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microinvasive squamous cell carcinoma. The lesion is represented
by the raised, velvety-looking area (arrows). D. Histology of the
microinvasive squamous carcinoma that is in continuity with the
atypical surface epithelium.




D


Female Genital Tract and Breast 361
A B


6-6. A. Early invasive squamous cell carcinoma
(arrow) of the vulva. B. More advanced invasive
squamous carcinoma of the vulva. C. Bisected vul-
vectomy specimen shows the pearly white-colored
invasive squamous carcinoma invading the under-
lying soft tissue of the vulva.




C




362 Female Genital Tract and Breast
A B

6-7. Squamous carcinoma of the vagina treated by
pelvic exenteration (removal of bladder, vagina and
uterus, and anorectum). A. Large tumor occupies
upper, posterior wall of the vagina. Note the
bisected urinary bladder on either side of the spec-
imen. B. Bisection of the same specimen showing
urinary bladder (left) and pro¬le of vaginal squa-
mous carcinoma (center) that has spread to involve
portion of uterine cervix and is in¬ltrating into the
rectum (right).



6-8. Chronic cervicitis with ectropion of the cervix
(columnar epithelium has replaced squamous
epithelium). The latter is shown as an extensive
reddened zone. The cervix is also scarred and
deformed from previous deliveries of infants.




Female Genital Tract and Breast 363
A B




C

6-9. Less advanced squamous carcinoma of the
cervix. A. Appearance of the exophytic, partly hem-
orrhagic-looking tumor protruding out of the exter-
nal os of the cervix. B. The extent of the cervical
cancer is better appreciated once the same speci-
men has been partially bisected. C. Adenosquamous
carcinoma of the cervix has no macroscopic distin-
guishing features. (continued on next page)




364 Female Genital Tract and Breast
D



6-9. (Continued) D. More advanced squamous cell
carcinoma of the ectocervix. E. Appearance of the
same cancer in the opened cervix.




E




Female Genital Tract and Breast 365
A



6-10. A. Uterine cavity of this bisected uterus con-
tains an intrauterine contraceptive device (no
longer used). Portions of a leiomyoma are also seen
(right). B. Gross appearance of a recently postpar-
tum uterus showing body (top), cervix (middle),
and vagina (bottom).




B




366 Female Genital Tract and Breast
6-11. An interstitial pregnancy (IP) develops in the
uterine (cornual) portion of the fallopian tube and
comes into the differential diagnosis of other forms
of tubal ectopic pregnancy and abdominal preg-
nancy. IP comprises only 2% to 4% of ectopic preg-
nancies and has a mortality rate double that of other
ectopic pregnancies. In this picture, the decapitated
cornus of the uterus shows an intact fetal sac
(arrow).




Female Genital Tract and Breast 367
A



6-12. Complete hydatidiform mole. A. Uterine cav-
ity is occupied by a mass of abnormal chorionic
villi resembling a bunch of grapes. Each villus is
distended by ¬‚uid to reach a diameter of about 1 to
3 mm. No fetus is present. B. Histology shows ¬‚uid-
¬lled, avascular villi with overlying hyperplastic
trophoblast that shows cellular atypia.




B




368 Female Genital Tract and Breast
A




B



6-13. Leiomyoma of the uterus is the most frequent
tumor of the female genital tract. A. Submucous
leiomyoma ¬lls most of the distended uterine cav-
ity. B. Bisected leiomyoma shows the characteristic
sharply circumscribed ¬‚eshy tumor with whorled
cut surface commonly called a “¬broid.” (continued
on next page)




Female Genital Tract and Breast 369
C




D



6-13. (Continued) C. Uterus bears multiple sub-
serosal intramural and submucous leiomyomata.
D. Cut surfaces of multiple leiomyomas of the
uterus. (continued on next page)




370 Female Genital Tract and Breast
E




F

6-13. (Continued) E. Histology of a leiomyoma
showing interlacing smooth muscle cells. F. Close-
up view of a subserosal “cellular” leiomyoma.




Female Genital Tract and Breast 371
6-14. Leiomyosarcoma of the uterus. The uterus is
expanded by a massive, ¬‚eshy, partly necrotic and
hemorrhagic-looking malignant tumor.




