Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Ovarian Endometrioid, Clear Cell, Transitional, and Mixed Epithelial–Stromal Tumors

Endometrioid Tumors Endometrioid tumors of the ovary resemble those encountered more frequently in the endometrium. They include endometrioid carcinomas, endometrioid stromal sarcomas, adenosarcomas, and malignant mesodermal mixed tumors (carcinosarcomas). Endometrioid carcinomas are the most common. Although an origin from endometriosis can be demonstrated in some cases, it is not required for the diagnosis (almost all müllerian tumors can originate from endometriosis). Recent molecular genetic studies, however,…

Ovarian Mucinous Tumors

General Features Mucinous tumors show cysts and glands lined by epithelial cells containing intracytoplasmic mucin. The tumor cells may resemble those of the endocervix, gastric pylorus, or intestine. They are typically diastase resistant PAS positive, and mucicarmine positive. Mucinous tumors account for 10–15% of all primary ovarian tumors. Approximately 80% are benign and the remainder are borderline tumors, noninvasive carcinomas, and invasive carcinomas. Although they generally…

Ovarian Epithelial-Stromal Tumors. Serous Tumors

Epithelial/Stromal Tumors The tumors in this category account for approximately two-thirds of all ovarian tumors and for about 90% of all ovarian cancers in the Western world. Epithelial ovarian tumors are heterogeneous neoplasms that are primarily classified according to cell type into serous, mucinous, endometrioid, clear cell, transitional, and squamous cell tumors. However, benign counterparts of these cells are not found in the normal ovary and…

Non-Neoplastic and Tumor-Like Conditions of the Ovary

Dysfunctional Cysts Definitions Dysfunctional ovarian cysts derive from the follicular apparatus either before or after ovulation ( Table 24.1 ). They may result from or cause disordered hypothalamic–pituitary–ovarian function. Although not always functional in the sense of producing steroid hormones, the cysts all have or have had the potential to do so at some stage in their development. Table 24.1 Classification of Dysfunctional Ovarian Cysts Cysts…

Normal Ovaries, Inflammatory and Non-Neoplastic Conditions

Anatomy, Histology, and Function Anatomy The ovaries are paired pelvic organs located close to the uterus, weighing 5–8 g and measure about 3.0 × 2.0 × 1.0 cm in women of reproductive age. They normally shrink in size after menopause. The external surface is smooth until after puberty, when it increasingly convolutes in the normal course of maturation, rupture of the follicles, and repair. Each ovary is attached…

Fallopian Tube

Introduction As the fallopian tube is the intermediary between the ovary and the uterus, it is the seat of various interactions that culminate in a normally implanted pregnancy. Its multiple functions include conditioning of both gametes before fertilization, guiding their journeys before encounter, providing an appropriate chemical environment for fertilization, supplying nutriment to the fertilized ovum for its first few hours of life, and delivering it…

Endometrial Stromal Tumors, Mixed Müllerian Tumors, Adenomyosis, Adenomyomas and Rare Sarcomas

Endometrial Stromal Tumors Introduction Even though endometrial stromal tumors represent the second most common category of mesenchymal tumors of the uterus, they are rare and account for less than 1% of all uterine tumors. Endometrial stromal and related tumors are defined by the latest classification into the following four main categories based on resemblance to (or lack of) proliferative-type endometrial stroma: (1) endometrial stromal nodule, (2)…

Uterine Smooth Muscle Tumors

Introduction Smooth muscle tumors of the uterus are very common and the vast majority are benign leiomyomas. In contrast, leiomyosarcomas are rare and constitute only 1.3% of uterine malignancies ( Figure 19.1 ). Nevertheless, leiomyosarcoma is the most frequent malignant mesenchymal tumor of the uterus, accounting for almost 60% of uterine sarcomas. Whereas almost all leiomyosarcomas are high-grade tumors and their diagnosis is straightforward, a small…

Endometrial Adenocarcinoma

Introduction Endometrial adenocarcinomas are a heterogeneous group of tumors derived from endometrial glandular epithelial cells. Most maintain a resemblance to endometrial glands (‘endometrioid’) but even in these cases mucinous or squamous differentiation occurs frequently. A much less common group of endometrial carcinomas shows non-endometrioid histology and includes clear cell and serous carcinomas. This chapter provides an overview of current diagnostic criteria as well as relevant molecular…

