Atlas of Gynecologic Pathology A Pattern-Based Approach, First edition

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Atlas of Gynecologic Pathology A Pattern-Based Approach, First edition

Editore

Wolters Kluwer

Anno

2023

Pagine

746

ISBN

9781975124762

I prezzi indicati possono subire variazioni poiché soggetti all'oscillazione dei cambi delle valute e/o agli aggiornamenti effettuati dagli Editori.

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Closely mirroring the daily sign-out process, Atlas of Gynecologic Pathology: A Pattern-Based Approach, by Dr. Tricia A. Numan (co-author of Diagnosis of Endometrial Biopsies and Curettings, A Practical Approach), is a highly illustrated, efficient guide to accurate diagnosis. This practical reference uses a proven, pattern-based approach to clearly explain how to interpret challenging cases by highlighting red flags in the clinical chart and locating hidden clues in the slides. Useful as a daily “scope-side guide,” it features numerous clinical and educational features that help you find pertinent information, reach a correct diagnosis, and assemble a thorough and streamlined pathology report.

More than 1,400 high-quality photomicrographs capture the subtle morphologic spectrum and if applicable, pertinent immunohistochemical staining patterns encountered in gynecologic pathology, including variations of tumor types, non-tumor pathology, artifacts, and normal histology. Each image is captioned with key diagnostic considerations and includes call-outs showing subtle features and diagnostic clues.
Practical tools throughout the text include:
- Tables that emphasize salient clinicopathologic features, management implications, and therapeutic options
- Discussions of how and when to incorporate molecular tools
- Checklists for key elements of the diagnostic approach and sample notes for inclusion in pathology reports
- Relevant diagnostic algorithms
- Brief reviews of normal histology that provide contrast to succeeding patterns
- “Pearls and Pitfalls” and “Near Misses” sections with lessons from real life sign-out experience
- “Frequently Asked Questions” sections that discuss common diagnostic dilemmas
- “Sample Note” sections that offer a template of how to synthesize complicated or especially challenging topics
- Comprehensive quiz provides experience with high-yield, board-style teaching topics

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1 VULVA.............................................................................................................1
Unremarkable Vulvar Histology......................................................................3
The Mons Pubis...................................................................................................3
Labia Majora........................................................................................................4
Labia Minora........................................................................................................5
Clitoris.................................................................................................................. 5
Vulvar Vestibule....................................................................................................5
Urethral Meatus....................................................................................................5
Infectious Diseases..........................................................................................6
Fungal Infections..................................................................................................6
Viral Infections......................................................................................................6
Bacterial Infections.............................................................................................11
Parasitic Infestations...........................................................................................14
Noninfectious Inflammatory Lesions.............................................................14
Interface............................................................................................................. 14
Graft-Versus-Host Disease.................................................................................17
Psoriasiform. ...................................................................................................... 17
Spongiotic.......................................................................................................... 18
Granulomatous. ................................................................................................. 19
Other.................................................................................................................. 19
Nonneoplastic Changes................................................................................21
Vulvodynia.......................................................................................................... 21
Endometriosis.................................................................................................... 22
Adenosis. ........................................................................................................... 22
Vulvar Cysts...................................................................................................22
Follicular Cyst/Epithelial Inclusion Cyst.............................................................22
Mucinous and Ciliated Vestibular Cysts.............................................................23
Bartholin Duct Cyst............................................................................................23
Cysts of the Canal of Nuck.................................................................................23
Mammary-like Cysts (Hidrocystoma)..................................................................23
Genital Stromal Tumors................................................................................24
Fibroepithelial Polyp..........................................................................................24
Superficial Myofibroblastoma............................................................................24
Cellular Angiofibroma........................................................................................27
Angiomyofibroblastoma. ................................................................................... 28
Deep (Aggressive) Angiomyxoma.....................................................................29
Squamous Precursor and Malignant Lesions................................................30
Vulvar Intraepithelial Neoplasia.........................................................................30
Differentiated Vulvar Intraepithelial Neoplasia..................................................34
Differentiated Exophytic Vulvar Intraepithelial Lesion.......................................35
Squamous Cell Carcinoma and Variants............................................................36
Basal Cell Carcinoma.........................................................................................44
Extramammary Paget Disease...........................................................................45
Anogenital Mammary-like Glandular Lesions...............................................48
Anogenital Mammary-like Glands......................................................................48
Hidradenoma Papilliferum.................................................................................48
Fibroadenoma.................................................................................................... 50
Phyllodes Tumor................................................................................................52
Adenocarcinoma of Mammary Type..................................................................52

