2015/10/28 B5 2015.10.28 [email protected] 2015/10/28 Primaryfollicle Primordialfollicle Maturefollicle Graffianfollicule Granulosacell Thecacell SalpingiFs Ø Ø Ø l l transmiJeddisease) / / / STD(sexually 2015/10/28 Endometriosis EndometrioFccyst endometrioFccyst u u u placenta fetus Ø Ø 90% Ø Ø villi syncyFaltrophoblast, cytotrophoblast 2015/10/28 Follicularcyst 1-2 Ø follicularcyst Ø PolycysFcovarysyndrome Stein-Leventhalsyndrome) 2-3 PolycysFcovarysyndrome 28 175cm,110kg, 14-90 2015/10/28 (ovarian surface epithelium; OSE) • 間断なき排卵仮説 The incessant ovulation hypothesis Surfaceepithelialinclusion cyst 2015/10/28 AR OV Y l l l l ( Arias-Stella ) ( ) 2015/10/28 l l pegcells secretorycells = = Seroustumors Seroustumors Benign/borderline/malignant - 65-70% 15-20% 5-10% 5% 90% 3-5% 2-3% 5% 20 0-25 or - G1,G2 ― (G3) 9 2015/10/28 I ( denovo II KRAS ) v-Ki-ras2Kirstenratsarcomaviraloncogenehomolog Ø II denovo KRAS,BRAF CTNNB1,PTEN PIK3CA KRAS TP53 TP53 TP53 KRAS Ø Ø I Ø Ø KRAS Ø NEW!! TP53 BRAF Ø KRAS Ø BRAFV600E Ø BRAF Ø Ø p53: Ø 17 I ( denovo II II denovo KRAS,BRAF CTNNB1,PTEN PIK3CA KRAS TP53 TP53 TP53 II p53 ) I p53 Ø Ø (17p13.1) ;DNA Ø Ø Ø Ø Ø 2015/10/28 Serouscystadenoma serousadenocarcinoma : Psammomabody Serousborderlinetumor p53 2015/10/28 p53 p53 p53 ProteintruncaFon p53 p53 TP53 wildtype p53 P53 p53 seroustumor Ø Ø Ø Ø 25% Ø CK7,p53 Ø Ø Ø BRCA*1,2 ,PAX8,WT-1 BRCA1,BRCA2: BRCA1:17 BRCA2:13 DNA 21.32 12-13 2015/10/28 Grade3( 50% Grade1( EndometrioidadenocarcinomaGrade1,2,3 Ø Ø Ø Ø Ø Grade1: 5-50% Grade2,50% Grade3 2015/10/28 Hobnail hób nàil C clearcelladenocarcinoma Ø Ø hobnail Ø Mucinouscystadenoma . 2015/10/28 Mucinous borderline tumor Mucinouscystadenocarcinoma “ pseudomyxoma peritonei” 卵巣粘液性腫瘍 Ce cu m • Ø Ø Ø CK7- /CK20- Low-grade appendiceal mucinous neoplasm 2015/10/28 mucinouscysFctumor Sexcordstromaltumor Ø Ø Ø Ø or Ø Ø Ø pseudomyxomaperitonei Ø Ø Call-exner Adultgranulosacelltumor Call-exner Ø Ø Ø Ø Ø Ø 5cm Ø 5 30 5/10HPF Thecoma/fibroma 2015/10/28 Ø thecoma/ Germcelltumor fibroma Meigs Ø 40% Leydig Sertoli Ø 20 Ø Leydig teratoma Ø 3 Ø teratoma: Ø teratoma mature Grade2,3( ) immature 2015/10/28 22 dysgerminoma Ø Ø Ø 30 Ø twocellpaJern Ø 5 95% twocellpaJern 21 17cm 2015/10/28 Schiller-Duval α-fetoprotein(AFP) yolksactumor Ø Ø -fetoprotein(AFP) Schiller-Duval hyalineglobule Krukenberg Signetringcellcarcinoma 2015/10/28 Seidman1 94%(29/31) <10cm 88%(7/8) =/>10cm 18%(2/11) PAS Ø Krukenberg carcinoma Ø signetringcell Khunamornpong2 95%(40/42) 80%(4/5) 58%(8/21) 2015/10/28 Cytotrophoblast Syncytiotrophoblast MUSC: Dr. Janice M Lage yolk sac MUSC: Dr. Janice M Lage 5 Omphalomesenteric duct( ) connecting