Neoplasma

SISTEM REPRODUKSI

UTERUS

TUBA

OVARIUM

Endometrial hyperplasia

Common.

Most peri- and post-menopausal. Women in the reproductive years usually develop a lesion in association with anovulatory cycles.

Usually present with abnormal bleeding, often related to unopposed estrogenic stimulation either due to anovulation or exogenous unopposed estrogen usage.

Simple hyperplasia, glands are cystically dilated, with occasional outpouchings surrounded by abundant cellular stroma. Sometimes glands are only minimally dilated but focally crowded. Cells lining glands are pseudostratified and columnar and cytologic atypia is absent.

Complex hyperplasia, composed of crowded glands with little intervening stroma. Back-to-back glands with papillary intraluminal infoldings are characteristic. Usually gland outlines are highly complex but can be tubular. Epithelial stratification is usually prominent. Cytologic atypia is absent.

BEHAVIOR

Less than 2% progress to carcinoma

ADENOCARCINOMA Most common invasive cancer of the female genial

tract

55 – 65 years PTEN tumor suppressor gene have been identified in 30% - 80%

Gross localized polipoid tumor or diffuse tumor involving the endometrial surface

Spread direct myometrium – perimetrium

Via lymph node

Endometrioid endometrial adenocarcinoma

ADENOCARCINOMA

Endometrial adenocarcinoma of endometrioid type with squamous metaplasia

LEIOMYOMA

very common.

Reproductive years, with a mean of 42 years.

Abnormal vaginal bleeding, lower abdominal pain, abdominal or pelvic mass.

Spherical, circumscribed, firm, whorled, white-tan mass

Ordinary leiomyoma has whorled, anastomosing fascicles of uniform smooth muscle cells with no atypia or necrosis and usually minimal mitotic activity (less than 5 mitotic figures/10 HPF). Variants of leiomyoma include epithelioid, myxoid, cellular, symplastic (hyperchromatic, degenerative nuclei in focal areas), and mitotically active (5-10 mitotic figures/10 HPF). See related lesion entry for Atypical leiomyoma.

LEIOMYOSARCOMA

1.3% of uterine malignancies.

Mean age of 52 years.

Compared to leiomyomas, tumors are softer, fleshy, gray-yellow, usually solitary, with irregular margins, and sometimes with hemorrhage and necrosis.

Diffuse, significant atypia, increased mitotic activity (greater than 10 mitotic figures/10 HPF), and coagulative tumor cell necrosis (any two features together are diagnostic).

Malignant.

Dermoid cyst. Most common ovarian teratoma, as well as the most

common ovarian germ cell neoplasm.

Occurs most commonly during the reproductive years, though has a wide age range.

Usually unilateral, though 8% - 15% are bilateral.

Usually presents as pelvic mass or is detected on radiologic examination of the abdomen.

Typically has a smooth surface and is cystic. Cut section demonstrates greasy yellow sebaceous material and hair. Often there is a thickening of the cyst wall (Rokitansky's protuberance) from which hair and sometimes teeth and bone arise. It is not common for a mature teratoma to be entirely solid (mature solid teratoma).

Mucinous carcinoma of ovary Mucinous adenocarcinoma

Accounts for 5% - 10% of malignant primary ovarian neoplasms, and 5% - 10% of ovarian mucinous tumors.

Usually 40's to 70's.

Usually unilateral.

Typically cystic multiloculated tumor with occasional solid areas and nodules.

Invasive type shows an irregular, infiltrative proliferation of mucinous type glands with a surrounding stromal reaction. Non-invasive type shows florid papillary and glandular epithelial proliferation with back-to-back crowding and areas that resemble atypically proliferating tumors. Microinvasion is manifested as small areas showing clusters of cells in a desmoplastic stroma.

BEHAVIOR

5-year survival rate is approximately 40% for all stages.

Mucinous adenoma

Mucinous adenoma

Micropapillary serous carcinoma.

Serous tumors are the most common surface epithelial neoplasms of the ovary, accounting for 25% of all benign ovarian neoplasms and 50% - 70% of all ovarian serous tumors.

Usually between 45-65 years of age.

Bilateral in approximately 2/3 of cases of all stages, and 1/3 of cases in Stage I.

Tumors can be cystic and multilocular with papillary excresences or can also be solid and firm without papillary structures.

Serous carcinoma has all tumors showing evidence of stromal invasion. Well differentiated tumors usually have a papillary architecture whereas moderately and poorly differentiated tumors become more solid. Nuclear atypia is variable but greater than in atypically proliferating tumors. Psammoma bodies are often found in well differentiated tumors.

BEHAVIOR

Malignant. Prognosis related to stage and degree of differentiation.

Serous adenoma

MOLA HYDATIDOSA

Hydrophic villi.

Early abortus.

Most frequent form of molar pregnancy. Incidence varies widely throughout the world. Incidence rate in the United States and Europe is between 1 in 1,000 and 1 in 2,000 pregnancies.

Reproductive age. Women over the age of 30 and especially those over 40 years are at increased risk.

Uterine cavity.

Typically develops between the 11th and 25th weeks of pregnancy. Often with vaginal bleeding or excessive uterine enlargement for the gestational age. Serum HCG levels are typically markedly elevated.

Villi are markedly enlarged and edematous, giving them a grape-like appearance.

Villi are edematous and enlarged. Many villi display central cistern formation characterized by a prominent central space that is entirely acellular. Trophoblastic proliferation is variable. Villi are usually avascular.

Choriocarcinoma Most cases appear to follow a recognizable gestational

event. 50% are preceded by a hydatidiform mole, 25% follow abortion, 22.5% follow normal pregnancy, and 2.5% follow ectopic pregnancy. May present with metastatic disease.

Hemorrhagic. Usually located within the endometrial cavity and myometrium.

Sheets of trophoblastic cells without chronic villi that invade surrounding tissues and permeate vascular spaces. Hemorrhage and necrosis are typical. Composed of a mixture of cytotrophoblast, intermediate trophoblast, and syncytiotrophoblast. Cytotrophoblast consists of polygonal cells with distinct cell membranes and clear cytoplasm, with round nuclei with prominent nucleoli. Syncytiotrophoblast consists of multinucleated tumor cells with eosinophilic to basophilic cytoplasm. Intermediate trophoblast is similar to cytotrophoblast but has larger more atypical nuclei.

TUGAS 1. Jelaskan tumor jinak dan ganas dari unsur otot polos

pada uterus!

2. Jelaskan tumor jinak dan ganas pada ovarium (dibuat berdasarkan asal sel tumor )!