Contributed by Marilin Rosa, M.D.
Actinomyces
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Actinomyces
IUD related changes
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Colposcopy
Contributed by Gulisa Turashvili, M.D., Ph.D., Seema Khutti, M.D., Jijgee Munkhdelger, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
AIS admixed with HSIL
AIS, gastric type
p16 in SMILE
Mucicarmine in SMILE
SMILE
Glands with crowding and stratification
Abundant mitosis and apoptosis
AIS with adjacent uninvolved glands
Transition to AIS
AIS p16
High grade cervical
glandular intraepithelial
neoplasia
High power
Nuclear atypia
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Atypical glandular cells
Groups of atypical rosette-like structures
Feathering
Feathering and enlarged hyperchromatic nuclei
Palisading and enlarged nuclei
Palisading and feathering
Forming a rosette-like structure
Enlarged nuclei
Feathering and enlarged nuclei
Homogenous chromatin pattern
Slightly atypical metaplastic cells
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Rounded nests of basaloid cells infiltrating the stroma
Small acini
Palisading arrangement around cellular nest
Cervical stroma
Cytologic and histopathologic features
IHC stains
EMA
Contributed by Ihab Hosny, M.D.
Various images
AFIP images
Cribriform architecture and basement membrane material
Contributed by Carlos Parra-Herran, M.D.
Contributed by Ihab Hosny, M.D.
Vascular invasion
Actin
CEA
EMA
High molecular weight keratin
S100
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Three dimensional structures
Contributed by Leonel Maldonado, M.D.
MRI of the pelvis
Sagittal T2
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Bulging tumor from anterior cervix (fig 1)
Contributed by Leonel Maldonado, M.D.
Endocervical mural tumor
Polypoid mass from uterine cervical wall
Polypoid mass with numerous cysts
Contributed by Leonel Maldonado, M.D.
Endocervical type glands surrounded by smooth muscle
Contributed by Leonel Maldonado, M.D.
Fragment of endocervical polyp
Benign endocervical cells
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Endocervical polypoid lesion
Contributed by Carlos Parra-Herran, M.D. and AFIP images
High grade adenosarcoma
Adenosarcoma with sarcomatous overgrowth
Low grade adenosarcoma
Phyllodes tumor-like pattern
Contributed by Ayse Ayhan, M.D., Ph.D.
Biphasic tumor
Periglandular cuff
Intraglandular papillae
Stromal mitoses
Squamous metaplasia
Sarcomatous overgrowth
Heterologous elements
AFIP images
Bulky exophytic mass
AFIP images
Poorly formed glands and squamous components
Sheets of cells with abundant lightly stained cytoplasm
Distinct cell border and prominent nucleoli
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Abundant granular cytoplasm
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Nests of tumor cells with PAS+ crystals
Contributed by Nada Mohamed, M.D.
Schematic of cervical anatomy
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Migration of squamocolumnar junction with age
Local anatomy
Microanatomy
Sagittal section of local anatomy
Uterus, cervix and vagina
Vasculature
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Zonal anatomy of cervix
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Normal cervix colposcopy
Migration of squamocolumnar junction with age
Contributed by Misty Hensch, P.A.
Anatomy of cervix
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Nulliparous cervix
Contributed by Nada Mohamed, M.D.
Normal cervical squamous epithelium
Normal cervical glandular epithelium
Histology of the cervix
Contributed by Leonel Maldonado, M.D.
Arias-Stella reaction, 10×
Arias-Stella reaction, 20×
Contributed by Bonnie Choy, M.D.
High N:C ratio
Irregular nuclear membranes and hyperchromasia
HSIL
Squamous metaplasia
Atrophy with inflammation
Endometrial cells
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WHO digital atlas
Contributed by Joseph Reznicek, M.D., Bonnie Choy, M.D. and Lucy Jager, M.D.
Enlarged nuclei
Slight hyperchromasia
Atypical parakeratosis
Radiation changes
LSIL
Pseudokoilocytes
Herpes cytopathic effect
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WHO digital atlas
Contributed by Marilin Rosa, M.D.
Atrophic sheet
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Various images
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Algorithm for initial workup of AGC
Algorithm for management after diagnostic examination
Contributed by Joseph Reznicek, M.D.
Atypical endocervical cells, favor neoplastic
Atypical glandular cells, NOS
Atypical glandular cells, NOS
Endocervical adenocarcinoma
Endometrial adenocarcinoma
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WHO digital atlas
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Conventional smears
Contributed by Rachel Jug, M.B.B.Ch., B.A.O. and Sarah M. Bean, M.D.
