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Gynecologic Pathology
Thursday, March 3, 2005 - 7:30 PM
Rivercenter Salon E
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Moderator:
Christopher P. Crum
Brigham & Women's Hospital
Boston, MA
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Clinical histories are printed below.
Click on the case numbers for text and references of each case.
Click on each slide thumbnail image for an enlarged view
Submitted by:
Teri A. Longacre
Stanford University Medical Center
Stanford, CA
A 48-year old woman, gravida 2 para 0, had irregular menses and abnormal Pap smear. The uterus was moderately enlarged on physical examination. Colposcopic exam was normal. Endocervical and endometrial curettage had similar findings.
Case 1 - Figure 1 - Endocervical adenocarcinoma, seen at low power in the curetting.
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Case 1 - Figure 2 - Endocervical adenocarcinoma. At higher power the glands display a micro-acinar pattern with eosinophilic cytoplasm.
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Case 1 - Figure 3 - Endocervical adenocarcinoma. In this field the neoplastic glands resemble endometrial adenocarcinoma. Note however, the prominent nuclear hyperchromasia and conspicuous eosinophilic cytoplasm.
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Case 1 - Figure 4 - Endocervical adenocarcinoma. This field underscores the more conspicuous atypia and lack of stratification relative to endometrioid adenocarcinoma.
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Submitted by:
C. Blake Gilks
University of British Columbia
Vancouver, BC, Canada
This 69 year old woman presented with post-menopausal bleeding and an endometrial biopsy showed "adenocarcinoma of endometrioid type, grade 2/3”. The submitted slide is from the subsequent hysterectomy and bilateral salpingo-oophorectomy specimen and is taken from the uterine corpus.
Case 2 - Figure 1 - Endometrial adenocarcinoma, mixed serous (left) and endometrioid (right) pattern.
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Case 2 - Figure 2 - Endometrial adenocarcinoma, mixed serous and endometrioid pattern.This focus exhibits endometrioid architecture; however, note the high nuclear grade.
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Case 2 - Figure 3 - Endometrial adenocarcinoma, mixed serous and endometrioid pattern. This focus exhibits classic serous morphology.
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Case 2 - Figure 4 - Endometrial adenocarcinoma, mixed serous and endometrioid pattern. This focus shows low-grade endometrioid morphology.
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Submitted by:
Phyllis C. Huettner
Washington University Medical Center
St. Louis, MO
The patient is a 59 year old woman who presented with abdominal distention. At age 42 a vaginal hysterectomy was performed for fibroids. At age 50 the patient had a left mastectomy and axillary node dissection for stage Ia breast cancer. Her course was complicated by a chest wall recurrence at age 54 which was treated with radiation therapy. She was well until a month before presentation when she noted abdominal distention. CT scan of the abdomen showed ascites and peritoneal implants. CA-125 was 226 (normal - 0 to 34). Exploratory laparotomy, bilateral salpingo-oophorectomy, omentectomy and radical tumor de-bulking were performed. The ovaries were mildly enlarged but firm. Multiple peritoneal implants were present.
Case 3 - Figure 1 - Sclerosing epithelioid fibrosarcoma. The tumor forms a nodular mass in the peritoneum.
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Case 3 - Figure 2 - Sclerosing epithelioid fibrosarcoma. The tumor forms ill-defined nodules consisting of spindled tumor cells in a vaguely storiform arrangement.
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Case 3 - Figure 3 - Sclerosing epithelioid fibrosarcoma. In this area the tumor cells are arranged in single file in a collagen stroma.
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Case 3 - Figure 4 - Sclerosing epithelioid fibrosarcoma. The tumor cells are uniformly round in appearance with inconspicuous nucleoli.
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Submitted by:
Marisa R. Nucci
Brigham and Women's Hospital
Boston, MA
39 year old woman with 10 cm bi-lobed solid and cystic, partially calcified pelvic mass on CT scan. At surgery, the mass only involved the omentum. Preoperative CA-125 level was 145.
Case 4 - Figure 1 - Polypoid endometriosis in the peritoneum, seen here as tan, homogeneous, fleshy mass with cystic change.
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Case 4 - Figure 2 - Polypoid endometriosis. Endometrial glands of variable size are distributed in a fibrous stroma, with focally prominent vessels.
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Case 4 - Figure 3 - Polypoid endometriosis. A higher power view displays the the fibrotic stroma and vessels (lower right).
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Case 4 - Figure 4 - Polypoid endometriosis. The glands are uniform in contour and encircled by loosely arranged stromal cells. Stromal cuffing and mitoses are not present.
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