Glandular Lesions..........................................................................................52
Bartholin Gland Carcinoma................................................................................52
Neuroendocrine Neoplasia...........................................................................53
Neuroendocrine Tumors....................................................................................53
Neuroendocrine Carcinoma...............................................................................53
Pigmented Lesions........................................................................................55
Vulvar Melanosis................................................................................................55
Common Acquired Nevus.................................................................................56
Atypical Genital Nevi.........................................................................................56
Malignant Melanoma.........................................................................................57
Mesenchymal Lesions...................................................................................59
Leiomyoma. ....................................................................................................... 59
Leiomyosarcoma................................................................................................ 59
Rhabdomyosarcoma.......................................................................................... 59
Alveolar Soft Part Sarcoma................................................................................60
Dermatofibrosarcoma Protuberans....................................................................61
Epithelioid Sarcoma...........................................................................................62
Skin Adnexal Lesions....................................................................................63
Sebaceous Gland Hyperplasia...........................................................................63
Syringoma.......................................................................................................... 63
Other Tumors................................................................................................63
Granular Cell Tumor...........................................................................................63
Yolk Sac Tumor...................................................................................................64
Near Miss......................................................................................................65
2 VAGINA........................................................................................................89
Unremarkable Vaginal Histology...................................................................90
Infectious Disorders......................................................................................90
Vaginal Cysts.................................................................................................91
Müllerian Cysts...................................................................................................91
Gartner (Mesonephric) Cysts..............................................................................93
Bartholin Duct Cyst............................................................................................93
Skene Duct Cyst/Skene Gland Cyst...................................................................95
Squamous Inclusion Cyst/Epithelial Inclusion Cyst............................................95
Benign Polyps...............................................................................................96
Tubulosquamous Polyp......................................................................................96
Fibroepithelial Polyp..........................................................................................97
Cellular Pseudosarcomatous Fibroepithelial Polyp............................................98
Epithelial Lesions..........................................................................................99
Human Papillomavirus–Associated Squamous Lesions.....................................99
Benign Glandular Lesions................................................................................104
Malignant Glandular Tumors............................................................................108
Mixed Tumor (Spindle Cell Epithelioma)....................................................110
Mesenchymal Lesions.................................................................................112
Rhabdomyoma................................................................................................. 112
Leiomyoma. ..................................................................................................... 114
Leiomyosarcoma.............................................................................................. 115
Embryonal Rhabdomyosarcoma, Botryoid Type..............................................115
Genital Stromal Tumors..............................................................................118
Malignant Melanoma..................................................................................118
Postoperative Spindle Cell Nodule............................................................121
Near Miss....................................................................................................122
3 CERVIX.......................................................................................................131
Unremarkable Cervical Histology...............................................................133
Squamous Epithelium......................................................................................133
Endocervical Glandular Epithelium..................................................................134

