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ATLAS OF TUMOR PATHOLOGY

Third Series
Fascicle 23

TUMORS OF THE OVARY,
MALDEVELOPED GONADS, FALLOPIAN
TUBE, AND BROAD LIGAMENT

by

ROBERT E. SCULLY, M.D.
Professor of Pathology Emeritus
Massachusetts General Hospital,
Harvard Medical School
Boston, Massachusetts

ROBERT H. YOUNG, M.D., FRCPath
Professor of Pathology
Massachusetts General Hospital,
Harvard Medical School
Boston, Massachusetts

PHILIP B. CLEMENT, M.D.
Professor of Pathology
Vancouver Hospital and
Health Sciences Centre
University of British Columbia
Vancouver, Canada

Published by the
ARMED FORCES INSTITUTE OF PATHOLOGY
Washington, D.C.

Under the Auspices of
UNIVERSITIES ASSOCIATED
FOR RESEARCH AND EDUCATION
IN PATHOLOGY, INC.
Bethesda, Maryland
1998

$clAccepted for Publication
1996

Available from the
American Registry of Pathology
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000
ISSN 0160-6344
ISBN 1-881041-43-3

ATLAS OF TUMOR PATHOLOGY

EDITOR
JUAN ROSAI, M.D.
Department of Pathology
Memorial Sloan-Kettering Cancer Center
New York, New York 10021-6007

ASSOCIATE EDITOR
LESLIE H. SOBIN, M.D.
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000


EDITORIAL ADVISORY BOARD

Jeffrey Cossman, M.D.
Georgetown University School of Medicine
Washington, D.C. 20007

Ronald A. DeLellis, M.D.
Tufts University School of Medicine
Boston, Massachusetts 02111

Glauco Frizzera, M.D.
New York University Medical Center
New York, New York 10016

Leonard B. Kahn, M.D.
Long Island Jewish Hospital
New Hyde Park, New York 11042

Richard L. Kempson, M.D.
Stanford University Medical School
Stanford, California 94305

Paul Peter Rosen, M.D.
Memorial Sloan-Kettering Cancer Center
New York, New York 10021

Robert E. Scully, M.D.
Harvard Medical School and
Massachusetts General Hospital
Boston, Massachusetts 02114

Steven G. Silverberg, M.D.
University of Maryland
School of Medicine
Baltimore, Maryland 21201

Sharon Weiss, M.D.
Emory University School of Medicine
Atlanta, Georgia 30322


EDITORS' NOTE

The Atlas of Tumor Pathology has a long and distinguished history. It was
first conceived at a Cancer Research Meeting held in St. Louis in September
1947 as an attempt to standardize the nomenclature of neoplastic diseases.
The first series was sponsored by the National Academy of Sciences-National
Research Council. The organization of this Sisyphean effort was entrusted to
the Subcommittee on Oncology of the Committee on Pathology, and Dr. Arthur
Purdy Stout was the first editor-in-chief. Many of the illustrations were
provided by the Medical Illustration Service of the Armed Forces Institute of
Pathology, the type was set by the Government Printing Office, and the final
printing was done at the Armed Forces Institute of Pathology (hence the
colloquial appellation "AFIP Fascicles"). The American Registry of
Pathology purchased the Fascicles from the Government Printing Office and
sold them virtually at cost. Over a period of 20 years, approximately 15,000
copies each of nearly 40 Fascicles were produced. The worldwide impact that
these publications have had over the years has largely surpassed the original
goal. They quickly became among the most influential publications on tumor
pathology ever written, primarily because of their overall high quality but
also because their low cost made them easily accessible to pathologists and
other students of oncology the world over.

Upon completion of the first series, the National Academy of
Sciences-National Research Council handed further pursuit of the project over
to the newly created Universities Associated for Research and Education in
Pathology (UAREP). A second series was started, generously supported by
grants from the AFIP, the National Cancer Institute, and the American Cancer
Society. Dr. Harlan I. Firminger became the editor-in-chief and was succeeded
by Dr. William H. Hartmann. The second series Fascicles were produced as
bound volumes instead of loose leaflets. They featured a more comprehensive
coverage of the subjects, to the extent that the Fascicles could no longer be
regarded as "atlases" but rather as monographs describing and
illustrating in detail the tumors and tumor-like conditions of the various
organs and systems.

Once the second series was completed, with a success that matched that of the
first, UAREP and AFIP decided to embark on a third series. A new
editor-in-chief and an associate editor were selected, and a distinguished
editorial board was appointed. The mandate for the third series remains the
same as for the previous ones, i.e., to oversee the production of an
eminently practical publication with surgical pathologists as its primary
audience, but also aimed at other workers in oncology. The main purposes of
this series are to promote a consistent, unified, and biologically sound
nomenclature; to guide the surgical pathologist in the diagnosis of the
various tumors and tumor-like lesions; and to provide relevant histogenetic,
pathogenetic, and clinicopathologic information on these entities. Just as
the second series included data obtained from ultrastructural (and, in the
more recent Fascicles, immunohistochemical) examination, the third series
will, in addition, incorporate pertinent information obtained with the newer
molecular biology techniques. As in the past, a continuous attempt will be
made to correlate, whenever possible, the nomenclature used in the Fascicles
with that proposed by the World Health Organization's International
Histological Classification of Tumors. The format of the third series has
been changed in order to incorporate additional items and to ensure a
consistency of style throughout. Close cooperation between the various
authors and their respective liaisons from the editorial board will be
emphasized to minimize unnecessary repetition and discrepancies in the text
and illustrations.

