by
ROBERT J. KURMAN, M.D.
Departments of Pathology
and Gynecology and Obstetrics
Johns Hopkins Hospital
Baltimore, Maryland 21287
HENRY J. NORRIS, M.D.
Department of Gynecologic and Breast Pathology
Armed Forces Institute of Pathology
Washington, D.C. 20306
and
EDWARD J. WILKINSON, M.D.
Department of Pathology
University of Florida College of Medicine
Gainesville, Florida 32610
1. Embryology of the Lower Female Genital Tract
1.1 Cervix and Vagina
1.2 Vulva
2. Anatomy of the Lower Female Genital Tract
2.1 Cervix
2.1.1 Squamous Epithelium
2.1.2 Endocervical Glandular Epithelium
2.1.3 Transformation Zone
2.2 Vagina
2.3 Vulva
3. Human Papillomaviruses and Cancer of the Lower Female Genital Tract
3.1 Classification, Properties, and Genomic Organization
3.2 Methods of Viral Detection
3.3 HPV Life Cycle
3.4 Evidence Associating HPV with Neoplasia
3.5 Distribution of HPV in Cervical Neoplasms
3.6 Distribution of HPV in Vaginal and Vulvar Neoplasms
3.7 Natural History of HPV Infection of the Cervix
4. Classification of Tumors of the Lower Female Genital Tract
4.1 Uterine Cervix
4.2 Vagina
4.3 Vulva
5. Tumors of the Cervix
5.1 Squamous Lesions
5.1.1 Squamous Papilloma
5.1.2 Condyloma Acuminatum
5.1.3 Squamous Metaplasia
5.1.4 Transitional Metaplasia
5.1.5 Squamous Atypia
5.1.6 Squamous Intraepithelial Lesions
5.1.7 Squamous Cell Carcinoma
5.1.8 Microinvasive Carcinoma
5.1.9 Invasive Squamous Cell Carcinoma
5.1.10 Verrucous Carcinoma
5.1.11 Warty (Condylomatous) Carcinoma
5.1.12 Papillary Squamous (Transitional) Cell Carcinoma
5.1.13 Lymphoepithelial-Like Carcinoma
5.2 Glandular Lesions
5.2.1 Endocervical Polyp
5.2.2 Müllerian Papilloma
5.2.3 Glandular Aytpia
5.2.4 Atypical Hyperplasia (Glandular Dysplasia)
5.2.5 Adenocarcinoma In Situ
5.2.6 Mucinous and Endometrioid Adenocarcinoma
5.2.7 Clear Cell Carcinoma
5.2.8 Minimal Deviation Adenocarcinoma
5.2.9 Well-Differentiated (Papillary) Villoglandular
Adenocarcinoma
5.2.10 Serous Adenocarcinoma
5.2.11 Mesonephric Adenocarcinoma
5.3 Other Epithelial Tumors
5.3.1 Adenosquamous Carcinoma
5.3.2 Glassy Cell Carcinoma
5.3.3 Adenoid Cystic Carcinoma
5.3.4 Adenoid Basal Carcinoma
5.3.5 Carcinoid Tumor (Adenocarcinoma with Features of Carcinoid
Tumor)
5.3.6 Small Cell Carcinoma
5.3.7 Undifferentiated Carcinoma
5.4 Mesenchymal Tumors
5.4.1 Leiomyoma
5.4.2 Other Benign Mesenchymal Tumors
5.4.3 Leiomyosarcoma
5.4.4 Endocervical Stromal Sarcoma
5.4.5 Sarcoma Botryoides (Embryonal Rhabdomyosarcoma)
5.4.6 Alveolar Soft-Part Sarcoma