Transformation Zone........................................................................................135
Changes in the Transformation Zone due to Squamous Epithelialization
and Squamous Metaplasia..............................................................................135
Cervical Stroma................................................................................................136
Noninfectious Inflammatory Changes........................................................137
Follicular Cervicitis and Russell Body Cervicitis...............................................137
Papillary Endocervicitis....................................................................................138
Inflammatory Changes Related to Infectious Diseases...............................139
Protozoal Causes of Cervicitis..........................................................................139
Bacterial Causes of Cervicitis...........................................................................139
Viral Causes of Cervicitis..................................................................................140
Fungal Disease.................................................................................................141
Cysts............................................................................................................ 141
Nabothian Cyst................................................................................................141
Polyps and Pseudopolyps...........................................................................143
Endocervical Polyp...........................................................................................143
Fibroepithelial Polyp........................................................................................144
Metaplasia................................................................................................... 144
Squamous Metaplasia......................................................................................144
Tubal/Tuboendometrioid Metaplasia...............................................................144
Transitional Cell Metaplasia.............................................................................145
Endocervical Glandular Hyperplasia...........................................................146
Microglandular Hyperplasia.............................................................................146
Tunnel Clusters.................................................................................................147
Lobular Endocervical Glandular Hyperplasia...................................................148
Diffuse Laminar Endocervical Glandular Hyperplasia......................................149
Melanocytic Lesions....................................................................................149
Blue Nevus.......................................................................................................149
Mucosal Melanosis...........................................................................................149
Miscellaneous Benign Lesions....................................................................150
Endometriosis.................................................................................................. 150
Endocervicosis................................................................................................. 150
Pregnancy-Related Changes.......................................................................150
Decidual Reaction or Decidual Pseudopolyp..................................................150
Arias-Stella Reaction........................................................................................151
Placental Site Trophoblastic Nodule................................................................153
Reactive and Reparative Lesions................................................................153
Radiation-Induced Atypia................................................................................153
Postoperative Spindle Cell Nodule..................................................................153
Florid Reactive Lymphoid Hyperplasia............................................................153
Mesenchymal Lesions, Benign and Malignant............................................154
Superficial Myofibroblastoma..........................................................................154
Leiomyoma. ..................................................................................................... 155
Adenomyoma. ................................................................................................. 155
Papillary Adenofibroma...................................................................................155
Adenosarcoma................................................................................................. 155
Mesonephric Remnants and Lesions..........................................................157
Mesonephric Remnants...................................................................................157
Mesonephric Hyperplasia................................................................................157
Adenocarcinoma, HPV-independent, Mesonephric Type,
of the Uterine Cervix.......................................................................................158
Squamous Precursor and Malignant Lesions..............................................160
Human Papillomavirus.....................................................................................160
Low-Grade Squamous Intraepithelial Lesion...................................................161
High-Grade Squamous Intraepithelial Lesion..................................................164
Superficially Invasive Squamous Cell Carcinoma.............................................167
Squamous Cell Carcinoma...............................................................................170
Morphologic Patterns of Squamous Cell Carcinoma.......................................172

