Normal Normal endometriumendometrium: : A,A, proliferativeproliferative. . B,B,secretorysecretory. .

NNộộii mmạạcc ttửử cungcung

NNộộii mmạạcc ttửử cungcung

Cyclic changes in Cyclic changes in endometriumendometrium. Approximate . Approximate relationship of useful microscopic changes. relationship of useful microscopic changes.

AriasArias--Stella reaction in endometrial mucosa. This Stella reaction in endometrial mucosa. This is not to be confused with a malignant condition. is not to be confused with a malignant condition.

Typical appearance of Typical appearance of endometriumendometrium after longafter long--term term administration of contraceptive pills. The glands are administration of contraceptive pills. The glands are

sparse and atrophic, whereas the sparse and atrophic, whereas the stromastroma is prominent is prominent and has and has decidualdecidual features. features.

Chronic Chronic endometritisendometritis showing an inflammatory showing an inflammatory infiltrate rich in lymphocytes and plasma cells. infiltrate rich in lymphocytes and plasma cells.

The oval to spindle and occasionally The oval to spindle and occasionally stellatestellateshape of endometrial shape of endometrial stromalstromal cells is a clue to the cells is a clue to the

diagnosis of chronic diagnosis of chronic endometritisendometritis. .

IUDIUD--related uterine related uterine actinomycosisactinomycosis. The disease . The disease had spread to the pelvic cavity. had spread to the pelvic cavity.

NoncaseatingNoncaseating granulomagranuloma in endometrial mucosa in endometrial mucosa consistent with consistent with sarcoidosissarcoidosis. .

A,A, SquamousSquamous metaplasiametaplasia of of endometriumendometrium with with morulemorule formation. formation.

B,B, SquamousSquamous metaplasiametaplasia of of endometriumendometrium with with morulemorule formation. formation.

TubalTubal metaplasiametaplasia of endometrial mucosa. All of endometrial mucosa. All three cell types that make up the normal mucosa three cell types that make up the normal mucosa

of the fallopian tube can be recognized. of the fallopian tube can be recognized.

Papillary (Papillary (syncytialsyncytial) ) metaplasiametaplasia of of endometriumendometrium. .

MucinousMucinous metaplasiametaplasia of of endometriumendometrium. Note the . Note the basal location of the nuclei and the basal location of the nuclei and the mucinmucin--containing cytoplasm of the columnar cells. containing cytoplasm of the columnar cells.

Clear cell Clear cell metaplasiametaplasia of of endometriumendometrium. The . The cytoplasm has a finely granular quality. cytoplasm has a finely granular quality.

Gross appearance of uterus involved by Gross appearance of uterus involved by adenomyosisadenomyosis. The wall is irregularly thickened . The wall is irregularly thickened

and contains small hemorrhagic foci. and contains small hemorrhagic foci.

IntramyometrialIntramyometrial foci of endometrial glands and foci of endometrial glands and stromastroma in in adenomyosisadenomyosis. .

SoSo--called called ““stromalstromal adenomyosisadenomyosis..”” An illAn ill--defined defined island of endometrial island of endometrial stromastroma is deeply embedded is deeply embedded

within the within the myometriummyometrium. .

Gross appearance of endometriosis involving the Gross appearance of endometriosis involving the anterior abdominal wall. anterior abdominal wall.

Endometriosis involving the umbilical region. Endometriosis involving the umbilical region.

SoSo--called called ““endocervicosisendocervicosis..”” The The stromastroma has an has an endometriumendometrium--like quality, but the glands are of like quality, but the glands are of

endocervicalendocervical type. type.

Various types of endometrial hyperplasia: Various types of endometrial hyperplasia: A,A,simple without simple without atypiaatypia. .

Various types of endometrial hyperplasia: Various types of endometrial hyperplasia: B,B,simple with simple with atypiaatypia. .

Various types of endometrial hyperplasia: Various types of endometrial hyperplasia: C,C,complex. complex.

