Diagnostic Gynecologic and Obstetric Pathology THIRD EDITION Christopher P. Crum, MD Professor Department of Pathology Harvard Medical School; Vice Chair and Director of Women's and Perinatal Pathology Department of Pathology Brigham and Women's Hospital Boston, Massachusetts Marisa R. Nucci, MD Professor of Pathology Harvard Medical School; Senior Pathologist Department of Pathology Brigham and Women's Hospital Boston, Massachusetts Brooke E. Howitt, MD Assistant Professor Department of Pathology 1 Harvard Medical School; Associate Pathologist Brigham and Women's Hospital Boston, Massachusetts Scott R. Granter, MD Associate Professor of Pathology Harvard Medical School; Associate Pathologist Department of Pathology Brigham and Women's Hospital Boston, Massachusetts Mana M. Parast, MD, PhD Associate Professor Department of Pathology University of California San Diego La Jolla, California Theonia K. Boyd, MD Director, Anatomic Pathology Department of Pathology Boston Children's Hospital; Staff Pathologist Division of Women's and Perinatal Pathology Department of Pathology Brigham and Women's Hospital Boston, Massachusetts 2 Associate Clinical Editors Hope K. Haefner, MD Professor Department of Obstetrics and Gynecology Michigan Medicine Ann Arbor, Michigan William A. Peters III, MD Clinical Professor Department of Obstetrics and Gynecology University of Washington; Division of Gynecologic Oncology Swedish Cancer Institute Seattle, Washington 3 Table of Contents Instructions for online access Cover image Title Page Copyright Dedication Contributors Preface Acknowledgments Chapter 1 Female Genital Tract Development and Disorders of Childhood Abstract Overview of Reproductive Tract Development Common Disorders of Gonadal and Genital Tract Development Key Points References Chapter 2 Noninfectious Inflammatory Disorders of the Vulva Abstract Introduction Types of Disorders Key Points References Chapter 3 Localized Vulvodynia Abstract 4 Introduction History of Vulvar Pain Terminology Causative Theories of Vulvodynia Histopathology Treatment of Localized Vulvodynia Key Points References Chapter 4 Infectious Disorders of the Lower Genital Tract Abstract Introduction Common Infections Common Infections Not Typically Linked to Sexually Transmitted Diseases Common Sexually Transmitted Infections Uncommon Sexually Transmitted Diseases Other Rare Infections Common and Rare Vulvar Infections Associated With Immune Suppression Key Points References Chapter 5 Benign Cysts, Rests, and Adnexal Tumors of the Vulva Abstract Introduction Benign Cysts Benign Rests Benign Adnexal Tumors Key Points References Chapter 6 Squamous Neoplasia of the Vulva Abstract 5 Introduction Low-Grade Squamous Intraepithelial Lesions Pediatric Complications of Human Papillomavirus Infection High-Grade Squamous Intraepithelial Lesions Diagnostic Terminology Differentiated Exophytic Vulvar/Squamous Intraepithelial Lesions Squamous Cell Carcinoma HPV-Negative Squamous Cell Carcinomas Proposed Report Wording With Diagnostic Terms Outcome Variables in Vulvar Squamous Carcinoma Extremely Well-Differentiated Verruco-Papillary Squamous Cell Neoplasms Basal Cell Carcinoma Key Points References Chapter 7 Glandular and Other Malignancies of the Vulva Abstract Introduction Adenosquamous Carcinoma Adenocarcinoma Carcinoma of Bartholin Gland Merkel Cell Carcinoma Cloacogenic Neoplasms Other Rare Primary and Metastatic Tumors Urethral Neoplasms Key Points References Chapter 8 Melanocytic Lesions of the Vulva Abstract Introduction 6 Evaluation of Pigmentation Genital Melanosis (Genital Melanotic Macule) Genital-Type Nevus Dysplastic Nevi Melanoma Key Points References Chapter 9 Soft Tissue Lesions of the Vulva and Vagina Abstract Introduction Vulvovaginal Stromal Tumors and Tumor-Like Lesions Fibrohistiocytic Tumors Lipomatous Tumors Smooth Muscle Tumors Skeletal Muscle Tumors Vascular Lesions Neural Tumors Miscellaneous Tumors Key Points References Chapter 10 Diseases of the Anus Abstract Introduction Non-Neoplastic Lesions Neoplasms of the Anus Key Points References Chapter 11 Benign Conditions of the Vagina Abstract 7 Introduction Benign Vaginal Epithelial Changes Occurring in Older Women Benign Lesions Following Hysterectomy Adenosis and Columnar Metaplasia Cysts of the Vagina Endometriosis Fibroepithelial Polyps of the Lower Female Genital Tract Traumatic Lesions Infections of Systemic Importance Rare Infections Inflammatory and Ulcerative Lesions of Unknown Cause Emphysematous Vaginitis Key Points References Chapter 12 Epithelial and Mixed Epithelial-Stromal Neoplasms of the Vagina Abstract Introduction Vaginal Squamous Intraepithelial Lesions Malignant Epithelial Neoplasms of the Vagina Key Points References Chapter 13 Cervical Squamous Neoplasia Abstract Introduction Cytology Nondiagnostic Squamous Atypia (Atypical Squamous Cells of Undetermined Significance) Diagnosis and Management of Invasive Squamous Cell Carcinoma Key Points 8 References Chapter 14 Columnar Cell Neoplasia of the Cervix Abstract Overview Principles of Cytology in the Diagnosis of Columnar Cell Neoplasia Diagnosis and Management of Adenocarcinoma in Situ Diagnosis and Management of Adenocarcinoma of the Cervix Key Points References Chapter 15 Neuroendocrine Carcinoma, Mixed Epithelial/Mesenchymal and Mesenchymal Tumors, and Miscellaneous Lesions of the Cervix Abstract Neuroendocrine Carcinoma Undifferentiated Carcinoma Mixed Epithelial/Mesenchymal Neoplasms Adenomyoma and Polypoid Adenomyoma of the Endocervical Type Cervical Adenofibroma Cervical Adenosarcoma Cervical Carcinosarcoma Mesenchymal Neoplasms Genital Rhabdomyoma Glomus Tumor Superficial Myofibroblastoma Smooth Muscle Tumors Alveolar Soft-Part Sarcoma Peripheral Neuroectodermal Tumor/Ewing Sarcoma Endometrial Stromal Sarcoma Undifferentiated Endocervical Stromal Sarcoma Melanocytic Lesions Hematopoietic Lesions 9
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