AFIP images
Ovary - lymphatics
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Anatomic relationships of ovary
Ovary - vascular relations
Section of the ovary
Ovarian stroma
Folliculogenesis
Contributed by Doaa Atwi, M.D.
Ovarian attachment
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Corpus luteum
Contributed by Doaa Atwi, M.D.
Mature follicle
Corpus luteum
Cortical granuloma
Cortical granuloma
Ovarian surface epithelium
Luteinized stromal cells
CD68
AFIP images
Undifferentiated gonad
Ovulation age of 48 days
Ovulation age of 5 months
Corpus luteum
Corpus albicans
Contributed by Carlos Parra-Herran, M.D.
Appendiceal adenocarcinoma
Low grade appendiceal mucinous neoplasm
Low grade appendiceal mucinous neoplasm
Contributed by Jutta Huvila, M.D., Ph.D. and C. Blake Gilks, M.D. and AFIP images
Solid, uniform cut surface
Fleshy appearance
Sharply demarcated
Fibroma-like appearance
Solid fibroma-like component and 2 cysts
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Infarcted tumor
Contributed by Jutta Huvila, M.D., Ph.D. and C. Blake Gilks, M.D.
Benign transitional nests
Nuclear grooves
Papillary architecture
Nuclear atypia
Stromal invasion
Malignant nuclear features
AFIP images
Fibromatous stromal component
Resembling coffee beans
Several lumens
Mucinous epithelium
Ciliated epithelium
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Diffuse infilitration
by lobular type
epithelial cells
Ductal
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Malignant cells
in cluster, Giemsa
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Calcifications associated with a mature teratoma
Contributed by Aurelia Busca, M.D., Ph.D.
Calcifications
Calcifications
Calcifications associated with low grade serous carcinoma of the ovary
Osseous metaplasia of the ovary
Contributed by Chenxi Wu, M.D., Ph.D.
T1 precontast MRI
T2 MRI
Noncontrast CT, coronal plane
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Ovarian mass intraoperatively
AFIP images
Insular tumor
Contributed by Krisztina Hanley, M.D., Rulong Shen, M.D. and AFIP
Trabecular pattern
Nuclear features
Mixed patterns
Strumal carcinoid
Thyroid component
Cytologic features of carcinoid
Chromogranin in strumal ovarian carcinoid
Synaptophysin in strumal ovarian carcinoid
Insular carcinoid
Insular carcinoid
Insular carcinoid
TTF1
AE1 / AE3
CDX2
Synaptophysin
Chromogranin
Inhibin
Mucinous carcinoid
Trabecular tumor
Germ cell neoplasms of the ovary - ovarian carcinoid tumor
by Dr. Wafaey Badawy
Contributed by Hayam Aiad, M.D.
Cut section
Contributed by Hayam Aiad, M.D.
Higher power
Low power
Carcinoid in meckels
High power showing uniform monotonus nuclei
Contributed by Mona Kandil, M.D., Ph.D.
Ovary
Uterus
Contributed by Hatem Kaseb, M.D., Ph.D., M.P.H. and Mona Kandil, M.D., Ph.D.
Carcinomatous component
Carcinomatous component
Carcinomatous and sarcomatous components
Sarcomatous component
Malignant stroma
High grade malignant glands
High grade tumor cells with mitotic figures
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Uterus, growth
in cervix
extending up to
endocervical canal
Bisected uterus, cut surface ovary
Contributed by Carlos Parra-Herran, M.D.
Endocervical carcinoma primary
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Foci of metastatic squamous cells, H&E
CIN
Metastases
p63, CK5/6, CK7, CK20
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High grade SIL
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Hemorrhagic mass
Ovarian mass
TAHBSO specimen
AFIP images
Plexiform pattern
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H&E stain
Atypical syncytio
cytotrophoblast
β hcG+
Contributed by Lucy Ma, M.D.
