Gyn

Front 1

A female patient who is 32 years old presents with intermittent vaginal bleeding. An
endometrial biopsy is performed, and representative images are shown for this case. Which of the following
is the best diagnosis?
A. Endometrial Adenocarcinoma
B. Placental Site Trophoblastic Tumor
C. Epithelioid Trophoblastic Tumor
D. Choriocarcinoma
E. Carcinosarcoma

Back 1

D. These images represent a choriocarcinoma. Choriocarcinoma is associated with a complete
hydatiform mole in 50% of cases. Interestingly, choriocarcinoma is often associated with some type of
abnormality during pregnancy. Time from pregnancy to presentation may sometime times be delayed many
years. The histologic hallmark of this lesion is the biphasic appearance of the tumor with
syncytiotrophoblastic cells and mononuclear trophoblastic cells. The syncytiotrophoblastic cells will stain
for beta hCG. Many of these tumors will have extensive necrosis, and additional sections with multiple
levels may be necessary to identify this biphasic cell population.

Front 2

A uterine mass is found in a 45-year-old female complaining of severe abdominal cramps for
which an abdominal hysterectomy was performed. Gross examination of the uterus showed a single 3 cm
nodule in the myometrial wall. Representative histologic images are shown for this case.
Immunohistochemistry for CK5/6 is positive in the nucleated cells shown at high power. Based on these
findings, which of the following is the best diagnosis?
A. Leiomyoma
B. Leiomyosarcoma
C. Endometrial stromal sarcoma
D. Adenomatoid tumor
E. Angiomyelolipoma

Back 2

D. Uterine adenomatoid tumor is usually found subserosal near the cornua. Epithelial like cells
(cuboidal or flat) are trapped between bands of smooth muscle. They can appear like a lymphangioma.
These lesions are not that common, and if the epithelial like cells are particularly flattened may easily be
dismissed as a leiomyoma. The epithelial like cells are mesothelial in origin and will stain with CK 5/6.

Front 3

After several months of abnormal bleeding, a 37-year-old female patient presents to her
gynecologist for an endometrial biopsy. Representative histologic images of this biopsy are shown.
Additional findings not shown include: fragments of unremarkable endometrium adjacent to lesional tissue
shown, and areas of morular metaplasia within lesional tissue. Based on these findings, which of the
following is the most likely diagnosis?
A. Atypical polypoid adenomyoma
B. Adenofibroma
C. Endometrial adenocarcinoma
D. Malignant mixed müllerian tumor
E. Endometrial Polyp

Back 3

A. Atypical Polypoid Adenomyoma (APA) usually occurs in the lower uterine segment and
rarely is found after menopause. It is characterized by features of atypical endometrial hyperplasia (>90%
have squamous morula formation) within bands of smooth muscle. Biopsies classically have fragments of
normal endometrium combined with fragments of APA.

Front 4

A 45-year-old patient presents to her gynecologist with severe of abdominal cramps.
Abdominal ultrasound is suspicious for uterine fibroids. An abdominal hysterectomy is performed, and
representative images of a uterine mass found to invade into the outer half of the myometrium is shown.
Based on these findings, which of the following is the best diagnosis?
A. Cellular leiomyoma
B. Stromal nodule
C. Low-grade endometrial stromal sarcoma
D. Undifferentiated uterine sarcoma
E. Leiomyosarcoma

Back 4

C. Low Grade Endometrial Stromal Sarcoma is essentially the same thing as an endometrial
stromal nodule, but it shows invasion into the myometrium and/or vasculature. It can often have a “bag of
worms” appearance grossly. In the past low grade ESS was differentiated from high grade ESS by a mitotic
index <10. Currently, high grade ESS is no longer recognized, and poorly differentiated forms are
categorized as undifferentiated uterine sarcomas. In differentiating low grade ESS from leiomyomas, CD10
often diffusely stains ESS and may focally be positive in leiomyomas. It should be noted that there is no
perfect marker, and H&E impression is often the best.

