آزمايشگاه رز - Ackerman Atlas(chaptr33)

Uterine Corpus

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Figure 33.1 Normal Endometrium. A, Proliferative; B, secretory

Figure 33.2 Cyclic Changes in Endometrium. Approximate relationship of microscopic changes. (From American Society for Reproductive Medicine. Noyes RW, Hertig AT, Rock J. Dating the endometrial biopsy. Fertil Steril. 1950;1:3-25)

Figure 33.3 Arias-Stella Reaction in Endometrial Mucosa. This is not to be confused with a malignant condition

Figure 33.4 Typical appearance of endometrium after long-term administration of contraceptive pills. The glands are sparse and atrophic, whereas the stroma is prominent and has deciduoid features, reflecting the predominant progestin effect

Figure 33.5 Chronic endometritis showing an inflammatory infiltrate rich in lymphocytes and plasma cells

Figure 33.6 The oval to spindle and occasionally stellate shape of endometrial stromal cells is a clue to the diagnosis of chronic endometritis

Figure 33.7 IUD-Related Uterine Actinomycosis. The disease had spread to the pelvic cavity

Figure 33.8 Noncaseating granuloma in endometrial mucosa consistent with sarcoidosis

Figure 33.9 A and B, Squamous metaplasia of endometrium with morule formation

Figure 33.10 Tubal Metaplasia of Endometrial Mucosa. All three cell types that make up the normal mucosa of the fallopian tube can be recognized

Figure 33.11 Papillary (syncytial) metaplasia of endometrium

Figure 33.12 Mucinous Metaplasia of Endometrium. Note the basal location of the nuclei and the mucin-containing cytoplasm of the columnar cells

Figure 33.13 Clear Cell Metaplasia of Endometrium. The cytoplasm has a finely granular quality

Figure 33.14 Gross Appearance of Uterus Involved by Adenomyosis. The wall is irregularly thickened and contains small hemorrhagic foci

Figure 33.15 Intramyometrial foci of endometrial glands and stroma in adenomyosis

Figure 33.16 So-Called Stromal Adenomyosis. An ill-defined island of endometrial stroma is deeply embedded within the myometrium

Figure 33.17 Gross appearance of endometriosis involving the anterior abdominal wall

Figure 33.18 Endometriosis involving the umbilical region

Figure 33.19 So-Called Endocervicosis. The stroma has an endome- trium-like quality, but the glands are of endocervical type

Figure 33.20 Endometrial Hyperplasia Without Atypia. There is mild irregularity of glandular architecture, and crowding

Figure 33.21 A, Endometrial hyperplasia with atypia, in a polyp; B, low-power, showing the glandular crowding, and C, high-power, from the edge of the hyperplastic focus, showing the cytologic difference between the atypical epithelium (on the left) and non-atypical epithelium

Figure 33.22 Papillary Proliferation of the Endometrium (PPE). A, PPE in an endometrial polyp; B, bland mucinous epithelial cells cover the papillae. This single focus, confined to a polyp, is simple PPE

Figure 33.23 Huge Endometrial Polyp Filling the Endometrial Cavity. There is also a smaller endocervical polyp and a subserosal leiomyoma. (Courtesy Dr. Pedro J Grases Galofrè; from Grases Galofrè PJ. Patologia ginecològica. Bases para el diagnòstico morfològico. Barcelona: Masson; 2002.)

Figure 33.24 Low-power appearance of endometrial polyp showing cystically dilated glands and a fibrous stroma with thick-walled vessels

Figure 33.25 A and B, Low- and high-power appearance of adeno- myomatous polyp

Figure 33.26 Atypical Polypoid Adenomyoma. The gross appearance is not substantially different from that of an ordinary polyp

Figure 33.27 A and B, Whole-mount and high-power appearance of atypical polypoid adenomyoma. Note the glandular architectural complexity, metaplastic changes, and atypia

Figure 33.28 Hypermutated/Mismatch Repair Deficient Endometrial Carcinoma. There is heterogeneity in the appearance of the tumor, with more solid areas alternating with glandular areas (A) and a prominent lymphoid infiltrate. Immunostaining shows loss of expression of MLH1 in the tumor cells, with retained expression in lymphocytes and stromal cells (B)

Figure 33.29 Ultramutated/Polymerase Epsilon Exonuclease Domain Mutated (POLE EDM) Endometrial Carcinoma. The cells of this endometrioid carcinoma show high-grade nuclear features, and there is a prominent lymphoid infiltrate, features associated with POLE EDM tumors

Figure 33.30 Outcomes of patients with the four genomic subtypes of endometrial carcinoma (POLE exonuclease domain mutation [POLE EDM], CN low/p53 wildtype, mismatch repair deficient [MMR-D], and CN high/p53 abnormal, from best to worst prognosis). A, Overall survival. B, Disease-specific survival. C, Progression-free survival. (From Talhouk A, McConechy MK, Leung S, et al. Confirma- tion of ProMisE: A simple genomics-based clinical classifier for endometrial cancer. Cancer 2017;123:802-813.)

