Publisher of the AFIP/ARP fascicles
(16)
Leydig cell tumors are ovarian stromal tumors that usually present clinically with endocrine manifestations (androgenic >>> estrogenic). The presence of Reinke crystals (D) and hilar location distinguish these tumors from steroid cell tumor, NOS.
While we're looking at thyroid tissue here, we are still indeed discussing the o***y fascicle - this is struma ovarii (A), a type of monodermal teratoma! Thyroid-type neoplasms can occur in these, including follicular (B,C) or papillary carcinoma.
From the o***y fascicle:
STK11 adnexal tumor, frequently associated with Peutz-Jeghers syndrome, is most commonly a paratubal mass that is densely cellular with variable amounts of epithelial cells with heterogeneous morphology.
More from the o***y fascicle!
Metaplastic papillary tumor is typically discovered incidentally in the fallopian tubes of pregnant/postpartum patients, and closely resembles (and may represent) a serous borderline tumor. All reported cases have been benign.
More from the o***y fascicle (available for purchase at arppress.org):
In cases of low-grade serous carcinoma of the o***y in which greater than 75% of tumor nests contain calcifications, the term serous psammocarcinoma can be utilized.
More from the o***y fascicle:
Ovarian fibromas are often unilateral with a white to yellow, fibrous cut surface (A,B), and microscopically vary from hypocellular to hypercellular fascicles of spindle cells (C,D). Eosinophilic hyaline globules can be seen (E).
More from the o***y fascicle (arppress.org):
Serous borderline tumors of the o***y have collagenous to edematous stromal papillae with hierarchical branching (left, A-D) that end in exfoliating micropapillae (right), a diagnostic requirement.
More from the newly available o***y fascicle (arppress.org):
Serous cystadenofibromas have both cystic and fibromatous growth and can mimic borderline tumors grossly. The papillae of cystadenofibromas are broad-based compared to those of borderline tumors.
From the newly available o***y/fallopian tube fascicle (arppress.org):
Microcystic stromal tumors are s*x cord-stromal tumors with a distinctive triad of solid cellular zones, fibrous stroma, and microcysts. These tumors may be associated with FAP.
More from the serosa fascicle:
Epithelioid mesothelioma stains for AE1/AE3, calretinin (A), WT-1 (B), CK5/6 (C), and D2-40 (D), while sarcomatoid mesothelioma less reliably expresses these markers with keratins (right) and D2-40 being the most likely to be positive.
More from the serosa fascicle:
Desmoplastic sarcomatoid mesothelioma can be deceptively bland (left). Areas with more obvious atypia (right) are helpful when present.
From the serosa fascicle (available at arppress.org):
Diffuse mesothelioma of the pleura classically forms a "rind" around the lung as it progresses, and it can grow both into the lung parenchyma and chest wall.
Well-differentiated papillary mesothelial tumor occurs in the peritoneum (most common), pleura, and pericardium and can present with ascites but has a good prognosis. These tumors show papillary architecture, lack of stratification, and low nuclear grade.
More from the serosa fascicle:
Calcifying fibrous tumor can occur in the abdomen or pleura and the histogenesis is uncertain. Tumors are characterized by a bland spindle cell infiltrate in a fibrous stroma with chronic inflammation and dystrophic calcification.
From our serosa fascicle (available at arppress.org):
Desmoplastic small round cell tumor is a malignant round cell mesenchymal neoplasm characterized by a EWSR1::WT1 fusion and has a dismal prognosis. Tumors are positive for keratins (C) and desmin (D)
Prepubertal v***ar fibroma is an uncommon, typically unilateral labial lesion of prepubescent/peripubescent girls consisting of an ill-defined spindle cell proliferation in a collagenous to edematous stroma. The spindle cells are often + CD34 and - SMA and desmin.
More from the cervix/v***a/va**na fascicle:
5-15% of granular cell tumors occur in the v***a, most frequently in the labium majus. Similar to other sites, the associated pseudoepitheliomatous hyperplasia can be a great mimic of well-differentiated squamous cell carcinoma
Vulvar sebaceous cell carcinoma is uncommon and comprised of nests or lobules of basaloid cells (A) and distinctive "sebocytes" with cytoplasmic vacuoles (B). While these tumors are diffusely p16 positive (C), they are not HPV-related. EMA is patchy (D).
Sometimes reviewing normal is nice - in the cervix, the transformation zone is where the endocervical columnar epithelium is replaced or overgrown by the squamous mucosa. Histologically, the junction of mature ectocervix and squamous metaplasia is seen (yellow line)
Lipoblastoma-like tumor of the v***a is a tumor of reproductive-aged women composed of lobules of variable amounts of mature adipose, lipoblasts, and spindle cells often in a myxoid matrix with branching blood vessels. These tumors lack DDIT3, PLAG1, and Rb alterations.
