Frozen Section Library: Gynecologic Pathology Intraoperative Consultation (eBook)

Frozen Section Library: Gynecologic Pathology Intraoperative Consultation 3
Foreword 7
Preface 9
Contents 11
Chapter 1: General Principles 13
Recommended Reading 15
Chapter 2: Vulva 17
Vulvar Biopsies and Other Limited Procedures 17
Clinical Background and Specimen Handling 17
Interpretation and Limitations 18
Vulvectomy for Squamous Cell Cancer 19
Clinical Background and Specimen Types 19
Specimen Handling 20
Interpretation and Differential Diagnostic Considerations 21
Vulvar Intraepithelial Neoplasia 23
Invasive Squamous Cell Carcinomas 25
Verrucous Carcinoma 29
Differential Diagnosis of Verrucous Lesions 30
Key Histologic Features of Verrucous Carcinoma 30
Key Histologic Features of Warty (Condylomatous) Carcinoma 31
Key Features of Condyloma Acuminatum 31
Lymph Node Dissection in Vulvar Cancer 32
Vulvectomy for Other Malignancies 32
Malignant Melanoma 32
Differential Diagnostic Considerations 36
Extramammary Paget Disease 36
Differential Diagnostic Considerations 37
Primary Adenocarcinoma 38
Differential Diagnostic Considerations 39
Basal Cell Carcinoma 41
Metastatic Neoplasms 41
Recommended Reading 42
Chapter 3: Vagina 44
Vaginectomy for Squamous Cell Neoplasms 44
Clinical Background 44
Specimen Handling 45
Interpretation 47
Differential Diagnostic Considerations 53
Vaginectomy for Adenocarcinoma 55
Clinical Background and Specimen Handling 55
Interpretation 56
Differential Diagnostic Considerations 58
Vaginectomy for Sarcomas and Other Spindle Cell Lesions 62
Clinical Background 62
Interpretation and Differential Diagnostic Considerations 63
Recommended Reading 68
Chapter 4: Uterine Cervix 70
Cervical Punch Biopsy 70
Loop Electrosurgical Excision Procedure 71
Cervical Cone Biopsy 72
Clinical Background 72
Specimen Handling 73
Interpretation 73
Limitations of Conization 73
Impact of Conization on Management 80
Radical Trachelectomy 81
Clinical Background 81
Specimen Handling 82
Assessment of Endocervical Margin in Trachelectomy 82
Alternative Techniques of Handling Trachelectomy 82
Tumors of the Cervix: Evaluation and Differential Diagnosis 84
Squamous Cell Carcinoma 84
Cervical Intraepithelial Neoplasms 85
Microinvasive Carcinomas 85
Key Features of Microinvasive (Superficially Invasive) Squamous Carcinoma 88
Invasive Squamous Cell Carcinoma 88
Differential Diagnostic Considerations 91
Adenocarcinoma 93
Glandular Intraepithelial Neoplasia 94
Key Histologic Features of AIS 95
Invasive Adenocarcinomas 95
Mucinous Adenocarcinoma 96
Key Histologic Features of Mucinous Adenocarcinoma 100
Endometrioid Adenocarcinoma 100
Minimal Deviation Adenocarcinoma 102
Differential Diagnostic Considerations 102
Neuroendocrine Carcinomas 104
Uncommon Neoplasms 108
References 110
Chapter 5: Uterine Body 113
Reasons for Intraoperative Consultation 113
Uterine Corpus Specimens 113
Endometrial Curettage and Endometrial Biopsy 114
Clinical Background 114
Specimen Handling 114
Interpretation and Differential Diagnostic Considerations 115
Hysterectomy for Benign Disease 115
Myomectomy 116
Clinical Background 116
Specimen Handling and Interpretation 116
Endometrial Polypectomy 117
Clinical Background and Specimen Handling 117
Interpretation and Differential Diagnostic Considerations 117
Hysterectomy for Cervical Cancer 120
Clinical Background and Types of Hysterectomy 120
Specimen Handling 122
Interpretation 122