Small glands / cysts
Low grade cytologic atypia
Adenofibromatous component
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Ovarian mass on ultrasound
Contributed by Ayse Ayhan, M.D. and AFIP images
External surface
Cut surface
External surface
Cut surface
Polypoid areas in a cyst
Contributed by Gulisa Turashvili, M.D., Ph.D., Sonali Lanjewar, M.D., M.B.B.S., Semir Vranić, M.D., Ph.D. and AFIP images
Variable architecture
Papillary architecture
Tubulocystic architecture
Tubulocystic and papillary architecture
Solid architecture
Targetoid cells
Left: cystic pattern; right: hobnail cells
Adenofibroma component
Hyaline bodies
HNF1β
Napsin A
AFIP images
Borderline malignancy
AFIP images
Borderline malignancy
- See Figure 5 for algorithm to determine origin using currently available markers: Int J Gynecol Pathol 2016;35:191
Table 1. Most common immunohistochemical expression
patterns seen in primary ovarian mucinous neoplasms and
secondary epithelial tumors from gastrointestinal origin
| Lower GI | Upper GI | Ovarian | |
| CK7 | Negative | Positive | Positive |
| SATB2 | Positive | Negative | Negative |
| PAX8 | Negative | Negative | Positive* |
| CK20 | Positive | Pos / neg | Pos / neg |
| CDX2 | Positive | Pos / neg | Pos / neg |
| MUC2 | Positive | Pos / neg | Pos / neg |
| ER | Negative | Negative | Pos / neg |
| Beta catenin | Pos / neg | Negative | Negative |
| MUC1 | Pos / neg | Positive | Positive |
- GI = gastrointestinal; pos = positive; neg = negative
- In this table, positive markers are those with expression in > 75% and negative markers those with expression in < 25% of tumors in the indicated category
- Expression ranging from 25 to 75% is coded as pos / neg
- *PAX8 expression was 75% in all primary ovarian neoplasms but lower in the subgroup of primary ovarian carcinomas (65%)
- Table contents adapted from Int J Gynecol Pathol 2016;35:191
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Cystic and solid architecture
Contributed by Carlos Parra-Herran, M.D. and Adam Lechner
Neoplastic columnar epithelium
Dirty necrosis
Dilated glands
Sharply defined, angulated glands
CK7
SATB2
CDX2
CK20
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CT: ruptured corpus luteum cyst and hemoperitoneum
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Intraoperative: hemorrhage of corpus luteum cyst
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Corpus luteum cyst
Contributed by Aurelia Busca, M.D., Ph.D.
Convoluted cyst lining
Bilayered cyst lining
Granulosa and theca cells
Reticulin stain
Contributed by Aurelia Busca, M.D., Ph.D.
Cystically dilated glands
AFIP images
Solid, fleshy, lobulated
Cystic degeneration
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Pale brown parenchyma and central scarring
Contributed by Sharon Song, M.D.
Medium sized cells
Eosinophilic cytoplasm
Cells growing as cords
Varied growth pattern
Nested growth
Inflammation in fibrous septae
Poor preservation
Epithelioid cytomorphology
OCT3/4
SALL4
CD117
AFIP images
Lymphocytes
Cords
Solid tubular pattern
Syncytiotrophoblasts
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Macroscopic appearance
Contributed by Aurelia Busca, M.D., Ph.D.
Deciduosis of ovarian stroma
Areas of deciduosis
Ovarian surface adhesions with deciduosis
Ovarian surface adhesions with deciduosis
Ovarian deciduosis in a patient on progestin therapy
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Ultrasound
CT abdominal mass & ascites
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External and cut surface of ovarian tumor
Contributed by Jessica L. Bentz, M.D. and AFIP
Primitive atypical cells
Mitoses and apoptotic debris
Papillary pattern
CD30
CD30
OCT 3/4
CK AE1 / AE3
AFIP images
Endometrioid stromal sarcoma
With sex cord-like differentiation
Reticulin stain
Metastatic to omentum
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High grade tumor
Monotonous cells
Endometrium-like glands
CD10+
AFIP images
With intraepithelial carcinoma, grade 1
Atypical
endometrioid
glands separated
by stroma
AFIP images
Ovary and uterus with tumor
Tumor arising in endometriotic cyst
Contributed by Ayse Ayhan, M.D.
Smooth ovarian capsule
Multiple papillary excrescences
Papillary / nodular solid component
Partially opened cyst wall
Cyst wall outer surface
Solid / papillary areas
Serial sections
Cross section
Outer aspect
Partially opened cyst wall
Fixation
Ovarian mass lesion
Contributed by Ozlen Saglam, M.D.
