
IIA: extension and/or implants on the uterus and/or tube(s); no malignant
cells in ascites or peritoneal washings.
IIB: extension to other pelvic tissues; no malignant cells in ascites or
peritoneal washings.
IIC: pelvic extension with malignant cells in ascites or peritoneal
washings.
IIIA: microscopic peritoneal metastasis beyond the pelvis.
IIIB: macroscopic peritoneal metastasis beyond the pelvis, 2cm or less
in size.
IIIC: peritoneal metastasis beyond the pelvis, > 2cm in size and/or
regional lymph node metastasis.
IV: distant metastasis
Definition: A collection of malignant epithelial tumors originating in the ovary.
Epidemiology • Rare, however a predominant cause of cancer-related mortality owing to its delayed presentation.
Aetiology • High parity and the utilization of oral contraceptives are consistently linked to a diminished risk of ovarian cancer. • Post-menopausal women using oestrogen replacement treatment have an elevated risk. • Emerging evidence indicates that obesity correlates with an increased risk.
Carcinogenesis • Recent morphological and genetic evidence indicates that ovarian carcinomas can be classified into several types based on their probable origin and behavior. One group (low-grade serous, mucinous, Brenner) has indolent behavior and infrequently demonstrates TP53 mutations. Certain workers hypothesize that these tumors originate from paraovarian Müllerian epithelium via a progression from benign cystadenoma to borderline neoplasm to invasive carcinoma. The second category, comprising high-grade serous, high-grade endometrioid, and undifferentiated carcinomas, represents highly aggressive malignancies that often exhibit TP53 mutations. Certain workers hypothesize that these tumors may originate in other pelvic organs, such as the Fallopian tubes, and subsequently affect the ovaries. Endometrioid and clear cell ovarian carcinomas are believed to develop from ovarian endometriosis.
Presentation: stomach pain, tiredness, abdominal distension, and diarrhea. The ambiguous and nonspecific characteristics of the symptoms frequently lead women to attribute them to stress or menopause. Women who pursue medical care are frequently misdiagnosed with benign gastrointestinal or urinary disorders. Most women present with advanced disease at the time of diagnosis. Macroscopy The ovary is hypertrophied and substituted by a neoplastic tumor that is frequently both solid and cystic. Mucinous tumors may comprise gelatinous substances. Histopathology Serous carcinomas consist of malignant epithelial cells that proliferate in irregular branching papillae and create slit-like glandular gaps. Psammoma bodies may be observed.
Endometrioid carcinomas consist of malignant epithelial cells that create round or oval glands similar to those found in endometrial carcinomas. Regions of squamous differentiation are prevalent. Mucinous carcinomas consist of malignant epithelial cells characterized by mucinous cytoplasm that forms glandular structures. Differentiating original ovarian mucinous carcinoma from metastatic mucinous carcinoma originating in the gastrointestinal tract can be quite challenging. transparent cell carcinomas consist of malignant epithelial cells characterized by transparent cytoplasm and hobnailing, which proliferate in tiny tubules and papillae. Transitional cell carcinomas exhibit morphological similarities to urothelial carcinomas; however, their immunophenotypic characteristics align more closely with serous carcinomas.
Prognosis: Generally unfavorable, as the majority of women arrive with advanced disease (FIGO III and IV), correlating with a 5-year survival rate of 25–30% (in contrast to 80–90% for FIGO I or II).
FIGO staging of ovarian carcinomas
IA: tumour limited to one ovary; capsule intact, no tumour on the
ovarian surface; no malignant cells in ascites or peritoneal washings.
IB: tumour limited to both ovaries; capsule intact, no tumour on the
ovarian surface; no malignant cells in ascites or peritoneal washings.
IC: tumour limited to one or both ovaries with any of the following:
capsule ruptured, tumour on the ovarian surface, malignant cells in ascites
or peritoneal washings.
IIA: extension and/or implants on the uterus and/or tube(s); no malignant
cells in ascites or peritoneal washings.
IIB: extension to other pelvic tissues; no malignant cells in ascites or
peritoneal washings.
IIC: pelvic extension with malignant cells in ascites or peritoneal
washings.
IIIA: microscopic peritoneal metastasis beyond the pelvis.
IIIB: macroscopic peritoneal metastasis beyond the pelvis, 2cm or less
in size.
IIIC: peritoneal metastasis beyond the pelvis, > 2cm in size and/or
regional lymph node metastasis.
