Multiple uterine fibroid tumors (Reproduced, with permission from Michael John Hughey, MD, All rights reserved.)

Fig. 1. A. Intramural leiomyoma with whorled arrangement of smooth muscle cells on a matrix of connective tissue cells (×200). B. Notice the absence of distinct connective tissue capsule (×175). ( A and B, 66% of original magnification.) Volume 1, Chapter 14.

Fig. 2. A. Uterine leiomyomas occupy various segments of the uterus and various depths inside and outside the myometrium, and they are designated by gross anatomic location. B. Fresh operative specimen of a uterus was removed for multiple uterine leiomyomas. Volume 1, Chapter 14.

Fig. 2. Cellular leiomyoma with closely arranged smooth muscle nuclei. An occasional mitotic figure is present (H&E, × 90) Volume 4, Chapter 22

Endometriosis (From Operational Obstetrics & Gynecology - 2nd Edition, The Health Care of Women in Military Settings, CAPT Michael John Hughey, MC, USNR, NAVMEDPUB 6300-2C, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C. 20372-5300, January 1, 2000. Original image courtesy CAPT Richard Stock, MC, USN)

Fig. 1. Characteristic "powder burn" appearance of endometriosis implants located on the pelvic peritoneum. Volume 1, Chapter20

Fig. 2. Endometriosis implants in the cul-de-sac exhibit multiple vesicles, “powder burn” lesions, and mild fibrosis. Volume 1, Chapter20

Fig. 4. Pelvic peritoneal biopsy shows characteristic features of endometriosis, with endometrioid glands surrounded by stroma (hematoxylin and eosin stain, original magnification ×200).(Courtesy of Mahendra Ranchod, M.D., Good Samaritan Hospital, San Jose, CA.) Volume 1, Chapter20

Fig. 4. Tuberculous endometritis. Photomicrograph of a single tuberculous granuloma is seen on the left, consisting of central epithelioid cells, with a Langerhans-type giant cell surrounded by a cuff of lymphocytes. No central caseation is present. The surrounding endometrium appears completely normal; the glands are proliferative, and there is no infiltrate in the stroma, seen on the right.(×100.) Volume 1, Chapter 49

Fig. 5. Tuberculous endometrium. A much more florid picture of numerous granulomata with dense lymphocyte infiltrate in the surrounding stroma is seen in this photomicrograph.(×100.) Volume 1, Chapter 49

Fig. 3. Arias-Stella phenomenon. Volume 1, Chapter 69

Fig. 17. Tubal metaplasia is probably the most frequently encountered metaplasia of the endometrium. Ciliated cells ( arrow) interdigitate with peg cells, which have perinuclear clearing. Volume 4, Chapter 15

Fig. 18. Papillary metaplasia may mimic an adenocarcinoma with papillary features at low magnification; however, the bland, uniform lining cells favor a benign process. Also, the papillae in papillary metaplasia are limited to the surface epithelium. Volume 4, Chapter 15

Fig. 1. Histology of endometrial hyperplasia (without atypia). A. Voluminous proliferative-type glands and abundant stroma. B. Higher power magnification of tall, columnar gland cells with regular nuclear pseudostratification and abundant intranuclear receptors for estrogen. There is an increased number of crowded and irregularly shaped glands relative to stroma. Volume 4, Chapter 12

Fig. 2. Histology of endometrial intraepithelial neoplasia (atypical hyperplasia). A. Voluminous gland with multiple intraluminal microlumens (cribriform pattern). The lining epithelium has pleomorphic, round nuclei devoid of regular pseudostratification. Macronucleoli are present. B. High magnification of hyperplastic (left) and neoplastic (right) epithelium. Note regular, nuclear pseudostratification of tall columnar gland lining epithelium in hyperplasia without atypia. Endometrial intraepithelial neoplasia (atypical hyperplasoa) has pleomorphic, round nuclei with macronucleoli, and nuclear pseudostratification is lost. Volume 4, Chapter 12

Fig. 4. Although the endometrial glands within this focus of complex hyperplasia are irregular and complex in configuration, intervening stroma is present between the glands. This feature is important in distinguishing complex hyperplasia from a well-differentiated adenocarcinoma. Volume 4, Chapter 15