5.4.7 Osteosarcoma
5.4.8 Other Malignant Mesenchymal Tumors
5.5 Mixed Epithelial and Mesenchymal Tumors
5.5.1 Papillary Adenofibroma
5.5.2 Adenosarcoma
5.5.3 Malignant Mixed Mesodermal Tumor
5.5.4 Wilms Tumor
5.6 Miscellaneous Tumors
5.6.1 Melanocytic Nevus
5.6.2 Blue Nevus
5.6.3 Malagnant Melanoma
5.6.4 Lymphoma and Leukemia
5.6.5 Tumors of Germ Cell Type
5.7 Secondary Tumors
5.8 Tumor-Like Lesions
5.8.1 Mesodermal Stromal Polyp (Pseudosarcoma Botryoides)
5.8.2 Microglandular Hyperplasia
5.8.3 Mesonephric Remnants
5.8.4 Mesonephric Hyperplasia
5.8.5 Arias-Stella Reaction
5.8.6 Endometriosis
5.8.7 Cysts
5.8.8 Decidual Nodule
5.8.9 Placental-Site Nodule
5.8.10 Amputation (Traumatic) Neuroma
5.8.11 Postoperative Spindle Cell Nodule
5.8.12 Intestinal Metaplasia
5.8.13 Tubal Metaplasia
5.8.14 Epidermal Metaplasia
5.8.15 Glial Polyp
5.8.16 Tunnel Clusters
5.8.17 Lymphoma-Like Lesion (Pseudolymphoma)
6. Tumors of the Vagina
6.1 Squamous Lesions
6.1.1 Squamous Papilloma
6.1.2 Condyloma Acuminatum
6.1.3 Transitional Metaplasia
6.1.4 Squamous Atypia
6.1.5 Squamous Intraepithelial Lesions
6.1.6 Squamous Cell Carcinoma
6.1.7 Verrucous Carcinoma
6.1.8 Warty (Condylomatous) Carcinoma
6.2 Glandular Lesions
6.2.1 Adenosis
6.2.2 Atypical Adenosis
6.2.3 Müllerian Papilloma
6.2.4 Endometrioid, Endocervical, and Intestinal-Type
Adenocarcinomas
6.2.5 Clear Cell Adenocarcinoma
6.2.6 Mesonephric Carcinoma
6.3 Other Epithelial Tumors
6.3.1 Adenosquamous Carcinoma
6.3.2 Adenoid Basal Carcinoma
6.3.3 Adenoid Cystic Carcinoma
6.3.4 Carcinoid Tumor and Small Cell Carcinoma
6.3.5 Undifferentiated Carcinoma
6.4 Mesenchymal Tumors
6.4.1 Leiomyoma
6.4.2 Rhabdomyoma
6.4.3 Other Benign Mesenchymal Tumors
6.4.4 Leiomyosarcoma
6.4.5 Sarcoma Botryoides (Embryonal Rhabdomyosarcoma)
6.4.6 Endometrioid Stromal Sarcoma
6.4.7 Other Malignant Mesenchymal Tumors
6.5 Mixed Epithelial and Mesenchymal Tumors
6.5.1 Mixed Tumor
6.5.2 Mixed Tumor Resembling Synovial Sarcoma
6.5.3 Adenosarcoma
6.5.4 Malignant Mixed Mesodermal Tumor
6.6 Miscellaneous Tumors
6.6.1 Melancytic Nevus
6.6.2 Blue Nevus
6.6.3 Malignant Melanoma
6.6.4 Yolk Sac Tumor
6.6.5 Mature Cystic Teratoma
6.6.6 Adenomatoid Tumor
6.6.7 Villous Adenoma
6.6.8 Malignant Lymphoma and Other Lymphohistiocytic Lesions
6.7 Secondary Tumors
6.8 Tumor-Like Lesions
6.8.1 Vaginal Polyp (Mesodermal Stromal Polyp)
6.8.2 Postoperative Spindle Cell Nodule
6.8.3 Vault Granulation Tissue
6.8.4 Prolapsed Fallopian Tube
6.8.5 Endometriosis
