Cytology and Surgical Pathology of Gynecologic Neoplasms (eBook)

Cytology and Surgical Pathology of Gynecologic Neoplasms 3
Preface 5
Contents 7
Chapter 1: Normal Histology of Female Genital Organs 11
1.1 Normal Histology of Vulva 11
1.2 Normal Histology of Vagina 11
1.3 Normal Histology of Cervix 11
1.4 Normal Histology of Uterus 12
1.5 Normal Histology of Fallopian Tube 14
1.6 Normal Histology of Ovary 14
1.7 Normal Cytology of Female Genital Tract Organs 15
1.7.1 Squamous Cells 15
1.7.1.1 Superficial Squamous Cells 15
1.7.1.2 Intermediate Squamous Cells 15
1.7.2 Parabasal Squamous Cells 16
1.7.3 Endocervical Cells 16
1.7.4 Squamous Metaplastic Cells 17
1.7.5 Endometrial Cells 17
1.7.5.1 Exfoliated Endometrial Glandular Cells 17
1.7.5.2 Exfoliated Endometrial Stromal Cells 18
1.7.6 Direct Sampling of the Lower Uterine Segment 18
1.8 The Bethesda System 20
1.8.1 Specimens Adequacy 21
1.8.2 Minimum Squamous Cellularity Criteria 21
1.8.3 Endocervical/Transformation Zone Component 22
1.8.4 Obscuring Factors 22
1.8.5 Management of Women with Unsatisfactory Pap Test 22
Suggested Reading 23
Chapter 2: Lesions of the Vulva and Vagina 24
2.1 General Classification of Tumors or Tumor-Like Conditions of Vulva and Vagina 24
2.2 Benign, Preneoplastic, and In Situ Neoplastic Squamous Lesions 24
2.3 Glandular Lesions 29
2.3.1 Benign Glandular Lesions 29
2.3.2 Adenocarcinomas 29
2.4 Other Epithelial or Epithelioid Lesions 34
2.5 Melanocytic Lesions 35
2.6 Mesenchymal and Lymphoid Neoplasms 35
2.7 Secondary Tumors 39
2.8 Cytology of Vulva 40
2.8.1 Dysplasia (Vulvar Intraepithelial Neoplasia) 40
2.8.2 Squamous Cell Carcinoma 40
2.8.3 Paget’s Disease 40
2.8.4 Mimics of Neoplastic Diseases 40
2.9 Cytology of Vagina 40
2.9.1 Diethylstilbestrol-Related Abnormalities 41
2.9.2 Vaginal Intraepithelial Neoplasia 41
2.9.3 Squamous Cell Carcinoma 42
2.9.4 Embryonal Rhabdomyosarcoma 42
2.9.5 Mimics of Neoplastic Diseases 42
2.9.6 Role of Vaginal Cytology Screening After Total Hysterectomy 42
Suggested Reading 43
Chapter 3: Squamous Lesions of the Cervix 44
3.1 General Classification of Tumors of Cervix 44
3.2 Squamous Intraepithelial Lesions and Other HPV-Related Lesions 44
3.3 Squamous Cell Carcinomas 47
3.4 Cytology 49
3.4.1 Atypical Squamous Cells 49
3.4.2 ASC-US 50
3.4.3 ASC-H 50
3.4.4 Low-Grade Squamous Intraepithelial Lesion 52
3.4.5 High-Grade Squamous Intraepithelial Lesions 54
3.4.6 LSIL Cannot Rule Out HSIL 55
3.4.7 HSIL with Glandular Involvement 56
3.4.8 Squamous Cell Carcinoma 57
3.4.9 Mimics of Neoplastic Diseases 58
3.4.9.1 Microorganisms 59
3.4.9.2 Bacterial Organisms 59
3.4.9.3 Fungal Organisms 60
3.4.9.4 Viral Organisms 61
3.4.9.5 Parasitic Organisms 61
3.4.9.6 Noninfectious Cervicovaginitis 62
3.4.9.6.1 Atrophic Vaginitis 62
3.4.9.6.2 Keratinization 62
3.4.9.6.3 Reactive Cellular Changes (Including Repair) 63
3.4.9.6.4 Therapeutic Changes 66
3.4.9.6.5 Artifacts 67
3.5 Clinical Staging and Management 67
Suggested Reading 67
Chapter 4: Glandular Lesions of the Cervix 68
4.1 Cervical Polyp and Other Tumor-Like Conditions 68
4.2 Glandular Dysplasia/Adenocarcinoma In Situ 71
4.3 Invasive Adenocarcinomas 71
4.4 Cytology of Cervical Glandular Lesions 81
4.4.1 Atypical Glandular Cells, Endocervical Origin 81
4.4.2 Endocervical Adenocarcinoma In Situ 82
4.4.3 Endocervical Adenocarcinoma 84
4.4.4 Mimics of Neoplastic Diseases 84
4.4.4.1 Reactive Endocervical Cells 84
4.4.4.2 Tubal Metaplasia 85
4.4.4.3 Microglandular Hyperplasia 86
4.4.4.4 Benign Glandular Cells Status Post-Hysterectomy 86
4.4.4.5 Pregnancy-Related Changes 86
4.4.5 Other Primary Malignant Neoplasms 87
4.4.5.1 Sarcomas 87
4.4.5.2 Melanoma 87
4.4.5.3 Lymphoma 87
4.4.5.4 Metastatic Tumors 87
Suggested Reading 89
Chapter 5: Human Papillomavirus for Cervical Pathology 90
5.1 Classification, Properties, and Viral Genome 90
5.2 Natural History of HPV Infection 90
5.3 Distribution of HPV in Cervical Lesions 91
