BOOK
Diagnostic Gynecologic and Obstetric Pathology E-Book
Christopher P. Crum | Marisa R. Nucci | Scott R. Granter | Brooke E. Howitt | Mana M. Parast | Theonia Boyd | Kenneth R. Lee | William A Peters III
(2017)
Additional Information
Book Details
Abstract
Comprehensive and practice-oriented, the fully updated 3rd Edition of this easy-to-use text covers the full range of obstetric and gynecologic pathology, including information on treatment and patient management. Written largely by the pathology and clinical faculty at Harvard's Brigham and Women's Hospital, it covers the most up-to-date information available in the field, including molecular genetics and diagnostics. Drs. Christopher P. Crum and Marisa R. Nucci are joined by new editors Scott R. Granter, Brooke E. Howitt, Mana M. Parast, and Theonia K. Boyd, to provide complete, beautifully illustrated coverage of both neoplastic and non-neoplastic disorders of the female genital system, ideal for improving pathological diagnosis.
- Provides distinct diagnostic/differential diagnostic criteria for any potential obstetric/gynecologic specimen encountered in practice.
- Features more than 2,250 full-color images, key points at the end of each chapter, and an appendix with commonly used ICD-10 codes
- Covers topics not often found in gynecologic pathology textbooks, such as vulvodynia, and diseases of the anus.
- Approaches topics from a practice-oriented point of view, beginning with clinical presentation and progressing through histopathology, differential diagnosis, and treatment for each disorder.
- Emphasizes new practice issues and their biologic basis including approaches to vulvar, cervical and endometrial precursors as well as the underpinnings of cervical, endometrial and ovarian cancer.
- A comprehensive look at mesenchymal neoplasia, including not only lower genital tract and uterus but also the retroperitoneum.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Diagnostic Gynecologic and Obstetric Pathology | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vi | ||
| Preface | ix | ||
| Acknowledgments | x | ||
| Table Of Contents | xi | ||
| 1 Female Genital Tract Development and Disorders of Childhood | 1 | ||
| Abstract | 1.e1 | ||
| Keywords | 1.e1 | ||
| Chapter Outline | 1 | ||
| Overview of Reproductive Tract Development | 1 | ||
| The Genital Ridge | 1 | ||
| Ovary Development and Sex Determination | 1 | ||
| The Uterus and Vagina | 5 | ||
| The External Genitalia | 8 | ||
| Common Disorders of Gonadal and Genital Tract Development | 9 | ||
| The Ovary and Fallopian Tube | 9 | ||
| Developmental Abnormalities | 9 | ||
| Ovarian Hypoplasia | 9 | ||
| Pathogenesis | 9 | ||
| 2 Noninfectious Inflammatory Disorders of the Vulva | 22 | ||
| Abstract | 22.e1 | ||
| Keywords | 22.e1 | ||
| Chapter Outline | 22 | ||
| Introduction | 22 | ||
| Types of Disorders | 22 | ||
| Eczematous Dermatitis | 22 | ||
| Clinical Presentation | 23 | ||
| Major Clinical Subtypes of Eczematous Dermatitis | 23 | ||
| Exogenous Dermatitis | 23 | ||
| Irritant Contact Dermatitis. | 24 | ||
| Allergic Contact Dermatitis. | 24 | ||
| Atopic Dermatitis | 24 | ||
| Nummular Dermatitis | 25 | ||
| Histopathology | 25 | ||
| Differential Diagnosis | 25 | ||
| Lichen Simplex Chronicus | 26 | ||
| Clinical Presentation | 26 | ||
| Histopathology | 26 | ||
| Differential Diagnosis | 27 | ||
| Treatment | 27 | ||
| Psoriasis | 27 | ||
| Clinical Presentation | 27 | ||
| Histopathology | 28 | ||
| Differential Diagnosis | 29 | ||
| Treatment | 29 | ||
| Reiter Syndrome | 30 | ||
| Clinical Presentation | 30 | ||
| Histopathology | 30 | ||
| Differential Diagnosis | 30 | ||
| Treatment | 30 | ||
| Seborrheic Dermatitis | 30 | ||
| Risk Factors and Clinical Presentation | 30 | ||
| Histopathology | 31 | ||
| Differential Diagnosis | 31 | ||
| Treatment | 31 | ||
| Lichen Sclerosus | 31 | ||
| Clinical Presentation | 31 | ||
| Histopathology | 32 | ||
| Differential Diagnosis | 33 | ||
| Cancer Risk | 34 | ||
| Treatment | 34 | ||
| Lichen Planus | 34 | ||
| Clinical Presentation | 34 | ||
| Histopathology | 35 | ||
| Differential Diagnosis | 36 | ||
| Treatment | 36 | ||
| Zoon Vulvitis (Plasma Cell Vulvitis) | 37 | ||
| Clinical Presentation | 37 | ||
| Histopathology | 37 | ||
| Differential Diagnosis | 37 | ||
| Treatment | 38 | ||
| Bullous and Cicatricial Pemphigoid | 38 | ||
| Bullous Pemphigoid | 38 | ||
| Cicatricial Pemphigoid | 38 | ||
| Histopathology | 39 | ||
| Differential Diagnosis | 39 | ||
| Treatment | 39 | ||
| Pemphigus Vulgaris and Pemphigus Vegetans | 40 | ||
| Clinical Presentation | 40 | ||
| Histopathology | 40 | ||
| Differential Diagnosis | 40 | ||
| Treatment | 41 | ||
| Hailey-Hailey Disease | 41 | ||
| Clinical Presentation | 41 | ||
| Histopathology | 41 | ||
| 3 Localized Vulvodynia | 53 | ||
| Abstract | 53.e1 | ||
| Keywords | 53.e1 | ||
| Chapter Outline | 53 | ||
| Introduction | 53 | ||
| History of Vulvar Pain Terminology | 53 | ||
| Causative Theories of Vulvodynia | 53 | ||
| Embryologic Development | 53 | ||
| Infection With Candida | 54 | ||
| Inflammation | 55 | ||
| Genetic and Immune Factors | 55 | ||
| Neuropathways | 56 | ||
| Human Papillomavirus | 56 | ||
| Steroid Receptor Pathways | 56 | ||
| Increased Muscle Tone | 56 | ||
| Histopathology | 56 | ||
| Treatment of Localized Vulvodynia | 58 | ||
| Key Points | 58 | ||
| References | 59 | ||
| 4 Infectious Disorders of the Lower Genital Tract | 62 | ||
| Abstract | 62.e1 | ||
| Keywords | 62.e1 | ||
| Chapter Outline | 62 | ||
| Introduction | 62 | ||
| Common Infections | 62 | ||
| Pediculosis Pubis (Crab Lice) | 62 | ||
| Clinical Background | 62 | ||
| 5 Benign Cysts, Rests, and Adnexal Tumors of the Vulva | 101 | ||
| Abstract | 101.e1 | ||
| Keywords | 101.e1 | ||
| Chapter Outline | 101 | ||
| Introduction | 101 | ||
| Benign Cysts | 101 | ||
| Bartholin Duct Cyst | 101 | ||
| 6 Squamous Neoplasia of the Vulva | 114 | ||
| Abstract | 114.e1 | ||
| Keywords | 114.e1 | ||
| Chapter Outline | 114 | ||
| Introduction | 114 | ||
| Low-Grade Squamous Intraepithelial Lesions | 114 | ||
| Condyloma Acuminatum | 114 | ||
| Relevant Historical/Clinical Background | 114 | ||
| Clinical Presentation and Gross Exam | 115 | ||
| Key Questions | 115 | ||
| Diagnostic Criteria | 115 | ||
| Immunohistochemistry and Special Studies | 118 | ||
| Differential Diagnosis and Potential Pitfalls | 119 | ||
| Proposed Report Wording With Diagnostic Terms | 120 | ||
| Clinical Correlates, Management and Prevention | 120 | ||
| Pediatric Complications of Human Papillomavirus Infection | 120 | ||
| Genital Warts | 120 | ||
| Recurrent Respiratory Papillomatosis | 123 | ||
| High-Grade Squamous Intraepithelial Lesions | 124 | ||
| Classic (Usual) High-Grade Squamous Intraepithelial Lesion (VIN II/VIN III) | 124 | ||
| Background | 124 | ||
| Clinical and Gross Exam, Including Pitfalls | 124 | ||
| Key Histologic Questions Faced by the Pathologist | 124 | ||
| Diagnostic Criteria | 124 | ||
| Immunohistochemistry and Special Studies | 128 | ||
| Differential Diagnosis | 130 | ||
| Terminology | 131 | ||
| Natural History and Outcome | 131 | ||
| Clinical Management | 131 | ||
| Differentiated High-Grade Squamous Intraepithelial Lesion or Differentiated Vulvar Intraepithelial Neoplasia | 131 | ||
| Background | 131 | ||
| Clinical Presentation and Gross Exam | 131 | ||
| Frozen Section Issues | 132 | ||
| Key Histologic Questions Faced by the Pathologist | 132 | ||
| Diagnostic Criteria | 132 | ||
| Immunohistochemistry and Special Studies | 134 | ||
| p53 Staining and Differentiated Vulvar Intraepithelial Neoplasia | 134 | ||
| p53 Staining in “Early” Differentiated Vulvar Intraepithelial Neoplasia and Normal Mucosa | 134 | ||
| Differential Diagnosis | 137 | ||
| Diagnostic Terminology | 138 | ||
| Natural History and Management | 138 | ||
| Differentiated Exophytic Vulvar/Squamous Intraepithelial Lesions | 138 | ||
| Background | 138 | ||
| Diagnostic Categories of Differentiated Exophytic Squamous Intraepithelial Lesion | 138 | ||
| Immunohistochemistry and Other Biomarkers | 140 | ||
| Differential Diagnosis and Potential Pitfalls | 140 | ||
| Proposed Report Wording With Diagnostic Term | 142 | ||
| Clinical Correlates/Tumor Board/Management Pitfalls (Where Appropriate) | 142 | ||
| Squamous Cell Carcinoma | 142 | ||
| Background | 142 | ||
| Clinical Presentation and Gross Exam | 142 | ||
| Superficially Invasive Squamous Cell Carcinoma | 142 | ||
| Patterns of Invasion in Squamous Carcinomas | 144 | ||
| Evaluation of the Small Biopsy Containing Suspected Vulvar Carcinoma | 144 | ||
| HPV-Associated Squamous Cell Carcinoma | 144 | ||
| Key Diagnostic Questions | 144 | ||
| Diagnostic Criteria | 146 | ||
| Immunohistochemistry | 146 | ||
| HPV-Associated Papillary Squamous Cell Neoplasia | 147 | ||
| Spindle Cell (Sarcomatoid) Squamous Carcinoma | 147 | ||
| HPV-Negative Squamous Cell Carcinomas | 147 | ||
| Key Diagnostic Questions | 147 | ||
| Diagnostic Criteria | 149 | ||
| Mixed Patterns | 150 | ||
| Immunohistochemistry | 150 | ||
| Proposed Report Wording With Diagnostic Terms | 151 | ||
| Differential Diagnosis of Invasive Squamous Carcinomas of the Vulva | 151 | ||
| Outcome Variables in Vulvar Squamous Carcinoma | 151 | ||
| Risk Factors for Adverse Outcome | 151 | ||
| Management | 154 | ||
| Prospects for Prevention | 154 | ||
| Extremely Well-Differentiated Verruco-Papillary Squamous Cell Neoplasms | 154 | ||
| Verrucous Carcinoma | 154 | ||
| Background | 154 | ||
