Update on the ISGyP Endocervical Adenocarcinoma Project
No abstract available (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: Society page Source Type: research

A Case of Recurrent Vulvar Carcinoma With Cardiac Metastasis: Case Report and Review of the Literature
A 67-yr-old female patient was diagnosed with squamous cell vulvar carcinoma and treated with a radical vulvectomy and bilateral sentinel lymphadenectomy. Three months after the surgery, the patient presented with local recurrence and underwent surgical excision of the mass, followed by chemotherapy. Eight months later, the patient was admitted due to weakness and pleural effusion. The patient underwent a chest computed tomography and echocardiogram, which revealed a large mass in the right ventricle penetrating into the pericardium and an additional mass residing on the tricuspid valve. She underwent a pericardial biopsy,...
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE LOWER TRACT: CASE REPORT Source Type: research

HPV-independent Vulvar Squamous Cell Carcinoma is Associated With Significantly Worse Prognosis Compared With HPV-associated Tumors
In conclusion, a subset of VSCC is associated with HPV, which correlates with better outcome. Relatively inexpensive tests such as histomorphologic evaluation, p16 immunohistochemistry, and HPV RNA ISH can be used to predict outcome in VSCC. Therefore, routine reporting of HPV status in VSCC is recommended. (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE LOWER TRACT: ORIGINAL ARTICLES Source Type: research

Correlation Between p16/Ki-67 Expression and the Grade of Cervical Intraepithelial Neoplasias
Interpretation of histopathology of cervical premalignant lesions suffers from marked interobserver variability due to its subjective nature. We aimed to evaluate the usefulness of the biomarkers p16 and Ki-67 in improving the diagnostic accuracy of cervical histopathology and assess the correlation between p16 expression and human papillomavirus test in different grades of cervical intraepithelial neoplasia (CIN). Cervical tissue specimens with a diagnosis of CIN 1 or worse (CIN 1+) on hematoxylin and eosin staining were selected for immunohistochemistry (IHC) staining for p16 and Ki-67. The IHC slides were examined by a ...
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE LOWER TRACT: ORIGINAL ARTICLES Source Type: research

White Adipocytes of the Uterine Cervix Tend to Appear in Women of Older Age, Postmenopause Status, and Higher Body Mass Index
The human uterine cervix consists mainly of epithelium and stroma, including smooth muscle cells and fibrovascular tissues. Fat cells in the uterine cervix have been rarely reported, and the only previous research article has shown that intracervical adipocytes are unrelated to clinical factors. The aim of this study was to investigate the frequency of fat cells in the uterine cervix, as well as to evaluate the relationship between intracervical adipocytes and clinicopathologic factors. We retrospectively selected 405 cases in Japanese women who received cervical conization at our hospital between 2003 and 2017. Cervical c...
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE LOWER TRACT: ORIGINAL ARTICLES Source Type: research

Synchronous Well-differentiated Endometrioid Adenocarcinoma and Leiomyosarcoma of the Uterus With Pulmonary Metastasis in a 50-Yr-Old Woman: A Case Report and Review of Literature
We report the case of a 50-yr-old woman who was diagnosed with concomitant endometrial adenocarcinoma and uterine leiomyosarcoma. The sarcomatous neoplasm was positive for anti-smooth muscle actin and CD10, and focally positive for Cytokeratin AE1/AE3 and Cytokeratin Cam 5.2. She underwent total abdominal hysterectomy with bilateral salpingoopherectomy followed by radiation, brachytherapy, and chemotherapy. Three years later, she presented with cough and dyspnea and was found to have pulmonary metastasis. These tumor cells were positive for anti-smooth muscle actin, Cytokeratin AE1/AE3, Cytokeratin Cam 5.2, and epithelial ...
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE CORPUS: CASE REPORTS Source Type: research

Genetically Related Choriocarcinoma Developing 5 Yr After a Complete Hydatidiform Mole and Simulating a Cornual Ectopic Pregnancy
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. She had a history of an ...
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE CORPUS: CASE REPORTS Source Type: research

