A 54-year-old woman with fibroids underwent simple hysterectomy. The uterus
contained a few small nodules and a 6 x 5 x 3.5 cm, well-circumscribed, submucosal mass. On cut surface,
the mass had a uniform, tan-white, non-whorled appearance without areas of hemorrhage or necrosis. The
rest of the nodules had white, whorling appearance typical of leiomyomas.
On microscopic examination the tumor was well-circumscribed. It had a fascicular
growth and was densely cellular. The tumor cells had abundant eosinophilic cytoplasm and nuclei that
ranged from small, and elongated, with a cigar-shape configuration and minimal degree of atypia to large,
mono or multinucleated and hyperchromatic with nuclear pseudoinclusions. Multiple karryorhectic figures
were seen but the average mitotic activity was low. No atypical mitoses or tumor cell necrosis was
identified.
A 50-year-old woman had a history of uterine fibroids. She underwent simple
hysterectomy. Multiple nodules were found in the myometrium ranging from 1 to 7 cm in largest dimension.
All of them were well circumscribed. On cut section one nodule was soft with a homogeneous yellow to tan
cut surface. The other nodules had a white, firm, whorled cut surface.
On microscopic examination the tumor was densely cellular. It had a fascicular
growth pattern that was more prominent at the periphery of the tumor. The cells had scant cytoplasm and
oval to elongated nuclei with minimal degree of cytologic atypia and almost no mitotic activity. There
were prominent large thick-walled blood vessels as well as cleft-like spaces throughout the tumor. The
tumor had poorly defined margins, and when those areas were examined at high magnification the tumor
cells merged with those of the surrounding myometrium.
A 52-year-old woman was noted to have a large abdomino-pelvic mass on a routine
gynecologic examination. The patient underwent total abdominal hysterectomy, omentectomy, and resection
of mesenteric and paraortic lymph nodes. Opening the uterus revealed a 12 cm, multilobulated mass.
Sectioning showed alternating firm and soft areas with multiple gelatinous areas. Peripherally to the
largest mass, there were multiple smaller masses that ranged from 4 to 9 cm, and had a similar gross
appearance. Some of these masses seemed to fill and distend myometrial vessels.
On microscopic examination the tumor had an extensive infiltrative growth into the
myometrium. It had a vague fascicular growth pattern and was hypocellular to moderately cellular. A
striking finding was a prominent myxoid background in many areas, while others areas were hyalinized.
On higher magnification the tumor cells had an oval to elongated nucleus with one or more small nucleoli,
scant cytoplasm and mild to focally moderate cytologic atypia. Mitotic activity was low, the highest
being 2 to 3 mitosis/10 high power fields. No tumor cell necrosis was identified.
A 56-year-old woman presented with postmenopausal bleeding. A total abdominal
hysterectomy, bilateral salpingo-oophorectomy, pelvic and periaortic lymph node dissection were
performed. On gross examination a 7 x 5 x 4.6 cm, tan, fleshy, soft polypoid mass was seen arising from
the fundic area. Sectioning the mass showed a tan homogenous appearance with no gross necrosis or
hemorrhage. The mass superficially infiltrated the myometrium. The remainder of the endometrium,
myometrium, cervix as well as adnexa were unremarkable.
On microscopic examination the tumor was composed of hollow or solid tubules,
some closely packed, and a few with a retiform pattern. The tubules were lined by cuboidal to tall cells
with abundant cytoplasm and round to oval nuclei with small nucleoli and scattered grooves. The tubules
were surrounded by scant amounts of stroma and in some areas bundles of smooth muscle could be seen
between them.
A 50-year-old woman was found to have an enlarged uterus on a routine gynecologic
examination. She underwent total abdominal hysterectomy and bilateral salpingo- oophorectectomy. The
uterus contained an 11 cm., well-circumscribed, intramural mass that on cut surface had alternating white
and yellow areas and focal cysts.
On microscopic examination the tumor was well-circumscribed and had varied
morphology. In areas there was a diffuse growth of densely packed small, uniform cells with very scant
cytoplasm and round to oval nuclei, with inconspicuous nucleoli, minimal cytologic atypia and low mitotic
activity. The cells were sometimes characteristically wrapping around small vessels. This component
merged with nodules of different sizes with a central area of hyalinization that had collagen bands
radiating towards the periphery entrapping cells with round nuclei and more abundant cytoplasm.These
areas merged with short disorganized fascicles of smooth muscle cells.
A 44-year-old woman presented with vaginal bleeding. She underwent hysterectomy. A
25 cm., well-circumscribed mass was found in the uterus. On cut section the neoplasm was yellow to brown
with extensive areas of cystification and hemorrhage.
On microscopic examination the tumor had a diffuse growth pattern although in some
areas the tumor cells formed cords. The tumor cells had abundant eosinophilic cytoplasm and round
nuclei, some of them multinucleated, with one or more nucleoli. The average mitotic count was 2/ 10 high
power fields. There was scant stroma. No tumor cell necrosis was seen.
A 39-year-old woman with vaginal bleeding underwent simple hysterectomy. On gross
examination, no discrete abnormalities were seen in the cervix except for a fissure-like appearance of
the endocervix.
A lobular proliferation of closely packed, rounded glands, some of which surround
a central cleft. The glands are lined by tall, mucinous, endocervical cells with bland, basally located
nuclei. There is no cytologic atypia or desmoplasia.
A 57-year-old woman with a history of uterine prolapse underwent hysterectomy and
was noted to have a multicystic mucinous lesion of the uterine cervix on gross inspection.
Lobular collection of multiple, small, closely packed, cystically dilated glands
with cuboidal to flattened epithlium. The lesion is located close to the endocervical canal and the
glands contain inspissated mucinous secretions. There is little to no cytologic atypia and few, if any,
mitoses.
A 60-year-old woman underwent hysterectomy for prolapse and was noted to have a
slightly enlarged, indurated uterine cervix.
Disorderly proliferation of glands with irregular outlines extending deeply into
the cervical wall. Cytologically atypical glands and desmoplasia are present.
A 40-year-old woman was noted to have circumferential enlargement of the uterine
cervix. Following a cervical biopsy, she had a hysterectomy. On gross examination, the uterine cervix
was uniformly expanded and firm.
Relatively diffuse but orderly proliferation of tubules with cuboidal epithelial
lining, some of which contain intraglandular eosinophilic material. The process extends deeply into the
cervical wall; however, there is no back-to-back glandular crowding, no nuclear atypia and no significant
mitotic activity. Neither lymphatic/vascular nor perineural invasion was identified.
A 35-year-old woman presented with vaginal bleeding and was found to have a
cervical mass. Following a cervical biopsy, she had a hysterectomy. On gross examination, the uterine
cervix contained a 1.0-cm ulcer beneath which was a 2.5-cm nodular area of firmness.
Confluent proliferation of glands and tubules reminiscent of endometrioid type
glands with areas of intervening solid spindled growth extending deeply into cervical wall with
infiltrative edge. No necrosis however, mitotic figures are frequent.
A 53-year-old woman underwent LEEP for a high-grade squamous intraepithelial lesion
diagnosed on prior cervical biopsy. Incidental finding.
Focal glandular proliferation present subjacent to the cervical epithelium
exhibits a papillary and cribriform architecture as well as cyst formation. Two cell layers line the
glands – a discontinuous basal cell layer and a columnar cell layer with abundant vacuolated cytoplasm.
Central squamous metaplasia is prominent in some of the glands.
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