Endometrioid adenocarcinoma, FIGO grade 1
Endometrioid adenocarcinoma, FIGO grade 2
Endometrioid adenocarcinoma, FIGO grade 3
Squamous differentiation
Peritoneal keratin granuloma
Ciliated cells
Secretory change
Oncocytic cells
Spindle variant
Trabecular pattern
resembling sex
cord stromal tumor
Endometrioid carcinoma and background adenofibroma
Endometriosis
Contributed by Sakinah A Thiryayi, M.D. and Gulisa Turashvili, M.D., Ph.D. (Case #500)
Glandular architecture
Back to back glands
Low grade cytology
Cellular intervening stroma
Plump stromal cells
Inhibin
p53
AFIP images
With endometriosis
Contributed by Stephanie L. Skala, M.D.
Variably dilated endometrioid glands
Endometrioid glands, some ciliated
Predominantly cystic neoplasm
Attenuated cyst lining
Contributed by University of Washington Medical Center and AFIP
Uterus with shaggy hemorrhagic adhesions
External surfaces of the ovarian wedges
Cyst contains chocolate colored fluid
Cyst has dark brown discoloration
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Small foci resembling powder burns
Chocolate cyst
Contributed by University of Washington Medical Center and Aurelia Busca, M.D., Ph.D.
Uterine serosa with endometriosis
Endometriosis, partially denuded
Endometriosis with hemosiderin
Endometriosis involving appendix
Denuded hemorrhagic cyst
Endometriotic cyst
CD10
ER
Contributed by Carmen Luz, M.D.
FNA from abdominal wall
Causes, symptoms, diagnosis, treatment, pathology
Histopathology - ovary
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Multiple lesions
Contributed by Aurelia Busca, M.D., Ph.D.
Cystically dilated glands
Cystically dilated glands with tubal differentiation
Cystically dilated glands with stromal microcalcifications
Contributed by Ayse Ayhan, M.D.
Clear cell carcinoma, case 1:
Schema
Outer appearance
Fixed pictures of surgical material
Cut surface
Clear cell carcinoma, case 2:
Outer appearance
Cut surface
Fixed cut surface
Bilateral endometrioid cancer:
Left, 730g, 14.5x12.6cm
Left, 730g, 14.5x12.6cm
Ovarian tumor:
Right, 70g, 7.5x3.5cm
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Bilateral ovarian fibroma on MRI
Unilateral ovarian fibroma on MRI
Contributed by Rex Bentley, M.D. and AFIP images
Chalky white surface
Edematous and focally hemorrhagic
Dense white mass
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Hard white tumor
Fibrothecoma
Contributed by Gulisa Turashvili, M.D., Ph.D., Kyle C. Strickland, M.D., Ph.D. and Rex Bentley, M.D.
Cellular spindle cell neoplasm
Mild cytologic atypia
Mitotic activity
Small tubules
Variable cellularity
Bland spindle cells
Spindled to ovoid nuclei
Dense collagen
Cellular spindle cell neoplasm
Reticulin
Inhibin
Calretinin
Contributed by Dr. Josehp Christopher Castillo
AFIP images
Clusters of lutein cells lie in the edematous stroma
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Loose stroma with occasional inflammatory cells
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Capsular disruption and hemorrhage
AFIP images
Moderate cytologic atypia
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Clusters of pleomorphic spindle cells
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Follicle cyst on ultrasound
AFIP images
Unilocular cyst with smooth lining
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Large follicle cysts
Contributed by Gulisa Turashvili, M.D., Ph.D.
Cyst wall
Cyst lining
Luteinized theca cells
Reticulin stain
AFIP images
Bilateral tumor, with germinoma
With germinoma
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Gonadal dysgenesis
AFIP images
Nests of tumor
With germinoma
Small sex cord type cells
AFIP images
Bilateral tumor, with germinoma
With germinoma
Contributed by Robert H. Byrd, M.D., Andreas Kontosis, M.D. and Julieta E. Barroeta, M.D.
Gonadoblastoma cells
Psammomatous calcifications
Calcifications
Extensive calcifications
Gonadoblastoma in streak gonad
Focus of anastomosing pattern
Gonadoblastoma and Leydig-like cells
Inhibin IHC
OCT3/4 IHC
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Negative FISH for Y sequence
Positive FISH for Y sequence
Case of gonadoblastoma and Swyer syndrome
Contributed by Eman Abdelzaher, M.D., Ph.D. and AFIP
Actinomycosis: tubo-ovarian
Actinomycosis
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Central suppuration
and surrounding
giant cells in
Crohn's disease
Tuberculosis
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Large pelvic mass
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Hirsutism
Intraoperative mass
Contributed by Shabnam Zarei, M.D. and AFIP
Solid, cystic and hemorrhagic mass
Solid and cystic mass
Solid yellow mass
Predominantly cystic mass
Solid and cystic tumor
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Solid cystic mass
Contributed by Shabnam Zarei, M.D. and Sharon Bihlmeyer, M.D.
