Pathology Notes

Lichen sclerosus   Updated: 01/04/2021 © Jun Wang, MD, PhD General features Mid age or older Chronic lymphocyte mediated May occur anywhere Risk factor for squamous cell carcinoma Clinical presentations Very itchy and scratchy skin Atrophic appearance Key morphological features Atrophic epidermis Loss of rete ridges Fibrotic dermis Management Topical super-potent corticosteroids Calcineurin inhibitors, tacrolimus and pimecrolimus Oral or topical retinoids Surveillance for squamous cell carcinoma Biopsy recommended to rule out squamous cell carcinoma Back to female genital tract Back to contents

Paget disease   Updated: 01/08/2021 © Jun Wang, MD, PhD General features Malignant tumor, but NOT associated with underlying cancer (unlike breast Paget disease ) Commonly in elderly, postmenopausal, Caucasian women Clinical presentations Often pruritic, may be painful or associated with burning sensation Erythematous or eczematous changes May have focal erosion Key morphological features Single or clusters of large cells with  abundant pale cytoplasm, irregularhyperchromic nuclei Confined to epidermis Differential diagnosis Melanoma in situ: Positive for S-100 and HMB45, negative for CK7 and CAM5.2 Paget disease: Negative for S-100 and HMB45, positive for CK7 and CAM5.2 Treatment Wide local excision Topical chemo/radiotherapy Photodynamic therapy Laser ablation Back to female genital tract Back to contents

Cervical carcinoma   Updated: 01/10/2023 © Jun Wang, MD, PhD General features Incident declining due to screening (Pap test, HPV test) Expected to decline more due to HPV vaccination Majority are squamous cell carcinoma, followed by adenocarcinoma Screening techniques NOT sensitive enough for adenocarcinoma May be HPV independent in both squamous and adenocarcinoma  HPV-independent cancers tend to have worse prognosis Current WHO classification 2020 Clinical presentations Usually asymptomatic Commonly identified after abnormal Pap test Most common symptom: vaginal bleeding, usually postcoital May have watery, mucoid or purulent discharges with malodor Symptoms associated with affected structures if advanced, including pelvic or lower back pain, bowel or urinary symptoms, etc Key risk factors Early age at first intercourse Multiple sexual partners Male partner with multiple prior sexual partners Cigarette smoking History of HSIL or adenocarcinoma in s

Cervical intraepithelial neoplasia (CIN) Updated: 02/29/2020 © Jun Wang, MD, PhD General features AKA Squamous Intraepithelial Lesion (SIL) Precancerous changes Human papilloma virus associated Usually start from cervical transformation zone Bethesda system (High and low grade) Low grade: CIN I High grade: CIN II and III Low grade dysplasia tend to regress Much higher risk for development of invasive cancer if high grade Clinical presentations Most time identified due to screening with Pap test Key risk factors Human papilloma virus infection, especially high risk group, such as HPV 16 and 18 Most HPV infections will regress, even without treatment  Key pathogenesis HPV products E6: Promotes degradation of p53 , abnormal activation of telomerase   E7: Inactivates retinoblastoma 1 , a tumor suppressor P16 overexpression in high grade dysplasia and cancers Key Laboratory findings Pap smears HPV test Key morphological features

Endocervical adenocarcinoma in situ   Updated: 01/04/2021 © Jun Wang, MD, PhD General features Malignant appearing glandular epithelium without invasion Significant risk of invasive adenocarcinoma if not treated Much less common than SIL Younger population Usually multifocal Clinical presentations Usually asymptomatic Key risk factors High risk HPV, particularly types 16 and 18 Key pathogenesis HPV products E6 : Promotes degradation of p53 and abnormally activates telomerase E7 : Suppresses retinoblastoma 1, a tumor suppressor Key morphological features Crowded enlarged hyperchromic nuclei (pencillike) Mitosis in apical side No invasion Treatment Hysterectomy Conization with surveillance if fertility preservation desired Back to female genital tract Back to contents

Molluscum contagiosum   Updated: 02/15/2021 © Jun Wang, MD, PhD General features Most common in children (age 2-5) or immunocompromised Caused by molluscum contagiosum virus (MCV) MCV 1-4, MCV-1 most prevalent MCV-2 most often sexually transmitted Highly contagious More common in skin, rare in genital tract Likely self limited in immunocompetent patients Clinical presentations Multiple firm, pruritic, pink-tan skin nodules Key morphological features Cytoplasmic viral inclusions in epidermal keratinocytes Treatment Based on age, health condition, etc Cryotherapy Curettage  Others Back to female genital tract Back to contents