Glandular Precursor Lesions and Malignant Tumors..................................177
Adenocarcinoma In Situ...................................................................................177
Histologic Variants of Endocervical Adenocarcinoma In Situ...........................179
Endocervical Adenocarcinoma, HPV-Associated.............................................182
Pattern-Based Classification of Endocervical Adenocarcinoma,
HPV-Associated............................................................................................... 185
Adenocarcinoma of the Cervix, HPV-independent, Gastric Type....................193
Adenoid Basal Lesions................................................................................195
Adenoid Basal Hyperplasia..............................................................................195
Adenoid Basal Cell Carcinoma........................................................................195
Adenoid Cystic Carcinoma..............................................................................197
Miscellaneous Tumors of the Cervix...........................................................198
Endometrioid Adenocarcinoma of the Cervix.................................................198
Clear Cell Carcinoma of the Cervix..................................................................200
Adenosquamous Carcinoma............................................................................200
Glassy Cell Carcinoma.....................................................................................201
Neuroendocrine Tumors of the Cervix.............................................................201
Low-Grade Neuroendocrine Tumors of the Cervix..........................................202
High-Grade Neuroendocrine Carcinomas of the Cervix..................................202
Near Miss....................................................................................................204
4 NONNEOPLASTIC AND NEOPLASTIC LESIONS
OF THE ENDOMETRIUM..........................................................................233
The Unremarkable Endometrium...............................................................235
Premenarchal Endometrium.......................................................................236
Endometrial Changes During Reproductive Years.....................................236
Menstrual Phase...............................................................................................236
Proliferative Phase............................................................................................237
Interval Phase...................................................................................................237
Secretory Phase...............................................................................................240
Postmenopausal Endometrium...................................................................244
Abnormal Uterine Bleeding........................................................................244
Disordered Proliferative Endometrium.......................................................247
Nonneoplastic Changes..............................................................................247
Artifacts in Endometrial Biopsies and Curettage Specimens...........................247
Epithelial Metaplasias (Epithelial Cell Change)................................................251
Inflammatory Changes................................................................................258
Endometritis..................................................................................................... 258
Hormone-Induced Changes........................................................................263
Arias-Stella Reaction........................................................................................263
Exogenous Hormone Therapy Effect...............................................................264
Benign Polyps.............................................................................................268
Endometrial Polyps..........................................................................................268
Endometrial Polyp With Bizarre Stromal Cells.................................................271
Tamoxifen-Associated Endometrial Polyp.......................................................273
Papillary Proliferations......................................................................................274
Precancerous Lesions..................................................................................276
Endometrial Hyperplasia/Atypical Hyperplasia...............................................276
Serous Endometrial Intraepithelial Carcinoma.................................................283
Clear Cell Endometrial Intraepithelial Carcinoma............................................287
Endometrial Carcinoma..............................................................................288
Endometrioid Carcinoma.................................................................................289
Serous Carcinoma............................................................................................309
Clear Cell Carcinoma.......................................................................................313
Carcinosarcoma. .............................................................................................. 319
Undifferentiated Carcinoma.............................................................................322
Dedifferentiated Carcinoma.............................................................................324

Other........................................................................................................... 325
Mesonephric-Like Adenocarcinoma................................................................325
Mucinous Carcinoma, Gastric (Gastrointestinal) Type......................................325
Squamous Cell Carcinoma...............................................................................327
Neuroendocrine Neoplasms............................................................................327
Neuroepithelial Tumors....................................................................................330
Near Miss....................................................................................................330
5 MESENCHYMAL AND MISCELLANEOUS TUMORS
OF THE UTERUS.......................................................................................355
The Unremarkable Mesenchymal Tissue of the Uterus..............................356
Endometrial Stroma.........................................................................................356
Myometrial Smooth Muscle.............................................................................358
Smooth Muscle Tumors..............................................................................358
Leiomyoma. ..................................................................................................... 358
Fumarate Hydratase–Deficient Leiomyoma.....................................................363
Smooth Muscle Tumor of Uncertain Malignant Potential................................365
Leiomyosarcoma.............................................................................................. 365
Perivascular Epithelioid Cell Tumor.................................................................371
Endometrial Stromal Tumors......................................................................374
Endometrial Stromal Nodule...........................................................................374
Low-Grade Endometrial Stromal Sarcoma.......................................................378
High-Grade Endometrial Stromal Sarcoma......................................................378
YWHAE-NUTM2A/B High-Grade Endometrial Stromal Sarcoma....................379
ZC3H7B-BCOR High-Grade Endometrial Stromal Sarcoma............................379
Undifferentiated Uterine Sarcoma...................................................................380
Uterine Tumor Resembling Ovarian Sex Cord Tumor................................380
Mixed Epithelial-Mesenchymal Tumors......................................................384
Atypical Polypoid Adenomyoma.....................................................................384
Adenofibroma.................................................................................................. 386
Adenosarcoma................................................................................................. 387
Other Mesenchymal Tumors.......................................................................391
Inflammatory Myofibroblastic Tumor...............................................................391
Miscellaneous Tumors.................................................................................392
Near Miss....................................................................................................392
6 FALLOPIAN TUBE..........................................................................................403
The Unremarkable Fallopian Tube..............................................................404
Fallopian Tube Grossing Protocols.............................................................405
Inflammatory Processes..............................................................................406
Bacterial Infections...........................................................................................406
Tuberculosis. .................................................................................................... 408
Pseudocarcinomatous Hyperplasia..................................................................409
Xanthogranulomatous/Pseudoxanthomatous Salpingitis................................410
Benign Nonneoplastic Processes................................................................410
Decidual Reaction............................................................................................410
Walthard Cell Nests.........................................................................................411
Metaplastic Changes.......................................................................................411
Metaplastic Papillary Tumor.............................................................................413
Salpingitis Isthmica Nodosa.............................................................................413
Mesothelial Tumors.....................................................................................414
Adenomatoid Tumor........................................................................................414
Benign Cysts...............................................................................................415
Paratubal Cysts................................................................................................415
Benign Epithelial Lesions............................................................................416
Papillary Tubal Hyperplasia..............................................................................416
Benign Epithelial Tumors............................................................................417
Papilloma......................................................................................................... 417
Serous Adenofibroma......................................................................................417

