CONTENTS
SECTION I. LOWER ANOGENITAL TRACT
A. Inflammatory Disorders
Eczematous Dermatitis, 3
Lichen Simplex Chronicus and Prurigo Nodularis, 5
Psoriasis, 7
Seborrheic Dermatitis, 9
Lichen Sclerosus Including Early Lichen Sclerosus, 11
Lichen Planus, 14
Zoon’s Vulvitis, 16
Bullous Pemphigoid, 18
Pemphigus Vulgaris, 20
Hailey-Hailey Disease, 22
Darier’s Disease, 24
Epidermolytic Hyperkeratosis, 26
Hidradenitis Suppurativa, 28
Crohn’s Disease of the Vulva, 30
Vulvodynia, 32
B. Vulvar Infections
Vulvovaginal Candidiasis, 34
Bacterial Vaginosis, 36
Molluscum Contagiosum, 38
Acute Herpes Simplex Virus Infection, 40
Chronic Erosive Herpes Simplex PITFALL, 42
Syphilis PITFALL, 44
Chancroid, 46
Granuloma Inguinale, 48
Schistosomiasis, 50
Bacillary Angiomatosis, 52
Necrotizing Fasciitis, 54
Varicella Zoster, 55
C. Vulvar Adnexal Lesions
Bartholin’s Duct Cyst, 57
Mucous Cyst of the Vagina, 59
Ectopic Breast Tissue, 61
Fibroadenoma, 63
Hidradenoma PITFALL, 65
Syringoma, 68
Hyperplasia of Bartholin’s Gland, 70
Bartholin’s Adenoma, 72
Adenoid Cystic Carcinoma, 74
Bartholin’s Gland Carcinoma, 76
D. Vulvar Epithelial Neoplasia
Condyloma, 79
Verruciform Xanthoma, 82
Warty Dyskeratoma, 84
Fibroepithelial Stromal Polyp, 86
Seborrheic Keratosis, 88
Pseudobowenoid Papulosis PITFALL, 90
Flat Condyloma (VIN1), 92
Classic (Usual) Vulvar Intraepithelial Neoplasia, 94
Classic Vulvar Intraepithelial Neoplasia with Lichen
Simplex Chronicus PITFALL, 98
Classic Vulvar Intraepithelial Neoplasia (Bowenoid
Dysplasia), 100
Pagetoid Vulvar Intraepithelial Neoplasia PITFALL, 102
Vulvar Intraepithelial Neoplasia with Columnar
Differentiation PITFALL, 104
Epidermodysplasia Verruciformis–Like Atypia
PITFALL, 106
Polynucleated Atypia of the Vulva, 108
Differentiated Vulvar Intraepithelial Neoplasia, 110
viii CONTENTS
Verruciform Lichen Simplex Chronicus, 114
Vulvar Acanthosis with Altered Differentiation (Atypical
Verruciform Hyperplasia), 116
Early Invasive Squamous Cell Carcinoma, 118
Vulvar Squamous Carcinoma: Basaloid and Warty
Patterns, 122
Vulvar Squamous Carcinoma: Keratinizing Pattern, 124
Verrucous Squamous Cell Carcinoma, 128
High-Grade Squamous Intraepithelial Lesion (Vulvar
Intraepithelial Neoplasia III) with Confluent Papillary
Growth, 131
Giant Condyloma of the External Genitalia
PITFALL, 134
Pseudoepitheliomatous Hyperplasia PITFALL, 137
Keratoacanthoma PITFALL, 139
Basal Cell Carcinoma, 141
Adenosquamous Carcinoma, 144
Paget’s Disease of the Vulva, 146
Merkel Cell Carcinoma, 149
Cloacogenic Neoplasia, 151
Metastatic Carcinoma of the Vulva, 153
E. Pigmented Lesions
Lentigo, 155
Genital-Type Nevus, 157
Dysplastic Nevus, 159
Melanoma, 161
F. Soft Tissue Vulvar Neoplasia
Angiomyofibroblastoma, 163
Aggressive Angiomyxoma PITFALL, 165
Superficial Angiomyxoma, 166
Cellular Angiofibroma, 168
Dermatofibroma (Fibrous Histiocytoma), 170
Dermatofibrosarcoma Protuberans, 172
