Difference between revisions of "An introduction to gynecologic pathology"

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(→‎Endosalpingiosis: misdiagnosis)
m (re-arr. add wolffian adnexal tumour)
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The ovary is affected by a huge number of tumours.
The ovary is affected by a huge number of tumours.


=Site specific=
==Vulva==  
==Vulva==  
{{Main|Vulva}}
{{Main|Vulva}}
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Gynecologic cytology is mostly cervical cytology and cervical cytology is the biggest part of [[cytology]].
Gynecologic cytology is mostly cervical cytology and cervical cytology is the biggest part of [[cytology]].
==Ovary==
{{main|Ovary}}
{{main|Ovarian tumours}}
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)==
{{main|Uterine 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".<ref name=pmid19574767>{{Cite journal  | last1 = Hirst | first1 = JE. | last2 = Gard | first2 = GB. | last3 = McIllroy | first3 = K. | last4 = Nevell | first4 = D. | last5 = Field | first5 = M. | title = High rates of occult fallopian tube cancer diagnosed at prophylactic bilateral salpingo-oophorectomy. | journal = Int J Gynecol Cancer | volume = 19 | issue = 5 | pages = 826-9 | month = Jul | year = 2009 | doi = 10.1111/IGC.0b013e3181a1b5dc | PMID = 19574767 }}</ref>
==Uterus==
{{main|Uterine tumours}}


==Endometrium==
==Endometrium==
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A look at endometrial carcinoma.
A look at endometrial carcinoma.


=Specific entities=
==Endometriosis==
{{main|Endometriosis}}
{{main|Endometriosis}}
A common non-malignant affliction that causes infertility and morbidity.
A common non-malignant affliction that causes infertility and morbidity.


==Ovary==
==Endosalpingiosis==
{{main|Ovary}}
===General===
{{main|Ovarian tumours}}
*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 ovary has a wealth of pathology. It has benign tumours and malignant ones. The ''[[ovary]]'' article covers cysts of the ovary.
===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>


==Uterine tube (Fallopian tube)==
Notes:
{{main|Uterine tube}}
*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>


This was ignored in the past... current thinking is that it may be the real culprit in what is often labeled as "ovarian cancer".<ref name=pmid19574767>{{Cite journal  | last1 = Hirst | first1 = JE. | last2 = Gard | first2 = GB. | last3 = McIllroy | first3 = K. | last4 = Nevell | first4 = D. | last5 = Field | first5 = M. | title = High rates of occult fallopian tube cancer diagnosed at prophylactic bilateral salpingo-oophorectomy. | journal = Int J Gynecol Cancer | volume = 19 | issue = 5 | pages = 826-9 | month = Jul | year = 2009 | doi = 10.1111/IGC.0b013e3181a1b5dc | PMID = 19574767 }}</ref>
==Wolffian adnexal tumour==
===General===
*Super rare.
*Adnexal - as the name suggests.
*Usu. benign.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970577-0 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970577-0]. Accessed on: 29 April 2011.</ref>


==Uterus==
===Microscopic===
{{main|Uterine tumours}}
Features:
*Tubular/glandular spaces.


==Pregnancy==
DDx:
{{main|Chorionic villi}}
*[[Brenner tumour]].
Chorionic villi are the minimum needed to diagnose pregnancy histologically.


{{main|Gestational trophoblastic disease}}
=Introduction to gynecologic tumours=
When reproduction goes wrong.
 
{{main|Placenta}}
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:'''
'''Where to start when considering a malignant (epithelial) tumour of the gynecologic tract:'''
{| class="wikitable"
{| class="wikitable"
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|}
|}


==Benign stuff==
=Benign stuff=
'''Where to start when it looks benign:'''
'''Where to start when it looks benign:'''
{| class="wikitable"
{| class="wikitable"
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*Common in post-menopausal women.
*Common in post-menopausal women.


===Micro.===
===Microscopic===
Features:
*Well-defined cell borders/spaced.
*Well-defined cell borders/spaced.
*Eosinophilic cytoplasm.
*Eosinophilic cytoplasm.
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*aka Wolffian duct - precursor of male reproductive tract.<ref>{{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>
*aka Wolffian duct - precursor of male reproductive tract.<ref>{{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>


===Micro===
===Microscopic===
*Cuboidal cells in glands/tubules - may surround cleft.<ref>Sternberg SE. Histology for Pathologists. 2nd Ed. P.893.</ref>
Features:<ref>Sternberg SE. Histology for Pathologists. 2nd Ed. P.893.</ref>
*Cuboidal cells in glands/tubules - may surround cleft.
   
