International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571

Original Research Article

Uncommon Gynecological Pathologies We Had Encountered - A Histopathological Potpourri

Shifa S. Ibrahim, Kamaleshwari Kesavaraj, Shamsath Nisha A. Ibrahim, Umasankari L Ramasamy, Manjula Rajendran

Assistant Professor, Madurai Medical College, Tamil Nadu, India.

Corresponding Author: Shifa S. Ibrahim

Received: 13/02/2016 Revised: 09/03/2016 Accepted: 14/03/2016

ABSTRACT

Background: Gynecological surgeries are done for both benign and malignant conditions involving the uterus, cervix, tubes, , vagina and . Very few rare entities are seen in the gynaecopathological practice. Aim: To analyze the uncommon benign and malignant entities diagnosed in the gynecological specimens. Materials and Methods: During our one year study period, all the gynecological specimens were retrieved from the records. Rarely encountered specimens were included in our study after reanalysis. The histomorphology and the differential diagnosis are discussed. Results: Out of 3100 gynecological specimens we received, few rare benign and malignant conditions were diagnosed. Most of them were incidental findings. The commonest presenting symptom was abdominal pain and the provisional diagnosis was leiomyoma in most of the cases. Ten interesting cases were diagnosed during our study period. Brief review of literature and differential diagnosis of these rare entities are discussed. Conclusion: Rare entities like pure lipomatous lesion of the uterus and of mammary gland like arising from papilliferum were encountered during our study period. Diagnostic criteria’s of these rare tumors and the review of literature gave us a true learning experience.

Key words: Stromal tumor, Polyp, Apocrine , Lipoma.

INTRODUCTION mention as they are rarely encountered in Among the gynecological surgeries, the gynaecopathological practice. Rare hysterectomy is the most common surgery specimens are analyzed and the literatures performed in the world. The first subtotal are reviewed with the learning objective. hysterectomy was performed by Charles Clay in Manchester, England in 1843 and MATERIALS AND METHODS first total abdominal hysterectomy in 1929. During our one year study period all [1] Hysterectomy is performed for abdominal the gynecological specimens were collected pain, abnormal bleeding, persistent chronic from the records. 3110 gynecological cervicitis, prolapse uterus and for specimens were received during our study gynecological malignant tumors. [2] period and the rarely encountered tumors Leiomyoma is the commonest entity that is were searched and reanalyzed. We had diagnosed among the gynecological encountered ten rare cases during this one specimens. [3-5] Few cases deserve special year period. Relevant case history was

International Journal of Health Sciences & Research (www.ijhsr.org) 124 Vol.6; Issue: 4; April 2016 taken. Both gross and microscopic On cut surface it was grey white with focal reevaluation was done by a panel of grey yellow areas. [Fig3] pathologists. Literatures were reviewed to establish their rarity and differential diagnosis and markers if relevant were analyzed. Incidence of these rare cases in our setup was calculated.

RESULTS Relevant case history, gross and microscopic findings are enumerated.

Case1: A sixty year old female came with Fig 2: Show a well encapsulated tumor composed of lobules of abdominal pain. Routine investigations were mature adipocytes. Myometrium is seen in the periphery [arrow]. - Lipoma of the uterus [40x H&E]. within normal limits. Ultrasound was done and she was diagnosed as having leiomyoma. Hysterectomy was done and the specimen was sent to us for histopathology. Gross: Hysterectomy specimen we received measured 9x7x5cm. Uterine cavity was compressed by a yellow tumor measuring five centimeter in diameter in the myometrium. The tumor was greasy to cut [Fig 1]. Fig 3: Show a well circumscribed grey white tumor with focal yellow areas in the myometrium.

Microscopy: Sections studied from the uterus showed proliferative endometrium. Sections studied from the myometrium showed a tumor composed of interdigitating fascicles of smooth muscles and scattered among them were adipocytes. Hyaline degeneration was also noted [Fig 4]. It was

Fig 1: Showa greasy yellow mass measuring 5cm in diameter diagnosed as a case of lipoleiomyoma. in the myometrium.