Huge endometrial polyp filling the endometrial Huge endometrial polyp filling the endometrial cavity. There is also a smaller cavity. There is also a smaller endocervicalendocervical polyp polyp

and a and a subserosalsubserosal leiomyomaleiomyoma. .

LowLow--power appearance of endometrial polyp power appearance of endometrial polyp showing showing cysticallycystically dilated glands and a fibrous dilated glands and a fibrous

stromastroma with thickwith thick--walled vessels. walled vessels.

TamoxifenTamoxifen--related endometrial polyp: related endometrial polyp: A,A, gross gross appearance. appearance.

TamoxifenTamoxifen--related endometrial polyp: related endometrial polyp: B,B,microscopic appearance. microscopic appearance.

A,A, LowLow-- power appearance of power appearance of adenomyomatousadenomyomatouspolyp. polyp.

B,B, HighHigh--power appearance of power appearance of adenomyomatousadenomyomatouspolyp. polyp.

Atypical Atypical polypoidpolypoid adenomyomaadenomyoma. The gross . The gross appearance is not substantially different from that appearance is not substantially different from that

of an ordinary polyp. of an ordinary polyp.

A,A, WholeWhole--mount appearance of atypical mount appearance of atypical polypoidpolypoidadenomyomaadenomyoma. Note the glandular architectural . Note the glandular architectural complexity, complexity, metaplasticmetaplastic changes, and changes, and atypiaatypia. .

B,B, HighHigh--power appearance of atypical power appearance of atypical polypoidpolypoidadenomyomaadenomyoma. Note the glandular architectural . Note the glandular architectural complexity, complexity, metaplasticmetaplastic changes, and changes, and atypiaatypia. .

AA and and B,B, Gross appearances of Gross appearances of endometrioidendometrioidadenocarcinomaadenocarcinoma. The tumor shown in . The tumor shown in AA is is polypoidpolypoid, ,

whereas that depicted in whereas that depicted in BB is highly infiltrating. is highly infiltrating.

AA and and B,B, Gross appearances of Gross appearances of endometrioidendometrioidadenocarcinomaadenocarcinoma. The tumor shown in . The tumor shown in AA is is polypoidpolypoid, ,

whereas that depicted in whereas that depicted in BB is highly infiltrating. is highly infiltrating.

EndometrioidEndometrioid endometrial endometrial adenocarcinomaadenocarcinoma: : A,A,well differentiated. well differentiated.

EndometrioidEndometrioid endometrial endometrial adenocarcinomaadenocarcinoma: : B,B,moderately differentiated. moderately differentiated.

EndometrioidEndometrioid endometrial endometrial adenocarcinomaadenocarcinoma: : C,C,poorly differentiated. poorly differentiated.

EndometrioidEndometrioid endometrial endometrial adenocarcinomaadenocarcinoma: : D,D,with with villoglandularvilloglandular pattern of growth. pattern of growth.

WellWell--differentiated differentiated endometrioidendometrioid adenocarcinomaadenocarcinomawith with squamoussquamous metaplasiametaplasia (so(so--called called

““adenoacanthomaadenoacanthoma””). ).

A,A, Endometrial Endometrial adenocarcinomaadenocarcinoma of of endometrioidendometrioid type type with with squamoussquamous metaplasiametaplasia. In contrast to the case . In contrast to the case shown in the above the shown in the above the squamoussquamous component has component has

markedly atypical markedly atypical cytologiccytologic features. features.

B,B, Endometrial Endometrial adenocarcinomaadenocarcinoma of of endometrioidendometrioid type type with with squamoussquamous metaplasiametaplasia. In contrast to the case . In contrast to the case shown in the above the shown in the above the squamoussquamous component has component has

markedly atypical markedly atypical cytologiccytologic features. features.

