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What is this?
Normal breast tissue
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What is this?
Normal breast nodule
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What is fibrocystic change in the breast? Why is it important for physicians to recognize it? Is the process usually unilateral or bilateral? What changes are associated with it histologically?
- Fibrocystic change: a lumpy bumpy breast on palpation (clinician), a desne breast with cysts (radiologist), and benign histological findings (pathologist); three main morphological changes are cystic change, fibrosis, and adenosisImportant because: it can simulate or obscure clinical, radiographic, gross, and microscopic appearances of breast carcinoma
- Most commonly seen in women between ages 25-50
- Although hormones play a role in its development, the pathogenesis is unclear
- Process is usually bilateral
- Histological changes: cyst formation (from small and large ducts), apocrine metaplasia in some cysts, stromal fibrosis, epithelial hyperplasia in many of the ducts, and microcalcifications (what often prompts biopsy)
- Note that microcalcifications can be seen in breast carcinomaa
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What is this? What can you see in the low power? What can you see in the high power?
- Fibrocystic change in breast
- Low power: cysts and dense fibrous tissue (dense pink strips)
- High power: columnar cells with dark pink cytoplasm and bulbous extensions (called apical snouts) lining the cysts; this is apocrine metaplasia and has no real significance
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From what two sources are breast neoplasms derived?
1. Stromal elements (fibroadenomas)2. Epithelial elements of terminal duct lobular unit (TDLU)
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Examples of fibrocystic change in breast
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What is this? Is it benign or malignant? How is it usually dx?
- Breast fibroadenoma: Focal proliferation of glandular and stromal elements that results in a circumscribed, firm nodule of tissue within the breast
- Benign: the most common benign tumor of the breast, seen in 10% of women usually ages 20-30
- Dx: via breast exam because of their firm, mobile circumscribed nature
- Note that the tumor is sharply circumscribed from surrounding tissue and is composed of an overgrowth of spindle shaped cells and collagen of the stroma; the enclosed ducts and alveoli appear stretched becauase of this overgrowth
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What is this?
Breast fibroadenoma (benign)
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What is this?
Breast fibroadenoma (benign)
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What is this?
Breast fibroadenoma (benign)
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Breast fibroadenoma (benign)
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What is this? What is desmoplasia? How are these tumors graded?
- Invasive ductal carcinoma of the breast: tumor is composed of irregular clusters of cells that are infiltrating the stroma
- Desmoplasia: When the tumor induces the surrounding stroma to become very dense and firm
- Close up of the tumor shows malignant cells with large, irregular nuclei, prominent nucleoli, and scant cytoplasm; there is no evidence of a basal membrane
- Tumor grading based on three features: 1) tubule formation 2) mitotic activity 3) nuclear pleomorphism
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What is this? What can you see here?
- Lymph node with metastatic breast carcinoma
- Notable: dark blue, small lymphocytes forming a sheet in part of the tissue and the metastatic carcinoma in the LN (solid pink clusters)
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What is this?
Metastatic breast cancer in lymphatic space
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What is this?
Invasive ductal carcinoma of the breast (malignant)
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What is this?
Invasive ductal carcinoma of the breast (malignant)
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What is this?
Invasive ductal carcinoma of the breast (malignant)
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What is this?
Metastatic breast carcinoma in lymph node
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What are germ cell tumors? In what age group are they most common? How are they divided? How do they arise? What is a pure vs mixed tumor? Do these tumors needed to be tx? How do testicular tumors present? What type of testis is at particular risk for developing a tumor?
- Germ cell tumor: most common malignant tumor of young men between 15-34
- Divided into two groups based on incidence and response to therapy: Seminoma and Non-seminomatous Germ Cell Tumors (NSGCT)
- Arise from: germinal epithelium (spermatogonia) but differentiate along embryonic cell lines
- Pure tumors: of one particular cell type
- Mixed tumors: of more than one cell type; more frequence than pure
- Tx?: Yes, because these tumors are aggressive, lymphadenectomy, radiation, and chemotherapy are required
- Presentation: painless mass that may grow slowly or astonishingly rapid
- Risk: cryptochid testis
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What is a Seminoma? Are they radiosensitive? What is the female counterpart?
Seminoma: account for 30-40% of testicular tumors and are a tumor of undifferentiated germ cellsAre exquisitely radiosensitive and respond to radation therapyFemale counterpart: dysgerminoma (fried egg cell appearance and lymphocyte infiltration)
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What is this? What features here are important? What are they indicating? What is composing the tumor?
- Seminoma of the testis
- Features that are important: small, atrophic seminiferous tubules with few or no spermatogonia and thickened fibrous tissue surroudnign the tubules, all typical of a cryptorchid testis
- Tumor composition: nests of cells separated by fibrovascular septa
- Note the fried egg appearance of tumor cells and infiltration of small mature lymphocytes
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What is this?
Seminoma
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What is this? With what is it associated? Are they limited to the penis? What do we see microscopically? What evidence do we see of the pathogen's influence?
- Condyloma acuminatum of the penis: a benign epithelial tumor
- Associated with: HPV types 6 and 11 infection
- Can be found anywhere on external genitalia and perineal areas in both men and women
- Considered low risk with low probability of progression to high grade dysplasia or carcinoma
- Microscopically: branching of papillary architecture with marked epithelial hyperplasia and hyperkeratosis
- Evidence of viral cytopathic effect: koilocytosis (clear vacuolization or halos in the cytoplasm of squamous cells)
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With what disease is this associated?
condyloma acuminatum (from HPV infection)
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What is this?
Condyloma acuminatum
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What is this?
Condyloma acumenatum
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What is this?
Condyloma acumentum
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What is it?
Condyloma acumenatum
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What is this? Where is it typically found? What can you see in the image?
- Squamous cell carcinoma in-situ of the penis: aka Bowen's disease
- Typically found: on the penis shaft and scrotum
- Note: features of disordered maturation of squamous epithelium with nuclear crowding, enlarged nuclei, hyperchromasia, and mitotic figures that extends from base to surface of epithelium
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