Breast and Cervical Pathology

Breast and Cervical Pathology

I. Cervix

1. Cervicitis:

• Acute Cervicitis:

• Gross Appearance: Red and swollen, with purulent discharge.

• Cause: Clostridium welchii.

• Chronic Cervicitis:

• Gross Appearance: Congestion, ulceration, infiltration of chronic inflammatory cells.

• Cause: Miscarriage, Chlamydia trachomatis.

2. Cervical Tumors:

• Cervical Polyp:

• Gross Appearance: Round mass protruding from the external os or cervical canal. May be mistaken for cancer.

• Microscopic Appearance: Lined by mucous columnar epithelium, with squamous metaplasia; edematous, congested stroma.

• Symptoms: Often asymptomatic or cause leukorrhea.

• Conclusion: Cervical polyps are the most common benign neoplasm of the cervix.

3. Cervical Intraepithelial Neoplasia (CIN):

• Definition: Hyperplasia in the cervical epithelium.

• Classification:

• CIN1: Mild dysplasia, can progress to CIN2 or CIN3 (50%) or regress.

• CIN2: Moderate dysplasia.

• CIN3: Severe dysplasia, high risk of progressing to cancer (60-70%).

• Gross Appearance: No characteristic appearance, relies on cytology, colposcopy, and biopsy.

• Microscopic Appearance: Disorder in squamous and basal cells, increased density, loss of polarity, distorted nuclei, increased mitosis.

4. Cervical Condyloma:

• Gross Appearance: Benign tumor, cauliflower-like warts, well-defined, elevated above surrounding epithelium.

5. Cervical Cancer:

• Gross Appearance: Exophytic type (most common), ulcerative, infiltrative.

• Microscopic Appearance:

• Squamous Cell Carcinoma: Well-differentiated, large nuclei, pleomorphic, abundant cytoplasm, numerous mitosis, intercellular bridges, keratin pearls.

• Undifferentiated Squamous Cell Carcinoma, Large Cell Type: Common, moderately differentiated, intercellular bridges but no keratin pearls.

• Undifferentiated Squamous Cell Carcinoma, Small Cell Type: Poorly differentiated, no intercellular bridges, no keratin pearls.

• Adenocarcinoma: Most common is cervical adenocarcinoma. Well and moderately differentiated, similar metastatic pathways to squamous carcinoma, but earlier.

II. Uterus

1. Endometritis:

• Acute Endometritis:

• Microscopic Appearance: Clusters of polymorphonuclear leukocytes in the stroma, forming small abscesses or within gland lumens, then rupture.

• Chronic Endometritis:

• Microscopic Appearance: Plasma cells, lymphocytes, stromal cells becoming spindle-shaped.

2. Adenomyosis:

• Definition: Endometrial glands (in proliferative phase) and stroma located within the myometrium.

• Gross Appearance: Enlarged uterus, posterior growth, soft on cut surface; areas of yellow-brown color, forming small cysts.

3. Endometriosis:

• Location: Broad ligament, fallopian tubes, ovaries, rectum, Douglas pouch.

• Found in: Women of reproductive age, postmenopausal women.

• Gross Appearance: Implants containing old hemorrhagic fluid during menstruation.

• Microscopic Appearance: Many hemosiderin-laden macrophages.

4. Endometrial Hyperplasia:

• Found in: Postmenopausal women.

• Gross Appearance: Thickened endometrium, resembling polyps, soft, pale pink.

• Microscopic Appearance:

• Simple Hyperplasia: Most common, more glands than stroma.

• Complex Hyperplasia: Complex branching, crowded, with little stroma.

• Atypical Hyperplasia: Hyperplasia with multiple layers of cells.

• Conclusion: Atypical hyperplasia has a risk of becoming cancerous.

5. Benign Tumors of the Uterine Body:

• Endometrial Polyp:

• Gross Appearance: Often at the fundus, 0.5-3cm, polyps protrude into the vagina through the cervical os.

• Microscopic Appearance: With fibrous stroma, many blood vessels, dilated endometrial glands, surface ulceration/hemorrhage.

• Leiomyoma:

• Gross Appearance: Multiple tumors, round, firm, located in the myometrium, beneath the endometrium, beneath the serosa.

• Submucosal Leiomyoma: Tumor beneath the endometrium, polyp-like, protrudes into the vagina through the cervical os.

• Microscopic Appearance: Increased smooth muscle proliferation arranged in bundles.

• Degenerative Changes: Hyaline and fibrous degeneration, focal hemorrhage, cystic degeneration, calcification.

6. Endometrial Cancer:

• Gross Appearance: Polyp-like, nodular, extending through the fallopian tubes into the peritoneal cavity.

• Microscopic Appearance: According to 3 degrees of differentiation.

• Well-differentiated: Formation of glandular structures, papillary/alveolar, solid areas <5%.

• Moderately differentiated: Solid areas 5-50%.

• Poorly differentiated: Solid areas >50%, highly atypical cells, numerous mitosis.

III. Ovary

1. Surface Epithelial Ovarian Tumors:

• Origin: From the mesothelial cells covering the ovarian surface or from the follicles in the stroma.

• Potential for Metaplasia: Cervical epithelium, endometrial epithelium, tubal epithelium.

• Borderline Malignant: Atypical cell proliferation, looking malignant but benign, not metastatic, not invasive.

2. Serous Ovarian Tumors:

• Benign Serous Tumors: Most common ovarian tumors.

• Malignant Serous Tumors: Most common type of ovarian cancer.

• Gross Appearance: 5-10cm, thin capsule, smooth, filled with clear fluid.

• Microscopic Appearance:

• Benign: Lined by simple columnar epithelium.

• Malignant: Multilayered proliferating epithelium, “psammoma bodies”.

3. Surface Epithelial Ovarian Tumors Include:

• Serous Tumors: Originating from the cervical epithelium.

• Mucinous Tumors: Originating from the cervical epithelium.

• Endometrioid Tumors: Originating from the endometrial epithelium.

• Clear Cell Tumors: Originating from the tubal epithelium.

• Brenner Tumors: Originating from the tubal epithelium.

4. Endometrioid Tumors:

• Gross Appearance: 10-20cm, solid/cystic with brown fluid containing papillary projections into the cyst lumen.

• Microscopic Appearance: Resemble endometrial adenocarcinoma.

5. Clear Cell Tumors:

• Gross Appearance: 15cm, hemorrhage and necrosis in solid areas.

• Microscopic Appearance: Polyhedral cells, abundant and clear cytoplasm.

IV. Breast

1. Benign Breast Tumors:

• Fibroadenoma:

• Phyllodes Tumor:

• Intraductal Papilloma:

2. Breast Cancer:

• In Situ Carcinoma: Early stage cancer, not invasive.

• Ductal Type: Not invasive, undetected unless calcified.

• Lobular Type: Cells arranged in single file “Indian file”, “cribriform”.

• Paget’s Disease of the Nipple:

• Origin: From major ducts, microscopic appearance in the basal layer of the epidermis.

• Usually accompanied by: In situ ductal carcinoma, invasive ductal carcinoma beneath.

• Invasive Ductal Carcinoma:

• Microscopic Appearance: Arranged in “solid nests”, stroma reaction rich in lymphocytes.

• Invasive Breast Carcinoma, NOS:

• Microscopic Appearance: Scattered/nodular/tubular glandular arrangement.

• Invasive Lobular Carcinoma:

• Microscopic Appearance: Cells arranged in single file “Indian file”, “cribriform”.

Note: This is just a general overview of breast and cervical pathology. For accurate and complete information, please consult a specialist.