Front 5

primary uterine serious carcinoma is found to extend from the uterus into the cervix (no
cervical stromal invasion) and invades the outer one half of the myometrium. What is the pathologic stage
(pT)?
A. pT1a
B. pT1b
C. pT1c
D. pT2a
E. pT2b

Back 5

pT2 is characterized by tumor that invades the cervix but does not extend outside the uterus. It
is subdivided into pT2a and pT2b, which is characterized by lack of invasion into cervical stromal
connective tissue and invasion of cervical stromal connective tissue, respectively.

Front 6

primary ovarian serious carcinoma is present on the surface of the right and left ovaries.
Malignant cells are identified in peritoneal washings, but there is no other pelvic extension and/or pelvic
implants. What is the pathologic stage (pT)?
A. pT1b
B. pT1c
C. pT2a
D. pT2b
E. pT3a

Back 6

pT1 in the ovary staging categorization scheme is when tumor is limited to one or both ovaries
(with or without malignant cells in peritoneal washings). pT2 is characterized by tumor involving one or
both ovaries with the presence of pelvic extension of disease (including implants).

Front 7

A cervical carcinoma is diagnosed at hysterectomy. It is found to extend laterally into the
pelvic wall, but does not invade into the uterus or lower third of the vagina. Based on these findings what is
the pathologic stage?
A. pT1
B. pT2a
C. pT2b
D. pT3
E. pT4

Back 7

Pathologic stage pT3 is classified by cervical carcinoma that extends to the pelvic wall, causes
hydronephrosis or a nonfunctioning kidney, or extends below the lower third of the vagina. If any one of
these findings is present, then it is pathological stage pT3. The pathologic stage pT2 is when the tumor
extends into the uterus but does not meet criteria for pT3 or pT4.

Front 8

Back 8

Hemorrhagic endovasculitis
Associated with chronic villitis of unknown etiology, chorionic vessel thrombi, villous erythroblastosis, villous fibrosis, primary infarcts, meconium staining, maternal hypertension

Front 9

22 y.o. woman, LMP 2 weeks, routine evaluation; DX?

Back 9

NILM: Endocervical cells

Front 10

conventional smear, interpretation?

Back 10

NILM: Squamous metaplasia

Front 11

25 year old female

Back 11

NILM: Shift in Flora suggestive of bacterial vaginosis

Front 12

Back 12

NILM: Cellular changes consistent with Herpes simplex virus

Front 13

Back 13

NILM: Trichomonas vaginalis and Leptothrix

Front 14

45 year old woman

Back 14

NILM: Fungal organisms, consistent with Candida spp.Spearing of epithelial cells by candida pseudohyphae ("shish kebob" effect).

Front 15

Back 15

NILM: Reactive squamous cells

Front 16

27 year old woman, routine exam, LMP 18 days

Back 16

NILM: Squamous metaplasia

Front 17

67 yo woman with uterine prolapse

Back 17

NILM: Reactive cellular changes, Repair; flat monolayer sheets with distinct cytoplasmic outlines, streaming nuclear polarity

Front 18

40 year old woman s/p squamous cell carcinoma of the cervix. Completion of radiation therapy 8 weeks ago

Back 18

NILM: Reactive cellular changes associated with Radiation

Hint 18

Enlarged nuclei with abundant polychromatic cytoplasm with vacuolization. Mild nuclear hyperchromasia without coarse chromatin, prominent nucleoli (coexisting repair). Note multinucleation (upper right corner insert).

Front 19

Back 19

NILM: Reactive cellular changes associated with IUD

Hint 19

small cluster of glandular cells with cytoplasmic vacuoles displacing nuclei. The cytoplasmic vacuoles may displace the nucleus, creating a signet-ring appearance.

Front 20

Routine Pap smear

Back 20

NILM: Lymphocytic (follicular) cervicitis

Hint 20

Abundant lymphocytes with tingible body macrophage located centrally.