| “Condylomatous” Tumors | 156 | ||
| Keratoacanthomas | 156 | ||
| Other Patterns | 157 | ||
| Basal Cell Carcinoma | 158 | ||
| Background | 158 | ||
| Gross Exam | 158 | ||
| Frozen Section Issues | 158 | ||
| Diagnostic Criteria | 158 | ||
| Immunohistochemistry | 158 | ||
| Differential Diagnosis | 158 | ||
| Management and Outcome | 158 | ||
| Key Points | 159 | ||
| References | 160 | ||
| 7 Glandular and Other Malignancies of the Vulva | 164 | ||
| Abstract | 164.e1 | ||
| Keywords | 164.e1 | ||
| Chapter Oultine | 164 | ||
| Introduction | 164 | ||
| Adenosquamous Carcinoma | 164 | ||
| Background and Clinical Presentation | 164 | ||
| Diagnostic Criteria | 164 | ||
| Differential Diagnosis | 165 | ||
| Management and Outcome | 165 | ||
| Adenocarcinoma | 165 | ||
| Paget Disease | 165 | ||
| Background and Clinical Presentation | 165 | ||
| Diagnostic Criteria | 166 | ||
| Differential Diagnosis | 166 | ||
| Management | 167 | ||
| Carcinoma Arising in Ectopic Breast Tissue | 169 | ||
| Other Adnexal Carcinomas | 172 | ||
| Carcinoma of Bartholin Gland | 172 | ||
| 8 Melanocytic Lesions of the Vulva | 181 | ||
| Abstract | 181.e1 | ||
| Keywords | 181.e1 | ||
| Chapter Outline | 181 | ||
| Introduction | 181 | ||
| Evaluation of Pigmentation | 181 | ||
| Genital Melanosis (Genital Melanotic Macule) | 181 | ||
| Clinical Features | 181 | ||
| Histopathology | 181 | ||
| Genital-Type Nevus | 183 | ||
| Clinical Features | 183 | ||
| Histologic Features | 183 | ||
| Dysplastic Nevi | 185 | ||
| Clinical Features | 185 | ||
| Histologic Features | 185 | ||
| Melanoma | 187 | ||
| Clinical Features | 187 | ||
| Histologic Features | 188 | ||
| Differential Diagnoses | 188 | ||
| Squamous Carcinomas | 188 | ||
| Extramammary Paget Disease | 188 | ||
| Distinction Between In Situ and Invasive Disease | 188 | ||
| Histologic Staging and Margins | 189 | ||
| Evaluation of Margins | 189 | ||
| Depth of Invasion | 189 | ||
| Sentinel Lymph Node Biopsy | 189 | ||
| Staging and Prognosis | 193 | ||
| Key Points | 194 | ||
| References | 195 | ||
| 9 Soft Tissue Lesions of the Vulva and Vagina | 197 | ||
| Abstract | 197.e1 | ||
| Keywords | 197.e1 | ||
| Chapter Outline | 197 | ||
| Introduction | 197 | ||
| Vulvovaginal Stromal Tumors and Tumor-Like Lesions | 197 | ||
| Fibroepithelial Stromal Polyp | 197 | ||
| Clinical Presentation | 197 | ||
| Pathologic Features | 197 | ||
| Differential Diagnosis | 198 | ||
| Prognosis and Management | 200 | ||
| Angiomyofibroblastoma | 200 | ||
| Clinical Presentation | 200 | ||
| Pathologic Features | 200 | ||
| Differential Diagnosis | 200 | ||
| Prognosis and Management | 201 | ||
| Cellular Angiofibroma | 201 | ||
| Clinical Presentation | 201 | ||
| Pathologic Features | 202 | ||
| Differential Diagnosis | 202 | ||
| Prognosis and Management | 202 | ||
| Mammary-Type Myofibroblastoma | 203 | ||
| 10 Diseases of the Anus | 224 | ||
| Abstract | 224.e1 | ||
| Keywords | 224.e1 | ||
| Chapter Outline | 224 | ||
| Introduction | 224 | ||
| Embryology | 224 | ||
| Anorectal Anomalies | 224 | ||
| Anatomy | 225 | ||
| Colorectal Zone | 226 | ||
| Anal Transitional Zone | 226 | ||
| Squamous Zone | 226 | ||
| Perianal Skin | 227 | ||
| Non-Neoplastic Lesions | 228 | ||
| Perianal Cysts | 228 | ||
| Hemorrhoids | 228 | ||
| Clinical | 228 | ||
| Histology | 228 | ||
| Anal Tags and Fibroepithelial Polyps | 229 | ||
| Inflammatory Polyps | 230 | ||
| Background | 230 | ||
| Clinical and Gross Examination | 230 | ||
| Histology | 230 | ||
| Management and Outcome | 230 | ||
| Anal Fissures and Ulcers | 230 | ||
| Clinical | 230 | ||
| 11 Benign Conditions of the Vagina | 258 | ||
| Abstract | 258.e1 | ||
| Keywords | 258.e1 | ||
| Chapter Outline | 258 | ||
| Introduction | 258 | ||
| Benign Vaginal Epithelial Changes Occurring in Older Women | 258 | ||
| Vaginal Prolapse | 258 | ||
| Atrophic Vaginitis | 259 | ||
| Radiation-Induced Atrophy | 260 | ||
| Lichen Sclerosus | 261 | ||
| Benign Lesions Following Hysterectomy | 261 | ||
| Granulation Tissue | 261 | ||
| Prolapse of the Fallopian Tube | 261 | ||
| Adenosis and Columnar Metaplasia | 262 | ||
| Adenosis | 262 | ||
| Benign Columnar Cells in the Vagina | 262 | ||
| Cysts of the Vagina | 263 | ||
| Müllerian Cysts | 263 | ||
| Epithelial Inclusion Cysts | 263 | ||
| Mesonephric Cysts | 264 | ||
| Endometriosis | 265 | ||
| Fibroepithelial Polyps of the Lower Female Genital Tract | 266 | ||
| Traumatic Lesions | 266 | ||
| Traumatic Injury | 266 | ||
| Tampon Ulcers | 267 | ||
| Other Traumatic Lesions | 267 | ||
| Infections of Systemic Importance | 267 | ||
| Human Immunodeficiency Virus | 267 | ||
| Group B Streptococcus | 267 | ||
| Toxic Shock Syndrome | 268 | ||
| Rare Infections | 269 | ||
| Malakoplakia | 269 | ||
| Tuberculosis | 269 | ||
| Inflammatory and Ulcerative Lesions of Unknown Cause | 269 | ||
| Desquamative Inflammatory Vaginitis | 269 | ||
| Ulcers and Other Dermatoses of the Vagina | 270 | ||
| Bullous Dermatoses | 270 | ||
| Vaginal Adhesions and Stevens-Johnson Syndrome | 270 | ||
| Behçet Disease | 270 | ||
| Aphthous Ulcers | 271 | ||
| Ligneous Vaginitis | 271 | ||
| Emphysematous Vaginitis | 271 | ||
| Key Points | 272 | ||
| References | 272 | ||
| 12 Epithelial and Mixed Epithelial-Stromal Neoplasms of the Vagina | 275 | ||
| Abstract | 275.e1 | ||
| Keywords | 275.e1 | ||
| Chapter Outline | 275 | ||
| Introduction | 275 | ||
| Vaginal Squamous Intraepithelial Lesions | 275 | ||
| Terminology | 275 | ||
| Clinical Background | 275 | ||
| Natural History | 276 | ||
| Examination of the Patient | 276 | ||
| Low-Grade Squamous Intraepithelial Lesions | 277 | ||
| Diagnostic Criteria | 277 | ||
| Differential Diagnosis | 277 | ||
| High-Grade Squamous Intraepithelial Lesions | 278 | ||
| Diagnostic Criteria | 278 | ||
| Differential Diagnosis | 278 | ||
| Squamous Intraepithelial Lesions of Uncertain Grade | 278 | ||
| Postradiation Atypia: Reactive and Neoplastic | 279 | ||
| Biomarkers | 279 | ||
| Management | 280 | ||
| Malignant Epithelial Neoplasms of the Vagina | 282 | ||
| Introduction | 282 | ||
| Squamous Cell Carcinoma | 282 | ||
| Introduction and Pathogenesis | 282 | ||
| Staging of Vaginal Cancer | 283 | ||
| Clinical Presentation | 283 | ||
| Diagnostic Criteria | 283 | ||
| Management of Invasive Carcinoma of the Vagina | 285 | ||
| Variants of Squamous Cell Carcinoma | 285 | ||
| Verrucous Carcinoma | 285 | ||
| Squamotransitional Carcinoma | 285 | ||
| Glandular Neoplasia and Adenocarcinoma of the Vagina | 285 | ||
| Primary Tumors Arising in Endometriosis | 286 | ||
| Clear Cell Adenocarcinoma | 286 | ||
| Clinical and Pathologic Findings | 286 | ||
| Cloacogenic Neoplasia | 287 | ||
| Metastatic Tumors to the Vagina | 287 | ||
| Vaginal Melanoma | 287 | ||
| Treatment and Survival | 287 | ||
| Mixed Tumors (Spindle Cell Epithelioma) | 293 | ||
| Müllerian Papilloma | 293 | ||
| Other Rare Tumors | 293 | ||
| Key Points | 294 | ||
| References | 295 | ||
| 13 Cervical Squamous Neoplasia | 298 | ||
| Abstract | 298.e1 | ||
| Keywords | 298.e1 | ||
| Chapter Outline | 298 | ||
| Introduction | 298 | ||
| Definition | 298 | ||
| Identifying Patients at Risk for Cervical Neoplasia | 298 | ||
| The Squamocolumnar Junction | 298 | ||
| Human Papillomaviruses | 298 | ||
| Non-Viral Factors | 301 | ||
| Human Papillomavirus Testing | 302 | ||
| Current Screening Algorithms | 303 | ||
| Cytology | 303 | ||
| Nondiagnostic Squamous Atypia (Atypical Squamous Cells of Undetermined Significance) | 305 | ||
| Introduction | 305 | ||
| Cytologic Alterations That Are Best Left Out of the ASCUS Category | 305 | ||
| Cytologic Criteria for the Diagnosis of ASCUS | 305 | ||
| Cytologic Criteria for Squamous Intraepithelial Lesions | 309 | ||
| Low-Grade Squamous Intraepithelial Lesions | 309 | ||
| High-Grade Squamous Intraepithelial Lesions | 310 | ||
| Differential Diagnosis of Low-Grade and High-Grade Squamous Intraepithelial Lesion | 311 | ||
| Cervical Cancer Prevention and Management of the Abnormal Papanicolaou Test | 312 | ||
| Current Guidelines for Screening and Human Papillomavirus Testing | 312 | ||
| Management of ASCUS and Squamous Intraepithelial Lesions | 313 | ||
| Histopathologic Diagnosis of Preinvasive Disease | 315 | ||
| Expectations From the Clinical Setting | 315 | ||
| Practical Considerations Before Examining the Biopsy | 315 | ||
| Excluding Infections Other Than Human Papillomavirus | 315 | ||
| The Squamocolumnar Junction and the Transformation Zone | 318 | ||
| Milestones in the Classification of Squamous Intraepithelial Lesions | 321 | ||
| Classification Systems and Approaches to Squamous Intraepithelial Lesion Diagnosis | 322 | ||
| Interobserver Agreement for the Diagnosis of CIN2 Is Fair at Best | 322 | ||
| Association Between p16 Immunostaining and SIL Grade | 322 | ||
| Predicting Cervical Intraepithelial Neoplasia Grade 2–Positive Outcome of p16 and/or Cytokeratin 7–Positive Low-Grade Squamous Intraepithelial Lesion | 323 | ||
| Diagnostic Criteria for Squamous Intraepithelial Lesions | 323 | ||
| Low-Grade Squamous Intraepithelial Lesions | 323 | ||
| High-Grade Squamous Intraepithelial Lesions | 326 | ||
| Histologic Criteria | 326 | ||
| Squamous Intraepithelial Lesions of Intermediate (Indeterminate) Grade (CIN1-CIN2) | 328 | ||
| Squamous Intraepithelial Lesions With a Predominate Metaplastic Phenotype | 328 | ||
| Immature Exophytic Low-Grade Squamous Intraepithelial Lesion (Immature Condyloma, Squamous Papilloma, Papillary Immature Metaplasia) | 328 | ||