Microscopy: The endometrium was compressed and atrophic and in the myometrium there was a well circumcised mass composed of mature fat cells arranged in lobules. There were neither atypia nor pleomorphism. [Fig2]. It was diagnosed as lipoma of the uterus. Case2: A fifty four year old female had abdominal pain and distension. She was Fig 4: Show smooth muscle fibers arranged in fascicles intermixed with mature adipocytes [black arrow] [40x H&E] - diagnosed as having leiomyoma in the Lipoleiomyoma ultrasound. Hysterectomy was done and sent to our lab. Case 3: A thirty four year old female had a Gross: Hysterectomy specimen measured chronic lower abdominal pain and white 11x9x7cm. On cut surface endometrium discharge. On investigation she had a mass was unremarkable and the myometrium in the uterine adnexa and was diagnosed as showed a tumor measuring 6cm in diameter. International Journal of Health Sciences & Research (www.ijhsr.org) 125 Vol.6; Issue: 4; April 2016 ovarian mass. Hysterectomy specimen and oriented along the long axis. The stroma the peritoneal biopsies were sent to us. was edematous, showed myxoid Gross: Uterus and cervix were grossly degeneration and thickened blood vessels. normal. The fimbrial end of one of the tube The endometrial glands showed no showed a grey white mass measuring epithelial hyperplasia, dysplasia nor 4x3x2cm.The other tube and the peritoneum malignancy. The diagnosis was tamoxifen was normal. induced endometrial polyp [Fig 6]. Microscopy: Sections studied from the uterus was unremarkable. Sections studied from one of the tube’s fimbrial end showed caseating granulomas and many langhans type of multinucleated giant cells. The tubal was ulcerated. [Fig 5] The diagnosis was caseating granulomas probably of tuberculous origin. AFB stainig show many bacilli confirming the diagnosis.

The peritoneum and the other tube were not Fig 6: Show multiple dilated stag horn shaped glands and involved. And there were no other organ nor periglandular stromal proliferation- Tamoxifen induced changes [40x H&E]. nodal involvement. Hence the diagnosis of unilateral primary tuberculous salpingitis Case 5 and 6: A sixty year old female and a was made. fifty year old female had abdominal pain. Hysterectomy and bilateral salphingo- oopherctomy was done suspecting leiomyoma. Gross: Uterus from both the specimen was unremarkable. The ovaries measured 6cm and 5cm in diameter respectively. On cut surface the ovaries were grey white and firm. [Fig7]

Fig 5: Show serous epithelium of the tube [black arrow] and the stroma shows Langhans giant cell and granuloma [red arrow] [40x H&E]

Case 4: A forty year old female with the complaints of abdominal pain and abnormal uterine bleeding was investigated and diagnosed as having a fleshy growth in the endometrium in the ultrasound. She was on tamoxifen for breast carcinoma since two Fig 7: Shows atrophic uterus [red arrow] and the ovarian months. Hysterectomy specimen was sent tumor measuring 5cm in diameter [Large black arrow]. On cut surface tumor were grey white and firm. The other for evaluation. [small arrow] was normal. Gross: Uterus and cervix measured 10x8x6cm. On cut surface the uterus Microscopy: Sections studied from the showed a large fleshy polypoidal lesion ovaries show replacement of the ovarian measuring 6x5cm extending up to the parenchyma by a fibrous tumor composed internal os. On cut surface it was grey white of fascicles of bland spindle shaped cells. and soft. There were no mitosis, atypia/ Microscopy: Sections studied from the pleomorphism. [Fig 8] The diagnosis was uterus showed a polyp consisting of of the ovary. multiple dilated, stag horn shaped glands

International Journal of Health Sciences & Research (www.ijhsr.org) 126 Vol.6; Issue: 4; April 2016 Case 8: A fifty four year old female had abdominal pain and hysterectomy was done with the diagnosis was leiomyoma. Gross: Uterus and one ovary were unremarkable. The other ovary measured 5x4x3cm and showed a solid and cystic mass on cut surface. [Fig 11]