6-15. This bisected uterus shows hemorrhage occur-
ring within proliferative phase endometrium and in
a serosal focus of endometriosis (arrow).




372 Female Genital Tract and Breast
6-16. Two endometrial polyps protrude into the
uterine cavity. The lesions are believed to arise from
endometrial foci that are hypersensitive to estrogen
stimulation and that fail to slough with menstrua-
tion.




Female Genital Tract and Breast 373
A




6-17. A. Endometrial hyperplasia (EH). The endome-
B
trial lining of the uterus is elevated in irregular
heaped-up folds. The spectrum of EH merges with
carcinoma. EH was originally classi¬ed into simple,
complex, or atypical hyperplasia, but now it is
termed endometrial intraepithelial neoplasia. Causes
of EH include anovulatory cycles, polycystic ovary
syndrome, estrogen-producing tumor, or obesity.
B. Histology of simple EH shows prominent cystic
dilatation of the glands, but no nuclear atypism is
present (unlike atypical hyperplasia).




374 Female Genital Tract and Breast
A



6-18. Endometrial adenocarcinoma (EA) may be
due to extended estrogenic stimulation of the
endometrium, and the median age at diagnosis is 63
years. A. Diffuse growth of an endometrioid type
of EA with focal polypoid tumor growth pattern.
B. Histology of the endometrioid carcinoma shows
an adenocarcinoma resembling endometrium in ap-
pearance. (continued on next page)




B




Female Genital Tract and Breast 375
C




D

6-18. (Continued) C. This EA has formed a single
large polypoid excrescence, in addition to its diffuse
growth over the surface of the endometrial cavity.
D. Advanced EA has invaded through the myome-
trium (top), and the bulky tumor has expanded the
uterine cavity. (continued on next page)




376 Female Genital Tract and Breast
E




F

6-18. (Continued) E. Clear cell carcinoma of the
endometrium. This tumor has a worse prognosis than
endometrioid carcinoma. F. Advanced endometrial
carcinoma has widely in¬ltrated the myometrium.




Female Genital Tract and Breast 377
A




C
B




6-19. Carcinosarcoma (malignant mixed mesoder-
mal tumor or MMMT) arises from multipotential
stromal cells. Both the epithelial and the stromal
components of the tumor are malignant. A. Bulky
tumor massively expands the uterine cavity and
shows implants elsewhere on the endometrial sur-
face. B. This MMMT is pedunculated, having been
attached to the uterus at its narrow end (top).
C. Myogenic differentiation in a MMMT.




378 Female Genital Tract and Breast
6-20. Hematometra. Previous cervical surgery led to
uterine cavity outlet obstruction, and the cavity
became distended with menstrual cyclical blood.
Most of the old blood drained away after the uterus
was bisected. No tumor is present, and the altered
blood is black in appearance. The obstruction may
have a congenital cause in some cases.




6-21. Malignant melanoma of the cervix uteri
(right) is seen as irregular black nodules in the
cervix. A metastatic, brown-colored deposit (center)
is noted within the myometrium.




Female Genital Tract and Breast 379
6-22. Walthard cell nests (“rests”) of mesothelial
origin are seen as multiple, small, partially cystic
nodules on the serosal surface of the fallopian tube.
In patients with intraabdominal malignancy, they
may be mistaken for tumor deposits.




6-23. Paratubal cyst (“hydatid of Morgagnii”) is
attached to the ¬mbriated end of the fallopian tube
by a short pedicle. The cyst is of müllerian origin.




380 Female Genital Tract and Breast
A




B




6-24. A. Bilateral subacute salpingitis evolving into
early hydrosalpinx. The dilated fallopian tubes are
still in¬‚amed and congested. B. Polymorphonuclear
leucocytes (PMNs) are seen both in the lumen and
under the epithelium of the fallopian tube.




Female Genital Tract and Breast 381
A




B




6-25. A. Fused tubo-ovarian mass composed of fal-
lopian tube, ovary, and organized purulent exudate
is present (left). B. Posterior view of same specimen
transected shows dilated, thick-walled fallopian
tube that has blood in its lumen and a cystic-
appearing ovary.