Low-Grade Fibromyxoid Sarcoma, 174
Lipoma, 176
Liposarcoma, 177
Synovial Sarcoma of the Vulva PITFALL, 179
Rhabdomyoma, 181
Angiokeratoma, 183
Granular Cell Tumor, 185
Prepubertal Vulvar Fibroma, 187
G. Anus
Anal Condyloma, 190
Anal Intraepithelial Neoplasia II and III, 193
Anal Carcinoma, 195
Anal Paget’s Disease, 197
H. Vagina
Prolapsed Fallopian Tube, 200
Granulation Tissue, 202
Vaginal Adenosis, 204
Polypoid Endometriosis, 206
Vaginal Papillomatosis (Residual Hymenal Ring)
PITFALL, 208
Low-Grade Vaginal Intraepithelial Lesion (Vaginal
Intraepithelial Neoplasia I and Condyloma), 210
High-Grade Vaginal Intraepithelial Lesion (Vaginal
Intraepithelial Neoplasia II-III), 212
High-Grade Vaginal Intraepithelial Neoplasia III, 215
Radiation-Induced Atrophy, 217
Papillary Squamous Carcinoma, 219
Clear-Cell Adenocarcinoma, 221
Metastatic Adenocarcinoma, 223
Melanoma PITFALL, 226
Spindle Cell Epithelioma PITFALL, 228
Embryonal Rhabdomyosarcoma, 230
SECTION II. CERVIX
A. Squamous Lesions
Exophytic Low-Grade Squamous Intraepithelial
Lesion, 235
Low-Grade Squamous Intraepithelial Lesion
(Flat Condyloma/Cervical Intraepithelial
Neoplasia I), 237
High-Grade Squamous Intraepithelial Lesion (Cervical
Intraepithelial Neoplasia II and III), 240
CONTENTS ix
Low-Grade Squamous Intraepithelial Lesion (Giant
Condyloma) PITFALL, 243
Low-Grade Squamous Intraepithelial Lesion (Immature
Condyloma), 245
Mixed-Pattern Squamous Intraepithelial Lesion
(Low- and High-Grade Squamous Intraepithelial
Lesions), 247
Atrophy Including Squamous Intraepithelial Lesion in
Atrophy, 249
Minor p16-Positive Metaplastic Atypias, 252
Squamous Intraepithelial Lesion, Not Amenable to
Precise Grading (QSIL), 255
Superficially Invasive Squamous Cell
Carcinoma, 259
Conventional Squamous Cell Carcinoma, 262
Pseudocrypt Involvement by Squamous Cell
Carcinoma, 266
Lymphoepithelial-Like Squamous Carcinoma, 268
B. Glandular Lesions
Superficial (Early) Adenocarcinoma In Situ, 270
Conventional Adenocarcinoma In Situ, 273
Stratified Adenocarcinoma In Situ, 276
Intestinal Variant of Adenocarcinoma In Situ, 278
Brooke E. Howitt
Cervical Endometriosis, 280
Pregnancy-Related Changes in the Cervix, 282
Reactive Atypias in the Endocervix, 284
Radiation Atypias, 286
Villoglandular Adenocarcinoma of the Cervix, 288
Superficially Invasive Endocervical Adenocarcinoma, 290
Extensive Adenocarcinoma In Situ vs Invasion, 292
Infiltrative Endocervical Adenocarcinoma, 295
Clear-Cell Carcinoma of the Cervix, 298
Atypical Lobular Endocervical Glandular
Hyperplasia and Invasive (Minimal Deviation)
Adenocarcinoma of the Cervix with Gastric
Differentiation, 300
“Serous” Carcinoma of the Cervix, 302
Signet-Ring Cell Carcinoma of the Cervix, 305
Adenoid Basal Carcinoma, 308
Mesonephric Remnants, 310
Mesonephric Carcinoma, 312
Prostatic Metaplasia of the Cervix, 315
Endocervical Glandular Hyperplasia, 317
