Uterine Cervix

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 Figure 32.1 Transition zone of uterine cervix between exocervical squamous cells and endocervical mucin-producing glandular epithelium

Figure 32.2 A and B, Florid mesonephric rests in endocervix. Note the eosinophilic inspissated secretion in the glandular lumen, an important diagnostic clue

 Figure 32.3 Squamous metaplasia of endocervix involving surface epithelium and glandular opening

Figure 32.4 Complex pattern resulting from cervical squamous metaplasia. It may result in an overdiagnosis of squamous cell carcinoma

 Figure 32.5 Typical appearance of transitional metaplasia, which lacks the nuclear atypia of HSIL (CIN2/3)

Figure 32.6 Tubal metaplasia of endocervix. Some of the lining cells are ciliated

 Figure 32.7 A and B, Low- and high-power appearance of herpes simplex infection of cervix. Multinucleated epithelial cells and intranuclear inclusions are evident in the high-power view

 Figure 32.8 Chronic endocervicitis resulting in a papillar

configuration at the surface. This pattern is sometimes referred to as papillary endocervicitis

Figure 32.9 Cervical tunnel clusters of predominantly cystic type

 Figure 32.10 Microglandular Hyperplasia of Cervix. The papillary configuration seen here is common in this condition

Figure 32.11 Predominantly Solid Form of Microglandular Hyper- plasia. This variety is particularly likely to be overdiagnosed as a malignant process

 Figure 32.12 Diffuse Laminar Endocervical Hyperplasia. The glands are medium sized, evenly spaced, and well differentiated

Figure 32.13 Hyperplastic mesonephric rests with mild atypia

Figure 32.14 Mesonephric glands embedded within the stroma of the uterine cervix exhibiting cystic dilation. The presence of a dense eosinophilic secretion is characteristic

 Figure 32.15 Focus of ectopic cervical decidual reaction

 Figure 32.16 Koilocytotic changes in cervical squamous epithelium involved by LSIL (CIN1). These are diagnostic of HPV infection

 Figure 32.17 HPV-induced LSIL (CIN1) lesion characterized by acanthosis, papillomatosis, and koilocytotic changes

Figure 32.18 Gross appearance of HSIL (CIN2/3) extensively involving the uterine cervix. (Courtesy of Dr Hector Rodriguez-Martinez, Mexico City.)

Figure 32.19 HSIL (CIN 2/3). There is proliferation and atypia, with increased N:C ratio and loss of normal maturation

Figure 32.20 Extensive involvement by HSIL (CIN2/3) of surface epithelium and glands of endocervix

Figure 32.21 Partial replacement of endocervical glandular epithelium by HSIL (CIN2/3)

 Figure 32.22 Low-power appearance of superficial invasive squamous cell carcinoma of cervix

Figure 32.23 Small focus of invasion underlying HSIL (CIN2/3). Note the greater degree of squamous differentiation in the microinvasive component

Figure 32.24 A and B, Gross appearance of invasive squamous cell carcinoma of cervix

 Figure 32.25 Microscopic appearance of invasive squamous cell

carcinoma of cervix of large cell keratinizing type

 Figure 32.26 Patterns of spread of squamous cell carcinoma of cervix as seen in pelvic exenteration specimens: A, large ulcerated tumor involving uterine isthmus and vagina; B, massive extension into uterine corpus; C, extension into bladder; D, extension into bladder and rectum; E, extension into rectal wall, with impingement into rectal mucosa. (A-D, Courtesy of Dr Hector Rodriguez-Martinez, Mexico City, Mexico.)

 Figure 32.27 Basaloid Squamous Cell Carcinoma of Uterine Cervix. The tumor grows in the form of well-defined nests showing peripheral palisading

Figure 32.28 Adenocarcinoma in situ with partial preservation of endocervical glands

 Figure 32.29 SMILE, a morphologically subtle variant of adenocarcinoma in situ/adenosquamous carcinoma in situ. (Courtesy of Dr Lien Hoang, Vancouver, Canada.)

Figure 32.30 Gross appearance of endocervical adenocarcinoma

Figure 32.31 Microscopic appearance of HPV-associated adenocarci- noma of usual type. Note the variable amounts of mucin in A compared with B

 Figure 32.32 Gastric-type adenocarcinoma of cervix

 Figure 32.33 A, Endocervical curettings of a low-grade gastric-type adenocarcinoma of cervix. The cells show focal positivity for CDX2 (B) and are negative for ER (C) and p16 (D) expression

 Figure 32.34 Adenoma malignum (minimal deviation adenocarcinoma), the very well-differentiated variant of gastric-type HPV-independent adenocarcinoma of cervix

Figure 32.35 Clear cell adenocarcinoma of cervix showing tubular, microcystic, and tubulocystic features

 Figure 32.36 Mesonephric adenocarcinoma of cervix

 Figure 32.37 High-grade small cell neuroendocrine carcinoma of cervix

Figure 32.38 Strong focal immunoreactivity for chromogranin in neuroendocrine carcinoma of cervix

 Figure 32.39 Various types of cervical lesions as seen on Pap smears:

A, herpes simplex infection; B, LSIL; C, LSIL (1); D, HSIL; E, HSIL; F, invasive squamous cell carcinoma; G, adenocarcinoma. (Courtesy of L. Alasio, Milan, Italy.)

 Figure 32.40 Embryonal (botryoid) rhabdomyosarcoma of cervix protruding in the form of grapelike masses

 Figure 32.41 A and B, Müllerian adenosarcoma of cervix. A, Gross appearance. B, Microscopic appearance of typical adenosarcoma, with an appearance reminiscent of phylloides tumor of breast. (A, Courtesy of Dr Juan José Segura, San José, Costa Rica.)

Figure 32.42 Poorly differentiated leiomyosarcoma of cervix

 Figure 32.43 Gross appearance of blue nevus of cervix. (Courtesy of Dr Luis Spitale, Córdoba, Argentina.)

Figure 32.44 Cavernous hemangioma of cervix, a most unusual occurrence

Figure 32.45 Diffuse large B-cell lymphoma of cervix growing between normal endocervical glands

Figure 32.46 High-grade serous carcinoma of ovary metastatic to cervix