382 Female Genital Tract and Breast
A




B

6-26. A. Hydrosalpinx has the appearance of an
enlarged, sausage-shaped fallopian tube ¬lled with
¬‚uid secondary to postinfective obstruction of the
¬mbrial end. The ¬‚uid is derived from tubal secre-
tions. In a pyosalpinx, the tube is ¬lled with pus.
B. Interior view of an opened hydrosalpinx showing
a smooth internal lining. Portion of an ovary con-
taining a corpus luteum is attached to the tube (right).


Female Genital Tract and Breast 383
A




6-27. Ectopic pregnancy (EP) de¬nes fetal implan-
B
tation at a site other than the endometrium. About
95% of EPs occur in the fallopian tube, especially
in its distal two-thirds. Interstitial EP is illustrated
in Fig. 6-11. A. Ruptured EP shows a fetus within
its membranes prolapsing through a defect in the
distal portion of the tube. B. EP shows fetus lying
within opened amniotic sac in this bisected,
enlarged fallopian tube that had not yet ruptured.




384 Female Genital Tract and Breast
6-28. Unilocular, simple follicular cyst of the ovary
(right) is related to abnormalities in the release of
pituitary gonadotrophins.




Female Genital Tract and Breast 385
A




6-29. A corpus luteum in the ovary should not be
mistaken for pathology (e.g., endometriosis). A.
Hemorrhage into a corpus luteum. Multiple small
follicular cysts are also present “ the normal ovary
is a cystic structure! B. Histology of a hemorrhagic
corpus luteum. C. Corpus luteum cyst may follow
previous hemorrhage and delayed resolution of the
cavity associated with increased oncotic pressure
may draw ¬‚uid into the cavity of the corpus luteum.
A corpus luteum cyst is diagnosed once the diam-
eter exceeds 2.5 cm.



B C




386 Female Genital Tract and Breast
A


6-30. Polycystic ovaries contain multiple follicular
cysts with variable luteinization of the theca
interna, and there is overlying sclerosis of the
stroma. Various syndromes may be associated,
including Stein“Leventhal syndrome (metropathia
hemorrhagica). A. Female organs are labeled in the
picture. Both ovaries are enlarged. The bisected
ovary contains multiple subcapsular cysts (arrows)
deep to a thickened cortex. B. Close-up view of a
polycystic ovary in a patient with Stein“Leventhal
syndrome. No corpora lutea are seen. C. Histology
of a portion of the polycystic ovary. The degree of
luteinization of the cyst lining cannot be appreci-
ated at this low power.



C
B




Female Genital Tract and Breast 387
A




B

6-31. Endometriosis is the presence of endometrial
glands and stroma in sites other than the body of
the uterus. Common sites include the pouch of Dou-
glas, the pelvic peritoneum, and the ovary. A. Both
ovaries affected by endometriosis show recent hem-
orrhage. B. Repeated menstrual cycle-related hem-
orrhages lead to altered blood (“chocolate cyst”), as
in the ovary on the left that also shows reactive
¬brosis. (continued on next page)




388 Female Genital Tract and Breast
C




E
D




6-31. (Continued) C. Hemorrhage and necrosis of
the ovary due to torsion may resemble endometrio-
sis. D. Ectopic pregnancy in the ovary should not
be mistaken for endometriosis. E. Histology of the
ectopic pregnancy seen in D shows chorionic villi.




Female Genital Tract and Breast 389
A

B




C




6-32. A. Streak gonad (bottom) in Turner syndrome
runs parallel to the fallopian tube (top). Note the
hydatid of Morgagnii attached to the tube. B. His-
tology of streak gonad shows ¬brous tissue that has
a pattern slightly reminiscent of ovarian stroma.
C. Hypoplastic ovary is much smaller than a nor-
mal ovary and is out of proportion to its accompa-
nying normal-size fallopian tube. Hypoplastic
ovaries may lead to premature ovarian failure. Some
patients have had mumps oophoritis.




