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8/8/2019 Diseases of the Female Genital Tract and Breast
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DISEASES OF THE FEMALE
GENITAL TRACT AND BREAST
Section 13
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Case 1. MATURE CYSTIC TERATOMA,
Ovary 25 year old female
Complaint: Gradual abdominal enlargement
PE: palpable right adnexal mass
Ultrasound: solid cystic mass with teethand bone-like structures
Underwent salpingoophorectomy
Gross:
Cyst measured 10 cm
Smoothgrayish white surface
Upon opening: filled with cream yellow amorphousgreasy material admixed with
hair
Protuberant mass was noted along the inner wall with fat, teethand bone-like
structures
Microscopically:
Cyst wall was composed of ovarian stroma
Lined by stratified squamous epithelium with dermal appendages
Otherareas: fat, smooth muscle, blood vessels, cartilage, and glandular tissues
Note: Please referto youratlas orotherreferences forclearerimage and distinction of parts.
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MATURE CYSTIC TERATOMA, Ovary
LPO
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MATURE CYSTIC TERATOMA, Ovary
HPO
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Case 2. ECTOPIC TUBAL PREGNANCY
30 year old female
Sudden left lowerquadrant pain
History of delay in menses for 8 weeks with positive pregnancy test
Ultrasound:
no gestational sac in uterus
Dilated left fallopian tube
Exploratory laparotomy: showed ruptured left fallopian tube withhemoperitoneum
amounting to 1 liter
Left fallopian tube:
edematousand hemorrhagic with friable blood clots
contained cream white soft to spongy placental tissues upon sectioning
Microscopic exam:
Placental tissuesalong the tubal mucosa partially obscured by blood clots
Immature villi with loose central stromal tissue containinga few blood vesselsand
surrounded by trophoblasts
Numerousacute inflammatory cellsand red blood cells within lumen and wall of
fallopian tube
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ECTOPIC TUBAL PREGNANCY
LPO
Muscular
wall
ChorionicVilli
RBCs
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ECTOPIC TUBAL PREGNANCY
LPOHPO
Trophoblasts
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Case 3. HYDATIDIFORM MOLE
25 year old G4P3
History ofabortion five monthsago and wasamenorrheic since then
Abdomen enlarged to 5 monthsgestational age
Profuse vaginal bleeding
Passed out a mass ofgrape-like structures
PE: enlarged uterus with no palpable fetus
Urine and blood levels ofHCG markedly elevated
Specimen: consisted of multiple vesicles, admixed withsoft hemorrhagic
tissuesamounting to5
cm in aggregate diameter Microscopically:
Large and distended chorionic villi without blood vessels
Central of villi composed of loose myxomatousstroma covered by
chorionic cilli, chorionic epithelium, cytotrophoblastsand syncitial
trophoblasts
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HYDATIDIFORM MOLE
Chorionic Villi
Avascular Stroma
Trophoblasts
LPO
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Case 4. SEROUS CYSTADENOMA,
Ovary
30 year old nulligravid female
Complaint: vague abdominal pain and gradual abdominalenlargement 5 months prior to consult
PE: distended abdomen and palpable right adnexal mass
Ultrasound: large cystic ovary filled with fluid
Gross exam: 5x5x3 cm ovary withsmooth pinkish cream surface with prominent vascular
markings
Uniloculated and filled with clear light yellow serous fluid
Smoothand glistening internal surface
No solid nodules or papillary masses
Microscopic exam: benign cuboidal to columnar epithelium(some ciliated) lining the cyst
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SEROUS CYSTADENOMA
LPO
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SEROUS CYSTADENOMA
HPO
Lining
epitheliumCyst wall
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Case 5. FIBROCYSTIC CHANGES OF THE
BREAST
20 year old female
Complaint: lump on breast
PE: 3 cm ill-defined slightly tender, movable breast mass just below areola
Gross: specimen was irregular withseveral brown to bluish colored cysts
containingsemi-translucent turbid fluid surrounded by dense fibrous
tissue
Microscopic:
Small cysts lined with cuboidal to columnar epithelium (some
multilayered)
Larger cysts with flattened epithelium
Some were lined with cells withabundant granular eosinophilic
cytoplasm withsmall round deeply chromatic nuclei
Stroma composed of fibrous tissue infiltrated with lymphocytes
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FIBROCYSTIC CHANGES OF THE BREAST
LPO
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FIBROCYSTIC CHANGES OF THE BREAST
HPO
Lining
epithelium
Cystic ducts
Stroma
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Case 6. FIBROADENOMA
30 year old female
Movable left breast mass of2 mos. duration
Mass: 4cm; firm; slightly tender; movable
Gross:
masswas well-circumscribed, lobulated withrubbery consistency
4x3x3cm
Cut sections: yellowishwhite slightly bulgingsurfaces withseveral slit-
like spaces
Microscopically:
Glandularand cystic spaces lined by heaped up and compressed
cuboidal epithelium surrounded by large irregular loose spindle cells
and fine wavy connective tissue fibers
Thin rim of fibrinous connective tissue separated the normal breast
parenchyma
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FIBROADENOMA
Fibroblastic stroma
LPO
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FIBROADENOMA
Glandularandcystic spaces
HPO
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Case 7. INVASIVE DUCTAL CARCINOMA
60 year old female Non-healing left breast ulcer
Began two yearsago asasmall firm non-tender, fixed nodule in the left upper
outerquadrant
PE: 3cm superficial ulcer with erythematousskin ulcer withan underlying palpable
fixed massbelow the nipple
Underwent radical mastectomy with lymph node dissection
Gross exam:
4cm fairly circumscribed hard reddish cream massbeneath ulcer
Had gritty solid cut surface withsmall pinpoint foci of chalk white necrotic
mass
Microscopically: Tumor composed of irregular nestsand cords of polyhedral cells withhyperchromatic
nuclei, prominent nucleoli, and ample eosinophilic cytoplasm
Dilated ducts were filled with necrotic material
Dense sclerotic connective tissue surrounded the tumor nests
Some glands exhibited cribriform pattern
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INVASIVE DUCTAL CARCINOMA
LPO
Fatty
tissue
Stroma
Malignant
glandular cells
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INVASIVE DUCTAL CARCINOMA
HPO
Malignantglandular
cells