Tumor Genital Wanita

8/17/2019 Tumor Genital Wanita

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TUMOR GENITAL WANITATUMOR GENITAL WANITA


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FEMALE REPRODUCTIVE SYSTEM


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Condyloma acuminatum (VIN)Condyloma acuminatum (VIN)

Numerous condyloms enc!rcl!n" #$e !n#ro!#us


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Venereal warts

%condylom cum!n#um&


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Flat condyloma %u#er!ne cer'!(&


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CondylomCondylom


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Acn#os!s) $y*er+er#os!s) nd

cy#o*lsm!c 'cuol!,#!on %+o!locy#os!s&


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VINVIN

-D!..use cellulr #y*!-Nucler cro/d!n"-P#$olo"!c m!#os!s


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PAGET0S DISEASE o. #$e VULVAPAGET0S DISEASE o. #$e VULVA


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EXTRAMAMMARY PAGET’S DISEASEEXTRAMAMMARY PAGET’S DISEASE


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PAGET0S DISEASE o. #$e VULVAPAGET0S DISEASE o. #$e VULVA


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S1UAMOUS CELL CAS1UAMOUS CELL CA


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CLEAR CELL ADENOCACLEAR CELL ADENOCA


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SARCOMA 2OTRYIOIDESSARCOMA 2OTRYIOIDES(embryonal rhabdomyosarcoma)(embryonal rhabdomyosarcoma)


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SARCOMA 2OTRYOIDESSARCOMA 2OTRYOIDES


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CERVI3CERVI3


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ANATOMY ANATOMY


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CERVIXCERVIX

Col*osco*y4 do##ed l!ne !s

#rns.orm#!on ,one

Pos#5meno*usl cer'!(


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ANATOMY (TRANSFORMATION ZONE)ANATOMY (TRANSFORMATION ZONE)


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ANATOMY ANATOMY

(TRANSFORMATION(TRANSFORMATIONZONE)ZONE)


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ANATOMY (TRANSFORMATIONANATOMY (TRANSFORMATION

ZONE)ZONE)


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Cervcal e!t"elal cells

(P*n!colou smer&


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Cer'!c!#!s 5 me#*ls!Cer'!c!#!s 5 me#*ls!


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S1UAMOUS METAPLASIAS1UAMOUS METAPLASIA


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ENDOCERVICAL POLYPENDOCERVICAL POLYP


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POLYPPOLYP


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Crc!nom4 *#$o*$ys!olo"yCrc!nom4 *#$o*$ys!olo"y


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EXPOSURE TO HPVEXPOSURE TO HPV

C ! #$ $ ! lC ! #$ $ ! l


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Spectrum of CINSpectrum of CIN

Cervical Intraepithelial Neoplasia (CIN)


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Cytolo#y$ normalCytolo#y$ normal CIN IIICIN III


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In S!#u 6 In's!'e C o. #$e Cer'!(In S!#u 6 In's!'e C o. #$e Cer'!(


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In's!'e C o. Cer'!(In's!'e C o. Cer'!(


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CIN IIICIN III


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CIN III /!#$ m!cro5!n's!onCIN III /!#$ m!cro5!n's!on


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SCCSCC


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MICROINVASIVE SCCMICROINVASIVE SCC


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SCCSCC


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SCC) +er#!n!,edSCC) +er#!n!,ed


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SCCSCC


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S#"!n"S#"!n"

S#"e 7S#"e 7 Carcinoma in situCarcinoma in situ S#"e IS#"e I Microinvasive and confned to cervixMicroinvasive and confned to cervix

S#"e I8S#"e I8 Invasive and confned to cervix Invasive and confned to cervix

S#"e IIS#"e II Extends to upper vagina but not to para-Extends to upper vagina but not to para-

metriummetrium

S#"e II8S#"e II8 Involve parametrium Involve parametrium

S#"e IIIS#"e III Extension to pelvis sidewall or lower vagina Extension to pelvis sidewall or lower vagina

S#"e IVS#"e IV Beyond the pelvis or involvement o rectal orBeyond the pelvis or involvement o rectal or

bladder mucosabladder mucosa


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U T E R U S


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ENDOMETRIAL HYPERPLASIAENDOMETRIAL HYPERPLASIA


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S!m*le9S/!ss c$eese

A#y*!cl $y*er*ls!