Front 21

exfoliated endometrial cells may be seen in this phase

Back 21

proliferative phase: tubular glands with columnar cells and surrounding dense stroma; 4-7days

Hint 21

endometrium
estrogen

Front 22

Back 22

secretory endometrium; subnuclear vacuoles in cells forming the glands is consistent with post-ovulatory day 2

Hint 22

endometrium
progesterone

Front 23

maximal stromal edema in luteal phase; best time for implantation (“day 22, I'm ready for you”)

Back 23

secretory phase follows a set 14 day course leading to either implantation of a fertilized ovum or menstruation

Front 24

43yo woman

Back 24

Endometrial cells are present in a woman >= 40 years of age. Negative for squamous intraepithelial lesion. (See Note)
Note: Endometrial cells after age 40, particularly out of phase or after menopause may be associated with benign endometrium, hormonal alterations and less commonly, endometrial /uterine abnormalities. Clinical correlation is recommended

Front 25

routine Pap smear in a 43 year old

Back 25

NILM; Round to spindle shaped deep stromal cells. Small oval nuclei. Scant cytoplasm.

Front 26

Back 26

NILM vs ASC-US

Front 27

Back 27

ASC-US

Front 28

premenopausal woman

Back 28

cannot exclude HSIL (ASC-H); Loosely cohesive metaplastic cells with increased N:C ; f/u was CIN3

Front 29

Back 29

NILM vs ASC-H;Findings may suggest either nuclear irregularity or bi-nucleation. Focusing "up and down" may be necessary to appreciate binucleation.

Front 30

Back 30

LSIL; Mature squamous cells display enlarged nuclei with granular chromatin and large cytoplasmic cavitations consistent LSIL and human papillomavirus cytopathic effect.

Front 31

Back 31

HSIL; Isolated abnormal cells with evenly distributed coarse chromatin, centrally placed enlarged nuclei, and dense / "metaplastic" cytoplasm are consistent with HSIL. A mitotic figure is evident.

Front 32

31 year old woman with hx of AEC on Pap smears over the previous two years and negative tissue studies.

Back 32

Atypical endocervical cells

Front 33

Postmenopausal woman. Routine Pap test

Back 33

Atrophy with inflammation (?atrophic vaginitis?). Note granular debris in background, degenerating parabasal cells and polymorphonuclear leukocytes.

Front 34

30 year old female, pregnant with right ovarian cyst.

Back 34

ASC-US; Multinucleated cell with enlarged nuclei. Some air drying present.

Front 35

Back 35

Endocervical adenocarcinoma in situ (AIS); Rosette arrangements, oval or elongated nuclei and evenly distributed granular chromatin are classic features of AIS.

Front 36

Back 36

Conventional smears containing cells consistent with HSIL often display dysplastic cells in a strand of mucus

Front 37

Within the laboratory, which of the following is true with regards to the Atypical Squamous Cells diagnosis
rate?

Back 37

It should not exceed 2 – 3 times the diagnosis rate of Low Grade SIL
With the new 2004 Bethesda System, the goal was to increase reproducibility and decrease the rates of
ASC. The rate of ASC diagnosis should not be more than 2 – 3 times the rate of the diagnosis of low grade SIL.
Rates above this should prompt reeducation and closer scrutiny. In general, the ASC rate should not exceed 5% of
cases.

Front 38

A 65-year-old female was noted to have an endometrial mass. Represent sections of the
biopsy are shown in the images for this case. At hysterectomy, the lesion was noted to be noninvasive,
confined to the endometrium, and had 1 mitotic figure per 10 hpf. Based on these findings, which of the
following is the best diagnosis?
A. Atypical Polypoid Adenomyoma
B. Adenofibroma
C. Adenosarcoma
D. Carcinosarcoma
E. Endometrial Stromal Sarcoma

