179. Cervical cancer, the role of viral infections in its development. Pathological anatomical characteristics (macro- and microscopic signs), features of metastasis, complications, causes of death.

The role of viral infections

A key role in the carcinogenesis of cervical cancer is assigned to papillomavirus infection, which has a tropicity to the epithelium of the cervix. HPV serotypes of high oncogenic risk (16, 18) are found in 95% of cases of cervical cancer: with squamous cell cervical cancer, HPV type 16 is more often detected; with adenocarcinoma and a low-grade form, HPV type 18.

Macro- and microscopic signs:

There are microinvasive and noninvasive cervical cancers.

Microinvasive cancer is characterized by the appearance of strands of anaplastic epithelium below the basement membrane, while the depth of invasion does not exceed 3 mm. The epithelium located above the basement membrane usually has signs of CIN3. Invasion of blood and lymphatic vessels is possible. Fibroblast proliferation, inflammatory infiltration and edema are noted in the stroma.

Invasive squamous cell carcinoma most often develops in the age range from 45 to 55 years. There are 2 main histological variants of squamous cell carcinoma: cancerous and non-cancerous. According to the degree of differentiation, highly, moderately and low-differentiated squamous cell carcinoma is distinguished. Under the microscope, squamous cell keratinous cancer is characterized by the formation of keratogyaline granules by tumor cells, the formation of cancer pearls." Mitoses are relatively rare.

In non-cancerous squamous cell carcinoma, tumor cells are usually oval or polygonal, with an eosinophilic cytoplasm. Kernels can be relatively monomorphic or have pronounced polymorphism. Intercellular bridges are usually not detected. Mitoses are frequent, including atypical ones.

The nature of tumor growth can be exophytic (papillomatous or polypoid), as well as endophytic (infiltrative or ulcerative).

The form of tumor growth largely determines the features of the clinical course of the disease. The tumor is accompanied by bloody discharge from the vagina, it usually quickly sprouts the surrounding tissue of the cervix, bladder, rectum. Vaginal-rectal and vaginal-vesicular fistulas are formed, which lead to the development of septic complications.

Cervical cancer metastasizes early and primarily through the lymphatic pathways to the lymph nodes of the pelvis, inguinal and retroperitoneal; later, hematogenous metastasis is observed. Implantation metastases are possible.

Complications:

Colon and urinary tract fistulas, anemia, bleeding, thromboembolism.

Causes of death:

Peritonitis, anemia, thromboembolism.

They include

180. Precancer and breast cancer: predisposing factors, pathological anatomy. Forms of growth, features of cancer metastasis, complications, outcomes, clinical significance. Immunohistochemical classification of breast cancer.

Precancerous diseases:

Intracurrent papilloma

Leaf-shaped fibradenoma

The proliferating form of mastopathy

Predisposing factors:

The presence of breast cancer in first-line relatives.

Earlier, the onset of menstruation

Late menopause, infertility.

Fatness.

Proliferative fibrocystic disease

5-10% of breast cancer is considered to be associated with congenital gene mutations. Those who inherit a mutant copy of one of these tumor suppressor genes develop breast cancer at a younger age (<40 years) and there is a tendency to develop bilateral tumors.

Pathological anatomy:

Macroscopic breast cancer is represented by nodular and diffuse forms, cancer of the nipple and nipple field (Paget's disease of the breast). Nodular cancer is a node with a diameter of up to several centimeters. In some cases, the node is dense, permeated with whitish layers of tissue penetrating into the surrounding fatty tissue, in others it is soft, juicy on the incision, easily disintegrates. Diffuse cancer covers the gland for a considerable length, the contours of the tumor are poorly marked. Sometimes cancer grows into the skin and forms a mushroom—shaped disintegrating formation on its surface - a cancerous ulcer. In some cases, the tumor spreads over the surface of the breast, which becomes covered with a dense shell, called carapace cancer.

Features of metastasis:

The spread of breast cancer is associated with germination into soft tissues. Lymphogenic metastases appear in regional lymph nodes: axillary, anterior thoracic, subclavian, supraclavicular, and circumflex. Hematogenous metastases are often found in bones, lungs, liver, and kidneys. After removal of breast cancer, relapses appear late, after 5-10 years.

Complications:

pain syndrome;

venous thrombosis (tumor cells produce substances that increase blood clotting, as a result of which blood clots can form);

Pleural effusion is the accumulation of fluid in the pleural cavity surrounding the lungs. It occurs in the late stages of the disease;

the addition of bacterial and viral infections as a result of reduced immunity;

hormonal disorders

bleeding

pathological fractures.

Outcomes:

The outcomes of breast cancer depend on the stage of the disease. In the early stages, complete recovery is possible (after surgical treatment in combination with chemotherapy or radiation therapy), with time the probability of death increases. Death can occur due to cachexia, pneumonia, anemia, brain metastases, etc.

Clinical significance:

any tumor formation in the breast;

the appearance or shape of the breast has changed;

there is discharge from the nipples:

the shape of the nipple or areola has changed;

the skin of the breast is reddened, has become too wrinkled or swollen;

there are visible areas with retracted skin on the chest.

Immunohistochemical classification of breast cancer.

A-luminal

B-luminal

Overexpressive

Basal - like