Fig 8: Shows a benign fibrous tumor arranged in fascicles completely replacing the ovary [10x H&E] – Fibroma of the ovary

Case 7: A thirty three year old female had fullness in her stomach and abdominal pain. The ultrasound diagnosis was . Hysterectomy with bilateral salpingo-oophorectomy was sent. Gross: Uterus was unremarkable. The ovary Fig 11: Show entire ovary replaced by a solid and cystic tumor measured 6x5x4cm and on cut surface Microscopy: Sections studied from the showed a grey yellow mass. [Fig 9] ovary showed a tumor composed of uniform

cells arranged in sheets. Focal areas showed Call Exner bodies. Individual cells showed scanty cytoplasm and nuclear grooving. [Fig 12] The diagnosis was granulosa tumor of the ovary.

Fig 9: Show an ovary completely replaced by grey yellow and firm tumor.

Microscopy: Sections studied from the ovary showed a tumor composed of cells with abundant eosinophilic cytoplasm and round to oval nuclei. Areas of calcification Fig 12: Shows Call Exner bodies composed of cells exhibiting were also seen. There was neither atypia nor nuclear grooving [40x H&E] - Granulosa tumor. pleomorphism seen. [Fig 10] The diagnosis Case 9: A fifty year old female had a mass was luteinized the coma of the ovary. in the vulva. A biopsy of the lesion was

sent. On microscopy the tumor showed abundant eosinophilic cytoplasm, dispersed nuclear chromatin with prominent nucleoli and marked pleomorphism. A provisional diagnosis of malignancy was given and later wide local excision was sent for analysis. Gross: Vulvectomy specimen was received measured 6x5x4cm.Skin was intact and on cut surface the tumor was in deep dermis, Fig 10: Shows a tumor composed of cells with vacuolated grey white infiltrating and measured cytoplasm and round nuclei [40x H&E] – Luteinized the coma. 3x3x2cm with an all-around clearance ranging from 2-3cm. [Fig 13]

International Journal of Health Sciences & Research (www.ijhsr.org) 127 Vol.6; Issue: 4; April 2016 peritoneal biopsy, ascitic fluid along with cervical nodes was sent for evaluation. Gross: Hysterectomy specimen we received measured 9x8x7cm. On cut surface the endometrial cavity was dilated and showed a polypoidal homogenous white mass measuring 5x4x3cm, extending up to the os and invading the myometrium grossly. Ovaries and peritoneal samples were Fig 13: Shows Vulvectomy specimen with a skin [Black arrow] and a grey white tumor [Red arrow] in the dermis. unremarkable grossly. Out of the three nodes we had received, one node was Microscopy: Sections studied from the enlarged and was homogenous white. [Fig tumor showed skin and the dermis showed 16] benign hidradenoma area and its transition into a malignant tumor. The individual cells had abundant eosinophilic cytoplasm and exhibited marked nuclear atypia and pleomorphism arranged in glandular, tubular pattern and in sheets. [Fig 14& 15] The diagnosis was mammary type adenocarcinoma arising from hidradenoma papilliferum.

Fig 16: A polypoidal homogenous grey white mass filling the endometrial cavity and extending up to the cervical os. Inset shows cervical node involved by the tumor.

Microscopy: The endometrium was completely replaced by tumor tissue consisting of uniform bland cells with oval nuclei, dispersed chromatin arranged in sheets and infiltrating the myometrium in a tongue like fashion. Many capillary sized Fig 14: Shows benign hidradenoma papilliferum area[ Black blood vessels were seen among the tumor arrow] and malignant adeocarcinoma area[ Red arrow].[4x H&E] cells. Mitosis was 2/10 high power field. [Fig 17] Out of the three cervical nodes sent, one showed metastatic deposits from the endometrial tumor. The peritoneal biopsy was unremarkable. Smear studied from the ascitic fluid was hemorrhagic and showed tumor cells arranged in sheets. [Fig 18] The diagnosis was endometrial stromal sarcoma- Low grade with metastatic deposits in a cervical node and ascitic fluid was positive for malignancy. Fig 15: Show malignant epithelial cells arranged in sheets. Individual cells show abundant eosinophilic cytoplasm, When the incidence of these tumors vesicular nuclei and prominent nucleoli [40x H&E] Inset show was calculated, almost all the tumors benign hidradenoma area [40x H&E]. included in our study except ovarian Case 10: 35 year old female was evaluated fibroma had an incidence of 0.003% for her abdominal pain and on ultrasound proving their rarity [Table1]. uterine tumor with nodal metastasis was diagnosed. Hysterectomy specimen,

