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International Journal of Gynecological Pathology

Jennifer X Ji, Dawn R Cochrane, Basile Tessier-Cloutier, Samuel Leung, Angela S Cheng, Christine Chow, Blake Gilks, David G Huntsman, Lynn N Hoang
The diagnosis of clear cell (CC) carcinoma of the endometrium can be challenging, especially when endometrioid (EC) and serous (SC) endometrial cancers exhibit nonspecific clear cell changes, in carcinomas with mixed histology and in the setting of Arias-Stella reaction (ASR). In this study, classic CC immunohistochemical markers (Napsin A, HNF-1β, and ER) and 2 recent novel markers, cystathionine gamma-lyase (CTH) and arginosuccinate synthase (ASS1), are assessed for their utility in distinguishing CC from its morphologic mimics...
May 13, 2019: International Journal of Gynecological Pathology
Danielle B Chau, Anna L Beavis, Brigitte M Ronnett, Erik Jenson, Christopher D Gocke, Jean Anderson, Amanda Nickles Fader, Rebecca Stone
Persistent gestational trophoblastic disease can arise from any type of antecedent pregnancy, including molar and tubal pregnancies. While most cases of persistent gestational trophoblastic disease present within the first year following initial diagnosis, recurrence has rarely been reported many years after initial diagnosis. Distinguishing recurrence from a new independent lesion is clinically important. A 25-yr-old woman presented with a mass in the right uterine cornu that was discontiguous with the endometrial cavity and was associated with an elevated serum human chorionic gonadotropin level...
April 24, 2019: International Journal of Gynecological Pathology
Alisa Abozina, Naveena Singh, C Blake
We report a 55-yr-old woman who presented with bilateral ovarian masses, 11 yr after hysterectomy for superficially invasive stage IA1 cervical adenocarcinoma of usual (human papillomavirus-associated) type. The bilateral ovarian tumors were composed of glands lined by malignant mucinous epithelium and these tumors were metastases from her previous cervical adenocarcinoma, based on morphology, immunophenotype, and positive in situ hybridization for human papillomavirus. In addition, there was extensive involvement of the mucosa of the left fallopian tube by malignant mucinous epithelium...
April 24, 2019: International Journal of Gynecological Pathology
Serra Akar, İsmail Harmankaya, Serdar Uğraş, Çetin Çelik
Nicotinamide N-methyltransferase (NNMT) is a cytosolic enzyme, overexpressed in various human malignancies. It is associated with cancer progression and resistance to treatment. The role of NNMT in cervical cancer has not been studied thus far. We aimed to evaluate expression of NNMT in cervical squamous cell carcinoma (SCC) and investigate its clinical significance. NNMT expression was assayed by use of immunohistochemistry in 61 cases of SCC, 11 cases of high-grade squamous intraepithelial lesion, 17 cases of low-grade squamous intraepithelial lesion, and 51 benign cervical tissues...
April 24, 2019: International Journal of Gynecological Pathology
Marie E Perrone, Nicholas P Reder, Sergay N Agoff, Rochelle L Garcia, Kathy J Agnew, Barbara M Norquist, Kathryn P Pennington, Elizabeth M Swisher, Mark R Kilgore
Intraepithelial fallopian tube neoplasia is thought to be a precursor lesion to high-grade serous carcinoma of the Müllerian adnexae, particularly in women with BRCA1 or BRCA2 mutations. This association has led to recommendations to assess fallopian tubes for intraepithelial atypia. However, the diagnostic reproducibility of a diagnosis of intraepithelial neoplasia is unclear. In this study, 2 gynecologic pathologists independently evaluated sections of fallopian tubes from a sample of women (N=198, 623 slides) undergoing salpingectomy...
April 24, 2019: International Journal of Gynecological Pathology
Mehmet M Meydanli, Koray Aslan, Murat Öz, Kamil H Muftuoglu, Ibrahim Yalcin, Yaprak Engin-Ustun
OBJECTIVE: The purpose of this retrospective study was to define a risk index that would serve as a surrogate marker of lymphovascular space invasion (LVSI) in women with endometrioid endometrial cancer (EC). MATERIALS AND METHODS: Final pathology reports of 498 women who underwent surgery with curative intent for endometrioid EC between January 2008 and June 2018 were retrospectively reviewed. Logistic regression was used to investigate clinicopathologic factors associated with positive LVSI status...