IV: distant metastasis
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Pathology - Ovarian benign tumors
Cystic teratoma in maturity Benign germ cell ovarian tumors, sometimes referred to as "dermoid cysts," are most common in young women aged 20 to 29. • Larger tumors may cause pelvic pain, but many are asymptomatic and found by accident. Torsion or rupture, which results in an acute abdomen, is the most dangerous consequence. • The tumor appears cystic from a macroscopic perspective and contains a soft, greasy yellow substance. Teeth, bone, cartilage, and hair may be apparent. • According to histology, the tumor is made up of mature adult-type tissues of almost any kind, such as cartilage, smooth muscle, fat, skin, brain, respiratory, and gastrointestinal tissue.Although they are far less common, the majority of other germ cell ovarian tumors (such as dysgerminoma and immature teratoma) exhibit malignant behavior.
Cystadenoma serous -Benign epithelial ovarian tumors typically affect premenopausal women. They can be discovered by chance when a pelvic mass or an acute abdomen from torsion is present. They can be unilocular or multilocular in appearance. Histologically, the cysts are lined by a single layer of bland columnar cells, which may be ciliated or non-ciliated. The cysts contain clear fluid and have a thin wall with a smooth lining.
Cystomatous mucinous tumor • Premenopausal women typically develop benign epithelial ovarian tumors. • It may be discovered by chance when there are signs of a pelvic mass or an acute abdomen brought on by torsion. • On a macroscopic level, the tumor is often unilateral and measures 10 cm on average, though there have been cases of enormous tumors. One or more cysts filled with viscous mucoid material make up the tumor. • A single layer of bland columnar cells, either intestinal or endocervical in origin, lines the cysts histologically.
Ovarian Fibroma
Benign sex-cord stromal ovarian tumors, which are made of collagen and fibrocytes, can occur in a variety of age groups, although the majority are found in women over 50. They are frequently found by accident and are little. Ascites and stomach pain may result from a large tumor. • From a macroscopic perspective, the tumor has a solid white sliced surface. • According to histology, the tumor is made up of bland spindled cells that are expanding within a collagenous stroma.
Ovarian tumors that are borderline epithelial
A class of epithelial tumors known as borderline epithelial ovarian tumors tends to behave indolently yet shows more marked proliferation than benign epithelial tumors. Serous (borderline serous) tumors make up the great bulk of borderline epithelial tumors. At the macroscopic level, they are enormous, often bilateral, cystic tumors that are typically multifocal. Numerous papillary excrescences protrude from the cysts' surface. The tumors exhibit low-grade nuclear atypia and are histologically formed of complicated branching papillae covered by proliferating columnar epithelial cells. The existence of tiny tumor "implants" in the peritoneum or omentum in around 15% to 30% of cases is an odd characteristic of borderline serous tumors. These implants can be classified as either invasive or non-invasive histologically. The majority are non-invasive, and the prognosis for these patients is typically favorable. Although invasive implants are extremely uncommon, they are typically linked to a poor prognosis
Cystic teratoma in maturity Benign germ cell ovarian tumors, sometimes referred to as "dermoid cysts," are most common in young women aged 20 to 29. • Larger tumors may cause pelvic pain, but many are asymptomatic and found by accident. Torsion or rupture, which results in an acute abdomen, is the most dangerous consequence. • The tumor appears cystic from a macroscopic perspective and contains a soft, greasy yellow substance. Teeth, bone, cartilage, and hair may be apparent. • According to histology, the tumor is made up of mature adult-type tissues of almost any kind, such as cartilage, smooth muscle, fat, skin, brain, respiratory, and gastrointestinal tissue.Although they are far less common, the majority of other germ cell ovarian tumors (such as dysgerminoma and immature teratoma) exhibit malignant behavior.
Cystadenoma serous -Benign epithelial ovarian tumors typically affect premenopausal women. They can be discovered by chance when a pelvic mass or an acute abdomen from torsion is present. They can be unilocular or multilocular in appearance. Histologically, the cysts are lined by a single layer of bland columnar cells, which may be ciliated or non-ciliated. The cysts contain clear fluid and have a thin wall with a smooth lining.
Cystomatous mucinous tumor • Premenopausal women typically develop benign epithelial ovarian tumors. • It may be discovered by chance when there are signs of a pelvic mass or an acute abdomen brought on by torsion. • On a macroscopic level, the tumor is often unilateral and measures 10 cm on average, though there have been cases of enormous tumors. One or more cysts filled with viscous mucoid material make up the tumor. • A single layer of bland columnar cells, either intestinal or endocervical in origin, lines the cysts histologically.