Classic diffuse pattern
Nuclear grooves
Luteinized
Luteinized with round nuclei
Luteinized
Calretinin
Reticulin
Diffuse pattern
Inhibin
Calretinin
CK7
AFIP images
Trabecular pattern
Insular pattern
Microfollicular pattern
Macrofollicular pattern
Watered silk (moiré silk) pattern
Gyriform pattern
Cystic tumor
Enlarged, hyperchromatic, bizarre nuclei
Theca cells
Sex cord stromal tumors of the ovary and mimics
Histopathology of adult granulosa cell tumor
Granulosa cell tumor
AFIP Images
Solid and slightly lobulated
Large locules with smooth linings
Solid and cystic
Contributed by Jutta Huvila, M.D., Ph.D. and AFIP
Lobulated growth pattern
Follicular differentiation
Atypical cells lining follicle
Solid growth
Solid cellular neoplasm with focal follicle formation
Solid nodules
Mitotic figures
Hobnail nuclei
Bizarre nuclei
AFIP images
Well differentiated
ovarian and testicular
type cells
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Cystic mass with papillary projections
Contributed by Erna Forgó, M.D. and Teri A. Longacre, M.D.
Cystic mass with papillary tumor growth
Contributed by Erna Forgó, M.D., Teri A. Longacre, M.D., Jijgee Munkhdelger, M.D., Ph.D., Andrey Bychkov, M.D., Ph.D. and Stephanie L. Skala, M.D. (Case #538)
Significant nuclear atypia and pleomorphism
Micropapillary growth pattern
SET pattern
SET pattern
PAX8 positive
ER positive
Variable PR (negative in this case)
WT1 positive
CK7 positive
CK20 negative
p53 overexpression
p53 null phenotype
Serous tubal intraepithelial carcinoma (STIC)
p53 overexpression in STIC
Ovarian serous carcinoma immunoprofile
High grade serous carcinoma with SET features
Aberrant p53 expression
Contributed by Erna Forgó, M.D. and Teri A. Longacre, M.D.
Malignant glandular cells in 3D clusters and singly
AFIP images
Both ovaries are
enlarged by
multiple thin
walled cysts
AFIP images
Luteinized granulosa cells
Prominent edema
in the luteinized
theca cell layer
Ovarian stroma is markedly edematous
AFIP images
25 cm unilocular cyst
Contributed by Raul S. Gonzalez, M.D.
Solitary luteinized follicle cyst
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Microscopic features of ovarian cyst
Histologic characteristics of ovarian cyst
AFIP images
Lobulated sectioned surface
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Gray-white with whorled pattern
Ovary replaced with creamy mass
AFIP images
Spindle cells arranged in intersecting fascicles
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Long fascicle of spindle shaped cells
H&E, desmin, α smooth muscle actin
Positive for SMA
AFIP images
Epithelioid tumor
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Pleomorphic tumor cells
H-Caldesmon, desmin and smooth muscle actin
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Ovarian causes of androgen overproduction
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Postmenopausal woman with areas of baldness
Contributed by Shima Rastegar, M.D.
Associated with nerve fibers
Associated with blood vessels
Lipofuscin granules
Hyaline globules
Crystalloids of Reinke
Positive for calretinin
Positive for inhibin
Ovarian Leydig cell hyperplasia in woman
AFIP images
Red-brown mass
Brown-black nodule
Contributed by Krisztina Lengyel, M.D., Lucy Ma, M.D. and AFIP
Eosinophilic clusters
Eosinophilic cells in cords and clusters
Eosinophilic Leydig cells with Reinke crystals
Reinke crystals
Eosinophilic Leydig cells
Fibrinoid replacement
Hilar based steroid cell tumor
Inhibin positive
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Solid pelvic mass with calcifications
Cystic pelvic mass with calcifications
Contributed by Erna Forgó, M.D. and Teri A. Longacre, M.D.
Irregular papillary mass
Heterogeneous cystic yellow friable mass
Contributed by Erna Forgó, M.D. and Teri A. Longacre, M.D.