Pelvic Lymph-Node Resection 122
Clinical Background 122
Specimen Handling 123
Interpretation and Differential Diagnostic Considerations 124
Hysterectomy for Endometrial Hyperplasia 125
Clinical Background 125
Specimen Handling 125
Interpretation 125
Differential Diagnostic Considerations 126
Hysterectomy for Endometrial Carcinoma 129
Clinical Background 129
Specimen Handling 130
Interpretation and Differential Diagnostic Considerations 132
Endometrioid Adenocarcinoma 133
Variants of Endometrioid Adenocarcinoma 135
Serous Papillary Carcinoma 137
Key Histologic Features of Serous Carcinoma 140
Key Histologic Features of Villoglandular Adenocarcinoma 140
Clear Cell Carcinoma 140
Key Histologic Features of Clear Cell Carcinoma 141
Key Histologic Features of Secretory Carcinoma 141
Hysterectomy for Sarcomas 142
Clinical Background 142
Specimen Handling 142
Interpretation and Differential Diagnostic Considerations 143
Leiomyosarcoma and Other Smooth Muscle Neoplasms 143
Epithelioid Smooth Muscle Tumor 148
Endometrial Stromal Sarcoma 150
Carcinosarcoma (Malignant Mixed Müllerian Tumor) 153
Adenosarcoma 160
Recommended Reading 161
Chapter 6: Ovary and Fallopian Tube 163
General Considerations 164
Ovarian and Tubal Specimens 166
Staging 166
Oophorectomy and Salpingooophorectomy 167
Specimen Handling 167
Cystectomy 168
Clinical Background 168
Specimen Handling and Interpretation 169
Ovarian Biopsy 169
Omental and Peritoneal Biopsies 170
Lymph Node Sampling 170
Pelvic, Peritoneal and Gutter Lavages 172
Interpretation and Differential Diagnosis in Adnexal Lesions 172
Non-neoplastic Lesions 173
Surface Epithelial Tumors 176
Serous Neoplasms 179
Key Features of Benign Serous Tumors (Figs.  6.11 – 6.14) 180
Key Features of Serous Borderline Tumors (Figs.  6.15 and 6.16) 185
Key Features of Serous Adenocarcinoma (Figs.  6.17 and 6.18) 187
Serous Carcinoma of the Peritoneum 187
Key Features of Serous Carcinoma of the Peritoneum 187
Peritoneal Implants 187
Key Features of Noninvasive Implants 187
Key Features of Invasive Implants 188
Mucinous Neoplasms 188
Key Features of Primary Benign Mucinous Tumors 188
Key Features of Mucinous Borderline Tumors 193
Key Features of Primary Mucinous Adenocarcinoma 194
Peritoneal Adenomucinosis (Pseudomyxoma Peritoneii) 195
Endometrioid Tumors 195
Key Features of Benign Endometrioid Tumors 197
Key Features of Borderline Endometrioid Tumors 198
Key Features of Endometrioid Adenocarcinomas 198
Clear Cell Neoplasms 198
Key Features of Benign and Borderline Clear Cell Tumors 199
Key Features of Clear Cell Carcinoma 199
Transitional Cell (Brenner) Tumors 200
Other Surface Epithelial Neoplasms 200
Sex Cord and Stromal Tumors 201
Granulosa Cell Tumors 204
Key Features of Adult Granulosa Cell Tumors 206
Key Features of Juvenile Granulosa Cell Tumors 206
Theca Cell Tumor and Fibroma 209
Key Features of Theca Cell Tumors 212
Sertoli–Leydig Cell Tumor (Androblastoma) 213
Key Features of Sertoli–Leydig Tumors 214
Other Sex Cord Stromal Neoplasms 214
Germ Cell Neoplasms 218
Mature Cystic Teratoma 218
Key Features of Mature Cystic Teratoma 219
Immature Teratoma 220
Mature Solid Teratoma 221
Monomorphic Teratomas 221
Dysgerminoma 224
Key Features of Dysgerminoma 226
Other Malignant Germ Cell Tumors 227
Metastatic Tumors 229
Key Features that Favor Metastases over Primary Ovarian Tumors 230
Krukenberg Tumor 235
Fallopian Tube Tumors 236
Recommended Reading 237
Chapter 7: Concluding Remarks 239
Index 240