Xanthogranulomatous inflammation of the female genital tract

We describe three cases of xanthogranulomatous inflammation in the female genital tract--one affecting endometrium, tube and ovary, one affecting tube, ovary and parametrium and one confined to the endometrium. To date, xanthogranulomatous inflammation in the female genital tract has been reported in a total of 19 cases including the present three. The inflammation most often affects the endometrium but involvement of the vagina, cervix, fallopian tube and ovary may also occur.     

Synchronous tumours of the female genital tract

Singh N
(2010) Histopathology 56, 277–285 Synchronous tumours of the female genital tract About 1–2% of women with gynaecological cancers are found to have two or more simultaneous independent primary malignancies. Low stage multiple primaries must be distinguished from metastasis from one to other site for correct management. Synchronous tumours in the ovary and endometrium are the commonest combination. Most of these can be accurately categorised by standard histological criteria. Molecular testing has been advocated for valuable adjunctive information in ambiguous cases but must be interpreted with clinicopathological correlation: loss of heterozygosity, pTEN or beta‐catenin gene mutational analysis, microsatellite instability and most recently gene expression profiling have all been used. The pattern of beta‐catenin immunohistochemical expression has been reported to be of value. A very low percentage of women with synchronous primaries in the uterus and ovary are HNPCC patients and testing for mismatch repair gene mutations is unnecessary in all cases, even if young; the diagnosis of HNPCC should be based on standard criteria. Women with endometrial cancer under 50 are more likely than older patients to have a synchronous ovarian cancer. Rarer combinations of synchronous tumours are less well studied but may also represent a mixture of unusual patterns of metastasis and multifocal origin; these are discussed briefly.     

Iatrogenic lesions of the female genital tract

Advances in management of obstetrical and gynaecological diseases mandate the practising pathologist to be familiar with various types of treatment-related pathology. This review addresses iatrogenic pathology of the female genital tract under the following headings: pathology related to surgery, pathology related to contraception, pathology related to assisted reproduction, effects of tamoxifen therapy, pathology of diethylstilbestrol, and effects of other specific drugs.     

女性生殖道黄色瘤样肉芽肿性炎

目的 探讨女性生殖道黄色瘤样肉芽肿性炎的病因、临床病理学特征和生物学行为.方法 对3例女性生殖道黄色瘤样肉芽肿性炎作了临床病理观察、免疫组化染色,并做了随访.结果 3例女性生殖道黄色瘤样肉芽肿性炎1例累及卵巢,1例累及双侧输卵管,1例累及子宫内膜.年龄分别是32、22和62岁.组织学观察显示病灶内大量泡沫状的组织细胞,混有淋巴细胞、浆细胞和少量嗜中性粒细胞浸润,偶见多核巨细胞.免疫组化染色:泡沫细胞CD68阳性,淋巴细胞CD3和CD20阳性,κ、λ阳性.结论 女性生殖道黄色瘤样肉芽肿性炎虽是一种罕见的炎性病变,但只要记住它的存在及特点,就可以避免误诊.     

Endocrine cells in the female genital tract

Endocrine cells are normal inhabitants of the para-urethral, Bartholin's and endocervical glands and of mesonephric rests. All these cells were characterized as serotonin-storing cells. In the para-urethral and Bartholin's glands, serotonin-containing cells were most often found in the transitional epithelium of excretory ducts. Endocrine cells participated in some pathological conditions. Abundant argentaffin cells were observed among the terminal ductules in chronic bartholinitis and serotonin-storing cells were identified in a peculiar ectocervical epithelium. Numerous serotonin-storing cells were detected in a well-differentiated adenocarcinoma of cervix occurring in a patient with the Peutz-Jeghers syndrome. Argyrophilic cells were present in cases of endometrial carcinomas; a striking feature was the demonstration of gut peptide hormones in an unusual type of endometrial adenocarcinoma. Finally, serotonin-storing cells were a constituent of Brenner tumours. It is suggested that a similar endocrine pattern may be shared by tissues originating from both Müllerian ducts and the urogenital sinus.     

Mycoplasma hominis in female genital tract

In dependence on health of women the female genital tract is colonised by different microorganisms. Mycoplasma hominis was the first mycoplasma of human origin to be isolated. M. hominis, a common inhabitant of the vagina of healthy women, becomes pathogenic once it invades the internal genital organs. M. hominis is associated with bacterial vaginosis but it is still unclear whether the organism really contributes to a pathological process in which so many different bacteria are involved. The aim of this article is to summarize known information about these microorganisms.     

Embryological observations on the female genital tract.