International Journal of Health Sciences & Research (www.ijhsr.org) 128 Vol.6; Issue: 4; April 2016

Fig 17: Shows uniform bland oval shaped cells arranged in Fig 18: Shows deposits from the endometrial stromal sarcoma sheets - Endometrial stromal sarcoma [40x H&E]. in the ascitic fluid [40x H&E].

Table 1: Incidence of these tumors encountered in our study Name of the tumor Incidence Lipomatous tumor Lipoma of the uterus 0.003% Lipoleiomyoma of the uterus 0.003% Unilateral primary tuberculous salpingitis 0.003% Tamoxifen induced endometrial polyp 0.003% 0.006% Ovarian Granulosa tumor 0.003% Mammary type adenocarcinoma arising from hidradenoma papilliferum in the vulva 0.003% Endometrial stromal sarcoma - Low grade with metastasis to a cervical node 0.003%

DISCUSSION Differential diagnosis include mixed Gynecological pathology lipomatous tumor, liposarcoma component encompasses a wide array of entities. Of of carcinosarcoma or lipoma may be a part which some are very rare in the routine of ovarian . Absence of other practices. Awareness of these rare entities component ruled out mixed lipomatous increases the diagnostic acumen of the tumor. Absence of atypia and other practicing pathologists. malignant epithelial component ruled out The lipoma of the uterus is a rare carcinosarcoma. Ovarian teratoma also has tumor with an incidence of 0.03 to 0.2%. [6- other components like squamous 8] Lipomatous tumor may be benign - pure epithelium, adnexal structures to name a or mixed with other components few and it was also ruled out confirming the [Lipoleiomyoma, Angiolipoma] or diagnosis of pure lipoma of the uterus. The malignant [Liposarcoma]. It was first incidence of pure lipoma of the uterus in our described by Lopstein in the year 1816. [9] It study was 0.003% in correlation with others is common in postmenopausal women. [10] studies. [6-8] Uterine bleeding and abdominal pain are the Lipoleiomyoma is most common most common presenting symptoms. among the lipomatous tumor of the uterus. Theories that were proposed for the origin [16] Lipoleiomyoma was first described by of the lipoma in the uterine wall include Meis and Enzinger in 1991. It is common in migration of adipose cells through the obese postmenopausal women. [17] It is an uterine arteries, mesenchymal remnant of a asymptomatic tumor. Inclusion of the fat pluripotential stem cell or from the cells in the uterine wall during surgery and metaplasia of the uterine smooth muscle. [11- fatty degeneration of the connective tissue 13] Diagnosis of purelipoma of the uterus were the theories proposed for the origin of should be made when the smooth muscle these tumors. [18] Malignant transformation cells are confined to the periphery of the in uterine lipoleiomyoma was reported in tumor. [14] Fat cells are immunoreactive for the literature. [18] Surgery is curative. vimentin, desmin and actin [smooth muscle Genital tract tuberculosis constitutes about markers]. [15] Direct transformation of the fat nine percent of all the extra-pulmonary cells from smooth muscle cells may be the tuberculosis. [19] The prevalence of genital reason for this immuno reactivity. tuberculosis in the female is 1-2%. [20] The