Female genital tract infections/inflammations Updated: 07/20/2022 © Jun Wang, MD, PhD General features Virus: Herpes, Human papillomavirus (HPV), molluscum contagiosum virus Bacteria: Gardinerella, Actinomycete (IUD), Syphilis, Gonorrhea, etc Chlamydia trachomatis: Most common STD Fungi: Candida Parasites: Trichomonas Pelvic inflammatory disease Bartholin cyst Blockage of Bartholin gland duct May be infected by chlamydia, gonorrhea, E. coli, etc Swelling Squamous and urothelial epithelium lined cysts with inflammation Herpes Associated with HSV1 and HSV2 Neonatal herpes associated with vaginal delivery in women with third trimester genital herpes Commonly asymptomatic Painful vesicular lesions until rupture and ulceration, usually heal in a few weeks Pathological findings: M ultinucleation, M olding of nuclei, M argining of chromatin, ground glass appearance Diagnosis: Pathological finding and HSV detection (PCR) Condyloma acuminatum Sexually tr

Pathology of female genital tract   Updated: 01/23/2024 © Jun Wang, MD, PhD Key anatomic features Opened channel, pathological basis for pelvic inflammatory disease Cervix: exocervix, endocervix, transformation zone Uterus: fundus, body Fallopian tube: intramural, isthmus, ampulla, infundibulum, fimbriae Placenta: umbilical cord, fetal membrane, placenta Key histologic features Stratified squamous epithelium from vulva to exocervix Simple columnar epithelium from endocervix to fimbriae Uterine corpus Endometrium: Glands, stroma Myometrium Perimetrium: Mesothelium/peritoneum Ovaries: three components Epithelium (mesothelium) Stroma Germ cells (follicles) Placenta: Cytotrophoblast, syncytiotrophoblast, intermediate trophoblast Infectious/inflammatory diseases Diseases of vagina and vulva Molluscum contagiosum Lichen sclerosus Paget disease Sarcoma botryoides Squamous cell carcinoma Diseases of cervix Cervical intraepithelial neopla

Practice question answers Tumor of heart and vessels © Jun Wang, MD, PhD 1. C. A hypocellular tumor with scattered stromal cells without significant atypia in an edematous/myxoid background is most likely myxoma . Angiosarcoma is the most common malignant tumor of heart, and is characterized anastomosing vessels with endothelial atypia. Mucinous adenocarcinoma has atypical epithelial cells in mucin pools, not myxoid background. Papillary fibroelastoma is characterized by a papillary growth with central dense fibrous cores surrounded by loose connective tissue, not myxoid background. Rhabdomyoma is characterized by sharp demarcation and “spider cells”. 2. A. This is a case of Carney complex , presented with Cushing syndrome due to adrenal cortex hyperplasia and cardiac myxoma. Horner syndrome is caused by interruption of the sympathetic nerve supply to the eye, presents with triad of miosis, partial ptosis and loss of hemifacial sweating. Superior vena cava syndrome is

Practice question II Tumors of heart and vessels © Jun Wang, MD, PhD 1. A 59-year old woman presents with dyspnea for 3 weeks. She denies fever, chill or weight loss. She has a history of mucinous adenocarcinoma of left breast that was treated with surgery and chemotherapy 3 years ago. Her past history is otherwise unremarkable. She does not smoke cigarette nor drink alcohol. Physical examination revealed no significant abnormalities.   Transthoracic echocardiography reveals a 2.2 cm pedunculated mass in her left atrium. The mass is removed and microscopically it has scattered mildly atypical round to oval nuclei in an edematous background. Thrombus is seen on the surface. Immunohistochemistry studies reveal no cytokeratin expressing cells. What is the most likely diagnosis? A. Angiosarcoma B. Metastatic mucinous breast cancer C. Myxoma D. Papillary fibroelastoma E. Rhabdomyoma 2. Use this case for the next two questions . A 27-year-old woman presents with oligo

Practice question I answers Tumor of vessels © Jun Wang, MD, PhD 1. C. Proliferation of capillaries without cytological atypia is most likely capillary hemangioma . Angiosarcoma is characterized anastomosing vessels with endothelial atypia. Bacillary angiomatosis has neutrophilic infiltrate, and Gram negative rods can be identified by special stains. Hemangioblastoma is usually found in central nervous system, and is composed of proliferation of vessels with stromal cell atypia . Kaposi sarcoma is spindle cell tumor with slit spaces and red blood cell extravasation, usually seen in immunocompromised patients. 2. D. This is a capillary hemangioma that commonly regress with aging. There is no risk of metastasis or invasion. Malignant transformation or sepsis due to local ulceration of benign hemangioma is very rare. 3. C. Tumor with largely dilated vessels without atypia is most likely cavernous hemangioma . Angiosarcoma is characterized anastomosing vessels with en