SecretorySecretory carcinoma of carcinoma of endometriumendometrium. This well. This well--differentiated lesion is a variant of differentiated lesion is a variant of endometrioidendometrioid

adenocarcinomaadenocarcinoma and is composed of cells with abundant and is composed of cells with abundant clear to finely granular cytoplasm. It should be clear to finely granular cytoplasm. It should be

distinguished from clear cell carcinoma. distinguished from clear cell carcinoma.

Endometrial Endometrial adenocarcinomaadenocarcinoma of of mucinousmucinous type. type.

Gross appearance of papillary serous carcinoma Gross appearance of papillary serous carcinoma of of endometriumendometrium. The neoplasm fills the . The neoplasm fills the

endometrial cavity. endometrial cavity.

A,A, Low power appearance of serous carcinoma. Low power appearance of serous carcinoma. Note the high nuclear grade. Note the high nuclear grade.

B,B, HighHigh--power appearance of serous carcinoma. power appearance of serous carcinoma. Note the high nuclear grade. Note the high nuclear grade.

Serous carcinoma limited to the superficial Serous carcinoma limited to the superficial portion of a portion of a tamoxifentamoxifen--related endometrial polyp. related endometrial polyp.

Clear cell carcinoma of Clear cell carcinoma of endometriumendometrium. .

Gross appearance of a clear cell carcinoma Gross appearance of a clear cell carcinoma involving a large endometrial polyp. involving a large endometrial polyp.

Gross appearance of small cell Gross appearance of small cell neuroendocrineneuroendocrinecarcinoma of carcinoma of endometriumendometrium. The tumor is red and . The tumor is red and

fleshy, and has a soft consistency. fleshy, and has a soft consistency.

Small cell Small cell neuroendocrineneuroendocrine carcinoma of carcinoma of endometriumendometrium showing a diffuse pattern of growth. showing a diffuse pattern of growth.

Small cell Small cell neuroendocrineneuroendocrine carcinoma of carcinoma of endometriumendometrium admixed with admixed with endometrioidendometrioid

adenocarcinomaadenocarcinoma. This is a common combination. . This is a common combination.

Typical microscopic appearance of endometrial Typical microscopic appearance of endometrial stromalstromal tumor, showing bland oval cells arranged tumor, showing bland oval cells arranged

concentrically around spiral arterioles. concentrically around spiral arterioles.

Endometrial Endometrial stromalstromal nodule. The lesion is nodule. The lesion is characteristically well circumscribed and has a characteristically well circumscribed and has a

yellow color. yellow color.

LowLow--grade endometrial grade endometrial stromalstromal sarcoma showing sarcoma showing diffuse permeation of the diffuse permeation of the myometriummyometrium in the form in the form

of small nodules bulging on the cut surface. of small nodules bulging on the cut surface.

Typical lowTypical low--power appearance of endometrial power appearance of endometrial stromalstromal sarcoma. sarcoma.

LowLow--grade endometrial grade endometrial stromalstromal sarcoma presenting as a sarcoma presenting as a huge huge polypoidpolypoid mass within the endometrial cavity. This mass within the endometrial cavity. This

pattern of growth is unusual in this tumor type. pattern of growth is unusual in this tumor type.

Endometrial Endometrial stromalstromal sarcoma sarcoma metastaticmetastatic to wall of to wall of large bowel. large bowel.

A,A, LowLow--power appearance of endometrial power appearance of endometrial stromalstromalsarcoma sarcoma metastaticmetastatic to lung. This lesion may be to lung. This lesion may be

misdiagnosed as spindle misdiagnosed as spindle carcinoidcarcinoid tumor, tumor, hemangiopericytomahemangiopericytoma, or solitary fibrous tumor. , or solitary fibrous tumor.

B,B, HighHigh--power appearance of endometrial power appearance of endometrial stromalstromalsarcoma sarcoma metastaticmetastatic to lung. This lesion may be to lung. This lesion may be

misdiagnosed as spindle misdiagnosed as spindle carcinoidcarcinoid tumor, tumor, hemangiopericytomahemangiopericytoma, or solitary fibrous tumor. , or solitary fibrous tumor.

