Difference between revisions of "An introduction to gynecologic pathology"

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An introduction to gynecologic pathology (view source)

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==Endosalpingiosis==
==Endosalpingiosis==
===General===
{{Main|Endosalpingiosis}}
*Benign entity that may lead to a misdiagnosis of adenocarcinoma<ref name=pmid19415948>{{cite journal |author=Lin O |title=Challenges in the interpretation of peritoneal cytologic specimens |journal=Arch. Pathol. Lab. Med. |volume=133 |issue=5 |pages=739–42 |year=2009 |month=May |pmid=19415948 |doi= |url=}}</ref> or serous carcinoma.
*The clinical significance of endosalpingiosis is not definitively settled; opinions differ on whether it is:
*# associated with pelvic pain,<ref name=pmid9350013>{{Cite journal  | last1 = deHoop | first1 = TA. | last2 = Mira | first2 = J. | last3 = Thomas | first3 = MA. | title = Endosalpingiosis and chronic pelvic pain. | journal = J Reprod Med | volume = 42 | issue = 10 | pages = 613-6 | month = Oct | year = 1997 | doi =  | PMID = 9350013 }}</ref> ''or''
*# an incidental finding discovered in the course of investigating something else (pelvic pain, menstrual irregularities, infertility).<ref name=pmid12039470>{{Cite journal  | last1 = Heinig | first1 = J. | last2 = Gottschalk | first2 = I. | last3 = Cirkel | first3 = U. | last4 = Diallo | first4 = R. | title = Endosalpingiosis-an underestimated cause of chronic pelvic pain or an accidental finding? A retrospective study of 16 cases. | journal = Eur J Obstet Gynecol Reprod Biol | volume = 103 | issue = 1 | pages = 75-8 | month = Jun | year = 2002 | doi =  | PMID = 12039470 }}</ref>
 
===Microscopic===
Features:<ref>URL: [http://radiographics.rsna.org/content/29/2/347.full http://radiographics.rsna.org/content/29/2/347.full]. Accessed on: 27 May 2010.</ref>
*Cystic lesions with:
**Ciliated (tubal type) epithelium, without endometrial stroma.
***Endosalpingiosis is surrounded by fibrous stroma; tubal type epithelial surrounded by ovarian stroma is a variant of [[endometriosis]].
*Associated with [[psammoma bodies]].<ref name=pmid1774734>{{cite journal |author=Hallman KB, Nahhas WA, Connelly PJ |title=Endosalpingiosis as a source of psammoma bodies in a Papanicolaou smear. A case report |journal=J Reprod Med |volume=36 |issue=9 |pages=675–8 |year=1991 |month=September |pmid=1774734 |doi= |url=}}</ref>
 
DDx:<ref>{{Cite journal  | last1 = Rosenberg | first1 = P. | last2 = Nappi | first2 = L. | last3 = Santoro | first3 = A. | last4 = Bufo | first4 = P. | last5 = Greco | first5 = P. | title = Pelvic mass-like florid cystic endosalpingiosis of the uterus: a case report and a review of literature. | journal = Arch Gynecol Obstet | volume = 283 | issue = 3 | pages = 519-23 | month = Mar | year = 2011 | doi = 10.1007/s00404-010-1700-1 | PMID = 20931212 }}</ref>
*Serous carcinoma.
*[[Peritoneal inclusion cyst]].
 
Notes:
#Not associated with hemorrhage.<ref>URL: [http://radiographics.rsna.org/content/29/2/347.full http://radiographics.rsna.org/content/29/2/347.full]. Accessed on: 27 May 2010.</ref>
#In a lymph node, endosalpingiosis may be misinterpreted as a [[lymph node metastasis|metastasis]]!<ref name=pmid20631604>{{Cite journal  | last1 = Corben | first1 = AD. | last2 = Nehhozina | first2 = T. | last3 = Garg | first3 = K. | last4 = Vallejo | first4 = CE. | last5 = Brogi | first5 = E. | title = Endosalpingiosis in axillary lymph nodes: a possible pitfall in the staging of patients with breast carcinoma. | journal = Am J Surg Pathol | volume = 34 | issue = 8 | pages = 1211-6 | month = Aug | year = 2010 | doi = 10.1097/PAS.0b013e3181e5e03e | PMID = 20631604 }}</ref>
 