| Immature Flat Metaplastic Squamous Intraepithelial Lesions | 330 | ||
| Immature Metaplastic Low-Grade Squamous Intraepithelial Lesions | 330 | ||
| Immature Metaplastic High-Grade Squamous Intraepithelial Lesions | 332 | ||
| Metaplastic High-Grade Squamous Intraepithelial Lesion With Columnar Differentiation | 332 | ||
| Metaplastic Squamous Intraepithelial Lesions of Intermediate Grade (CIN1-CIN2) | 332 | ||
| Immunohistochemistry (Table 13.6) | 335 | ||
| Differential Diagnosis of Squamous Intraepithelial Lesions | 336 | ||
| Mimics of Low-Grade Squamous Intraepithelial Lesion | 336 | ||
| Differential Diagnosis of Squamous Intraepithelial Lesion of High or Indeterminate Grade | 336 | ||
| Endocervical Curettage | 340 | ||
| Resolving Discordant Papanicolaou Test and Biopsy Results | 340 | ||
| Management of Squamous Intraepithelial Lesions | 343 | ||
| Management of Low-Grade Squamous Intraepithelial Lesion | 343 | ||
| Management of High-Grade Squamous Intraepithelial Lesion | 345 | ||
| Management of Young Women (Age 21 to 25) | 345 | ||
| Ablative Procedures (Electrical Excision, Loop Electrosurgical Excision Procedure or Large Loop Excision of the Transformation Zone, Cone Biopsy, or Cryocautery) | 345 | ||
| Management of the Loop Electrosurgical Excision Procedure Specimen | 345 | ||
| Processing and Interpretation | 345 | ||
| Interpretation of the Endocervical Curettage | 346 | ||
| The Status of the Margins | 347 | ||
| Postexcision Follow-Up | 347 | ||
| Diagnosis and Management of Invasive Squamous Cell Carcinoma | 347 | ||
| Introduction | 347 | ||
| Colposcopic, Cytologic, and Histologic Predictors of Malignancy | 347 | ||
| Sensitivity and Specificity of the Papanicolaou Test for Invasion | 347 | ||
| Role of Human Papillomavirus Testing | 348 | ||
| Cytologic Alterations Most Commonly Associated With “Missed” Invasive Carcinomas | 348 | ||
| Clinical Detection of Invasion | 350 | ||
| Percentage of High-Grade Squamous Intraepithelial Lesions Associated With (Micro) Invasion | 350 | ||
| Risk of Invasion Following Treatment for High-Grade Squamous Intraepithelial Lesion | 350 | ||
| Features of High-Grade Squamous Intraepithelial Lesion Portending Stromal Invasion | 350 | ||
| Diagnosis of Invasion | 350 | ||
| Introduction | 350 | ||
| Criteria for Invasive Squamous Cell Carcinoma | 350 | ||
| Immunohistochemistry | 354 | ||
| Differential Diagnosis of Invasion | 354 | ||
| Defining Superficially Invasive (Microinvasive) Squamous Cell Carcinoma | 355 | ||
| When Cone Biopsy Should Be Considered | 356 | ||
| Measurement of Invasion | 356 | ||
| Parameters of Importance | 356 | ||
| Capillary-Lymphatic Space Invasion | 356 | ||
| Conditions Mimicking Vascular Space Invasion | 357 | ||
| Reporting Superficially Invasive Squamous Carcinoma | 358 | ||
| Common Dilemmas and Their Management | 359 | ||
| Management of Superficially Invasive Squamous Cell Carcinoma (Stage IA) | 361 | ||
| Pathology of Invasive Squamous Carcinoma | 361 | ||
| Grading | 361 | ||
| Significance of Columnar Cell Differentiation | 365 | ||
| Reporting Squamous Carcinomas | 365 | ||
| Treatment and Outcome of Squamous Carcinoma | 366 | ||
| Clinical Factors Influencing Outcome/Presentation | 366 | ||
| Presenting Signs/Symptoms | 366 | ||
| Age of Presentation | 366 | ||
| Presentation During Pregnancy | 366 | ||
| Influence of Pregnancy on Outcome | 366 | ||
| Safety of Delays in Treatment | 366 | ||
| Viral Factors and Outcome | 366 | ||
| Management of Squamous Cell Carcinoma | 367 | ||
| Improvements in Prognosis Since the Late 1970s | 367 | ||
| Standard Treatment Options | 367 | ||
| Stage IIA | 367 | ||
| Stage IIB | 367 | ||
| Stage IIIA | 368 | ||
| Stage IIIB | 368 | ||
| Stage IVA | 368 | ||
| Stage IVB | 368 | ||
| Prevention | 368 | ||
| Vaccines | 368 | ||
| Targeting the Squamocolumnar Junction | 369 | ||
| Key Points | 370 | ||
| References | 370 | ||
| 14 Columnar Cell Neoplasia of the Cervix | 375 | ||
| Abstract | 375.e1 | ||
| Keywords | 375.e1 | ||
| Chapter Outline | 375 | ||
| Overview | 375 | ||
| The Precursor-Cancer Connection | 375 | ||
| Identifying Women at Risk for Glandular Neoplasia | 375 | ||
| Squamocolumnar Junction and Columnar Cell Neoplasia | 376 | ||
| Principles of Cytology in the Diagnosis of Columnar Cell Neoplasia | 376 | ||
| Criteria for Adenocarcinoma in Situ | 377 | ||
| Cytologic Findings of Invasive Adenocarcinoma | 377 | ||
| Smear Presentation | 377 | ||
| Cell Pattern | 378 | ||
| Features of the Cells | 378 | ||
| Differential Diagnosis | 378 | ||
| Similarities With Reactive Epithelial Cells | 378 | ||
| False-Negative Interpretations | 379 | ||
| Adenocarcinoma in Situ Mistaken for Menstrual or Directly Sampled Endometrial Cells | 379 | ||
| Adenocarcinoma in Situ or Adenocarcinoma Mistaken for Reactive Endocervical Cells | 379 | ||
| False-Positive Interpretations | 380 | ||
| Tubal and Tuboendometrial Metaplasia | 380 | ||
| Lower Segment Endometrium, Directly Sampled | 381 | ||
| Menstrual Endometrial Cells | 381 | ||
| Reactive Endocervical Cells | 382 | ||
| Atrophy | 382 | ||
| Misdiagnosis: High-Grade Squamous Intraepithelial Lesion Mistaken for Adenocarcinoma in Situ | 383 | ||
| Atypical Glandular Cells: General | 383 | ||
| Classification of Columnar Cell Abnormalities | 384 | ||
| Interpretation of Cervical Glandular Abnormalities Using Liquid-Based Preparations | 384 | ||
| Human Papillomavirus Testing Following Atypical Glandular Cells or Atypical Endocervical Cells | 384 | ||
| Diagnosis and Management of Adenocarcinoma in Situ | 385 | ||
| Histologic Considerations | 385 | ||
| Clinical and Colposcopic Detection | 385 | ||
| Diagnostic Criteria | 385 | ||
| Distinguishing Features | 385 | ||
| Epithelial Cell Crowding | 385 | ||
| Nuclear Enlargement | 385 | ||
| Prominent Nuclear Hyperchromasia, With Chromatin Coarsening | 385 | ||
| Mitotic Figures | 385 | ||
| Apoptotic Bodies | 385 | ||
| Conspicuous Architectural Alterations | 385 | ||
| Subtypes | 385 | ||
| Endocervical Subtype | 385 | ||
| Endometrioid Subtype | 387 | ||
| Intestinal Subtype | 387 | ||
| Tubal Subtype | 387 | ||
| Adenocarcinoma in Situ, Stratified Type | 388 | ||
| Adenosquamous Carcinoma in Situ | 388 | ||
| Subtle Variants of Adenocarcinoma in Situ: Superficial (Early) Type | 388 | ||
| Immunohistochemistry | 388 | ||
| p16ink4 | 388 | ||
| Ki-67 (MIB-1) | 388 | ||
| Stathmin-1 | 388 | ||
| Differential Diagnosis and Potential Pitfalls | 388 | ||
| Glandular Dysplasia and Cervical Glandular Intraepithelial Neoplasia | 388 | ||
| Normal Variants of Endocervical Mucosa | 389 | ||
| Tubal and Endometrioid Metaplasia | 389 | ||
| Cervical Endometriosis | 390 | ||
| Cervical Arias-Stella Reaction and Other Pregnancy-Related Epithelial Changes | 390 | ||
| Radiation and Cautery Effects | 390 | ||
| Cervicitis and Reactive Epithelial Changes | 390 | ||
| Glandular Atypia Secondary to Herpesvirus and Cytomegalovirus Infections | 392 | ||
| Proposed Report Wording With Diagnostic Terms | 392 | ||
| Management | 392 | ||
| Florid Adenocarcinoma in Situ (Versus Invasive Adenocarcinoma) | 392 | ||
| Background | 392 | ||
| Clinical Correlates | 394 | ||
| Diagnostic Criteria | 394 | ||
| Expansile Pattern | 394 | ||
| Exophytic Pattern | 394 | ||
| Extensive Adenocarcinoma in Situ Associated With Endometrial or Ovarian Involvement | 396 | ||
| Immunohistochemistry | 397 | ||
| Differential Diagnosis | 397 | ||
| Preferred Terminology | 397 | ||
| Clinical Considerations and Outcome | 397 | ||
| Early or Superficial Invasive Endocervical Adenocarcinoma (HPV Associated) | 397 | ||
| FIGO Classification | 397 | ||
| Diagnostic Criteria for Invasion | 398 | ||
| Immunohistochemistry | 398 | ||
| Differential Diagnosis | 398 | ||
| Preferred Terminology | 399 | ||
| Management of Superficially Invasive Adenocarcinoma | 399 | ||
| Invasive Endocervical Adenocarcinoma | 399 | ||
| Background and Clinical Presentation | 399 | ||
| Gross Pathology | 399 | ||
| Histologic Features | 400 | ||
| Histologic Subtypes of HPV-Associated Adenocarcinoma | 400 | ||
| Diagnosis and Management of Adenocarcinoma of the Cervix | 401 | ||
| Endocervical (Mucinous) Adenocarcinoma: Usual Type | 401 | ||
| Endometrioid Adenocarcinoma: Usual Type | 402 | ||
| Intestinal Adenocarcinoma | 402 | ||
| Adenosquamous Carcinoma: Usual Type | 402 | ||
| Glassy Cell and Clear Cell Adenosquamous Carcinomas | 403 | ||
| Well-Differentiated Villoglandular Adenocarcinoma | 404 | ||
| Primary Endocervical Adenocarcinomas Resembling High-Grade Serous Carcinomas | 404 | ||
| Adenoid Basal and Adenoid Cystic Carcinomas | 406 | ||
| Management | 407 | ||
| Metastatic Spread | 407 | ||
| Staging | 407 | ||
| Treatment | 408 | ||
| HPV-Negative Endocervical and Glandular Neoplasia | 408 | ||
| Neoplasms With Gastric Differentiation | 408 | ||
| Invasive Adenocarcinomas With Gastric Differentiation | 408 | ||
| Background | 408 | ||
| Lobular Endocervical Glandular Hyperplasia and Atypical Lobular Endocervical Glandular Hyperplasia (Adenoma Malignum in Situ) | 408 | ||
| Lobular Endocervical Glandular Hyperplasia | 408 | ||
| Atypical Lobular Endocervical Glandular Hyperplasia | 409 | ||
| Clinical Presentation and Gross Pathology | 410 | ||
| Diagnostic Criteria | 410 | ||
| Immunohistochemistry | 411 | ||
| Differential Diagnosis | 411 | ||
| Preferred Diagnostic Terminology | 412 | ||
| Management and Outcome | 412 | ||
| Minimal Deviation Adenocarcinoma, Endometrioid Type | 412 | ||
