Fig. 1 (above). Endometrial hyperplasia, simple. Hyperplastic glands of unequal size, some of which are cystically dilated Fig. 2 (below).

Transcription

1 81 Fig. 1 (above). Endometrial hyperplasia, simple. Hyperplastic glands of unequal size, some of which are cystically dilated Fig. 2 (below). Endometrial hyperplasia, simple. Proliferative type epithelium lining cystically dilated glands. Compare proliferative stroma with that of an endometrial polyp (Fig. 8)

2 82 Fig. 3 (above). Endometrial hyperplasia, complex. Markedly crowded glands Fig.4 (below). Endometrial hyperplasia, complex. Crowded, architecturally abnormal glands without cytologic atypia

3 83 Fig. 5 (above). Atypical endometrial hyperplasia. Glandular epithelium showing nuclear atypia and loss of polarity Fig. 6 (below). Atypical endometrial hyperplasia. Atypical gland with large, irregular nuclei showing loss of polarity and containing prominent nucleoli and abundant cytoplasm, which was eosinophilic

4 84 Fig. 7 (above). Endometrial polyp. Dilated glands and dense stroma Fig. 8 (below). Endometrial polyp. Higher magnification of portion of Fig. 7, showing thick-walled blood vessels, one of which contains a thrombus, a dilated gland, and dense stroma

5 85 Fig.9 (above). Endometrioid adenocarcinoma, corpus. Crowded endometrioid glands that are back-to-back or separated by fibrotic stroma Fig.tO (below). Endometrioid adenocarcinoma, corpus. Back-to-back glands lined by cells with atypical nuclei

6 86 Fig.n. Endometrioid adenoarcinoma, corpus. Solid growth with minor gland formation Fig. U. Endometrioid adenocarcinoma, corpus. Villoglandular pattern

7 87 Fig.13. Endometrioid adenocarcinoma, secretory variant, corpus. Neoplastic glands resembling those of early secretory endometrium Fig.14. Endometrioid adenocarcinoma, ciliated cell variant, corpus. Well differentiated neoplastic glands lined by ciliated cells

8 88 Fig. IS (above). Adenocarcinoma with squamous differentiation (adenoacanthoma), corpus. Intraglandular morule Fig.I6 (below). Adenocarcinoma with squamous differentiation (adenosquamous carcinoma), corpus. Neoplastic glands blending with malignant squamous epithelium, which borders reactive stroma

9 89 Fig.17 (above). Adenocarcinoma with squamous differentiation (adenosquamous carcinoma), corpus. Poorly differentiated adenocarcinoma blending with malignant squamous component Fig. IS (below). Serous adenocarcinoma, corpus. Papillae with fibrous cores lined by poorly differentiated complex epithelium with exfoliation of cells into lumens

10 90 Fig.19. Mucinous adenocarcinoma, corpus. Glands and villi lined by neoplastic cells containing abundant mucin Fig. 20. Endometrial stromal nodule. Pushing border between tumour and compressed endometrium (above)

11 91 Fig. 21 (above). Endometrial stromal nodule. Tumour cells resembling normal proliferative endometrial stromal cells whirling around small arteries Fig. 22 (below). Endometrial stromal sarcoma, low grade. Extension of tumour into myometrium and distended thin-walled vessels

12 92...~.... ''' ' "... #... - f' --.,,..., ~... \ ~... r ""\I :..-=-. _...,r;.... ':.." ti ",!,.~.....,;..... ",....,.._ ~ - - ~..._- # - - ".... ',,:--.. ".... "', 7'.::... -,'.e.: :.,,..".., J... ~ -... :......, "....., ',... _ #-t'.,;..... ~ _... ~....., Fig. 23 (above). Endometrial stromal sarcoma, low grade. Cells resembling endometrial stromal cells surrounding numerous small arteries that resemble normal spiral arteries Fig. 24 (below). Endometrial stromal sarcoma, high grade. Pleomorphic, mitotically active tumour cells

13 93 Fig.25 (above). Leiomyoma, corpus. Intersecting fascicles of spindle cells lacking atypia Fig.26 (below). Leiomyoma, corpus. Hyaline bands separating groups of smooth muscle cells

14 94 Fig. 27 (above). Cellular leiomyoma, corpus. Tumour significantly more cellular than normal myometrium, but without nuclear atypia or mitotic activity Fig.28 (below). Epithelioid leiomyoma, corpus. Round tumour cells with abundant clear cytoplasm; no mitotic activity

15 95 Fig. 29. Epithelioid leiomyoma, corpus. Plexiform arrangement of epithelioid smooth muscle cells with dense cytoplasm Fig. 30. Bizarre leiomyoma, corpus. Numerous symplastic giant cells; no mitotic activity

16 96 Fig. 31 (above). Lipoieiomyoma, corpus. Intimate admixture of smooth muscle cells and lipocytes Fig. 32 (below). Leiomyosarcoma, corpus. Hypercellular tumour with nuclear pleomorphism, hyperchromatism, and mitotic figures