Fig. 5. A. Adenomatous hyperplasia of the endometrium. The basal portion of gland lining cells is shown. Note spindle-shaped configuration of nuclei, abundant and narrow bundles of microfilaments ( arrow) extending to the supranuclear region, and monomorphic mitochondria in close association with membranes of granular endoplasmic reticulum (7000). B. Carcinoma in situ of the endometrium. Note nuclear rounding, pleomorphic organelles, and interlacing bundles of microfilaments in a perinuclear location (8000). C. Well-differentiated, invasive adenocarcinoma of the endometrium. The ultrastructural features are essentially similar to those found in carcinoma in situ cells. The lateral plasma membranes ( arrow) and granular endoplasmic reticulum are more convoluted than in carcinoma in situ cells (8000; bl, basal lamina).(Courtesy of Alex Ferenczy) Volume 4, Chapter 20

Fig. 1. A well-differentiated endometrioid adenocarcinoma obtained from a curettage specimen. Note the absence of intervening stroma between the irregularly shaped glands. Nuclei demonstrate only mild pleomorphism. Volume 4, Chapter 15

Fig. 2. Contrast the marked nuclear pleomorphism and solid growth pattern of this grade 3 endometrioid adenocarcinoma with the well-differentiated carcinoma in Fig. 1. Volume 4, Chapter 15

Fig. 3. The altered stroma adjacent to the invasive foci of this high-grade endometrioid carcinoma is characteristic of a desmoplastic stromal response. The pale staining is due to edema and myxoid change, which is often accompanied by an inflammatory cell infiltrate. Volume 4, Chapter 15

Fig. 6. ( A) Secretory carcinoma is characterized by prominent cytoplasmic vacuoles and intraluminal secretions. ( B) The arrow denotes the uniform subnuclear vacuoles. Volume 4, Chapter 15

Fig. 7. Ciliated cell carcinoma. Most of the neoplastic glands are lined by ciliated cells ( arrow) showing mild to moderate nuclear atypia. Volume 4, Chapter 15

Fig. 8. Squamous differentiation in endometrial adenocarcinoma is frequent. This is an example of a squamous morule ( arrow ), which is a collection of polygonal cells with abundant eosinophilic cytoplasm forming a nodular structure between neoplastic endometrial glands. Volume 4, Chapter 15

Fig. 9. Mucinous carcinoma is generally well differentiated and is characterized by columnar cells with basally located nuclei and mucin-rich cytoplasm. Volume 4, Chapter 15

Fig. 10. Complex arborization of papillary structures is seen in serous carcinoma. Cellular budding and tufting can often be appreciated under low power. Volume 4, Chapter 15

Fig. 11. Serous carcinoma. The papillae have fibrovascular cores and are lined by vesicular nuclei with prominent eosinophilic nucleoli. Small clusters of cells that have separated from the papillae are referred to as cellular budding ( arrow ). Volume 4, Chapter 15

Fig. 12. Although more commonly seen in serous carcinoma, psammoma bodies ( arrow) may also be found in the villoglandular variant of endometrial carcinoma. Volume 4, Chapter 15

Fig. 4. A. Endometrial carcinoma, grade 1. A biopsy specimen prior to the administration of progestogen. B. Endometrial biopsy performed 8 weeks after commencement of 400 mg medroxyprogesterone three times per week by intramuscular injection. C. The patient was treated for 12 weeks with intramuscular medroxyprogesterone. Endometrium is shown at the time of hysterectomy; no carcinomatous tissue is visible. Volume 4, Chapter 20

