Contents
List of abbreviations xi
Foreword xii
WHO classification of tumours of the female genital tract
Tumours of the ovary 1
Tumours of the peritoneum 3
Tumours of the fallopian tube 4
Tumours of the broad ligament and other uterine ligaments 5
Tumours of the uterine corpus 6
Gestational trophoblastic disease 7
Tumours of the uterine cervix 8
Tumours of the vagina 9
Tumours of the vulva 10
Neuroendocrine neoplasia 11
Haematolymphoid proliferations and neoplasia 12
Mesenchymal tumours of the lower genital tract 13
Melanocytic lesions 14
TNM staging of gynaecological tumours 15
Ovarian, fallopian tube, and primary peritoneal carcinoma 16
Tumours of the uterus – endometrium 18
Uterine sarcomas 20
Gestational trophoblastic neoplasms 22
Tumours of the cervix uteri: 2021 revision 23
Tumours of the vagina 25
Tumours of the vulva 26
TNM staging of tumours of soft tissues 27
General introduction 29
1 Tumours of the ovary 31
Introduction 32
Serous tumours
Benign serous tumours
Serous cystadenoma, adenofibroma, and surface
papilloma 36
Borderline serous tumours
Serous borderline tumour 38
Malignant serous tumours
Low-grade serous carcinoma 43
High-grade serous carcinoma 45
Mucinous tumours
Benign mucinous tumours
Mucinous cystadenoma and adenofibroma 48
Borderline mucinous tumours
Mucinous borderline tumour 50
Malignant mucinous tumours
Mucinous carcinoma 53
Endometrioid tumours
Benign endometrioid tumours
Endometrioid cystadenoma and adenofibroma 55
Borderline endometrioid tumours
Endometrioid borderline tumour 56
Malignant endometrioid tumours
Endometrioid carcinoma 58
Clear cell tumours
Benign clear cell tumours
Clear cell cystadenoma and adenofibroma 62
Borderline clear cell tumours
Clear cell borderline tumour 63
Malignant clear cell tumours
Clear cell carcinoma 65
Seromucinous tumours
Benign seromucinous tumours
Seromucinous cystadenoma and adenofibroma 68
Borderline seromucinous tumours
Seromucinous borderline tumour 69
Malignant seromucinous tumours
Seromucinous carcinoma 70
Brenner tumours
Benign Brenner tumours
Brenner tumour 71
Borderline Brenner tumours
Borderline Brenner tumour 73
Malignant Brenner tumours
Malignant Brenner tumour 75
Other carcinomas
Mesonephric-like adenocarcinoma 77
Undifferentiated and dedifferentiated carcinomas 79
Carcinosarcoma 81
Mixed carcinoma 83
Mesenchymal tumours
Endometrioid stromal sarcoma 85
Smooth muscle tumours 87
Ovarian myxoma 89
Other ovarian mesenchymal tumours 90
Mixed epithelial and mesenchymal tumours
Mixed malignant epithelial and mesenchymal tumours
Adenosarcoma 91
Sex cord–stromal tumours
Pure stromal tumours
Ovarian fibroma 93
Thecoma 94
Luteinized thecoma associated with sclerosing
peritonitis 95
Sclerosing stromal tumour 96
Microcystic stromal tumour 97
Signet-ring stromal tumour 99
Leydig cell tumour 100
Steroid cell tumour 102
Ovarian fibrosarcoma 104
Pure sex cord tumours
Adult granulosa cell tumour 105
Juvenile granulosa cell tumour 107
Sertoli cell tumour 109
Sex cord tumour with annular tubules 111
Mixed sex cord–stromal tumours
Sertoli–Leydig cell tumour 113
Sex cord–stromal tumour NOS 116
Gynandroblastoma 117
Germ cell tumours
Mature teratoma 119
Immature teratoma 121
Dysgerminoma 123
Yolk sac tumour 125
Embryonal carcinoma 127
Non-gestational choriocarcinoma 129
Mixed germ cell tumour 131
Monodermal teratomas and somatic-type tumours
arising from a dermoid cyst
Struma ovarii 132
Ovarian carcinoid 134
Neuroectodermal-type tumours 136