Com*le( $y*er*ls!

S:umous me#*ls!


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II.II.

ENDMETRIA!ENDMETRIA!

G!AND"!ARG!AND"!ART"MRST"MRS

Endome-Endome-

trioidtrioid

Carcino-Carcino-mama

Rel#!ons mon" *rol!.er#!on

$y*er*ls!) #y*!cl $y*er5

*ls!) nd endome#r!l C;

IVIV


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IV.IV.

ENDOMETRIAL POLYPSENDOMETRIAL POLYPS

5O.#en *eduncul#ed) my 8e sol!#ry

or mul#!*le

5Commonly com*osed o. $y*er*ls#!c

endome#r!um /!#$ cys#!clly d!l#ed

"lnds) cellulr s#rom) nd #$!c+

/lled 'essels

5My cuse !n#erm!##en# 8leed!n")


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Endome#r!l Poly*Endome#r!l Poly*

A s!n"le *oly* e(#en# !n#o endome#r!l

c'!#y; T$e necro#!c %rro/& #!* !s res5

*ons!8le .or cl!n!cl 8leed!n";

Sl!"$#ly d!l#ed endome#r!l

"lnds em8edded !n mr+edly

.!8rous s#rom;

Ad ! . #$ E d # !Ad ! . #$ E d # !


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Adenocrc!nom o. #$e Endome#r!um Adenocrc!nom o. #$e Endome#r!um


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Histological radingHistological rading

II ENDMETRIA! G!AND"!AR T"MRS


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II. ENDMETRIA! G!AND"!AR T"MRSII. ENDMETRIA! G!AND"!AR T"MRS

Endometrioid CarcinomaEndometrioid Carcinoma


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Endome#r!o!d denoc > s:umous d!..eren#!#!on %/ellEndome#r!o!d denoc > s:umous d!..eren#!#!on %/ell

d!..eren#!#ed&d!..eren#!#ed& A%ENOACANT&OMAA%ENOACANT&OMA

Vr!n#s o. endome#r!l denocrc!nom4Vr!n#s o. endome#r!l denocrc!nom4


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Vr!n#s o. endome#r!l denocrc!nom4Vr!n#s o. endome#r!l denocrc!nom4

Serous denocrc!nom Cler cell denocrc!nomSerous denocrc!nom Cler cell denocrc!nom

E d t i l St l SE d t i l St l S


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Endometrial Stromal SarcomaEndometrial Stromal Sarcoma

The myometrium is irregularly invaded y the tumor!"hich displays a rich vascular net"or#$

A S


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MYMETRIA! T"MRSMYMETRIA! T"MRS

POSSI!LE LOCATION O" LEIOMYOMAPOSSI!LE LOCATION O" LEIOMYOMA


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POSSI!LE LOCATION O" LEIOMYOMAPOSSI!LE LOCATION O" LEIOMYOMA


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LEIOMYOMALEIOMYOMA

A; Well demrc#ed /$!#e **ernce mss 8ul"!n" !n#o #$e u#er!ne c'!#y2; Well d!..eren#!#ed s*!ndle s$*ed cells !n !n#erlc!n" 8undles


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!EIMYSARCMA!EIMYSARCMA

A; Lr"e $emorr$"!c #umor mss d!s#ends #o #$e lo/er cor*us nd .ln+ed8y #/o le!omyoms

2; T$e #umor cells re !rre"ulr !n s!,e 6 s$*e) /!#$ $y*erc$rom#!c nucle!


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LEIOMYOSARCOMALEIOMYOSARCOMA

Le!omyom

Le!omyosrcom

M!#os!s


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Necross$ u#er!ne srcom


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ECTOPIC PRENANCYECTOPIC PRENANCY

5 Mos# ec#o*!c *re"nnc!es !n'ol'e #$e .llo*!n #u8e %?7=&5 Pred!s*os!n" .c#ors !nclude #$# !n$!8!# #u8l #rns*or#4 c$ron!c sl*!n"!#!s)

*er!#u8l d$es!on) lr"e cys#) #umors) e#c;5 A.#er @5 /ee+s "ro/!n" ru*#ure $em#osl*!n( %!n #u8e&) B@ /ee+s !n