| 15 Neuroendocrine Carcinoma, Mixed Epithelial/Mesenchymal and Mesenchymal Tumors, and Miscellaneous Lesions of the Cervix | 430 | ||
| Abstract | 430.e1 | ||
| Keywords | 430.e1 | ||
| Chapter Outline | 430 | ||
| Neuroendocrine Carcinoma | 431 | ||
| Historical and Clinical Background | 431 | ||
| Clinical Presentation | 431 | ||
| Histogenesis | 431 | ||
| Gross Examination | 431 | ||
| Diagnostic Criteria | 431 | ||
| Cytologic Features | 431 | ||
| Histologic Features | 432 | ||
| Molecular Features | 434 | ||
| Immunohistochemistry | 434 | ||
| Differential Diagnosis | 436 | ||
| Preferred Diagnostic Terminology | 440 | ||
| Outcome | 440 | ||
| Management | 442 | ||
| Undifferentiated Carcinoma | 442 | ||
| Mixed Epithelial/Mesenchymal Neoplasms | 443 | ||
| Endocervical Polyp | 443 | ||
| Clinical Background | 443 | ||
| Gross Examination (Clinical Presentation) | 443 | ||
| Diagnostic Criteria | 443 | ||
| Histologic Features | 443 | ||
| Differential Diagnosis | 443 | ||
| Management | 444 | ||
| Adenomyoma and Polypoid Adenomyoma of the Endocervical Type | 445 | ||
| Clinical Background | 445 | ||
| Gross Examination | 445 | ||
| Diagnostic Criteria | 445 | ||
| Histologic Features | 445 | ||
| Immunohistochemistry | 446 | ||
| Differential Diagnosis | 446 | ||
| Outcome and Management | 447 | ||
| Cervical Adenofibroma | 447 | ||
| Cervical Adenosarcoma | 447 | ||
| Clinical Background | 447 | ||
| Gross Examination | 447 | ||
| Histologic Features | 447 | ||
| Immunohistochemistry | 448 | ||
| Differential Diagnosis | 449 | ||
| Proposed Report Wording With Diagnostic Terms | 449 | ||
| Outcome and Management | 449 | ||
| Cervical Carcinosarcoma | 449 | ||
| Clinical Presentation | 449 | ||
| Histogenetic Categories and Diagnostic Criteria | 450 | ||
| Immunohistochemistry | 452 | ||
| Differential Diagnosis | 452 | ||
| Proposed Report Wording With Diagnostic Terms | 453 | ||
| Outcome and Management | 453 | ||
| Mesenchymal Neoplasms | 453 | ||
| Genital Rhabdomyoma | 454 | ||
| Glomus Tumor | 455 | ||
| Superficial Myofibroblastoma | 455 | ||
| Smooth Muscle Tumors | 455 | ||
| Leiomyoma | 455 | ||
| Leiomyosarcoma | 455 | ||
| Schwannoma | 456 | ||
| Malignant Peripheral Nerve Sheath Tumors | 456 | ||
| Alveolar Soft-Part Sarcoma | 457 | ||
| Peripheral Neuroectodermal Tumor/Ewing Sarcoma | 457 | ||
| Endometrial Stromal Sarcoma | 458 | ||
| Undifferentiated Endocervical Stromal Sarcoma | 458 | ||
| Melanocytic Lesions | 459 | ||
| Blue Nevi | 459 | ||
| Malignant Melanoma | 460 | ||
| Hematopoietic Lesions | 461 | ||
| Lymphoma | 461 | ||
| Granulocytic Sarcoma | 461 | ||
| Other Entities | 462 | ||
| Deciduosis | 462 | ||
| Ectopic Tissues/Metaplasias (Gliosis, Cartilage, Bone) | 462 | ||
| Benign Vascular Tumors | 462 | ||
| Amyloidosis | 463 | ||
| Ligneous Cervicitis | 463 | ||
| Malakoplakia | 463 | ||
| Trophoblastic Lesions | 464 | ||
| Atypical Stromal Cells | 464 | ||
| Gland-Poor Endometriosis (Stromatosis) | 464 | ||
| Key Points | 465 | ||
| References | 465 | ||
| 16 Evaluation of the Cyclic Endometrium and Benign Endometrial Disorders | 471 | ||
| Abstract | 471.e1 | ||
| Keywords | 471.e1 | ||
| Chapter Outline | 471 | ||
| Introduction | 471 | ||
| Cycling Endometrium (Third and Fourth Decades) | 472 | ||
| Menstrual Phase | 473 | ||
| Early Proliferative Phase With Residual Stromal Breakdown (Late Menstrual/Early Proliferative Endometrium) | 476 | ||
| Proliferative Phase Endometrium | 477 | ||
| 16-Day Endometrium (Postovulatory Day 2) | 477 | ||
| Vacuole Phase of Secretory Endometrium (17 to 19 Days; Postovulatory Day 3 to 5) | 477 | ||
| Exhaustive Phase of Secretory Endometrium (20 to 22 Days; Postovulatory Day 6 to 8) | 478 | ||
| Predecidual Phase of Secretory Endometrium (23 to 28 Days; Postovulatory Day 9 to 14) | 479 | ||
| Infertility and the Pathologist | 481 | ||
| Confirmation of Ovulation | 483 | ||
| Luteal Phase Defect | 484 | ||
| Recurrent Implantation Failure and Chronic Endometritis | 484 | ||
| Preparatory Cycles in Ovum Donation Recipients | 485 | ||
| Summary | 485 | ||
| Recurrent Pregnancy Loss | 485 | ||
| Abnormal Uterine Bleeding | 486 | ||
| Clinical Evaluation of Abnormal Uterine Bleeding | 486 | ||
| Diagnostic Evaluation | 488 | ||
| Diagnostic Considerations According to Age | 488 | ||
| Management of Abnormal Uterine Bleeding | 489 | ||
| Endometrial Pathology | 490 | ||
| Patterns Commonly Associated With Unscheduled Bleeding | 490 | ||
| Anovulation | 490 | ||
| Alterations Signifying Breakdown in the Absence of Persistent Follicle | 492 | ||
| Endometrial Polyp | 493 | ||
| Endometritis | 493 | ||
| Intrauterine Contraceptive Devices | 503 | ||
| Submucosal Leiomyoma/Fibroid | 504 | ||
| Hormonal Therapy | 505 | ||
| Oral Contraceptives | 506 | ||
| Progesterone Administration | 508 | ||
| Strong Progestins | 509 | ||
| Hormone Replacement Therapy | 509 | ||
| Tamoxifen | 510 | ||
| Clomiphene Therapy | 510 | ||
| Mixed Pattern Endometrium | 510 | ||
| Anovulation Followed by Hormonal Therapy or Ovulation | 511 | ||
| Intrinsic Disturbances in Secretory Maturation | 511 | ||
| Clonal Events Leading to Mixed Gland Phenotypes | 512 | ||
| Postmenopausal Endometrium | 512 | ||
| Inactive | 513 | ||
| Atrophy | 513 | ||
| Excess Estrogen Effect | 514 | ||
| Current or Postpregnancy/ Postpartum Endometrium | 515 | ||
| Decidua | 515 | ||
| Implantation Site | 515 | ||
| Glandular Changes, Including Arias-Stella Effect | 515 | ||
| Benign Atypias/Artifacts Encountered in Routine Evaluation of Endometrium | 515 | ||
| Exfoliation (Fixation) Artifacts | 516 | ||
| Inspissated Gland Artifacts | 517 | ||
| Arias-Stella–Like Patterns | 517 | ||
| Altered Surface Epithelial Changes, Including Repair | 518 | ||
| Ablation | 519 | ||
| Contamination From Other Samples | 519 | ||
| Introduction of Tissues via Perforation | 520 | ||
| Focal Necrotic Polyps, Hyaline Changes, Macrophage Responses | 520 | ||
| Key Points | 521 | ||
| References | 521 | ||
| 17 Preinvasive Endometrial Neoplasia | 524 | ||
| Abstract | 524.e1 | ||
| Keywords | 524.e1 | ||
| Chapter Outline | 524 | ||
| Introduction | 524 | ||
| Precursors to Endometrioid Carcinoma—Endometrioid Intraepithelial Neoplasia | 524 | ||
| Definition | 524 | ||
| Historical Background | 525 | ||
| Implementation of the Endometrioid Intraepithelial Neoplasia Schema by the World Health Organization in 2014 | 525 | ||
| The Patient at Risk | 526 | ||
| Endocrine Factors | 526 | ||
| Genetic Factors | 527 | ||
| Epidemiologic Factors | 527 | ||
| Medication Factors | 527 | ||
| Screening and Detection | 527 | ||
| Hysteroscopy and Sonography | 527 | ||
| Endometrial Sampling | 527 | ||
| Sampling Devices | 528 | ||
| Specimen Adequacy | 528 | ||
| Pathology | 529 | ||
| Rationale | 529 | ||
| Criterion 1: Endometrioid Intraepithelial Neoplasia Differs From Normal Tissues | 529 | ||
| Criterion 2: Endometrioid Intraepithelial Neoplasia Shares Some But Not All Features With Carcinoma | 529 | ||
| Criterion 3: Endometrioid Intraepithelial Neoplasia Can Be Diagnosed | 529 | ||
| Criterion 4: Endometrioid Intraepithelial Neoplasia Increases Risk for Carcinoma | 529 | ||
| Criterion 5: Genetic and Hormonal Mechanisms of Carcinogenesis Converge in Endometrioid Intraepithelial Neoplasia | 529 | ||
| Criterion 6: Introducing Endometrioid Intraepithelial Neoplasia Genotype Into an Animal Produces Premalignant Lesions and Heightened Cancer Risk | 529 | ||
| Biomarkers—PTEN and PAX2 | 529 | ||
| Combined Molecular and Histopathologic Model for Endometrioid Intraepithelial Neoplasia | 531 | ||
| Topography | 531 | ||
| Diagnostic Criteria | 531 | ||
| Architecture | 532 | ||
| Cytology | 533 | ||
| Size | 533 | ||
| Exclusion of Benign Mimics and Adenocarcinoma | 534 | ||
| Differential Diagnosis | 534 | ||
| Common Benign Patterns That May Be Misclassified | 534 | ||
| Reactive Changes | 535 | ||
| Artifactual Gland Displacement | 535 | ||
| Persistent Estrogen Effect: Anovulation and Endometrial Hyperplasia Without Atypia | 536 | ||
| Mid- to Late Secretory Endometrium | 536 | ||
| Endometrial Polyps | 537 | ||
| Endometrial Breakdown | 537 | ||
| Interpretative Problems in Endometrioid Intraepithelial Neoplasia Diagnosis | 537 | ||
| Subdiagnostic Endometrioid Intraepithelial Neoplasia–Like Lesion | 538 | ||
| Histologic Patterns of Endometrioid Intraepithelial Neoplasia That May Cause Confusion | 539 | ||
| Monotonous, Tubular-Appearing Gland Arrays | 539 | ||
| Well-Spaced Glands With Intraglandular Complexity | 540 | ||
| Endometrioid Intraepithelial Neoplasia Within an Endometrial Polyp | 540 | ||
| Endometrioid Intraepithelial Neoplasia With Surface Papillary Changes | 540 | ||
| Nonendometrioid Endometrioid Intraepithelial Neoplasia Versus Metaplasia | 541 | ||
| Confounding Progestin Exposure | 541 | ||
| Exclusion of Carcinoma | 543 | ||
| Endometrioid Adenocarcinomas | 544 | ||
| Other Carcinomas That May Mimic Endometrioid Intraepithelial Neoplasia | 544 | ||
| Uterine Papillary Serous Carcinomas | 544 | ||
| Endocervical Adenocarcinomas In Situ | 544 | ||
| Management | 545 | ||
| Preinvasive Uterine Serous Neoplasia | 547 | ||
| Definition | 547 | ||
| The Patient at Risk | 547 | ||
| Pathology of Noninvasive Serous Neoplasia | 547 | ||
| General Principles | 547 | ||
| Latent Serous Precursors: p53 Signatures | 548 | ||
| Endometrial Glandular Dysplasia | 548 | ||
| Serous Endometrial Intraepithelial Carcinoma | 549 | ||
| Biomarkers | 551 | ||
| Differential Diagnosis | 552 | ||