Metastatic Serous Carcinoma to the Cervix, 319
Metastatic Endometrioid Carcinoma to the
Cervix, 321
Atypical Endocervical Polyp, 324
Brooke E. Howitt
Adenomyoma of the Cervix, 326
Microglandular Hyperplasia of the Cervix, 328
Adenosarcoma of the Cervix, 331
Brooke E. Howitt
C. Miscellaneous Lesions
Cervical Schwannoma, 333
Glial Polyp of the Cervix, 335
SECTION III. UTERUS
A. Benign Endometrium
Dysfunctional Uterine Bleeding (Early or Mid-Cycle
Breakdown), 339
Breakdown Mimicking Neoplasia, 341
Anovulatory Endometrium with Persistent
Follicle, 343
Benign Endometrial Hyperplasia, 345
Telescoping Artifacts Mimicking Neoplasia, 347
Mixed-Pattern Endometrium, 349
Adenomyomatous Polyp, 351
Chronic Endometritis, 353
Pseudoactinomycotic Radiate Granules, 355
Pyometra, 357
Tubercular Endometritis, 359
Submucosal Leiomyoma, 361
Exfoliation Artifact, 364
Perforation, 366
Ablation Artifact, 368
x CONTENTS
B. Endometrial Glandular Neoplasia and
Its Mimics
Endometrial Intraepithelial Neoplasia (Atypical
Hyperplasia), 370
Atypical Polypoid Adenomyoma, 374
Endometrial Involvement by Endocervical Glandular
Neoplasia, 376
Degenerative Repair, 378
Proliferative Repair, 380
Mucinous Metaplasia of the Endometrium, 382
Squamous and Morular Metaplasia, 384
Ichthyosis Uteri, 387
Squamous Carcinoma of the Endometrium, 389
Tubal and Eosinophilic (Oxyphilic) Metaplasia, 391
Microglandular Endometrial Adenocarcinoma in
Curettings, 393
Endometrioid Adenocarcinoma, 396
Lower Uterine Segment Adenocarcinoma, 400
Lynch Syndrome Screening, 403
Brooke E. Howitt
Myoinvasion in Endometrial Adenocarcinoma, 406
Intraperitoneal Keratin Granuloma, 410
Endometrial Histiocytes and Foamy Stromal
Macrophages, 412
Serous Cancer Precursors, 414
Serous Endometrial Intraepithelial Carcinoma, 417
Ischemic Atypias of the Endometrium, 419
Reactive Atypia in the Endometrium, 421
Uterine Serous Carcinoma, 423
Mixed-Pattern Adenocarcinoma, 426
p53-Positive Endometrioid Adenocarcinoma, 428
Neuroendocrine Differentiation in Endometrial
Carcinoma, 430
Undifferentiated Carcinoma of the
Endometrium, 432
Clear-Cell Carcinoma, 434
Endometrioid or Clear-Cell Carcinoma? 437
Carcinosarcoma, 440
Adenocarcinoma with Spindle Cell Features, 445
Wilms’ Tumor of the Endometrium, 447
C. Mesenchymal Lesions of the Uterus
Endometrial Stromal Nodule, 449
Stromomyoma, 451
Endometrial Stromatosis, 453
Low-Grade Endometrial Stromal Sarcoma, 455
Uterine Tumor Resembling Sex Cord Stromal Tumor, 459
High-Grade Endometrial Stromal Sarcoma, 461
Undifferentiated Uterine Sarcoma, 464
Adenosarcoma of the Endometrium, 466
Brooke E. Howitt
Atypical Endometrial Polyp, 469
Brooke E. Howitt
Adenomatoid Tumor, 472
Lipoleiomyoma, 475
Cellular Leiomyoma, 477
Hydropic Leiomyoma, 479
Mitotically Active Leiomyoma, 481
Atypical Leiomyoma (Leiomyoma with Bizarre
Nuclei), 483
Leiomyomatosis, 485
Intravenous Leiomyoma, 487
Bradley J. Quade
