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Aims To report 18 yolk sac tumours ( YSTs) of the female genital tract (17 ovary, one uterus) in patients aged 40 years or over, most arising from a somatic epithelial neoplasm. Methods and results Six patients had pure YST, two were associated with immature teratoma (one with an endometrioid adenocarcinoma) and in 11 there was an epithelial neoplasm comprising high-grade serous carcinoma ( HGSC) ( n = 5), clear cell carcinoma ( n = 1), borderline clear cell adenofibroma ( n = 1), endometrioid adenocarcinoma ( n = 2), serous tubal intra-epithelial carcinoma ( n = 1) and large-cell neuroendocrine carcinoma ( n = 1). In one case of pure YST, there was an ipsilateral endometriotic cyst but no other neoplastic component. In two cases, the YST was a hepatoid variant and in most of the others it exhibited predominantly glandular morphology, closely mimicking an epithelial neoplasm. Conclusions Pathologists should be aware of the association between YST and an epithelial neoplasm, the former probably arising from the latter through a process of neometaplasia/retrodifferentiation. Those rare gynaecological pure glandular YSTs in adults may arise secondary to total overgrowth of an epithelial neoplasm. Pathologists need a high index of suspicion to diagnose the YST component, as the morphology is characteristically of a glandular variant with marked morphological overlap with adenocarcinomas. There is also often significant immunophenotypical overlap with epithelial neoplasms, as the YST component may be positive with epithelial membrane antigen ( EMA), Ber EP4 and cytokeratin 7 ( CK7), as well as YST markers. We propose the term 'somatically derived YSTs' for these neoplasms and suggest unification of the terminology between different sites where such neoplasms occur. [ABSTRACT FROM AUTHOR]

Paediatric and adolescent gynaecology involves the care of young women and their special needs as their bodies change and grow into adulthood. Diagnosis and management of common problems in gynaecology in this age group requires knowledge regarding congenital reproductive anomalies, disorders of gender development, reproductive endocrinopathies, gender identity, and gynaecologic malignancies. Gynaecologic disease states in paediatric patients frequently present with vulval and vaginal manifestations, while those in the adolescent age range present as abdominal-pelvic pain and abnormal menstrual bleeding. A case-based learning of common childhood gynaecologic disorders and their treatment is presented. [ABSTRACT FROM AUTHOR]

Purpose Many low-income patients enroll in Medicaid at the time of cancer diagnosis, which improves survival outcomes. Medicaid enrollment before cancer diagnosis may confer additional benefits. Our objective was to compare stage at diagnosis and overall mortality between women with and without Medicaid enrollment before gynecologic cancer diagnosis. Methods and Materials Women younger than 65 years with a gynecologic cancer (2003 to 2008) were identified through the North Carolina Central Cancer Registry and linked to state Medicaid enrollment files. Those with and without Medicaid enrollment within 6 months before diagnosis were identified. Propensity matching was used to balance the exposure groups. Stage at diagnosis was evaluated by using logistic regression, and all-cause mortality was assessed with Cox proportional hazard models. Results Of 564 women, one half (n = 282) had prediagnosis Medicaid enrollment. Disease sites included the cervix (44%), uterus (25%), ovary (26%), and vulva/vagina (5%). More than one half (51%) of cancers were advanced stage. Women without prediagnosis Medicaid had an increased odds of advanced-stage disease (hazard ratio, 1.46; 95% CI, 1.03 to 2.05). Crude survival outcomes differed significantly between the groups; however, when adjusted for stage at diagnosis, lack of prediagnosis Medicaid coverage had a hazard ratio of 1.19 (95% CI, 0.92 to 1.53). Conclusion Medicaid enrollment before gynecologic cancer diagnosis is associated with an earlier stage at presentation. Given the existence of a cervical cancer screening program in North Carolina and lack of Medicaid expansion, these data suggest that screening programs alone are not sufficient to counteract the delay in diagnosis that is common for uninsured individuals. [ABSTRACT FROM AUTHOR]

The International Federation of Gynecology and Obstetrics (FIGO) has recognized serous tubal intraepithelial carcinoma as a precursor lesion for high‐grade serous epithelial ovarian cancer. Future staging systems should consider reclassifying stage based on tumor biologic behavior. [ABSTRACT FROM AUTHOR]

A quiz pertaining to various topics, including vacuum manual aspiration, miscarriage and analgesia, is presented.