| Management and Outcome | 553 | ||
| Key Points | 553 | ||
| Acknowledgments | 553 | ||
| References | 553 | ||
| 18 Altered Endometrial Differentiation (Metaplasia) | 556 | ||
| Abstract | 556.e1 | ||
| Keywords | 556.e1 | ||
| Chapter Outline | 556 | ||
| Introduction | 556 | ||
| Origins of Metaplasia | 556 | ||
| The Patient at Risk | 558 | ||
| Classification and Outcomes of Glandular Metaplasias | 558 | ||
| Squamous Metaplasia | 559 | ||
| Mucinous Metaplasia | 564 | ||
| Tubal Metaplasia | 569 | ||
| Eosinophilic (Oxyphilic) Metaplasia | 571 | ||
| Other Epithelial Metaplasias | 571 | ||
| Further Considerations | 572 | ||
| Surface Epithelial Changes— Repair-Metaplasia Sequence | 572 | ||
| Degenerative Surface Epithelial Changes (Repair) | 572 | ||
| Stratified Epithelial Changes With Breakdown | 572 | ||
| Mild Epithelial Stratification | 572 | ||
| Papillary Syncytial Metaplasia | 577 | ||
| Surface Proliferative Changes With Architectural Complexity | 577 | ||
| Reactive Phenomena With Prominent Nuclear Atypia | 577 | ||
| Algorithm for Assessing Metaplasia | 578 | ||
| Squamous Metaplasia | 578 | ||
| Mucinous and Ciliated Metaplasia | 578 | ||
| Papillary Lesions | 579 | ||
| Nonepithelial Metaplasias and Heterotopias of the Endometrium | 579 | ||
| Key Points | 580 | ||
| References | 580 | ||
| 19 Adenocarcinoma, Carcinosarcoma, and Other Epithelial Tumors of the Endometrium | 582 | ||
| Abstract | 582.e1 | ||
| Keywords | 582.e1 | ||
| Chapter Outline | 582 | ||
| Introduction | 582 | ||
| Endometrial Adenocarcinoma | 582 | ||
| The Patient at Risk | 582 | ||
| Demographics | 582 | ||
| Ethnicity | 583 | ||
| Hormone Replacement or Suppressive Therapy | 584 | ||
| Estrogens | 584 | ||
| Tamoxifen | 584 | ||
| Familial Syndromes and Risk Factors for Other Cancers | 584 | ||
| Modified Amsterdam Criteria | 584 | ||
| Bethesda Criteria | 584 | ||
| Molecular Genetics of Endometrial Carcinomas | 586 | ||
| POLE-Mutated (Ultramutated) | 586 | ||
| Microsatellite Instability (Hypermutated) | 587 | ||
| Copy Number Low (Microsatellite Stability) | 587 | ||
| Copy Number High (Serous-Like) | 587 | ||
| Precursor Lesions | 588 | ||
| Clinical Parameters for Assessing Risk | 589 | ||
| Postmenopausal Bleeding | 589 | ||
| Age (Menopausal Status) | 589 | ||
| Setting | 589 | ||
| Persistent Bleeding | 589 | ||
| Transvaginal Ultrasound | 589 | ||
| Hysteroscopy | 589 | ||
| Histopathology of Endometrial Adenocarcinoma | 590 | ||
| Tumor Types and Grading Schemes | 590 | ||
| Lower Grade Endometrioid Adenocarcinomas | 595 | ||
| Morphologic Patterns | 595 | ||
| Endometrioid Gland Patterns | 595 | ||
| Squamous Differentiation | 596 | ||
| Mucinous Differentiation | 598 | ||
| Tubal (Ciliated Cell) Differentiation | 599 | ||
| Secretory Differentiation | 599 | ||
| Clear Cell Changes | 600 | ||
| Villoglandular Carcinoma | 600 | ||
| Endometrioid Carcinoma With Spindled Morphology, Sex Cord–Like Areas, and Hyalinization | 601 | ||
| Differential Diagnosis and Diagnostic Pitfalls. | 601 | ||
| Intermediate- and Indeterminate-Grade Endometrioid Carcinomas | 601 | ||
| Intermediate-Grade (Architectural Grade 2) Endometrioid Adenocarcinomas | 601 | ||
| Indeterminate-Grade (Architectural Grade 1 or 2 Neoplasms With High Nuclear Grade) | 601 | ||
| Endometrioid Carcinomas. | 601 | ||
| High-Grade Endometrial Carcinomas | 602 | ||
| Grade 3 Endometrioid Carcinomas | 605 | ||
| Uterine Serous Carcinomas | 605 | ||
| Growth Patterns | 605 | ||
| Papillary Glandular Architecture. | 605 | ||
| Disturbed Glandular Architecture With Slit-Forming Glands. | 606 | ||
| Poorly Differentiated Large Cell Patterns. | 606 | ||
| Tumors With Organized Fibrous Stroma. | 606 | ||
| Microcystic Patterns. | 606 | ||
| Tumors Confined to the Surface Mucosa. | 606 | ||
| Tumors Confined to Polyps. | 607 | ||
| Immunohistochemistry. | 607 | ||
| Tumor Sharing Features With Serous and Endometrioid Carcinomas (and Other Problematic Patterns) | 607 | ||
| Clear Cell Carcinomas | 608 | ||
| Diagnostic Criteria | 608 | ||
| Differential Diagnosis | 608 | ||
| Immunohistochemistry and Biomarkers | 608 | ||
| Management, Outcome, Tumor Board | 608 | ||
| Undifferentiated Carcinoma | 608 | ||
| Background and Clinical Presentation | 608 | ||
| Diagnostic Criteria | 609 | ||
| Immunohistochemistry | 609 | ||
| 20 Uterine Mesenchymal Tumors | 652 | ||
| Abstract | 652.e1 | ||
| Keywords | 652.e1 | ||
| Chapter Outline | 652 | ||
| Introduction | 652 | ||
| Definition | 652 | ||
| Identifying Patients at Risk for Mesenchymal Neoplasia | 652 | ||
| General Clinical Features | 653 | ||
| Endometrial Stromal Tumors | 653 | ||
| Definition and Classification | 653 | ||
| Clinicopathologic Features | 653 | ||
| Endometrial Stromal Nodule | 653 | ||
| Low-Grade Endometrial Stromal Sarcoma | 655 | ||
| Endometrial Stromal Nodule and Low-Grade Endometrial Stromal Sarcoma | 655 | ||
| Mixed Endometrial Stromal–Smooth Muscle Tumors | 655 | ||
| Endometrial Stromal Tumor Resembling Ovarian Sex Cord Tumor | 655 | ||
| Endometrial Stromal Tumor With Endometrioid Glands | 656 | ||
| High-Grade Endometrial Stromal Sarcoma | 656 | ||
| Undifferentiated Uterine Sarcoma (Undifferentiated Endometrial Sarcoma) | 660 | ||
| Molecular Genetics | 661 | ||
| Low-Grade Endometrial Stromal Sarcoma | 661 | ||
| High-Grade Endometrial Stromal Sarcoma | 661 | ||
| Uterine Tumor Resembling Ovarian Sex Cord Tumors | 661 | ||
| Interpretation of Curettings | 661 | ||
| Management and Prognosis | 663 | ||
| Endometrial Stromal Nodule | 663 | ||
| Low-Grade Endometrial Stromal Sarcoma | 663 | ||
| High-Grade Endometrial Stromal Sarcoma | 663 | ||
| Undifferentiated Uterine Sarcoma | 664 | ||
| Biomarkers and Differential Diagnosis | 664 | ||
| Endometrial Stromal Nodule and Low-Grade Endometrial Stromal Sarcoma | 664 | ||
| High-Grade Endometrial Stromal Sarcoma | 666 | ||
| Tumors of the Myometrium | 667 | ||
| Definition and Classification | 667 | ||
| Benign Leiomyoma | 667 | ||
| Clinical Considerations | 667 | ||
| Pathobiologic Features of Typical Leiomyoma | 668 | ||
| Hormonal Pathophysiology | 668 | ||
| Clonality | 668 | ||
| Genetics | 669 | ||
| Macroscopic and Microscopic Features of Typical Leiomyoma | 670 | ||
| Alternative Patterns of Differentiation | 671 | ||
| Plexiform and Epithelioid Leiomyoma | 671 | ||
| Lipoleiomyoma | 672 | ||
| Vascular Leiomyoma | 673 | ||
| Miscellaneous Patterns of Differentiation | 673 | ||
| Malignant Leiomyosarcoma | 673 | ||
| Clinical Considerations | 673 | ||
| Pathobiologic Features | 674 | ||
| Macroscopic and Microscopic Features | 675 | ||
| Evaluation of Mitotic Activity | 676 | ||
| Evaluation of Atypical Mitotic Figures | 677 | ||
| Evaluation of Cytologic Atypia | 678 | ||
| Evaluation of Tumor Cell Necrosis | 678 | ||
| Practical Diagnostic Strategy | 679 | ||
| Epithelioid Leiomyosarcoma | 679 | ||
| Myxoid Leiomyosarcoma | 679 | ||
| Prognostic Factors and Therapeutic Decision Making | 681 | ||
| Prognostic Importance of Mitotic Activity | 681 | ||
| Prognostic Importance of Histologic Grade, Necrosis, and Size | 682 | ||
| Role of Biomarkers in Prognostication | 682 | ||
| Clinical Management | 682 | ||
| Histologic Variants of Leiomyoma | 682 | ||
| Degeneration | 683 | ||
| Cellularity | 685 | ||
| Mitotic Activity | 688 | ||
| Difficult to Classify Smooth Muscle Tumors | 689 | ||
| Atypia | 689 | ||
| Atypical Smooth Muscle Tumors With Histologic Phenotype Corresponding to HLRCC Syndrome | 689 | ||
| Infiltration | 691 | ||
| Difficult to Classify Smooth Muscle Tumors | 691 | ||
| Diagnostic Terminology | 691 | ||
| Clinical Implications | 692 | ||
| Application of Biomarkers to Smooth Muscle Neoplasia | 693 | ||
| Practical Approaches to the Intraoperative Examination of Uterine Smooth Muscle Tumors | 693 | ||
| Atypical Smooth Muscle Tumors | 694 | ||
| Quasimalignant Smooth Muscle Proliferations | 694 | ||
| Intravenous Leiomyomatosis | 694 | ||
| Disseminated Peritoneal Leiomyomatosis | 695 | ||
| Intrauterine Leiomyomatosis | 696 | ||
| Benign Metastasizing Leiomyoma | 697 | ||
| Tumors Mimicking Smooth Muscle Tumors | 697 | ||
| Adenomyosis and Adenomyoma | 697 | ||
| Adenomatoid Tumors | 699 | ||
| Mixed Epithelial and Mesenchymal Tumors | 699 | ||
| Adenosarcoma | 699 | ||
| Definition | 699 | ||
| Clinical Presentation | 699 | ||
| Histopathologic Features | 700 | ||
| Differential Diagnosis | 701 | ||
| Prognosis and Management | 702 | ||
| Molecular Features | 702 | ||
| Carcinosarcoma (Malignant Mixed Müllerian Tumor) | 702 | ||
| Miscellaneous Tumors | 702 | ||
| Uterine Perivascular Epithelioid Cell Tumor | 702 | ||
| Inflammatory Myofibroblastic Tumor | 704 | ||
| Definition | 704 | ||
| Clinical Presentation | 704 | ||
| Histopathologic Features | 704 | ||
| Differential Diagnosis | 705 | ||
| Prognosis and Management | 705 | ||
| Key Points | 706 | ||
| References | 706 | ||
| 21 The Fallopian Tube and Broad Ligament | 716 | ||
| Abstract | 716.e1 | ||
| Keywords | 716.e1 | ||
| Chapter Outline | 716 | ||
| Introduction | 716 | ||
| Tubal Anatomy and Histology | 716 | ||
| Benign Epithelial Proliferations | 718 | ||
| Approach to Commonly Received Specimens | 721 | ||
| Tubal Ligation | 721 | ||
| Tubal Reanastomosis | 721 | ||
| Foreign Bodies (Coils and Springs) | 721 | ||
| Sectioning Protocols for Fallopian Tubes Received Intact | 722 | ||
| Hysterectomies With Attached Tubes | 723 | ||
| Rests or Benign Proliferations | 724 | ||
| Cysts | 727 | ||
