ADENOMA THYROID

CLINICAL SIGN
The mass of the thyroid, unilateral --Uninodosa Palpation: no pain very large mass may cause swallowing disorders. More common in women.

Macroscopy
single nodule Solid, encapsulated

Fig. 9.40 Follicular adenoma of thyroid. F/35. This presented as a solitary enlargement of one lateral lobe of the thyroid. The cut surface shows a single, well circumscribed nodule of brownish-coloured tissue.

ADENOMA of The THYROID

MICROSCOPY
Follicular proliferation,containing colloid, covered by cylindrical epithelial cells. Encapsulated There are signs of compression of normal tissue outside the nodule. There was no sign of anaplasia

No capsular invasion

capsular invasion

Follicular carcinoma

Squamous Cell Carcinoma (CERVIX & PENIS)

SIGNS & SYMPTOMS

ABNORMAL VAGINAL BLEEDING(POST COITAL,MENOMETRORARGIA) VAGINAL DISCHARGE (SEROSANGUINUS/YELLOWISH,SMELLING FATIGUE,ANEMIA. LOWER SOSIOECONOMIC, SMOOKING,MULTIPAROUS, AGE AT FIRST INTERCOURSE <18 YEARS, MANY SEXUAL PARTNERTS

MACROSCOPY
MICROINVASIVE : RED PAPULE, WHITE PLAQUE IRREGULAR ULCERATED LESIONS. INVASIVE : EXOPHYTIC PAPILLARY MASS OR ENDOPHYTIC ULCER. NOTE : CAULIFLOWER MASS, FRAGILE, BLOODY

CARCINOMA OF THE CERVIX

Fig. 8.30 Carcinoma in situ plus early invasive squamous cell carcinoma of the cervix. F/41. The cervix is eroded. The diagnosis was made on Papanicolaou smear and biopsy.

Carcinoma of the penis

Figure 21-19 Carcinoma of the penis. The glans penis is deformed by a firm, ulcerated, infiltrative mass.

MICROSCOPY
-

NESTS, CORDS / SINGLE MALIGNANT SQUAMOUS EPITHELIAL CELLS WITH HIGH N/C RATIO,NUCLEAR PLEOMORPH WITH IRREGULAR CHROMATIN & EOSINOPHYLIC CYTOPLASM ATYPICAL MITOSIS KERATIN PEARL FORMATION/INDIVIDUAL CELL KERATINIZATION.

All associated with HPV infection. Histologically similar but clinically distinct. Squamous cell carcinoma appears glans or shaft of the penis to form an infiltrative ulcerating lesions that can spread to the inguinal lymph nodes. Often appear in male smokers who did not circumcision.

Fig. 8.27 Squamous cell carcinoma arising from the right labium minus. F/79. Treated by radical vulvectomy. Squamous cell carcinoma of the vulva usually occurs as a complication of long-standing lichen sclerosis et atrophicus in older women, or as a complication of HPV (human papilloma virus) infection in younger women.

ADENOCARCINOMA COLON

CLINICAL SIGN
Age: > 60 yo, 20% < 50 yo Male female ratio: 1.2 : 1 Sign:

Firstly asimptomatik bowel habit changes Anemia Weight loss

MACROSCOPY
Solid, fragile, bloody Not encapsulated Exophytic/fungating/ulceratif

ADENOCARCINOMA CAECUM

MICROSCOPY

Anaplastic epithelial cell proliferation, with the characteristics: - pleomorphic nuclei, increased of N / C ratio, hypercromatic nuklei with coarse chromatin & prominent nukleoli. - many mitotic - Arranged to the glands / acini structure - Growing infiltrative

ADENOCARCINOMA CORPUS UTERI

MACROSCOPIC
Infiltrative : diffuse thickening of endometrium Exophytic : polipoid on the surface Solid, fragile, bloody

MICROSCOPIC
85 % Adenocarcinoma Proliferation of Gland, increase in number, various form, papillary Stratified columnar epithelial with anaplasia + Invasive in stroma myometrium serousa

ADENOCARCINOMA PROSTAT

Figure 21-34 Adenocarcinoma of the prostate. Carcinomatous tissue is seen on the posterior aspect (lower left). Note the solid whiter tissue of cancer in contrast to the spongy appearance of the benign peripheral zone on the contralateral side.