April 24, 2019: International Journal of Gynecological Pathology
Vimal Krishnan, Philippe Sauthier, Diane Provencher, Kurosh Rahimi
Leiomyosarcoma (LMS) is a malignant mesenchymal neoplasm showing smooth muscle differentiation. Uterine LMS is more frequent that nonuterine LMS, and represents 1% of all malignant neoplasms of the uterus. Pleomorphic undifferentiated uterine sarcoma is a rare entity, and is defined by high-grade sarcoma histology with loss of muscular markers. Several cases of pleomorphic undifferentiated uterine sarcoma have been reported in the literature, with worse clinical outcome when compared with conventional LMS. Here we report the first case of a pleomorphic undifferentiated uterine sarcoma in association with LMS in a young woman of 33 yr old...
April 24, 2019: International Journal of Gynecological Pathology
Samantha Simpson, Michael Simoni, Pei Hui, Hugh Taylor, Natalia Buza
Extragonadal pelvic yolk sac tumor (YST) in postpubertal female patients is a rare malignant neoplasm with potentially 2 distinct histogenetic pathways, and no clear treatment algorithm, especially in young patients desiring future fertility. Here we report a case of extragonadal YST arising within the myometrium in a 30-yr-old nulligravid woman. The patient presented with heavy and irregular bleeding, and imaging studies showed an 8.2 cm uterine mass, most consistent with a degenerating uterine leiomyoma...
April 24, 2019: International Journal of Gynecological Pathology
Karen L Talia, Lisa Fiorentino, James Scurry, W Glenn McCluggage
"Atypical endosalpingiosis" (AE) is a diagnostic term used variably among pathologists to denote peritoneal lesions exhibiting architectural changes and/or cytologic atypia intermediate between endosalpingiosis and primary peritoneal serous borderline tumor (SBT). AE is a contentious entity and is not recognized in the current World Health Organisation Classification. We report a series of 10 cases classified as AE, in attempt to further characterize this lesion. The patients ranged in age from 24 to 72 yr (mean, 39...
April 24, 2019: International Journal of Gynecological Pathology
Gloria Zhang, Yun Zhao, Fadi W Abdul-Karim, Bin Yang
P16 immunohistochemistry has been widely used in facilitating the diagnosis of human papillomavirus (HPV)-related usual type vulvar intraepithelial neoplasm. However, studies of p16 expression in primary vulvar extramammary Paget disease (EMPD) are limited. We assessed the p16 expression by immunohistochemistry in 40 cases of primary vulvar EMPD, including 34 cases of intraepithelial vulvar EMPD and 6 cases of invasive vulvar EMPD and correlated p16 expression patterns with disease progression. Overall, p16 expression was present in 36 cases (90%), including 20 cases (50%) with focal staining pattern and 16 cases (40%) with diffuse staining pattern...
April 24, 2019: International Journal of Gynecological Pathology
Shi Bai, Lloyd M Hutchinson, Xiuling Meng, Hongwei Bai, Ediz F Cosar, Ashraf Khan, Kristine Cornejo
Dedifferentiated carcinoma is defined as undifferentiated carcinoma coexisting with a second component of FIGO grade 1 or 2 endometrioid carcinoma. It is a rare entity with highly aggressive behavior. Dedifferentiated carcinoma combined with another primary uterine tumor is even rarer. We here describe a case containing 3 different morphologies comprised of a dedifferentiated carcinoma associated with a low-grade endometrioid carcinoma coexisting with a low-grade Müllerian adenosarcoma. We also used targeted genomic analysis to show all 3 components arise from the same founding clone and identify novel mutations that drive tumor progression...
March 22, 2019: International Journal of Gynecological Pathology
Maiar Elghobashy, Maher Elgaly, Nabeel Salmons, Alaa El-Ghobashy
A 37-yr-old patient previously diagnosed with human immunodeficiency virus initially presented with a genital lesion which upon histologic assessment was diagnosed as a pseudotumor associated with herpes simplex virus infection. The pseudotumor responded to initial treatment with Acyclovir, however, the lesion recurred 2 yr later and was diagnosed as plasma cell vulvitis. We discuss the clinical presentation, diagnostic work up and treatment options of such a rare lesion.