Monodermal cystic teratoma 137
Somatic neoplasms arising from teratomas 138
Germ cell–sex cord–stromal tumours
Gonadoblastoma 140
Mixed germ cell–sex cord–stromal tumour,
unclassified 143
Miscellaneous tumours
Rete cystadenoma, adenoma, and adenocarcinoma 144
Wolffian tumour 145
Solid pseudopapillary tumour 147
Small cell carcinoma of the ovary, hypercalcaemic type 149
Wilms tumour 151
Mesothelial tumours (see Ch. 3)
Tumour-like lesions
Follicle cyst 153
Corpus luteum cyst 154
Large solitary luteinized follicle cyst 155
Hyperreactio luteinalis 156
Pregnancy luteoma 158
Stromal hyperplasia and hyperthecosis 160
Fibromatosis and massive oedema 161
Leydig cell hyperplasia 162
Metastases 163
2 Endometriosis and related conditions 169
Endometriosis and derived tumours 170
3 Tumours of the peritoneum 175
Introduction 176
Mesothelial tumours
Adenomatoid tumour 177
Well-differentiated papillary mesothelial tumour 179
Mesothelioma 181
Epithelial tumours
Epithelial tumours of Müllerian type
Serous borderline tumour 184
Low-grade serous carcinoma 186
High-grade serous carcinoma 187
Mesenchymal tumours specific to peritoneum
Smooth muscle tumours
Leiomyomatosis peritonealis disseminata 188
Miscellaneous primary tumours
Desmoid fibromatosis 190
Calcifying fibrous tumour 192
Extragastrointestinal stromal tumour 193
Solitary fibrous tumour 195
Endometrioid stromal sarcoma 197
Desmoplastic small round cell tumour 199
Tumour-like lesions
Mesothelial hyperplasia 201
Peritoneal inclusion cysts 202
Transitional cell metaplasia 203
Endosalpingiosis 204
Histiocytic nodule 205
Ectopic decidua 206
Splenosis 207
Other tumour-like lesions 208
Metastases
Carcinomas and sarcomas 209
Pseudomyxoma peritonei 211
Gliomatosis 214
4 Tumours of the fallopian tube 215
Introduction 216
Epithelial tumours
Benign serous tumours
Serous adenofibroma and papilloma 217
Borderline serous tumours
Serous borderline tumour 218
Malignant epithelial tumours
High-grade serous carcinoma 219
Endometrioid carcinoma 221
Carcinosarcoma 222
Tumour-like lesions
Paratubal cysts 223
Tubal hyperplasia 224
Tubo-ovarian abscess 225
Salpingitis isthmica nodosa 226
Metaplastic papillary lesion 227
Placental site nodule 228
Mucinous metaplasia 229
Endosalpingiosis 230
Mixed epithelial and mesenchymal tumours
Adenosarcoma 230
Germ cell tumours
Teratoma 231
5 Tumours of the broad ligament and other uterine
ligaments 233
Introduction 234
Mesenchymal and mixed tumours
Leiomyoma 235
Adenomyoma 236
Adenosarcoma 237
Leiomyosarcoma 238
Other mesenchymal and mixed tumours 238
Miscellaneous tumours
Wolffian tumour 239
Papillary cystadenoma 240
Ependymoma 242
Tumour-like lesions
Adrenocortical remnants 243
6 Tumours of the uterine corpus 245
Introduction 246
Endometrial epithelial tumours and precursors
Precursor lesions
Endometrial hyperplasia without atypia 248
Endometrial atypical hyperplasia / endometrioid
intraepithelial neoplasia 250
Endometrial carcinomas
Endometrioid carcinoma 252
Serous carcinoma 256
Clear cell carcinoma 258
Undifferentiated and dedifferentiated carcinomas 260
Mixed carcinoma 262
Other endometrial carcinomas 264
Carcinosarcoma 266
Tumour-like lesions
Endometrial polyp 268
Endometrial metaplasia 269
Arias-Stella reaction 271
Mesenchymal tumours of the uterus
Smooth muscle tumours
Uterine leiomyoma 272
Intravenous leiomyomatosis 277
Smooth muscle tumour of uncertain malignant
potential 279
Metastasizing leiomyoma 281
Uterine leiomyosarcoma 283