Figure 21-36 A, Photomicrograph of a small focus of adenocarcinoma of the prostate demonstrating small glands crowded in between larger benign glands. B, Higher magnification shows several small malignant glands with enlarged nuclei, prominent nucleoli, and dark cytoplasm, compared to the larger benign gland (top).

Figure 21-38 A, Low-grade (Gleason score 1 + 1 = 2) prostate cancer consisting of back to back, uniformly sized malignant glands. Glands contain eosinophilic intraluminal prostatic crystalloids, a feature that is more commonly seen in cancer than in benign glands and more frequently seen in lower grade than in higher grade prostate cancer. B, Needle biopsy of the prostate with variably sized, more widely dispersed glands of moderately differentiated (Gleason score 3 + 3 = 6) adenocarcinoma. C, Poorly differentiated Gleason score (5 + 5 = 10) adenocarcinoma composed of sheets of malignant cells.

MICROSCOPY

MUCINOUS
BENIGN MALIGNANT

MUCINOUS CYSTADENOMA OVARIUM

MACROSCOPY:
Cysts, white-brownish gray Outside : smooth surface. USUALLY bigger than serous tumor In slices: Multilocular, often contain mucinous material.

Fig. 8.58 Benign mucinous cystadenoma of the ovary. F/76. The solid tumour on the left is a benign Brenner tumour. This combination is quite frequent. Fig. 8.59 The cut surface of the specimen in Figure 8.58 shows a multiloculated cyst containing mucin, most of which has been removed.

MIKROSKOPIK :
Dinding kista dilapisi sel-sel epitel selapis silindris ,dengan inti terletak dibasal ,sitoplasma luas diatasnya (terdistensi oleh mucin). DALAM LUMEN KELENJAR TAMPAK MASA AMORF/CAIRAN YANG BERWARNA MERAH MUDA.

Cyst wall covered by a layer of cylindrical epithelial cells, with a nucleus in basal, caused by broad cytoplasm above

MALIGNANT

OVARIAL MUCINOUS CYSTADENOCARCINOMA

MACROSCOPY : CYSTIC MASSES ,TAN TO GREYISH WHITE, SMOOTH ON SURFACE PARTLY,NECROTIC AND HAEMORRHAGE AREAS CUT SECTION : CYSTIC - SOLID PARTLY, MULTILOCULATED AREAS FILLED MUCOUS FLUID ,NECROTIC AND HAEMORRHAGE AREAS

Fig. 8.60 Mucinous cystadenocarcinoma of the ovary. F/47. Solid areas of tumour are present as well as multiple loculi of benign mucinous cystadenoma.

MICROSCOPY

CYST WALL LINED BY ANAPLASTIC EPITHELIAL CELLS, STRATIFIED FASHION, INVASIVE GROWTH WITHIN STROMA.

MIKROSKOPIK:
DIDAPATKAN SEL-SEL ANAPLASTIK YANG MELAPISI DINDING KISTA & PAPILYG MENONJOL SERTA NODUL MURAL ,BAHKAN TELAH TUMBUH INVASIVE KEDALAM STROMA. PADA LUMEN KELENJAR TAMPAK MASA AMORF MERAH MUDA

SEROUS

SEROUS TUMORS
BENIGN MALIGNANT

BENIGN
SEROUS CYSTADENOMA OVARY MACROSKOPY : Unilocular cyst, thin-walled, contained clear fluid.

Fig. 8.54 Benign serous cystadenoma of the ovary. F/19. This is a unilocular, thin-walled cyst containing clear fluid.

MICROSCOPY

Cyst wall covered by columnar epithelial cells, ciliated, sometimes flat structure PSAMMOMA BODIES : +/PAPIL : +/-

MALIGNANT

OVARIAL SEROUS CYSTADENOCARCINOMA

MACROSCOPY : Ovarial masses, tan to grey, smooth partly on surface mass Cut section : cystic partly ( there is small mural nodule, solid, sometimes papillary structure), may be there were necrotic and haemorrhage areas. NOTE : If there were extension to outer surface Rough appearance on outer surface of the cyst.

