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08 Gynae
| Question | Answer | |
|---|---|---|
| Lichen sclerosus (D) | Thinned epidermis with hyperkeratosis, interface vacuolar change, subepidermal hyaline band and chronic inflammation. No dysplasia. | lmpimg.med.utoronto.ca/LMP12056.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Lichen sclerosus (FW) | IHC: p53 wild-type. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FGeneral_Histopathology%2FHisto_EQA_CircH_Set4%2F8559.svs |
| Lichen sclerosus (AV) | Clinically wrinkled red-white patches. Immune mediated chronic fibroinflammatory condition. Most common in postmenopausal women. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FSets%2FGynae%2FSet_9%2F379860.svs |
| Papillary hidradenoma (D) | Labia with a well-circumscribed papillary tumour. Double-layered papillae of inner columnar and outer myoepithelial cells. Complex and interconnecting. Mitotic activity may be high. Oxyphilic metaplasia is common. | lmpimg.med.utoronto.ca/LMP87276.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Papillary hidradenoma (FW) | IHC: CK7, EMA, CEA, GCDFP-15, ER, PR, AR. S100 highlights myoepithelium. | lmpimg.med.utoronto.ca/LMP16547.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Papillary hidradenoma (AV) | Women, mostly 30-50 yrs. Benign, may recur. Rarely involves ectopic sites (head, neck, chest, abdomen). | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FR_Bishop_Collection%2FCard_index_Set%2FSkin%2F33844.svs |
| Deep (aggressive) angiomyxoma (D) | Locally infiltrative vulval tumour. Poorly marginated, paucicellular. small oval, spindle, and stellate cells. Loose myxomatous stroma w/ delicate collagen fibrils and thick-walled vessels. No atypia, rare mitoses. Entrapment of muscle, nerve, fat. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FNW%2FCirc_AA%2F50953.svs |
| Deep (aggressive) angiomyxoma (FW) | IHC: Desmin, SMA, ER, and PR. ± CD34. Negative S100. Low Ki67 index. | rosai.secondslide.com/view/sem1168/sem1168-case2.svs |
| Deep (aggressive) angiomyxoma (AV) | HMGA2 rearrangement in 1/3. Benign, locally infiltrative. Women of reporoductive age. High local recurrance rate. | rosai.secondslide.com/view/sem1338/sem1338-case4.svs |
| Cellular angiofibroma (D) | Vulvovaginal or inguinal well-circumscribed tumour with bland spindle cells, short bundles of delicate collagen fibres, and thick-walled vessels, ± adipose tissue. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FSara_Edward%2FSet_4%2F95669.svs |
| Cellular angiofibroma (FW) | IHC: CD34, ± SMA, desmin, ER/PR. Loss of RB1. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FSara_Edward%2FSet_4%2F95669.svs |
| Cellular angiofibroma (AV) | Loss of RB1 (13q14). Rare, M=F. Painless, slow-growing mass. Rare local recurrance. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FSara_Edward%2FSet_4%2F95669.svs |
| Mesonephric remnants and hyperplasia (D) | Cervix containing small to medium-sized tubules lined by cuboidal cells with scant eosinophilic cytoplasm and round to ovoid bland nuclei. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FR_Bishop_Collection%2FCard_index_Set%2FGynae%2F33667.svs |
| Mesonephric remnants and hyperplasia (FW) | IHC (not needed): CD10, calretinin, GATA3, PAX8. | rosai.secondslide.com/view/sem1448/sem1448-case7.svs |
| Mesonephric remnants and hyperplasia (AV) | Benign, often incidental finding, in up to 20% of cervixes. Lobular (most common), diffuse, ductal, or mixed type. Arises from residual cells of the mesonephric duct. Rarely in prostate, and mimic prostate carcinoma. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FR_Bishop_Collection%2FCard_index_Set%2FGynae%2F33667.svs |
| Microglandular hyperplasia (D) | Endocervix with clusters of crowded small glands lined by cuboidal to columnar mucinous epithelium. Subnuclear vacuolation and reserve cell hyperplasia. Uniform nuclei and scant mitoses. | rosai.secondslide.com/view/sem333/sem333-case14.svs |
| Microglandular hyperplasia (FW) | IHC: Ki-67 proliferation index < 10%. (Negative for p16.) | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FMaleki_FRCPath_collection%2FSet_006%2F334535.svs |
| Microglandular hyperplasia (AV) | In women of reproductive age. Usually incidental finding or presents with contact bleeding. Often associated with pregnancy and progestogen therapy. | rosai.secondslide.com/view/sem333/sem333-case14.svs |
| Menstrual phase endometrium (D) | Endometrium (usually proliferative) with stromal breakdown. Dense round aggregates of stromal cells ± moulding, admixed with inflammatory cells and blood. Papillary syncytial metaplasia is common, thought to be a reparative response. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FNigerian_VPP%2F2017%2FTSL_Workshops_May%2F366013.svs |