17 97 Fig.33 (above). Leiomyosarcoma, corpus. Prominent nuclear pleomorphism and atypical mitotic figure Fig.34 (below). Intravenous leiomyomatosis, corpus. Cytologically benign, focally hyalinized leiomyomatous tissue within myometrial veins

18 98 Fig. 35. Diffuse leiomyomatosis, corpus. Multiple, closely packed leiomyomas occupying most of myometrium Fig. 36. Mixed endometrial stromal and smooth muscle tumou/; corpus. Irregularly oval nodule of smooth muscle (above) present within otherwise typical endometrial stromal tumour

19 99 Fig. 37 (above). Adenomatoid tumour, corpus. Dilated tubules and small cysts extensively infiltrating the myometrium Fig. 38 (below). Adenomatoid tumour, corpus. Single layer of flattened tumour cells lining tubules and cysts in myometrium

20 100 Fig.39 (above). Atypical polypoid adenomyoma, corpus. Endometrial glands separated by fascicles of cellular smooth muscle Fig.40 (below). Atypical polypoid adenomyoma, corpus. Large foci of morular squamous metaplasia

21 101 Fig.41 (above). Adenosarcoma, homologous, corpus. Club-shaped polyps lived by benign appearing endometrioid epithelium, with hypercellular stromal component Fig.42 (below). Adenosarcoma, heterologous, corpus. Glands with focal squamous metaplasia surrounded by dense cuffs of neoplastic stromal cells, and islands of immature cartilage within less cellular stromal component

22 102 Fig. 43 (above). Carcinosarcoma, homologous, corpus. Carcinoma cells with a complex pattern lining polypoid masses of malignant-appearing stroma Fig. 44 (below). Carcinosarcoma, heterologous, corpus. Malignant-appearing glands and stroma containing strap-shaped rhabdomyoblasts

23 103 Fig.45 (above). Carcinosarcoma, heterologous, corpus. Large focus of malignantappearing osteoid and central focus of malignant squamous cells Fig. 46 (below). Sex cord-like tumour, corpus. Closely packed bands of well differentiated cells with an epithelial pattern, some of which have lipid-rich cytoplasm

24 104 Fig.47. Sex cord-like tumour, corpus. Irregular nests of cells separated by cellular fibrous tissue, resembling a granulosa cell tumour Fig.48. Glioma, corpus. Irregular islands of glial tissue invasive of myometrium

25 105 Fig.49 (above). Metastatic lobular carcinoma of breast origin, corpus. Diffuse replacement of endometrial stroma with two residual benign endometrial glands Fig. 50 (below). Squamous metaplasia, endometrium. Confluent squamous morules, which have replaced endometrial glands

26 106 Fig. 51. Mucinous metaplasia, endometrium. Surface epithelium mostly replaced by mucin-filled cells Fig.52. Hobnail cell metaplasia, endometrium. Uniform cells with bulbous, apical, bland appearing nuclei lining adjacent endometrial glands

27 107 Fig. 53. Clear cell change, endometrium. Closely packed hypersecretory glands containing regularly arranged papillae lined by large clear cells (from a pregnant patient) Fig. 54. Eosinophilic cell metaplasia, endometrium. Glands lined by single layer of cells with abundant cytoplasm, which was eosinophilic

28 108 Fig.55. Surface syncytial change, endometrium. Surface lined by an irregularly thick layer of cells with bland nuclei forming microcysts Fig.56. Papillary change, endometrium. Several dilated glands with papillae that are focally confluent and lined by cells with abundant cytoplasm

29 109 Fig.57. Arias-Stella change, endometrium. Closely packed glands with regularly arranged papillae lined by hobnail type cells Fig. 58. Arias-Stella change, endometrium. Lining cells with bulbous, apical nuclei, many of which have a smudgy appearance

30 110 Fig. 59. Foam cell change, endometrium. Vacuolated endometrial stromal cells filled with small lipid droplets Fig.60. Adenomyosis, corpus. Island of endometrial tissue in myometrium connected to endometrium

31 111 Fig. 61. Chronic endometritis. Stroma replaced by round cell infiltrate, which contained plasma cells, and glands that are hyperplastic and architecturally abnormal Fig.62. Lymphoma-like lesion, corpus. Polymorphous lymphoid infiltrate occupying stroma and eroding into an endometrial gland

32 112 Fig.63 (above). Inflammatory pseudotumour. corpus. Myometrial mass composed predominantly of spindle cells, plasma cells and lymphocytes Fig. 64 (below). Sixteen-day conceptus containing of chorionic vi/b, cytotrophoblast, syncytiotrophoblast and intermediate trophoblast (lower left)

33 113 Fig. 65 (above). Complete hydatidiform mole. Hydropic swelling with cistern formation and slight hyperplasia of trophoblast Fig. 66 (below). Complete hydatid(form mole. Trophoblastic hyperplasia

34 114 Fig. 67 (above). Complete hydatidiform mole. Trophoblastic atypia Fig.68 (below). Partial hydatidiform mole. Two populations of villi, one normal in size and the other showing hydropic swelling, some with a scalloped outline