390 Female Genital Tract and Breast
A




B




6-33. Tumors originating from germ cells form
about 25% of all ovarian tumors. Germ cell tumors
in adult women are mainly benign (e.g., dermoid
cyst), while in younger patients most are malignant.
A monodermal teratoma may show only thyroid tis-
sue (“struma ovarii”) or a carcinoid tumor. A. Exter-
nal appearance of a mature cystic teratoma (der-
moid cyst). B. Contents of this dermoid cyst include
hairs, inspissated keratin, and two teeth (“buck-
tooth,” “smiling benign teratoma”). (continued on
next page)



Female Genital Tract and Breast 391
C




6-33. (Continued) C. Histology of the cyst lining
D
shows skin with appendages covered by old keratin.
D. Elsewhere, the dermoid cyst histology showed
well-differentiated columnar cells suggestive of
intestinal differentiation.




392 Female Genital Tract and Breast
A




B C




6-34. A. Immature (malignant) teratoma of the
ovary in a child has a solid ¬‚eshy appearance with
a few small cystic areas. B. Histology shows foci of
immature neuroepithelium mixed with loose undif-
ferentiated mesenchymal tissue. C. This immature
teratoma also contained areas of embryonal carci-
noma (X).




Female Genital Tract and Breast 393
A



6-35. If the neoplastic germ cells in an ovary show
no differentiation, then a dysgerminoma develops.
This tumor is analogous to a testicular seminoma.
A. External appearance of an ovarian dysgermi-
noma. B. Histology of dysgerminoma shows nests of
uniform malignant cells resembling oogonia of the
fetal ovary. Note the clear, glycogen-rich cytoplasm.
The resemblance to a seminoma is striking.




B




394 Female Genital Tract and Breast
A



6-36. Yolk sac (endodermal sinus) carcinoma is
highly malignant, occurs in young women, and is
usually unilateral. A. Large, ¬‚eshy yolk sac tumor
shows focal hemorrhage and necrosis at its periph-
ery. The ovary is totally replaced by the tumor.
B. Histology of yolk sac tumor shows epithelial
cells forming microcysts. Immunohistochemistry
will be positive for alpha-fetoprotein. Schiller“
Duval body is the name given to the central struc-
ture that vaguely resembles a glomerulus in appear-
ance and is said to be reminiscent of the endoder-
mal sinuses of the rat placenta.




B




Female Genital Tract and Breast 395
A




6-37. A. Gonadoblastoma is a rare tumor of the
B
ovary that occurs in phenotypic women younger
than 30 years who show virilization, primary amen-
orrhea, and abnormal genital development. These
phenotypic women possess a “y” chromosome. The
tumor may also be found in phenotypic men with
cryptorchidism, hypospadias, and female internal
organs. B. Histology of gonadoblastoma showing an
appearance suggestive of a dysgerminoma in situ.
These tumors show an organoid pattern of cell nests
comprising germ cells that may be admixed with
immature sex cord elements (Sertoli and granulosa
cells).




396 Female Genital Tract and Breast
A




6-38. Tumors of sex cord and stroma may arise from
B
the primitive sex cords or from the mesenchymal
stroma of the developing gonad. A. Fibroma of the
ovary comprises a well-circumscribed, yellow-
white, ¬rm solid tumor. B. Histology of ¬broma
shows mature-looking stromal spindle cells lying
between mature collagenous tissue. (continued on
next page)




Female Genital Tract and Breast 397
C




6-38. (Continued) C. Fibroma-thecoma of the ovary.
The ¬broma component (white tissue, left) is well
demarcated from the thecoma (yellow tissue, right).
D. Thecoma of the ovary in a postmenopausal
woman. Thecoma may produce estrogen or andro-
gen. The yellow color is due to high lipid content
of the tumor cells. (continued on next page)



D




398 Female Genital Tract and Breast
E




6-38. (Continued) E. Thecoma histologically shows
elongated cells with central nuclei surrounded by
collagen. Stains for lipid are positive in thecoma.
F. Serous cystadeno¬broma of the ovary. (continued
on next page)



F




Female Genital Tract and Breast 399
G




6-38. (Continued) G. Granulosa cell tumor in an
H
adult woman shows areas of cystic change. Most
granulosa cell tumors are malignant and secrete
estrogen, which favors endometrial hyperplasia and
cancer. H. Histology of granulosa cell tumor shows
nuclear grooving (coffee bean appearance) (arrows).