| Large Paratubal Müllerian Cysts (Hydatids of Morgagni) | 727 | ||
| Endosalpingiosis | 727 | ||
| Mesothelial (and Simple) Cysts | 727 | ||
| Endometriosis | 730 | ||
| 22 Benign Conditions of the Ovary | 761 | ||
| Abstract | 761.e1 | ||
| Keywords | 761.e1 | ||
| Chapter Outline | 761 | ||
| Introduction | 761 | ||
| Anatomy of the Ovary | 761 | ||
| Surface, Cortex, and Medulla | 761 | ||
| Hilus | 762 | ||
| Common Incidental Findings Seen at Hysterectomy | 762 | ||
| Surface | 762 | ||
| Adhesions | 762 | ||
| Mesothelial Proliferation | 763 | ||
| Endosalpingiosis | 763 | ||
| Ovarian Cortex | 763 | ||
| Cortical Inclusion Cysts | 763 | ||
| Müllerian and Simple Cysts | 764 | ||
| Follicles and Corpora Lutea | 766 | ||
| Primordial Follicles | 766 | ||
| Primary Follicles | 766 | ||
| Secondary Follicles | 766 | ||
| Graafian Follicles | 766 | ||
| Cystic Follicles | 766 | ||
| Atretic Follicles | 766 | ||
| Differential Diagnosis of Follicular Changes | 767 | ||
| Recent and Degenerating Corpora Lutea | 768 | ||
| Gross Appearance | 768 | ||
| Microscopic | 768 | ||
| Differential Diagnosis | 768 | ||
| Clinical Complications | 768 | ||
| Hilus | 768 | ||
| Wolffian Remnants | 768 | ||
| Hilus Cells | 770 | ||
| The Ovary in Pregnancy | 771 | ||
| Corpus Luteum of Pregnancy | 771 | ||
| Theca-Lutein Hyperplasia of Pregnancy (Including So-Called Pregnancy Luteoma) | 771 | ||
| Hyperreactio Luteinalis | 775 | ||
| Solitary Luteinized Follicle Cyst | 775 | ||
| Hemangiomas | 776 | ||
| Deciduosis (Ectopic Decidua) | 776 | ||
| Conditions Associated With Clinical Infertility | 777 | ||
| Premature Ovarian Failure | 777 | ||
| Autoimmune Disorders and Autoimmune Oophoritis | 778 | ||
| The Patient at Risk and Pathogenesis | 778 | ||
| Clinical Presentation | 779 | ||
| Pathology | 779 | ||
| Differential Diagnosis | 780 | ||
| Management | 780 | ||
| Polycystic Ovarian Syndrome | 780 | ||
| Definition and Patient at Risk | 780 | ||
| Pathogenesis | 780 | ||
| Clinical Presentation and Diagnosis | 781 | ||
| Treatment | 783 | ||
| Pathology | 783 | ||
| Other Genital Tract Pathology | 783 | ||
| Endometriosis | 783 | ||
| Risk Factors and Pathogenesis | 783 | ||
| Relationship to Infertility | 784 | ||
| Pathology | 785 | ||
| The Perimenopausal and Postmenopausal Ovary | 786 | ||
| Atrophy | 786 | ||
| Stromal Hyperplasia | 786 | ||
| Definition and Patient at Risk | 786 | ||
| Clinical Features | 786 | ||
| Pathology | 787 | ||
| Treatment | 787 | ||
| Stromal Hyperthecosis | 788 | ||
| 23 Disorders of the Peritoneum | 800 | ||
| Abstract | 800.e1 | ||
| Keywords | 800.e1 | ||
| Chapter Outline | 800 | ||
| Introduction | 800 | ||
| Müllerian-Derived Lesions of the Peritoneum | 800 | ||
| Ectopic Decidua (Deciduosis) | 800 | ||
| Background | 800 | ||
| Clinical Features | 800 | ||
| Diagnosis | 801 | ||
| Immunohistochemistry and Differential Diagnosis | 801 | ||
| Treatment and Prognosis | 801 | ||
| Endosalpingiosis | 801 | ||
| Background | 801 | ||
| Clinical Features | 801 | ||
| Pathology | 801 | ||
| Immunohistochemistry | 802 | ||
| Differential Diagnosis | 802 | ||
| Treatment and Prognosis | 802 | ||
| Endocervicosis | 802 | ||
| Background | 802 | ||
| 24 Assessing Pelvic Epithelial Cancer Risk and Intercepting Early Malignancy | 844 | ||
| Abstract | 844.e1 | ||
| Keywords | 844.e1 | ||
| Chapter Outline | 844 | ||
| Introduction | 844 | ||
| Risk Identification | 844 | ||
| Genetic Ovarian Cancer Syndromes | 844 | ||
| Breast Ovarian Cancer Syndrome and Site-Specific Ovarian Cancer Syndrome | 844 | ||
| Lynch Syndrome | 845 | ||
| Hereditary Predisposition to Ovarian Cancer: Beyond BRCA and Mismatch Repair Genes | 846 | ||
| Demographic Risk Factors for Ovarian Cancer | 846 | ||
| Dietary Factors | 846 | ||
| Talc Exposure | 846 | ||
| Infertility and Infertility Drugs | 847 | ||
| Hormone Replacement Therapy | 847 | ||
| Endometriosis | 847 | ||
| Reducing Risk | 847 | ||
| Oral Contraceptives | 847 | ||
| Tubal Ligation | 847 | ||
| Risk Reduction Surgery | 847 | ||
| Early Detection | 848 | ||
| Pelvic Examination | 848 | ||
| Biomarker Screening Alone | 848 | ||
| Combining Biomarkers With Ultrasound and Other Imaging Techniques | 848 | ||
| Molecular Screening for Ovarian Cancer | 849 | ||
| Presenting Signs and Symptoms | 850 | ||
| The Role of the Pathologist in Risk Reduction and Early Detection | 850 | ||
| Prophylactic Surgery and Detection of Early Malignancy | 850 | ||
| The SEE-FIM Protocol | 851 | ||
| Histologic Criteria for Early Tubal Cancer (Serous Tubal Intraepithelial Carcinoma) | 852 | ||
| Endometrioid Tubal Intraepithelial Carcinoma | 853 | ||
| Mucinous Tubal Intraepithelial Carcinoma | 854 | ||
| Early Invasive Serous Carcinoma | 854 | ||
| Differential Diagnosis of Serous Tubal Intraepithelial Carcinoma | 854 | ||
| Benign Tubal Epithelial Hyperplasias (Secretory/Stem Cell Outgrowths) | 856 | ||
| Serous Tubal Epithelial Proliferations/Lesions | 856 | ||
| Benign Serous Tubal Epithelial Proliferations/Lesions (p53 Signatures) | 856 | ||
| Serous Tubal Epithelial Proliferations/Lesions of Uncertain Significance | 858 | ||
| Other Benign Tubal Abnormalities | 860 | ||
| Clinical Impact | 860 | ||
| Early Ovarian Cancer | 860 | ||
| Key Points | 861 | ||
| References | 861 | ||
| 25 The Pathology of Pelvic-Ovarian Epithelial (Epithelial-Stromal) Tumors | 865 | ||
| Abstract | 865.e1 | ||
| Keywords | 865.e1 | ||
| Chapter Outline | 865 | ||
| Epithelial Tumors | 865 | ||
| Tumor Origin, Terminology, and Classification | 865 | ||
| Molecular Pathogenesis | 867 | ||
| The Continuum of Borderline and Low-Grade Malignancy | 867 | ||
| Resolving the Paradox of Peritoneal Implants | 868 | ||
| Strengths and Weaknesses of Tumor Typing and Grading | 868 | ||
| Serous Tumors | 869 | ||
| General Features | 869 | ||
| Benign Serous Tumors (Cystadenomas, Cystadenofibromas, Adenofibromas, Papillary Adenofibromas, Surface Papillary Adenofibromas) | 870 | ||
| Noninvasive Low-Grade Serous Tumors With Potential for Adverse Outcome | 874 | ||
| Borderline (Atypical Proliferative) Serous Tumors | 874 | ||
| Borderline Serous Tumors With Micropapillary/Cribriform Architecture (Noninvasive Low-Grade Serous Carcinomas) | 879 | ||
| Assessment of Peritoneal Involvement | 881 | ||
| Implants Versus Benign Mimics | 881 | ||
| Peritoneal Cytology | 884 | ||
| Invasive Versus Noninvasive Implants | 884 | ||
| Low- and High-Grade Serous Carcinomas | 885 | ||
| Invasive Low-Grade Serous Carcinomas | 885 | ||
| Low- Versus High-Grade Serous Carcinoma | 889 | ||
| High-Grade Serous Carcinomas | 889 | ||
| Determining the Origin of High-Grade Pelvic Serous Carcinoma | 894 | ||
| Differential Diagnosis of Serous Neoplasms | 895 | ||
| Benign Serous Tumors | 895 | ||
| Borderline Tumors | 895 | ||
| Serous Carcinomas | 896 | ||
| Cervical “Papillary Serous Carcinoma,” p53 and p16 Staining | 896 | ||
| Serous Versus Endometrioid Carcinoma | 897 | ||
| Mucinous Tumors | 897 | ||
| General Features and Clinical Aspects | 897 | ||
| Gross Examination | 899 | ||
| Microscopic Examination | 901 | ||
| Benign Mucinous Tumors: Cystadenomas, Cystadenofibromas, and Adenofibromas | 901 | ||
| Borderline Mucinous Tumors: Intestinal and Endocervical-Like Types | 901 | ||
| Intestinal-Type Mucinous Borderline Tumors With Atypia Only | 902 | ||
| Intestinal-Type Mucinous Borderline Tumors With Intraepithelial Carcinoma | 903 | ||
| Intestinal-Type Mucinous Borderline Tumors With Microinvasion | 903 | ||
| Endocervical-Like Borderline Tumors | 904 | ||
| Mucinous Carcinomas | 905 | ||
| Mucinous Tumors With Mural Nodules | 907 | ||
| Pseudomyxoma Peritonei | 909 | ||
| Differential Diagnosis | 910 | ||
| Metastatic Mucinous Carcinoma | 910 | ||
| Endometrioid Carcinomas With Mucinous Differentiation | 911 | ||
| Sertoli-Leydig Cell Tumors With Heterologous Gastrointestinal Epithelium | 911 | ||
| Mucinous (Goblet Cell) Carcinoid Tumor | 911 | ||
| Site of Origin of Mucinous Neoplasms | 911 | ||
| Mixed Epithelial Tumors | 912 | ||
| General Features and Clinical Aspects | 912 | ||
| Gross Examination | 913 | ||
| 26 Germ Cell Tumors of the Ovary | 949 | ||
| Abstract | 949.e1 | ||
| Keywords | 949.e1 | ||
| Chapter Outline | 949 | ||
| Mature Germ Cell Tumors | 949 | ||
| Mature (Cystic) Teratoma | 949 | ||
| Genetics | 950 | ||
| Clinical Presentation | 950 | ||
| Gross Examination | 951 | ||
| Fetiform Teratoma (Homunculus) | 952 | ||
| Mature Solid Teratoma | 952 | ||
| Exclusion of Immature Teratoma | 952 | ||
| Exclusion of a Malignancy Arising in a Mature Teratoma | 953 | ||
| Diagnostic Criteria | 953 | ||
| Ectoderm | 953 | ||
| Mesoderm | 953 | ||
| Endoderm | 953 | ||
| Questionable Immaturity of Neural Tissues | 953 | ||
| Burned-Out Teratoma | 954 | ||
| Meningothelial Proliferations | 954 | ||
| Cerebellum | 954 | ||
| Florid Vascular Proliferations | 954 | ||
| Anti-N-Methyl-d-Aspartate Receptor Encephalitis | 955 | ||
| Immunohistochemistry | 955 | ||
| Immature Teratoma | 956 | ||
| Monodermal Teratomas | 956 | ||
| Struma Ovarii | 956 | ||
| Carcinoid Tumor | 957 | ||
| Somatic-Type Malignancies | 957 | ||
| Differential Diagnosis | 957 | ||
| Malignant Germ Cell Tumors | 957 | ||
| Mature Teratoma | 957 | ||
| Proposed Report Wording | 958 | ||
| Management and Outcome | 958 | ||
| Monodermal and Malignant Variants of (Mature) Teratoma | 958 | ||
| Struma Ovarii | 958 | ||
| Clinical Presentation | 959 | ||
| Gross Examination | 959 | ||
| Diagnostic Criteria | 960 | ||
| Immunohistochemistry | 960 | ||
