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68 Cards in this Set
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Breast disorders: Key points |
Upper outer quadrant has a high density of breast tissue which is why cancer is commonly located here. Also beneath the nipple. Oestrogen stimulates ductal and alveolar cell growth, fat and stroma, progesterone stimulates alveolar cell proliferation and lobule differentiation for milk production, breast swelling in secretory phase. Prolactin stimulates lactogenesis and secretion. Oxytocin released by suckling reflex causes expulsion of milk into ducts. Lymph nodes - Outer quadrant cancers drain to axillary lymph nodes and inner quadrant cancers drain to the internal mammary nodes. |
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Nipple discharges |
Galactorrhoea - Mechanical stimulation of nipple due to prolonged sucking, sexual intercourse - Prolactinoma, most common pathological cause - Primary hypothyroidism, most common nonpituitary endocrine cause due to increased TRP which stimulates prolactin - Drugs: OCPs, phenothiazines, methyldopa, H2-receptor blockers, anxiolytics, tricyclic antidepressants (TCAs) Bloody nipple discharge - Intraductal papilloma, ductal cancer Purulent nipple discharge - Acute mastitis due to S.aureus - Usually occurs during lactation or breast-feeding - Treatment, if not methicillin resistant, dicloxacillin or cephalexin. If resistant, co-trimoxazole double strength. Greenish-brown nipple discharge - Mammary duct ectasia (plasma cell mastitis) |
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Breast pain |
Most common cause is fibrocystic change Mondor disease (rare) - Superficial thrombophlebitis of veins overlying the breast - Presents as a palpable painful cord |
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Examples of benign types of micro-calcification in mammograms |
Popcorn calcifications Round calcifications |
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Fibrocystic change (FCC) |
Most common painful breast mass in women <50 years old Occurs in >50% of women in the reproductive period of life Distortion of normal cyclic breast changes Small and large cysts - Some cysts haemorrhage into the cyst fluid, called blue dome cysts - Vary in size with menstrual cycle - No malignant potential - May have to surgically remove if recurrent Fibrosis - No malignant potential Sclerosing adenosis - Proliferation of small ductules/acini in the lobule, pattern confused with infiltrating ductal cancer - Often contains micro-calcifications Ductal hyperplasia - Ducts are estrogen sensitive - Pathological findings, papillary proliferation is called papillomatosis, apocrine metaplasia refers to the presence of large, pink-staining cells, atypical duct hyperplasia increases the risk of developing cancer as it is due to excess oestrogen stimulation |
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Inflammation |
Acute mastitis Mammary duct ectasia (plasma cell mastitis) - 25% of women in menopause - Main duct fills up with debris, causing dilation, rupture and inflammation. Greenish-brown nipple discharge - May produce skin and nipple retraction simulating cancer - No increased risk for breast cancer Treatment - Antibiotics if infection present - Surgical removal of blocked duct Traumatic fat necrosis - Trauma to breast tissue - Microscopic findings, lipid-laden macrophages with foreign body giant cells. Fibrosis, dystrophic calcification. - Painless, indurated mass. (painful in acute stage) - May produce skin retraction simulating cancer Silicone breast implant - Polymer of silica, oxygen and hydrogen - Silicone gel can leak and implant can rupture, silicone produces foreign body giant cells and chronic inflammation - Associations with autoimmune disease has not been proved |
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Benign breast tumours |
Fibroadenoma Phyllodes tumour Intraductal papilloma |
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Fibroadenoma |
Most common breast tumour in women <35 years old Most commonly diagnosed breast tumour Develop in 50% of women who receive cyclosporin after renal transplant Discrete movable, painless or painful mass - Multiple lesions may be present (10-15% of cases) Benign tumour derived from the stroma - Stroma proliferates and compresses the ducts - Duct epithelium is not neoplastic Increases in size during pregnancy - oestrogen sensitive May spontaneously disappear or involute during menopause Do not progress into cancer; however breast cancer may secondarily develop within duct epithelial cells as a separate event (3% of cases) Diagnosis - Fine needle or core needle biopsy Treatment - Surgical removal - Cryoablation |
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Phyllodes tumour |
