Gynecologic and Obstetric Pathology

SECTION I. LOWER ANOGENITAL TRACT

A. Inflammatory Disorders

1. Eczematous dermatitis

2. Lichen simplex chronicus and prurigo nodularis

3. Psoriasis

4. Seborrheic dermatitis

5. Lichen sclerosus including early lichen sclerosus

6. Lichen planus

7. Zoon vulvitis

8. Bullous pemphigoid

9. Pemphigus vulgaris

10. Hailey-Hailey disease

11. Darier disease

12. Epidermolytic hyperkeratosis

13. Hidradenitis suppurativa

14. Crohns disease of the vulva

15. Vulvodynia

B. Vulvar Infections

16. Vulvovaginal candidiasis

17. Bacterial vaginosis

18. Molluscum contagiosum

19. Acute herpes simplex virus infection

20. Chronic erosive herpes simplex, PITFALL

21. Syphilis, PITFALL

22. Chancroid

23. Granuloma inguinale

24. Schistosomiasis

25. Bacillary angiomatosis

26. Necrotizing fasciitis

27. Varicella zoster

C. Vulvar Adnexal Lesions

28. Bartholins duct cyst

29. Mucus cyst

30. Ectopic breast tissue

31. Fibroadenoma

32. Hidradenoma, PITFALL

33. Syringoma

34. Hyperplasia of Bartholin gland

35. Bartholin adenoma

36. Adenoid cystic carcinoma

37. Bartholin gland carcinoma

D. Vulvar Epithelial Neoplasia

39. Condyloma

40A. Verruciform xanthoma

40B. Warty dyskeratoma

41. Fibroepithelial stromal polyp

42. Seborrheic keratosis

43. Pseudobowenoid papulosis, PITFALL

44. Flat condyloma (VIN1)

45. Classic (usual) vulvar intraepithelial neoplasia

46. Classic vulvar intraepithelial neoplasia with lichen simplex chronicus, PITFALL

47. Classic vulvar intraepithelial neoplasia (bowenoid dysplasia)

48. Pagetoid vulvar intraepithelial neoplasia, PITFALL

49. Vulvar intraepithelial neoplasia with columnar differentiation, PITFALL

50. Epidermodysplasia-verruciformis-like atypia, PITFALL

51. Polynucleated atypia of the vulva

52. Differentiated vulvar intraepithelial neoplasia

53. Verruciform lichen simplex chronicus

54. Vulvar acanthosis with altered differentiation (atypical verruciform hyperplasia)

55. Early invasive squamous cell carcinoma

56. Vulvar squamous carcinoma: basaloid and warty patterns

57. Vulvar squamous carcinoma: keratinizing pattern

58. Verrucous squamous cell carcinoma

59. High-Grade Squamous Intraepithelial lesion (Vulvar Intraepithelial Neoplasia III) with Confluent Papilary Growth

60. Giant condyloma of the external genitalia, PITFALL

61. Pseudoepitheliomatous hyperplasia, PITFALL

62. Keratoacanthoma, PITFALL

63. Basal cell carcinoma

64. Adenosquamous carcinoma

65. Paget disease of the vulva

66. Merkel cell carcinoma

67. Cloacogenic carcinoma

68. Metastatic carcinoma to the vulva

E. Pigmented Lesions

69. Lentigo

70. Genital type nevus

71. Dysplastic nevus

72. Melanoma

F. Soft Tissue Vulvar Neoplasia

73. Angiomyofibroblastoma

74. Aggressive Angiomyxoma, PITFALL

75. Superficial angiomyxoma

76. Cellular angiofibroma

77. Dermatofibroma (fibrous histiocytoma)

78. Dermatofibrosarcoma protuberans

79. Low grade fibromyxoid sarcoma

80. Lipoma

81. Liposarcoma

81B. Synovial sarcoma of the vulva, PITFALL

82. Rhabdomyoma

83. Angiokeratoma

84. Granular cell tumor

85. Prepubertal vulvar fibroma

G. Anus