A,A, Endometrial Endometrial stromalstromal sarcoma with structures sarcoma with structures resembling ovarian sex cord tumors. resembling ovarian sex cord tumors.

B,B, SoSo--called called ““plexiformplexiform tumortumor”” of the uterus. This of the uterus. This lesion is probably related to endometrial lesion is probably related to endometrial stromalstromal

neoplasmsneoplasms, but its , but its histogenesishistogenesis is still is still controversialcontroversial

Peritoneal metastasis from endometrial Peritoneal metastasis from endometrial stromalstromalsarcoma accompanied by benign sarcoma accompanied by benign endometrioidendometrioid

glands. glands.

A,A, Gross appearance of highGross appearance of high--grade endometrial grade endometrial sarcoma. sarcoma.

B,B, Microscopic appearance of highMicroscopic appearance of high--grade grade endometrial sarcoma. endometrial sarcoma.

Malignant mixed Malignant mixed mmüüllerianllerian tumor of uterus tumor of uterus resulting in a huge resulting in a huge polypoidpolypoid mass. mass.

Glandular and Glandular and mesenchymalmesenchymal components of components of mixed mixed mmüüllerianllerian tumor. tumor. HeterologousHeterologous elements in elements in

the form of cartilage are present. the form of cartilage are present.

Skeletal muscle elements in mixed Skeletal muscle elements in mixed mmüüllerianlleriantumor, seen on H&E stain (tumor, seen on H&E stain (AA). ).

Skeletal muscle elements in mixed Skeletal muscle elements in mixed mmüüllerianlleriantumor, seen on tumor, seen on immunostainingimmunostaining for for myoglobinmyoglobin

((BB). ).

MMüüllerianllerian adenosarcomaadenosarcoma. The tumor shows a . The tumor shows a lesser degree of necrosis and hemorrhage than lesser degree of necrosis and hemorrhage than

the usual malignant mixed the usual malignant mixed mmüüllerianllerian tumor. tumor.

A,A, LowLow--power view of power view of mmüüllerianllerian adenosarcomaadenosarcoma. . The resemblance to The resemblance to phylloidesphylloides tumor of breast is tumor of breast is

obvious. obvious.

B,B, HighHigh--power view of power view of mmüüllerianllerian adenosarcomaadenosarcoma. . The resemblance to The resemblance to phylloidesphylloides tumor of breast is tumor of breast is

obvious. obvious.

MMüüllerianllerian adenosarcomaadenosarcoma (top) with (top) with sarcomatoussarcomatousovergrowth (bottom). overgrowth (bottom).

Papillary Papillary adenofibromaadenofibroma of uterus. This lesion of uterus. This lesion represents the lower end of the represents the lower end of the mmüüllerianllerian

adenosarcomaadenosarcoma spectrum. spectrum.

Multiple uterine Multiple uterine leiomyomasleiomyomas. .

Large uterine Large uterine leiomyomaleiomyoma with intramural and with intramural and subseroussubserous involvement. involvement.

Elongated spindle cells with Elongated spindle cells with fibrillaryfibrillary acidophilic acidophilic cytoplasm in the usual type of uterine cytoplasm in the usual type of uterine leiomyomaleiomyoma. .

This uterine This uterine leiomyomaleiomyoma has undergone massive has undergone massive red degeneration. red degeneration.

LeiomyomaLeiomyoma with edematous (with edematous (hydropichydropic) changes ) changes leading to the formation of cystic cavities. leading to the formation of cystic cavities.

SoSo--called called ““perinodularperinodular hydropichydropic degenerationdegeneration”” in in uterine uterine leiomyomaleiomyoma. .

Cellular Cellular leiomyomaleiomyoma. There is no . There is no pleomorphismpleomorphism, , undue mitotic activity, or necrosis. undue mitotic activity, or necrosis.