Images:
*[http://commons.wikimedia.org/wiki/File:Endosalpingiosis_-_low_mag.jpg Endosalpingiosis -  low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Endosalpingiosis_-_high_mag.jpg Endosalpingiosis - high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Endosalpingiosis_-_cropped_2_-_very_high_mag.jpg Endosalpingiosis - very high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Endosalpingiosis_in_lymph_node_-_intermed_mag.jpg Endosalpingiosis in a LN - intermed. mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Endosalpingiosis_in_lymph_node_-_very_high_mag.jpg Endosalpingiosis in a LN - very high mag. (WC)].


==Female adnexal tumour of probable Wolffian origin==
==Female adnexal tumour of probable Wolffian origin==
*Abbreviated ''FATWO''.
*Abbreviated ''FATWO''.
*[[AKA]] ''Wolffian adnexal tumour''.
*[[AKA]] ''Wolffian adnexal tumour''.
===General===
{{Main|Female adnexal tumour of probable Wolffian origin}}
*Super rare.<ref name=pmid22611973>{{Cite journal  | last1 = Tianmin | first1 = X. | last2 = Weiqim | first2 = C. | last3 = Mianhua | first3 = C. | last4 = Xiaocui | first4 = L. | last5 = Hongwen | first5 = G. | last6 = Min | first6 = Y. | title = Tumor of the mesosalpinx: case report of a female adnexal tumor of probable Wolffian origin. | journal = Eur J Gynaecol Oncol | volume = 33 | issue = 2 | pages = 233-5 | month =  | year = 2012 | doi =  | PMID = 22611973 }}</ref>
*Adnexal - as the name suggests.
*Usually benign.
**May be malignant.<ref name=pmid21542539>{{Cite journal  | last1 = Heller | first1 = DS. | last2 = Kadire | first2 = B. | last3 = Cracchiolo | first3 = B. | title = Malignant female adnexal tumor of probable Wolffian origin: a case report. | journal = J Reprod Med | volume = 56 | issue = 3-4 | pages = 175-7 | month =  | year =  | doi =  | PMID = 21542539 }}</ref>
 
===Microscopic===
Features:
*Tubular/glandular spaces.
 
DDx:
*[[Brenner tumour]].


=Introduction to gynecologic tumours=
=Introduction to gynecologic tumours=
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| ovoid, small  
| ovoid, small  
| eosinophilic
| eosinophilic
| [[FATWO]]
| [[FATWO]], [[mesonephric adenocarcinoma]]
| Develops into vas deferens in males.  
| Develops into vas deferens in males.  
| [http://www.uoguelph.ca/~rfoster/repropath/surgicalpath/female/cat/F%20fel%20anomaly%20mesonephric%20remnants%20YB108065%2011wl.jpg mesonephric r., cat (uoguelph.ca)]
| [[Image:Mesonephric duct remnant -- intermed mag.jpg|100px|thumb|center|MR (WC)]]
|-
|-
|[[Walthard cell rest]]
|[[Walthard cell rest]]
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| [[Brenner tumour]]
| [[Brenner tumour]]
| nil  
| nil  
| [http://commons.wikimedia.org/wiki/File:Walthard_cell_rest_-_very_high_mag.jpg Coffee bean n. (WC)], [http://commons.wikimedia.org/wiki/File:Walthard_cell_rest_-_very_low_mag.jpg WCR (WC)]
|[[Image:Walthard_cell_rest_-_very_high_mag.jpg|thumb|center|100px|WCR (WC)]][[Image:Walthard_cell_rest_-_very_low_mag.jpg|thumb|center|100px|WCR (WC)]]
|}
|}


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**Round nucleus +/- nucleolus.
**Round nucleus +/- nucleolus.


Images:
====Images====
*[http://path.upmc.edu/cases/case394.html Hilus cell hyperplasia (upmc.edu)].
*[http://path.upmc.edu/cases/case394.html Hilus cell hyperplasia (upmc.edu)].
===IHC===
Features:
*Inhibin +ve.
*Calretinin +ve.
*PLAP -ve.