6.8.6 Decidua
6.8.7 Cysts
6.8.8 Lymphoma-Like Lesion
7. Tumors of the Vulva
7.1 Squamous Lesions
7.1.1 Squamous (Vestibular) Papilloma
7.1.2 Fibroepithelial Polyp
7.1.3 Condyloma Acuminatum
7.1.4 Seborrheic Keratosis
7.1.5 Keratoacanthoma
7.1.6 Squamous Intraepithelial Lesions
7.1.7 Squamous Cell Carcinoma
7.1.8 Superficially Invasive Squamous Cell Carcinoma
7.1.9 Invasive Squamous Cell Carcinoma
7.1.10 Basaloid Carcinoma
7.1.11 Verrucous Carcinoma
7.1.12 Warty (Condylomatous) Carcinoma
7.1.13 Basal Cell Carcinoma
7.2 Glandular Lesions
7.2.1 Papillary Hidradenoma (Hidradenoma Papilliferum)
7.2.2 Nodular (Clear Cell) Hidradenoma
7.2.3 Syringoma
7.2.4 Trichoepithelioma
7.2.5 Trichilemmoma
7.2.6 Adenoma of Minor Vestibular Glands
7.2.7 Paget Disease
7.2.8 Bartholin Gland Tumors
7.2.9 Breast Carcinoma and Other Tumors Arising in Ectopic
Mammary Tissue
7.2.10 Carcinomas of Sweat Gland Origin
7.2.11 Other Adenocarcinomas
7.3 Benign Mesenchymal Tumors
7.3.1 Lipoma/Fibrolipoma
7.3.2 Hemangioma
7.3.3 Angiokeratoma
7.3.4 Pyogenic Granuloma
7.3.5 Lymphangioma
7.3.6 Fibroma
7.3.7 Leiomyoma
7.3.8 Granular Cell Tumor
7.3.9 Neurofibroma
7.3.10 Schwannoma (Neurilemmoma)
7.3.11 Glomus Tumor
7.3.12 Fibrous Histiocytoma
7.3.13 Rhabdomyoma
7.4 Malignant Mesenchymal Tumors
7.4.1 Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)
7.4.2 Aggressive Angiomyxoma
7.4.3 Leiomyosarcoma
7.4.4 Dermatofibrosarcoma Protuberans
7.4.5 Malignant Fibrous Histiocytoma
7.4.6 Epithelioid Sarcoma
7.4.7 Malignant Rhabdoid Tumor
7.4.8 Malignant Schwannoma
7.4.9 Angiosarcoma
7.4.10 Kaposi Sarcoma
7.4.11 Hemangiopericytoma
7.4.12 Liposaroma
7.4.13 Alveolar Soft-Part Sarcoma
7.5 Miscellaneous Tumors
7.5.1 Benign Melanocytic Tumors
7.5.2 Malignant Melanoma
7.5.3 Malignant Lymphoma
7.5.4 Tumors of Germ Cell Type
7.5.5 Neurectodermal Tumors
7.6 Secondary Tumors
7.7 Tumor-Like Lesions
7.7.1 Pseudoepitheliomatous Hyperplasia
7.7.2 Endometriosis and Decidua
7.7.3 Langerhans Cell Histiocytosis (Histiocytosis X Including
Eosinoph Granuloma)
7.7.4 Benign Xanthogranuloma
7.7.5 Verruciform Xanthoma
7.7.6 Desmoid Tumor (Extra-abdominal Fibromatosis, Aggressive
Fibromatosis)
7.7.7 Sclerosing Lipogranuloma
7.7.8 Nodular Fasciitis
7.7.9 Nevus Lipomatosis Superficialis
7.7.10 Crohn Disease
7.7.11 Cysts
7.8 Other Epithelial Disorders of Skin and Mucosa
7.8.1 Lichen Sclerosus (Formerly Lichen Sclerosus et Atrophicus)
7.8.2 Squamous Cell Hyperplasia (Formerly Hyperplastic Dystrophy)
8. Index