35 115 Fig.69 (above). Partial hydatidiform mole. Two populations of villi, one normal and the other hydropic; minimal trophoblastic hyperplasia Fig. 70 (below). Partial hydatidiform mole. Trophoblastic inclusion

36 116 Fig. 71 (above). Abortus. Hydropic chorionic villi, one of which contains a cistern Fig.72 (below). Abortus. Hydropic change and polar orientation of trophoblast, which lacks atypia

37 117 Fig. 73 (above). Invasive hydatidiform mole. Molar villus exhibiting trophoblastic hyperplasia and detached nodule of hyperplastic trophoblast (left) within vascular space in myometrium Fig.74 (below). Choriocarcinoma, corpus. Predominant population of cytotrophoblast and intermediate trophoblast; syncytiotrophoblast lining vascular spaces

38 118 Fig.75 (above). Choriocarcinoma, corpus. Dimorphic pattern of cytotrophoblast and syncytiotrophoblast, with latter lining vascular spaces Fig. 76 (below). Choriocarcinoma, corpus. Cytotrophoblast and syncytiotrophoblast (right) and intermediate trophoblast (left)

39 119 Fig. 77 (above). Choriocarcinoma, corpus. Immunoreactive chorionic gonadotropin localized mainly in syncytiotrophoblast and, to a lesser extent, in intermediate trophoblastic cells (left) Fig. 78 (below). Placental site trophoblastic tumour. Predominant composition of intermediate trophoblast with single syncytiotrophoblastic cell and fibrinoid in vessel wall (lower right)

40 120 Fig. 79 (above). Placental site trophoblastic tumour. Infiltration of myometrium with separation of smooth muscle bundles Fig. SO (below). Placental site trophoblastic tumour (clinically malignant). Clarity of cytoplasm of some intermediate trophoblastic cells

41 121 Fig.81. Placental site trophoblastic tumour (clinically malignant). Nuclear atypia and mitotic figure (arrolv) Fig.82. Placental site trophoblastic tumour. Immunoreactive placental lactogen in intermediate trophoblastic cells

42 122 Fig. 83 (above). Exaggerated placental site. Intermediate trophoblastic cells without formation of confluent mass Fig.84 (below). Exaggerated placental site. Smudgy, degenerative appearance of nuclei despite marked pleomorphism

43 123 Fig. 85 (above). Placental site nodule. Well circumscribed margin and marked hyalinization of two nodules Fig. 86 (below). Placental site nodule. Intermediate trophoblastic cells without significant nuclear atypia

44 124 Fig.87. Squamous papilloma, cervix. Papilla lined by thick layer of cellular squamous epithelium lacking nuclear atypia Fig.88. Squamous metaplasia, cervix. Immature squamous epithelium undermining columnar, mucinous epithelium

45 125 Fig.89. Transitional metaplasia, cervix. Cervical surface epithelium replaced by transitional epithelial cells containing grooved, "coffee bean" nuclei Fig. 90. Squamous atypia, cervix. Thin layer of atypical surface epithelium overlying chronically inflamed cervical stroma

46 126 Fig.91. Mild dysplasia (CINI). Human papilloma-viral changes in upper portion of epithelium characterized by cytoplasmic clarity and abnormal nuclei Fig. 92. Mild dysplasia (ClNI). Koilocytotic atypia in superficial epithelial layer, characterized by cytoplasmic swelling and clarity, enlarged, hyperchromatic nuclei, and occasional binucleated cells

47 127 Fig. 93. Moderate dysplasia (CIN2). Cytoplasmic maturation and moderate nuclear atypia with numerous mitotic figures confined to lower half of epithelium Fig.94. Severe dysplasia (CIN3). Cytoplasmic maturation in upper portion of epithelium and nuclear abnormalities including atypical mitotic figures throughout epithelium

48 128 Fig. 95. Carcinoma in situ (CIN3). Nuclear abnormalities involving full thickness of the epithelium without cytoplasmic maturation Fig.96. Squamous cell carcinoma, microinvasive, cervix. Multiple buds of differentiating squamous cells extending into superficial cervical stroma

49 129 Fig.97. Squamous cell carcinoma, microinvasive, cervix. Single bud of differentiating squamous cells invading cervical stroma from gland involved by carcinoma in situ Fig. 98. Squamous cell carcinoma, microinvasive, cervix. Measurable tumour mass 3 mm in depth and 5 mm in lateral dimension

50 130 Fig.99. Squamous cell carcinoma, keratinizing, cervix. Irregular, invasive nests of malignant squamous cells, several of which contain central pearls Fig.100. Squamous cell carcinoma, nonkeratinizing, cervix. Irregular aggregate of squamous cells with abundant cytoplasm and without pearl formation