International Journal of Health Sciences & Research (www.ijhsr.org) 129 Vol.6; Issue: 4; April 2016 mean age incidence is 20-40 years. It is more common following tamoxifen therapy. commonly asymptomatic. If symptomatic, Follow up of these patients with the presenting symptoms include infertility, hysteroscopy and endometrial sampling is amenorrhea, menorrhagia, abdominal pain necessary even in asymptomatic patients on and dyspareunia. It is incidentally diagnosed tamoxifen. during the investigations for infertility. Ovarian fibroma constitutes 4% of Morgagni was the first to describe the signs all ovarian tumors. [28] This tumor occurs in of female genital tuberculosis infection. [21] the perimenopausal women. [29] Usually Unilateral primary tubal tuberculous asymptomatic, ovarian fibroma can cause infection is very rare. Criteria to diagnose abdominal pain due to torsion. 90% of primary genital tuberculosis include: No ovarian are unilateral. It is other site should be infected with associated with two syndromes- Gorlin and tuberculosis and the genital lesions should Meig. Bilateral, nodular and calcified be the first tuberculous infections and the ovarian fibroma is associated with Gorlin regional lymph node should also be syndrome. [28] In Meigs syndrome, ovarian involved by tuberculous lesion. In the fibroma is associated with hydrothorax and absence of a peritoneal lesion, tuberculosis ascites. This syndrome is observed with 1- of the fallopian tube is likely to be primary 10% of ovarian fibromas. Most of the tumor in origin. [22] Diagnosis is by histopathology, is solid and firm and have grey white cut demonstration of the bacilli using AFB surface. formation is also seen. stain, fluorescent aura mine stain, culture Microscopically, this tumor show and PCR. Culture is negative in one third of intersecting fascicles or a storiform the cases. [23] arrangement of bland spindle cells with Tamoxifen is a non-steroidal ant ovoid to elongated nuclei. Cellular variant is estrogenic agent which is used as an adjunct also noted. It shows diffuse vimentin, WT-1 to treat breast . It also has a weak and CD56 positivity. [30] It is a benign estrogenic effect leading on to various and treated with surgical excision. estrogen induced side effects on the female The coma is very rare and the incidence is genital tract which includes estrogenic about 1% of solid ovarian tumors. [31] It is effect on the vagina, stimulate the growth of common among postmenopausal female. fibroid, and stimulate endometriosis, causes The symptomatology includes vaginal endometrial polyp, endometrial hyperplasia, bleeding, symptoms related to estrogen atypical endometrial changes and carcinoma secretion and virilizing symptoms related to endometrium. Atypical lesions are seen androgen excess. Luteinized the coma is when there is preexisting endometrial lesion associated with androgenic excess. It is a and carcinoma is seen in postmenopausal solid grey yellow tumor. Microscopically female. [24,25] The patients may be this tumor show sheets and nests of ovoid to symptomatic or asymptomatic. Grossly, the spindle cells with round to oval nuclei, uterus is bulky and there is increased inconspicuous nucleoli, abundant pale or endometrial thickening. Microscopically, vacuolated cytoplasm with indistinct the polyp may be single or multiple and cellular borders. [32] Reticulin stains the show periglandular proliferation of the individual cells. Inhibin, calretinin, CD10, stroma, glandular and epithelial and vimentin are positive in the coma. [30] proliferation, metaplasia, dysplasia and They are benign neoplasm and surgery is carcinomatous changes. The polyps are the treatment of choice. larger and consist of stag horn shaped There are two types of granulosa glands arranged along the long axis with tumor - Adult and Juvenile. Adult granulosa edema and myxoid change isseen in the tumor is common in peri and stroma. [26,27] Low-grade endometrioid and postmenopausal women. It is an estrogen serous carcinoma are three to four times producing, solid and cystic tumor.