400 Female Genital Tract and Breast
A



6-39. Rarely, an ovarian granulosa cell tumor may
occur before puberty, and estrogen production by
the tumor cells may lead to precocious puberty.
A. Juvenile granulosa cell tumor has a bright yel-
low color due to the presence of lipid-laden
luteinized granulosa cells. Areas of necrosis and
hemorrhage are also present. B. Histology of juve-
nile granulosa cell tumor shows tumor cells sur-
rounding spaces (secondary to degeneration) giving
an appearance termed Call“Exner bodies.




B




Female Genital Tract and Breast 401
B




A




C




6-40. Epithelial tumors of the ovary comprise benign, borderline
(low malignant potential), or malignant varieties. They are believed
to arise from the mesothelial cell layer covering the ovarian surface
that may undergo metaplasia to müllerian epithelium. Resultant
tumors may differentiate to resemble tubal mucosa (serous tumors),
endocervical mucosa (mucous tumors), or endometrium (endometri-
oid tumors). Transitional cell tumors (Brenner tumor) may also occur.
A. Mucinous cystadenoma of the ovary consists of multiloculated
mucin-¬lled cysts “ most of the mucin has been washed away prior
to photography. B. The mucinous cystadenoma is lined by a single
layer of mature-looking mucinous epithelial cells. C. Brenner (tran-
sitional cell) tumor of ovary.



402 Female Genital Tract and Breast
6-41. Serous ovarian tumor of borderline malig-
nancy shows inwardly protruding papillary projec-
tions within the opened cyst.




Female Genital Tract and Breast 403
A




B

6-42. A. Massive mucinous cystadenocarcinoma
is seen as a very large, tense, cystic structure. B.
Bisected lesion shows scanty solid areas “ the car-
cinoma is usually present in the solid areas. (con-
tinued on next page)




404 Female Genital Tract and Breast
C



6-42. (Continued) C. Another mucinous cystadeno-
carcinoma shows more extensive solid areas (center).
D. Multilayered mucinous cells comprise the lining
of the glands of the invasive cystadenocarcinoma.




D




Female Genital Tract and Breast 405
6-43. A. Serous papillary cystadenocarcinoma com-
prises about 30% of all ovarian primary malignan-
cies. The external surface of this cystic tumor
appears quite smooth. B. Serous papillary adeno-
carcinoma with a single, dominant, central cystic
area containing tumor tissue. The tumor encom-
passing the cyst shows focal necrosis and cystic
A
degeneration. (continued on next page)




B




406 Female Genital Tract and Breast
6-43. (Continued) C. Histology of serous cystadeno-
carcinoma showing papillary formations and stro-
mal invasion. D. High-power view shows ¬brovas-
cular core supporting multilayered serous cells,
C
which show pleomorphism and mitoses.




D




Female Genital Tract and Breast 407
A




*




6-44. A. Well-differentiated endometrioid adeno-
B
carcinoma (*) of the ovary. B. Endometrioid carci-
noma is seen in this histologic section of the ovary.




408 Female Genital Tract and Breast
6-45. Fibrosarcoma that has arisen in the ovary.




6-46. Metastatic adenocarcinoma from the colon in
the ovary. Bilateral ovarian involvement by second-
ary carcinoma (often from the stomach) is termed
“Krukenberg tumors.”




Female Genital Tract and Breast 409
6-47. Involvement of the ovary by nodular-scleros-
ing Hodgkin disease.




6-48. Lactating breast plus enlarged pituitary gland
(right) due to a prolactin-secreting pituitary adenoma.




410 Female Genital Tract and Breast
A




B

6-49. A. Breast shows mammary duct ectasia with
prominent surrounding ¬brosis. The bisected nip-
ple is seen on the right. B. Duct ectasia of the breast
with marked periductal in¬‚ammation and ¬brosis.




Female Genital Tract and Breast 411
6-50. Fat necrosis (arrow) is present on the midpor-
tion of the upper end of the sample of breast tissue.




6-51. Plasma cell granuloma of the breast mimics
the gross appearance of a neoplasm.




