DISEASES OF THE FEMALE

GENITAL TRACT AND BREAST

Section 13
Case 1. MATURE CYSTIC TERATOMA,
Ovary
• 25 year old female
• Complaint: Gradual abdominal enlargement
• PE: palpable right adnexal mass
• Ultrasound: solid cystic mass with teeth and bone-like structures
• Underwent salpingoophorectomy
• Gross:
– Cyst measured 10 cm
– Smooth grayish white surface
– Upon opening: filled with cream yellow amorphous greasy material admixed with hair
– Protuberant mass was noted along the inner wall with fat, teeth and bone-like structures
• Microscopically:
– Cyst wall was composed of ovarian stroma
– Lined by stratified squamous epithelium with dermal appendages
– Other areas: fat, smooth muscle, blood vessels, cartilage, and glandular tissues

Note: Please refer to your atlas or other references for clearer image and distinction of parts.
MATURE CYSTIC TERATOMA, Ovary

LPO
MATURE CYSTIC TERATOMA, Ovary

HPO
Case 2. ECTOPIC TUBAL PREGNANCY
• 30 year old female
• Sudden left lower quadrant 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 with hemoperitoneum amounting to 1
liter
• Left fallopian tube:
– edematous and hemorrhagic with friable blood clots
– contained cream white soft to spongy placental tissues upon sectioning
• Microscopic exam:
– Placental tissues along the tubal mucosa partially obscured by blood clots
– Immature villi with loose central stromal tissue containing a few blood vessels and surrounded
by trophoblasts
– Numerous acute inflammatory cells and red blood cells within lumen and wall of fallopian tube
ECTOPIC TUBAL PREGNANCY

Chorionic
Villi

RBCs
Muscular
wall

LPO
ECTOPIC TUBAL PREGNANCY

Trophoblasts

HPO
LPO
Case 3. HYDATIDIFORM MOLE
• 25 year old G4P3
• History of abortion five months ago and was amenorrheic since then
• Abdomen enlarged to 5 months gestational age
• Profuse vaginal bleeding
• Passed out a mass of grape-like structures
• PE: enlarged uterus with no palpable fetus
• Urine and blood levels of HCG markedly elevated
• Specimen: consisted of multiple vesicles, admixed with soft hemorrhagic tissues
amounting to 5cm in aggregate diameter
• Microscopically:
– Large and distended chorionic villi without blood vessels
– Central of villi composed of loose myxomatous stroma covered by chorionic
cilli, chorionic epithelium, cytotrophoblasts and syncitial trophoblasts
HYDATIDIFORM MOLE

Chorionic Villi

Avascular Stroma
Trophoblasts

LPO
Case 4. SEROUS CYSTADENOMA,
Ovary
• 30 year old nulligravid female
• Complaint: vague abdominal pain and gradual abdominal
enlargement 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
– with smooth pinkish cream surface with prominent vascular
markings
– Uniloculated and filled with clear light yellow serous fluid
– Smooth and glistening internal surface
– No solid nodules or papillary masses
• Microscopic exam: benign cuboidal to columnar epithelium
(some ciliated) lining the cyst
SEROUS CYSTADENOMA

LPO
SEROUS CYSTADENOMA

Lining
epithelium
Cyst wall

HPO
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 with several brown to bluish colored cysts
containing semi-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 with abundant granular eosinophilic
cytoplasm with small round deeply chromatic nuclei
– Stroma composed of fibrous tissue infiltrated with lymphocytes
FIBROCYSTIC CHANGES OF THE BREAST
LPO
FIBROCYSTIC CHANGES OF THE BREAST

Lining
epithelium

Cystic ducts

Stroma
HPO
Case 6. FIBROADENOMA
• 30 year old female
• Movable left breast mass of 2 mos. duration
• Mass: 4cm; firm; slightly tender; movable
• Gross:
– mass was well-circumscribed, lobulated with rubbery consistency
– 4x3x3cm
– Cut sections: yellowish white slightly bulging surfaces with several slit-like
spaces
• Microscopically:
– Glandular and 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
FIBROADENOMA

Fibroblastic stroma

LPO
FIBROADENOMA

Glandular and
cystic spaces

HPO
Case 7. INVASIVE DUCTAL CARCINOMA
• 60 year old female
• Non-healing left breast ulcer
• Began two years ago as a small firm non-tender, fixed nodule in the left upper outer quadrant
• PE: 3cm superficial ulcer with erythematous skin ulcer with an underlying palpable fixed mass
below the nipple
• Underwent radical mastectomy with lymph node dissection
• Gross exam:
– 4cm fairly circumscribed hard reddish cream mass beneath ulcer
– Had gritty solid cut surface with small pinpoint foci of chalk white necrotic mass
• Microscopically: Tumor
– composed of irregular nests and cords of polyhedral cells with hyperchromatic 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
INVASIVE DUCTAL CARCINOMA

Fatty
tissue

Stroma

Malignant
LPO
glandular cells
INVASIVE DUCTAL CARCINOMA

Malignant
glandular
cells

HPO