International Journal of Health Sciences & Research (www.ijhsr.org) 130 Vol.6; Issue: 4; April 2016 Unilateral involvement of the ovary is likes areas. The tumor exhibits an common. Microscopically, variable growth aggressive behavior, with 60% of patients patterns such as diffuse sheets, trabecular, having regional lymph node metastasis at insular, tubular, corded, micro follicular; the time of presentation. [39] Immuno macro follicular and watered silk are seen. histochemically, loss of s100, ER and PR Call Exner bodies that ismicrofollicle filled help to differentiate benign hidradenoma with eosinophilic basement membrane from its malignant counterpart. In addition, material is seen in this tumor. The tumor markers like mammaglobin and gross cystic cells have scant cytoplasm, angulated nuclei disease fluid protein 15[GCDFP15] are and have nuclear grooves [coffee bean]. [33] positive in this tumor. Juvenile granulosa cell tumor is common in Endometrial stromal sarcomas were the first three decades and presents with once called as endolymphatic stromal hyper estrogenic symptoms. [34] It is myosis. Typicallythis tumor infiltrates the associated with Maffuci syndrome and myometrium and has a tendency to Ollier disease. [34] It is unilateral grey yellow permeate lymph vessels. The or tan colored tumor. Microscopically, the lymphovascular invasion can be seen tumor exhibits follicle like spaces lined by grossly as a yellow ropy mass. The risk of cells with hyperchromatic non grooved cells nodal metastases ranges from 0% to 44%. and filled with eosinophilic material. The [40] Endometrial stromal sarcoma is divided cytoplasm is abundant eosinophilic to into low grade and high grade based on the vacuolated. Increase in mitosis and atypia is mitotic figure [<10/ 10 high power field or noted in this type. This tumor is inhibin and more than10]. [41] The size of the tumor, calretinin positive. This is a benign tumor mitotic figures and extension of the tumor with good prognosis. Recurrence is seen in are the prognostic factors. Histological adult granulosa tumors. differential diagnosis include epithelioid Hidradenoma papilliferum is a variant of . The presence of benign tumor arising from specialized thin walled vessels, Multinodular pattern anogenital mammary-like sweatgland. [35,36] and CD10 positivity helps to differentiate Hidradenoma papilliferum is composed of endometrial stromal tumor from numerous tubules and acini linedby a single leiomyosarcoma. Endometrial stromal or double layer of cuboidal cells and outer tumor has a tendency to recur and rarely myoepithelial cells. Intraductal carcinoma metastases. resembling mammary-type apocrine epithelium arising in hidradenomais a rare CONCLUSION entity. [37] It was first reported in 1936 by Diagnostic criteria of lipoma of the Greene. Approximately 30 to 40 cases of uterus, primary fimbrial tuberculosis and adenocarcinoma of mammary-like glands mammary type adenocarcinoma of the vulva were reported in the literature to date. [38] turned out to be an eye opener for us. The presence of a transition zone between Stromal tumors of the ovary are rarely normal mammary-like glands and the encountered and their incidence was 0.003% carcinoma component is necessary to in our study, thus proving rarity. Very few establish a diagnosis. The loss of the cases of mammary type adenocarcinoma myoepithelial layer, nuclear pleomorphism arising from hidradenoma papilliferum had and invasiveness are used to diagnose been reported so far. One such case is invasive adenocarcinoma. documented in our study. Histopathologically, these tumors show varied patterns. They show predominantly REFERENCES ductal to lobular pattern. Other patterns 1. John A, Rock MD, Jhon D, Thompson include mixed ductal and lobular, MD; Telinds’s Operative Gynaecology. tubulolobular, mucinous, and adenoid cystic 1st Edition Lippincott- Ravenplace.

