Case 1 - Click here for Text and References
Submitted by: Christina S. Kong
Clinical Summary:
41 year old woman with ASC-US diagnosis on recent cervical cytology and positive high-risk HPV test. Colposcopy with cervical biopsy was performed.
Low power view of fragmented, tangentially sectioned cervical biopsy
Extensive squamous metaplasia undermining endocervical columnar mucosa
Atypical cells exhibiting nuclear pleomorphism with loss of polarity and focal crowding
Atypical metaplastic type cells replacing endocervical columnar mucosa.
Scattered atypical cells with enlarged, hyperchromatic nuclei intermixed with and undermining endocervical glandular mucosa.
Atypical cells with enlarged nuclei and irregular nuclear membranes. Note mitotic figure in the upper half of mucosa, loss of polarity along the basal layer, and cellular crowding.
Case 2 - Click here for Text and References
Submitted by: Anna Yemelyanova
Clinical Summary:
48 year-old HIV positive woman with a history of abnormal Pap smears and vulvar condylomata. She presents with recurrence of vulvar "warts".
H&E
H&E
p16_IHC - The lesion demonstrates diffuse p16 expression (present in at least one half of the epithelial thickness)
HPV wide spectrum ISH - In situ hybridization preparation demonstrates positive signals with the HPV wide spectrum probe [HPV types 6,11,16,18,31,33,35,45,51,52] and HPV 18 (not shown). There was no detectable HPV with the HPV 6/11 probe (not shown)
Case 3 - Click here for Text and References
Submitted by: Michael H. Roh
Clinical Summary:
53 year old woman who presented with postmenopausal bleeding and uterine fibroids. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. The images are taken from an incidental finding in the right fallopian tube.
Low power view of the incidental lesion in the fallopian tube.
Medium power view of the atypical endometrioid glands exhibiting cribriform architecture associated with squamous differentiation.
Immunohistochemistry for p53.
Immunohistochemistry for Ki-67.
Immunohistochemistry for WT-1.
Immunohistochemistry for beta-catenin.
Case 4 - Click here for Text and References
Submitted by: Joseph T. Rabban
Clinical Summary:
This 50 year old G1P1 woman presented with pelvic pain and abdominal distension. Physical exam revealed a palpable pelvic mass which, on radiologic imaging, was a complex solid-cystic mass. Serum CA125 was elevated (120 U/ml). Exploratory laparotomy revealed bilateral ovarian masses and peritoneal carcinomatosis. Total abdominal hysterectomy, bilateral salpingo-oophorectomy and tumor debulking was performed. The main gross pathologic finding was bilateral solid-cystic, necrotic ovarian masses (4 cm and 14 cm) and several peritoneal samplings contained solid irregularly nodular dense tissue. Aside from serosal excrescences, the fallopian tubes, uterine body and cervix were grossly normal. The patient reported a distant history of breast cancer and of biliary tract adenocarcinoma and had previously received chemotherapy; the surgeries and treatment were performed at another institution. She did not report any history of gynecologic disease, nor any family history of breast or gynecologic cancer. She was not of Ashkenazi Jewish family background. The submitted virtual slides are of one of the fallopian tubes (H&E stain and p53 immunohistochemical stain). The tumor in the ovaries and serosal deposits exhibited similar morphology and p53 positivity.
Case 4 - Slide 1
Case 4 - Slide 2