| Disordered proliferative endometrium (D) | Endometrium containing irregularly shaped or cystic dilated glands with relatively normal gland to stroma ratio. ± Tubal metaplasia, eosinophilic syncytial metaplasia. No atypia. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FNigerian_VPP%2F2017%2FTSL_Workshops_May%2F366020.svs |
| Disordered proliferative endometrium (AV) | Asymptomatic or menorrhagia, anovulation. Benign, not precancerous, but → hyperplasia w/o atypia. Due to unopposed oestrogen. Common in PCOS, obesity, perimenopause. Rx: Observation, progesterone, if symptomatic, treat cause of oestrogen. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FSets%2FGynae%2FSet_1%2F378685.svs |
| Endometrial polyp (D) | Endometrial polypoid lesion with a disorganised proliferation of branched or cystically dilated glands in altered stroma. ± thick-walled blood vessels. Glands are inactive and cystic, with tubal metaplasia. | lmpimg.med.utoronto.ca/LMP25576.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Endometrial polyp (FW) | IHC: Glands: CK7, PAX8, ER/PR. Stroma: ER/PR, SMA. Negative CK20, p53 (wild-type). | lmpimg.med.utoronto.ca/LMP38705.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Endometrial polyp (AV) | Perimenopausal or postmenopausal. Small risk of subsequent hyperplasia and carcinoma. Related to tamoxifen therapy (10% risk of carcinoma). | lmpimg.med.utoronto.ca/LMP68593.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Endometrial hyperplasia without atypia (D) | Endometrium w/ glands of irregular size and shape. Increased gland–to–stroma ratio. Tubular, branching, and/or cystically dilated glands resembling proliferative endometrium. No atypia. Occasional tubal metaplasia, fibrin thrombi, and stromal breakdown. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FSets%2FGynae%2FSet_8%2F379941.svs |
| Endometrial hyperplasia without atypia (FW) | IHC: Loss of PTEN, PAX2 (not specific). | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FSets%2FGynae%2FSet_8%2F379941.svs |
| Endometrial hyperplasia without atypia (AV) | Presents with bleeding and thickened endometrium. Usually during perimenopause. Progresses to well-differentiated endometrial carcinoma occurs in 1–3%. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FSets%2FGynae%2FSet_8%2F379941.svs |
| Endometrial atypical hyperplasia / endometrioid intraepithelial neoplasia (D) | Endometrium with crowded glandular architecture (glands > stroma) and altered epithelial cytology, distinct from the surrounding endometrium and/or entrapped non-neoplastic glands. | lmpimg.med.utoronto.ca/LMP90326.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Endometrial atypical hyperplasia / endometrioid intraepithelial neoplasia (FW) | IHC: Loss of PTEN, PAX2, or MMR. | lmpimg.med.utoronto.ca/LMP58610.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Endometrial atypical hyperplasia / endometrioid intraepithelial neoplasia (AV) | Presents with PMB. Risks: ^oestrogen, Lynch, Cowden, PAX2 inactivation, PTEN mutation. Up to ⅓ have cancer at 1 year. Treatment is likely total hysterectomy. Entire endometrium should be sampled. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FBlack_Box%2F03-Mar-11%2F143789.svs |
| Endometrial endometrioid carcinoma (D) | Endometrium with invasive carcinoma of endometrioid differentiation. (Villo)glandular architecture, composed of usually columnar cells with pseudostratified nuclei. Some degree of squamous, secretory, or mucinous differentiation. | lmpimg.med.utoronto.ca/LMP93780.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Endometrial endometrioid carcinoma (FW) | IHC: LG shows diffuse strong ER/PR and patchy p16. HG difficult to distinguish from serous EC. Molecular PolE testing / MLH1 promoter hypermethylation. | lmpimg.med.utoronto.ca/LMP30932.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Endometrial endometrioid carcinoma (AV) | FIGO grade 1, 2, or 3 (≤ 5%, 6–50%, and > 50% solid non-glandular, non-squamous growth). Molecular subtypes: PolE-ultramutated (5%), MMR-deficient (25%), p53-mutant (25%), NSMP (no specific molecular profile, 45%). | rosai.secondslide.com/view/sem1198/sem1198-case1.svs |
| CIN 1 (D) | Cervix showing full-thickness atypia with moderate/abundant cytoplasm in cells within the upper 2/3; basaloid morphology and significant mitoses restricted to the lower 1/3. Koilocytic atypia in middle and surface cells. | |
| CIN 1 (FW) | IHC: p16 normal (to rule out HSIL). HPV ISH in selected cases | |
| CIN 1 (AV) | 10% progress to HSIL, usually driven by HSV16. Recall in 12 months. If treated then "Test of cure" follow-up at 6 months. | |
