Li shuhua
Diseases of female
genital system
Cervix diseases
Gestational trophoblastic diseases
Breast diseases
Cervix diseases
Cervical epithelial dysplasia and
carcinoma in situ
Cervical carcinoma
Cervical epithelial dysplasia
and carcinoma in situ
the Site of the disease,
Nature,precancerous lesions
the joint of the squamous epithelialium and
the columnar epithelialium
Pathologic types
CIN I,atypia limited to 1/3
CINII,atypia limited to 1/3~2/3
CINIII,atypia is over 2/3
CINI
THE DYSPLASIA LIMITED DOWN TO 1/3 OF
THE CERVIX EPITHELIAL
CINII
THE DYSPLASIA LIMITED DOWN TO 1/3 TO
2/3 OF THE CERVIX EPITHELIAL
CINIII
THE DYSPLASIA INVADE up
2/3 of the cervical
EPITHELIAL
Carcinoma in situ
The Ends and Prognosis
CINI CINIII
2% INVASIVE CANCER 20%
Cervical carcinoma
One of the most dangerous cancer for
adult females
Many factors may cause it,the HPV is
the most important one
Macroscopic forms
Eroding tumor
Fungating tumor
Infiltrative tumor
ulcerative tumor
This is the gross appearance of a fungating tumor,it appears as a
cauliflower-like mass with necrosis on the surface
Fungating
type
The ulcerative form
Infiltrative tumor The irregular grey-brown
tumor extends toward bladder and up into the uterus.
Histological forms
squamous cell carcinoma 75-90%
microinvasive type <5mm
invasive type
adenocarcinoma 10-25%
microinvasive type,
Depth<5mm
invasive type,This cancer is well-
differentiated,as evidenced by keratin
pearls.
Squmous cell carcinoma of the
cervix
spread
Local invading
Lymphatic metastasis most happen
Hematogenous metastasis
carcinoma of the breast
The 1st cause of cancer death
in females
Most locate in upper outer
quadrant
Genetics,environment,age,obes
ity are risk factor
pathologic forms
Noninfiltrating
infiltrating
The normal microscopic appearance of female breast tissue is
shown here,There is a larger duct to the right and lobules to the
left,A collagenous stroma extends between the structures,A
variable amount of adipose tissue can be admixed with these
elements.
noninfiltrating carcinoma
Intraductal carcinoma in situ
Lobular carcinoma in situ
Paget disease
Intraductal carcinoma in situ
Without invading the ductal basement
membrane
Filled with necrotic tumor tissue
With fibrous tissue proliferation
This high power microscopic view demonstrates intraductal
carcinoma,Neoplastic cells are still within the ductules and have
not broken through into the stroma,Note that the two large
lobules in the center contain microcalcifications,Such
microcalcifications can appear on mammography.
Here is a comedocarcinoma pattern of intraductal carcinoma,
which is characterized by the presence of rapidly proliferating,
high-grade malignant cells,Note the prominent central necrosis in
the ducts.
comedocarcinoma
The cells in the center of the ducts with comedocarcinoma are
often necrotic and calcify,as shown here,This central necrosis
leads to the gross characteristic of extrusion of cheesy material
from the ducts with pressure (comedone-like).
comedocarcinoma
Lobular carcinoma in situ
Arise from terminal ductules of the
lobule
Without invading the basement
membrane
Paget disease
An unusual form of ductal breast
cancer
It extends to infiltrate the skin of nipple
and areola
The skin is fissured,ulcered,oozing
Infiltrating carcinoma
Invasive ductal carcinoma 70%
Invasive lobular carcinoma 5-15%
Invasive ductal carcinoma
Gray,hard,gritty texture
Infiltrative and retracted below the
surrounding tissue
It causes dimpling of skin,retraction of
the nipple,and fixation to the chest
Note the small nests and infiltrating strands of neoplastic cells
with prominent bands of collagen between them in this ductal
carcinoma of the breast,It is this marked increase in the dense
fibrous tissue stroma that produces the characteristic hard
"scirrhous" appearance of the typical infiltrating ductal carcinoma..
infiltrating ductal carcinoma of breast.