!s#$mus


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ECTOPIC PRENANCYECTOPIC PRENANCY


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GESTATIONAL TROPHOBLASTIC DISEASEGESTATIONAL TROPHOBLASTIC DISEASE

A; Com*le#e yd#!d!.orm Mole A; Com*le#e yd#!d!.orm Mole

- content all of hydropic villi- content all of hydropic villi

- etiology: lost or inactivation of maternal chromosome in the fertilized egg- etiology: lost or inactivation of maternal chromosome in the fertilized egg

- bleeding and high hCG level in the urine- bleeding and high hCG level in the urine

2; Incom*le#e %Pr#!l& Mole2; Incom*le#e %Pr#!l& Mole

- admixture of normal and hydropic villi- admixture of normal and hydropic villi

C; In's!'e Mole %c$or!odenom des#ruen&C; In's!'e Mole %c$or!odenom des#ruen&

- invasion of molar villi trophobastic tissue into ! through myometrium- invasion of molar villi trophobastic tissue into ! through myometrium

D; C$or!ocrc!nomD; C$or!ocrc!nom

- arise from normal pregnancy "#$%& and abnormal pregnancy "'$%- arise from normal pregnancy "#$%& and abnormal pregnancy "'$% hydatidiform mole&hydatidiform mole&

-very high level of urine hCG-very high level of urine hCG

. 6F #!l! #! ## . # 6 #! l l


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Fer#!l!,#!on *##ern o. com*e#e 6 *r#!l moleFer#!l!,#!on *##ern o. com*e#e 6 *r#!l mole


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Tr!lody$ *r#!l $yd#!.orm mole


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YDATIDIFORM MOLEYDATIDIFORM MOLE

Numerous s/ollen '!ll! %$ydro*!c de"ener#!on&



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%E& ( 7



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Pr#!l mole Com*le#e mole

Norml5loo+!n"

'!ll!

INVASIVE MOLEINVASIVE MOLE


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INVASIVE MOLEINVASIVE MOLE

T$e mole !n'de !n#o myome#r!um


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CORIOCARCINOMACORIOCARCINOMA

'&C$ c$or!ocrc!nom


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&C$ c$or!ocrc!nom

%I& ( @77


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O#ARYO#ARYNON-NEOPLASTICNON-NEOPLASTIC

O#ARIAN ENLARMENTO#ARIAN ENLARMENT

NEOPLASTICNEOPLASTIC O#ARIANO#ARIAN

ENLAREMENTENLAREMENT $%&' are$%&' are(enign)(enign)

NON-NEOPLASTICNON-NEOPLASTIC


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O#ARIAN ENLARMENTO#ARIAN ENLARMENT

() *Germinal+ ,nclusion Cyst() *Germinal+ ,nclusion Cyst- common cyst in pre-menopausal period result of do.n gro.th- common cyst in pre-menopausal period result of do.n gro.th

and entrapment of the surface epithelium into the ovarian cortexand entrapment of the surface epithelium into the ovarian cortex

/) Physiologic or 0unctional Cyst/) Physiologic or 0unctional Cyst

- follicle cyst- follicle cyst- corpus luteum cyst- corpus luteum cyst

- theca lutein cyst- theca lutein cyst

C) Polycystic ovariesC) Polycystic ovaries

1) 2tromal 3yperplasia1) 2tromal 3yperplasia stromal hyperthecosisstromal hyperthecosis

"OLLICLE CYST"OLLICLE CYST


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"OLLICLE CYST"OLLICLE CYSTO" THE O#ARYO" THE O#ARY

T*e r+,t+re o t*e t*in .alled ollic+lar c/st led to a(dominal *emorr*age

%&'CSTIC &VRIES%&'CSTIC &VRIES


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*+ilateral and multiple cyst! as one of the more common cause ofinfertility! dulu diseut sindroma Stein*'eventhal! ditemu#an

pada ,*-. "anita usia reprodu#si

*'ined y granulosa*theca cells (may e luteini/ed 0 androgen secreting)*Symptom1 varies from hyperestrinism (anormal leeding) to virili/ation (amenorrhea! hirsutism)