Angiokeratoma occurs in a wide anatomic distribution, including the v***a, and can be associated with Fabry disease. Histology shows an acanthotic epidermis that partially surrounds blood-filled dilated vascular channels within the papillary dermis which can thrombose.
From the cervix/va**na/v***a fascicle (arppress.org):
Vestibular papillomas are villiform excrescences at the introitus that are not true papillomas. They are likely hymenal ring remnants and are unrelated to HPV.
More from the cervix/va**na/v***a fascicle (arppress.org):
As opposed to va**nal embryonal rhabdomyosarcoma (ERMS) which occurs in infants, cervical ERMS occurs in adolescents/adults and has a better prognosis than other sarcomas that arise at this site.
More on sclerosing epithelioid mesenchymal neoplasm from the pancreas fascicle (arppress.org):
In studies thus far, SEMN is exclusive to the pancreas and a recurrent molecular alteration has not identified. More studies are needed to define biologic behavior.
Sclerosing epithelioid mesenchymal neoplasm (SEMN) is a recently described pancreatic tumor composed of bland, spindled to round/ovoid cells that express CK18 and CD99 by IHC. Tumors have alternating cellular and hypocellular areas in a geographic pattern.
More from the pancreas fascicle:
Undifferentiated carcinoma with osteoclast-like giant cells represents
More from the pancreas fascicle (arppress.org):
Acinar cell carcinoma (née "acinic") is a malignant epithelial neoplasm with acinar differentiation. Tumors are often well-circumscribed with a pushing border (left), but can invade locally (i.e. spleen; right).
One more post on solid pseudopapillary neoplasm (SPN):
SPN is considered of low malignant potential as metastases can infrequently occur. Tumors do frequently have infiltrative borders (without stromal reaction) despite a generally well-circumscribed gross appearance.
More on solid pseudopapillary neoplasm (SPN), from the pancreas fascicle:
"Pseudopapillary" refers to the frequent finding of degeneration/cell noncohesion with cells clinging to vessels (left). Tumors can also appear more solid or nested (right).
More from the pancreas fascicle (arppress.org):
Solid pseudopapillary neoplasm (SPN) is a rare tumor (1-3% of pancreas neoplasms) classically seen in young women which is variably solid to cystic. More on SPN later this week!
More from the pancreas fascicle:
Pancreatoblastoma is a malignant epithelial neoplasm of the pancreas, most common in childhood, composed of cells with acinar differentiation and squamoid nests.
From the newly released "Tumors of the pancreas" fascicle, available at arppress.org:
Mucinous cystic neoplasm (MCN) is a cyst-forming neoplasm composed of mucinous epithelium and ovarian-type stroma, associated with invasive carcinoma in 5% of cases.
Vaginal adenosis is a benign proliferation of glandular epithelium most often in the upper one third of the va**na associated with in utero exposure to Diethylstilbestrol (DES), a synthetic estrogen prescribed ~1940-1970 to prevent pregnancy loss.
Often mimicking condyloma on clinical exam, lymphangioma circumscriptum is a benign disorder of lymphatics that can occur in the v***a. These can be congenital or acquired, and the acquired form can be associated with any cause of lymphatic obstruction.
More from the cervix/va**na/v***a fascicle:
Adenoid cystic carcinoma can be primary to the Bartholin gland - these share the same morphologic and molecular features of those at other sites, including NFIB rearrangement (most often MYB::NFIB fusion).
More from the cervix/va**na/v***a fascicle:
Hidradenoma papilliferum is the most common benign tumor of the anogenital mammary-like glands, consisting of an intradermal proliferation of papillae and tubules with an epithelial cell layer and a myoepithelial cell layer.
Differentiated v***ar intraepithelial neoplasia (dVIN) is an HPV-independent precursor lesion characterized by TP53 alterations and abnormal keratinocyte differentiation, with atypia usually confined to the first two to three cell layers.
From the cervix/va**na/v***a fascicle (available now at arppress.org):
Molluscum contagiosum is a viral (poxvirus) skin disease transmitted through s*xual or close contact. The viral inclusions, Henderson-Patterson bodies, are a distinctive feature.
Cervix: Arias-Stella reaction (ASR) isn't just for the endometrium - it can affect endocervical glands as well! ASR, a distinctive morphologic response to progesterone, shows cells with enlarged, hyperchromatic, and smudged nuclei with abundant cytoplasm with hobnailing.
Cervix: Microglandular hyperplasia is a benign, reactive epithelial proliferation with a complex architecture characterized by subnuclear vacuolization and prominent underlying immature squamous metaplastic epithelium (reserve cells)
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