51 131 Fig. 101 (above). Squamous cell carcinoma, non-keratznizmg, cervix. Squamous cells with small, hyperchromatic nuclei and scanty cytoplasm growing in discrete nests separated by stroma Fig.I02 (below). Squamous cell carcinoma, non-keratinizing, cervix. Small squamous cells with differentiation and degeneration in center of nest

52 132 Fig.l03. Lymphoepithelioma-like carcmoma, cervix. Undifferentiated large neoplastic cells and extensive sprinkling of lymphocytes throughout tumour Fig Endocervical polyp. Polypoid mass composed of endocervical-type glands and fibrous stroma

53 133 Fig.lOS. Mullerian papilloma, cervix. Multiple small polypoid projections composed largely of chronically inflamed fibrous stroma and lined by simple epithelium, arising at squamocolumnar junction Fig Glandular dysplasia, cervix. Nuclear atypia, focal loss of nuclear polarity and loss of intracytoplasmic mucin

54 134 Fig Adenocarcinoma in situ, cervix. Glands lined by highly atypical columnar epithelium merging with squamous carcinoma in situ; atypical mitotic figures Fig.l0S. Adenocarcinoma in situ, cervix. Normal endocervical gland (left) and glands partly or completely replaced by highly atypical columnar epithelium (right)

55 135 Fig.l09. Mucinous adenocarcinoma, endocervical type, cervix. Glands lined by highly atypical endocervical type cells filled with mucin Fig.l10. Mucinous adenocarcinoma, endocervical type (adenoma malignum), cervix. Irregularly branching, large glands and small glands lined by mucin-rich cells infiltrating cervical wall

56 136 Fig.lli. Mucinous adenocarcinoma, endocervical type (adenoma malignum), cervix. Small, highly differentiated glands of endocervical type infiltrating muscle of cervical wall Fig. Ill. Mucinous adenocarcinoma, endocervical type, cervix. Villoglandular pattern

57 137 Fig Mucinous adenocarcinoma, endocervical type, cervix. Villoglandular pattern; moderately differentiated, stratified tumour cells devoid of mucin in this area Fig Mucinous adenocarcinoma, intestinal type, cervix. Neoplastic glandular epithelium containing numerous goblet cells

58 138 Fig.1lS. Endometrioid adenocarcinoma, cervix. Villoglandular pattern Fig.1l6. Mesonephric adenocarcinoma, cervix. Closely packed, small, round tubules filled with colloid-like material and arranged back-to-back, resembling normal mesonephric tubules

59 139 Fig Mesonephric adenocarcinoma, cervix. Mesonephric duct-like structures lined by stratified nonmucin-containing epithelium (left); hyperplastic mesonephric tubules (center and right) Fig.11S. Adenosquamous carcinoma, cervix. Squamous cell carcinoma (left) merging with adenocarcinoma (right)

60 140 Fig. 119 (above). Glassy cell carcinoma, cervix. Undifferentiated neoplastic cells with abundant ground-glass cytoplasm, central nuclei with prominent nucleoli and prominent cell membranes; atypical mitotic figures Fig.UO (below). Adenoid cystic carcinoma, cervix. Large, rounded nests with a cribriform pattern separated by fibrous stroma

61 141 Fig.12I. Adenoid cystic carcinoma, cervix. Anastomosing, thin bands of neoplastic epithelial cells separated by cylinders of hyalinized stroma Fig.I22. Adenoid basal carcinoma, cervix. Small nests of cells resembling basal cells, containing a few glandular spaces and undergoing squamous differentiation (upper center)

62 142 Fig.123. Adenoid basal carcinoma, cervix. Gland formation (upper center) Fig Carcinoid tumour, cervix. Nests and bands composed of uniform cells with round, hyperchromatic nuclei

63 143 Fig. US. Small cell carcinoma, cervix. Diffuse infiltration of uniform small cells occupying cervical stroma and surrounding an endocervical gland Fig.126. Small cell carcinoma, cervix. Uniform, small, oval, and elongated nuclei containing stippled chromatin and lacking nucleoli; scanty cytoplasm

64 144 Fig.l27. Endocervical stromal sarcoma. Malignant spindle cell tumour without specific features surrounding endocervical gland Fig.l2S. Adenofibroma, cervix. Polypoid growth composed of well differentiated fibrous tissue lined by bland epithelium

65 145 Fig Blue naevus, cervix. Elongated cells containing melanin pigment in cervical stroma Fig.l30. Endocervical glandular hyperplasia. Closely packed, hyperplastic endocervical glands forming a layer sharply demarcated from underlying stroma

66 146 Fig.131. Tunnel cluster, cervix. Rounded aggregate of closely packed, dilated endocervical glands Fig.132. Tunnel cluster, cervix. Sharply circumscribed aggregate of closely packed endocervical glands, some of which are small and hyperplastic and others of which are cystically dilated

67 147 Fig Microglandular hyperplasia, cervix. Polypoid nodule composed of small glands and solid proliferation of loosely arranged epithelial cells Fig Microglandular hyperplasia, cervix. Nodule composed of mostly small glands containing mucin and acute inflammatory cells