Bulky tumour derived from stromal cells Most often benign but can be malignant in some cases, hypercellular stroma with mitoses are signs of malignancy Lobulated tumour with cystic spaces containing leaf-like extensions. Often reaches a massive size. Treat by wide excision |
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Intraductal papilloma |
Most common cause of a bloody nipple discharge in women <50 years old Develops in the lactiferous ducts or sinuses No increased risk for cancer Surgically remove the duct or sinus |
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Breast cancer: overview |
Most common cancer in adult women (1:8 lifetime risk) - Mean age is 64 years old - Risk increases with age Most common breast mass in women >50 years old Slightly decreasing in incidence due to early detection and treatment Second most common cancer-producing death in women, second most common cancer-producing death in adults |
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Breast cancer: Factors increasing risk |
Two main features are: - Prolonged oestrogen stimulation - Genetically susceptible background Increased risk if breast cancer involves first generation relatives - Mother, sister Genetic basis is involved in <10% of cases - Autosomal dominant BRCA1 and BRCA2 association, breast or ovaries are frequently prophylactically removed - Li-Fraumeni multicancer syndrome, inactivation of p53 tumour suppressor gene Other gene relationships: RAS oncogene, ERBB2, RB1 suppressor gene Prolonged oestrogen stimulation - Early menarche/late menopause - Nulliparity - Postmenopausal obesity - aromatisation of androstenedione to estrone - Hormone replacement therapy - DCIS, LCIS Atypical ductal hyperplasia Endometrial cancer, ionising radiation, smoking cigarettes High breast density (determined by mammogram) Recent use of OCPs |
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Breast cancer: Factors that decrease risk |
Breast-feeding Moderate or vigorous physical training Healthy body weight |
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Breast Cancer: Clinical findings and mammography |
Clinical findings - Painless mass in breast, usually in the upper outer quadrant - Skin or nipple retraction - Painless axillary lymphadenopathy - Hepatomegaly, bone pain if metastasis has occurred Mammography - Primarily a screening test, detects non-palpable breast masses (80-90% of non-palpable masses) - Does not distinguish benign from malignant lesions - Screening usually starts at 40, earlier if patient is at high risk - Identifies micro-calcifications and and spiculated masses with or without micro-calcification (30-50% of cases). Most often occur in DCIS and sclerosing adenosis (FCC). The following pattern suggests malignancy, five or more tightly clustered microcalcifications that are punctate, micro-linear or branching |
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Types of breast cancer |
Noninvasive - Ductal carcinoma in situ - Lobular carcinoma in situ Invasive - Infiltrating ductal carcinoma - Paget disease of nipple - Medullary carcinoma - Inflammatory carcinoma - Invasive lobular carcinoma - Tubular carcinoma - Colloid (mucinous) carcinoma |
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Breast cancer: Natural history, treatment and prognosis |
Spread first by lymphatics and then a hematogenous route - Outer quadrant spreads to axillary nodes - Inner quadrant cancers spread to internal mammary nodes Extranodal metastasis - Common sites for metastasis: lungs, bone, liver, brain, ovaries - May metastasise 10-15 years after treatment - Pain in bone metastasis is relieved with radiation Staging - Extranodal metastasis has greater significance than nodal metastasis Sentinel node biopsy (initial node that drains the tumour is sampled), If negative for metastasis, the other nodes in that group are usually negative. If positive for metastasis, there is a 1/3 chance that other nodes in that group have metastases. Estrogen and progesterone receptor assays (ERA and PRA) - Most often positive in postmenopausal women - Clinical significance, confers an overall better prognosis, however, this improvement decreases as the follow-up interval increases - Candidate for antioestrogen therapy (tamoxifen, oophorectomy) Other tests performed on tissue - S phase fraction (>5% is poor prognosis) - DNA ploidy, diploid tumour is better than an aneuploid tumour - ERBB2 (HER-2NEU) oncogene status, poor prognosis if amplification or over-expression are present |
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Breast cancer: Treatment and prognosis |