5.4 Methods of Detection 91
5.5 Indications for HPV Testing 91
5.6 Applications for HPV Testing in Cytology 92
5.6.1 Triage of ASC-US and/or LSIL 92
5.6.2 Surveillance After Treatment of CIN 92
5.6.3 Primary Screening 93
5.6.4 HPV Genotyping 93
Suggested Reading 94
Chapter 6: Endometrial Epithelial Neoplasms 95
6.1 General Classification of Uterine Corpus Neoplasms 95
6.2 Benign Tumors and Tumor-Like Conditions 95
6.3 Endometrial Hyperplasia 97
6.4 Endometrial Carcinomas 99
6.5 Cytology 107
6.5.1 Atypical Glandular Cells, Endometrial Origin 109
6.5.2 Endometrial Adenocarcinoma 109
6.5.3 Gynecologic Cytology and the Detection of Endometrial Hyperplasia and Malignancy 109
6.5.4 Hyperchromatic Crowded Groups 113
Suggested Reading 113
Chapter 7: Nonepithelial Tumors of Uterine Corpus 114
7.1 General Classification of Nonepithelial Tumors of Uterine Corpus 114
7.2 Endometrial Stromal Tumors 114
7.3 Mullerian Mixed Epithelial and Stromal Tumors 118
7.4 Smooth Muscle Tumors 124
7.5 Other Mesenchymal Tumors 130
7.6 Cytology 132
7.6.1 Sarcomas 135
7.6.2 Melanoma 135
7.6.3 Lymphoma 135
7.6.4 Metastatic Tumors 135
Suggested Reading 136
Chapter 8: Gestational Trophoblastic Disease 137
8.1 General Classification of Gestational Trophoblastic Disease 137
8.2 Hydatidiform Moles 137
8.2.1 Complete Hydatidiform Mole 137
8.2.2 Partial Hydatidiform Mole 139
8.2.3 Invasive Hydatidiform Mole 139
8.3 Gestational Choriocarcinoma 140
8.4 Placental Site Trophoblastic Tumor 140
8.5 Epithelioid Trophoblastic Tumor 141
8.6 Exaggerated Placental Site Reaction 141
8.7 Placental Site Nodule 143
Suggested Reading 144
Chapter 9: Tumors of Fallopian Tube and Broad Ligament 145
9.1 Benign Tumors and Tumor-Like Conditions 145
9.2 Malignant Epithelial Tumors 145
9.3 Cytology 146
Suggested Reading 149
Chapter 10: Epithelial Neoplasms of Ovary 150
10.1 General Classification of Ovarian Neoplasms 150
10.2 Primary Epithelial Ovarian Neoplasms 150
10.3 Ovarian Epithelial Tumors of Uncertain Origin 164
10.4 Secondary Carcinomas Involving Ovary 167
10.5 Cytology 173
10.5.1 Exfoliative Cytology in Pap Test 173
10.5.2 Fine Needle Aspiration Biopsy 173
10.5.3 Nonneoplastic Cysts 173
10.5.3.1 Follicular Cysts 173
10.5.3.2 Endometriosis 173
10.5.3.3 Neoplastic Ovarian Cysts 175
10.5.3.3.1 Serous Tumors 175
10.5.3.3.2 Mucinous Tumors 175
10.5.3.3.3 Other Surface Epithelial Tumors 175
10.5.3.3.4 Metastatic Tumors 177
Suggested Reading 177
Chapter 11: Nonepithelial Tumor of Ovary 178
11.1 General Classification of Nonepithelial Ovarian Tumors 178
11.2 Ovarian Germ Cell Tumors 178
11.3 Ovarian Sex Cord-Stromal Tumors 185
11.3.1 Granulosa Cell Tumors 185
11.3.2 Thecomas and Fibrous Tumors 186
11.3.3 Sertoli-Stromal Cell Tumors 189
11.3.4 Steroid Cell Tumors 190
11.4 Miscellaneous Primary Ovarian Tumors 194
11.5 Cytology 194
11.5.1 Mature Cystic Teratomas 194
11.5.2 Dysgerminoma 195
11.5.3 Other Germ Cell Tumors 195
11.5.4 Granulosa Cell Tumors 196
Suggested Reading 196
Chapter 12: Tumors of Peritoneum 197
12.1 General Classification of Tumors of Peritoneum 197
12.2 Mesotheliomas 197
12.3 Other Mesenchymal Tumors 201
12.4 Cytology 201
12.4.1 Cytology of Benign and Nonneoplastic Conditions 201
12.4.1.1 Endosalpingiosis 203
12.4.1.2 Collagen Balls 203
12.4.2 Psammoma Bodies 203
12.4.3 Neoplastic Conditions 205
12.4.3.1 Metastatic Adenocarcinoma 205
12.4.3.2 Borderline Serous Ovarian Tumors 205
12.4.3.3 Pseudomyxoma Peritonei 206
12.4.3.4 Primary Malignant Mesothelioma 207
12.4.3.5 Primary Peritoneal Carcinoma 208
12.4.3.6 Role of Peritoneal Washing Cytology in Gynecologic Malignancies 208
12.4.4 Ancillary Studies 209
12.4.4.1 Mesothelial Cells Versus Adenocarcinoma 209
12.4.4.2 Positive Mesothelial Markers 209
12.4.4.3 Positive Adenocarcinoma Markers 210
12.4.4.4 Reactive Mesothelial Cells Versus Malignant Mesothelial Cells 211
Suggested Reading 211
Appendix 212
Index 219