stalk Steven HL et al. Pathology of the Placenta Placental Anatomy • ( • • Placental disc villi, cotyledon) Umbilical cord (2 1 Placental membranes: amnion chorion MUSC: Dr. Janice M Lage Amnion Chorion ) decidua Cytotrophoblast Decidua S.Minamiguchi S.Minamiguchi 2015/10/28 Placental Villi Chorionic plate • Dual system: • syncytiotrophoblast) HCG Cytotrophoblast Terminal villi • Stem villi trophoblast Decidua S.Minamiguchi S.Minamiguchi Villi 6 23 35 39 2 S.Minamiguchi V A A S.Minamiguchi 1 2015/10/28 2 1 3 4 7 8 10 11 DiDi 25 30 DiMo 70 75 MoMo conjoint twin 1 2 1 S.Minamiguchi Steven HL et al. Pathology of the Placenta Separated placenta Diamnionic-monochorionic placenta Divided membrane S.Minamiguchi Diamnionic-dichorionic placenta S.Minamiguchi Separated placenta Divided membrane S.Minamiguchi S.Minamiguchi 2015/10/28 Diamnionic-monochorionic placenta • Monochorionic single-disc • Artery-parenchymal (25-40%) artery-artery(20%) parenchymal-parenchymal (20%) artery-vein(10%) vein-vein(10%) 33 1700g (R), 1200 (D) single umbilical artery (A-V, V-V Steven H. Lewis et al. Pathology of the Placenta S.Minamiguchi S.Minamiguchi S.Minamiguchi Acute chorioamnionitis • • • • • • 36%(209/581 VV VV VV A Acute chorioamnionitis ) Grading acute chorioamnionitis S.Minamiguchi Group B βstreprococci slight S.Minamiguchi 2015/10/28 34 IUGR S.Minamiguchi S.Minamiguchi CMV Chronic villitis Villi S.Minamiguchi S.Minamiguchi Pregnancy induced hypertension (PIH) • • IUGR • • • • • 77/581 SLE • 2005 4 PIH) CMV S.Minamiguchi S.Minamiguchi 2015/10/28 33 280g Pregnancy induced hypertension preeclampsia S.Minamiguchi S.Minamiguchi Decidual vasculopathy Decidual vasculopathy (atherosis) PIH S.Minamiguchi S.Minamiguchi Knot Villi (+) S.Minamiguchi villi term placenta S.Minamiguchi 2015/10/28 Accelerated villous maturation “ • • • PIH • 38-42 accelerated villous maturation • (knots) S.Minamiguchi S.Minamiguchi Pregnancy induced hypertension (PIH) • 6 23 35 39 decidual vasculopathy (“atherosis”) fibrinoid foamy macrophage fibrin knots villi (accelerated maturation) S.Minamiguchi S.Minamiguchi Hyda@diformmole(HM) hydatidform mole : choriocarcinoma Anabnormalplacentawithvilloushydrops andvariabledegreeoftrophoblas@c prolifera@on (WHO,2003) 2015/10/28 • • 25 7-8 HCG humanchorionicgonadotoropin) , 9w, 2015/10/28 Cytotrophoblast Syncytiotrophoblast MUSC: Dr. Janice M Lage 2015/10/28 • • • • • • • hCG 3-5 2015/10/28 • • • • Inclusion • • choriocarcinoma 46,XX (46,XY) 3 (69,XXX,69,XXY) • • 50% hCG • • 20 • hCG 40 1/2000 & Biphasic pattern 2015/10/28 • • ( HCG MIB-1 100% HCG (+) MIB-1: •
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