412 Female Genital Tract and Breast
A




6-52. A. Fibroadenoma (FA) of the breast is sharply
circumscribed and has a lobulated cut surface.
B. Histology of FA in a low-power view shows
epithelial-lined clefts in the ¬brous tissue compris-
ing most of the lesion. (continued on next page)



B




Female Genital Tract and Breast 413
C




6-52. (Continued) C. Higher-power view of epithe-
lial-lined clefts. D. Area of adenosis in a ¬broade-
noma. E. Old hyalinized ¬broadenoma of the breast
in an elderly woman.



D E




414 Female Genital Tract and Breast
A




B




6-53. A. Nonproliferative ¬brocystic disease of the
breast is characterized by dense ¬brous tissue
encompassing a number of variable-size cysts.
B. Another example of ¬broadenosis showing more
prominent cyst formation. (continued on next page)




Female Genital Tract and Breast 415
C




6-53. (Continued) C. Histology of ¬brocystic disease
shows cystic dilatation of the terminal ducts with
increased surrounding collagen. D. Post ¬ne-needle
aspiration hemorrhage complicating ¬brocystic dis-
ease of the breast.



D




416 Female Genital Tract and Breast
A


6-54. A. Bisected benign, well-circumscribed phyl-
lodes tumor (“giant ¬broadenoma”) showing the
characteristic macrolobulated (phyllodes pages)
appearance. B. Histology shows the characteristic
leaf-like arrangement of a phyllodes tumor of the
breast. The stroma is more cellular than a ¬broade-
noma. A malignant phyllodes tumor has a sarco-
matous stroma that predominates over the ductal
elements and invades the breast.




B




Female Genital Tract and Breast 417
A




B



6-55. A. Juvenile papillomatosis (JP) (“Swiss cheese
disease”) presenting as a solitary, unilateral breast
lump in a 9-year-old girl. The lesion is often mis-
taken for a phyllodes tumor clinically. Note the cir-
cumscribed, but not encapsulated, lesion containing
multiple cysts. Differential diagnosis also includes
¬brocystic disease, pubertal macromastia, and juve-
nile ¬broadenoma. JP is a marker for families at risk
for breast cancer coincidentally or later. B. JP with
larger cysts and an appearance strongly resembling
¬brocystic disease of the breast. C. Histology of JP
shows dilated breast ducts lined by a proliferation
of highly atypical-looking epithelium that would be
regarded as precancerous in an older woman.
C


418 Female Genital Tract and Breast
6-56. Intraduct papilloma (arrow) of the breast sit-
uated in a large subareolar duct. This middle-age
woman presented with a bloody discharge from the
nipple. The papilloma is not associated with an
increased risk of developing breast cancer.




6-57. A. Focal area of intraductal carcinoma with a
comedo appearance. B. Histology shows carcinoma
con¬ned within the duct.

B
A




Female Genital Tract and Breast 419
A




B C




6-58. A. Paget disease of the breast. Eczematous-
like changes in the skin of the nipple, areola, and
adjacent areas of breast skin are due to in¬ltration
by an intraduct carcinoma that has spread up the
duct to the nipple. B. Histology also shows an
intraduct cancer that has extended into the adjacent
lobules. C. Histology of Paget disease shows
intraepidermal cancer cells derived from an intra-
ductal breast carcinoma.




420 Female Genital Tract and Breast
A




B




6-59. The most common form of breast cancer is invasive duc-
tal carcinoma, which usually evokes a marked desmoplastic
response (proliferation of ¬broblasts producing collagen) that
adds to the lesion™s bulk. Prognosis is stage dependent. A. In-
drawing of the nipple due to desmoplasia in an underlying
advanced breast carcinoma is a late feature of breast cancer “
the aim is to diagnose the cancer much earlier than this (see
Fig. 6“60C). Note the “peau d™orange” (skin edema) appearance
of the breast skin due to tumor obstruction of the dermal lym-
phatics. B. Bisected mastectomy specimen shows the crab-like
outline of the invasive ductal carcinoma (cancer a crab).
(continued on next page)