Endometrial Hyperplasia without Atypia and EIN

Introduction and Terminology The meaningful resolution of endometrial hyperplasias, a mixed group of diseases, has challenged pathologists for decades. Long envisioned as a continuous spectrum of morphologic changes of increasing severity, in reality they encompass only two discrete disease states, which can and should be diagnosed independently of carcinoma ( Table 17.1 ). This consensus has now been endorsed by the Clinical Practice Committee of the…

Endometritis, Metaplasias, Polyps, and Miscellaneous Changes

Inflammatory and Infectious Processes Infections of the gynecologic tract are relatively common, and cause an enormous health impact. It is estimated that there are 19 million cases of sexually transmitted diseases (STDs) in the United States, with a total healthcare cost of roughly $16.4 billion. These infections can be both symptomatic and asymptomatic, and it is believed that up to 24,000 cases of infertility in the…

Exogenous Hormones and their Effects on the Endometrium

Introduction Exogenous hormonal agents represent one of the most commonly prescribed medications in women. Hormonal therapies are used for a wide range of indications, including birth control, postmenopausal hormone replacement, dysfunctional uterine bleeding, endometriosis, infertility, and the treatment of malignant and premalignant lesions of the endometrium and breast. These drugs can be administered by many methods, including oral, parenteral, transdermal, transvaginal, and subcutaneous, vaginal, or intrauterine…

The Normal Endometrium

Components of the Normal Endometrium The mucosal lining of the uterus consists of glands, stroma, and blood vessels. The function of the endometrium is to form a receptive site for pregnancy. This is initially accomplished through a nutrient effect of the glands and their secretions on the blastocyst in the 24 hours or so before implantation takes place (on or about day 7 post ovulation). Once…

Miscellaneous Cervical Neoplasms

Epithelial Tumors Adenoid Basal Carcinoma (Adenoid Basal Epithelioma) Definition Adenoid basal carcinoma (adenoid basal epithelioma) is composed of bland, uniform, basaloid cells arranged in nests with a variable amount of glandular and squamous differentiation. Based on their favorable outcome, there is a proposal to designate this tumor as ‘epithelioma,’ rather than carcinoma. General Features Adenoid basal carcinoma (epithelioma) accounts for less than 1% of cervical cancers…

Cervical Glandular Neoplasia

Preinvasive Glandular Lesions Terminology In keeping with the terminology used for squamous cervical intraepithelial neoplasia (CIN), earlier investigators recognized three grades of cervical glandular intraepithelial neoplasia (CGIN), but this has proven unrealistic. Three grades (glandular atypia, glandular dysplasia, and atypical hyperplasia), with only subtle differences among them, are not reproducible, and far less so than for corresponding squamous lesions. Even squamous intraepithelial lesions, in the Bethesda…

Cervical Squamous Cell Carcinoma

Epidemiology and Staging Epidemiology Cancer of the cervix is the second most common cancer in women worldwide after cancer of the breast. Each year, approximately 529,828 new cases are diagnosed worldwide. In the United States in 2012, cervical cancer was a distant third most common neoplasm of the female genital tract (12,170 cases, or about 14% of all genital cancers), after endometrium (47,130 cases) and ovary…

Cervical Squamous Intraepithelial Lesions

Introduction Human papillomavirus (HPV) infection is now understood to be the underlying cause of squamous carcinogenesis in the cervix. Older diagnostic classifications of preinvasive disease based purely on descriptive correlation of histology with clinical behavior included dysplasia/carcinoma in situ (CIS; a four-grade system) and cervical intraepithelial neoplasia (CIN; a three-grade system). Each provided a convenient diagnostic spectrum against which patient samples could be matched, and both…

Biology of Cervical Squamous Neoplasia

Introduction In the past half-century, cytologic screening, particularly in high-resource settings, has dramatically decreased the burden of squamous cervical cancers, virtually all of which are caused by tissue-specific, persistent infection with human papillomavirus (HPV). The elucidation of the infectious etiology of this disease led to a Nobel Prize in 2008, and to development of preventative vaccines that became commercially available in 2006. This was a public…

Cervical Benign and Non-Neoplastic Conditions

Normal Structure Anatomy The cervix is the lower part of the uterus. A fibromuscular junction, usually referred to as the internal cervical os, marks the junction between the muscular corpus and the predominantly fibrous cervix. The cervix projects into the vagina at the vaginal vault and has supravaginal and vaginal portions of approximately equal lengths. The folds of mucosa between vagina and cervix are known as…