Ovarian Fibroma
Benign sex-cord stromal ovarian tumors, which are made of collagen and fibrocytes, can occur in a variety of age groups, although the majority are found in women over 50. They are frequently found by accident and are little. Ascites and stomach pain may result from a large tumor. • From a macroscopic perspective, the tumor has a solid white sliced surface. • According to histology, the tumor is made up of bland spindled cells that are expanding within a collagenous stroma.
Ovarian tumors that are borderline epithelial
A class of epithelial tumors known as borderline epithelial ovarian tumors tends to behave indolently yet shows more marked proliferation than benign epithelial tumors. Serous (borderline serous) tumors make up the great bulk of borderline epithelial tumors. At the macroscopic level, they are enormous, often bilateral, cystic tumors that are typically multifocal. Numerous papillary excrescences protrude from the cysts' surface. The tumors exhibit low-grade nuclear atypia and are histologically formed of complicated branching papillae covered by proliferating columnar epithelial cells. The existence of tiny tumor "implants" in the peritoneum or omentum in around 15% to 30% of cases is an odd characteristic of borderline serous tumors. These implants can be classified as either invasive or non-invasive histologically. The majority are non-invasive, and the prognosis for these patients is typically favorable. Although invasive implants are extremely uncommon, they are typically linked to a poor prognosis
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Pathology - Polycystic Ovary Syndrome
Definition: A metabolic syndrome characterized by testosterone excess, ovulatory dysfunction, and, in certain women, the presence of polycystic ovaries.
Epidemiology • Prevalent, impacting approximately 5% of women. Aetiology Insulin resistance seems to be the principal underlying reason
Pathogenesis • Insulin resistance, obesity, and increased androgen synthesis by the ovaries. • Androgens contribute to hirsutism, acne, and irregular follicle maturation. • Irregular follicle maturation may result in polycystic ovaries in certain women. • Chronic anovulation leads to subfertility and decreased estrogen production. • Prolonged estrogen exposure results in endometrial hyperplasia and increases the chance of developing endometrial intraepithelial neoplasia and endometrial carcinoma
Presentation • Subfertility is a prevalent manifestation. • Certain women exhibit hirsutism and acne.
Radiology • Polycystic ovaries may be observed in certain women, but not universally. Biochemistry • Increased blood androgen levels. • Diminished glucose tolerance or overt diabetes.
Prognosis • The primary concerns are the difficulties linked to obesity and the possibility of endometrial carcinoma. • Weight loss, insulin-sensitizing medications, and progesterone therapy all contribute to mitigating these complications.
Definition: A metabolic syndrome characterized by testosterone excess, ovulatory dysfunction, and, in certain women, the presence of polycystic ovaries.
Epidemiology • Prevalent, impacting approximately 5% of women. Aetiology Insulin resistance seems to be the principal underlying reason
Pathogenesis • Insulin resistance, obesity, and increased androgen synthesis by the ovaries. • Androgens contribute to hirsutism, acne, and irregular follicle maturation. • Irregular follicle maturation may result in polycystic ovaries in certain women. • Chronic anovulation leads to subfertility and decreased estrogen production. • Prolonged estrogen exposure results in endometrial hyperplasia and increases the chance of developing endometrial intraepithelial neoplasia and endometrial carcinoma
Presentation • Subfertility is a prevalent manifestation. • Certain women exhibit hirsutism and acne.
Radiology • Polycystic ovaries may be observed in certain women, but not universally. Biochemistry • Increased blood androgen levels. • Diminished glucose tolerance or overt diabetes.
Prognosis • The primary concerns are the difficulties linked to obesity and the possibility of endometrial carcinoma. • Weight loss, insulin-sensitizing medications, and progesterone therapy all contribute to mitigating these complications.
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Pathology - Functional ovarian cysts
Definition • Ovarian follicles exhibiting pathogenic cystic alterations. • A suggested threshold distinguishing normal cystic follicles from functional cysts is 2.5 cm.
Terminology: Cysts originating from pre-ovulatory follicles are termed follicular cysts, whereas those arising from the corpus luteum are referred to as corpus luteum cysts.
Epidemiology: Highly prevalent.