March 12, 2019: International Journal of Gynecological Pathology
Karishma P Ramlakhan, Floris H Groenendijk, Mark-David Levin, Leonard A Noorduyn, Sjarlot G Kooi
Vulvar malignancies are rare and have diverse origins and presentations. The majority of these tumors are squamous cell carcinoma. An ulcerating vulvar tumor was found in a 74-yr-old woman presenting with fatigue and leukocytosis. Tumor biopsy revealed infiltration of blastoid cells from myeloid origin. Through bone marrow aspiration chronic myelomonocytic leukemia was diagnosed, of which the vulvar tumor was a rare extramedullary disease manifestation named myeloid sarcoma. Limited palliative treatment was instated with a focus on the patient's quality of life...
March 1, 2019: International Journal of Gynecological Pathology
Debra Heller, Fadi Hatem
No abstract text is available yet for this article.
March 1, 2019: International Journal of Gynecological Pathology
Jhalak Dholakia, Wei Chen, David M O'Malley, Brigitte M Ronnett
Placental site nodule (PSN) is a benign lesion composed of chorionic-type intermediate trophoblastic cells and is typically an incidental finding in uterine or endocervical curettage specimens. Epithelioid trophoblastic tumor (ETT) and placental site trophoblastic tumor (PSTT) are intermediate trophoblastic neoplasms of chorionic and implantation site types, respectively. ETT is speculated to be the neoplastic counterpart of PSN. The term atypical placental site nodule (APSN) has been proposed for PSN-type lesions displaying one or more concerning features, including larger size/more abundant lesional tissue, more extensive plaque-like growth, increased cellularity with more cohesive nests and cords of cells, a greater extent/distribution of necrosis, increased atypia, mitotic activity, and/or a Ki-67 proliferation index greater than usually encountered in the typical PSN...
March 1, 2019: International Journal of Gynecological Pathology
Ibrahim Fahoum, Eli Brazowski, Dov Hershkovitz, Asaf Aizic
Tumor-to-tumor metastasis is being described in different types of tumors and in increasing amount of cases. Being aware of this phenomenon is important, as it affects disease stage and treatment approach. In this report, we descried an incidental histopathologic finding of metastatic adenocarcinoma to an ovarian cystadenofibroma and review cases published previously in the literature.
February 25, 2019: International Journal of Gynecological Pathology
David B Chapel, Ernst Lengyel, Lauren L Ritterhouse, Ricardo R Lastra
We present an instructive case of FIGO grade 1 endometrioid endometrial carcinoma with a biphasic morphology, corresponding to subclonal loss of mismatch repair proteins (MMRP) MLH1 and PMS2 by immunohistochemistry and subclonal microsatellite instability. A pulmonary metastasis represented only the tumor component with retention of MMRPs. This case illustrates the need for pathologists to recognize and report heterogenous expression of MMRPs in endometrial carcinoma, to consider tumor heterogeneity when selecting foci for molecular studies, and to re-evaluate MMRP expression in tumor metastases, when clinically indicated...
February 21, 2019: International Journal of Gynecological Pathology
Michelle Moore, W Glenn McCluggage
The distinction between a uterine endometrial stromal nodule (ESN) and low-grade endometrial stromal sarcoma (LGESS) is based on the nature of the interface between the lesion and the surrounding myometrium and the presence or absence of vascular invasion. Most LGESS exhibit widespread irregular myometrial invasion with or without vascular invasion, whereas ESNs are well-circumscribed without vascular invasion. Tavassoli and Norris proposed that minor marginal irregularity (up to 3 protrusions, each <3 mm beyond the main mass) is allowable in an ESN and these criteria have been incorporated into the World Health Organization Classification...
February 21, 2019: International Journal of Gynecological Pathology
Robert H Young
No abstract text is available yet for this article.
May 2019: International Journal of Gynecological Pathology
Eman Abdulfatah, Leonardo Lordello, Muhammad Khurram, Koen Van de Vijver, Baraa Alosh, Sudeshna Bandyopadhyay, Esther Oliva, Rouba Ali-Fehmi
Uterine carcinosarcomas are rare aggressive biphasic neoplasms. Because of its rarity, limited data are available on potential prognostic parameters. While several studies support that carcinomatous components predict outcomes, others do not. In this study, we evaluated the clinical and histopathologic features of 196 uterine carcinosarcomas to identify potential prognostic factors. Patients' ages ranged from 34 to 95 yr (median, 68 yr). Seventy-three (38%) patients experienced tumor recurrence during follow-up...
May 2019: International Journal of Gynecological Pathology
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