Figure 33.31 A and B, Gross appearances of endometrioid adenocarcinoma. The tumor shown in A is polypoid, whereas that depicted in B is highly infiltrating

Figure 33.32 Endometrioid Endometrial Adenocarcinoma. A, Grade 1; B, grade 2; C, grade 3; D, with villoglandular pattern of growth

Figure 33.33 Well-differentiated endometrioid adenocarcinoma with squamous metaplasia

Figure 33.34 A and B, Endometrial adenocarcinoma of endometrioid type with squamous metaplasia. In contrast to the case shown in Fig. 33.36, the squamous component has markedly atypical cytologic features

Figure 33.35 Secretory Carcinoma of Endometrium. This well-differ- entiated lesion is a variant of endometrioid adenocarcinoma and is composed of cells with abundant clear to finely granular cytoplasm. It should be distinguished from clear cell carcinoma

Figure 33.36 Gross appearance of serous carcinoma of endometrium. The neoplasm fills the endometrial cavity

Figure 33.37 A and B, Low- and high-power appearance of serous carcinoma. Note the high nuclear grade

Figure 33.38 Serous carcinoma limited to the superficial portion of an endometrial polyp

Figure 33.39 Carcinosarcoma of uterus resulting in a huge polypoid mass

Figure 33.40 Glandular and mesenchymal components of carcinosar- coma. Heterologous elements in the form of cartilage are present

Figure 33.41 Clear cell carcinoma of endometrium

Figure 33.42 Gross appearance of a clear cell carcinoma involving a large endometrial polyp. (Courtesy Dr. Juan José Segura, San José, Costa Rica.)

Figure 33.43 Undifferentiated carcinoma (A), with loss of MLH1 expression in the tumor cells (B)

Figure 33.44 Typical microscopic appearance of low-grade endometrial stromal tumor, showing bland oval cells arranged concentrically around spiral arterioles

Figure 33.45 Endometrial Stromal Nodule. The lesion is characteristically well circumscribed and has a yellow color

Figure 33.46 Low-grade endometrial stromal sarcoma showing diffuse permeation of the myometrium in the form of small nodules bulging on the cut surface

Figure 33.47 Typical low-power appearance of endometrial stromal

sarcoma

Figure 33.48 Low-grade endometrial stromal sarcoma presenting as a huge polypoid mass within the endometrial cavity. This pattern of growth is unusual in this tumor type

Figure 33.49 Low-grade endometrial stromal sarcoma metastatic to wall of large bowel

Figure 33.50 A and B, Low- and high-power appearance of low-grade endometrial stromal sarcoma metastatic to lung. This lesion may be misdiagnosed as spindle carcinoid tumor, hemangiopericytoma, or solitary fibrous tumor

Figure 33.51 Low-grade endometrial stromal sarcoma with structures resembling ovarian sex cord tumors

Figure 33.52 Peritoneal metastasis from endometrial stromal sarcoma accompanied by benign endometrioid glands

Figure 33.53 High-grade endometrial stromal sarcoma with t(10:17) YWHAE-NUTM2 translocation. The nuclei are higher grade than in low- grade endometrial stromal sarcoma. (Courtesy Dr. Lien Hoang, Vancouver.)

Figure 33.54 Myxoid high-grade endometrial stromal sarcoma with Z3H7B-BCOR translocation. (Courtesy Dr. Lien Hoang, Vancouver.)

Figure 33.55 A and B, Gross and microscopic appearance of undif- ferentiated uterine sarcoma

Figure 33.56 Müllerian Adenosarcoma. The tumor shows less degree of necrosis and hemorrhage than the usual malignant mixed müllerian tumor

Figure 33.57 A and B, Low- and high-power view of müllerian adeno- sarcoma. The resemblance to phyllodes tumor of breast is obvious

Figure 33.58 Müllerian adenosarcoma (top) with sarcomatous overgrowth (bottom)

Figure 33.59 Multiple uterine leiomyomas

Figure 33.60 Large uterine leiomyoma with intramural and subserous involvement

Figure 33.61 Elongated spindle cells with fibrillary acidophilic cytoplasm in the usual type of uterine leiomyoma

Figure 33.62 This uterine leiomyoma has undergone massive so-called red degeneration

Figure 33.63 Leiomyoma with edematous (hydropic) changes leading to the formation of cystic cavities (Courtesy Dr. Pedro J. Grases Galofré; from Grases Galofré PJ. Patología ginecológica. Bases para el diagnóstico morfológico. Barcelona: Masson; 2002.)

