Dr Ismet M Nur Sp PA (K) MM
The portio (ectocervix) :
covered by a stratified
nonkeratinizing squamous
epithelium
Endocervix:
lined by columnar, mucus secreting
epithelium
The point at which the squamous &
columnar epithelim meet is the
squamocolumnar junction
The portion of the columnar ept.
that is replaced by squamous ept. is
termed “transformation zone”
Transformation zone
Reserve cells in the transformation zone are
continuous with the basal cells of the ectocervix
and may undergo having metaplasia become columnar
and squamous differentiated
Transformation zone is the origin of precursor lessions
Colposcopic view of the cervix :
A. in the reproductive age woman
B. the postmenopausal cervix
Risk factor for cervical neoplasia:
early stage at first intercourse
multiple sexual partners
increased parity
A male with multiple previous sexual partners
The presence of a cancer-associated HPV
The persistent detection of high-riskHPV,
particularly in high concentration
Exposure to oral contraceptives & nicotine
Genital infections (chlamydia)
Normal Cervix
normal ectocervix has a typical stratified Squamous
epithelium
maturation cels,the eosinofilic cytoplasm expands
greatly and the cells are pushed upward into a stratum
the cytoplasm becomes progressively flattened
Cytoplasmic staining in superficial cell shows
exfoliating superficial squamous epithelial cells
Cervix normal
Cervical Precancer
Cervical precancers have been classified in :
Displasia / Ca insitu system (mild and severe)
Cervical intraepithelial neoplasia (CIN classification)
ex. CIN I,II,III
Non Invasive Lession (Low grade / CIN I and High
grade / Ca Insitu/CIN III intraepithelial lession)
Cervical intra-epithelial neoplasia (CIN I)
Mild dysplasia
Low grade intraepithelial lesion
Koilocytotic atipia :
Nuclear changes as enlargement and hiperkromasia
accompanied by cytoplasmic halos
Koilocytotic atipia as the effect of active viral replication in the
maturing cells (Viral cytophatic effect)
Few alteration in the lower third epithelial cells
(enlarged,crowded, hyperchromated, increased mitotic act)
Often contain abundant papilloma Virus nucleic acid
Cervical intra-epithelial neoplasia (CIN I)
Cervical intra-epithelial neoplasia
(CIN II)
Basal cells proliferation extend from one-third to two-
third of thickness of epithelium
Atypical cells in the lower layers of squamous
epithelium
Atypical cells shows changes in :
nucleo-cytoplasmic ratio
variation in nuclear size
increased mitotic figures ( abnormal mitosis and
hiperkromasi)
they take on some of the characteristics of malignant
cells
Cervical intra-epithelial neoplasia
(CIN II)
Cervical intra-epithelial neoplasia
(CIN III)
High grade intraepithelial lesion
Carcinoma insitu
The atypical cells extend into the upper third of
epitheliumuntil its totally replaced
mitotic or abnormal mitotic figures are common and
are seen above the basal layer
Progressive loss of differentiation
Cervical intra-epithelial neoplasia (CIN III)
Endometrial hiperplasia
1. Simple non-atypical hyperplasia
changes in glands of various size, producing
irregularity in gland shape, with cystic alteration
2. Complex atypical hyperplasia
increase in the number & size of endometrial
glands, with gland crowding, enlargement, and
irregular shape. Mitotic figures are commons
Endometrial hyperplasia
Appears to be a response to excessive or uncoordinated
oestrogen production
simplex or complex in form
Associated with an increased risk of invasive
endometrial Ca
risk complex >> simplex
greatest in complex hyperplasia with atypia
Heavy uterine bleeding is the most common symptom
Endometrial hyperplasia
Complex Hyperplasia
Proliferation of the endometrial glands
Many are irregular in shape and size, often with
papillary infolding
Adjacent glands may be closely packed
there is little intervening stroma
nuclear and cytoplasmic pleomorf more often
mitotic activity >>>
Complex Hyperplasia
Simplex Hyperplasia
Endometrial lining becomes thickened by
proliferation of the endometrial glandular tissue
Formation of numerous tiny cysts scattered among
normal endometrial glands
Cysts result from dilated endometrial gland
intervening stroma containing prominent thin-walled
blood vessels
Simplex Hyperplasia
Endometrial hyperplasia
Hydatidiform mole
The condition known as hydatiform mole arises in
a small portion of pregnancies,after miscarriages
or terminations of pregnancy or even year after a
pregnancies
Characterized by cystic swelling of the chorionic
villi, accompanied by variable trophoblastic
proliferation
partial or complete
complete mole: all or most chorionic villi are
edematous with central cystic spaces, diffuse
trophoblast hyperplasia, > 90% have a 46,XX
diploid pattern
Hydatidiform mole
Cisternae (Central cystic space ) are invested by a
layer hiperplastic cytotrofoblast and
syncytiotrophoblast
Some Tropholast cells lying free of the villi and
showing mild cellular pleomorfism
partial mole: some of the villi are edematous, the
trophoblasic proliferation is focal, the karyotype is
triploid (e.g 69,XXY)
wide spectrum of behaviour, some eradicated by
curretage, other persist, small number develop
malignancies as Chorio Ca
Feature Complete Partial mole
mole
Karyotype 46,XX (46,XY) Triploid
Villous All villi Some villi
edema
Trophoblast Diffuse, Focal, slight
proliferation cicumferential
Atypia Often present Absent
Serum hCG Elevated Less elevated
hCG in tissue ++++ +
Behavior 2% choriocarc. Rare chorioca.