High risk patients without breast cancer - Treatment with tamoxifen or raloxifene reduces risk Surgical procedures - Modified radical mastectomy (nipple/areolar complex, All breast tissue, pectoralis minor, axillary node dissection). Risk of developing winged scapula (long thoracic damage) or lymphadenopathy. - Breast conservation therapy (lumpectomy with microscopically free margins), sentinel node biopsy and breast irradiation Prognosis - Prognosis after curative therapy is dependent on tumour size, extent of nodal metastasis, pathologic grade of the tumour and systemic adjuvant chemotherapy - Patient with 1 cm tumour with no axillary node involvement has a 10-year disease free survival rate of 90% - Patient with 3 cm tumour with metastasis in 4 nodes has a 10-year disease free survival rate of 15% if no adjuvant therapy is given - Outlook for most other is somewhere in between these extremes |
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Ductal carcinoma in situ (DCIS) |
Non-palpable Patterns: cribriform (sieve-like), comedo (necrotic center) Commonly contain microcalcifications, cannot be detected by mammogram unless microcalcifications are present 1/3 eventually invade Treated with lumpectomy |
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Lobular carcinoma in situ (LCIS) |
Non-palpable; virtually aways an incidental finding in a breast biopsy for other reasons; cannot be identified by mammography. (no calcifications) Lobules are distended with bland neoplastic cells, 1/3 eventually invade, usually positive for oestrogen and progesterone receptors Increased incidence of cancer in the opposite breast (20-40% of cases) |
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Infiltrating ductal carcinoma |
Stellate morphology (gross specimen and mammogram), indurated, gray-white tumour 1/3 have amplification of the ERBB2 oncogene Gritty on cut section: induration is caused by reactive fibroplasia (desmoplasia) of the stroma of the tumour |
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Paget disease of nipple |
Extension of DCIS into the lactiferous ducts and skin of the nipple producing a rash, with or without nipple retraction Paget cells are present Palpable mass is present in 50-60% of cases |
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Medullary carcinoma |
Associated with BRCA1 mutations Bulky, soft tumour with large cells and a lymphoid infiltrate Majority are negative for oestrogen and progesterone receptors |
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Inflammatory carcinoma |
Erythematous breast with dimpling like an orange (peau d'orange) due to fixed opening of the sweat glands, which cannot expand with lymphedema Plugs of tumour blocking the lumen of dermal lymphatics cause localised lymphoedema Very poor prognosis Combination chemotherapy is followed by surgery and irradiation |
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Invasive lobular carcinoma |
Neoplastic cells are arranged linearly or in concentric circles (bull's eye appearance) in the stroma; invasive carcinoma develops in contralateral breast in 5-10% of cases |
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Tubular carcinoma |
Develops in terminal ductules Increased incidence of cancer in opposite breast (10% of cases) |
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Colloid (mucinous) carcinoma |
Usually occurs in elderly women Neoplastic cells are surrounded by extracellular mucin |
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Cervical Pap smear |
Purpose - screening test to rule out squamous dysplasia and cancer. To evaluate the hormone status of the woman. Sample sites - Vagina, exocervix, TZ Transformation zone is the site for squamous dysplasia and squamous cancer, it must be adequately sampled. The presence of metaplastic squamous cells or mucus-secreting columnar cells indicates proper sampling. Absence indicates that the smear should be repeated. Interpretation - Superficial squamous cells indicate adequate oestrogen - Intermediate squamous cells indicate adequate progesterone - Parabasal cells indicate a lack of oestrogen and progesterone - Normal, nonpregnant adult women have 70% superficial squamous cells, 30% intermediate squamous cells - Pregnant women - 100% intermediate squamous cells from progesterone effect - Elderly woman with lack of oestrogen and progesterone, atrophic smear with parabasal cells and inflammation - Woman with continuous exposure to oestrogen without progesterone, 100% superficial squamous cells. Woman may be taking oestrogen without progesterone or she has a tumour secreting oestrogen. (granulosa cell tumour of the ovary) |
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Cervical (endocervical polyp) |
Nonneoplastic polyp that protrudes from the cervical os Arises from the endocervix, not the cervix Most commonly present in perimenopausal women and mutligravida women Most commonly occurs between 30 and 50 years of age Not precancerous Pathogenesis - Inflammation, trauma and pregnancy Clinical findings - Postcoital bleeding, vaginal discharge Treatment - surgical excision |