A,A, LowLow--power view of bizarre power view of bizarre leiomyomaleiomyoma. The . The size of some of the tumor cell nuclei makes them size of some of the tumor cell nuclei makes them

almost visible to the naked eye. almost visible to the naked eye.

B,B, High power view of bizarre High power view of bizarre leiomyomaleiomyoma. The . The size of some of the tumor cell nuclei makes them size of some of the tumor cell nuclei makes them

almost visible to the naked eye. almost visible to the naked eye.

MitoticallyMitotically active active leiomyomaleiomyoma. There is no . There is no pleomorphismpleomorphism or necrosis. or necrosis.

Admixture of mature smooth muscle and adipose Admixture of mature smooth muscle and adipose tissue in tissue in leiomyolipomaleiomyolipoma. .

Clear cell Clear cell leiomyomaleiomyoma (benign (benign leiomyoblastomaleiomyoblastoma): ): A,A, gross appearance. The tumor cells have a gross appearance. The tumor cells have a

round shape and an round shape and an artifactuallyartifactually clear cytoplasm.clear cytoplasm.

Clear cell Clear cell leiomyomaleiomyoma (benign (benign leiomyoblastomaleiomyoblastoma): ): B,B,microscopic appearance. The tumor cells have a round microscopic appearance. The tumor cells have a round

shape and an shape and an artifactuallyartifactually clear cytoplasm. clear cytoplasm.

MicronodularMicronodular microscopic appearance of uterine microscopic appearance of uterine leiomyomaleiomyoma having the gross appearance of sohaving the gross appearance of so--

called called ““cotyledonoidcotyledonoid dissecting type.dissecting type.””

Large plugs of mature smooth muscle filling the Large plugs of mature smooth muscle filling the vascular vascular luminalumina in intravenous in intravenous leiomyomatosisleiomyomatosis. .

Intravenous Intravenous leiomyomatosisleiomyomatosis composed of clear composed of clear smooth muscle cells. smooth muscle cells.

LeiomyosarcomaLeiomyosarcoma resulting in a large intramural resulting in a large intramural and and submucoussubmucous mass. There are foci of mass. There are foci of

hemorrhage and necrosis. hemorrhage and necrosis.

LeiomyosarcomaLeiomyosarcoma showing showing hypercellularityhypercellularity, , pleomorphismpleomorphism, atypical mitoses, and necrosis. , atypical mitoses, and necrosis.

Uterine Uterine myxoidmyxoid leiomyosarcomaleiomyosarcoma

Malignant giant cell tumor of uterus. This is Malignant giant cell tumor of uterus. This is regarded as a variant of regarded as a variant of leiomyosarcomaleiomyosarcoma with with

osteoclastosteoclast--like giant cells. like giant cells.

AdenomatoidAdenomatoid tumor of uterus. tumor of uterus. A,A, Gross Gross appearance. The location at one of the appearance. The location at one of the cornuacornua is is

characteristic. characteristic.

AdenomatoidAdenomatoid tumor of uterus. tumor of uterus. B,B, Microscopic Microscopic appearance showing tubular formations lined by appearance showing tubular formations lined by

flattened flattened mesothelialmesothelial cells. cells.

EwingEwing’’s sarcoma/PNET presenting as a uterine s sarcoma/PNET presenting as a uterine mass, a most unusual occurrence. mass, a most unusual occurrence.

EpithelioidEpithelioid angiosarcomaangiosarcoma arising within an uterine arising within an uterine leiomyosarcomaleiomyosarcoma. .

LowLow--grade marginal zonegrade marginal zone--type malignant type malignant lymphoma involving uterine mucosa. lymphoma involving uterine mucosa.

Lobular breast carcinoma Lobular breast carcinoma metastaticmetastatic to to myometriummyometrium. Note the Indian file pattern of . Note the Indian file pattern of

growth. growth.