Mild to moderate (low grade) cytologic atypia
Admixed glandular, micropapillary and cribriform invasive patterns
Contributed by Erna Forgó, M.D. and Teri A. Longacre, M.D.
Finely vacuolated cytoplasm
Hyperchromatic nuclei
Clusters of uniform cells
Prominent nucleoli
Micropapillary clusters
Contributed by Rajesh Thampy, M.D.
Sclerosing encapsulating peritonitis, abdominopelvic CT
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Luteinized thecoma
Contributed by Rayan Sibira, M.D. and Mahmoud A. Khalifa, M.D., Ph.D.
Spindled and luteinized cells
Luteinized cells
Luteinized cells with scarred mitosis
Sex cord-like differentiation
Peritoneal lesions
Reticulin stain
Calretinin IHC stain
Beta catenin IHC stain
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MGAT5B::NCOA3 fusion gene
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Bilateral ovarian masses
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Irregularly dilated endometrial glands
CD10, MIC2, calretinin, progesterone receptor, MIB1
Contributed by Daniel Graham, M.D., Adele Wong, M.B., B.Ch., B.A.O. and Lucy Ma, M.D.
Glandular growth pattern
Variety of histologic patterns
Variable growth patterns
Glandular morphology
Glands
Multiple growth patterns
Glandular and cystic areas
Micropapillary architecture
Mitotic activity
Papillary architecture
Variable morphology
PAX8
GATA3
GATA3
TTF1
TTF1
CD10
CD10
CD10
Estrogen receptor
Progesterone receptor
p53
Ki67
WT1
Varied morphology
PTC-like nuclear features
Mesonephric-like adenocarcinoma by Dr. Lewis Hassell
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Solid and cystic bilateral ovarian masses
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Bilateral ovarian masses with multinodular cut surfaces
Contributed by Lucy Ma, M.D.
Krukenberg tumor
Metastatic cervical adenosquamous carcinoma
Metastatic low
grade appendiceal
mucinous
neoplasm
Metastatic lobular breast carcinoma
Contributed by Stephanie L. Skala, M.D.
Lobulated microcystic tumor
Prominent microcystic features
Multinucleated cells, bizarre nuclei
Areas of nested architecture
Nuclear beta catenin expression
CD10 positivity
Contributed by Vijaya Kadam Maruthi, M.D. and Natalia Buza, M.D.
CCC: tubulocystic pattern
CCC: glandular pattern
CCC with background endometriosis
CCC: eosinophilic cytoplasm
EC with background endometriosis
EC: confluent glandular pattern
CCC: IHC
HNF-1B
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Computed tomography of ovarian mass
Computed tomography of pelvic mass
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Firm, solid & cystic
Contributed by Russell Vang, M.D.
Admixed germ cell and sex cord components
Atypical and proliferative plump germ cells
AFIP images
Lobulated, focally hemorrhagic
AFIP images
Mixed malignant germ cell tumor
Diffuse embryoma
Contributed by Azin Mashayekhi, M.D., M.B.A. and Gulisa Turashvili, M.D., Ph.D.
Magnetic resonance imaging (MRI) of pelvis
Contributed by Azin Mashayekhi, M.D., M.B.A. and Gulisa Turashvili, M.D., Ph.D.
Cystic lesion
Contributed by Azin Mashayekhi, M.D., M.B.A. and Gulisa Turashvili, M.D., Ph.D.
Cystic lesion
Cystic lesion
Intracystic proliferation
GFAP
Contributed by Russell Vang, M.D.
Multiloculated cyst
Contributed by Neshat Nilforoushan, M.D., Russell Vang, M.D. and @AminiaCiobanoiu on Twitter
Complex architecture, tufting and villus formation
Mucinous intestinal type epithelium
Intraepithelial carcinoma
Microinvasion
Mucinous borderline tumor
AFIP images
Mucinous
cystadenocarcinoma
Gelatinous with extensive hemorrhage and necrosis
Mucinous cystic
tumor with
various
components
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Mucinous
cystadenocarcinoma
AFIP images
Cribriform pattern
Resembling endometrioid adenocarcinoma
Mostly apical
mucin, but several
goblet cells
with red mucin
With microinvasion of stroma
Disorderly
arrangement of
cysts and glands
of irregular shapes
Invasive small glands and small collections of signet ring cells
Cyst lined by cells with abundant mucin and highly stratified; nuclei highly atypical and presence of necrotic debris in lumen
Resembling
mucinous (colloid)
carcinoma
of intestine
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Palpable lower abdominal mass
Right pelvic pain
AFIP images
Mucinous cystadenoma
Associated with dermoid cyst
Contributed by Gulisa Turashvili, M.D., Ph.D. and AFIP images
Unilocular cyst
Bland mucinous epithelium
Mucinous adenofibroma
Mucinous cystic tumor
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Mural anaplastic carcinoma
Mural leiomyoma
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Mural leiomyoma
Sarcoma-like mural nodule
Anaplastic carcinoma mural nodule
Clear cell mural nodule
Contributed by Kruti P. Maniar, M.D. and Jian-Jun Wei, M.D.