   
DDx:
DDx:
Line 151: Line 174:
Image: [http://commons.wikimedia.org/wiki/File:Luteinized_follicular_cyst.jpg Luteinized follicular cyst (WC)].
Image: [http://commons.wikimedia.org/wiki/File:Luteinized_follicular_cyst.jpg Luteinized follicular cyst (WC)].


==Endosalpingiosis==
=Other=
===General===
==Pregnancy==
*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.
{{main|Chorionic villi}}
Chorionic villi are the minimum needed to diagnose pregnancy histologically.


===Microscopic===
{{main|Gestational trophoblastic disease}}
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>
When reproduction goes wrong.
*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>


Notes:
{{main|Placenta}}
*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>
A big endocrine organ that gets completely ignored by almost everyone.


==See also==
=See also=
*[[Testicular tumours]].
*[[Testicular tumours]].
*[[Gastrointestinal pathology]].
*[[Gastrointestinal pathology]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Gynecologic pathology]]
[[Category:Gynecologic pathology]]

Revision as of 18:13, 29 April 2011

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.

Site specific

Vulva

Main article: Vulva

This covers the topic of vulva.

Vagina

Main article: Vagina

This covers the topic of vagina.

Cervix

Main article: Cervix

The most common type of cervical cancer is: squamous cell carcinoma.

Main article: Cervical polyp

Common benign cause of bleeding.

Gynecologic cytology is mostly cervical cytology and cervical cytology is the biggest part of cytology.

Ovary

Main article: Ovary
Main article: Ovarian tumours

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)

Main article: Uterine 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

Main article: Uterine tumours


Endometrium

Main article: Endometrium

Addresses dating of the endometrium.

Main article: Endometrial hyperplasia

Endometrial hyperplasia is considered the precursor of carcinoma.

Main article: Endometrial carcinoma

A look at endometrial carcinoma.

Specific entities

Endometriosis

Main article: Endometriosis

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

Endosalpingiosis

General

  • Benign entity that may lead to a misdiagnosis of adenocarcinoma[2] or serous carcinoma.

Microscopic

Features:[3]

  • 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.[4]

Notes:

  • Not associated with hemorrhage.[5]

Wolffian adnexal tumour

General

  • Super rare.
  • Adnexal - as the name suggests.
  • Usu. benign.[6]

Microscopic

Features:

  • Tubular/glandular spaces.

DDx:

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. (WC), WCR (WC)

Hilus cell

Ref: Sternberg H4P.[7]

Epidemiology

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

Microscopic

Features:

  • 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.[8]

Microscopic

Features:[9]

  • Cuboidal cells in glands/tubules - may surround cleft.

DDx:

  • Adenocarcinoma
    • Mesonephric remnant has no cellular atypia

Image: [1]

Walthard cell rest

General

  • AKA Walthard cell nest.
  • Benign.

Epidemiology

Microscopic

Features:[10]

  • 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:

Luteinized follicular cyst

Features:[11]

  • 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: Luteinized follicular cyst (WC).

Other

Pregnancy

Main article: Chorionic villi

Chorionic villi are the minimum needed to diagnose pregnancy histologically.

Main article: Gestational trophoblastic disease

When reproduction goes wrong.

Main article: Placenta

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. ↑ Lin O (May 2009). "Challenges in the interpretation of peritoneal cytologic specimens". Arch. Pathol. Lab. Med. 133 (5): 739–42. PMID 19415948.
  3. ↑ URL: http://radiographics.rsna.org/content/29/2/347.full. Accessed on: 27 May 2010.
  4. ↑ Hallman KB, Nahhas WA, Connelly PJ (September 1991). "Endosalpingiosis as a source of psammoma bodies in a Papanicolaou smear. A case report". J Reprod Med 36 (9): 675–8. PMID 1774734.
  5. ↑ URL: http://radiographics.rsna.org/content/29/2/347.full. Accessed on: 27 May 2010.
  6. ↑ URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970577-0. Accessed on: 29 April 2011.
  7. ↑ Sternberg SE. Histology for Pathologists. 2nd Ed. P.953.
  8. ↑ 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.
  9. ↑ Sternberg SE. Histology for Pathologists. 2nd Ed. P.893.
  10. ↑ Nucci, Marisa R.; Oliva, Esther (2009). Gynecologic Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 332. ISBN 978-0443069208.
  11. ↑ URL: http://www.med-ed.virginia.edu/courses/path/gyn/ovary2.cfm. Accessed on: 20 May 2010.
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