Back 38

B. Adenofibromas usually occur in postmenopausal women. They typically arise in either the
cervix or endometrium, but rarely can occur in the uterus. They are characterized by papillary projections
with benign epithelium. The epithelial lining can be serious, nucinous, or endometroid with or without
squamous metaplasia. The stroma must be bland and can have no more than 2 mitotic figures per 10 highpower
fields. The most important thing to realize when making a diagnosis of an adenofibroma is to know
that it cannot be diagnosed on biopsy. Adenosarcomas often very from area to area in mitotic activity and
cellularity. Therefore, an adenosarcoma cannot be eliminated as a diagnostic possibility in a biopsy sample.
When this diagnostic possibility arises on a biopsy sample, a hysterectomy should be recommended for
complete evaluation.

Front 39

A female patient who is 32 years old presents with intermittent vaginal bleeding. An
endometrial biopsy is performed, and representative images are shown for this case. Which of the following
is the best diagnosis?
A. Endometrial Adenocarcinoma
B. Placental Site Trophoblastic Tumor
C. Epithelioid Trophoblastic Tumor
D. Choriocarcinoma
E. Carcinosarcoma

Back 39

D. These images represent a choriocarcinoma. Choriocarcinoma is associated with a complete
hydatiform mole in 50% of cases. Interestingly, choriocarcinoma is often associated with some type of
abnormality during pregnancy. Time from pregnancy to presentation may sometime times be delayed many
years. The histologic hallmark of this lesion is the biphasic appearance of the tumor with
syncytiotrophoblastic cells and mononuclear trophoblastic cells. The syncytiotrophoblastic cells will stain
for beta hCG. Many of these tumors will have extensive necrosis, and additional sections with multiple
levels may be necessary to identify this biphasic cell population.

Front 40

A 55-year-old female presents with intermittent vaginal bleeding. A Pap smear was
performed, and a representative image is shown. Clinically, the uterus is slightly enlarged, and the cervix is
grossly unremarkable. Based on these findings, what is the most likely diagnosis?
A. CIN I
B. CIN II
C. CIN III
D. AGUS
E. Endometrial Adenocarcinoma

Back 40

E. This image represents the cytology of endometrial adenocarcinoma. It would be an unfair
question to show one cytology image and expect someone to make the exact classification. However, given
the patient's history combined with the architectural findings, the most reasonable diagnosis in this case
would be endometrial adenocarcinoma. CIN I-III are squamous lesions and the characterization is based on
nuclear features which are not shown in this image. This image shows a relative low-power of a large threedimensional
structure with pleomorphic nuclei (i.e. malignant features). The most reasonable approach this
question is to realize that this cytology is a malignant, and combine these factors with the clinical
information to arrive at the diagnosis.

Front 41

A 65-year-old female presents with an ovarian mass. An oophorectomy is performed, and
representative images are shown for this case. Based on the histologic findings, what is the best diagnosis?
A. Endometrioid Adenocarcinoma
B. Yolk Sac Tumor
C. Brenner Tumor
D. Dysgerminoma
E. Clear Cell Carcinoma

Back 41

E. Clear cell carcinoma the ovary is often accompanied by endometriosis, and account for
approximately 5% of ovarian cancers. Morphologically the two most common patterns are tubulocystic and
diffuse. The clear cells have the same appearance as clear cell carcinoma of the endometrium with
hobnailing, clear cytoplasm, and atypical nuclei. In some cases, there can be prominent eosinophilia, but
typical clear cells can still usually be found.

Front 42

A 40-year-old female presents with an ovarian mass. An oophorectomy is performed, and
representative images are shown. Based on the findings, what is the best diagnosis?
A. Serous Cystadenoma
B. Serous Cystadenoma of Borderline Malignant Potential
C. Mucinous Cystadenoma
D. Mucinous Cystadenoma Borderline Malignant Potential
E. Endometrioid Cystadenoma

Back 42

C. Mucinous tumors are on average the largest ovarian tumor. Benign, borderline, and malignant
mucinous tumors can be indistinguishable grossly. Benign mucinous cystadenomas are lined by a single
layer of mucin containing cells. In contrast, intestinal-type mucinous borderline tumors have cellular
stratification (two to three layers), fusiform papilla, and mild to moderate atypia. This case lacks significant
stratification. In cases of pseudomyxoma peritonei, an appendiceal primary tumor is usually found.
Therefore, be careful in making the diagnosis of a borderline mucinous tumor in a patient with
pseudomyxoma peritonei because it most likely represents a metastatic lesion from the appendix.