MICROSCOPY
CYST WALL LINED BY ANAPLASTIC EPITHELIAL CELLS, PAPILLARY FASHION, INVASIVE GROWTH WITHIN STROMA. OCCASIONALLY THERE WERE A LOT OF NUMBER PSAMMOMA BODIES SURROUND

UNDIFFERENTIATED CARCINOMA

MICROSCOPY

Tumor consisted of anaplastic epithelial cell. Hallmark: showed no differentiation (undifferentiated) feature Infiltrative tumor growth within stroma.

RENAL CELL CARCINOMA

GRAWITZ TUMOR

Renal Cell Carcinoma

Derived from renal tubular epithelium, predominantly cortical location 80% - 85% malignancy of the kidney ,2% -3% of all adult malignancy. frequently on 7th decade, male : female 2:1 Increase risk on :

Smoker Policystic Kidney dis chronic dialysis

Clinical Features

Clinical sign & symptom:

Costovertebral pain Palpable mass Hematuria

Macrosocpy
Can rise in all of the kidney, commonly on upper pole Spherical masses, solid, yellow to greyishwhite With necrotic and haemorrhage areas.

Figure 20-59 Renal cell carcinoma. Typical cross-section of yellowish, spherical neoplasm in one pole of the kidney. Note the tumor in the dilated thrombosed renal vein.

Microscopy
Tumor cells : polygonal shape, clear and large amount of cytoplasm. Mild pleomorphic, hyperchromatic nuclei. Tumor cells arranged on lobular structure

Figure 20-60 Renal cell carcinoma. A, Clear cell type, B, Papillary type. Note the papillae and foamy macrophages in the stalk. C, Chromophobe type. (Courtesy of

Dr. A. Renshaw,Brigham and Women's Hospital, Boston, MA.)

Transisional cell carcinoma / Urothelial Carcinoma

Figure 21-6 Four morphologic patterns of bladder tumors.

Figure 21-7 Cross-section of bladder with upper section showing a large papillary tumor. The lower section demonstrates multifocal smaller papillary neoplasms.

(Courtesy of Dr. Fred Gilkey, Sinai Hospital, Baltimore, MD.)

Figure 20-61 Urothelial carcinoma of the renal pelvis. The pelvis has been opened to expose the nodular irregular neoplasm, just proximal to the ureter

Figure 21-12 Opened bladder showing a highgrade invasive urothelial cell carcinoma at an advanced stage. The aggressive multinodular neoplasm has fungated into the bladder lumen and spread over a wide area. The yellow areas represent areas of ulceration and necrosis.

Microscopy
Low-grade papillary urothelial carcinoma with an overall orderly appearance, a thicker lining than papilloma, and scattered hyperchromatic nuclei and mitotic figures High-grade papillary urothelial carcinoma with marked cytologic atypia

Figure 21-9 Low-grade papillary urothelial carcinoma with an overall orderly appearance, a thicker lining than papilloma, and scattered hyperchromatic nuclei and mitotic figures (arrows).

Figure 21-10 High-grade papillary urothelial carcinoma with marked cytologic atypia.

MOLA HYDATIDOSA

CLINICAL SIGN

FIRST TIME SAME AS NORMAL PREGNANCY : AMENORRHEA, PREGNANCY TEST (+) Enlargement of UTERUS was larger than normal pregnancy Vaginal bleeding usually on 3-4-5 months, admixed with grape-like structure. Serum and Urinary Beta Human Chorionic Gonadotropin level always markedly increased

MACROSCOPY
Enlargement of uterus was larger than normal pregnancy Vaginal bleeding usually on 3-4-5 months, admixed with grape-like structure. Uterus cavity filled grape-like masses, thin walled, translucent, cystous, greyish white

Fig. 8.72 Hydatidiform mole. F/26. Curetted specimen. Note variably sized vesicles, no normal placenta and no fetus.

MACROSCOPY
Enlarge of Villi Chorealis, Edemathous Avascular stroma Markedly Trophoblastic proliferation