Hereditary Breast and Ovarian Cancer Syndrome......................................418
Epithelial Precursor Lesions........................................................................418
p53 Signature...................................................................................................419
Serous Tubal Intraepithelial Lesion..................................................................420
Serous Tubal Intraepithelial Carcinoma...........................................................420
Secretory Cell Outgrowths...............................................................................424
Epithelial Borderline Tumors.......................................................................424
Atypical Proliferative (Borderline) Serous Tumor..............................................424
Malignant Epithelial Tumors.......................................................................424
High-Grade Serous Carcinoma........................................................................424
Endometrioid Carcinoma.................................................................................426
Paratubal Tumors........................................................................................426
Female Adnexal Tumor of Probable Wolffian Origin.......................................426
Near Miss....................................................................................................428
7 BENIGN OVARY.........................................................................................437
Embryology................................................................................................. 438
The Unremarkable Ovary............................................................................438
Ovarian Surface................................................................................................438
Ovarian Stroma................................................................................................439
Hilus................................................................................................................. 440
Rete Ovarii.......................................................................................................440
Follicles. ...................................................................................................... 441
Folliculogenesis. .............................................................................................. 441
Cystic Follicles and Follicle Cysts.....................................................................442
Corpus Luteum................................................................................................443
Corpus Luteum Cyst........................................................................................444
Atretic Follicles.................................................................................................445
Ovarian Surface Epithelium........................................................................445
Epithelial Inclusion Glands and Cysts..............................................................445
Reactive Mesothelial Proliferation....................................................................447
Walthard Cell Nest...........................................................................................447
Polycystic Ovary..........................................................................................447
Stromal Endometriosis................................................................................449
Decidual Reaction.......................................................................................450
Cortical Granuloma.....................................................................................451
Surface Stromal Proliferation......................................................................451
Stromal Hyperplasia and Stromal Hyperthecosis.......................................452
Cortical Fibrosis..........................................................................................454
Ovarian Torsion, Massive Edema, and Fibromatosis..................................454
Hilus. ........................................................................................................... 456
Rete Cyst and Cystadenomas..........................................................................456
Hilus Cells and Hilus Cell Hyperplasia.............................................................457
Pregnancy-Related Findings.......................................................................457
Pregnancy Luteoma.........................................................................................457
Hyperreactio Luteinalis (Multiple Luteinized Follicle Cysts).............................459
Large Solitary Luteinized Follicle Cyst of Pregnancy and Puerperium.............459
Granulosa Cell Proliferations of Pregnancy......................................................460
Near Miss....................................................................................................462
8 OVARIAN EPITHELIAL TUMORS...............................................................469
Serous Tumors.............................................................................................470
Benign Serous Tumors.....................................................................................470
Atypical Proliferative (Borderline) Serous Tumor..............................................472
Peritoneal Lesions Including Endosalpingiosis,
Noninvasive Peritoneal Implants, and Invasive Peritoneal Implants
(Low-Grade Serous Carcinoma).......................................................................477