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Cervical intraepithelial neoplasia: Causes |
Majority of cases are associated with HPV - Types 6 and 11 carry a low risk - Types 16 and 18 carry a high risk - HPV produces koilocytosis in squamous cells, clear halo with a wrinkled, pyknotic nucleus. Enlarged and hyperchromatic. Peak incidence is 35 years of age. False negative rate for detecting dysplasia on a cervical pap smear is 40%. Risk factors: - Early age of onset of sexual intercourse - Multiple, high-risk partners - High-risk types of HPV in a biopsy - Smoking, oral contraceptive pills (OCPs), immunodeficiency |
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Cervical intraepithelial neoplasia: Classification, Clinical findings, Treatment |
Classification - CIN I - Mild dysplasia involving the lower 1/3 of epithelium - CIN II - Moderate dysplasia involving the lower 2/3 of epithelium - CIN III - Severe dysplasia involving the full thickness of the the epithelium Progression from CIN I to CIN III is not inevitable - Reversal to normal is more likely in CIN I - Requires approx 10 years to progress from CIN I to CIN III - Requires approx 10 years to progress from CIN III to invasive cancer. Average age for cervical cancer is approx 45 years. Clinical findings - Dysplasia is not usually visible under the naked eye and require colposcopy. May see flat to warty condyloma acuminata. - Colposcopy findings after application of acetic acid include, white areas with punctation, mosaic pattern or abnormal vascularity Treatment - Electrocoagulation - Cryotherapy - Laser ablation - Local surgery (conization) |
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CIN morphology |
Hyperchromatic etc. |
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Cervical cancer |
Least common gynaecological cancer and least common gynaecological cancer producing mortality Higher incidence in developing countries (no easy access to healthcare) Majority are SCC (75-80% of cases) - Small cell cancer and adenocarcinoma are less common types - Cause and risk factors: Same as for CIN Cervical Pap smears have markedly reduced the incidence and mortality from cervical cancer - Pap smear detection of low-grade cervical dysplasia had a sensitivity of 70 and spec of 75% - Pap smear detection of high-grade cervical dysplasia has a sensitivity of 75% and spec of 95% Clinical findings - Abnormal vaginal bleeding (most common), usually postcoital - Malodorous discharge Cancer characteristics - Extends down into the vagina - Extends into lateral wall of cervix and vagina - Frequently infiltrates the bladder wall and obstructs the ureters, postrenal azotemia leading to renal failure is a common cause of death - Distant metastasis (e.g. lungs) Treatment of invasive cancer - Surgery, radiation or both - Chemotherapy in selected cases Prognosis - 1 and 5 year relative survival rates are 88% and 72% |
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Endometritis |
Definition: Uterine infection following delivery (vaginal/cesarean section) or abortion Rate of postpartum endometritis (1-8%) Most common genital tract infection after delivery More common in preterm deliveries Acute endometritis - Most often due to bacterial infection following delivery or miscarriage - Group B streptococcus (streptococcus agalactiae) is a common pathogen - Other pathogens: Group A strep, Staphylococcus aureus, Bacteroides fragilis, C.trachomatis, N.gonorrhoea, E.Coli Clinical findings - Fever - Uterine tenderness - Purulent or foul vaginal discharge (lochia) - Abdominal pain Treatment - Cefoxitin, ticarcillin-clavulanate, ampicillin-sulbactam Chronic endometritis Causes - Retained placenta - Gonorrhoea, IUD (Actinomyces isrealii) Key histologic finding is the presence of plasma cells. Treatment as for acute case |
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Adenomyosis |
Definition - Invagination of stratum basalis into the myometrium - Glands and stroma thicken myometrial tissue - Uterus becomes enlarged - Highest incidence occurs in women in mid to late 40s - Common finding in hysterectomy specimens Clinical findings - Menorrhagia, dysmenorrhoea, pelvic pain Definitive diagnosis with myometrial biopsy Treatment - Hysterectomy |
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Endometriosis: Overview, pathogenesis and common sites |
Definition - Functioning glands and stroma are located outside the uterus, cyclic bleeding of gland and stromal implants wherever they are located. Prevalence is highest in women with dysmenorrhoea (40-60% of cases) Average age at time of diagnosis is 25-29 years old Multifactorial inheritance has been implicated, approximately 7% occurrence rate in first degree-female relatives Pathogenesis - Reverse menses through fallopian tubes (most common), implantation of viable endometrial cells - Coelomic metaplasia - Vascular or lymphatic spread Common sites - Ovaries (most common), rectal pouch, fallopian tubes, intestine |