necrosis
desmoplasia
Invasive lobular carcinoma
The tumor cells are small and
uniform,with little pleomorphism
Loosely dispersed and difficult to
determine
spread
Local invading
Lymphatic metastasis most happen
Hematogenous metastasis
Lymphatic metastasis
The primary tumor auxillary
nodes supraclavicular nodes
lung,liver,skeleton
Gestational trophoblastic disease
1,hydatidiform mole
2,invasive mole
3,choriocarcinoma
hydatidiform mole
benign disease,reason is unknown
Incidence,1 per 150 pregnancies
Asia country > Western country
pathological forms
Complete hydatidiform mole
Partial hydatidiform mole
Macroscopic pathologesis
The lesion didn`t invade uterine
muscle
The chorionic villi was dilated,it
developed into a thin-walled,
translucent,grape-like struture
hydatidiformmol
Microscopic pathologesis
Hydropic swelling of chorionic villi
Virtual absence of vascularization of villi
Some degree of proliferation of both
cytotrophoblast and syncytial trophoblast
Hydatidiform mole
cytotrophoblast
Syncytial
trophoblast
the ends
healing Invasive
mole
choriocar
noma
80-90% 10% 2.5%
diagnose
irregular homerrhage
The level of HCG in blood and urine
invasive mole
The character compare with the
hydatidiform mole:
Penetrate the
uterine wall
deeply,even
invade distant
organs
The epithelium
of the villi is
markedly
hyperplastic
and atypical
Penetrate the
uterine wall
deeply
The necrosis
of the villi and
homorrhage is
visible
Invasive mole
choriocarcinoma
Hydatidiform mole
abortion delivery
premature delivery
ectopic pregnancy
50% 25% 20% 5%
Macroscopic pathologesis
The tumor invade the myometrium and
even penetrate through the uterium
The tumor is soft with a lot of necrosis
and homorrhage in it
3,choriocarcinoma
homorrhage
tumor
Microscopic pathologesis
The tumor is purely epithelial,
cytotrophoblast // syncytiotrophoblast
no chorionic villi formed and no vessels
Infiltrate the host`s vessel and cause
homorrhage
choriocarcinoma
HCG（ +）
spread
Local invading
Hematogenous metastasis
widely disseminated to lung,vagina
clinic relation
irregular bloody discharge
Rising titer of HCG
treatment
Chemotherapy has achieved remarkable
results
Diseases of female
genital system
Cervix diseases
Gestational trophoblastic diseases
Breast diseases
Cervix diseases
Cervical epithelial dysplasia and
carcinoma in situ
Cervical carcinoma
Cervical epithelial dysplasia
and carcinoma in situ
the Site of the disease,
Nature,precancerous lesions
the joint of the squamous epithelialium and
the columnar epithelialium
Pathologic types
CIN I,atypia limited to 1/3
CINII,atypia limited to 1/3~2/3
CINIII,atypia is over 2/3
CINI
THE DYSPLASIA LIMITED DOWN TO 1/3 OF
THE CERVIX EPITHELIAL
CINII
THE DYSPLASIA LIMITED DOWN TO 1/3 TO
2/3 OF THE CERVIX EPITHELIAL
CINIII
THE DYSPLASIA INVADE up
2/3 of the cervical
EPITHELIAL
Carcinoma in situ
The Ends and Prognosis
CINI CINIII
2% INVASIVE CANCER 20%
Cervical carcinoma
One of the most dangerous cancer for
adult females
Many factors may cause it,the HPV is
the most important one
Macroscopic forms
Eroding tumor
Fungating tumor
Infiltrative tumor
ulcerative tumor
This is the gross appearance of a fungating tumor,it appears as a
cauliflower-like mass with necrosis on the surface
Fungating
type
The ulcerative form
Infiltrative tumor The irregular grey-brown
tumor extends toward bladder and up into the uterus.
Histological forms
squamous cell carcinoma 75-90%
microinvasive type <5mm
invasive type
adenocarcinoma 10-25%
microinvasive type,
Depth<5mm
invasive type,This cancer is well-
differentiated,as evidenced by keratin
pearls.