International Journal of Health Sciences & Research (www.ijhsr.org) 131 Vol.6; Issue: 4; April 2016 2. Nausheen F, Iqbal J, Bhatti FA, Khan Journal of Gynecological Pathology AT, Sheikh S. Hysterectomy: The 1989; 8(4): 357-363 patient’s perspective. Annals Gynecol 14. Willen R, Gad A, Willen H. Lipomatous 2004; 10:339-41. lesions of the uterus. Virchows Arch A 3. Baird DD, Dunson DB, Hill MC, Pathol Anat Histol 1978; 377:351-61. CousinsD, Schectman JM. High 15. Mignogna C, Di Spiezio Sardo A, cumulative incidence of uterine Spinelli M, et al. A case of pure uterine leiomyoma in black and white women: lipoma: immunohistochemical and Ultrasound evidence. Am J Obstet ultrastructural focus.Arch Gynecol Gynecol 2003; 188:100-7. Obstet 2009; 280: 1071-4. 4. Adelusola KA, Ogunniyi SO. 16. Kitajima K, Kaji Y, Imanaka K, Hysterectomies in Nigerians; Sugihara R, Sugimura K. MRI findings histopathological analysis of cases seen of uterine lipoleiomyoma correlated in Ile-Ife. Niger Post grad Med J 2001; with pathologic findings. AJR Am J 8:37-40. Roentgenol 2007; 189: W100-W104. 5. Borgfeldt C, Andolf E. Transvaginal 17. Manjunatha HK, Ramaswamy AS, ultrasonographic findings in the uterus Kumar BS, Kumar SP, Krishna L. and the endometrium: Low prevalence Lipoleiomyoma of uterus in a of leiomyoma in a random sample of postmenopausal woman. J Midlife women age 25-40. Acta Obstet Gynecol Health 2010; 1:86-8. Scand 2000; 79:202-7. 18. Lau LU, Thoeni RF. Case report. 6. Krenning R A and De Goey W B Uterine lipoma: Advantage of MRI over .Uterine lipomas. Review of the ultrasound. Br J Radiol 2005; 78:72-4. literature. Clinical and Experimental 19. Sharma SK, Mohan A. Extra pulmonary Obstetrics and Gynecology 1983; 10(2- tuberculosis. Indian J Med Res. 2004; 3): 91-94. 120:316-53. 7. Robertson J W and Barker H. Lipoma 20. Lakshmi S. Essentials of gynaecology. of the uterus. American Journal of New Delhi, Wolters Kluwer India Pvt Obstetrics & Gynecology 1953; Ltd 2012. 65(4):920-922. 21. Tripathy SN. Gynaecological 8. Kovacs J and Poka R. Lipoma of the tuberculosis-An update. Ind. J. Tub. uterus. Pathology & 1998; 45:193. Research.1996; 2(3):181-183. 22. Jones M H. Primary Unilateral 9. Al-Maghrabi A, Sait K H and Lingawi Tuberculosis of the Fallopian Tube. S S. Uterine lipoma. Saudi Medical Brit. Med. Journ. 1884; 177-87. Journal.2004; 25(10):1492-1494. 23. Ankit S, Madhur K, Kusum G, Leela P, 10. Resta L, Maiorano E, Piscitelli D and Anjali M. Cytodiagnosis and pitfalls of Botticella M. A. Lipomatous tumors of genital tuberculosis: A report of two the uterus: clinico-pathological features cases J Cytol 2011 28(3):141-43. of 10 cases with immunocytochemical 24. Berliere M, Radikov G, Galant C, Piette study of histogenesis. Pathology P, Marbaix E, Donnez J. Identification Research and Practice. 1994; 190 (4): of women athigh risk of developing 378-383. on tamoxifen, Eur J 11. Fujimoto Y, Kasai K, Furuya M, Honda Cancer. 2000; 36 (4):S35-6. N, Tojo R, Saito S, et al. Pure uterine 25. Fisher B, Costantino JP, Wickerham lipoma. Journal of Obstetrics and DL, Redmond CK, Kavanah M, Cronin Gynaecology Research 2006; WM, et al. Tamoxifen for prevention of 32(5):520-523. breast cancer: report of the National 12. Gupta R K and. Hunter R E. Lipoma of Surgical Adjuvant Breast and Bowel the uterus. Review of literature with Project P-1 Study, J Natl Cancer Inst. views of histogenesis. Obstetrics 1998; 90 (18): 1371-88. &Gynecology1964; 24: 255-257. 26. Kennedy MM, Baigrie CF, Manek S 13. Sieinski W. Lipomatous nonmetaplasia Tamoxifen and the endometrium: of the uterus. Report of 11 cases with review of 102 cases and comparison discussion of histogenesis. International with HRT-related and non-HRT-related