68 148 Fig.135. Arias-Stella change, cervix. Numerous endocervical glands with uniformly spaced fine papillae; patient was pregnant Fig.136. Arias-Stella change, cervix. Glands with regularly spaced papillae lined by hobnail type cells; higher magnification of Fig. 135

69 149 Fig Mesonephric remnants, cervix. Mesonephric duct with pseudopolypoid stromal projections into lumen and mesonephric tubules lined by cuboidal epithelium with colloid-like material in lumen Fig Mesonephric hyperplasia, cervix. Lobular arrangement of closely packed mesonephric tubules in cervical wall

70 150 Fig Mesonephric hyperplasia, cervix. Closely packed mesonephric tubules, some of which are cystic ally dilated, filled with colloid-like material Fig Mesonephric hyperplasia, cervix. Papillary hyperplasia of mesonephric duct

71 151 Fig Ciliated cell metaplasia, cervix. Gland lined by pseudostratified, ciliated epithelium Fig.142. Endometriosis, cervix. Endometrial type glands and stroma attached to endocervical mucosa; large focus of smooth muscle metaplasia of endometriotic stroma

72 152 Fig Ectopic decidua, cervix. Polypoid mass composed largely of stromal cells resembling decidual cells of the endometrium Fig Adenosls, vagina. Glands surrounded by inflammatory cells lying in the superficial lamina propria

73 153 Fig.145. Adenosis, vagina. Glands lined by mucinous epithelium Fig.l46. Adenosis, vagina. Tuboendometrial gland lined by ciliated epithelium

74 154 Fig.147. Adenosis, vagina. Glands and surface epithelium completely replaced by metaplastic squamous epithelium Fig Clear cell adenocarcinoma, vagina. Diffuse, clear cell pattern resembling that of renal cell carcinoma

75 155 Fig Clear cell adenocarcinoma, vagina. Tubular pattern with tubular structures lined by hobnail cells Fig. ISO. Clear cell adenocarcinoma, vagina. Cystic pattern

76 156 Fig.1S1. Rhabdomyoma, vagina. Large, mature striated muscle cells in fibrous stroma Fig.1S2. Sarcoma botryoides (embryonal rhabdomyosarcoma), vagina. Multiple polypoid projections composed of cellular tumour covered by squamous epithelium

77 157 Fig.lS3. Sarcoma botryoides (embryonal rhabdomyosarcoma), vagina. Superficial (cambium) layer of cellular tumour and subjacent layer of oedematous tumour Fig.lS4. Sarcoma botryoides (embryonal rhabdomyosarcoma), vagina. Rhabdomyoblasts

78 158 Fig. ISS. Mixed tumour, vagina. Epithelial component separated by stroma from overlying squamous epithelium Fig Mixed tumour, vagina. Nest of squamous cells adjacent to predominant small cells of stromal type

79 159 Fig.IS7. Malignant lymphoma, vagina. Solid mass of lymphoid cells situated mainly deep in vaginal wall Fig. ISS. Stromal polyp (pseudosarcoma botryoides), vagina. Stroma containing numerous large cells and dilated, thin-walled vessels

80 160 Fig.159. Stromal polyp (pseudosarcoma botryoides), vagina. Star-shaped cells, some of which are multinucleated, with pointed processes; absence of mitotic activity Fig Postoperative spindle cell nodule, vagina. Intersecting fascicles of closely packed spindle cells resembling sarcoma

81 161 Fig.161. Postoperative spindle cell nodule, vagina. Spindle cells with large nuclei; numerous mitotic figures Fig Prolapse of fallopian tube, vagina. Plicae expanded and fused with chronic inflammation and fibrosis of stroma

82 162 Fig.163. Vestibular squamous papilloma. Squamous epithelium without atypia lining delicate fibrovascular stalk Fig.164. Fibroepithelial polyp, vulva. Polypoid lesion with prominent fibrovascular core covered by hyperkeratotic squamous epithelium that lacks atypia

83 163 Fig Condyloma acuminatum, vulva. Multipolypoid lesion lined by thick squamous epithelium Fig Condyloma acuminatum, vulva. Focal, superficial, human papilloma-virus changes

84 164 Fig.167. Moderate dysplasia (VIN2). Disorderly arrangement of atypical cells in lower half of epithelium and maturation in upper half Fig Severe dysplasia (VIN3). Corps ronds with pyknotic nuclei surrounded by haloes; atypical nuclei in upper third of epithelium

85 165 Fig.169. Carcinoma in situ (VIN3). Crowded small cells without maturation occupying full thickness of epithelium Fig Carcinoma in situ (simplex type) (VIN3). Nuclear abnormalities with abortive pearl formation in papillary downgrowth of squamous epithelium

86 166 Fig.I71. Squamous cell carcinoma, vulva. Nests of malignant squamous cells, some of which are rounded and basaloid and others of which show squamous cell maturation Fig.I72. Squamous cell carcinoma, nonkeratinizing, vulva. Anastomosing trabeculae