86. Anal condyloma

87. Anal Intraepithelial Neoplasia II and III

88. Anal carcinoma

88B. Anal Pagets disease

H. Vagina

89. Prolapsed fallopian tube

90. Granulation tissue

91. Vaginal adenosis

92. Polypoid endometriosis

93. Vaginal Papilomatosis (Residual Hymenal Ring), PITFALL

94. Low grade vaginal intraepithelial lesion (Vaginal Intraepithelial Neoplasia I and condyloma)

95. Vaginal intraepithelial lesion, not amenable to precise grading (Vaginal Intraepithelial Neoplasia II-III)

96. High grade vaginal intraepithelial neoplasia III

97. Radiation-induced Atrophy

98. Papillary squamous carcinoma

99. Clear cell adenocarcinoma

100. Metastatic adenocarcinoma

101. Melanoma, PITFALL

102. Spindle cell epithelioma, PITFALL

103. Embryonal rhabdomyosarcoma

SECTION II. CERVIX

A. Squamous Lesions

105. Exophytic low grade squamous intraepithelial lesion

106. Low grade squamous intraepithelial lesion (flat condyloma/Cervical Intraepithelial Neoplasia I)

107. High grade squamous intraepithelial lesion (Cervical Intraepithelial Neoplasia II and III)

108. Low grade squamous intraepithelial lesion (giant condyloma), PITFALL

109. Low grade squamous intraepithelial lesion (immature condyloma)

110. Mixed pattern squamous intraepithelial lesion (Low- and High-Grade Squamous Intraepithelial Lesions)

111. Atrophy including squamous intraepithelial lesion in atrophy

112. Minor p16-positive metaplastic atypias

113. Squamous intraepithelial lesion, not amenable to precise grading (QSIL)

114. Superficially invasive squamous cell carcinoma

115. Conventional squamous cell carcinoma

116. Pseudocrypt involvement by squamous cell carcinoma

117. Lymphoepithelial-like squamous carcinoma

B. Glandular Lesions

118. Superficial (early) adenocarcinoma in situ

119. Conventional adenocarcinoma in situ

120. Stratified adenocarcinoma in situ

121. Intestinal variant of adenocarcinoma in situ

122. Cervical endometriosis

123. Pregnancy-related changes in the cervix

124. Reactive atypias in the endocervix

125. Radiation atypias

126. Villoglandular adenocarcinoma of the cervix

127. Superficially invasive endocervical adenocarcinoma

128. Extensive adenocarcinoma in situ vs invasion

129. Infiltrative endocervical adenocarcinoma

130. Clear cell carcinoma of the cervix

131. Atypical Lobular Endocervical Glandular Hyperplasia and Invasive (minimal deviation) adenocarcinoma of the cervix with gastric differentiation

132. Serous carcinoma of the cervix

133. Signet ring cell carcinoma of the cervix

134. Adenoid basal carcinoma

135. Mesonephric remnants

136. Mesonephric carcinoma

137. Prostatic metaplasia of the cervix

138. Endocervical glandular hyperplasia

139. Metastatic serous carcinoma to the cervix

140. Metastatic endometrioid carcinoma to the cervix

141. Atypical endocervical polyp

142. Adenomyoma of the cervix

143. Microglandular hyperplasia of the cervix

144. Adenosarcoma of the cervix

C. Miscellaneous Lesions

145A. Cervical schwannoma

145B. Glial polyp of the cervix

SECTION III. UTERUS

A. Benign Endometrium

146A. Dysfunctional uterine bleeding (early or mid-cycle breakdown)