Fig. 6. A. Well-differentiated adenocarcinoma 4 weeks after treatment with medroxyprogesterone acetate. The early cellular effects of progestin therapy include lack of nuclear chromatin clumping, regular nuclear membranes, accumulation of large masses of intracytoplasmic glycogen ( Gly ), and hypertrophy of the Golgi complex ( G ). These features are consistent with active synthesis of glycoproteins (5000). (Courtesy of Alex Ferenczy) B. Moderately differentiated, invasive adenocarcinoma 90 days after treatment with medroxyprogesterone acetate. ( Inset) Following secretory conversion and activity, the neoplastic cells appear reduced in size (“exhausted”) and have supranuclear vacuoles ( arrow ). Note nuclear normochromasia and lack of nuclear pseudostratification (H&E, 350). As a result of secretory differentiation, the granular endoplasmic reticulum ( GER ), mitochondria, and Golgi complex ( G) are hypertrophic. Owing to secretion of glycogen-rich apical cytoplasmic substance, only minute amounts of glycogen granules ( arrow) are found at this stage of therapy (27,000; N, nucleus).(Courtesy of Alex Ferenczy) Volume 4, Chapter 20

Fig. 13. ( A) This example of the papillary pattern of clear cell carcinoma demonstrates complex papillae with fibrovascular cores lined by one to multiple layers of clear cells. ( B) Hobnail cells protrude into a cystic space ( arrow ). Other cells display the typical clear cell morphology with irregular, primitive-appearing nuclei and abundant clear cytoplasm that is rich in glycogen. Volume 4, Chapter 15

Fig. 14. Clear cell carcinoma may exhibit a solid pattern consisting of sheets of clear cells separated focally by thin fibrous bands. Volume 4, Chapter 15

Fig. 15. ( A) As with squamous cell carcinoma in other locations, the presence of keratin pearls ( arrow) or intercellular bridges is diagnostic. ( B) The neoplastic cells have voluminous eosinophilic cytoplasm and marked nuclear atypia. Volume 4, Chapter 15

Fig. 16. Small cell carcinoma is characterized by sheets of round to oval cells with granular chromatin and often dot-like nucleoli. The mitotic rate is quite high in these clinically aggressive lesions. Volume 4, Chapter 15

Fig. 3. Leiomyosarcoma displaying pleomorphism, giant cells, and abnormal mitosis (H&E, × 350) Volume 4, Chapter 22

Fig. 4. Endometrial stromal sarcoma composed of nests of uniform cells with round nuclei separated by a delicate stroma. Several abnormal mitoses are present (H&E, × 350) Volume 4, Chapter 22

Fig. 5. Endometrial stromal sarcoma infiltrating between muscle bundles (H&E, × 90) Volume 4, Chapter 22

Fig. 6. Cellular detail of endolymphatic stromal myosis. The cells are uniform. There is minimal cellular atypia and no mitosis (H&E, × 350) Volume 4, Chapter 22

Fig. 7. Endolymphatic stromal myosis showing pushing margin (H&E, × 90) Volume 4, Chapter 22

Fig. 8. Müllerian adenosarcoma is composed of branching endometrial glands lined by benign epithelium and surrounded by malignant stroma (H&E, × 90) Volume 4, Chapter 22

Fig. 9. Cellular detail of müllerian adenosarcoma. The epithelium lining this endometrial gland appears benign; however, the surrounding stromal cells are round to spindle shaped with several mitotic figures present (H&E, × 350) Volume 4, Chapter 22

Fig. 10. Rhabdomyosarcoma showing strap-shaped rhabdomyoblasts ( arrows) with cross-striations (× 600). Volume 4, Chapter 22

Fig. 14. Mixed homologous mesodermal sarcoma showing islands of adenocarcinoma ( A) scattered in a leiomyosarcomatous stroma ( B) (H&E, × 350) Volume 4, Chapter 22

Fig. 15. Mixed homologous mesodermal sarcoma composed of islands of adenocarcinoma ( A) and squamous carcinoma ( B) with leiomyosarcoma ( C) (H&E, × 350) Volume 4, Chapter 22

Fig. 16. Mixed heterologous mesodermal sarcoma showing chondrosarcoma ( A) as the heterologous element (H&E, × 90) Volume 4, Chapter 22

Fig. 17. Mixed heterologous mesodermal sarcoma showing osteogenic ( A) sarcoma as the heterologous component (H&E, × 350) Volume 4, Chapter 22

Fig. 18. Mixed heterologous mesodermal sarcoma showing liposarcoma ( A) as the heterologous element of the neoplasm and adenocarcinoma ( B) (H&E, × 350) Volume 4, Chapter 22