Front 43

A 48-year-old female is found to have a 1.5 cm ovarian mass lesion that is separate from
another lesion for which an oophorectomy was being performed. The images for this case show that
histology for the 1.5 cm mass lesion. Based on the findings, what is the diagnosis?
A. Brenner Tumor
B. Proliferating Brenner Tumor
C. Malignant Brenner Tumor
D. Transitional Cell Carcinoma
E. Squamous Cell Carcinoma

Back 43

A. Brenner Tumors are characterized by epithelial cells arranged in nests surrounded by fibrous to
thecomatous stroma. The epithelial cells often will have a longitudinal groove (adult granulose cell tumors
will also often have this groove) and resemble urothelial cells. Approximately 1/3rd of cases are associated
with a mucinous lesion (e.g. mucinous cystadenoma). Benign Brenner tumors are usually less than 2cm and
sharply circumscribed.

Front 44

Brenner tumors associated with what type and frequency of a lesion?
A. Serous lesions, 30%
B. Serous lesions, 70%
C. Mucinous lesions, 30%
D. Mucinous lesions, 70%
E. Endometriosis of the ovary, 50%

Back 44

C. Approximately one third of Brenner tumors are associated with a mucinous lesion in the ovary.

Front 45

In a patient with choriocarcinoma, which is a fall Lab abnormalities do you expect to find
elevated, which may be helpful diagnostically?
A. Beta hCG
B. Alpha-fetoprotein
C. LDH
D. CEA
E. CD19-9

Back 45

A. Beta hCG is typically elevated choriocarcinoma. In fact, beta hCG immunohistochemistry will
usually stain the syncytiotrophoblastic cells in the tumor. Alpha-fetoprotein is often elevated in yolk sac
tumors and hepatocellular carcinoma.

Front 46

An endometrial adenocarcinoma that invades two thirds of the depth of the myometrium
would be classified as which of the following according to the AJCC cancer staging manual, sixth edition?
A. T1a
B. T1b
C. T1c
D. T2a
E. T2b

Back 46

C. T1c is characterized by tumor that invades at least one half or more of the myometrial thickness.
T1a is limited to the endometrium, and T1b as invasion through less than one half of the myometrium.

Front 47

When staging a primary ovarian tumor, according to the AJCC staging manual, which of the
following categories would represent tumor limited to the ovary but having positive peritoneal washings?
A. T1a
B. T1b
C. T1c
D. T2c
E. T3c

Back 47

C. T1 represents tumor limited to the ovaries. The designation “c” is used in the categories T1 and
T2 to designate positive peritoneal washings. T2 represents tumor extending beyond the ovaries into the
pelvis, and T3 represents tumor outside of the pelvis.

Front 48

An ovarian mass found in a 73-year-old patient. An oophorectomy is performed, and
representative images of the mass are shown. Based on these findings, which of the following is the best
diagnosis?
A. Granulosa cell tumor
B. Sertoli Leidig cell tumor
C. Malignant Brenner tumor
D. Clear cell carcinoma
E. Dysgerminoma

Back 48

D. Clear Cell Carcinoma (Ovary). Clear cell carcinoma the ovary is often accompanied by
endometriosis, and account for approximately 5% of ovarian cancers. Morphologically the two most
common patterns are tubulocystic and diffuse. The clear cells have the same appearance as clear cell
carcinoma of the endometrium with hobnailing, clear cytoplasm, and atypical nuclei. In some cases, there
can be prominent eosinophilia, but typical clear cells can still usually be found.