Mural carcinosarcoma
Stromal invasion
Atypical spindled and epithelial cells
CK7
Vimentin
Mural neuroendocrine carcinoma
Stromal invasion
Marked atypia
Synaptophysin
Mural anaplastic carcinoma
Marked atypia
Vascular / stromal invasion
Metastasis
Mural carcinosarcoma
Stromal invasion
Malignant cells
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Rhabdomyoblastic
Sarcomatoid anaplastic
AFIP images
Enlarged ovary is
pearly white
Contributed by Krisztina Lengyel, M.D. and AFIP
Multiple variably sized cysts and cystic follicles
Atretic follicle with bands of luteinized theca cells
Bands of luteinized theca cells with hemorrhage
Outer cortex is
collagenized with
several follicle
cysts
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Peripherally located multinodular ovarian masses
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Bilaterally enlarged ovaries
Multicentric and bilateral tumor
Contributed by Swati Bhardwaj, M.B.B.S., M.D., Tamara Kalir, M.D., Ph.D. and AFIP images
Multinodular,
well circumscribed
pregnancy
luteoma
Uniform, round, eosinophilic luteoma cells
Luteoma with brisk mitoses
Stromal edema
Stromal edema with nested appearance of luteoma cells
Reticular pattern
Granulosa cell proliferations adjacent to luteoma
Groups of cells surrounded by reticulin fibers
Mitoses
AFIP images
Small cyst in hilus
Numerous small crevices
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CT ovarian mass
MRI ovarian mass
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Laparoscopy
Large mass
Contributed by Jennifer Bennett, M.D.
Yellow-white mass
Contributed by Jennifer Bennett, M.D. and @MirunaPopescu13 on Twitter
Alternating cellularity
Pseudolobule
Collagenous background
Abundant eosinophilic cytoplasm
Sclerosing stromal tumor
Sclerosing stromal tumor
Inhibin
Contributed by Shannon Mingo Welter, M.D.
Endometriotic cyst
Squamous and endocervical
Stromal cores with edema or fibrosis
Papillary tumor
Fibrous cores with inflammation
Variable cell types
Hobnail and endocervical
Endocervical cell lining
Nondescript eosinophilic cells
Ovary tumors associated with endometriosis
Contributed by Gulisa Turashvili, M.D., Ph.D.
Cyst wall lined by simple epithelium
Cyst wall lined by simple epithelium consisting of serous type ciliated cells admixed with endocervical type mucinous cells
Contributed by Aarti Sharma M.D. and Ricardo R. Lastra, M.D.
26 cm mass
Contributed by Aarti Sharma M.D. and Ricardo R. Lastra, M.D.
Papillary clusters
Excrescences
Contributed by Aarti Sharma M.D., Ricardo R. Lastra, M.D. and Carlos Parra-Herran, M.D.
Conventional SBT
Micropapillary SBT
Lymph node involvement
Noninvasive implants
Microinvasion
Contributed by Aarti Sharma M.D. and Ricardo R. Lastra, M.D.
Clusters of cells with irregular contours
High N/C ratio in clusters
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Serous cystadenoma
Cystadenofibroma
Contributed by Catherine J. Roe, M.D. and Krisztina Hanley, M.D.
Serous cystadenofibroma
Serous cystadenoma
Serous cystadenoma with focal epithelial proliferation
Papillary tufting
Cytologic features
Focal epithelial proliferation
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Small epithelial cell cluster
CD68
Contributed by Mahmoud A. Khalifa, M.D., Ph.D.
Sex cord classification
AFIP images
Yellow and lobulated
Contributed by Shannon Mingo Welter, M.D.