| CIN 2 (D) | Cervix showing full-thickness atypia characterized by basaloid cells and mitotic activity extending into the upper 1/2 to 2/3, but with retained koilocytic change on the surface. | |
| CIN 2 (FW) | IHC: p16 block positive in lower 1/2 to 2/3. HPV ISH in selected cases. | |
| CIN 2 (AV) | Treat and recall in 6m for "Test of cure". Cancer progression is 0.5–1% per year. | |
| CIN 3 (D) | Cervix with full-thickness atypia where base of the lesion is indistinguishable from the surface. Mitotic activity may be throughout. Upper epithelium shows significantly higher N:C than in CIN 2. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FUndergraduate%2F1078.svs |
| CIN 3 (FW) | IHC: p16 full thickness block positivity. HPV ISH in selected cases. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FSets%2FGynae%2FSet_9%2F379858.svs |
| CIN 3 (AV) | Treat and recall in 6m for "Test of cure". Cancer progression is 0.5–1% per year. | lmpimg.med.utoronto.ca/LMP55936.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| CGIN (adenocarcinoma in situ) (D) | Cervix with pre-existing glands showing pseudostratified, hyperchromatic nuclei with easily identified apical mitotic figures and karyorrhexis. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FFRCPath%2F2013%2FAutumn%2F236751.svs |
| CGIN (adenocarcinoma in situ) (FW) | IHC: p16 block positivity. ± HPV ISH. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FWednesday_Teaching%2F28-March-12%2F169817.svs |
| CGIN (adenocarcinoma in situ) (AV) | Usually associated with HSIL. Treat and recall in 6m for "Test of cure". | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FFRCPath%2F2013%2FAutumn%2F236751.svs |
| Serous carcinoma of the uterine corpus - D | Endometrial carcinonoma with diffuse, marked nuclear pleomorphism. Typically papillary and/or glandular growth patterns. | virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FSpeciality_Teaching%2FGynaepathology%2F2011-07-01%2F144772.svs |
| Serous carcinoma of the uterine corpus - FW | IHC: abnormal p53 and diffuse p16. IMP3, and HMGA2. ERBB2 (HER2) overexpression. | virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FSpeciality_Teaching%2FGynaepathology%2F2011-08-12%2F148227.svs |
| Serous carcinoma of the uterine corpus - AV | TP53 mutations. ERBB2 (HER2) overexpression in > 30% Presents with PMB. | virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FMaleki_FRCPath_collection%2FSet_011%2F334749.svs |
| Clear cell carcinoma of the uterine corpus - D | Endometrial tumour with an admixture of tubulocystic, papillary, and/or solid patterns. Clear to eosinophilic cuboidal, polygonal, hobnail, or flat cells. | rosai.secondslide.com/view/sem1174/sem1174-case8.svs |
| Clear cell carcinoma of the uterine corpus - FW | IHC: HNF1β, napsin A, and AMACR. +/- p53. Usually negative ER/PR. | rosai.secondslide.com/view/sem1174/sem1174-case8.svs |
| Clear cell carcinoma of the uterine corpus - AV | Usually no specific molecular profile or can be p53, MMR or POLE. Rare. Often postmenopausal women with vaginal bleeding. Grading not applicable. Poor prognosis. | rosai.secondslide.com/view/sem1174/sem1174-case8.svs |
| Endometrial stromal nodule - D | Uterus with a very well-circumscribed endometrial stromal tumour resembling proliferative-phase endometrial stroma and lacking lymphovascular invasion. Low mitotic activity. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FManchester_FRCPath%2Fseminar_4%2F115880.svs |
| Endometrial stromal nodule - FW | IHC: CD10, ER, PR, WT1, SMA, CKs | rosai.secondslide.com/view/sem1154/sem1154-case8.svs |
| Endometrial stromal nodule - AV | JAZF1-SUZ12 fusion (70%). Rare, benign. Perimenopausal women. A/w hypoestrogenism, tamoxifen, radiation. Submucosal, intramural, or (rarely) subserosal. R/o endometrial stromal sarcoma. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FManchester_FRCPath%2Fseminar_4%2F115880.svs |
| Carcinosarcoma of the uterine corpus - D | Endometrial tumour with a biphasic pattern, comprising a high-grade epithelial carcinoma (epithelial) component and sarcomatous (mesenchymal) elements. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FR_Bishop_Collection%2FCard_index_Set%2FGynae%2F33606.svs |
| Carcinosarcoma of the uterine corpus - FW | IHC: Not necessary for diagnosis. +/- HER2. Carcino: CKs, EMA, PAX8. Sarco: p53, desmin, myogenin. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FNW%2FCirc_AC%2F50888.svs |
| Carcinosarcoma of the uterine corpus - AV | TP53 mutations (90%). ^Risk in tamoxifen use (6%) and pelvic radiotherapy. Often presents in Stage III or IV (poor prognosis). Prolapses from cervix in 50%. Previously 'Malignant mixed Müllerian tumour' (MMMT). | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FManchester_FRCPath%2Fseminar_4%2F115874.svs |
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