Resembling koilocytes
Nuclear enlargement
Koilocyte
Binucleation
High N:C ratio
Hyperchromasia
Nuclear contour irregularities
Binucleated cell with hyperchromasia, LSIL
Hyperchromatic nucleus and small halo, ASCUS
Nuclear overlap and elongation, atypical glandular cells
Hyperchromatic and irregular nucleus, atypical glandular cells
AFIP images
Pigment containing nevus cells in cervical stroma
Contributed by @AnaPath10 on Twitter
Candida / fungi
Candida / fungi
Candida / fungi
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Candida albicans
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Various images
Contributed by Ali Ismail, M.B.B.S.
Chronic inflammation
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Lymphofollicular cervicitis in a
53 year old woman
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Vascularized, indurated lesion
Contributed by Philip T. Valente, M.D.
Tan-white lesion
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Exophytic mass on the posterior lip of cervix
Didelphys uterus with a cervical mass
Contributed by Nadia Hameed, M.D.
Tubulocystic pattern
Tubulocystic pattern
Papillary pattern
Papillary pattern
Solid pattern
Solid pattern
Rare intracytoplasmic eosinophilic globules
Contributed by Nadia Hameed, M.D.
SurePath Pap test
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Mitochondria and rough endoplasmic reticulum
Clear cell neoplasms of the gynecologic tract
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Intracytoplasmic inclusions #1 (endocervical cells)
#2 (endothelial cells)
CMV+ glands and stroma
Associated acute inflammatory infiltrate
Intracytoplasmic vacuoles within endocervical glandular cells
Fibrin thrombi within small vessels
Not cervix:
Lung #1 - Giemsa stain
Kidney
Pancreas
Contributed by Aung Phyo, M.D. (Case #480)
Decidualized cervical nodule
Multiple prominent nucleoli
Low N:C ratio
Intermixed lymphocytes
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Female genital tract development
Müllerian duct embryonic formation
Fusion of Müllerian ducts
Classic theory versus Acien theory
Congenital uterine malformations
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MRI showing uterovaginal absence
Hysterosalpingogram
showing double
cervix
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Speculum examination showing double cervix
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Fetal female reproductive tract
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Fusion of Müllerian ducts to UVC
Histology of UVC
Cervical development
Female genital tract embryology
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Colposcopy
Polyp
Contributed by Natalia Buza, M.D.
Small polyp
Contributed by Natalia Buza, M.D. and Andrey Bychkov, M.D., Ph.D.
Thick walled arteries
Microglandular hyperplasia
Squamous metaplasia
Chronic inflammation
Mitoses
Cystically dilated glands
Contributed by Marilin Rosa, M.D. and Carmen Luz, M.D.
Endometrial adenocarcinoma
Endometrial group with atypia
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Various images
AFIP images
Endometriosis
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Barrel shaped cervix on MRI in MDA
Ill defined cervical mass on MRI in MDA
Contributed by Gulisa Turashvili, M.D., Ph.D.
Radical hysterectomy for gastric type adenocarcinoma
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Bulging cervix in MDA
Cervical swelling without a mass in MDA
Contributed by Gulisa Turashvili, M.D., Ph.D.
Well differentiated gastric type adenocarcinoma
Poorly differentiated gastric type adenocarcinoma
Well differentiated gastric type adenocarcinoma
Gastric type adenocarcinoma in hysterectomy
Poorly differentiated gastric type adenocarcinoma
Gastric type adenocarcinoma involving fallopian tube
Contributed by Gulisa Turashvili, M.D., Ph.D.
Gastric type adenocarcinoma on Pap cytology
AFIP images
Polypoid mass of glia below endocervical surface
Case #135
H&E and GFAP
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Grossing diagrams
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Hysterectomy specimen
Contributed by Kyle Devins, M.D.
Schematic of exocervix and transformation zone
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Location of glandular and squamous epithelium
Contributed by Kyle Devins, M.D.
Uterus and cervix
Bivalved uterus and cervix
Contributed by Kyle Devins, M.D.
Squamocolumnar junction
Cervical squamous epithelium
Benign endocervical glands
Dilated endocervical glands
Normal cervical squamous p16 IHC
Normal endocervical p16 IHC
Contributed by Carlos Parra-Herran, M.D.