Hollow and solid tubules
Tubules with hyalinized stroma
Tubular and trabecular
Trabecular
Diffuse with tubules
Mixed patterns
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Large tumor
Contributed by Natalia Buza, M.D.
Intermediate grade tumor
Contributed by Natalia Buza, M.D.
Well differentiated tumor
Moderately differentiated tumor
Poorly differentiated tumor
Retiform pattern
Heterologous elements
AFIP images
Predominantly solid tumor
Contributed by Krisztina Lengyel, M.D. and AFIP
Sharply delineated bland nests
Variably sized nests
Variably sized discrete nests
Numerous and variable nests
Multiple cysts and nests in young patient
Multiple nests of cells
Contributed by Glenn McCluggage, M.D.
Spindled and signet ring cells
Signet ring cells
AFIP images
Fleshy cream colored tissue
Contributed by Basile Tessier-Cloutier, M.D. and AFIP
Follicle-like spaces and myxoid stroma
Solid and corded architecture
Rhabdoid morphology
SMARCA4 / BRG1 loss of expression
Reduced SMARCA4 / BRG1 expression
Diffuse growth of small cells with scanty cytoplasm
Hyperchromatic nuclei
Growing in nests
Large cell variant
Follicle-like structures with eosinophilic material
Several mucinous glands
Signet ring cells in basophilic mucin
Several glands lined by tumor cells, some with mucin
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Solid pseudopapillary neoplasm
Contributed by Kamaljeet Singh, M.D.
Circumscribed mass
Nests with fibrous septa
Pseudopapillae
Intracytoplasmic vacuoles
β catenin
c-kit
CAM5.2
CD10
CD99
Synaptophysin
Vimentin
WT1
E-cadherin
Ki67
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Dermoid cyst with heterogeneous echotexture
Adnexal heterogeneous masses
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Teratoma with metastatic nodules
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Abscessed left ovarian tumor
Mature teratoma
Contributed by Cinzia Giacometti, M.D.
Mature teratoma
Dermoid cyst
Mucinous low grade adenocarcinoma
CDX2 IHC
CK7 IHC
CK20 IHC
Contributed by Natalia Buza, M.D.
Ovarian surface involvement (pT1c2)
Rectosigmoid colon (pT2b)
Splenic hilum and parenchyma (pM1b)
Contributed by Natalia Buza, M.D.
Ovarian surface involvement (pT1c2)
Uterine serosal (pT2a)
Appendiceal serosal (pT3b)
Splenic capsule (pT3c)
Splenic parenchyma (pM1b)
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Enhancing adnexal mass
Fat containing pelvic mass
Homogeneous isoechoic mass
Solid adnexal mass
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Hirsutism
Male pattern baldness
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Yellow cut surface
Metastatic steroid cell tumor
Lobulated cut surface
Nodular solid tumor
Tan-brown, well circumscribed tumor with hemorrhage
Contributed by Fatemeh Ghazanfari Amlashi, M.D., Tamara Kalir, M.D., Ph.D. and AFIP
Well defined tumor
Sparse stroma
Diffuse sheets
Moderate to abundant cytoplasm
Round to polygonal cells
Distinct cell borders
Spongy and eosinophilic cytoplasm
2 atypical mitotic figures
Inhibin
Calretinin
MelanA
Abundant lipid (oil red O stain)
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Large polygonal cells
Steroid cell tumor
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Ovarian stromal hyperplasia
AFIP images
Enlarged ovaries
Contributed by Hafza Asma Adnan, M.B.B.S. and AFIP
Diffuse stromal hyperplasia
Ovarian stromal hyperplasia
Nests of vacuolated, luteinized cells
Large nodule of luteinized cells
Lutein cells contain abundant lipid (oil red O stain)
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Left adnexal mass
Contributed by Kseniya Korchagina, M.D. and AFIP
Cystic teratoma
Solid and cystic
Reddish brown solid mass
Cystic tumor
Contributed by Sharon Song, M.S., M.D., Kseniya Korchagina, M.D. and AFIP
Follicular variant PTC
Capsular invasion
TTF1 stain
Papillary thyroid carcinoma in struma ovarii
Papillary thyroid carcinoma in struma ovarii
Macrofollicular, microfollicular and solid areas
Solid tubular pattern
Oxyphilic cells arranged in nests
With peripheral formation of lutein cells
Resembling clear cell carcinoma
Cystic tumor
Thyroglobulin
With papillary carcinoma
AFIP images
4 cm, rounded, brown nodule (bottom)
AFIP images
Admixed: struma (right) merges with trabecular carcinoid (left)
Admixed: trabecular
carcinoid with
microfollicles
containing colloid
Chromogranin (top), thyroglobulin (bottom)
With formation of
layer of steroid cells
in adjacent ovarian
stroma
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Complex ovarian mass
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Solid ovarian mass with variegated appearance
Contributed by Aurelia Busca, M.D., Ph.D.