Intravenous Leiomyomatosis, 489
Bradley J. Quade
Morcellation-Related Dissemination of Smooth Muscle
Neoplasia, 491
Bradley J. Quade
Disseminated Peritoneal Leiomyomatosis, 493
Bradley J. Quade
Pathology Following Uterine Artery Embolization, 495
Bradley J. Quade
Hereditary Leiomyomatosis and Renal Cell Carcinoma
Syndrome PITFALL, 497
Leiomyosarcoma, 499
Myxoid Leiomyosarcoma, 501
Epithelioid Leiomyosarcoma, 503
CONTENTS xi
PEComa, 505
Reproductive Tract Lymphoma, 507
Emily E.K. Meserve
SECTION IV. FALLOPIAN TUBE
A. Benign, Inflammatory/Reactive
Adrenal Rest, 511
Pseudoxanthomatous Salpingiosis, 513
Xanthogranulomatous Salpingitis, 515
Follicular Salpingitis, 517
Salpingitis Isthmica Nodosum, 519
Granulomatous Salpingitis, 520
Torsion of the Tube and Ovary, 522
Tubal Arias-Stella Effect PITFALL, 524
B. Neoplastic and Preneoplastic
Adenofibroma, 527
Benign Epithelial Hyperplasia (Secretory Cell
Outgrowths), 529
p53 Signatures, 532
Low-Grade Serous Tubal Intraepithelial Neoplasia
(Serous Tubal Intraepithelial Lesion), 535
Papillary Hyperplasia, 539
High-Grade Serous Tubal Intraepithelial Neoplasia
(Serous Tubal Intraepithelial Carcinoma), 541
The Risk Reducing Salpingo-Oophorectomy, 545
Salpingoliths, 547
Adenocarcinoma of the Fallopian Tube, 549
Endosalpingeal Implants from Remote Tumors, 552
Female Adnexal Tumor of Wolffian Origin, 554
SECTION V. OVARY
A. Benign
Tangentially Sectioned Ovarian Follicle PITFALL, 559
The Ovary in Pregnancy, 561
Solitary Luteinized Follicle Cyst, 564
Polycystic Ovarian Syndrome, 566
Emily E.K. Meserve
Cortical Stromal Hyperplasia and Hyperthecosis, 569
Endometrioma with Mucinous Metaplasia, 571
Endometrioma with Atypia, 573
Decidualized Endometrioma PITFALL, 575
Serous Cystadenomas and Cystadenofibromas, 577
Cortical Inclusion Cysts, 580
Endosalpingiosis, 582
Malakoplakia, 584
B. Epithelial Neoplasia
High-Grade Serous Carcinoma, Classic Type, 586
Brooke E. Howitt
High-Grade Serous Carcinoma with “SET” Patterns, 588
Brooke E. Howitt
Low-Grade Endometrioid Adenocarcinoma with
Squamotransitional or Spindle Features, 590
Carcinosarcoma, 592
Adenosarcoma of the Ovary, 594
Serous Borderline Tumor (SBT), 597
Serous Borderline Tumor with Complex
Architecture, 600
Low-Grade Invasive Serous Carcinoma of
the Ovary, 602
Invasive Implants of Low-Grade Serous
Tumor, 605
Mucinous Carcinoma, 607
Mucinous Tumors with Mural Nodules, 610
Mucinous Borderline Tumor, 613
Mucinous Borderline Tumor with Intraepithelial
Carcinoma, 615
Low-Grade Endometrioid Adenocarcinoma, 617
Endometrioid Adenofibroma, 620
Proliferative (Borderline) Endometrioid
Adenofibroma, 622
Müllerian Mucinous and Seromucinous Tumors of the
Ovary, 625
Benign Brenner Tumor, 629
Malignant Brenner Tumor, 631
Clear-Cell Carcinoma, 633
xii CONTENTS
Ovarian Adenocarcinoma with Yolk Sac Differentiation
PITFALL, 636
Brooke E. Howitt
Borderline Clear-Cell Adenofibroma, 638