Female Genital Tract and Breast 421
C




6-59. (Continued) C. Hemorrhagic needle biopsy
D
tract within an occult, early breast cancer that was
diagnosed by mammography. D. Histology of inva-
sive ductal carcinoma of the breast shows cords of
poorly differentiated adenocarcinomatous cells in a
¬brous stroma. (continued on next page)




422 Female Genital Tract and Breast
E




6-59. (Continued) E. Positive immunohistochemical
staining for estrogen receptor protein in a breast
cancer. F. Close-up view of an invasive ductal car-
cinoma. The tumor cuts with the consistency of an
unripe pear. G. Composite picture of breast cancer
from an autopsy shows clockwise from bottom
right: mastectomy specimen with the cancer, adre-
nal gland with scattered small metastatic nodules,
tumor-in¬ltrated axillary lymph node, and metasta-
tic tumor in a vertebral body.


F




G




Female Genital Tract and Breast 423
A



6-60. Invasive lobular carcinoma of the breast is
second in frequency after invasive ductal cancer. It
may produce a similar gross appearance to the lat-
ter, or, if less desmoplasia occurs, the tumor appears
ill de¬ned. A. Invasive lobular carcinoma with
scanty desmoplasia forms an ill-de¬ned mass in the
breast tissue. B. Histology of lobular carcinoma
showing tumor cells arranged in lines between the
collagen bundles.




B




424 Female Genital Tract and Breast
A



6-61. Medullary cancer of the breast has a better
prognosis than invasive ductal carcinoma. A. Gross
appearance of medullary cancer showing a well-cir-
cumscribed, ¬‚eshy, tan-colored tumor. B. Histologi-
cally, the margin of the tumor is encompassed by a
lymphocytic in¬ltration (top).




B




Female Genital Tract and Breast 425
6-62. Typical glistening, mucoid cut surface of a
colloid (mucinous) carcinoma of the breast. If not
admixed with an ordinary ductal carcinoma, this
tumor has a better prognosis than in¬ltrating duc-
tal or lobular carcinoma.




6-63. A. Metaplastic carcinoma of the breast is a
form of breast carcinoma that shows differentiation
toward malignant squamous epithelium, cartilagi-
nous, or bony tissue. B. Histology of this metaplas-
tic breast carcinoma showed areas of malignant
squamous epithelium.

A B




426 Female Genital Tract and Breast
6-64. Angiosarcoma (arrow) of the breast is seen as
a reddish, cavitated nodule within the mammary
6-65. Gynecomastia is enlargement of the male
tissue.
breast analogous to juvenile hypertrophy of the
female breast. Histology shows active epithelium
within a proliferation of mammary ducts with sur-
rounding ¬brosis.




Female Genital Tract and Breast 427
7 Diseases of the Male Genital System




7-1. Carcinoma in situ of the glans penis is seen as
multiple focally depressed areas in which the
epithelium appears both erythematous and more
translucent. This form of carcinoma in situ of the
penis has been called erythroplasia of Queyrat in
contradistinction to Bowen disease, which produces
a grayish-white plaque.




7-2. A. Microinvasive squamous cell carcinoma of
the glans penis and the foreskin presenting as
slightly depressed, vascularized areas with focal
epithelial thickening. B. Histology shows microin-
vasion (i.e., the squamous carcinoma has penetrated
the basement membrane and is starting to invade
the underlying stroma).

B
A




428 Diseases of the Male Genital System
A B




7-3. A. Invasive squamous cell carcinoma arising in
the prepuce (foreskin) of the penis has formed an
exophytic, papillary tumor. The disease is rare in
the United States due to the popularity of circum-
cision. B. Histology of the lesion shows a kera-
tinizing squamous carcinoma with surrounding
nonspeci¬c chronic in¬‚ammation.




7-4. Longitudinally sectioned penis that was surgically removed
because of a squamous carcinoma (*) of the foreskin that is invading
the distal end of the penis (arrow).




*



*




Diseases of the Male Genital System 429
7-5. Bisected penile resection specimen shows a very advanced, large
squamous carcinoma invading the inferior aspect of the penis,
including the corpus cavernosum.




7-6. Paget disease of the skin of the penis and scrotum presenting as
multifocal, thickened, scaling areas of skin.




430 Diseases of the Male Genital System
A




B




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