Mature component
Immature component
Immature component
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Ultrasound characteristics
CT characteristics
MRI characteristics
Contributed by Shannon Mingo Welter, M.D., AFIP and @Andrew_Fltv on Twitter
Fragmented ovarian mature teratoma
Ovarian mature teratoma
Mature teratoma
Mature teratoma
Contributed by Shannon Mingo Welter, M.D. and @Andrew_Fltv on Twitter
Skin with sebaceous glands
Skin with keratin and adnexa
Rokitansky nodule
Mucin producing epithelium
Multiple tissue types
Orderly arrangement of tissues
Cartilage and other mature tissues
Glial tissue
Gliomatosis peritonei
Mature teratoma
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Bilateral thecomas on MRI
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Bitemporal hair loss
Frontal balding and hirsutism
Contributed by Victoria Collins, M.D., Tamara Kalir, M.D., Ph.D. and AFIP
Well circumscribed, yellow-tan mass
Lobulated and yellow
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Yellow, lobulated mass
Contributed by Victoria Collins, M.D., Tamara Kalir, M.D., Ph.D., AFIP and @SeoparjooAzmel on Twitter
Well circumscribed
Ovoid to round cells
Mild nuclear atypia
Thecoma and fibroma areas
Cystic change
Hyaline plaques
Stromal calcification
Thecoma
Thecoma
Vacuolated tumor cells
Reticulin
Inhibin
Oil red O stain
Thecoma of ovary
Ovarian pathology
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Fallopian tube
AFIP images
Hemorrhagic infarction of tube
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Surgical specimen
Contributed by Basile Tessier-Cloutier, M.D.
Undifferentiated and differentiated components
Solid architecture
Discohesive rhabdoid cells
ARID1B
Contributed by Carlos Parra-Herran, M.D.
Gastric
Pancreatic
Contributed by Lewis A. Hassell, M.D.
Serous borderline tumor
Serous
borderline tumor,
micropapillary
type
High grade serous carcinoma
Clear cell carcinoma, ovary
Clear cell adenofibroma, borderline
Seromucinous borderline tumor
Dedifferentiated carcinoma in ovary
Sclerosing stromal tumor
Steroid cell tumor, ovary
Granulosa cell tumor, adult type
Sex cord tumor with annular tubules
Retiform Sertoli-Leydig tumor
Sertoli-Leydig tumor, intermediate
Mixed germ cell tumor
Immature teratoma
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Wilms tumor involving both kidneys
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Adult tumor (kidney)
Various images (kidney)
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Pelvic sonography
shows a mixed
echogenicity mass
T2 MRI shows multiseptated cystic mass
Axial T2 weighted turbo spin echo MRI (TR / TE, 3900 / 99)
Axial T1 weighted spin echo MRI (800 / 12)
Contributed by Jian-Hua Qiao, M.D.
Yellow nodules
Contributed by Jian-Hua Qiao, M.D.
Foamy histiocytes in cystic wall
Foamy histiocytes mixed with inflammatory cells
Foamy histiocytes
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Large mass with ascites
Bilateral ovarian mass
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Large ovarian tumor
Contributed by Debra L. Zynger, M.D. and AFIP images
Smooth, nodular exterior
Gelatinous cut surface
Gelatinous cystic surface
Honeycomb surface (polyvesicular vitelline pattern)
Contributed by Gulisa Turashvili, M.D., Ph.D., Sharon Song, M.D. and AFIP images
Reticular / microcystic pattern
Glandular pattern
Endometrioid-like glandular variant
Solid pattern
Papillary pattern
Polyvesicular vitelline pattern
Schiller-Duval body
Hepatoid variant
AFP
SALL4
GATA3
Pancytokeratin
CK7
Carlson: 2023
Clement: 2019
Crum: 2015
Crum: 2017
Fadare: 2015
Heller: 2015
IARC: 2020
Kigawa: 2015
Kurman: 2019
Nucci: 2020
Nucci: 2023
Vang: 2023
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