Aetiology • Follicular cysts are believed to indicate dysfunction of the pituitary-ovarian axis. Corpus luteum cysts arise from severe hemorrhage within a corpus luteum.
Presentation • Nearly all are identified incidentally, either through imaging or by a surgeon examining the pelvis. • Large cysts may intermittently manifest as a pelvic mass. Macroscopy: Follicular cysts are often solitary and range in size from 2.5 to 10 cm. The structures are characterized by smooth contours and contain a transparent fluid. Corpus luteum cysts typically range in size from 2.5 to 5 cm. The cyst contains sanguineous fluid, and the wall is frequently yellow
Cytopathology . : The aspirated fluid from a follicular cyst comprises many granulosa cells characterized by spherical nuclei, coarse chromatin, and a narrow rim of cytoplasm. Nuclear grooves may be observed. Certain cysts may also comprise luteinized cells. Aspirated fluid from a corpus luteum cyst comprises blood, haemosiderin-laden macrophages, and many completely luteinized granulosa cells. These are sizable polyhedral cells characterized by copious finely granular cytoplasm. The nuclei are round to elliptical, exhibiting finely granular chromatin and conspicuous nucleoli. Nuclear grooves are absent. Histopathology Follicular cysts are composed of granulosa and theca cells, which may exhibit luteinization. Corpus luteum cysts have significant central hemorrhage. The lining consists of entirely luteinized granulosa and theca cells.
Prognosis: Functional ovarian cysts are completely benign. They are mostly of clinical significance, as big cysts may raise suspicion for a cystic neoplasm.
Definition • Ovarian follicles exhibiting pathogenic cystic alterations. • A suggested threshold distinguishing normal cystic follicles from functional cysts is 2.5 cm.
Terminology: Cysts originating from pre-ovulatory follicles are termed follicular cysts, whereas those arising from the corpus luteum are referred to as corpus luteum cysts.
Epidemiology: Highly prevalent.
Aetiology • Follicular cysts are believed to indicate dysfunction of the pituitary-ovarian axis. Corpus luteum cysts arise from severe hemorrhage within a corpus luteum.
Presentation • Nearly all are identified incidentally, either through imaging or by a surgeon examining the pelvis. • Large cysts may intermittently manifest as a pelvic mass. Macroscopy: Follicular cysts are often solitary and range in size from 2.5 to 10 cm. The structures are characterized by smooth contours and contain a transparent fluid. Corpus luteum cysts typically range in size from 2.5 to 5 cm. The cyst contains sanguineous fluid, and the wall is frequently yellow
Cytopathology . : The aspirated fluid from a follicular cyst comprises many granulosa cells characterized by spherical nuclei, coarse chromatin, and a narrow rim of cytoplasm. Nuclear grooves may be observed. Certain cysts may also comprise luteinized cells. Aspirated fluid from a corpus luteum cyst comprises blood, haemosiderin-laden macrophages, and many completely luteinized granulosa cells. These are sizable polyhedral cells characterized by copious finely granular cytoplasm. The nuclei are round to elliptical, exhibiting finely granular chromatin and conspicuous nucleoli. Nuclear grooves are absent. Histopathology Follicular cysts are composed of granulosa and theca cells, which may exhibit luteinization. Corpus luteum cysts have significant central hemorrhage. The lining consists of entirely luteinized granulosa and theca cells.
Prognosis: Functional ovarian cysts are completely benign. They are mostly of clinical significance, as big cysts may raise suspicion for a cystic neoplasm.
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Pathology - Uterine leiomyomas
Definition
Synonym • Fibroids. • Benign neoplasms of smooth muscle originating in the myometrium.
Epidemiology • Highly prevalent tumors identified in up to 75% of all women. Approximately 20% of women are affected by symptomatic fibroids. Aetiology The exact etiology remains ambiguous; nevertheless, contributing factors encompass race and parity, with black and nulliparous women exhibiting a higher susceptibility.
Pathogenesis • Hormonal tumors that predominantly affect women of reproductive age, exhibit rapid growth during pregnancy, and undergo regression post-menopause. Genetic research indicates that they are clonal neoplasms characterized by chromosomal abnormalities.
Presentation: Menorrhagia. • Subfertility: this is likely attributable to endometrial deformation, hindering implantation. • Pelvic pain: this may be associated with tumor infarction or torsion of a pedunculated fibroid. • Palpable mass: fibroids may attain sufficient size to be discerned abdominally.