Context.--Immunohistochemistry has assumed an increasing role in the identification and characterization of gynecologic disorders including lesions with deceptively bland morphology, uncommon and underdiagnosed neoplasms, and neoplasms with specific genetic alterations associated with overexpression or loss of expression of specific proteins. The diagnostic accuracy has been significantly improved owing to the discovery and increasing experience with the tumor-associated biomarkers, and the increasing demand for precise tumor classification to assess suitability for the expanding therapeutic modalities including clinical trials. Objective.--To differentiate lesions of the gynecologic tract through the use of effective immunohistochemical panels. Data Sources.--Literature review and authors’ personal practice experience. Conclusions.--The application of diagnostic and prognostic immunohistochemical panels has enabled pathologists to better guide therapeutic decisions and to better predict the clinical outcome. It is now well established that the use of ancillary testing, including immunohistochemistry, has a significant power in the identification, differentiation, and classification of reactive, premalignant, and malignant gynecologic disorders. This article discusses the utilities and pitfalls of the commonly used immunohistochemical markers in the context of overlapping morphologic features encountered in the uterus, ovaries, and fallopian tubes. [ABSTRACT FROM AUTHOR]

Hepatoid adenocarcinoma is a rare and unusual tumor in the female genital tract. Hepatoid adenocarcinoma resembles hepatocellular carcinoma morphologically but develops in extrahepatic organs, and usually demonstrates foci of adenocarcinoma of the primary organ. Tumor cells often stain positive for anti-α-fetoprotein antibody, and may be associated with elevated serum α-fetoprotein, which may be useful as a tumor marker to guide treatment. There is little reliable information to guide clinical management of these unusual tumors and prognosis is poor despite multi-modal treatment. This report describes the diagnosis and treatment of this tumor in a postmenopausal woman. [ABSTRACT FROM AUTHOR]

Context.-Inflammatory myofibroblastic tumor is a predominantly benign, spindle cell, mesenchymal neoplasm with myxoid areas that occurs rarely in the female genital tract and may be confused with other spindle cell lesions, particularly leiomyosarcoma. Objective.-To investigate the utility of detecting anaplastic lymphoma kinase-1 protein expression and ALK gene rearrangements in the diagnosis of inflammatory myofibroblastic tumors in the female genital tract. Design.-Eight inflammatory myofibroblastic tumors arising in the female genital tract and seen in consultation (from 2004 to 2011) were reviewed. Immunohistochemistry for anaplastic lymphoma kinase-1 and fluorescence in-situ hybridization studies for ALK gene rearrangements were performed. Results.-The anatomic sites included myometrium (4 cases) and endometrium, fallopian tube, cervix, and a cervical polyp (1 each), with a patient age range from 25 to 52 years. Histologic features ranged from bland spindle cells to striking cytologic atypia, embedded in a prominent myxoid background. Anaplastic lymphoma kinase-1 immunohistochemistry was positive in 7 cases. Fluorescence in-situ hybridization studies detected ALK gene rearrangements in 5 cases. Five cases had both immunopositivity and fluorescence in-situ hybridization abnormalities, 2 cases had immunopositivity only, and 1 case was negative by both methods. Conclusions.-This is the first report, to our knowledge, of ALK gene rearrangements in inflammatory myofibroblastic tumors in the female genital tract. If a myxoid background is appreciated in a spindle cell lesion of the female genital tract, especially if inflammatory cells are present, anaplastic lymphoma kinase-1 staining along with fluorescence in situ hybridization studies, for ALK gene rearrangements, may aid in distinguishing inflammatory myofibroblastic tumors from their malignant mimics. [ABSTRACT FROM AUTHOR]