87 167 Fig Squamous cell carcinoma, basaloid, vulva. Carcinoma cells resembling those of squamous carcinoma in situ of cervix Fig Verrucous carcinoma, vulva. Abundant keratin formation and bulbous downgrowths of well differentiated squamous epithelium

88 168 Fig.17S. Verrucous carcinoma, vulva. High degree of differentiation of tumour cells Fig Warty (condylomatous) carcinoma, vulva. Verrucous surface and underlying invasive carcinoma

89 169 Fig Warty (condylomatous) carcinoma, vulva. Noninvasive component with koilocytosis-iike changes ~Depthof invasion Fig.178. Method of measurement ofthickness and depth of invasion of squamous cell carcinoma of vulva

90 170.,. Fig.179. Squamous cell carcinoma, vulva. Tumour 5 mm in maximal vertical thickness Fig.ISO. Basal cell carcinoma, vulva. Anastomosing bands of malignant basal cells arising from base of squamous epithelium

91 171 Fig.ISI. Papillary hidradenoma, vulva. Cystic papillary tumour sharply demarcated from adjacent stroma Fig. IS2. Papillary hidradenoma, vulva. Slit-like and rounded glands with papillae; apocrine metaplasia of tumour cells (left)

92 172 Fig Papillary hidradenoma, vulva. Layer of myoepithelial cells subjacent to secretory cells Fig Paget disease, vulva. Large, rounded, pale Paget cells distributed within thickened squamous epithelium

93 173 Fig.18S. Paget disease, vulva. Paget cells with foamy cytoplasm, some of which have a signet ring appearance Fig.186. Paget disease, vulva. Associated invasive carcinoma

94 174 Fig.1S7. Bartholin gland adenocarcinoma. Papillary pattern Fig.1SS. Granular cell tumour, vulva. Replacement of dermis by tumour cells with overlying pseudo epitheliomatous hyperplasia

95 175 Fig Granular cell tumour, vulva. Coarse granules filling cytoplasm of tumour cells Fig.190. Aggressive angiomyxoma, vulva. Tumour composed of hypocellular, loose, myxoid tissue containing numerous blood vessels and invading fat (right)

96 176 Fig Aggressive angiomyxoma, vulva. Myxoid tissue containing blood vessels with slightly thickened walls Fig Dysplastic melanocytic naevus, vulva. Atypical naevus cells in papillary and reticular dermis

97 177 Fig.193. Malignant melanoma, vulva. Pigmented and nonpigmented spindle cells diffusely replacing upper dermis Fig Malignant melanoma, vulva. Large rounded cells with central nuclei and prominent nucleoli and with pigmented, abundant cytoplasm at junction of epidermis and dermis

98 178 Fig.195. Malignant melanoma, vulva. Spindle-shaped nuclei creating a resemblance to spindle cell sarcoma Fig.196. Langerhans cell histiocytosis, vulva. Diffuse proliferation of histiocytes with a few eosinophils (arrows)

99 179 Fig.197. Bartholin duct cyst. Cyst lined by mucinous and metaplastic squamous epithelium Fig.198. Epidermal cyst. Cyst filled with keratin and lined by thin layer of squamous epithelium

100 180 Fig Lichen sclerosus, vulva. Loss of rete ridges, homogeneous, parvicellular subepithelial layer and deep layer containing numerous round cells Fig Squamous cell hyperplasia, vulva. Acanthosis and hyperkeratosis without atypia and without features of specific forms of dermatosis or dermatitis

101 Subject Index Adenofibroma.... Adenoma, minor vestibular glands Adenoma, villous.... Adenomatoid tumour.... Adenomyoma.... atypical polypoid.... Adenomyosis.... Adenosarcoma.... heterologous.... homologous.... Adenosis.... atypical.... with dysplasia-carcinoma in situ Angiokeratoma.... Angiomyxoma, aggressive.... Arias-Stella change.... Atypia after radiation therapy.... glandular.... squamous.... Atypical polypoid adenomyoma.. Bartholin gland carcinoma.... adenocarcinoma.... adenoid cystic.... adenosquamous.... squamous cell.... transitional cell.... Bethesda system.... Blighted ovum.... Bone, retention of fetal.... Bowen disease.... Bowenoid papulosis.... Pages 23, ,61 23,49 23, ,24,49,60 24,49 24,49 56, ,51, ,14,43,57 40,55 23, ,56 34, Candida infection Carcinofibroma Carcinoid tumour... 47,58 Carcinoma adenoacanthoma ,16 Figures ,38 39,40 39, , ,191 57,58,135,136 5, , ,