Front 49

A 21-year-old patient is found to have an ovarian mass. A right-sided oophorectomy is
performed, and representative histologic images are shown. Based on these findings, which of the following
is the best diagnosis?
A. Yolk sac tumor
B. Granulosa Cell Tumor
C. Seminoma
D. Dysgerminoma
E. Teratoma

Back 49

D. Dysgerminoma (Ovary). The dysgerminoma of the ovary is the female counterpart of the
seminoma in the male. Sometimes it can be associated with hypercalcemia, which is classically associated
with small cell carcinoma of the ovary. It usually occurs during the first two decades of life. Histologically,
fibrous septa are usually present throughout the tumor, which also have a prominent lymphocyte infiltrate.
Sometimes the infiltrate may be so dominant that it overshadows the underlying tumor cells. The individual
cells will have well-defined membranes, clear cytoplasm, and nuclei with prominent nucleoli. The cells
generally have a uniform appearance from cell to cell. Seminomas and dysgerminomas are positive for PAS
(highlights glycogen within the cells) and PLAP. CD 117 is also positive in most cases. EMA and CD30 are
typically negative. Sometimes a dysgerminoma may be difficult to distinguish from a yolk sac tumor

Front 50

A 21-year-old patient is found to have an ovarian mass. A right-sided oophorectomy is
performed, and representative histologic images are shown. Based on these findings, which of the following
is the best diagnosis?
A. Yolk sac tumor
B. Granulosa Cell Tumor
C. Seminoma
D. Dysgerminoma
E. Teratoma

Back 50

D. Dysgerminoma (Ovary). The dysgerminoma of the ovary is the female counterpart of the
seminoma in the male. Sometimes it can be associated with hypercalcemia, which is classically associated
with small cell carcinoma of the ovary. It usually occurs during the first two decades of life. Histologically,
fibrous septa are usually present throughout the tumor, which also have a prominent lymphocyte infiltrate.
Sometimes the infiltrate may be so dominant that it overshadows the underlying tumor cells. The individual
cells will have well-defined membranes, clear cytoplasm, and nuclei with prominent nucleoli. The cells
generally have a uniform appearance from cell to cell. Seminomas and dysgerminomas are positive for PAS
(highlights glycogen within the cells) and PLAP. CD 117 is also positive in most cases. EMA and CD30 are
typically negative. Sometimes a dysgerminoma may be difficult to distinguish from a yolk sac tumor

Front 51

A 42 y/o female with dysfunctional uterine bleeding is found to have a mass present within
the uterine cavity. There is no gross evidence of invasion and does not appear to extend to the lower uterine
segment. What is the most likely diagnosis?
A. Endometrial Adenocarcinoma
B. Simple hyperplasia
C. Clear cell carcinoma
D. Cervical adenocarcinoma
E. Serous carcinoma

Back 51

A. This case represents endometrial carcinoma. Adenocarcinoma of the cervix can look virtually
identical, but there is no evidence of a mass being associated with the cervix. Serous and Clear cell
carcinoma have high grade histology, which is not present in this case.

Front 52

A primary uterine serious carcinoma is found to extend from the uterus into the cervix (no
cervical stromal invasion) and invades the outer one half of the myometrium. What is the pathologic stage
(pT)?
A. pT1a
B. pT1b
C. pT1c
D. pT2a
E. pT2b

Back 52

D. pT2 is characterized by tumor that invades the cervix but does not extend outside the uterus. It
is subdivided into pT2a and pT2b, which is characterized by lack of invasion into cervical stromal
connective tissue and invasion of cervical stromal connective tissue, respectively.

Front 53

A primary ovarian serious carcinoma is present on the surface of the right and left ovaries.
Malignant cells are identified in peritoneal washings, but there is no other pelvic extension and/or pelvic
implants. What is the pathologic stage (pT)?
A. pT1b
B. pT1c
C. pT2a
D. pT2b
E. pT3a

Back 53

B. pT1 in the ovary staging categorization scheme is when tumor is limited to one or both ovaries
(with or without malignant cells in peritoneal washings). pT2 is characterized by tumor involving one or
both ovaries with the presence of pelvic extension of disease (including implants).