==Mesonephric duct remnant==  
==Mesonephric duct remnant==  
:''Gartner duct cyst'', ''mesonephric duct cyst'' and ''Wolffian duct cyst'' redirect here.
*[[AKA]] ''Wolffian duct remnant''.
*[[AKA]] ''Wolffian duct remnant''.
*[[AKA]] ''Gartner duct''.<ref>URL: [http://webpathology.com/image.asp?n=3&Case=540 http://webpathology.com/image.asp?n=3&Case=540]. Accessed on: 22 October 2012.</ref>  
*[[AKA]] ''Gartner duct''.<ref>URL: [http://webpathology.com/image.asp?n=3&Case=540 http://webpathology.com/image.asp?n=3&Case=540]. Accessed on: 22 October 2012.</ref>  
 
{{Main|Mesonephric duct remnant}}
===General===
Epidemiology:
*Embryological remnant - benign.
**Wolffian duct = precursor of male reproductive tract.<ref name=pmid16567946>{{cite journal |author=Hannema SE, Print CG, Charnock-Jones DS, Coleman N, Hughes IA |title=Changes in gene expression during Wolffian duct development |journal=Horm. Res. |volume=65 |issue=4 |pages=200–9 |year=2006 |pmid=16567946 |doi=10.1159/000092408 |url=}}</ref>
 
Notes:
*This is ''not'' a finding that is reported.  The importance of this finding is knowing it isn't something neoplastic.
*Lame way of remember the synonyms ''Gartner, Mesonephric, and Wolffian'': ''GMW''... it is trying to be a ''BMW'' but in ''g''irls.
 
===Microscopic===
Features:<ref>Sternberg SE. Histology for Pathologists. 2nd Ed. P.893.</ref>
*Small duct -- typically ~50-100 micrometres in diameter.
**Duct lined by cuboidal cells with moderate eosinophilic cytoplasm.
DDx:
*[[Cervical adenocarcinoma]], not otherwise specified.
*[[Mesonephric adenocarcinoma]] - has cellular atypia.
 
Images:
*[http://www.webpathology.com/image.asp?case=550&n=1 Mesonephric duct remnant - low mag. (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=2&Case=550 Mesonephric duct remnant - high mag. (webpathology.com)].
 
===IHC===
Features:<ref name=Ref_WMSP442>{{Ref WMSP|442}}</ref>
*CD10 +ve.
*CK7 +ve.


==Walthard cell rest==
==Walthard cell rest==
===General===
*[[AKA]] ''Walthard cell nest''.
*[[AKA]] ''Walthard cell '''n'''est''.
{{Main|Walthard cell rest}}
*Benign.
 
====Epidemiology====
*Thought to be related to [[Brenner tumour]].  
 
===Microscopic===
Features:<ref name=Ref_GP332>{{Ref_GP|332}}</ref>
*Collection of eosinophilic (i.e. pink) cuboidal cells; usually solid, may be cystic.
*Elliptical nucleus with single groove along major axis; "coffee bean" nucleus -- '''key feature'''.
 
Location:
*Usually in soft tissue of the uterine tube.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Walthard_cell_rest_-_very_high_mag.jpg Coffee bean nucleus (WC)].
*[http://commons.wikimedia.org/wiki/File:Walthard_cell_rest_-_very_low_mag.jpg WCR (WC)].


==Paraurethral cyst==
==Paraurethral cyst==
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==Luteinized follicular cyst==
==Luteinized follicular cyst==
Features:<ref>URL: [http://www.med-ed.virginia.edu/courses/path/gyn/ovary2.cfm http://www.med-ed.virginia.edu/courses/path/gyn/ovary2.cfm]. Accessed on: 20 May 2010.</ref>
{{Main|Luteinized follicular cyst}}
*Stratified cuboidal/columnar epithelium-like cells with:
**Small nuclei and small nucleoli.
**Cytoplasm may be eosinophilic.
**Sit on spindled cells (theca interna) that is luteinized.
 
Image: [http://commons.wikimedia.org/wiki/File:Luteinized_follicular_cyst.jpg Luteinized follicular cyst (WC)].


=Other=
=Other=
Michael
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