Pleomorphic Undifferentiated Uterine Sarcoma in a Young Patient Presenting With Elevated Beta-hCG and Rare Variants of Benign Leiomyoma: A Case Report and Review of the Literature
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 33 yr old...
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE CORPUS: CASE REPORTS Source Type: research

Combination of MCM2 With Ki67 and p16 Immunohistochemistry Can Distinguish Uterine Leiomyosarcomas
Our objective was to evaluate the diagnostic utility of 2 new proliferation markers, cyclin D1 and minichromosome maintenance complex component 2 (MCM2), in comparison with p16, p53, and Ki67 in differentiating the spectrum of smooth muscle tumors. An institutional database search from 2009 to 2017 identified 10 cases of uterine leiomyoma with bizarre nuclei (LBN), 12 smooth muscle tumors of uncertain malignant potential, and 13 leiomyosarcomas (LMS). Ten resected leiomyomas (LM) were included as controls. Immunohistochemistry was performed on the befitting representative block from each case. Ki67 was 10% in all LMSs. Alt...
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE CORPUS: ORIGINAL ARTICLES Source Type: research

Use of Immunohistochemical Markers (HNF-1β, Napsin A, ER, CTH, and ASS1) to Distinguish Endometrial Clear Cell Carcinoma From Its Morphologic Mimics Including Arias-Stella Reaction
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. Tissue microarrays containing 64 CC, 128 EC, 5 EC with clear cell change, 16 SC, 5 mixed carcinomas, and 11 whole ASR sections were stained, with 12 additional examples of ASR stained subsequently. A cutoff of 70% and moderate intensity were used for HNF-1β, 80% of cells and strong intensity were used for CTH, and any staining was considered positive for the ...
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE CORPUS: ORIGINAL ARTICLES Source Type: research

A New Classification of Benign, Premalignant, and Malignant Endometrial Tissues Using Machine Learning Applied to 1413 Candidate Variables
Benign normal (NL), premalignant (endometrial intraepithelial neoplasia, EIN) and malignant (cancer, EMCA) endometria must be precisely distinguished for optimal management. EIN was objectively defined previously as a regression model incorporating manually traced histologic variables to predict clonal growth and cancer outcomes. Results from this early computational study were used to revise subjective endometrial precancer diagnostic criteria currently in use. We here use automated feature segmentation and updated machine learning algorithms to develop a new classification algorithm. Endometrial tissue from 148 patients ...
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE CORPUS: ORIGINAL ARTICLES Source Type: research

Primary Peritoneal Low-grade Serous Carcinoma in a Patient With Lynch Syndrome: A Case Report
Lynch syndrome (LS) is an autosomal dominant disease caused by a germline mutation in DNA mismatch repair genes which increases the risk of several cancers such as endometrial and colorectal cancers. However, there are only a few reports of peritoneal malignancies in patients with LS. Herein, we report the first case of a primary peritoneal low-grade serous carcinoma in a woman with LS and provide a literature review of peritoneal malignancies in patients with LS. The patient was a 72-yr-old gravid 2 para 2 Japanese woman with a germline mutation in MLH1. She had a history of colon cancer and endometrial cancer and was tre...
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE UPPER TRACT: CASE REPORTS Source Type: research

BRAF Wild-type, PTEN Mutant Malignant Uveal Melanoma Arising Within a Mature Ovarian Teratoma: A Case Report and Review of the Literature
We present a case of primary malignant melanoma arising within a mature cystic teratoma in a young patient, who ultimately developed widespread metastasis necessitating systemic therapy. Our case highlights the role of molecular medicine not only in forming an understanding the origin of the melanoma, but also guiding targeted systemic therapies. Alongside the case we present a review of the literature describing the incidence of molecular aberrations within melanoma as well as the established and emerging techniques and cytotoxic agents for malignant melanoma. (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE UPPER TRACT: CASE REPORTS Source Type: research