Lymph Nodes...................................................................................................480
Malignant Serous Tumors.................................................................................481
Mucinous Tumors........................................................................................494
Benign Mucinous Tumors.................................................................................495
Atypical Proliferative (Borderline) Mucinous Tumor.........................................497
Mucinous Tumors With Mural Nodules............................................................500
Atypical Proliferative (Borderline) Seromucinous
(Endocervical-Like or Müllerian) Tumors.........................................................500
Malignant Mucinous Tumors............................................................................503
Endometrioid Tumors.................................................................................511
Benign Endometrioid Tumors..........................................................................511
Atypical Proliferative (Borderline) Endometrioid Tumor...................................513
Endometrioid Carcinoma.................................................................................514
Clear Cell Tumors........................................................................................524
Clear Cell Adenofibroma.................................................................................524
Atypical Proliferative (Borderline) Clear Cell Tumor.........................................524
Clear Cell Carcinoma.......................................................................................525
Brenner (Transitional Cell) Tumors..............................................................532
Benign Brenner Tumor.....................................................................................532
Atypical Proliferative (Borderline) Brenner (Transitional Cell) Tumor................534
Malignant Brenner Tumors (Malignant Transitional Cell Tumors).....................535
Squamous Tumors.......................................................................................537
Benign Squamous Tumors (Epidermoid Cyst).................................................537
Squamous Cell Carcinoma...............................................................................537
Carcinosarcoma. ......................................................................................... 538
Undifferentiated Carcinoma and Dedifferentiated Carcinoma...................539
Mesonephric-Like Adenocarcinoma...........................................................539
Near Miss....................................................................................................540
9 OVARIAN GERM CELL TUMORS...............................................................555
Primitive Germ Cell Tumors........................................................................556
Dysgerminoma................................................................................................. 556
Yolk Sac Tumor.................................................................................................559
Embryonal Carcinoma......................................................................................569
Polyembryoma................................................................................................. 572
Nongestational Choriocarcinoma....................................................................573
Teratoma..................................................................................................... 574
Mature Cystic Teratoma...................................................................................575
Mature Solid Teratoma.....................................................................................578
Gliomatosis Peritonei.......................................................................................578
Immature Teratoma..........................................................................................578
Chemotherapeutic Retroconversion and the Growing
Teratoma Syndrome........................................................................................582
Mixed Germ Cell Tumors............................................................................582
Monodermal Teratomas and Somatic-Type Tumors Arising
From a Teratoma........................................................................................583
Struma Ovarii...................................................................................................583
Thyroid-Type Tumors Arising in Struma Ovarii.................................................585
Carcinoid Tumor...............................................................................................585
Insular Carcinoid..............................................................................................588
Trabecular Carcinoid........................................................................................588
Strumal Carcinoid.............................................................................................589
Mucinous Carcinoid.........................................................................................591
Mucinous Tumors Arising in Mature Teratomas...............................................591
Sebaceous Tumors...........................................................................................593
Neuroepithelial Tumors....................................................................................594
Malignant Transformation of a Mature Teratoma.............................................596

Gestational Trophoblastic Neoplasms........................................................690
Choriocarcinoma.............................................................................................. 691
Placental Site Trophoblastic Tumor..................................................................693
Epithelioid Trophoblastic Tumor......................................................................697
Near Miss....................................................................................................701
APPENDIX A: ATLAS OF GYNECOLOGIC PATHOLOGY
STUDY QUESTIONS707
APPENDIX B: ATLAS OF GYNECOLOGIC PATHOLOGY
STUDY QUESTIONS: ANSWERS725
INDEX747

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