An introduction to gynecologic pathology

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Gynecologic pathology, informally gyne path, 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.

Site specific

Vulva

This covers the topic of vulva.

Vagina

This covers the topic of vagina.

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.

Ovary

The ovary has a wealth of pathology. It has benign tumours and malignant ones. The ovary article covers cysts of the ovary.

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]

Uterus

The article covers uterine leiomyomas, uterine carcinosarcomas and endometrial stromal tumours.

Endometrium

Addresses dating of the endometrium.

Endometrial hyperplasia is considered the precursor of carcinoma.

A look at endometrial carcinoma.

Specific entities

Endometriosis

A common non-malignant affliction that causes infertility and morbidity.

Peritoneal inclusion cyst

This is dealt with in the omentum article. It is also known as benign multicystic mesothelioma[2] and inflammatory cyst of the peritoneum.

Endosalpingiosis

Female adnexal tumour of probable Wolffian origin

  • Abbreviated FATWO.
  • AKA Wolffian adnexal tumour.

Introduction to gynecologic tumours

Where to start when considering a malignant (epithelial) tumour of the gynecologic tract:

Type Histology Differentiators Associations Typical age Grade IHC Main DDx
Serous cilia, columnar cells
psammoma bodies, papillary arch.
cilia, psammoma bodies atrophy usually 60s+ typically high grade p53+ diffuse, WT-1 +ve, D2-40 +ve, CA-125 +ve poorly diff. endometrioid
Endometrioid gland forming, endometrium-like squamous metaplasia endometriosis, endometrial hyperplasia 40-60 typically low grade WT-1 -ve serous
Mucinous mucinous glands, colon-like mucin, lack of necrosis (?) varies (?) often low metastatic tumour (usually GI)

Benign stuff

Where to start when it looks benign:

Entity 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 FATWO, mesonephric adenocarcinoma Develops into vas deferens in males.
MR (WC)
Walthard cell rest cuboidal, nested, solid "coffee bean" shape eosionphilic Brenner tumour nil
WCR (WC)
WCR (WC)

Hilus cells

General

Features:[3]

  • Present in embryo.
  • Absent in childhood.
  • Reappear at puberty.
  • Common in post-menopausal women.

Associated pathology:

Microscopic

Features:[4]

  • Similar to Leydig cells:
    • Typically found in small clusters.
    • Eosinophilic cytoplasm.
    • Round nucleus +/- nucleolus.

Images

IHC

Features:

  • Inhibin +ve.
  • Calretinin +ve.
  • PLAP -ve.

Mesonephric duct remnant

  • AKA Wolffian duct remnant.
  • AKA Gartner duct.[5]

Walthard cell rest

  • AKA Walthard cell nest.

Paraurethral cyst

Luteinized follicular cyst

Other

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.

See also

References

  1. 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.
  2. Vallerie, AM.; Lerner, JP.; Wright, JD.; Baxi, LV. (May 2009). "Peritoneal inclusion cysts: a review.". Obstet Gynecol Surv 64 (5): 321-34. doi:10.1097/OGX.0b013e31819f93d4. PMID 19386139.
  3. Sternberg, Stephen S. (1997). Histology for Pathologists (2nd ed.). Lippincott Williams & Wilkins. pp. 953. ISBN 978-0397517183.
  4. URL: http://path.upmc.edu/cases/case394/dx.html. Accessed on: 16 January 2012.
  5. URL: http://webpathology.com/image.asp?n=3&Case=540. Accessed on: 22 October 2012.