Front 54

A cervical carcinoma is diagnosed at hysterectomy. It is found to extend laterally into the
pelvic wall, but does not invade into the uterus or lower third of the vagina. Based on these findings what is
the pathologic stage?
A. pT1
B. pT2a
C. pT2b
D. pT3
E. pT4

Back 54

D. Pathologic stage pT3 is classified by cervical carcinoma that extends to the pelvic wall, causes
hydronephrosis or a nonfunctioning kidney, or extends below the lower third of the vagina. If any one of
these findings is present, then it is pathological stage pT3. The pathologic stage pT2 is when the tumor
extends into the uterus but does not meet criteria for pT3 or pT4.

Front 55

median age 19 years
Serum α-fetoprotein level elevated

Back 55

Yolk Sac Tumor

Front 56

Usually childbearing age
75% have hyperestrinism
Elevated serum inhibin and follicle regulatory proteins

Back 56

Granulosa Cell Tumor

Front 57

Back 57

Figure 22-16 In the diagram (upper), reserve cells in the transformation zone are continuous with the basal cells of the ectocervix (right) and may undergo columnar and squamous differentiation (metaplasia). Photomicrographs at bottom depict (from left to right) quiescent subcolumnar reserve cells, reserve cells undergoing columnar differentiation (second from left), reserve cells undergoing squamous metaplasia (second from right) and ectocervical squamous epithelium (right).

Front 58

Back 58

development of the cervical transformation zone

Front 59

Back 59

Serous cystadenoma. This benign cyst is lined by a single layer of ciliated columnar cells resembling normal tubal epithelium.

Front 60

Primarily children and adolescents:
most aged 3–12 years

Back 60

Embryonal Rhabdomyosarcoma Aka sarcoma botyroides
small tumor cells with oval nuclei, cytoplasm protrudes from one end; resemble tennis rackets with bright, eosinophilic granular cytoplasm suggesting of rhabdomyoblastic differentiation
Dense zone of undifferentiated tumor cells immediately beneath epithelium:
Nicholson's cambium layer

Front 61

Usually young patients (81% under age 30)
5% associated with gonadal dysgenesis/Swyer syndrome

Back 61

Positive stains: OCT4 (strong nuclear staining in 90%+ cells, Am J Surg Pathol 2004;28:1341), c-kit (87%, Mod Pathol 2005;18:1411), CAM5.2 (20%), AE1-AE3 (8%, Hum Pathol 2006;37:1015)
Negative stains: CK7, CK20, EMA, HMW keratin, CD30, vimentin

Front 62

Young age group (median age 15 years):
47% prepubertal at diagnosis, 43% of whom present with precocious puberty1
Vaginal bleeding in 33%
Amenorrhea in 7%
Hirsutism in 7%
Serum α-fetoprotein levels often elevated
Chorionic gonadotropin levels invariably high:
results in consistently positive pregnancy tests

Back 62

Embryonal carcinoma

Front 63

Usually young patients (81% under age 30)
5% associated with gonadal dysgenesis/Swyer syndrome

Back 63

Positive stains: OCT4 (strong nuclear staining in 90%+ cells, Am J Surg Pathol 2004;28:1341), c-kit (87%, Mod Pathol 2005;18:1411), CAM5.2 (20%), AE1-AE3 (8%, Hum Pathol 2006;37:1015)
Negative stains: CK7, CK20, EMA, HMW keratin, CD30, vimentin

Front 64

Usually women age 15+ years; 75% associated with hyperestrogenism, causes precocious puberty in children, metrorrhagia (bleeding between periods), endometrial hyperplasia / carcinoma (usually well differentiated and superficial), breast fibrocystic changes in adults

Back 64

Embryonal carcinomaGranulosa cell tumor-adult