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:
• 

FAA702 Operations and PRISM Collection Details