Endometrial stromal and related tumours
Endometrial stromal nodule 286
Low-grade endometrial stromal sarcoma 287
High-grade endometrial stromal sarcoma 289
Undifferentiated uterine sarcoma 292
Miscellaneous mesenchymal tumours
Uterine tumour resembling ovarian sex cord tumour 294
Perivascular epithelioid cell tumour (PEComa) 296
Inflammatory myofibroblastic tumour 298
Other mesenchymal tumours of the uterus 300
Mixed epithelial and mesenchymal tumours
Adenomyoma 301
Atypical polypoid adenomyoma 303
Adenosarcoma 305
Miscellaneous tumours
Central primitive neuroectodermal tumour / CNS
embryonal tumour 307
Germ cell tumours 308
7 Gestational trophoblastic disease 309
Introduction 310
Tumour-like lesions
Non-neoplastic lesions
Exaggerated placental site reaction 311
Placental site nodule and plaque 313
Abnormal (non-molar) villous lesions 315
Molar pregnancies
Partial hydatidiform mole 317
Complete hydatidiform mole 319
Invasive and metastatic hydatidiform moles 322
Gestational trophoblastic neoplasms
Epithelioid trophoblastic tumour 323
Placental site trophoblastic tumour 325
Gestational choriocarcinoma 327
Mixed trophoblastic tumour 332
8 Tumours of the uterine cervix 335
Introduction 336
Squamous epithelial tumours
Mimics of squamous precursor lesions
Squamous metaplasia 338
Atrophy 341
Squamous cell tumours and precursors
Condyloma acuminatum (see Ch. 10)
Squamous intraepithelial lesions 342
Squamous cell carcinoma, HPV-associated 347
Squamous cell carcinoma, HPV-independent 350
Squamous cell carcinoma NOS 351
Glandular tumours and precursors
Benign glandular lesions
Endocervical polyp 352
Müllerian papilloma 353
Nabothian cyst 354
Tunnel clusters 355
Microglandular hyperplasia 356
Lobular endocervical glandular hyperplasia 357
Diffuse laminar endocervical hyperplasia 358
Mesonephric remnants and hyperplasia 359
Arias-Stella reaction 360
Endocervicosis 361
Tuboendometrioid metaplasia 362
Ectopic prostate tissue 363
Adenocarcinomas
Adenocarcinoma in situ, HPV-associated 364
Adenocarcinoma, HPV-associated 367
Adenocarcinoma in situ, HPV-independent 372
Adenocarcinoma, HPV-independent, gastric type 374
Adenocarcinoma, HPV-independent, clear cell type 376
Adenocarcinoma, HPV-independent, mesonephric
type 378
Other adenocarcinomas 380
Other epithelial tumours
Carcinosarcoma 382
Adenosquamous and mucoepidermoid carcinomas 383
Adenoid basal carcinoma 384
Carcinoma, unclassifiable 386
Mixed epithelial and mesenchymal tumours
Adenomyoma 387
Adenosarcoma 388
Germ cell tumours 389
9 Tumours of the vagina 391
Introduction 392
Epithelial tumours
Benign squamous lesions
Condyloma acuminatum (see Ch. 10)
Squamous papilloma 393
Atrophy 394
Tubulosquamous polyp 395
Squamous cell tumours and precursors
Squamous intraepithelial lesions 396
Squamous cell carcinoma, HPV-associated 398
Squamous cell carcinoma, HPV-independent 400
Squamous cell carcinoma NOS 401
Benign glandular lesions
Villous adenoma 402
Müllerian papilloma 403
Vaginal adenosis 404
Endocervicosis 405
Cysts 406
Glandular tumours
Adenocarcinoma, HPV-associated 407
Endometrioid carcinoma 408
Clear cell carcinoma 409
Mucinous carcinoma, gastric type 410
Mucinous carcinoma, intestinal type 411
Mesonephric adenocarcinoma 412
Carcinosarcoma 413
Other epithelial tumours
Mixed tumour of the vagina 414
Adenocarcinoma of Skene gland origin 415
Adenosquamous carcinoma 416
Adenoid basal carcinoma 416
Mixed epithelial and mesenchymal tumours
Adenosarcoma 417
Miscellaneous tumours
