Reproductive Pathology Slides

K Gyn-1

This microslide represents squamous hyperplasia.  There is hyperkeratosis seen as a cellular keratin layer.  Rete-ridges of epidermis reveal elongation, widening, clubbing and confluency.  The individual squamous cells are regular showing no nuclear atypicality.  No abnormally placed mitosis seen.

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This slide reveals histology of lichen sclerosus.  There is hyperkeratosis (not a constant feature in all cases).  The epithelium is thin with loss of rete-ridges.  There is subepithelial homogenization of dermis, followed by a band-like inflammatory infiltrate, mainly mononuclear cells.

K Gyn-4

Carcinoma in situ of vulva - reveals full thickness involvement of epithelium by atypical cells.  There is marked crowding of cells.  No maturation of cells is evident.  Nuclei are hyperchromatic and show marked pleomorphism.  There is an increase in number of mitosis, which are also evident in the superficial layers of epidermis.  A few dyskeratotic cells are also seen.

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Paget's disease of vulva - Single and small nests of large pale Paget cells are seen in the epidermis.  These should be differentiated from melanocytes of malignant melanoma.  o underlying carcinoma was shown in this site.

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Invasive squamous cell carcinoma.  This slide reveals presence of a normal squamous epithelium on the upper left hand corner of the slide tracing it towards the right side it shows evidence of an ulcerated tumor invading the underlying stroma.  It is composed of anastomosing sheets of atypical squamous cells surrounded by fibrous tissue.

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High power view of invasive squamous cells:  - The individual cells are atypical with hyperchromatic and pleomorphic nuclei, dyskeratotic cells and frequent mitoses.  A dyskeratotic cell is seen in the center field of this slide.  This is well differentiated squamous cell carcinoma in which intercellular bridges are prominent and cells reveal abundant eosinophilic cytoplasm.

K Gyn-8

Vaginal adenosis - gross photograph through colposcopic examination - Reveals an elevated round pink area.  This area did not stain with an Iodine test (shown on the next slide No. 12) due to presence of glandular epithelium which does not contain glycogen as do the cells of squamous epithelium.  In addition, this slide also reveals a structural change due to presence of a concentric band giving rise to a pseudopolyp-like appearance to this area.

K Gyn-10

Microscopically, the areas of adenosis reveal glandula epithelium lined by columnar cells which resemble the epithelium of endocervix, endometrium or fallopian tube.  In this slide, the epithelium is like that of a fallopian tube, being columnar and ciliated.

K Gyn-11

Adenocarcinoma of vagina (DES exposed).  This slide reveals multiple fleshy nodular lesions in the vaginal wall.  The surface is shiny and mucoid with areas of ulceration .  Although the gross features suggest multicentricity, the submucosal continuity has been found microscopically.

K Gyn-12

Clear cell adenocarcinoma of vagina (DES exposed).  A tubular pattern is noted.  The tubules are lined by neoplastic cells with clear cytoplasm.  Nuclei are hyperchromatic and markedly pleomorphic.  (Special stains reveal presence of glycogen in the cytoplasm of these clear cells).  The light and EM of these lesions is similar to clear cell adenocarcinoma of the ovary and endometrium.

K Gyn-13

Cervical intraepithelial neoplasia (CIN).  CIN grade I - This slide reveals some crowding of the nuclei in the lower one third of the epithelium due to lack of maturation.  Upper two thirds reveal evidence of maturation characterized by increase eosinophilic cytoplasm and decrease nuclear size.

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CIN grade II - The atypical nuclear changes involve about two thirds of the epithelium, above that maturation is evident.  N/C ratio is increased, Pleomorphism of the nuclei is noted.

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CIN grade III - This slide reveals approximately full thickness involvement of epithelium by atypical cells characterized by lack of maturation, hyperchromasia and increased number of mitoses which are also seen in the superficial layers of epithelium.  Only one or two layers of flattened epithelium noted on the surface with hyperkeratosis.

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Carcinoma in situ (CIS) - No cellular maturation present throughout the thickness of the epithelium.  Marked nuclear pleomorphism, hyperchromasia and chromatin clumping is evident.

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Carcinoma of cervix (Gross).  At the 12 o'clock region the cervix is replaced by an ulcerated red fleshy lesion with irregularly elevated margins.  At about 1 - 2 o'clock position of the cervix the lesion extends over the vaginal wall.

K Gyn-18

This slide reveals a well differentiated squamous cell carcinoma of the cervix.  There is normal columnar epithelium of endocervix seen as the Rt side which blends with in situ lesion of squamous epithelium and then is invasive lesion.  Invasive lesion shows clusters of malignant squamous cells, some of them reveal presence of keratin pearls in the centers of the nests of epithelial cells.

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Non-specific chronic endometritis:  This slide reveals presence of two endometrial glands separated by stromal cells.  Many plasma cells are seen in the stroma which is the hallmark of chronic endometritis.  The lymphocytes and lymphoid follicles occur in normal endometrium.

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Tuberculous Endometritis:  Slide reveals presence of multiple granulomas containing Langhans type of giant cells.  Granulomas are surrounded by mononuclear inflammatory infiltrate.