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Endometriosis: Clinical findings, Diagnosis and treatment |
Clinical findings - Dysmenorrhoea (most common) - Abnormal bleeding, premenstrual spotting, menorrhagia - Painful stooling during menses (bleeding implants on the rectal serosa in the pouch of douglas are stretched with stooling) - Intestinal obstruction and intestinal bleeding during menses - Increased risk for ectopic pregnancy - Infertility, dyspareunia - Enlargement of ovaries (blood-filled cysts) Diagnosis - Laparoscopy useful for diagnosis and treatment, implants have a powder burn appearance - Increased serum cancer antigen 125 (CA125), excellent sensitivity but poor specificity. More useful in excluding endometriosis when it returns negative. Treatment - Combination oral contraceptives - Progestins (medroxyprogesterone acetate) - Gonadotrophin-releasing hormone agonists - Laparoscopic removal of implants |
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Endometrial polyp |
Benign polyp that enlarges with oestrogen stimulation Does not progress to endometrial carcinoma Can protrude through cervix into vagina Clinical findings - Common cause of menorrhagia in 20-40 year old age bracket - Spotting occurs between menstrual periods or after menopause Diagnosis - Vaginal ultrasound - Dilation and curettage Treatment - Dilation and curettage - Hysteroscopy |
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Endometrial hyperplasia: Overview and risk factors |
Definition - Endometrial gland hyperplasia due to prolonged, unopposed oestrogen stimulation Risk factors - Early menarche or late menopause - Nulliparous - Obesity (increased aromatisation of androgens to estrogen in adipose) - PCOS - Anovulatory menstrual cycles - HNPCC |
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Endometrial hyperplasia: Classification, Clinical findings, diagnosis and treatment |
Simple hyperplasia - Increased number of cystically dilated glands - No glandular crowding Complex hyperplasia - Increased number of dilated glands with branching - Glandular crowding Atypical hyperplasia - Glandular crowding and dysplastic epithelium - Greatest risk for endometrial cancer Clinical findings - Menorrhagia, metorrhagia, menometorrhagia - Postmenopausal bleeding Diagnosis - Endometrial biopsy Treatment - OCPs - Medroxyprogesterone acetate - Hysterectomy if atypia is present |
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Endometrial carcinoma: Overview |
Most common gynaecological tumour Median age at onset, 60 years old Pathogenesis - Prolonged oestrogen stimulation, same risk factors as endometrial hyperplasia - OCPs decrease risk due to antioestrogen effect of progestins - Slightly increased risk for breast cancer Types of endometrial cancer - Well-differentiated adenocarcinoma, most common type made up of adenocanthoma (contains foci of benign squamous tissue (no prognostic significance) and adenosquamous carcinoma (contains foci of malignant squamous cancer (worse prognosis) - Papillary adenocarcinoma (highly aggressive cancer) Cancer characteristics - Spreads down into the endocervix - Spreads out into the uterine wall - Lungs are the most common site of metastasis Clinical findings - Postmenopausal bleeding (90% of cases) Diagnosis - Endometrial biopsy Treatment - Surgery, radiation, hormones (tamoxifen), or chemotherapy depending on stage |
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Leiomyoma (fibroids) |
Benign smooth muscle tumour Most frequently diagnosed gynecologic tumour Occurs in 20-50% of women >30 years old More common in blacks than whites Estrogen-sensitive tumours (may become larger during pregnancy) Tumour characteristics - Commonly undergo the following 1) Degeneration 2) Dystrophic calcification 3) Hyalinisation (reason for the term fibroids) Rarely transform into leiomyosarcomas (<1% of cases) Clinical findings - Menorrhagia (when located in submucosa) - Obstructive delivery - Cramping during menses - Pressure on colon (constipation) - Pressure on bladder (increasing frequency, urgency, incontinence) Diagnosis - Transabdominal or transvaginal ultrasound - MRI Treatment - Myotomy for women who want to preserve fertility - Hysterectomy |
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Ovarian tumours: Overview and risk factors |