146B. Breakdown mimicking neoplasia

147. Anovulatory endometrium with persistent follicle

148. Benign hyperplasia

149. Telescoping artifacts mimicking neoplasia

150. Mixed pattern endometrium

151. Adenomyomatous polyp

152. Chronic endometritis

153. Pseudoactinomycotic radiant granules

154. Pyometra

155. Tubercular endometritis

156. Submucosal leiomyoma

157. Exfoliation artifact

158. Perforation

159. Ablation artifact

B. Endometrial Glandular Neoplasia and Its Mimics

160. Endometrial intraepithelial neoplasia (atypical hyperplasia)

161. Atypical polypoid adenomyoma

162. Endometrial involvement by endocervical glandular neoplasia

163. Degenerative repair

164. Proliferative repair

165. Mucinous metaplasia of the endometrium

166. Squamous and morular metaplasia

167A. Ichthyosis uteri

167B. Squamous carcinoma of the endometrium

168. Tubal and eosinophilic (oxyphilic) metaplasia

169. Microglandular endometrial adenocarcinoma in curettings

170A. Endometrioid adenocarcinoma

170B. Lower uterine segment adenocarcinoma

170C. Lynch syndrome screening

171. Myoinvasion in endometrial adenocarcinoma

172. Intraperitoneal keratin granuloma

173. Endometrial histiocytes and foamy stromal macrophages

174. Serous cancer precursors

175. Serous endometrial intraepithelial carcinoma

176. Ischemic atypias of the endometrium

177. Reactive atypias in the endometrium

178. Uterine serous carcinoma

179. Mixed pattern adenocarcinoma

180. p53 positive endometrioid adenocarcinoma

181. Neuroendocrine differentiation in endometrial carcinoma

182. Undifferentiated carcinoma of the endometrium

183. Clear cell carcinoma

184. Endometrioid or clear cell carcinoma?

185. Carcinosarcoma

186. Adenocarcinoma with spindle cell features

187. Wilms tumor of the endometrium

C. Mesenchymal Lesions of the Uterus

188. Endometrial stromal nodule

189. Stromomyoma

190. Endometrial stromatosis

191. Low grade endometrial stromal sarcoma

192. Uterine tumor resembling sex cord stromal tumor

193. High grade endometrial stromal sarcoma

194. Undifferentiated uterine sarcoma

195. Adenosarcoma of the endometrium

196. Atypical endometrial polyp

197. Adenomatoid tumor

198. Lipoleiomyoma

199. Cellular leiomyoma

200. Hydropic leiomyoma

201. Mitotically active leiomyoma

202. Atypical leiomyoma (leiomyoma with bizarre nuclei)

203. Leiomyomatosis

204. Intravenous leiomyoma

205. Intravenous leiomyomatosis

205A. Morcellation-related dissemination of smooth muscle neoplasia

206A. Disseminated intraperitoneal leiomyomatosis

206B. Pathology following uterine artery embolization

206C. Hereditary leiomyomatosis and renal cell carcinoma syndrome, PITFALL

207. Leiomyosarcoma

208. Myxoid leiomyosarcoma

209. Epithelioid leiomyosarcoma

210. PEComa

211. Reproductive tract lymphoma

SECTION IV. FALLOPIAN TUBE

A. Benign, Inflammatory/Reactive

212. Adrenal rest

213. Pseudoxanthomatous salpingiosis

213A. Xanthogranulomatous salpingiosis

214. Follicular salpingitis

215. Salpingitis isthmica nodosum

216. Granulomatous salpingitis

217. Torsion of the tube and ovary

217A. Tubal Arias-Stella effect, PITFALL

B. Neoplastic and Preneoplastic

218. Adenofibroma

219. Benign epithelial hyperplasia (secretory cell outgrowths)

219A. p53 signatures

219B. Low grade serous tubal intraepithelial neoplasia (serous tubal intraepithelial lesion)