International Journal of Health Sciences & Research (www.ijhsr.org) 132 Vol.6; Issue: 4; April 2016 endometrial pathology. Int J Gynecol 125 cases. Am J Surg Pathol. 1984; Pathol 1999: 18:130-137. 8(8):575-96. 27. Schlesinger C, Kamoi S, Ascher SM, 35. Van der Putte SCJ Mammary-like Kendell M, Lage JM, Silverberg SG. glands of the vulva and their disorders. Endometrial polyps:a comparison study Int J Gynecol 1994; 13:150-160. of patients receiving tamoxifen with two 36. Parks A, Branch KD, Metcalf J, control groups. Int J Gynecol Pathol Underwood P, Young J. Hidradenoma 1998; 17:302-311. papilliferum with mixed histopathologic 28. Seracchioli R, Bagnoli A, Colombo FM, features of syringocystadenoma Missiroli S, Venturoli S. Conservative papilliferum and anogenital mammary- treatment of recurrent ovarian fibromas like glands: report of a case and review in a young patient affected by Gorlin of the literature. Am J Dermatopathol. syndrome. Human Reproduction 2001; 2012; 34(1):104-109. 16:1261-3. 37. Pelosi G, Martignoni G, Bonetti F 29. Leung SW, Yuen PM. Ovarian fibroma: Intraductal carcinoma of mammary-type A review on the clinical characteristics, apocrine epithelium arising within a diagnostic difficulties, and management papillary hidradenoma of the vulva. options of 23 cases. Gynecol Obstet Report of a case and review of the Invest 2006; 62:1-6. literature. Arch Pathol Lab Med 1991; 30. Tiltman AJ, Haffajee Z. Sclerosing 115:1249-1254. stromal tumors, the comas, and 38. Greene HJ. Adenocarcinoma of fibromas of the ovary: an supernumerary breasts of the labia immunohistochemical profile. Int J majora in a case of epidermoid Gynecol Pathol. 1999; 18(3):254-8. carcinoma of the vulva. Am J Obstet 31. Siekierska-Hellmann M, Sworczak K, Gynecol. 1936; 31:660-663. 136. Babińska A, Wojtylak S. Ovarian 39. Van der Putte SC, van Gorp LH. with androgenic manifestations Adenocarcinoma of the mammary-like in a postmenopausal woman. Gynecol glands of the vulva: a concept unifying Endocrinol 2006; 22:405-8. sweat gland carcinoma of the vulva, 32. Bjorkholm E, Silfversward C. Theca- carcinoma of supernumerary mammary cell tumors. Clinical features and glands and extra mammary Paget’s prognosis. Acta Radiol Oncol. disease. J Cutan Pathol. 1994; 1980;19(4):241-4. 21(2):157-163. 33. Fox H, Agrawal K, Langley FA. A 40. Riopel J, Plante M, Renaud MC, Roy clinic pathologic study of 92 cases of M, Têtu B. Lymph node metastases in granulosa cell tumor of the ovary with low-grade endometrial stromal sarcoma. special reference to the factors Gynecol Oncol. 2005 Feb; 96(2):402-6. influencing prognosis. Cancer. 1975; 41. Norris HJ, Taylor HB: Mesenchymal 35(1):231-41. tumors of the uterus. I, A clinical and 34. Young RH, Dickersin GR, Scully RE. pathological study of 53 endometrial Juvenile granulosa cell tumor of the stromal tumors. Cancer 1966; 19:755- ovary. A clinic pathological analysis of 766.

How to cite this article: Ibrahim SS, Kesavaraj K, Ibrahim SNA et al. Uncommon gynecological pathologies we had encountered - a histopathological potpourri. Int J Health Sci Res. 2016; 6(4):124-133.

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International Journal of Health Sciences & Research (www.ijhsr.org) 133 Vol.6; Issue: 4; April 2016