Tumours are more likely benign if <45 years of age - Risk increases with age - Median age of presentation is 61 years of age - Incidence peaks in women in their late 70s - Approximately 60% present with advanced disease Risk factors - Nulliparity (greater number of ovulatory cycles increases risk), risk for surface-derived ovarian tumours is increased - Genetic factors - BRCA1 and BRCA2 suppressor genes, Lynch syndrome, Turner syndrome increased risk for dysgerminoma. Peutz-Jeghers syndrome, increased incidence of ovarian sex cord tumours. - History of breast cancer - Postmenopausal oestrogen therapy, obesity (increased oestrogen) - OCPs/pregnancy decrease risk for surface-derived ovarian cancers as they decrease number of ovulatory cycles |
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Classification of ovarian tumours |
Surface-derived tumours - Account for 65-70% of ovarian tumours - Derive from coelomic epithelium - Account for the greatest number of malignant ovarian tumours - Malignant tumours commonly seed the omentum Germ cell tumours - They account for 15 - 20% of ovarian tumours - Cancers are similar to those seen in the testicle - A relatively small number of germ cell tumours are malignant Sex cord-stromal tumours - Account for 3-5% of ovarian tumours - Derives from stromal cells - Some of these are hormone producing (granulosa cell tumour produces oestrogen) - Majority of these tumours are benign Metastasis - Accounts for 5% of ovarian tumous - Majority are haematogenous metastasis; seeding is less common - Common primary cancers metastasising to ovaries include mullerian origin from uterus, fallopian tubes, contralateral ovary. Extramullerian origin from breast, GI tract. Krukenberg tumour is unique in that signet ring cells and present and implicate diffuse cancer of the stomach or breast cancer as the primary site. |
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Ovarian tumour: Clinical findings |
Abdominal enlargement due to fluid (most common sign) - Malignant ascites is most often due to seeding - Signs of malignant ascites due to seeding include induration in the rectal pouch on DRE. Intestinal obstruction with colicky pain. Palpable ovarian mass in a postmenopausal woman - Ovaries should not be palpable in menopausal women because they are atrophic Malignant pleural effusion - Pleural cavity is a common site for ovarian cancer metastasis Cystic teratomas undergo torsion leading to infarction - Radiographs show calcification from bone and/or teeth Signs of hyperestrinism from oestrogen-secreting tumours - Bleeding occurs from endometrial hyperplasia/cancer - 100% superficial squamous cells are present in a cervical Pap smear Hirsutism or virilisation is associated with androgen-secreting tumours - Sertoli-Leydig cell tumour |
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Ovarian tumour: Tumour markers, Treatment and Prognosis |
Tumor markers - Cancer antigen 125 (CA125) - Only increased in surface-derived malignant tumours Treatment - Surgery, chemotherapy, occasionally radiation Prognosis - Better prognosis if <65 years old - Overall 1- and 5- year relative survival rates for ovarian cancer are 75% and 45% respectively. |
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Surface derived tumours |
Serous tumours Mucinous tumours Endometrioid Brenner tumour |
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Serous tumours |
Most common group of primary benign and malignant tumours Most common group of tumours that can be bilateral Cysts are lined by ciliated cells (similar to the fallopian tube) Serous cystadenoma: benign and most common benign ovarian tumour Serous cystadenocarcinoma: malignant. Has psammoma bodies (dystrophically calcified tumour cells) |
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Mucinous tumours |
Cysts are lined by mucus-secreting cells (similar to endocervix) Large, multiloculated tumours Seeding may produce pseudomyxoma peritonei (most common primary site for pseudomyxoma peritonei is not mucinous tumours of the ovary but mucinous tumours of the appendix) Mucinous cystadenoma: benign, may be associated with Brenner tumour Mucinous cystadenocarcinoma: Malignant |
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Endometrioid |
Malignant tumours that are commonly associated with endometrial carcinoma (15-30% of cases); tumour resembles endometrial carcinoma. Commonly bilateral |
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Brenner tumour |
Usually benign Contain Walthard cell rests (transitional-like epithelium) |
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Cystic teratoma |
Most are benign; <1% become malignant (usually squamous cancer) Most common benign germ cell tumour; contain ectodermal (e.g. hair), mesodermal (muscle), and endodermal tissues (thyroid); ectodermal differentiation (hair, sebaceous glands and teeth) is the most prominent component. Most of these derivatives are found in a nipple-like structure called Rokitansky tubercle. Immature malignant types contain mature and immature components (muscle, neuroepithelium) Struma ovarii type has functioning thyroid tissue and will take up radioactive iodine-123 |