Macroscopy • Well-defined, white, whorled tumors that typically protrude from the adjacent myometrium upon incision. • Frequently numerous and may be intramural or extend from the serosal surface (subserosal) or into the uterine cavity (submucosal). • Calcification is prevalent. Infarcted tumors exhibit a red coloration instead of white, a phenomenon referred to as 'red degeneration.'
Histopathology Classical fibroids consist of interlacing fascicles of unremarkable smooth muscle cells characterized by blunt-ended nuclei and eosinophilic cytoplasm. Regions of hyalinization and calcification are prevalent. Numerous histological variants are well-documented, all exhibiting benign behavior. These encompass cellular leiomyoma, highly cellular leiomyoma, mitotically active leiomyoma, and atypical leiomyoma.
Prognosis: Benign tumors exhibit no potential for malignant behavior. Uterine leiomyosarcoma Uterine leiomyosarcoma is a malignant neoplasm of smooth muscle originating in the myometrium. While rare, it constitutes the most prevalent uterine sarcoma. The swift growth of a uterine tumor may raise concerns for leiomyosarcoma; nevertheless, many cases are not identified prior to surgery and are presumed to be big fibroids.
Macroscopically, leiomyosarcomas are inadequately defined and typically do not protrude from the adjacent myometrium due to their infiltrative characteristics. They are more pliable than fibroids and may exhibit signs of necrosis.
Histologically, leiomyosarcomas are neoplasms of smooth muscle that exhibit several abnormal characteristics, including widespread cytological atypia, necrosis of tumor cells, and elevated mitotic activity. Leiomyosarcomas are aggressive tumors characterized by a propensity for local recurrence and metastasis, especially to the liver and lungs.
Definition
Synonym • Fibroids. • Benign neoplasms of smooth muscle originating in the myometrium.
Epidemiology • Highly prevalent tumors identified in up to 75% of all women. Approximately 20% of women are affected by symptomatic fibroids. Aetiology The exact etiology remains ambiguous; nevertheless, contributing factors encompass race and parity, with black and nulliparous women exhibiting a higher susceptibility.
Pathogenesis • Hormonal tumors that predominantly affect women of reproductive age, exhibit rapid growth during pregnancy, and undergo regression post-menopause. Genetic research indicates that they are clonal neoplasms characterized by chromosomal abnormalities.
Presentation: Menorrhagia. • Subfertility: this is likely attributable to endometrial deformation, hindering implantation. • Pelvic pain: this may be associated with tumor infarction or torsion of a pedunculated fibroid. • Palpable mass: fibroids may attain sufficient size to be discerned abdominally.
Macroscopy • Well-defined, white, whorled tumors that typically protrude from the adjacent myometrium upon incision. • Frequently numerous and may be intramural or extend from the serosal surface (subserosal) or into the uterine cavity (submucosal). • Calcification is prevalent. Infarcted tumors exhibit a red coloration instead of white, a phenomenon referred to as 'red degeneration.'
Histopathology Classical fibroids consist of interlacing fascicles of unremarkable smooth muscle cells characterized by blunt-ended nuclei and eosinophilic cytoplasm. Regions of hyalinization and calcification are prevalent. Numerous histological variants are well-documented, all exhibiting benign behavior. These encompass cellular leiomyoma, highly cellular leiomyoma, mitotically active leiomyoma, and atypical leiomyoma.
Prognosis: Benign tumors exhibit no potential for malignant behavior. Uterine leiomyosarcoma Uterine leiomyosarcoma is a malignant neoplasm of smooth muscle originating in the myometrium. While rare, it constitutes the most prevalent uterine sarcoma. The swift growth of a uterine tumor may raise concerns for leiomyosarcoma; nevertheless, many cases are not identified prior to surgery and are presumed to be big fibroids.
Macroscopically, leiomyosarcomas are inadequately defined and typically do not protrude from the adjacent myometrium due to their infiltrative characteristics. They are more pliable than fibroids and may exhibit signs of necrosis.
Histologically, leiomyosarcomas are neoplasms of smooth muscle that exhibit several abnormal characteristics, including widespread cytological atypia, necrosis of tumor cells, and elevated mitotic activity. Leiomyosarcomas are aggressive tumors characterized by a propensity for local recurrence and metastasis, especially to the liver and lungs.
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Pathology - Fibrocystic change
Definition: A series of modifications in the breast that represent natural, but amplified, reactions to hormonal influences.