102 182 Subject Index Carcinoma, adenocarcinoma.... argyrophil cell.... Bartholin gland.... ciliated cell.... clear cell.... ectopic cloacal.... endometrioid.... in situ.... mesonephric.... minimal deviation.... mixed.... mucinous.... endocervical type.... intestinal type.... papillary.... Bartholin gland.... clear cell.... endocervical.... endometrioid.... mucmous.... secretory.... serous.... Skene gland.... sweat gland.... villogiandular.... with squamous differentiation.... adenoid basal.... adenoid cystic.... adenoma malignum.... adenosquamous.... basal cell.... meta typical.... basosquamous.... breast, ectopic.... glassy cell.... grade, endometrial.... metastatic.... mucoepidermoid.... signet-ring cell.... small cell.... squamous cell acantholytic.... Bartholin gland.... Pages Figures 14-18,27,28,42,44-46,9-19, , 51,52,58,62,63, ,186, ,16,27,28,42,45 52,58, ,45, ,46,52, ,44,45,58,70 44,58 45,58 15,16,44,45, , , ,44, ,47,58,68 46,58, ,46,58, , ,16 26,45,50,56,61,75, , ,47,58 17,18,39-43,47,53, 56,65-68, , , , ,111 19, ,18,19,112,113, 115, , ,112, ,19,112,113, , , ,111 16,17, , ,107,

103 Subject Index 183 basaloid.... condylomatous.... in situ.... keratinizing.... lymphoepithelioma-like... microinvasive.... non-keratinizing.... papillary.... verrucous.... warty.... transitional cell.... undifferentiated.... giant cell.... large cell.... small cell.... spindle cell.... verrucous.... with choriocarcinoma.... Carcinosarcoma.... heterologous.... homologous.... Cartilage, metaplasia.... retention of fetal.... Cell argentaffin.... argyrophil.... foam.... Paneth.... Cervical intraepithelial neoplasia (CrN).... Change (see also metaplasia) Arias-Stella.... clear cell.... foam cell.... myxoid in leiomyoma.... in leiomyosarcoma.... papillary.... surface syncytial.... Chorioadenoma destruens.... Choriocarcinoma.... germ cell origin.... gestational.... with carcinoma.... CrN (cervical intraepithelial neoplasia).... Condyloma acuminatum.... giant (Buschke and Lowenstein).... Pages 67 42,56,67 39,40,43,47,56,65,66 42,56,66, ,42,47,53 42,47, ,18,42,56,67 42,56, ,47, ,47, ,18,42,56, ,49,60 24,49 24, ,44,45 18, ,44,47 28,51, ,29 19, , , ,44,47 39,55,64,65 67 Figures ,177 95,107,169, ,102,171, , , , , , , ,107 57,58,135, , ,166

104 184 Subject Index Condyloma, flat.... Crohn's disease.... Cyst Bartholin duct.... canal of Nuck cervical.... ciliated.... dermoid.... epidermal.... epithelial, myometrial.... Gartner duct.... mesonephric.... mesothelial.... mucinous.... mullerian.... myometrial, epithelial.... nabothian.... paraurethral.... wolffian duct.... Decidua, ectopic.... Deportation, villous.... Dermatitis, eczematous.... Dermatofibroma.... Dermatofibrosarcoma protuberans Dermoid cyst.... Desmoid tumour.... Dysplasia glandular.... squamous Endodermal sinus tumour.... Endolymphatic stromal myosis.. Endometrial stroma (see stroma) Endometriosis.... stromal.... Endometritis, chronic.... xanthogranulomatous.... Eosinophilic granuloma.... Erythroplasia of Queyrat Fallopian tube, prolapse Fasciitis, nodular.... Fibrolipoma.... Fibroma.... Fibromatosis (desmoid tumour) Fibrosis, subepidermal nodular. Germ cell tumours.... Glia, retention offetal.... Pages ,78 50,61 63, , ,78 51, , , ,40,47,56,65,66 25,50,60,75 18,19 53,63, , ,50,60,61,75 25,29,54 Figures ,167,168 22,

105 Subject Index 185 Pages Glioma... 25,29 Glomus tumour Granular cell tumour Granulation tissue, vaginal vault. 62 Figures , 189 Haemangioma.... acquired.... capillary.... cavernous.... sclerosing.... Hidradenoma clear cell.... papillary.... Histiocytoma benign fibrous.... malignant fibrous.... Histiocytosis, Langerhans cell (histiocytosis X).... HPV (human papilloma virus).. Hydatidiform mole complete.... mvaslve.... partial.... Hydropicabortus.... Hyperplasia endocervical glandular.... endometrial.... adenomatous.... atypical.... complex.... simple.... mesonephric.... microglandular.... pseudoepitheliomatous.... squamous cell , ,40,42,55,56, ,35 34, ,14 13,14 13,14 13,14 13,14 45,46,52 51, , ,6 3,4 1, , Infection, candida.... Inflammatory pseudo tumor Intravenous leiomyomatosis... Kaposi sarcoma.... Keratoacanthoma.... Koilocytosis.... Leiomyoblastoma.... Leiomyoma.... bizarre.... cellular.... clear cell.... epithelioid , ,41, ,20,21,47,59, , , ,29