Adenocarcinoma in situ
Invasive adenocarcinoma, pattern A
Invasive adenocarcinoma, pattern B
Invasive adenocarcinoma, pattern C
Contributed by Tanner Storozuk, M.D. and Jennifer Bennett, M.D. (Case #495)
Invasive stratified mucin producing carcinoma (iSMILE)
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Inflammatory exocervical smear
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MRI
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Stage I
Stage III
Stage IV
Contributed by Gulisa Turashvili, M.D., Ph.D., Jijgee Munkhdelger, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Tumor involving transformation zone
Nests of epithelioid cells
Deeply infiltrative tumor
Atypical epithelioid cells
Atypical cells
Atypical cells within inflamed stroma
Marked pleomorphism
Bizarre cells
p16 immunostain
HPV in situ hybridization
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Pleomorphic malignant cells
Pleomorphic and keratinized malignant cells
Pleomorphic malignant cells, isolated or in clusters
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Tumor cell in intratumoral vessel
Contributed by Yevgen Chornenkyy, M.D., M.Sc. and Bonnie Choy, M.D.
High N/C ratio
Metaplastic or dense cytoplasm
Irregular nuclear contour, indentations / grooves
Lack of nucleoli
Variable cytoplasm
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WHO digital atlas
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Low grade disease with unsatisfactory colposcopy
Acetowhite epithelium
High grade disease and unsatisfactory colposcopy
Before acetic acid
Dense acetowhite epithelium after acetic acid
Before acetic acid
Acetowhite epithelium
Contributed by Khaled J. Alkhateeb, M.B.B.S.
Squamocolumnar junction HSIL
Cytoplasmic maturation
CIN III involving endocervical glands
Full thickness atypia
HSIL involving endocervical glands
HSIL with superficial keratinization
HSIL / CIN III with adjacent squamous cell carcinoma
Invasive squamous cell carcinoma
HSIL with significant nuclear pleomorphism
p16 IHC
Contributed by Ziyan T. Salih, M.D.
Marked nuclear atypia
Sharp contrast from surrounding benign cells
Contributed by Julieta E. Barroeta, M.D., Andreas Kontosis, M.D. and Ricardo R. Lastra, M.D.
Infiltrative nests
Intratumoral and peritumoral inflammation
Metastatic ISMC
SMILE and AIS
Mucicarmine
p16 IHC
PAX8 IHC
p40 IHC
ER IHC
Contributed by Hiba Al Dallal, M.D.
Cytolysis
Cytolysis
Lactobacillus on the top of squamous cells
Lactobacillus, normal vaginal bacterial rods
Case #327
H&E
CK7
p16
Chromogranin
Synaptophysin
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Pseudorosette
Contributed by Ziyan T. Salih, M.D.
Cytologic smear with Leptothrix
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Filamentous Leptothrix species
Leptothrix
LBC: Leptothrix with Trichomonas
Long, filamentous structure
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Gastric type cervical lesion spectrum
Proposed management algorithm
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LEGH with cosmos pattern
Contributed by Carlos Parra-Herran, M.D.
Densely packed glands
Round mucinous glands
Lobulated / floret-like appearance
Glands lined by benign columnar cells
PAS - Alcian blue stain
Contributed by @MirunaPopescu13 on Twitter
Lobular endocervical glandular hyperplasia
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LEGH and MDA
Contributed by Lucy Jager, M.D. and Bonnie Choy, M.D.
Nuclear enlargement and hyperchromasia
Multinucleation
Binucleation and perinuclear cavitation
Koilocytosis with nuclear abnormalities
Koilocytosis with nuclear abnormalities
Pseudokoilocytes
Herpes cytopathic effect
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WHO digital atlas
Contributed by Ziyan T. Salih, M.D.
LSIL / koilocytic atypia
Koilocytic atypia
Cervical biopsy (LSIL)
Contributed by Ziyan T. Salih, M.D.
Koilocytosis (LSIL)
Squamous lesions of the cervix and their differential diagnosis
by Carlos Parra-Herran, M.D.
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Vagina: well circumscribed tumor
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Various Images
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Various images and immunostains
Papillary tumor with various epithelial types
Focal atypia due
to stratification,
pleomorphism and
atypical mitotic figure
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MRI cervical tumor
Contributed by Lynn Hoang, M.D.
Mix of morphologic patterns
Tubular pattern
Tubular pattern with adjacent mesonephric remnants
Tubular pattern with desmoplasia
Ductal
(pseudoendometrioid)
pattern
Ductal pattern
Papillary pattern
Sieve-like pattern
Solid pattern
Mesonephric carcinosarcoma
GATA3+
ER-
TTF1+
CD10+
Wild type p53
Contributed by Michela Campora, M.D., Carlos Parra-Herran, M.D. and AFIP
Mesonephric hyperplasia
Marked tubular proliferation
More nuclear variation
Bland glands deep in cervical stroma
Clusters of mesonephric tubules
Mesonephric remnants
Cuboidal cells
Focal squamous metaplasia
AFIP images
Breast carcinoma metastatic to cervix
Case #125 (metastatic lobular carcinoma to endometrial polyp)
Various images
ER
PR
GCDFP-15
Contributed by Carmen Luz, M.D.