219C. Papillary hyperplasia

220. High grade serous tubal intraepithelial neoplasia (serous tubal intraepithelial carcinoma)

220B. The risk reducing salpingo-oophorectomy

222. Salpingoliths

223. Adenocarcinoma of the fallopian tube

225. Endosalpingeal implants from remote tumors

226. Female adenexal tumor of wolffian origin

SECTION V. OVARY

A. Benign

228. Tangentially sectioned ovarian follicle, PITFALL

229. Ovary in pregnancy

230. Solitary luteinized follicle cyst

231. Polycystic ovarian syndrome

232. Cortical stromal hyperplasia and hyperthecosis

233. Endometrioma with mucinous metaplasia

233A. Endometrioma with atypia

234. Decidualized endometrioma, PITFALL

235. Serous cystadenomas and cystadenofibromas

236. Cortical inclusion cysts

237. Endosalpingiosis

237C. Malakoplakia

B. Epithelial Neoplasia

238A. High grade serous carcinoma, classic type

238B. High-grade serous carcinoma with SET patterns

240. Low grade endometrioid adenocarcinoma with squamotransitional or spindle features

241. Carcinosarcoma

241A. Adenosarcoma of the ovary

242. Serous borderline tumor (SBT)

243. Serous borderline tumor with complex architecture

244. Low grade invasive serous carcinoma of the ovary

245. Invasive implants of low-grade serous tumor

246. Mucinous carcinoma

247. Mucinous tumors with mural nodules

248. Mucinous borderline tumor

249. Mucinous borderline tumor with intraepithelial carcinoma

250. Low grade endometrioid adenocarcinoma

251. Endometrioid adenofibroma

252. Proliferative (borderline) endodometrioid adenofibroma

253. Mullerian mucinous and seromucinous tumors of the ovary

254. Benign Brenner tumor

254A. Malignant Brenner tumor

255. Clear cell carcinoma

255A. Ovarian adenocarcinomas with yolk sac differentiation, PITFALL

256. Borderline clear cell adenofibroma

259. Metastatic carcinoma to the ovary

260. Pseudomyxoma peritonei

C. Germ Cell Tumors

261. Mature cystic teratoma: normal neural differentiation

261A. Fetiform teratoma

262. Struma ovarii

263. Malignant struma

264. Strumal carcinoid

264A. Metastatic carcinoid

265. Malignancy arising in teratomas

266. Dysgerminoma

267. Yolk sac carcinoma

267A. Embryonal carcinoma

269. Immature teratoma

270. Mixed germ cell tumor

D. Sex Cord-Stromal Tumors

272. Thecoma-fibroma

273. Fibroma with minor sex cord elements

274. Sclerosing peritonitis

275. Granulosa cell tumor

276. Granulosa cell tumor variants, PITFALL

277. Juvenile granulosa cell tumor, PITFALL

278. Sertoli Leydig cell tumor

279. Retiform Sertoli Leydig cell tumor, PITFALL

280. Leydig cell (hilar) tumor

280B. Stromal luteoma

281. Pregnancy luteoma

282. Sclerosing stromal tumor

283. Small cell carcinoma of hypercalcemic type

283A. Small cell carcinoma of pulmonary (neuroendocrine) type

284. Sex cord tumor with annular tubules

E. Miscellaneous Tumors

285. Solitary fibrous tumor

286. Gastrointestinal stromal tumor

287. Primitve neuroectodermal tumor

288. Desmoplastic small round cell tumor

289. Benign cystic mesothelioma

290. Papillary mesothelioma

290A. Papillary mesothelial hyperplasia

291. Malignant mesothelioma

SECTION VI. GESTATIONAL

A. Early Gestation

292. Gestational sac

293. Fresh implantation site, PITFALL

293b. Implantation site nodule

294. Spontaneous abortion

294A. Ectopic pregnancy

B. Trophoblastic Neoplasia

295. Complete hydatidiform mole, PITFALL

295B. Invasive hydatidiform mole

296. Partial hydatidiform mole

297. Mesenchmal dysplasia, PITFALL

298. Choriocarcinoma

299. Intraplacental choriocarcinoma, PITFALL

300. Placental site trophoblastic tumor, PITFALL

301. Molar implantation site

302. Epithelioid trophoblastic tumor

302B. Chorangioma

C. Second and Third Trimester Placenta

303. Knots in the umbilical cord

303A. Single umbilical artery (SUA)

303B. Hyper and hypocoiled umbilical cord

303C. Variations on cord insertion (marginal, membraneous, furcate)

303D. Circummarginate and circumvallate placentas

304. Fetal vascular thrombosis, PITFALL

305. Amniotic bands

306. Maternal floor infarct/massive perivillous fibrin deposition

307. Chorioamnionitis

308. Gestational candida infection

309. Listeria placentitis, PITFALL

310. Chronic villitis

311. Chronic histiocytic intervillositis

312. Congenital syphilis

313. Lyosomal storage disorder

314. Inflammatory abruption

314B. Hypertensive (ball in socket) infarct

315. Congenital parvovirus infection

315B. Fetal leukemia

318. Placenta creta

318B. Placenta previa

320. Toxoplasmosis

321. Toxemia

322. Placental infarction

323. Meconium staining

324. Distal villous pathology

325. Fetal to maternal hemorrhage

Appendix: Common Pitfalls in Diagnostic Gynecologic and Obstetric Pathology