Squmous cell carcinoma of the
cervix
spread
Local invading
Lymphatic metastasis most happen
Hematogenous metastasis
carcinoma of the breast
The 1st cause of cancer death
in females
Most locate in upper outer
quadrant
Genetics,environment,age,obes
ity are risk factor
pathologic forms
Noninfiltrating
infiltrating
The normal microscopic appearance of female breast tissue is
shown here,There is a larger duct to the right and lobules to the
left,A collagenous stroma extends between the structures,A
variable amount of adipose tissue can be admixed with these
elements.
noninfiltrating carcinoma
Intraductal carcinoma in situ
Lobular carcinoma in situ
Paget disease
Intraductal carcinoma in situ
Without invading the ductal basement
membrane
Filled with necrotic tumor tissue
With fibrous tissue proliferation
This high power microscopic view demonstrates intraductal
carcinoma,Neoplastic cells are still within the ductules and have
not broken through into the stroma,Note that the two large
lobules in the center contain microcalcifications,Such
microcalcifications can appear on mammography.
Here is a comedocarcinoma pattern of intraductal carcinoma,
which is characterized by the presence of rapidly proliferating,
high-grade malignant cells,Note the prominent central necrosis in
the ducts.
comedocarcinoma
The cells in the center of the ducts with comedocarcinoma are
often necrotic and calcify,as shown here,This central necrosis
leads to the gross characteristic of extrusion of cheesy material
from the ducts with pressure (comedone-like).
comedocarcinoma
Lobular carcinoma in situ
Arise from terminal ductules of the
lobule
Without invading the basement
membrane
Paget disease
An unusual form of ductal breast
cancer
It extends to infiltrate the skin of nipple
and areola
The skin is fissured,ulcered,oozing
Infiltrating carcinoma
Invasive ductal carcinoma 70%
Invasive lobular carcinoma 5-15%
Invasive ductal carcinoma
Gray,hard,gritty texture
Infiltrative and retracted below the
surrounding tissue
It causes dimpling of skin,retraction of
the nipple,and fixation to the chest
Note the small nests and infiltrating strands of neoplastic cells
with prominent bands of collagen between them in this ductal
carcinoma of the breast,It is this marked increase in the dense
fibrous tissue stroma that produces the characteristic hard
"scirrhous" appearance of the typical infiltrating ductal carcinoma..
infiltrating ductal carcinoma of breast.
necrosis
desmoplasia
Invasive lobular carcinoma
The tumor cells are small and
uniform,with little pleomorphism
Loosely dispersed and difficult to
determine
spread
Local invading
Lymphatic metastasis most happen
Hematogenous metastasis
Lymphatic metastasis
The primary tumor auxillary
nodes supraclavicular nodes
lung,liver,skeleton
Gestational trophoblastic disease
1,hydatidiform mole
2,invasive mole
3,choriocarcinoma
hydatidiform mole
benign disease,reason is unknown
Incidence,1 per 150 pregnancies
Asia country > Western country
pathological forms
Complete hydatidiform mole
Partial hydatidiform mole
Macroscopic pathologesis
The lesion didn`t invade uterine
muscle
The chorionic villi was dilated,it
developed into a thin-walled,
translucent,grape-like struture
hydatidiformmol
Microscopic pathologesis
Hydropic swelling of chorionic villi
Virtual absence of vascularization of villi
Some degree of proliferation of both
cytotrophoblast and syncytial trophoblast
Hydatidiform mole
cytotrophoblast
Syncytial
trophoblast
the ends
healing Invasive
mole
choriocar
noma
80-90% 10% 2.5%
diagnose
irregular homerrhage
The level of HCG in blood and urine
invasive mole
The character compare with the
hydatidiform mole:
Penetrate the
uterine wall
deeply,even
invade distant
organs
The epithelium
of the villi is
markedly
hyperplastic
and atypical
Penetrate the
uterine wall
deeply
The necrosis
of the villi and
homorrhage is
visible
Invasive mole
choriocarcinoma
Hydatidiform mole
abortion delivery
premature delivery
ectopic pregnancy
50% 25% 20% 5%
Macroscopic pathologesis
The tumor invade the myometrium and
even penetrate through the uterium
The tumor is soft with a lot of necrosis
and homorrhage in it
3,choriocarcinoma
homorrhage
tumor
Microscopic pathologesis
The tumor is purely epithelial,
cytotrophoblast // syncytiotrophoblast
no chorionic villi formed and no vessels
Infiltrate the host`s vessel and cause
homorrhage
choriocarcinoma
HCG（ +）
spread
Local invading
Hematogenous metastasis
widely disseminated to lung,vagina
clinic relation
irregular bloody discharge
Rising titer of HCG
treatment
Chemotherapy has achieved remarkable
results