Ovarian clear cell carcinoma
Contributed by Gulisa Turashvili, M.D., Ph.D.
Benign glandular proliferation
Back to back glands lacking atypia
Bland epithelial lining
Rare mitosis
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Isolated rounded endocervical cells
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Nabothian cysts on computed tomography
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Multiple nabothian cysts
Nabothian cyst
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Nabothian cysts
Contributed by Gulisa Turashvili, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Cystically dilated glands
Bland epithelial lining
Endocervical polyp with nabothian cysts
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Hysterectomy specimen
Contributed by Shuyue Ren, M.D., Ph.D.
Squamous cells, superficial
Squamous cells, intermediate
Squamous cells, parabasal and basal cells
Endocervical glandular cells
Endometrial cells
Endometrial cells: exodus
Squamous cells: bland enlargement
Hyperkeratosis
Parakeratosis
Tubal metaplasia
Squamous metaplasia
Neutrophils
Abundant blood
Glandular cells status posthysterectomy
Reactive changes
associated with
inflammation
Contributed by David B. Chapel, M.D.
Cervical endometriosis
Cervical endometrioid adenocarcinoma, FIGO grade 1
Minimal deviation endometrioid adenocarcinoma
HPV independent glandular lesions
Benign endocervical lesions
Cytology: glandular cervical lesions
AFIP images
Dense lymphoid
infiltrate with
germinal centers
Contributed by Carlos Parra-Herran, M.D.
Radiation atypia - squamous epithelium
Radiation atypia - vascular endothelium
Contributed by Erika Baardsen, D.O.
Pap smear
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Pap smear
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Vaginal embryonal rhabdomyosarcoma
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Cervical embryonal
rhabdomyosarcoma
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Gray surface and areas of hemorrhage
Contributed by Kyle Devins, M.D.
Edematous stroma
Cambium layer
Rhabdomyoblasts
Hyaline cartilage
Nests, sheets and alveolar spaces
Alveolar spaces
Desmin
Myogenin
Nuclear pleomorphism
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Brushing of
uterine embryonal
rhabdomyosarcoma
AFIP and Case #327
Sheets of small cells with scant cytoplasm and hyperchromatic nuclei
H&E
CK7
p16
Chromogranin
Synaptophysin
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Lesional cells, Pap
Single necrotic cells, Pap
Amphophilic cytoplasm
Large aggregates of malignant cells
Malignant cells loosely cohesive
Scant cytoplasm
PanCK
Synaptophysin
p16
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Resembles HSIL but with abundant mucin
Adenocarcinoma in situ stratified type
Contributed by Masatsugu Ueda, M.D.
Transformation zone
Contributed by Mikami Yoshiki, M.D., Ph.D.
Transformation zone
Contributed by Mikami Yoshiki, M.D., Ph.D.
Transformation zone
Primary squamocolumnar junction
Secondary squamocolumnar junction
Squamous metaplasia
overlying
preexisting glands
Reserve cell hyperplasia
Immature squamous metaplasia
Squamous metaplasia involving endocervical glands
Contributed by Mikami Yoshiki, M.D., Ph.D.
Squamous metaplasia
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Trophozoite
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Strawberry cervix
Contributed by Soumya Jaladi, M.B.B.S., Marilin Rosa, M.D. and @zaalruwai83 on Twitter
Trichomonas in a cytologic preparation
Trichomonas
Trichomonas vaginalis
Trichomonas vaginalis
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Filamentous Leptothrix species
Trichomonas in wet mount
Trichomonas in conventional
Pap smear
Trichomonas vaginalis with Leptothrix
Trichomonas
Trophozite
Inflammatory ectocervix with Trichomonas infection
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T. vaginalis parasite
Contributed by Carlos Parra-Herran, M.D.
TEM and relevant stains
Contributed by Gulisa Turashvili, M.D., Ph.D.
Type A tunnel clusters
Alcian blue / PAS in type A tunnel clusters
Type B tunnel clusters
Alcian blue / PAS in type B tunnel clusters
Case #91
Inflammatory infiltrate in the vessel wall
Lymphocytes, neutrophils and occasional eosinophils
Fibrinoid necrosis within the media
Ali: 2019
Clement: 2019
Crum: 2017
Howitt: 2019
Hui: 2015
IARC: 2020
Malpica: 2015
Mody: 2022
Nayar: 2015
Nucci: 2020
Nucci: 2023
Nucci: 2023
Soslow: 2020
Vang: 2017
Zheng: 2019
Zheng: 2019
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