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Dysgerminoma |
Most common malignant germ cell tumour; same histologic appearance as a seminoma of the testis. Characteristic increase in serum LDH. Associated with the streak gonads of Turner syndrome. |
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Yolk sac tumour |
Malignant tumour (similar to yolk sac tumour in males) Most common ovarian cancer in girls <4 years old; however, the average age of occurrence of the tumour is 23 years old Contain Schiller-Duval bodies (resemble yolk sac) Increased serum alpha-fetroprotein |
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Thecoma-fibroma |
Benign tumour associated with Meigs syndrome (ascites, right-sided pleural effusion); regression of effusions follows removal of tumour Commonly calcify |
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Granulosa-theca cell tumours |
Low-grade malignant tumour Feminising tumour (produces estrogen) that contains Call-Exner bodies |
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Sertoli-Leydig cell tumour |
Benign masculinising tumour (produces androgens) Pure Leydig cell tumours contain cells with crystals of Reinke Association with Peutz-Jehgers syndrome |
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Gonadoblastoma |
Malignant tumour with mixture of a germ cell tumour (dysgerminoma) and sex-cord stromal tumour Associated with abnormal sexual development in 80% of cases Commonly calcify |
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Metastasis from mullerian tumours or extramullerian tumours |
May effect one or both ovaries; usually haematogenous spread; less commonly due to seeding Mullerian origin - uterus, fallopian tubes, contralateral ovary Extra-mullerian origin - breast, GI tract |
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Krukenberg tumour |
May affect one or both ovaries Contains signet-ring from haematogenous spread of a gastric cancer (diffuse carcinoma with linitus plastica); breast cancer also metastases to the ovaries (some breast cancer variants have signet ring cells) |
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Vulval intra-epithelial neoplasia |
Dysplasia ranges from mild to carcinoma in situ (CIS) Strong association with HPV type 16 Precursor for developing SCC |
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Squamous cell carcinoma of the vulva |
Most common cancer Risk factors: - HPV type 16 - Smoking cigarettes - Immunodeficiency Affects all vulvar structures. Metastasise first to the inguinal nodes |
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Extramammary Paget Disease |
Red, crusted vulvar lesion Intraepithelial adenocarcinoma - Tumour derives from primitive epithelial progenitor cells - Malignant Paget cells contain mucin which is periodic acid-Schiff positive - Spread along the epithelium (rarely invades the dermis) |
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Non-neoplastic dermatoses of the vulva |
Lichen sclerosus - Usually occurs in postmenopausal women - Thinning of the epidermis, parchment like appearance of the skin - Small risk for developing squamous cell carcinoma (SCC) Lichen simplus chronicus - White plaque-like lesion (leukoplakia), due to squamous cell hyperplasia - Small risk for developing SCC |
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Vaginal tumours |
Rhabdomyoma Embryonal rhabdomyosarcoma Clear cell adenocarcinoma Vaginal squamous cell carcinoma |
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Rhabdomyoma |
Benign tumour (hamartoma?) of skeletal muscle Other locations are the tongue and heart (associated with tuberous sclerosis) |
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Embryonal rhabdomyosarcoma |
Most common sarcoma in girls - Malignancy of skeletal muscle (rhabdomyoblasts with striations) Occurs in girls <5 years old Necrotic, grape-like mass protrudes from the vagina |
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Clear cell adenocarcinoma of the vagina |
Occurs in women with intrauterine exposure to diethylstilboestrol, was used to prevent a threatened abortion DES inhibits mullerian differentiation, these include the fallopian tubes, uterus, cervix, upper 1/3 of vagina Vaginal adenosis - Benign remnants of mullerian glands which produces red, superficial ulcerations in the upper portion of the vagina - Precursor lesion for clear cell adenocarcinoma Risk for developing cancer is small (1/1000) Cancer involves the upper vagina Other DES abnormalities - Abnormally shaped uterus that thwarts implantation - Cervical incompetence, common cause of recurrent abortions |
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Vaginal squamous cell carcinoma |
Primary SCC is associated with HPV 16 Most cancers are an extension of a cervical SCC into the vagina Primary cancers metastasise to the inguinal lymph nodes |