Prophylactic Risk-reducing Hysterectomies and Bilateral Salpingo-oophorectomies in Patients With Lynch Syndrome: A Clinicopathologic Study of 29 Cases and Review of the Literature
In this study, we present the clinicopathologic findings of 29 cases of LS patients that underwent risk-reducing gynecologic surgery at our institution over a period of 13 yr. Clinical-pathologic information was obtained from the patients’ charts and pathology reports. Significant pathologic abnormalities were identified in 17% (5/29) of cases, all showing endometrial hyperplasia. Four of them with atypical and 1 without atypical. All of our cases with endometrial pathology had significant findings on preoperative endometrial sampling. To further study the recommendation of in toto submission of the endometriu...
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE UPPER TRACT: ORIGINAL ARTICLES Source Type: research

Mutational and Immunophenotypic Profiling of a Series of 8 Tubo-ovarian Carcinosarcomas Revealed a Monoclonal Origin of the Disease
Carcinosarcomas are rare, highly aggressive neoplasms composed of a combination of carcinomatous and sarcomatous elements. These tumors represent a paradigmatic field for the study of intratumor heterogeneity. A series of 8 tubo-ovarian carcinosarcomas was characterized for the following: (i) immunohistochemical expression of MNF116, epithelial membrane antigen, vimentin, S100, chromogranin, synaptophysin, desmin, myogenin (MYF4), and p53; (ii) mutational profiling of KRAS, BRAF, PIK3CA, NRAS, TP53, and DICER1 genes. Heterologous differentiation was present in 6 of 8 tumors. Cytokeratin MNF116 and epithelial membrane antig...
Source: International Journal of Gynecological Pathology - June 13, 2020 Category: Pathology Tags: PATHOLOGY OF THE UPPER TRACT: ORIGINAL ARTICLES Source Type: research

Gynecological Pathology Fellowship Training Programs World-wide Results of an ISGyP Membership Survey
No abstract available (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: Society page: PDF Only Source Type: research

Case Study: Schistosomiasis of the Endocervical Canal, A Rarely Reported Localization
We report the asymptomatic case of endocervical schistosomiasis without visible exocervical lesions in a 41-yr-old Malagasy woman with human papillomavirus-positive status detected during a cervical cancer screening campaign in Andilampanahy, Madagascar. Schistosomiasis involving only the endocervical canal is rarely reported and can be diagnosed histologically with endocervical brushing, which therefore represents a minimally invasive and well-tolerated tool for disease detection. (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE LOWER TRACT: CASE REPORTS Source Type: research

Transtubal Spread of a Superficially Invasive Cervical Adenocarcinoma to the Ovaries After 11 Years
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. The patient is alive a...
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE LOWER TRACT: CASE REPORTS Source Type: research

Expression and Clinical Significance of Nicotinamide N-Methyltransferase in Cervical Squamous Cell Carcinoma
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. NNMT immunoreactivity was scored based...
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE LOWER TRACT: ORIGINAL ARTICLES Source Type: research

HPV-negative Tumors in a Swedish Cohort of Cervical Cancer
Despite the common perception that the human papilloma virus (HPV) is a requirement for the development of cervical cancer (CC), a considerable number of CCs test HPV negative. Presently, many countries are shifting to HPV primary CC screening, and it is of importance to increase the knowledge about the group of CCs that test HPV negative. The aim of this study was to reinvestigate a proportion of cervical tumors with a primary negative or invalid test result. Reinvestigation with repeated genotyping (targeting L1) was followed by analysis with an alternative target method (targeting E6/E7) on existing or additional tumor ...
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE LOWER TRACT: ORIGINAL ARTICLES Source Type: research

Low-grade Serous Carcinoma Arising in Inguinal Nodal Endosalpingiosis: Report of 2 Cases and Literature Review
We report 2 cases of low-grade serous carcinoma probably arising from endosalpingiosis within inguinal lymph nodes. The neoplasms occurred in 51- and 58-yr old women in the absence of tumor within the adnexa, peritoneum or elsewhere. These represent the first reported examples of low-grade serous carcinoma arising within and confined to inguinal nodes. We review the pertinent literature regarding primary nodal low-grade serous carcinoma. (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE LOWER TRACT: ORIGINAL ARTICLES Source Type: research

