Case 1

submitted by:
Lora H. Ellenson
Weill Medical College-Cornell University
New York, New York

Clinical Summary:

Two 70 year old women with postmenopausal bleeding followed by clinical procedures, the specimens from which are represented by cases A and B.

Case 1 - Figure 1(A) - Low: Low power magnification of case A.

Case 1 - Figure 2(A) - High: High power magnification of case A.

Case 1 - Figure 3(B) - Low: Low power magnification of case B.

Case 1 - Figure 4(B) - High: High power magnification of case B.

Case 2

submitted by:
W. Glenn McCluggage
Royal Group of Hospitals Trust
Belfast, Northern Ireland

Clinical Summary:

A 61 year old postmenopausal woman, para 0, presented with irregular vaginal bleeding. She had been taking continous combined hormone replacement therapy for six years. Hysteroscopy and endometrial biopsy was performed. At hysteroscopy a polypoid endometrial lesion was seen. She then underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy.

Case 2 - Figure 1 - Low power of the lesion showing a pronounced papillary pattern.

Case 2 - Figure 2 - The cores of the papillary processes are cellular and contain spindle-shaped cells. The papillary processes are lined by a single layer of bland epithelial cells.

Case 2 - Figure 3 - Focally the papillae are lined by bland epithelial cells but in areas the epithelial cells are enlarged with pleomorphic nuclei containing prominent nucleoli.

Case 2 - Figure 4 - In areas there is invasion of the stromal cores of the papillae by cells with enlarged pleomorphic nuclei.

Case 3

submitted by:
Anais Malpica
M.D. Anderson Cancer Center
Houston, Texas

Clinical Summary:

A 22 year old female presented with ascites. Laparoscopic examination revealed a pelvic mass involving the cecum. Diffuse peritoneal studding was also noted. A biopsy was obtained.

Case 3 - Figure 1 - Low magnification showing a cellular proliferation embedded in a myxoid background.

Case 3 - Figure 2 - Intermediate magnification showing infiltration into adipose tissue.

Case 3 - Figure 3 - Intermediate magnification showing neoplastic cells arranged in a cystic pattern and small cords.

Case 3 - Figure 4 - Higher magnification showing a uniform cellular proliferation composed of round to polygonal cells with eosinophilic cytoplasm, round nucleus and inconspicuous nucleoli. Scattered cells with a signet-ring appearance are present.

Case 4

submitted by:
Esther Oliva
Massachusetts General Hospital
Boston, Massachusetts

Clinical Summary:

A 68 year old woman, status post-hysterectomy, was found to have a pelvic mass. Bilateral oophorectomy revealed the right ovary to be replaced by a 13 x 13 x 8 cm multilobulated mass that was solid, yellow-tan and homogeneous. The contralateral ovary was unremarkable.

Case 4 - Figure 1 - Compact and spindle nests of tumor cells associated with scant fibromatous stroma. The cells have moderate amounts of eosinophilic cytoplasm and uniform oval to spindled nuclei.

Case 4 - Figure 2 - The tumor contains scattered "endometrioid-type glands" admixed with predominantly solid tubules and some hollow tubules.

Case 4 - Figure 3 - Small solid tubules with abundant clear cytoplasm surrounded by abundant fibromatous stroma. Notice the absence of Leydig cells.

Case 4 - Figure 4 - Well-formed, elongated solid tubules with elongated, very focally grooved nuclei associated with some mitotic activity.

Case 5

submitted by:
Charles J. Zaloudek
University of California
San Francisco, California

Clinical Summary:

A 46 year old woman had an abnormal Pap smear. A cervical biopsy revealed adenocarcinoma in situ. A cone biopsy, from which this slide was prepared, was performed.

Case 5 - Figure 1 - Irregular endocervical glands lined by cells with stratified, hyperchromatic nuclei.

Case 5 - Figure 2 - High magnification view of an endocervical gland showing the nuclear features.

Case 5 - Figure 3 - Small solid nodule among endocervical glands.

Case 5 - Figure 4 - Trabecular growth of cells within the solid nodule.