Figure 33.64 So-called perinodular hydropic degeneration in uterine leiomyoma

Figure 33.65 Cellular leiomyoma. There is no pleomorphism, undue mitotic activity, or necrosis

Figure 33.66 A and B, Two views of leiomyoma with bizarre nuclei. The size of some of the tumor cell nuclei makes them almost visible to the naked eye

Figure 33.67 Mitotically Active Leiomyoma. There is also hypercellularity but no pleomorphism or necrosis

Figure 33.68 Admixture of mature smooth muscle and adipose tissue in leiomyolipoma

Figure 33.69 Epithelioid Leiomyoma. A, Gross appearance; B, microscopic appearance. The tumor cells have a round shape and an artifactually clear cytoplasm

Figure 33.70 Micronodular microscopic appearance of uterine leiomyoma having the gross appearance of so-called cotyledonoid dissecting type

Figure 33.71 Large plugs of mature smooth muscle filling the vascular lumina in intravenous leiomyomatosis

Figure 33.72 Intravenous leiomyomatosis composed of clear smooth muscle cells

Figure 33.73 Leiomyosarcoma resulting in a large intramural and submucous mass. There are foci of hemorrhage and necrosis

Figure 33.74 Leiomyosarcoma showing hypercellularity, pleomorphism, atypical mitoses, and necrosis

Figure 33.75 Uterine myxoid leiomyosarcoma. (Courtesy Dr. Robert E Scully, Boston.)

Figure 33.76 Inflammatory myofibroblastic tumor

Figure 33.77 Complete Mole. All villi are markedly swollen. (Courtesy Dr. Pedro J Grases Galofrè; from Grases Galofrè PJ. Patologia gine- cològica. Bases para el diagnòstico morfològico. Barcelona: Masson; 2002.)

Figure 33.78 Complete mole showing large villi with stromal edema and marked trophoblastic proliferation

Figure 33.79 Partial Mole With Attached Fetus. The fetus showed no abnormality and was connected to the mole by a normal umbilical cord. (Courtesy Dr. Pedro J Grases Galofré; from Grases Galofré PJ. Patología ginecológica. Bases para el diagnóstico morfológico. Barcelona: Masson; 2002.)

Figure 33.80 Partial mole showing scalloping of villi and isolated tro- phoblastic cells embedded in the stroma

Figure 33.81 Gross Appearance of Invasive Mole. A hemorrhagic mass has permeated half of the thickness of the myometrial wall

Figure 33.82 Whole-Mount View of Invasive Mole. Abnormal villi are seen permeating the thickened myometrium (arrows)

Figure 33.83 Hydropic villi covered by proliferating trophoblast are seen permeating the myometrium in this invasive mole

Figure 33.84 A and B, Uterine choriocarcinoma showing typical highly hemorrhagic appearance

Figure 33.85 Intimate admixture of syncytiotrophoblast and cytotropho- blast in choriocarcinoma

Figure 33.86 A and B, Placental site trophoblastic tumor. A, Gross appearance. A solid hemorrhagic nodule is seen distending the myometrium and protruding into the endometrial cavity. B, Microscopic appearance. Medium-sized cells of intermediate trophoblastic type are seen growing in a diffuse fashion into the myometrium. The biphasic pattern resulting from the admixture of cytotrophoblast and syncytiotrophoblast, which is typical of choriocarcinoma, is absent

Figure 33.87 Epithelioid Trophoblastic Tumor. The microscopic appearance closely simulates carcinoma of either squamous or glassy cell type

Figure 33.88 Trophoblastic cells infiltrating the myometrium in a tumorlike fashion in exaggerated placental site reaction

Figure 33.89 A and B, Low- and medium-power appearance of placental site nodule. The appearance is vaguely chondroid and can be easily misinterpreted

Figure 33.90 A and B, Adenomatoid tumor of uterus. A, Gross appearance. The location at one of the cornua is characteristic. B, Microscopic appearance showing tubular formations lined by flattened mesothelial cells

Figure 33.91 Ewing sarcoma/primitive neuroectodermal tumor presenting as a uterine mass, a most unusual occurrence

Figure 33.92 Lobular breast carcinoma metastatic to myometrium. Note the Indian file pattern of growth