Tumor-to-Tumor Metastasis of Colorectal Adenocarcinoma to Ovarian Cystadenofibroma: A Case Report and Review of the Literature
In this report, we descried an incidental histopathologic finding of metastatic adenocarcinoma to an ovarian cystadenofibroma and review cases published previously in the literature. (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE UPPER TRACT: CASE REPORT Source Type: research

An Alternate Diagnostic Algorithm for the Diagnosis of Intraepithelial Fallopian Tube Lesions
In this study, 2 gynecologic pathologists independently evaluated sections of fallopian tubes from a sample of women (N=198, 623 slides) undergoing salpingectomy. A total of 101 (54%) women were undergoing risk-reducing salpingo-oophorectomy. Pathologists were blinded to patient histories and prior diagnoses. Pathologists rendered one of three diagnoses for each slide: “negative for fallopian tube intraepithelial neoplasia (FTIN),” “indeterminate for FTIN,” or “definite for FTIN.” Cases that were considered by histology definite for FTIN or suspicious for FTIN were stained with p53 and K...
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE UPPER TRACT: ORIGINAL ARTICLES Source Type: research

A Clinicopathologic Study and Descriptive Analysis of “Atypical Endosalpingiosis”
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, 39.7 yr) and the commonest presenting complaint was abdominal pain. Operative findings usually comprised small peritoneal nodules and/or fibrous adhesions, predominantly involving the pelvis. The lesions were either mesothelial or submesothelial in location and typically exhibited mixed tubular and papillary architecture, sometimes with minor components of solid, cribriform or single cell growth. Epithelial multilayering was present in all cases but usually involv...
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE UPPER TRACT: ORIGINAL ARTICLES Source Type: research

Extragonadal Yolk Sac Tumor Limited to the Myometrium: Report of a Case With Potential Fertility Preservation and Molecular Analysis Suggesting Germ Cell Origin
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. The patient underwent abdominal myomectomy, and intraoperative frozen section evaluation revealed a high-grade ...
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE CORPUS: CASE REPORTS Source Type: research

A Rare Case of Atypical Placental Site Nodule With an Emerging Intermediate Trophoblastic Tumor
We report a case of a 39-yr-old woman who developed abnormal uterine bleeding 44 mo after her last recognized pregnancy. An endometrial curettage specimen demonstrated an APSN with some features concerning for an intermediate trophoblastic tumor. A hysterectomy specimen demonstrated residual APSN with foci consistent with emerging PSTT and ETT. This case illustrates the earliest form of PSTT and ETT arising in association with an APSN and supports interpretation of APSN as an intermediary lesion between typical PSN and intermediate trophoblastic tumors. (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE CORPUS: CASE REPORTS Source Type: research

Interpretation of Mismatch Repair Protein Immunohistochemistry in Endometrial Carcinoma Should Consider Both Lynch Syndrome Screening and Immunotherapy Susceptibility: An Illustrative Case Report
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....
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE CORPUS: CASE REPORTS Source Type: research

Lymphangioleiomyoma of the Uterus and Pelvic Lymph Nodes: A Report of 3 Cases, Including the Potentially Earliest Manifestation of Extrapulmonary Lymphangioleiomyomatosis
We present 3 cases of extrapulmonary lymphangioleiomyomatosis (LAM) identified incidentally in the uterine corpus and pelvic nodes resected for other reasons. One patient, a 47-yr-old female with corpus cancer, underwent a total hysterectomy and nodal dissection; the other 2 patients, aged 44 and 49 yr, underwent simple hysterectomy for corpus leiomyomas. None of the patients had evidence of tuberous sclerosis complex or any significant lesions in other organs. An area of spindle cell proliferation, intimately associated with dilated and tortuous lymphatic vessels, was found in the myometrium of all 3 patients, and ...
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE CORPUS: CASE REPORTS Source Type: research

Uterine Endometrial Stromal Tumors With Limited Infiltration: First Report of a Case Series Indicating Potential for Malignant Behavior
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 (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE CORPUS: ORIGINAL ARTICLES Source Type: research