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This slide reveals a presence of cyst containing chocolate colored material (old hemorrhage) in the lumen.  In the upper medial portion of the wall, a yellowish structure represents a corpus luteum, suggesting the cyst is ovarian.  A portion of fallopian tube with adherent omental fat is evident forming a greyish yellow mass due to fibrous adhesions.  This kind of ovarian cyst can be resulted from twisted simple cyst, corpus luteum cyst and endometrial cyst.  Histologic examination can establish its nature.

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Endometriosis of ovary:  Slide reveals a cystic cavity lined by endometrial type of epithelium with underlying glands and stroma.  In the wall, there is recent hemorrhage.

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This slide shows a section of fallopian tube on the left, the lumen of which is characterized by papillary endothelium.  On the serosal fat surrounding the tube, endometrial glands are seen surrounded by dense bluish stroma, in keeping with endometriosis.

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This slide reveals some cystically dilated glands lined by columnar epithelium.  There is abundant stromal tissue separating the glands.  This is called simple hyperplasia, without atypia.

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Complex hyperplasia with atypia  - This slide shows marked proliferation of endometrial glands which are small and crowded but still each gland is separated from its neighbour gland by small amount of stroma.  On high power (not seen here).  The nuclei are atypical with enlargement and prominent nucleoli.

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Well differentiated adenocarcinoma:  - The glands show "back to back" crowding with no stromal tissue in between.  There is marked pseudostratification with nuclear atypicality.  Mitoses are usually prominent, which are not quite evident at this power.

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Adenocarcinoma with squamous differentiation:  - The slide reveals mainly glandular proliferation.  The glands are tortuous and closely packed containing  atypical nuclei.  In one focal area, the cells show  squamous differentiation. 

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This gross picture reveals multiple variable sized leiomyomata of uterus.  The cut surface of all of them reveals whorled appearance, they are well circumscribed with a pseudocapsule.  One large leiomyoma is present submucosally causing compression of endometrial cavity which is hemorrhagic.  Others are seen intramurally and subserously.

K Gyn-31

This gross photograph is that of a cross section of a leiomyoma with cystic degeneration which was present at the fundus.  A portion of body of uterus is seen on the left hand side of the slide.  With cystic degeneration, leiomyomata show sudden increase in size and clinically can be mistaken for a malignant growth.

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Microscopic appearance of leiomyoma showing typical interlacing bundles of spindle cells of well differentiated smooth muscle cells.

K Gyn-40

Wedge resection of ovaries seen in the previous photograph reveal multiple cysts in the cortex, with smooth inner surface.

On microscopic examination there are multiple follicular cysts in the cortex and thick capsule.

High power picture of the cysts seen in reveals granulosa cell lining with the underlying theca cells showing luteninization.  These are the cells responsible for hormonal activity.

K Gyn-41

Serous Cyst Adenocarcinoma - Gross photograph of uterus, tubes and ovaries.  Right ovary is replaced by a papillary growth on the surface.  The tumor has arisen from the surface epithelium.  These tumors can arise from invaginated surface epithelium and in those cases the growth is intraovarian.

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Serous Cyst Adenoma - Histology of the case No. Gyn K-43 showing single layer of columnar ciliated cells lining the cyst.

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Photograph shows a large bluish cystic lesion attached to a portion of fallopian tube.  The blue coloration is due to the mucinous material in the cystic cavity.

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Microphotograph of case No. 43 showing a cyst lined by a single layer of mucous secreting cells.  Note the basal position of the nuclei, which is displaced by the cytoplasmic mucin.  The lining epithelium resembles that of the lining epithelium of the endocervix.

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Moderately differentiated, mucin secreting adenocarcinoma.  Some of the glands lining the cyst show presence of mucinous material in the cytoplasm.  Note the stromal invasion by same glands showing malignant characteristics of the cells.

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Endometrioid Carcinoma of Ovary.  Gross-uterus is half cut.  The left ovary is replaced by a partly solid and partly cystic tumor mass showing areas of haemorrhage and necrosis.

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Shows moderately differentiated adenocarcinoma with squamoid differentiation.  The squamoid differentiation is evident in the center of the slide which is seen in about 50% of cases of endometrioid carcinoma of the ovary.  The presence of mucin in the luminar borders of the cells and in the glandular lumen is not uncommon in these tumors.

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Granulosa Cell Tumor - This is a cut section of an ovary showing a yellowish colored tumor nodule which is well demarcated from normal ovarian tissue but shows irregular margins.  The cut-surface is irregular with areas of haemorrhage and necrosis.

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Granulosa Cell Tumor of Ovary - This microscopic slide reveals presence of two Call-Exner bodies, (the small gland-like cavities containing degenerating cells) surrounded by granulosa cells, which are haphazardly arranged.  The nuclei are angular and some reveal presence of groove, giving them appearance of coffee bean.

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Dysgerminoma - A large solid tumor replacing the left ovary.  The endometrium in this case was bulky due to very early pregnancy.  Seen on histology.  Right ovary reveals a corpus luteum of pregnancy.

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Dysgerminoma - Clusters to tumor cells, separated by a fibrous stroma containing lymphocytes.

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A gross photograph of benign cystic teratoma.  The ovary is replaced by a cystic tumor which is open and reveals presence of hair and sebaceous material in the cavity.

K Gyn-55

This is a microphotograph of chorio-carcinoma showing proliferation of syncytio and cytotrophoblastic cells.  The cells which look like giant cells (multinucleated) are syncytio-trophoblast and others in which each nucleus is surrounded by its own cytoplasm is cytotrophoblast.