Case 1

submitted by:
CHARLES V. BISCOTTI
Cleveland Clinic Foundation
Cleveland, OH

Clinical Summary:

A 51-year-old presented for resection of a hepatic endometrioma diagnosed by tissue biopsy three years prior. At that time, she had a significant response to leuprolide acetate: however, the mass recurred approximately 2.5 years after discontinuing monthly injections. Repeat tissue biopsy was again interpreted as endometriosis. This time, the patient had a poor response to leuprolide acetate. A 10x12x1.5 cm mass was excised.

Case 1 - Figure 1 - A variably thick capsule of soft tissue surrounds a central cavity containing blood clot and hemorrhagic soft tissue.

Case 1 - Figure 2 - Some of the periphery of the mass has endometrial tissue (left) a relatively hypocellular fibrous zone (center) and liver tissue (right).

Case 1 - Figure 3 - In this field, hypocellular fibrous stroma surrounds endometrial glands of varying size and shape.

Case 1 - Figure 4 - Some of the mass has more crowded and abnormally shaped endometrial glands surrounded by a more cellular stroma.

Case 1 - Figure 5 - This field represents an area of greatest stromal cellularity.

Case 2

submitted by:
KATHLEEN R. CHO
University of Michigan Medical School
Ann Arbor, MI

Clinical Summary:

A 16 year-old girl presented with non-specific abdominal pain and a two week history of flu-like symptoms. A CAT scan demonstrated a large left ovarian mass with solid and cystic components. Exploratory laparotomy revealed a 25 cm ovarian tumor focally adherent to the omentum, but without obvious rupture. Multiple small white nodules on the peritoneal surface of the right hemi-diaphragm and cul de sac were also observed. A left salpingo-oophorectomy, omentectomy, and biopsies of the right ovary and peritoneal nodules were performed.

Case 2 - Figure 1 - Low magnification, ovarian mass.

Case 2 - Figure 2 - Intermediate magnification, ovarian mass.

Case 2 - Figure 3 - Low magnification, omentum.

Case 2 - Figure 4 - High magnification, omental nodule.

Case 3

submitted by:
KENNETH R. LEE
Brigham and Women's Hospital and Harvard Medical School
Boston, MA

Clinical Summary:

A 33 year-old woman described a sensation of "falling out." She was found to have 4 or 5 discrete vaginal polyps, each 1 to 2 cm, in the area of the hymenal ring. One of these was biopsied.

Case 3 - Figure 1 - Vaginal polyp at low power showing normal surface squamous epithelium and cellular and edematous stroma.

Case 3 - Figure 2 - Higher power demonstrating a zone of connective tissue separating the surface from the more cellular deep stroma.

Case 3 - Figure 3 - Vaginal polyp with atypical epithelioid cells in a "cuffing" pattern around a blood vessel.

Case 3 - Figure 4 - Mononuclear and multinucleated cells in an edematous stroma with rare mitotic figures (shown).

Case 3 - Figure 5 - Mononuclear and multinucleated cells with small and large cytoplasmic vacuoles.

Case 4

submitted by:
NILSA C. RAMIREZ
Ohio State University School of Medicine
Columbus, OH

Clinical Summary:

55-year-old woman presented with postmenopausal bleeding and a past history of an abnormal PAP smear. Colposcopy followed by cervical conization revealed a neoplastic process involving the cervix. Clinically she had disease consistent with stage 1B1. She underwent radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy.

Case 4 - Figure 1 - The neoplastic process diffusely infiltrates the myometrium of the lower uterine segment without a significant stromal reaction

Case 4 - Figure 2 - Glands with a tubular architecture arranged in a back to back pattern. Note the presence of intraluminal eosinophilic secretions.

Case 4 - Figure 3 - Perineural invasion is prominent.

Case 4 - Figure 4 - Mitotic activity is focal.

Case 5

submitted by:
MICHAEL WELLS
University of Sheffield
Sheffield, United Kingdom

Clinical Summary:

34 year old female. Consultation case: "I would value your opinion on this lady's products of conception. Grossly, some of the placental villi were slightly enlarged measuring up to 2mm in diameter".

Case 5 - Figure 1

Case 5 - Figure 2

Case 5 - Figure 3

Case 5 - Figure 4

Case 5 - Figure 5

Case 5 - Figures 1-5 - Early diploid complete hydatidiform mole. Photomicrographs show abnormally shaped chorionic villi (including branching and polypoid forms), the presence of stromal mucin, and stromal nuclear (apoptotic) debris.