Epidemiology • Highly prevalent. • Present in over one-third of premenopausal adult females. Aetiology • A condition driven by hormonal factors in response to estrogens.
Pathogenesis • The mechanism remains rather ambiguous; nevertheless, some researchers hypothesize that the initial event involves apocrine metaplasia of the breast ducts. • The secretions generated by these cells result in ductal dilatation and cyst development.
Presentation • The primary characteristic is breast nodularity and lumpiness. • Cyclical discomfort may also be present.
Macroscopy • The breast tissue exhibits a firm, rubbery consistency. • Cysts are typically discernible, presenting a brown or bluish coloration.
Cytopathology • Aspirates from cysts reveal debris, foamy macrophages, and apocrine cells. • Aspirates from non-cystic regions consist of cohesive fragments of bland ductal epithelial cells with numerous background naked bipolar nuclei.
Histopathology • Characterized by several histological alterations, including cystic transformation, apocrine metaplasia, adenosis, moderate epithelial hyperplasia, and stromal hyperplasia.
Prognosis: Benign with no elevated risk for later invasive breast carcinoma.
Definition: A series of modifications in the breast that represent natural, but amplified, reactions to hormonal influences.
Epidemiology • Highly prevalent. • Present in over one-third of premenopausal adult females. Aetiology • A condition driven by hormonal factors in response to estrogens.
Pathogenesis • The mechanism remains rather ambiguous; nevertheless, some researchers hypothesize that the initial event involves apocrine metaplasia of the breast ducts. • The secretions generated by these cells result in ductal dilatation and cyst development.
Presentation • The primary characteristic is breast nodularity and lumpiness. • Cyclical discomfort may also be present.
Macroscopy • The breast tissue exhibits a firm, rubbery consistency. • Cysts are typically discernible, presenting a brown or bluish coloration.
Cytopathology • Aspirates from cysts reveal debris, foamy macrophages, and apocrine cells. • Aspirates from non-cystic regions consist of cohesive fragments of bland ductal epithelial cells with numerous background naked bipolar nuclei.
Histopathology • Characterized by several histological alterations, including cystic transformation, apocrine metaplasia, adenosis, moderate epithelial hyperplasia, and stromal hyperplasia.
Prognosis: Benign with no elevated risk for later invasive breast carcinoma.
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Pathology - Fat tissue necrosis
Definition: An inflammatory response to injured adipose tissue. Epidemiology: Prevalent. Aetiology: Trauma to the breast. • Following surgical intervention or radiation. Pathogenesis • Compromised adipocytes release their lipid contents, provoking an inflammatory response that leads to the formation of a palpable mass.
Presentation • The majority present with a breast mass that is firm and indurated.Can closely resemble breast carcinoma in clinical presentation. Macroscopy • The breast tissue exhibits yellow-white flecks of discolouration. Cytopathology: FNA cytology reveals foamy macrophages, multinucleated large cells, and background detritus. Histopathology: Degenerating adipocytes are observed, encircled by foamy macrophages, multinucleated giant cells, lymphocytes, and plasma cells. Subsequent alterations encompass fibrosis and calcification.
Prognosis: Benign with no elevated risk of breast cancer.
Definition: An inflammatory response to injured adipose tissue. Epidemiology: Prevalent. Aetiology: Trauma to the breast. • Following surgical intervention or radiation. Pathogenesis • Compromised adipocytes release their lipid contents, provoking an inflammatory response that leads to the formation of a palpable mass.
Presentation • The majority present with a breast mass that is firm and indurated.Can closely resemble breast carcinoma in clinical presentation. Macroscopy • The breast tissue exhibits yellow-white flecks of discolouration. Cytopathology: FNA cytology reveals foamy macrophages, multinucleated large cells, and background detritus. Histopathology: Degenerating adipocytes are observed, encircled by foamy macrophages, multinucleated giant cells, lymphocytes, and plasma cells. Subsequent alterations encompass fibrosis and calcification.
Prognosis: Benign with no elevated risk of breast cancer.
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Pathology - Fibroadenoma
Definition • A benign fibroepithelial tumor of the breast.
Epidemiology: Prevalent. • Predominantly affects young women aged 20 to 30 years.
Aetiology • The majority of experts consider them to be neoplastic proliferations of fibroblasts inside the specialized connective tissue of the intralobular stroma.
Pathogenesis • The proliferating neoplastic fibroblasts inside the intralobular stroma entrap and compress terminal duct lobular units and interlobular stroma, resulting in the formation of a well-defined nodular mass.