The embryology of the genital tract and urinary system is described, and the hypothesis is advanced that the vagina is an organ embryologically derived from the mesonephric or Wolffian ducts in addition to the Müllerian tubercle. This is based on experimental studies and case reports in the literature and our own cases of genital malformations, especially in patients with unilateral renal agenesis and an ipsilateral blind vagina. The importance of the mesonephric ducts as guides or 'inductor' elements for adequate Müllerian development is emphasized. A new embryological classification of female genital malformations is proposed, based on these embryological concepts.     

WT1 expression in the female genital tract

The Wilms tumor gene 1 (WT1) has been reported in normal tissues and many neoplasms of the female genital tract. This review discusses WT1 expression in the female genital tract and its potential utility in the differential diagnosis of neoplasms that occur at this location. WT1 is of value in the differential diagnosis of synchronous serous carcinomas arising in the ovary/fallopian tube/peritoneum and endometrium, as strong WT1 positivity in both tumors points toward an extrauterine origin. In addition, WT1 can be used to distinguish sex cord stromal tumors (WT1 positive) from endometrioid carcinomas (OECs). WT1 expression is not helpful in the differential diagnosis of ovarian serous carcinomas (OSCs) and transitional carcinomas, as both are typically positive and has limited value in the distinction of serous tumors arising in the ovary/fallopian tube/peritoneum from mesotheliomas. WT1 is also not helpful to differentiate small cell carcinoma of hypercalcemic type from juvenile granulosa cell tumor, a common diagnostic problem. Intra-abdominal desmoplastic round cell tumor reacts to WT1 (C-terminal) in contrast to all other tumors discussed which helps to separate this rare tumor from most other small round cell tumors that may involve, primarily or secondarily, the ovary with the exception of small cell carcinoma of hypercalcemic type that typically reacts with the N-terminal of WT1.     

Surfactant protein D in the female genital tract

Surfactant protein D (SP-D) plays a role in innate immunity against various pathogens and in vivo studies have demonstrated that SP-D also has anti-inflammatory properties. SP-D was originally demonstrated in alveolar type II cells, but recent studies have shown extrapulmonary expression of SP-D indicating a systemic role for the protein. This study describes the presence of SP-D in the female genital tract, the placenta and in amniotic fluid using immunohistochemistry and enzyme-linked immunosorbent assay. SP-D was observed in cells lining surface epithelium and secretory glands in the vagina, cervix, uterus, fallopian tubes and ovaries. In the placenta, SP-D was seen in all villous and extravillous trophoblast subpopulations. Endometrial presence of SP-D in non-pregnant women varied according to stage of the menstrual cycle and was up-regulated towards the secretory phase. It is suggested that endometrial SP-D may prevent intrauterine infection at the time of implantation and during pregnancy.     

SWI/SNF-deficient malignancies of the female genital tract

Mutations and other molecular events involving subunits of the SWI/SNF chromatin remodelling complex are common in a wide variety of malignancies, including those arising at various sites in the female genital tract. Endometrioid and clear cell carcinomas in the uterine corpus and ovary not uncommonly contain mutations in ARID1A and these also occur in other endometriosis-associated ovarian neoplasms such as seromucinous tumours. In these organs, mutations in SMARCA4, SMARCB1, ARID1A and ARID1B (with subsequent loss of corresponding protein expression as a reliable surrogate) are relatively common in undifferentiated carcinomas, including the undifferentiated component of dedifferentiated carcinoma. SMARCA4 mutations are extremely common (almost ubiquitous) in small cell carcinoma of the ovary of hypercalcaemic type (SCCOHT), occurring in about 98% of these neoplasms, often in association with epigenetic SMARCA2 loss. SMARCB1-deficient vulval neoplasms include epithelioid sarcoma and myoepithelial carcinoma, as well as related malignancies which defy easy classification. Recently the spectrum of SWI/SNF deficient female genital malignancies has been expanded to include SMARCA4-deficient undifferentiated uterine sarcoma and mural nodules of anaplastic carcinoma in ovarian mucinous neoplasms.     

Undifferentiated and dedifferentiated neoplasms of the female genital tract

Undifferentiated neoplasms in the female gynecologic tract comprise two main groups—undifferentiated carcinoma, most common in the endometrium and ovary, and undifferentiated uterine sarcoma, although tumors with an undifferentiated appearance may occur in all gynecologic organs. Their differential diagnosis is broad and generous sampling, careful morphological evaluation, judicious use of immunohistochemistry, and in many cases, molecular testing is often essential in the diagnostic work-up. As some of these neoplasms fail to respond to conventional chemotherapy regimens and/or radiation therapy, targeted therapy may be valuable in treating these highly aggressive tumors, thus the importance of precise diagnosis. In this review we discuss the clinicopathological features of undifferentiated carcinoma, dedifferentiated carcinoma, and undifferentiated uterine sarcoma, followed by a comprehensive analysis of morphological mimickers. Finally, we briefly review ovarian and lower genital tract tumors with an undifferentiated histological appearance.