Germ cell tumours 418
10 Tumours of the vulva 419
Introduction 420
Epithelial tumours
Benign squamous lesions
Seborrhoeic keratosis 421
Condyloma acuminatum 422
Squamous cell tumours and precursors
Squamous intraepithelial lesions, HPV-associated 424
Vulvar intraepithelial neoplasia, HPV-independent 426
Squamous cell carcinoma, HPV-associated 429
Squamous cell carcinoma, HPV-independent 432
Squamous cell carcinoma NOS 434
Basal cell carcinoma 434
Glandular tumours and cysts
Mammary-type glandular lesions
Papillary hidradenoma 435
Chondroid syringoma 436
Fibroadenoma 437
Phyllodes tumour 438
Adenocarcinoma of mammary gland type 439
Bartholin gland lesions
Bartholin gland cyst 440
Hyperplasia, adenoma, and adenomyoma 441
Bartholin gland carcinomas 442
Other cysts 444
Adenocarcinomas of other types
Paget disease 445
Carcinomas of sweat gland origin 447
Adenocarcinoma of intestinal type 448
Germ cell tumours 449
11 Neuroendocrine neoplasia 451
Introduction 452
Neuroendocrine tumour 453
Neuroendocrine carcinoma
Small cell neuroendocrine carcinoma 455
Large cell neuroendocrine carcinoma 457
Mixed neuroendocrine–non-neuroendocrine neoplasms
Carcinoma admixed with neuroendocrine carcinoma 459
12 Haematolymphoid proliferations and neoplasia 461
Introduction 462
Reactive lymphoid hyperplasia
Florid reactive lymphoid hyperplasia 465
Lymphomas
Diffuse large B-cell lymphoma 467
Extranodal marginal zone lymphoma 469
Follicular lymphoma 471
Burkitt lymphoma 473
Myeloid leukaemia
Myeloid sarcoma 474
13 Mesenchymal tumours of the lower genital tract 477
Introduction 478
Adipocytic tumours
Lipoma 480
Lipoblastoma-like tumour of the vulva 481
Liposarcoma 483
Fibroblastic and myofibroblastic tumours
Postoperative spindle cell nodule 485
Fibroepithelial stromal polyp 486
Prepubertal fibroma 488
Superficial myofibroblastoma 490
Myofibroblastoma 491
Cellular angiofibroma 493
Angiomyofibroblastoma 495
Solitary fibrous tumour 497
Dermatofibrosarcoma protuberans 498
NTRK-rearranged spindle cell neoplasm (emerging) 500
Vascular tumours
Kaposi sarcoma 502
Angiosarcoma 504
Smooth muscle tumours
Leiomyoma 506
Smooth muscle tumour of uncertain malignant potential 508
Leiomyosarcoma 509
Skeletal muscle tumours
Rhabdomyoma 511
Rhabdomyosarcoma 512
Peripheral nerve sheath tumours
Benign peripheral nerve sheath tumours 515
Granular cell tumour 517
Tumours of uncertain differentiation
Superficial angiomyxoma 519
Deep (aggressive) angiomyxoma 520
Epithelioid sarcoma 522
Alveolar soft part sarcoma 524
Undifferentiated small round cell sarcomas
Ewing sarcoma 526
14 Melanocytic lesions 527
Naevi
Acquired melanocytic naevus 528
Congenital melanocytic naevus 530
Blue naevus 532
Atypical melanocytic naevus of genital type 534
Dysplastic melanocytic naevus 535
Melanoma
Mucosal melanoma 537
15 Metastasis 539
Metastasis to the lower female genital tract 540
16 Genetic tumour syndromes of the female genital tract 543
BRCA1/2-associated hereditary breast and ovarian cancer
syndrome 544
Lynch syndrome 546
Cowden syndrome 548
Li–Fraumeni syndrome 550
Peutz–Jeghers syndrome 552
Ataxia–telangiectasia 554
Carney complex 555
DICER1 syndrome 556
Ovarian dysgenesis 558
Von Hippel–Lindau syndrome 560
Hereditary leiomyomatosis and renal cell carcinoma 561
Other genetic tumour syndromes 563
Contributors 564
Declaration of interests 570
IARC/WHO Committee for ICD-O 571
Sources 572
References 577
Subject index 625
Previous volumes in the series 632