POLYCYSTIC O#ARIESPOLYCYSTIC O#ARIES


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POLYCYSTIC O#ARIESPOLYCYSTIC O#ARIES$,ol/c/stic disease o t*e o0ar/)$,ol/c/stic disease o t*e o0ar/)

Cut section of the ovary sho" numerous cysts emedded in sclerotic stroma

Pat*ogenesisPat*ogenesis

Polycys#!c O'ry SyndromePolycys#!c O'ry Syndrome


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Polycys#!c O'ry SyndromePolycys#!c O'ry Syndrome

Stromal H/,ert*ecosisStromal H/,ert*ecosis


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Stromal H/,ert*ecosisStromal H/,ert*ecosis

2ocal luteini/ation of ovarian stromal cells nest of luteini/edstromal cells often functional virili/ation

NEOPLASTIC O#ARIAN ENLAREMENTNEOPLASTIC O#ARIAN ENLAREMENT


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$1)$1)

() 456O72 187,981 07O6 2570(C8 "G876,(L& 8P,438L,56() 456O72 187,981 07O6 2570(C8 "G876,(L& 8P,438L,56

1.1. 2erous 4umors2erous 4umors

a. Serous cystadenomaa. Serous cystadenoma

b. Serous cystadenocarcinoma b. Serous cystadenocarcinoma

c. Serous borderline tumor c. Serous borderline tumor

2.2. 6ucinous 4umors6ucinous 4umors

a. Mucinous cystadenomaa. Mucinous cystadenoma

b. Mucinous cystadenocarcinoma b. Mucinous cystadenocarcinoma

c. Mucinous borderline tumor c. Mucinous borderline tumor ;) 8ndometrioid 4umors;) 8ndometrioid 4umors


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o0arian e,it*elial-stromal t+morso0arian e,it*elial-stromal t+mors

Serous TumorSerous Tumor


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Serous Tumor

Serous e*!#$el!l #umor "ro/#$ .rom #$e sur.ce o. #$e o'ry

S # d . #$S # d . #$


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Serous cys#denom o. #$e o'rySerous cys#denom o. #$e o'ry

u"e un!loculr #umor T$e cys# !s l!ned 8y s!n"le lyeredcyl!#ed #u8l5#y*e e*!#$el!um

Muc!nous Cys#denomMuc!nous Cys#denom


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yy

Muc!nous cys#denom /!#$ mul#!cys#!c Columnr cell l!n!n"

Muc!nous Cys#denom o. #$e O'ryMuc!nous Cys#denom o. #$e O'ry


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Muc!nous Cys#denom o. #$e O'ryMuc!nous Cys#denom o. #$e O'ry

Numerous cys#s .!lled /!#$ #$!c+)V!scous .lu!d

A s!n"le lyer o. muc!nous e*!#$el!lcells l!nes #$ cys#

S # . 8 d l! l!S # . 8 d l! l!


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Serous #umor o. 8orderl!ne ml!"nncySerous #umor o. 8orderl!ne ml!"nncy

/orderline 2erous Cystadenoma Cystadenocarcinoma/orderline 2erous Cystadenoma Cystadenocarcinoma


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/orderline 2erous Cystadenoma Cystadenocarcinoma/orderline 2erous Cystadenoma Cystadenocarcinoma

Del!c#e **!llry #umor "ro/#$ Lr"e) 8ul+y #umor mss

/orderline 2erous Cystadenoma/orderline 2erous Cystadenoma


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Incresed rc$!#ec#url com*le(!#y nd e*!#$el!l cell s#r#!.!c#!on

S # d !Serous cys#denocrc!nom


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Serous cys#denocrc!nomSerous cys#denocrc!nom


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!renner T+mor!renner T+mor


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2renner #umor 2en!"n cys#!c #er#om

C$rc#er!s#!c e*!#$el!l nes# /!#$!n o'r!l s#rom

Tumor 3ina# pada eragai umur! separo timul pada umur 4 56 th$Nama lain1 tumor sel transisional

2renner #umor2renner #umor


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2renner #umor 2renner #umor


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$2)$2)

!3 TUMORS DERI#ED "ROM SE4!3 TUMORS DERI#ED "ROM SE4CORD5STROMACORD5STROMA

B; Grnulos5T$ec Cell TumorsB; Grnulos5T$ec Cell Tumors

@; F!8rom@; F!8rom


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ran+losa cell t+morran+losa cell t+mor