Is It Possible to Develop a Prediction Model for Lymphovascular Space Invasion in Endometrioid Endometrial Cancer?
Conclusions It seems possible to predict the presence of LVSI in women with endometrioid EC when the “risk of LVSI index” is calculated. However, external validation of this model is warranted. (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE CORPUS: ORIGINAL ARTICLES Source Type: research

LAG-3 and GAL-3 in Endometrial Carcinoma: Emerging Candidates for Immunotherapy
LAG-3 is an immunosuppressive checkpoint molecule expressed on T cells. One of its ligands, GAL-3, can promote the progression of malignancy and has been identified on tumor cells. Both LAG-3 and GAL-3 are the targets of emerging immunotherapies, but have not been well-studied in endometrial carcinomas. LAG-3, CD3, and GAL-3 immunohistochemistry was performed on 75 endometrial cancers (25 nonmethylated mismatch repair-deficient, 25 MLH1-hypermethylated mismatch repair-deficient, and 25 mismatch repair-intact). LAG-3+ and CD3+ lymphocytes were averaged per high-power field. Tumoral GAL-3 expression was semiquantitatively sc...
Source: International Journal of Gynecological Pathology - April 8, 2020 Category: Pathology Tags: PATHOLOGY OF THE CORPUS: ORIGINAL ARTICLES Source Type: research

Ovarian Sclerosing Stromal Tumor and Müllerian Cyst in an 11-yr-old Girl: A Case Report and Review of the Literature
Sclerosing stromal tumor (SST) is an extremely rare ovarian neoplasm that primarily affects young female individuals. Patients with SST often present with pelvic pain and menstrual irregularities. Herein, we report a case of SST of the ovary in an 11-yr-old girl with symptoms of abdominal pain and menstrual irregularities. A preoperative diagnosis of tumors in the left adnexa and right ovary was made by pelvic ultrasonography and magnetic resonance imaging, and the patient underwent exploratory laparotomy and laparoscopic cystectomy. The ovarian masses were removed and proven to be SST in the left ovary and Müllerian ...
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Online Article: Case Report Source Type: research

Incidental Microscopic Granulosa Cell Proliferations: Tumorlet or Non-neoplastic?
We report a case of a 22-yr-old nulliparous woman with incidental microscopic granulosa cell proliferation in the wall of an endometriotic cyst. Excision of the cyst revealed extensive endometriosis and incidental microscopic nests and cords of granulosa cells measuring 1.5 mm and positive for inhibin A and calretinin. A rare Call-Exner body was noted. An extensive literature review of both ovarian and extraovarian granulosa cell proliferations were performed to determine their possible origin, variable morphologic features and differential diagnosis. Forty-seven cases were identified occurring in pregnant (26%) and...
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Upper Tract: Case Reports Source Type: research

Bilateral Signet-ring Stromal Tumor of the Ovary: A Case Report With Next-generation Sequencing Analysis and FOXL2 Mutation Testing
Signet-ring stromal tumor (SRST) is a rare benign stromal neoplasm of the ovary with only a handful of cases reported in the literature. To date, all but one reported cases have been unilateral, and the pathogenesis and underlying genetic abnormalities of this entity are not well characterized. Here we report a case of a 70-yr-old woman with bilateral ovarian SRST, clinically presenting with abdominal distention and rectal bleeding, and bilateral ovarian masses on imaging studies. Total hysterectomy and bilateral salpingo-oophorectomy were performed, revealing bilateral solid ovarian tumors with characteristic signet-ring ...
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Upper Tract: Case Reports Source Type: research

Primary Ovarian Tumors With Lymphogenic and Hematogenic Metastasis Express High MMP-14, Which Colocalizes With Highly Sulfated Chondroitin Sulfate in the Stroma
Lymphogenic and hematogenic metastases are uncommon in ovarian cancer, especially at presentation. We hypothesized that MMP-14 and MMP-2, CD44, and highly sulfated chondroitin sulfate (CS-E) may be overexpressed in tumors with these metastatic patterns. These molecules are all present in the ovarian tumor microenvironment, wherein they may interact. In an ovarian cancer cohort of 44 patients with metastases in lymph nodes, spleen, and/or liver, the presence of MMP-14, MMP-2, CD44, and CS-E in both the primary tumor and the metastases was determined with immunohistochemistry and related to clinical characteristics. Immunohi...
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Upper Tract: Original Articles Source Type: research