Mola hydatidiform
Mola hydatidiform
Complete hydatidiform mole suspended in saline
showing numerous swollen
Ectopic pregnancy
Implantation of the fetus in any site other than a
normal uterine location
90% is within the tube, the other site are the ovary,
abdominal cavity, & intrauterine portion of fallopian
tube
Ussually become dramatically apparent by severe
hemorrhage in the lumen often followed by tracking of
blood into peritoneal cavity
only very rare of the pregnancies continue to near
normal term
Ectopic pregnancy
Right: muscular wall of the tube
Lumen:contains blood clot & chorionic villi, sheets
of trophoblast
The epithelial lining of the tube has been replaced
by well-developed decidua
Extensive haemorrhage into the lumen of the tube
The trofoblast burrows into the wall of fallopian
tube leading to perforation
Ectopic pregnancy
Ovarian tumors
Risk factor: nulliparity, family history & heritable
mutation. Higher freq. in unmarried woman and
in married woman with low parity
Pathogenesis: mutations in both BRCA1 or BRCA2
(20%-60% by the age 70)
Tumour may arise from epithelial, stromal,germ
cell, metastatic
Classification: WHO Histological Classification
1993 surface epithelial-stromal tumors, sex
cord-stromal tumors, germ cell tumors, malignant
not otherwise specified, and metastatic
nonovarian cancer
Ovarian tumors
Cystic cavity tends to be filled by complex branching
papillary structures
These are covered by columnar cells that are crowded
and dysplastic
The cells are stratified and form solid sheet
Essential for diagnostic malignancy is evidence of
invasion tumour cells to stomal
Papillary cystadenocarcinoma serosum
ovarium
This was a large tumor with
many cystic cavities filled with
watery fluid. One cystic cavity is
shown
It is lined by deeply basophilic
epithelium which forms long
papilliferous processes.
The epth. grown outwards,
penetrating the fibrous wall of
the cyst to reach the serosa
Fibroadenoma mammae
Tend to be found in younger woman (20-35 years)
Very rarely become malignant
Forms a firm well-defined mass, up to about 3 cm in
diameter
Are mixed tumours, in having both epithelial &
connective tissue components
Fibroadenoma mamae
Fibroadenoma mamae
The tumor consist of both
stromal & glandular
hyperplasia
The stromal underwent a
myxomatous degeneration
The duct dilatated, & the
epithelial nuclei normal
The nodules are
surrounded by bands of
denser fibrous tissue
Fibroadenoma mamae
Pericanalicular pattern : Epithelial component of
rounded ducts that remain small and undistorted
stromal aroun them symetris and regular manner
Intracanalicular pattern : The ducts appear elongated ,
flattened spaces compressed by nodular proliferation
of the stromal component
Invasive ductal carc. mamae
Invading malignant epithelial cells form small ductal
stuctures
Solid nest
Stroma frequently fibrotic
Invasive ductal carc. mamae
The tumor cell are polygonal hyperplastis, some give a ductuli
appearance with central necrosis
The stromal is fully invaded by the tumor cells
Alhamdulillah..
Thank you