%enampang melintang menun3u##an tumor solid dengan perdarahan$+agian #uning menun3u##an #elompo# sel*sel granulosa erlipid$

7amaran mi#ros#opi# entu# foli#ular spesifi# (Call*E8ner odies)$

l C ll Tran+losa Cell T+mor


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ran+losa Cell T+morran+losa Cell T+mor

The tumor cells are arranged in sheets punctuated ysmall follicle*li#e structures (Call*E8ner odies)


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F!8rom 55 .!8ro#$ecomF!8rom 55 .!8ro#$ecom

*9ost (:6.) are unilateral! solid! round! firm! "hite masses 5*;6 cm in si/e*Some time a thecal component may e present firothecoma*


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Sertoli Le/dig cell t+mor/ g

Immature solid tuules of emryonic Sertoli cells are ad3acent to clustersof aleydig cells that e8hiit aundant eosinophilic cytoplasm$

Ser#ol! Cell TumorSer#ol! Cell Tumor


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Ser#ol! Cell Tumor Ser#ol! Cell Tumor

Well d!..eren#!#ed Ser#ol! cell #u8ulesGolden yello/ **ernces o. #$e #umor

cu# sur.ce;

F!8rom o'r!!F!8rom o'r!!


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Me!" syndrome



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$6)$6)

C3 TUMORS DERI#ED "ROM ERM CELLSC3 TUMORS DERI#ED "ROM ERM CELLS

B; Ter#omB; Ter#om

5 M#ure Cys#!c Ter#om5 M#ure Cys#!c Ter#om

5 Imm#ure %Ml!"nn#& Ter#om5 Imm#ure %Ml!"nn#& Ter#om@; Dys"erm!nom@; Dys"erm!nom


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t+mors o germ cell origint+mors o germ cell origin

%ermod cyst


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%ermod cyst

Mat+re C/stic TeratomaMat+re C/stic Teratoma

$dermoid c/st)$dermoid c/st)


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$dermoid c/st)$dermoid c/st)

!r !n#erm!n"led /!#$

8u##er5l!+e su8s#nce

A m!(#ure o. #!ssues

2r!n #!ssue !s lyered 8y

s+!n #!ssue

Mat+re c/stic teratomaMat+re c/stic teratoma


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Mat+re c/stic teratomaMat+re c/stic teratoma

Matre teratoma


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%E& ( @

Immat+re teratomaImmat+re teratoma


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Immat+re teratomaImmat+re teratoma

Imm#ure neurl #!ssue e($!8!# rosse##e %R & /!#$ mul#!lyered nucle!

Em8ryonl "l! %G& d!s*ly densely *c+ed #y*!cl nucle!

Immatre teratoma

% &


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%E& ( @

I T


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Immat+re TeratomaImmat+re Teratoma

Pr!m!#!'e

neuroe*!#$el!um


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Yol7-sac CarcinomaYol7-sac Carcinoma

Sc$!ller5Du'l 8od!es

Yol7 sac carcinomaYol7 sac carcinoma


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Tumor cells are arrayed in reticular patternSchiller*?uval odies1 papilla protruding into the lumen lined y tumor cells

D/sgerminoma o0ariiD/sgerminoma o0arii


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%olyhedral tumor cells "ith central round nuclei and ad3acent inflammation$The neoplastic cells have clear! glycogen filled cytoplasm$

DYSGERMINOMA 7VARIIDYSGERMINOMA 7VARII


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DYSGERMINOMA 7VARIIDYSGERMINOMA 7VARII

Metastatic T+morsMetastatic T+mors

8r+7en(erg t+mor8r+7en(erg t+mor


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8r+7en(erg t+mor8r+7en(erg t+mor

The ovary is enlarged and partially hemorrhagic$ microscopic section reveals mucinous (signet*ring) cells

infiltrating the ovary

Pse+dom/9oma PeritoneiPse+dom/9oma Peritonei$$ rom a,,endi9)rom a,,endi9)


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&varian tumor "ith e8tensive mucinous ascites! cystic epithelial implantson the peritoneal surfaces! and adhesions intestinal ostruction 0 death

O#ARYO#ARY


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Tumor Genital Wanita