An introduction to gynecologic pathology
Gynecologic pathology is a big part of surgical pathology. Radiologists have a lot of trouble in this area. On CT it is not infrequently hard to pick-out the ovaries... and it is a reason they don't comment on 'em. The ovary is affected by a huge number of tumours.
Vulva
Cervix
The most common type of cervical cancer is: squamous cell carcinoma.
Common benign cause of bleeding.
Gynecologic cytology is mostly cervical cytology and cervical cytology is the biggest part of cytology.
Endometrium
Addresses dating of the endometrium.
Endometrial hyperplasia is considered the precursor of carcinoma.
A look at endometrial carcinoma.
A common non-malignant affliction that causes infertility and morbidity.
Ovary
The ovary has a wealth of pathology. It has benign tumours and malignant ones.
Uterine tube (Fallopian tube)
This was ignored in the past... current thinking is that it may be the real culprit in what is often labeled as "ovarian cancer".[1]
Pregnancy
Chorionic villi are the minimum needed to diagnose pregnancy histologically.
When reproduction goes wrong.
A big endocrine organ that gets completely ignored by almost everyone.
Introduction to gynecologic tumours
Where to start when considering a malignant (epithelial) tumour of the gynecologic tract:
| Serous | Endometrioid | Mucinous | |
| Characteristics | cilia, columnar cells psammoma bodies, papillary arch. |
gland forming, endometrium-like | mucinous glands, colon-like |
| Differentiators | cilia, psammoma bodies | squamous metaplasia | mucin, lack of necrosis |
| Associations | atrophy | endometriosis, endometrial hyperplasia | (?) |
| Typical age | usually 60s+ | 40-60 | varies (?) |
| Grade | typically high grade | typically low grade | often low |
| IHC | p53+ diffuse, WT-1 +ve, D2-40 +ve, CA-125 +ve | WT-1 -ve | CK7 +ve, CK20 +ve (others CK7 +ve, CK20 -ve) |
| Main DDx | poorly diff. endometrioid | serous | metastatic tumour (usually GI) |
Benign stuff
Where to start when it looks benign:
| Morphology | Nucleus | Cytoplasm | Tumour | Other | Image | |
| Hilus cells | well-defined cell borders, solid | eccentric, mild pleomorphism | eosinophilic | Hilus cell tumour | absent in childhood | Need one |
| Mesonephric remnant (aka Wolffian duct) | cuboidal, glands/lumen present | ovoid, small | eosinophilic | ? | Develops into vas deferens in males. | mesonephric r., cat (uoguelph.ca) |
| Walthard cell rest | cuboidal, nested, solid | "coffee bean" shape | eosionphilic | Brenner tumour | nil | Coffee bean n. (WP), Brenner t. (WP) |
Hilus cell
Ref: Sternberg H4P.[2]
Epidemiology
- Present in embryo.
- Absent in childhood.
- Reappear at puberty.
- Common in post-menopausal women.
Micro.
- Well-defined cell borders/spaced.
- Eosinophilic cytoplasm.
- Prominent nucleus.
- In small clumps.
- Similar to Leydig cells.
Pathology
Mesonephric remnant
Epidemiology
- Embryological remnant - benign.
- aka Wolffian duct - precursor of male reproductive tract.[3]
Micro
- Cuboidal cells in glands/tubules - may surround cleft.[4]
DDx:
- Adenocarcinoma
- Mesonephric remnant has no cellular atypia
Image: [1]
Walthard cell nest
Micro
- Collection of eosinophilic (i.e. pink) cuboidal cells, solid (?).
- Located on serosal surface of uterine tube.
- Ellipical grooved nucleus ("coffee bean" appearance).
Epidemiology
- Thought to be related to Brenner tumour (?)
Ref: [5]
See also
References
- ↑ Hirst, JE.; Gard, GB.; McIllroy, K.; Nevell, D.; Field, M. (Jul 2009). "High rates of occult fallopian tube cancer diagnosed at prophylactic bilateral salpingo-oophorectomy.". Int J Gynecol Cancer 19 (5): 826-9. doi:10.1111/IGC.0b013e3181a1b5dc. PMID 19574767.
- ↑ Sternberg SE. Histology for Pathologists. 2nd Ed. P.953.
- ↑ Hannema SE, Print CG, Charnock-Jones DS, Coleman N, Hughes IA (2006). "Changes in gene expression during Wolffian duct development". Horm. Res. 65 (4): 200–9. doi:10.1159/000092408. PMID 16567946.
- ↑ Sternberg SE. Histology for Pathologists. 2nd Ed. P.893.
- ↑ http://pathologyoutlines.com/fallopiantubes.html#walthard