Macroscopy • Well-defined, movable breast masses often measuring 3 cm or less. • The cut surface is generally solid, whorled, and grey-white in hue.
Cytopathology • Aspirates exhibit cellularity, featuring numerous branching sheets of cohesive, bland ductal epithelial cells alongside a substantial presence of naked bipolar nuclei in the background. • Fragments of stromal material may also be observed.
Histopathology • Histological examination reveals a well-circumscribed multinodular tumor distinct from the adjacent breast tissue. Each nodule comprises an enlarged myxoid intralobular stromal compartment populated by inconspicuous spindled fibroblastic cells. The terminal duct lobular unit is constricted into narrow channels. • Narrow strands of interlobular stroma exist between each nodule of the fibroadenoma. • Mature lesions frequently exhibit fibrosis and calcification.
Prognosis: • Benign lesions exhibiting no potential for malignant behavior. Surgical excision through straightforward 'shelling out' is nearly invariably curative with minimal likelihood of recurrence.
Phyllodes tumors
Phyllodes tumors are a category of potentially aggressive fibroepithelial neoplasms. These are rare tumors that often manifest as a progressively enlarging breast lump in women over 50 years of age. Some are believed to originate from pre-existing fibroadenomas. Macroscopically, the tumors typically present as big, fleshy, lobulated masses exhibiting regions of cystic alteration. Histologically, these are fibroepithelial tumors characterized by the excessive proliferation of neoplastic stromal cells, resulting in a disordered and heterogeneous morphology of the epithelial component. The stroma exhibits variability in cellularity and the composition of the extracellular matrix. Substantial stromal nodules extending into cystic cavities generate distinctive 'leaf-like' projections. All phyllodes tumors possess the potential for local recurrence and are typically managed with extensive local resection. In actuality, the majority do not reappear, even after uncomplicated enucleation. Phyllodes tumors may acquire the ability to spread, however this occurrence is exceedingly rare.
Definition • A benign fibroepithelial tumor of the breast.
Epidemiology: Prevalent. • Predominantly affects young women aged 20 to 30 years.
Aetiology • The majority of experts consider them to be neoplastic proliferations of fibroblasts inside the specialized connective tissue of the intralobular stroma.
Pathogenesis • The proliferating neoplastic fibroblasts inside the intralobular stroma entrap and compress terminal duct lobular units and interlobular stroma, resulting in the formation of a well-defined nodular mass.
Macroscopy • Well-defined, movable breast masses often measuring 3 cm or less. • The cut surface is generally solid, whorled, and grey-white in hue.
Cytopathology • Aspirates exhibit cellularity, featuring numerous branching sheets of cohesive, bland ductal epithelial cells alongside a substantial presence of naked bipolar nuclei in the background. • Fragments of stromal material may also be observed.
Histopathology • Histological examination reveals a well-circumscribed multinodular tumor distinct from the adjacent breast tissue. Each nodule comprises an enlarged myxoid intralobular stromal compartment populated by inconspicuous spindled fibroblastic cells. The terminal duct lobular unit is constricted into narrow channels. • Narrow strands of interlobular stroma exist between each nodule of the fibroadenoma. • Mature lesions frequently exhibit fibrosis and calcification.
Prognosis: • Benign lesions exhibiting no potential for malignant behavior. Surgical excision through straightforward 'shelling out' is nearly invariably curative with minimal likelihood of recurrence.
Phyllodes tumors
Phyllodes tumors are a category of potentially aggressive fibroepithelial neoplasms. These are rare tumors that often manifest as a progressively enlarging breast lump in women over 50 years of age. Some are believed to originate from pre-existing fibroadenomas. Macroscopically, the tumors typically present as big, fleshy, lobulated masses exhibiting regions of cystic alteration. Histologically, these are fibroepithelial tumors characterized by the excessive proliferation of neoplastic stromal cells, resulting in a disordered and heterogeneous morphology of the epithelial component. The stroma exhibits variability in cellularity and the composition of the extracellular matrix. Substantial stromal nodules extending into cystic cavities generate distinctive 'leaf-like' projections. All phyllodes tumors possess the potential for local recurrence and are typically managed with extensive local resection. In actuality, the majority do not reappear, even after uncomplicated enucleation. Phyllodes tumors may acquire the ability to spread, however this occurrence is exceedingly rare.