106 186 SUbject Index Leiomyoma,lipoleiomyoma.. metastasizing.... pleomorphic.... plexiform.... symplastic.... uncertain malignant potential. Leiomyomatosis diffuse.... intravenous.... Leiomyosarcoma.... epithelioid.... myxoid.... Leukemia.... Lichen planus.... sclerosus.... simplex chronicus.... Lipogranuloma, sclerosing.... Lipoleiomyoma.... Lipoma.... Lymphangioma.... Lymphoepithelioma-like carcinoma Lymphoma, malignant.... Lymphoma-like lesions.... Pages ,21,47,59, ,50,61, ,71 22, ,30,50,61,75 30,54,63 Figures , Malakoplakia.... Malignant fibrous histiocytoma.... mesodermal mixed tumour... Melanoma, malignant.... Merkel cell tumour.... Mesonephric adenocarcinoma.... cyst.... hyperplasia.... remnants.... Metaplasia (see also change) adipocyte.... cartilaginous.... ciliated cell.... eosinophilic cell.... epidermal.... fatty (adipocyte).... hobnail cell.... intestinal.... morular.... mucinous.... endocervical-type.... intestinal-type ,49,60 50,61, ,46,52,58 63,78 45,46, , , , , , ,

107 oncocytic osseous.... smooth muscle.... squamous.... stromal.... transitional.... tubal.... Microglandular hyperplasia Mixed tumour (see tumour) Naevus blue lipomatosus superficialis.... melanocytic.... acquired.... congenital.... dysplastic.... Neurilemoma (schwannoma)... Neurofibroma.... Neuroma, traumatic (amputation) Paget disease.... Papilloma mullerian.... squamous.... Placental site exaggerated.... nodule and plaque.... trophoblastic tumour.... Plexiform leiomyoma.... Polyp endocervical.... endometrial.... fibroepithelial.... stromal.... Postoperative spindle cell nodule. Prolapse, fallopian tube.... Psammoma bodies.... Pseudo epitheliomatous hyperplasia.... Pseudo sarcoma botryoides (stromal polyp).... Pseudotumor, inflammatory.... Psoriasis.... Pyogenic granuloma.... Radiation therapy atypia.... Remnants, mesonephric.... Pages ,28,29 26,39,40,57,78 28,29 40, ,63 50,60, ,60,74, ,57 39,55, ,53 36, ,62 31, 54, , ,62 30, Subject Index 187 Figures ,50,88,147, , ,163 83,84 85, , , , ,

108 188 Subject Index Rhabdoid tumour, malignant... Rhabdomyoma.... Pages 73 59,72 Figures 151 Sarcoma (see also tumour) alveolar soft-part.... angiosarcoma.... botryoides.... chondrosarcoma.... dermatofibrosarcoma protuberans 73 endocervical stromal endometrial stromal.... high grade.... low grade.... endometrioid stromal.... Kaposi.... leiomyosarcoma.... liposarcoma.... malignant fibrous histiocytoma nerve sheath tumours, malignant osteosarcoma.... rhabdomyosarcoma.... secondary.... Schwannoma (neurilemoma)... Seborrheic keratosis.... Sex cord-like tumors.... SIL (squamous intraepithelial lesions).... Smooth muscle metaplasia.... tumour of uncertain malignant potential.... Spindle cell nodule, postoperative Squamous intraepitheliallesions (see SIL) Stroma endocervical stromal sarcoma.. 47 endometrial stromal nodule.... stromal sarcoma.... stromal tumour, mixed.... endometrioid stromal sarcoma endometriosis, stromal.... polyp, stromal.... Syringoma , ,48,59, ,19,53 18,19 18,19,53 48, ,21,47,59,73 22, ,48,59,73 48,59, ,56,65,66 18,28, ,54, ,19,48,53, ,53,59 48,53 53, ,23 32, , , , , ,159 Teratomas.... mature cystic (dermoid cyst).. Trichilemmoma.... Trichoepithelioma ,50,61 50,

109 Subject Index 189 Pages Trophoblastic lesions, unclassified 38 Tumour (see also carcinoma, sarcoma) adenomatoid... 22,61 carcinoid... 47,58 desmoid (fibromatosis) ectopic mammary tissue.... germ cell.... glial.... glomus.... granular cell.... malignant rhabdoid.... Merkel cell.... metastatic (see Tumour, secondary) mixed adenofibroma adenomyoma adenosarcoma carcinofibroma.... endometrial stromal and malignant mesodermal.... smooth muscle.... synovial sarcoma-like.... vaginal.... nerve sheath, malignant.... neuroectodermal.... plexiform leiomyoma.... secondary.... sex cord-like.... soft tissue.... heterologous.... homologous.... Wilms.... Yolk sac.... Tumouriet, plexiform.... Tunnel cluster ,50,60,61,75 25, ,49 23,49 23,24,49, ,49, ,45,48,50,56, 59-61,75, ,48,60, ,50, 60, Figures 37, , ,40 41, , , , ,132 VAIN (vaginal intraepithelial neoplasia).... Villous deportation.... VIN (vulvar intraepithelial neoplasia).... Wilms tumour.... Xanthogranuloma, benign.... Xanthoma, verruciform.... Yolk sac tumour , ,50,60,