Lymphatic Invasion in the Fallopian Tube is a Late Event in the Progression of Pelvic Serous Carcinoma and Correlates With Distant Metastasis
The majority of extrauterine high-grade serous carcinomas are believed to arise in the fallopian tube as serous tubal intraepithelial carcinomas. The primary mode of metastasis is intraperitoneal, and patients usually present with peritoneal carcinomatosis. Although the tubes have a rich lymphatic network, tubal lymphatic invasion is observed in only a minority of cases. Fallopian tube sections from 222 patients with advanced stage high-grade extrauterine serous carcinoma were reviewed and lymphatic invasion within the lamina propria and myosalpinx were assessed. Seventeen patients were FIGO stage II, 162 stage III, and 43...
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Upper Tract: Original Articles Source Type: research

CDX2, SATB2, GATA3, TTF1, and PAX8 Immunohistochemistry in Krukenberg Tumors
This study shows that the panel of immunostains is useful in confirming the site of origin of a metastatic Krukenberg tumor when one is known and has limited diagnostic value for diagnosing metastases of unknown origin. (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Upper Tract: Original Articles Source Type: research

Evidence for a Novel Endometrioid Carcinogenic Sequence in the Fallopian Tube With Unique Beta-Catenin Expression
This report is the first to link components of a unique β-catenin+ endometrioid carcinogenic sequence in the fallopian tube. It further emphasizes the multifocal nature of endometrioid neoplasia in the female genital tract and poses questions regarding the frequency and biologic underpinnings of β-catenin+ proliferations in the oviduct. (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Upper Tract: Original Articles Source Type: research

Histopathologic Changes in Placental Tissue Associated With Vertical Transmission of Zika Virus
Zika virus (ZIKV) is highly neurotropic after crossing the placenta, inducing teratogenic effects that result in delayed development and microcephaly in infants. The available evidence for vertical transmission of this infection is based on placental studies showing alterations in trophoblastic tissue. However, complete characterization of ZIKV-infected placenta and involved pathways has yet to be fully clarified. This case report of placental ZIKV infection describes morphologic and molecular changes in the placenta. Hyperplasia of placental Hofbauer cells in chorionic villi and numerous histiocyte-like cells in the decid...
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Corpus: Case Reports Source Type: research

Uterine Inflammatory Myofibroblastic Tumor Showing an Atypical ALK Signal Pattern by FISH and DES-ALK Fusion by RNA Sequencing: A Case Report
Inflammatory myofibroblastic tumors (IMTs) are spindle cell neoplasms of intermediate (borderline) biologic potential with tendency for local recurrence but low risk of metastasis. They affect children more than adults. The most common sites of involvement are the lung, soft tissue, peritoneum, bladder, and less commonly the gynecologic tract. IMTs are characterized by spindle to epithelioid cells with myofibroblastic differentiation, some degree of smooth muscle differentiation, myxoid stroma and usually associated with brisk lymphoplasmacytic infiltrates. In about half of the cases, IMTs are associated with rearrangement...
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Corpus: Case Reports Source Type: research

Pathologic Changes in Uterine Leiomyomas After Extended Treatment With Ulipristal Acetate
Ulipristal acetate is a selective progesterone receptor modulator that acts on progesterone receptors in uterine muscle and endometrium. It is effective in reducing the size of uterine leiomyomas (fibroids) and in managing associated menorrhagia. Although ulipristal acetate–associated pathologic changes have been previously documented in the endometrium, it is unclear what morphology can be expected in posttreatment fibroids. We herein report 2 cases in which patients underwent hysterectomy, after at least two 3-mo courses of ulipristal acetate. The fibroids demonstrated some pathologic changes that have previously b...
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Corpus: Case Reports Source Type: research