Metastatic Carcinoma to the Ovary, 640
Pseudomyxoma Peritonei, 644
C. Germ Cell Tumors
Mature Cystic Teratoma: Normal Neural
Differentiation, 646
Fetiform Teratoma, 648
Odise Cenaj and Jelena Mirkovic
Struma Ovarii, 650
Malignant Struma, 653
Strumal Carcinoid, 656
Metastatic Carcinoid, 659
Malignancy Arising in Teratomas, 662
Dysgerminoma, 664
Yolk Sac Tumor, 667
Embryonal Carcinoma, 670
Immature Teratoma, 672
Mixed Germ Cell Tumor, 675
D. Sex Cord Stromal Tumors
Thecoma-Fibroma, 677
Fibroma with Minor Sex Cord Elements, 680
Sclerosing Peritonitis, 682
Granulosa Cell Tumor, 684
Granulosa Cell Tumor Variants PITFALL, 687
Juvenile Granulosa Cell Tumor PITFALL, 690
Sertoli-Leydig Cell Tumor, 693
Retiform Sertoli-Leydig Cell Tumor PITFALL, 696
Leydig Cell (Hilar) Tumor, 698
Stromal Luteoma, 701
Pregnancy Luteoma, 703
Sclerosing Stromal Tumor, 705
Small Cell Carcinoma of Hypercalcemic Type, 707
Small Cell Carcinoma of Pulmonary (Neuroendocrine)
Type, 709
Sex Cord Tumor with Annular Tubules, 711
E. Miscellaneous Tumors
Solitary Fibrous Tumor, 713
Gastrointestinal Stromal Tumor, 715
Primitive Neuroectodermal Tumor, 717
Desmoplastic Small Round Cell Tumor, 719
Benign Cystic Mesothelioma, 721
Papillary Mesothelioma, 723
Papillary Mesothelial Hyperplasia, 725
Malignant Mesothelioma, 727
SECTION VI. GESTATIONAL
A. Early Gestation
Gestational Sac, 731
Fresh Implantation Site PITFALL, 733
Implantation Site Nodule, 735
Spontaneous Abortion, 737
Ectopic Pregnancy, 739
B. Trophoblastic Neoplasia
Complete Hydatidiform Mole PITFALL, 741
Invasive Hydatidiform Mole, 745
Partial Hydatidiform Mole, 748
Mesenchymal Dysplasia PITFALL, 750
Choriocarcinoma, 752
Intraplacental Choriocarcinoma PITFALL, 754
Placental Site Trophoblastic Tumor PITFALL, 757
Molar Implantation Site, 759
Epithelioid Trophoblastic Tumor, 761
Chorangioma, 764
C. Second and Third Trimester Placenta
Knots in the Umbilical Cord, 766
Single Umbilical Artery (SUA), 768
CONTENTS xiii
Hypercoiled and Hypocoiled Umbilical Cord, 769
Kathleen Sirois
Variations on Cord Insertion (Marginal, Membranous,
Furcate), 770
Kathleen Sirois
Circummarginate and Circumvallate Placentas, 772
Kathleen Sirois
Fetal Vascular Thrombosis PITFALL, 774
Amniotic Bands, 776
Maternal Floor Infarct/Massive Perivillous Fibrin
Deposition, 778
Chorioamnionitis, 780
Gestational Candida Infection, 783
Listeria Placentitis PITFALL, 785
Chronic Villitis, 787
Chronic Histiocytic Intervillositis, 789
Congenital Syphilis, 791
Lysosomal Storage Disorder, 793
Inflammatory Abruption, 795
Hypertensive Bleeding (Ball-in-Socket) Infarct, 798
Congenital Parvovirus Infection, 800
Fetal Leukemia, 802
Placenta Creta, 804
Placenta Previa, 807
Toxoplasmosis, 808
Toxemia, 810
Placental Infarction, 812
Meconium Staining, 814
Distal Villous Pathology, 816
Fetal to Maternal Hemorrhage, 818

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