| Differential Diagnosis | 960 | ||
| Carcinoid Tumors | 960 | ||
| Strumal Carcinoids | 960 | ||
| Sex Cord–Stromal Tumors | 962 | ||
| Müllerian Adenocarcinomas | 962 | ||
| Melanomas and Pituitary-Like Adenomas Arising in a Mature Teratoma | 962 | ||
| Metastatic Malignancies | 962 | ||
| Proposed Report Wording | 962 | ||
| Management and Outcome | 962 | ||
| Malignant Struma Ovarii | 963 | ||
| Clinical Presentation | 963 | ||
| Gross Examination | 963 | ||
| Diagnostic Criteria | 964 | ||
| Histologically Malignant Struma Ovarii Resembling Papillary Thyroid Carcinoma | 964 | ||
| Proliferative (Malignant) Struma Ovarii | 964 | ||
| Highly Differentiated Follicular Carcinoma of Ovarian Derivation | 964 | ||
| Histologically Malignant Struma Ovarii With High-Grade Features | 964 | ||
| Immunohistochemistry and Genetics | 964 | ||
| Differential Diagnosis | 964 | ||
| Classic Papillary Thyroid Carcinoma | 967 | ||
| Follicular Variants of Papillary Thyroid Carcinoma and Proliferative (Malignant) Struma | 967 | ||
| Highly Differentiated Follicular Carcinoma of Ovarian Derivation | 967 | ||
| Tumors With High-Grade Features | 967 | ||
| Proposed Report Wording | 967 | ||
| Management and Outcome | 968 | ||
| Carcinoid Tumors | 968 | ||
| Insular Carcinoids | 969 | ||
| Background and Clinical Presentation | 969 | ||
| Gross Examination | 969 | ||
| Diagnostic Criteria | 969 | ||
| Immunohistochemistry and Differential Diagnosis | 969 | ||
| Management and Outcome | 970 | ||
| Trabecular Carcinoids | 970 | ||
| Background and Clinical Presentation | 970 | ||
| 27 Sex Cord-Stromal and Miscellaneous Tumors of the Ovary | 1011 | ||
| Abstract | 1011.e1 | ||
| Keywords | 1011.e1 | ||
| Chapter Outline | 1011 | ||
| Introduction | 1011 | ||
| Histogenesis | 1011 | ||
| Frequency and Clinical Significance | 1011 | ||
| The Patient at Risk | 1011 | ||
| Frequency | 1011 | ||
| Age | 1011 | ||
| Presenting Signs and Symptoms | 1012 | ||
| Outcome | 1012 | ||
| A Histopathologic Algorithm of Stromal and Sex Cord–Stromal Tumors | 1013 | ||
| Classification of Stromal and Sex Cord–Stromal Tumors | 1013 | ||
| Fibromas | 1013 | ||
| Definition | 1013 | ||
| The Patient at Risk | 1017 | ||
| Gross Features | 1018 | ||
| Histopathology | 1018 | ||
| Differential Diagnosis | 1019 | ||
| Management and Outcome | 1019 | ||
| Cellular Fibromas and Fibrosarcomas | 1019 | ||
| Definition and Background | 1019 | ||
| The Patient at Risk | 1019 | ||
| Gross Features | 1019 | ||
| Histology | 1020 | ||
| Fibroma Versus Cellular Fibroma | 1020 | ||
| Cellular Fibroma Versus Fibrosarcoma | 1020 | ||
| Other Mimics | 1020 | ||
| Outcome | 1020 | ||
| Genetics | 1021 | ||
| Thecomas | 1021 | ||
| Definition | 1021 | ||
| The Patient at Risk | 1021 | ||
| Gross Features | 1021 | ||
| Histopathology | 1022 | ||
| Differential Diagnosis | 1023 | ||
| Outcome | 1025 | ||
| Granulosa Cell Tumors | 1026 | ||
| Definition | 1026 | ||
| Clinical Features and Pathogenesis | 1026 | ||
| Gross Findings | 1026 | ||
| Histology | 1026 | ||
| Adult Granulosa Cell Tumor | 1026 | ||
| Juvenile Granulosa Cell Tumor | 1027 | ||
| Differential Diagnosis | 1029 | ||
| Management and Outcome | 1032 | ||
| Sertoli-Leydig Cell Tumors | 1032 | ||
| Clinical Features and Pathogenesis | 1032 | ||
| Gross Features | 1032 | ||
| Histopathology | 1032 | ||
| Well-Differentiated Sertoli-Leydig Cell Tumor | 1032 | ||
| Intermediately Differentiated Sertoli-Leydig Cell Tumor | 1035 | ||
| Poorly Differentiated Sertoli-Leydig Cell Tumor | 1035 | ||
| Sertoli-Leydig Cell Tumor With a Retiform Pattern | 1036 | ||
| Sertoli-Leydig Cell Tumor With Heterologous Elements | 1036 | ||
| Sertoli Cell Tumors | 1037 | ||
| Clinical Features | 1037 | ||
| Gross Features | 1037 | ||
| Histopathology | 1037 | ||
| Differential Diagnosis | 1038 | ||
| Prognosis and Management | 1039 | ||
| Gynandroblastoma | 1039 | ||
| Sex Cord Tumors With Annular Tubules | 1039 | ||
| Definition and Background | 1039 | ||
| Pathology and Differential Diagnosis | 1039 | ||
| Outcome | 1040 | ||
| Sex Cord–Stromal Tumors Unclassified (Not Otherwise Specified) | 1040 | ||
| Steroid Cell Tumors | 1040 | ||
| Leydig Cell Tumor | 1040 | ||
| Steroid Cell Tumors, Not Otherwise Specified | 1041 | ||
| Other Stromal Tumors | 1042 | ||
| Signet Ring Stromal Tumor | 1042 | ||
| Microcystic Stromal Tumor | 1043 | ||
| Sclerosing Stromal Tumor | 1043 | ||
| Other Ovarian Tumors | 1044 | ||
| Poorly Differentiated (Small Round Cell) Tumors of the Ovary | 1044 | ||
| Small Cell Carcinoma of Hypercalcemic Type | 1044 | ||
| Small Cell Carcinoma of Pulmonary (Neuroendocrine) Type | 1044 | ||
| Intra-abdominal Desmoplastic Small Round Cell Tumor | 1045 | ||
| Primitive Neuroectodermal Tumor | 1045 | ||
| Endometrial Stromal Cell Sarcoma | 1047 | ||
| Lymphoma and Leukemia | 1047 | ||
| Other Rare Ovarian Neoplasms of Uncertain Classification | 1047 | ||
| Key Points | 1048 | ||
| References | 1048 | ||
| 28 Metastatic Tumors Involving the Ovary | 1050 | ||
| Abstract | 1050.e1 | ||
| Keywords | 1050.e1 | ||
| Chapter Outline | 1050 | ||
| Introduction | 1050 | ||
| Gross Evaluation of Ovarian Masses | 1050 | ||
| Metastatic Tumors From the Gynecologic Tract | 1050 | ||
| Metastatic Endometrial Carcinoma | 1050 | ||
| Metastatic Uterine Sarcoma | 1051 | ||
| Metastatic Fallopian Tube Carcinoma | 1052 | ||
| Metastatic Cervical Carcinoma | 1052 | ||
| Metastatic Tumors From the Gastrointestinal and Pancreaticobiliary Tracts | 1052 | ||
| Gastric Carcinoma | 1052 | ||
| Colorectal Carcinoma | 1054 | ||
| Tumors of the Small Bowel | 1054 | ||
| Appendiceal Carcinoma | 1055 | ||
| Pancreatic and Biliary Tract Carcinoma | 1056 | ||
| Other Secondary Tumors of the Ovary | 1058 | ||
| Metastatic Breast Carcinoma | 1058 | ||
| Metastatic Lobular Carcinoma | 1059 | ||
| Metastatic Ductal Carcinoma | 1059 | ||
| Metastatic Triple Negative Breast Carcinoma | 1059 | ||
| Metastatic Lung Carcinoma | 1059 | ||
| Metastatic Renal Cell Carcinoma | 1061 | ||
| Metastatic Urothelial Carcinoma | 1062 | ||
| Malignant Melanoma | 1062 | ||
| Metastatic Sarcoma | 1063 | ||
| Metastatic Small Round Blue Cell Tumors | 1065 | ||
| Metastatic Malignant Mesothelioma | 1065 | ||
| Lymphoma and Leukemia Involving the Ovaries | 1066 | ||
| Malignant Lymphoma | 1066 | ||
| Leukemia | 1066 | ||
| Key Points | 1067 | ||
| References | 1067 | ||
| 29 Placental Development and Complications of Previable Pregnancy | 1070 | ||
| Abstract | 1070.e1 | ||
| Keywords | 1070.e1 | ||
| Chapter Outline | 1070 | ||
| Early Development | 1070 | ||
| Embryo | 1070 | ||
| Placenta | 1070 | ||
| Placental Development | 1071 | ||
| Villous Placenta Across Gestation | 1071 | ||
| Markers of Villous Trophoblasts | 1072 | ||
| Extravillous Trophoblast | 1072 | ||
| At the Implantation Site | 1072 | ||
| Within the Placental Disc | 1072 | ||
| In the Fetal Membranes | 1072 | ||
| Markers of Extravillous Trophoblast | 1075 | ||
| Endometrium During Pregnancy | 1076 | ||
| Endometrial Glands (Arias-Stella Reaction) | 1076 | ||
| Endometrial Stroma (Decidua) | 1076 | ||
| Complications of Previable Pregnancy | 1077 | ||
| Clinical Scenarios and General Considerations | 1077 | ||
| Early Pregnancy Loss (Below 14 Weeks’ Gestation) | 1077 | ||
| Patient With First-Trimester Spontaneous, Including Recurrent, Abortion | 1077 | ||
| Patient With Elective Termination of Pregnancy | 1077 | ||
| Patient With Suspected Ectopic Pregnancy | 1077 | ||
| Late Previable Pregnancy Loss (Between 14 and 24 Weeks’ Gestation) | 1077 | ||
| Clinical Evaluation of Early Pregnancy | 1078 | ||
| Gross Examination of Products of Conception | 1078 | ||
| Embryonic and Fetal Tissues | 1078 | ||
| Placental Tissue | 1079 | ||
| Villous Hydrops | 1082 | ||
| Cytogenetic Analysis | 1082 | ||
| Ectopic Pregnancy | 1083 | ||
| The Patient at Risk | 1083 | ||
| Clinical Presentation | 1084 | ||
| Clinical Diagnostic Algorithm and Management | 1084 | ||
| Examination of the Curettings | 1084 | ||
| Examination of the Tissues | 1084 | ||
| Pitfalls in Histologic Examination of Endometrial Curettings | 1085 | ||
| Contaminating Tissues or Trophoblast Not Diagnostic of Current Intrauterine Pregnancy | 1085 | ||
| Mature Villi | 1085 | ||
| Shed Immature Villi or Syncytiotrophoblasts | 1085 | ||
| Implantation Site | 1085 | ||
| Implantation Site Nodule From Prior Pregnancy | 1085 | ||
| Placental Site Trophoblastic Tumors | 1085 | ||
| Molar Pregnancy | 1085 | ||
| Mimics of an Implantation Site | 1087 | ||
| Reactive or Inflammatory Change in Decidua | 1087 | ||
| Arias-Stella Effect | 1087 | ||
| Combined Intrauterine and Ectopic Pregnancies | 1087 | ||
| Pitfalls to Be Avoided by Clinician and Pathologist | 1087 | ||
| Examination of the Fallopian Tube | 1087 | ||
| Confirmation of Ectopic Pregnancy | 1087 | ||
| Establishing Possible Causes | 1088 | ||
| Differential Diagnosis | 1088 | ||
| Other Sites of Ectopic Gestation | 1088 | ||
| Ovary | 1088 | ||
| Cervix | 1089 | ||
| Abdomen | 1089 | ||
| Posthysterectomy Pregnancy | 1089 | ||
| Sample Reports | 1090 | ||
| Spontaneous Pregnancy Loss | 1091 | ||
| In the First Trimester | 1091 | ||
| The Patient at Risk | 1091 | ||
| Clinical Presentation | 1091 | ||
| Pathology | 1091 | ||
| Changes Associated With Embryonic Death | 1091 | ||
| Changes That Appear Abnormal but Typify Early Gestation | 1091 | ||
| Villous Edema | 1092 | ||
| Histopathologic Findings Indicative of a Specific Mechanism of Demise | 1092 | ||