Dedifferentiated Carcinoma of the Endometrium Associated With Low-grade Müllerian Adenosarcoma: A Clinicopathologic Case Report Including the Immunohistochemical and Molecular Profile
We 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. (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Corpus: Case Reports Source Type: research

Muir-Torre Syndrome With a Frame-shift Mutation in the MSH2 Gene: A Rare Case Report and Literature Review
Muir-Torre syndrome is a rare subtype of Lynch syndrome characterized by coincidence of skin neoplasm and visceral malignancies. Here, we report a case of this rare disease, whose diagnosis of the syndrome was first suspected by the pathologist. This was a 60-yr-old woman who presented with an axillary skin nodule, which was diagnosed as basal cell carcinoma. Further inquiry revealed that she was hospitalized for evaluation of a recurrent vaginal stump endometrial carcinoma. Histologic workup and immunohistochemistry for mismatch repair proteins of both the skin and vaginal tumor suggested the possibility of Muir-Torre syn...
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Corpus: Case Reports Source Type: research

Distinct Histologic, Immunohistochemical and Clinical Features Associated With Serous Endometrial Intraepithelial Carcinoma Involving Polyps
The origin of serous endometrial intraepithelial carcinoma (SEIC) is debated, due to its premalignant and independently malignant nature. It often arises next to endometrial serous carcinoma (ESC), with a propensity for polypoid growth. We aimed to better characterize this discrepancy by analyzing the clinical, histologic, and immunohistochemical features of polypoid carcinoma associated with SEIC (P-SEIC), and compared them with usual endometrial serous carcinoma without SEIC (UESC). Consecutive patients with P-SEIC were recruited and compared with UESC controls from our institutional research center. Clinical, histologic...
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Corpus: Original Articles Source Type: research

Clinicopathologic and Immunohistochemical Correlates of CTNNB1 Mutated Endometrial Endometrioid Carcinoma
Endometrial endometrioid carcinomas (EECs) with exon 3 CTNNB1 mutations characterize a more aggressive subset of tumors in patients with low-grade low-stage disease. Thus, prospectively identifying these cases may be clinically relevant. The aim of this study was to examine the feasibility of β-catenin and Cyclin D1 immunohistochemistry to identify EECs harboring CTNNB1 mutations and to evaluate the clinicopathologic features of EECs with exon 3 CTNNB1 mutations. Thirty-nine CTNNB1 mutated EECs and 40 CTNNB1 wild-type EECs were identified from a cohort of previously sequenced endometrial carcinomas using a targeted ne...
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Corpus: Original Articles Source Type: research

Hypertrophic Herpes Simplex With Subsequent Development of Plasma Cell Vulvitis: A Potential Diagnostic Pitfall
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. (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Lower Tract: Case Reports Source Type: research

An Exceptional Vulvar Tumor: Myeloid Sarcoma of the Labia Majora
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 termed myeloid sarcoma. Limited palliative treatment was instated with a focus on the patient’s quality of life. Myeloid sarcoma (chloroma; granulocytic sarcoma) is a ...
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Lower Tract: Case Reports Source Type: research

P16 Expression in Primary Vulvar Extramammary Paget Disease
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%) wit...
Source: International Journal of Gynecological Pathology - February 12, 2020 Category: Pathology Tags: Pathology of the Lower Tract: Original Article Source Type: research

Risk of Malignancy in Postmenopausal Patients With Ovarian Torsion
No abstract available (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - December 13, 2019 Category: Pathology Tags: ONLINE ARTICLES: LETTERS TO THE EDITOR Source Type: research

Peritoneal Carcinomatosis From Yolk Sac Tumor in a Postmenopausal Woman Following Chemotherapy for High-grade Ovarian Serous Carcinoma
No abstract available (Source: International Journal of Gynecological Pathology)
Source: International Journal of Gynecological Pathology - December 13, 2019 Category: Pathology Tags: ONLINE ARTICLES: LETTERS TO THE EDITOR Source Type: research