Primary squamous cell carcinoma arising from the fallopian tube (SCCFT) is extremely rare with only six reported cases. We report a case of primary SCCFT accompanied by multifocal pyloric glandular metaplasia in the genital tract. An accompanying review of the literature describes the characteristics of this rare histological subtype invading into the muscular layer of the fallopian tube to involve adjacent pelvic organs, while the most common serous type tends to spread into the abdominal cavity through tubal ducts. Due to the low response rate of adjuvant therapies, the 5-year survival rate of patients bearing primary SCCFT at stage II-IV is very poor, only accounting for 25%. All patients were alive without disease where optimal resection had been successfully achieved. These findings imply that radical tumor resection is mandatory for satisfactory treatment of primary SCCFT. [ABSTRACT FROM AUTHOR]

Imiquimod modulates the immune response, and is a new approach for treatment of papillomavirus-associated lesions, although it has not been approved for the treatment of intraepithelial neoplasia. We present a case of a patient treated with imiquimod on account of high-grade intraepithelial neoplasia in the vulva and other locations. The posterior biopsies confirm the absence of lesions but show drug-induced pemphigus as a side effect. [Copyright &y& Elsevier]

Ovarian, fallopian tube, and peritoneal cancers have a similar clinical presentation and are treated similarly, and current evidence supports staging all 3 cancers in a single system. The primary site (i.e. ovary, fallopian tube, or peritoneum) should be designated where possible. The histologic type should be recorded. Intraoperative rupture ("surgical spill") is IC1; capsule ruptured before surgery or tumor on ovarian or fallopian tube surface is IC2; and positive peritoneal cytology with or without rupture is IC3. The new staging includes a revision of stage III patients; assignment to stage IIIA1 is based on spread to the retroperitoneal lymph nodes without intraperitoneal dissemination. Extension of tumor from omentum to spleen or liver (stage IIIC) should be differentiated from isolated parenchymal metastases (stage IVB). [ABSTRACT FROM AUTHOR]

An asymptomatic 66-year-old woman showed a large perineal mass extending close to pelvic organs on MRI. CT-guided needle biopsies revealed a desmoid tumour (DT). The patient refused radical surgery. Four years later, the tumour had marginally increased in size and was still asymptomatic. The revision of earlier biopsies then revealed typical aspects of aggressive angiomyxoma (AA). AA and DT are rare mesenchymal tumours of lowgrade malignancy, usually of large size, that occurs in female pelvi-perineal region. Radical resection with wide margins is classically advocated in such tumours in order to prevent the high risk of recurrences. However, due to a slow growth, rare infiltration of adjacent organs and a very low metastatic potential, a watchful waiting policy can be proposed when high postoperative morbidity is expected. In order to propose the accurate treatment, frontline biopsies of the tumour are essential. [ABSTRACT FROM AUTHOR]

A response from the author of the article "Staging classification for cancer of the ovary and fallopian tube should include in situ carcinoma" in the previous issue is presented.

A letter to the editor is presented in response to the article "Staging classification for cancer of the ovary and fallopian tube should include in situ carcinoma" in the previous issue.

An introduction is presented in which the editor discusses various reports within the issue on topics including the implications of obesity on women's health, the physiological changes caused by obesity, ultrasound diagnosis of miscarriage and tubal pregnancy.

The article presents the author's views on the plans of the Great Britain to establish a centralized healthcare system for the management of all gynaecological and other malignancies. Topics discussed includes a prediction model to discriminate between different types of ovarian tumour, country's policy for suspicious ovarian tumours and the Adjuvant ChemoTherapy in Ovarian Neoplasm (ACTION) study.