| The Implantation Site | 1093 | ||
| Maternal Tissues | 1093 | ||
| Sample Reports | 1094 | ||
| In the Second Trimester | 1094 | ||
| The Patient at Risk | 1094 | ||
| Clinical Presentation | 1094 | ||
| Spontaneous Delivery of Extremely Preterm, Previable Fetus | 1094 | ||
| Intrauterine Fetal Deaths | 1094 | ||
| Pathology | 1094 | ||
| Spontaneous Delivery of Extremely Preterm, Previable Fetus | 1095 | ||
| Dissecting Intervillous Hemorrhage That Splays Villi Apart as It Forms a Space-Occupying Mass | 1095 | ||
| Intravillous Hemorrhage as Common Feature of Second-Trimester Abruption | 1095 | ||
| Intrauterine Fetal Demise in the Second Trimester | 1095 | ||
| Sample Reports | 1097 | ||
| Recurrent Pregnancy Loss | 1098 | ||
| The Patient at Risk | 1098 | ||
| Karyotypic Analysis | 1098 | ||
| Histologic Findings | 1098 | ||
| Massive Chronic Intervillositis | 1098 | ||
| Elective Termination of Pregnancy | 1099 | ||
| In the First Trimester | 1099 | ||
| In the Second Trimester | 1099 | ||
| Sample Reports | 1100 | ||
| Postabortion Complications | 1100 | ||
| The Patient at Risk | 1100 | ||
| Clinical Presentation | 1100 | ||
| Pathologic Findings | 1100 | ||
| Management and Outcome | 1101 | ||
| Sample Reports | 1101 | ||
| Key Points | 1101 | ||
| References | 1101 | ||
| 30 Trophoblast Neoplasia | 1103 | ||
| Abstract | 1103.e1 | ||
| Keywords | 1103.e1 | ||
| Chapter Outline | 1103 | ||
| Introduction | 1103 | ||
| The Patient at Risk | 1103 | ||
| Age | 1103 | ||
| Ethnicity | 1103 | ||
| Nulliparity and Prior Spontaneous Abortion | 1104 | ||
| Prior Hydatidiform Mole | 1104 | ||
| Molecular Pathogenesis | 1104 | ||
| Target Cells and Tissues | 1105 | ||
| International Federation of Gynecology and Obstetrics Staging of Gestational Trophoblastic Disease | 1109 | ||
| Hydatidiform Mole | 1110 | ||
| Complete Hydatidiform Mole | 1110 | ||
| Classic (Late) Complete Mole | 1110 | ||
| Early Complete Mole | 1111 | ||
| Differential Diagnosis | 1111 | ||
| Early/Hydropic Abortus | 1112 | ||
| Exuberant Trophoblast Cell Columns Associated With an Early/Aneuploid Gestation | 1112 | ||
| Gestational Sac Masquerading as a Cavitated Villus | 1112 | ||
| Partial Hydatidiform Mole | 1112 | ||
| Clinical and Histologic Features | 1112 | ||
| Differential Diagnosis | 1113 | ||
| Dysmorphic Changes Associated With Aneuploidy | 1115 | ||
| Mesenchymal Dysplasia and Beckwith-Wiedemann Syndrome | 1115 | ||
| Twin Pregnancy With Complete Mole and Normal Gestation | 1118 | ||
| Androgenetic/Biparental Mosaic/Chimeric Conception | 1118 | ||
| Biomarkers of Hydatidiform Mole | 1118 | ||
| Molecular Studies | 1118 | ||
| Management and Outcome | 1119 | ||
| Invasive Mole | 1120 | ||
| Choriocarcinoma | 1122 | ||
| Clinical Features | 1122 | ||
| Gross and Histologic Features | 1122 | ||
| Ancillary Studies | 1123 | ||
| Differential Diagnosis | 1124 | ||
| Early Gestation Trophoblast | 1124 | ||
| Postmolar Curettings | 1124 | ||
| Placental Site Trophoblastic Tumor | 1125 | ||
| Undifferentiated Carcinoma | 1125 | ||
| Management and Outcome | 1125 | ||
| Intraplacental Choriocarcinoma | 1125 | ||
| Clinical and Histologic Features | 1125 | ||
| Differential Diagnosis | 1125 | ||
| Placental Site Trophoblastic Tumor | 1126 | ||
| Risk Factors and Clinical Features | 1126 | ||
| Gross and Histologic Features | 1127 | ||
| Epithelioid Trophoblastic Tumor: A Morphologic Variant of Placental Site Trophoblastic Tumor | 1128 | ||
| Differential Diagnosis | 1128 | ||
| Exaggerated Implantation Site | 1128 | ||
| Placental Site Nodule | 1128 | ||
| Other Malignant Neoplasms | 1128 | ||
| Differential Diagnosis of Extrauterine Trophoblastic Tumors | 1131 | ||
| Molecular Studies | 1132 | ||
| Treatment and Follow-Up | 1132 | ||
| A Decision Algorithm for Managing Problematic Early Gestations | 1134 | ||
| Key Points | 1134 | ||
| References | 1134 | ||
| 31 Evaluation of the Placenta | 1137 | ||
| Abstract | 1137.e1 | ||
| Keywords | 1137.e1 | ||
| Chapter Outline | 1137 | ||
| General Principles | 1137 | ||
| Historical and Clinical Background | 1137 | ||
| Selection of Placentas for Tissue Examination | 1137 | ||
| Fixation and Sampling | 1138 | ||
| Special Procedures: Cultures, Karyotyping, Photography | 1140 | ||
| Pitfalls | 1140 | ||
| Gross Examination of the Placenta | 1140 | ||
| General Appearance | 1140 | ||
| Shape | 1140 | ||
| Weight | 1141 | ||
| Color | 1141 | ||
| Pitfalls | 1142 | ||
| Umbilical Cord and Membranes | 1142 | ||
| Umbilical Cord | 1142 | ||
| Insertion | 1142 | ||
| Distribution of Vessels | 1143 | ||
| Twist | 1143 | ||
| Length | 1143 | ||
| Color | 1143 | ||
| Pitfall | 1144 | ||
| Knots | 1144 | ||
| Vessel Number | 1144 | ||
| Vessel Patency | 1144 | ||
| Perivascular Bleeding | 1144 | ||
| Placental Membranes | 1146 | ||
| Distribution | 1146 | ||
| Integrity | 1146 | ||
| Opacity and Color | 1146 | ||
| Odor | 1146 | ||
| Fetal Surface | 1146 | ||
| Thrombi | 1146 | ||
| Cysts | 1147 | ||
| Small Nodules | 1147 | ||
| Large Nodules | 1147 | ||
| Chorangiomas | 1147 | ||
| Fetus Papyraceous | 1147 | ||
| Subchorionic Hematoma | 1147 | ||
| Absent Subchorionic Fibrin | 1148 | ||
| Maternal Surface | 1148 | ||
| Fragmentation | 1148 | ||
| Retroplacental Blood Clot | 1149 | ||
| Pitfall | 1149 | ||
| Sectioned Surfaces of the Placenta | 1149 | ||
| Thickness | 1150 | ||
| Color | 1150 | ||
| Masses | 1150 | ||
| Infarcts | 1150 | ||
| Intervillous Thrombi | 1151 | ||
| Chorangiomas (Placental Hemangiomas) | 1151 | ||
| Septal Cysts | 1151 | ||
| Fibrin Deposition | 1151 | ||
| Localized | 1151 | ||
| Extensive | 1151 | ||
| Maternal Floor Infarction | 1151 | ||
| Gitter Infarct | 1151 | ||
| Placenta From Multiple Gestations | 1152 | ||
| Inspection of the Umbilical Cords | 1152 | ||
| Discs Separate or Fused | 1152 | ||
| Pitfalls | 1153 | ||
| Dichorionic Separated Twin Placenta Fused Only by Membranes | 1153 | ||
| Dichorionic Fused Twin Placenta | 1153 | ||
| Pitfall | 1153 | ||
| Monochorionic Twin Placenta | 1153 | ||
| Surface Vascular Anastomoses | 1153 | ||
| Deep Vascular Anastomoses | 1153 | ||
| Significance of Intertwin Anastomoses | 1153 | ||
| Injection Studies | 1153 | ||
| All Multifetal Gestations | 1154 | ||
| Microscopic Examination of the Placenta | 1154 | ||
| Umbilical Cord and Membranes | 1154 | ||
| Umbilical Cord | 1154 | ||
| Membrane Roll | 1154 | ||
| Inflammation | 1154 | ||
| Differential Diagnosis | 1154 | ||
| Vascular Pathology | 1154 | ||
| Retromembranous Blood | 1155 | ||
| Pitfall | 1155 | ||
| Pigmented Membrane Macrophages | 1155 | ||
| Differential Diagnosis | 1156 | ||
| Chorionic Plate | 1157 | ||
| Amnion | 1157 | ||
| Definition | 1157 | ||
| Conditions | 1157 | ||
| Amniotic Epithelial Reactive Changes | 1157 | ||
| Amniotic Epithelial Erosion | 1157 | ||
| Amniotic Stromal Macrophage Pigment | 1160 | ||
| Microorganisms | 1160 | ||
| Acute Inflammatory Cells | 1161 | ||
| Differential Diagnosis. | 1161 | ||
| Amniotic-Chorionic Cleft | 1161 | ||
| 32 Placental Correlates of Unanticipated Fetal Death | 1182 | ||
| Abstract | 1182.e1 | ||
| Keywords | 1182.e1 | ||
| Chapter Outline | 1182 | ||
| Introduction | 1182 | ||
| Placenta in Fetal Death | 1182 | ||
| General Historical/Clinical Background | 1182 | ||
| Primary Placental Disorders | 1183 | ||
| Acute Catastrophic Demise | 1183 | ||
| General Historical/Clinical Background | 1183 | ||
| Cord Prolapse | 1183 | ||
| Historical/Clinical Background | 1183 | ||
| Clinical Evaluation | 1184 | ||
| Clinical Correlates/Outcome | 1184 | ||
| Gross Examination Including Pitfalls | 1184 | ||
| Key Histologic Questions Faced by the Pathologist | 1184 | ||
| Abruptio Placentae | 1184 | ||
| Historical/Clinical Background | 1184 | ||
| Clinical Evaluation | 1185 | ||
| Clinical Correlates/Outcome | 1185 | ||
| Gross Examination | 1185 | ||
| Diagnostic Criteria | 1185 | ||
| Pitfalls | 1185 | ||
| Key Histologic Questions Faced by the Pathologist | 1185 | ||
| Ruptured Vasa Previa | 1185 | ||
| Historical/Clinical Background | 1185 | ||
| Clinical Evaluation | 1186 | ||
| Clinical Correlates/Outcome | 1187 | ||
| Gross Examination | 1187 | ||
| Diagnostic Criteria | 1187 | ||
| Pitfall | 1187 | ||
| Amniotic Fluid Embolism | 1188 | ||
| 33 Gestational Diseases and the Placenta | 1219 | ||
| Abstract | 1219.e1 | ||
| Keywords | 1219.e1 | ||
| Chapter Outline | 1219 | ||
| Introduction | 1219 | ||
| Premature Birth or Accelerated Delivery | 1219 | ||
| Acute Chorioamnionitis | 1220 | ||
| Historical/Clinical Background | 1220 | ||
| Pathophysiology | 1220 | ||
| Clinical Evaluation | 1220 | ||
| Clinical Correlates/Outcome | 1221 | ||
| Gross Evaluation | 1221 | ||
| Diagnostic Criteria | 1221 | ||
| Immunohistochemistry and Special Studies | 1221 | ||
| Differential Diagnosis and Potential Pitfalls | 1221 | ||
| Key Clinicopathologic Questions Faced by the Pathologist | 1221 | ||
| Cervical Incompetence | 1221 | ||
| Historical/Clinical Background | 1221 | ||
| Pathophysiology | 1221 | ||
| Appendix A Suggested ICD-10 Codes* | 1250 | ||
| Index | 1254 | ||
| A | 1254 | ||
| B | 1256 | ||
| C | 1256 | ||
| D | 1259 | ||
| E | 1260 | ||
| F | 1262 | ||
| G | 1263 | ||
| H | 1265 | ||
| I | 1266 | ||
| J | 1267 | ||
| K | 1267 | ||
| L | 1267 | ||
| M | 1268 | ||
| N | 1271 | ||
| O | 1272 | ||
| P | 1272 | ||
| Q | 1275 | ||
| R | 1275 | ||
| S | 1276 | ||
| T | 1279 | ||
| U | 1280 | ||
| V | 1281 | ||
| W | 1282 | ||
| X | 1282 | ||
| Y | 1282 | ||
| Z | 1282 | ||
| Inside Back Cover | ibc1 |