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The vagina, like other orifices that interface between the external environment and the interior milieu, acts as a barrier to many potentially invasive microorganisms. It is, thus, not surprising that the vagina is the site of a variety of infections, both sexually and nonsexually transmitted, and this, in fact, represents the predominant type of pathology of this organ. In contrast, neoplasms are...
The World Health Organization (WHO) recognizes three general categories of invasive carcinoma of the cervix: squamous cell carcinoma, adenocarcinoma, and “other epithelial tumors” (Table6.1 ) [278]. The “other epithelial tumors” include adenosquamous carcinoma, adenoid basal cell carcinoma, adenoid cystic carcinomas, as well as neuroendocrine tumors and undifferentiated carcinoma (Table...
The histopathological classification of a disease should reflect both current concepts of its pathogenesis as well as its clinical behavior. Over the last 50 years, our understanding of the pathobiology and behavior of cervical cancer precursors has evolved considerably. As a result, the terminology used to classify preinvasive lesions of the cervix has frequently changed. Although these changes in...
Endometrial hyperplasia often precedes the development of endometrioid carcinoma, the most common type of endometrial carcinoma. More recently, studies have found that the risk of endometrial hyperplasia is associated with increasing body mass index and nulliparity [24]. In addition, obesity, anovulatory cycles, and exogenous hormones are associated with both endometrioid carcinoma and hyperplasia...
Worldwide, ovarian cancer is the sixth most common cancer in women and the seventh most common cause of cancer death. There are about 204,000 new cases and 125,000 deaths annually [29]. In most Western countries, ovarian carcinoma is the fifth most common malignancy and ranks fourth in cancer mortality. In the Western hemisphere, it accounts for 4% of cancer in women and is the most frequent cause...
Gestational trophoblastic disease (GTD) encompasses a heterogeneous group of lesions with specific clinical features, morphological characteristics, and pathogenesis. The World Health Organization classification of GTD includes complete and partial hydatidiform mole, invasive mole, choriocarcinoma, placental site trophoblastic tumor (PSTT), epithelioid trophoblastic tumor, exaggerated placental site,...
Endometrial carcinoma is the most common invasive neoplasm of the female genital tract and the fourth most frequently diagnosed cancer in women in the USA. In 2008, it is estimated there will have been 40,100 new cases and 7,470 deaths resulting from this neoplasm. These figures represent an estimated 6% of the new cancer cases and 3% of the cancer deaths in women [377]. Worldwide, approximately 150,000...
Since the publication of the 1/e in 1977, Blaustein's Pathology of the Female Genital Tract has consolidated its position as the leading textbook of gynecological pathology. An essential reference for all pathologists and residents, this thoroughly updated Sixth Edition includes more than 1400 illustrations in color, informative tables and 22 revised chapters written by internationally recognized...
Recognition of the features of gestational endometrium, trophoblast, and villi, as well as the pathologic changes in chorionic tissues, is an important part of endometrial biopsy interpretation. The presence of intrauterine products of conception generally excludes the diagnosis of ectopic pregnancy and can help explain other pathologic states such as abnormal bleeding or chronic endometritis.
Endometritis usually is a disorder of the reproductive years, although it may occur in postmenopausal patients. Endometrial inflammation typically accompanies pelvic inflammatory disease of the upper genital tract. It may also be associated with a recent pregnancy, either an abortion or a term pregnancy. Other possible causes include instrumentation, such as a prior biopsy, an intrauterine contraceptive...
Gestational trophoblastic disease (GTD) includes disorders of placental development (hydatidiform mole) and neoplasms of the trophoblast (choriocarcinoma, placental site trophoblastic tumor [PSTT], and epithelioid trophoblastic tumor).1;2 The recent classification of these lesions by the World Health Organization (WHO) clearly defines the different histologic forms of GTD (Table 4.1).
The histologic features of what constitutes “normal” endometrium change with a woman’s age, through the premenarchal, reproductive, perimenopausal, and postmenopausal years. During the reproductive years, the cyclical hormonal changes of the menstrual cycle provide a continuously changing morphologic phenotype that is “normal.” In biopsy specimens, the combination of these cyclical changes along with...
Endometrial hyperplasia is a noninvasive proliferation of the endometrium that results in a morphologic pattern of glands with irregular shapes and varying size. This disorder results from sustained, unopposed estrogen stimulation and presents clinically as abnormal uterine bleeding. Sometimes hyperplasia is encountered incidentally in a biopsy performed for other reasons, such as infertility workup...
There are several methods of sampling the endometrium. The “gold standard” is dilation and curettage (D&C), which requires dilation of the cervix to allow insertion of a curette into the endometrial cavity. This technique allows for the most thorough sampling of the endometrium but requires anesthesia for cervical dilation. The curette is drawn across the anterior and posterior endometrial surfaces,...
Women receive hormone preparations for a variety of reasons, including birth control and treatment for dysfunctional uterine bleeding, perimenopausal and postmenopausal symptoms, endometriosis, endometrial hyperplasia and carcinoma, breast carcinoma, and certain types of infertility. Usually the exogenous hormone is some form of progestin, but estrogenic and even androgenic hormones are used for some...
Uterine tumors other than benign polyps or carcinoma are rarely encountered in endometrial biopsies and curettings. The classification in Table 11.1 lists most of these other neoplasms. Among this group of tumors, malignant= mixed mesodermal tumor (MMMT) is the most common malignancy, yet it accounts for only 1% to 2% of all uterine neoplasms. MMMT typically arises in the endometrium and is often...
Most endometrial polyps appear to originate from localized hyperplasia of the basalis, although their pathogenesis is not well understood. Polyps occur over a wide age range, but are most common in women in the fourth and fifth decades, becoming less frequent after age 60. Usually they present with abnormal uterine bleeding, and have been implicated as a cause of abnormal bleeding in between 2% and...
Endometrial biopsies and curettings are among the most common tissue specimens received in the pathology laboratory. In several respects these specimens present a unique challenge for the surgical pathologist. The normal endometrium undergoes a variety of morphologic changes, especially during the reproductive years, when cyclical hormonal influences and pregnancy affect uterine growth. Biopsyinduced...
This chapter specifically addresses uterine bleeding resulting from alterations in the normal cyclical changes of the endometrium. This type of bleeding is commonly referred to as dysfunctional uterine bleeding (DUB). Clinically, DUB indicates ovulatory dysfunction. By definition, DUB excludes postmenopausal bleeding or bleeding caused by the presence of specific pathologic processes such as inflammation,...
Endometrial adenocarcinoma is the most common malignant tumor of the female genital tract in the United States. This neoplasm represents a biologically and morphologically diverse group of tumors, with differing pathogenesis. These tumors have two basic clinicopathologic forms, type I and type II. These two forms of endometrial carcinoma display different clinicopathologic, immunohistochemical, and...
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