To its everlasting credit, the participation and commitment of the AFIP
to this venture is even more substantial and encompassing than in previous
series. It now extends to virtually all scientific, technical, and financial
aspects of the production.

The task confronting the organizations and individuals involved in the
third series is even more daunting than in the preceding efforts because of
the ever-increasing complexity of the matter at hand. It is hoped that this
combined effort — of which, needless to say, that represented by the
authors is first and foremost — will result in a series worthy of its two
illustrious predecessors and will be a suitable introduction to the tumor
pathology of the twenty-first century.

Juan Rosai, M.D.
Leslie H. Sobin, M.D.


ACKNOWLEDGMENTS

The authors are grateful to the many pathologists who over the years have
submitted interesting cases for consultation, providing the authors with
a broad experience in the subject matter of this Fascicle. The reviewers of
the initial manuscript offered many helpful suggestions, which have enabled
us to improve the clarity of the text. We owe special thanks to Dr. Debra A.
Bell and Dr. Judith A. Ferry of the Massachusetts General Hospital and Dr.
Arthur L. Herbst of the Chicago Lying-In Hospital for reviewing specific
sections of the text. Mrs. Marlene Fairbanks typed the manuscript and Mr.
Stephen Conley and Ms. Michelle Forrestall provided photographic assistance.
Finally, we wish to thank the editorial staff of UAREP for their support and
patience.

Robert E. Scully, M.D.
Robert H. Young, M.D., FRCPath
Philip B. Clement, M.D.


Permission to use copyrighted illustrations has been granted by:


American College of Surgeons:
Manual for Staging of Cancer, 4th ed., 1992.
For table 2-2.

American Medical Association:
Arch Pathol Lab Med 1984;108:786-91. For
figure 9-12.

American Society for Clinical Pathologists:
Am J Clin Pathol 1980;73;272-6. For figure 7-20.
Am J Clin Pathol 1978;69:276-83. For figure 5-51.
Am J Clin Pathol 1972;58:479-88. For figure 2-6.

Appleton & Lange:
Pathol Ann 1988;23(Pt. 1):231-96. For figures
9-3, 10-1 and 11-13.

Churchill-Livingstone:
Tumors and Tumor-like Conditions of the
Ovary, 1985. For figures 9-15 and 22-41.

Elsevier Science:
Obstet Gynecol 1990;75:540-2. For figure 20-4.

John Wiley & Sons:
Cancer 1993;71:407-18. For figure 18-47.
Cancer 1989;64:899-904. For figure 18-65.
Cancer 1988;61:340-8. For figures 4-16 and 4-17.
Cancer 1984;53:1143-55. For figures 5-54 and
5-56.
Cancer 1982;50:2448-56. For figure 11-32.
Cancer 1982;50:1384-402. For figures 11-45 and
11-47.
Cancer 1979;44:1332-44. For figure 4-35.
Cancer 1976;38:2404-19. For figure 13-14.
Cancer 1976;38:2420-33. For figure 13-33.
Cancer 1975;36:404-18. For figure 15-13.
Cancer 1973;31:671-7. For figures 27-7 through
27-9.
Cancer 1973;31:664-70. For figures 10-22 and
10-27.
Cancer 1967;20:1405-17. For figures 6-1, 6-3 and
6-7.
Cancer 1960;13:804-11. For figures 14-6 and 14-7.
TNM Classification of Malignant Tumors, 5th
ed., 1997. For table 2-2.

Lippincott-Raven:
Manual for Staging of Cancer, 4th ed., 1992.
For table 2-2.
Diagnostic Surgical Pathology, 2nd ed., 1994.
For figures 10-24, 11-16, 12-6, 13-10, 15-6, 17-30,
18-13, 22-8, 22-12, 22-19, 22-20, 22-23, 26-20,
26-22, and 26-31.
Diagnostic Surgical Pathology, 1st ed. 1989.
For figures 3-33, 4-6, 6-17, 7-1, and 13-1.
Am J Surg Pathol 1996;20:823-33. For figure
14-26.
Am J Surg Pathol 1994;18:1102-16. For figures
17-6, 17-11, 17-14.
Am J Surg Pathol 1994;18:1-13. For figures
10-10 through 10-12.
Am J Surg Pathol 1993;17:764-78. For figures
15-28 and 15-30.
Am J Surg Pathol 1990;14:925-32. For figures
5-39 and 5-40.
Am J Surg Pathol 1987;11:835-45. For figure
12-13.
Am J Surg Pathol 1983;7:755-71. For figures
11-10 and 11-30.
Am J Surg Pathol 1982;6:513-22. For figures
5-33 and 5-37.
Clin Obstet Gynecol 1984;11:93-134. For figure
10-2.
Int J Gynecol Pathol 1994;13:259-66. For figure
11-5.
Int J Gynecol Pathol 1987;6:40-8. For figure
12-16.
Int J Gynecol Pathol 1984;3:153-78. For figure
22-22.
Int J Gynecol Pathol 1984;3:77-90. For figure
11-12.
Int J Gynecol Pathol 1983;2:227-34. For figure
10-20.
Gynecology and Obstetrics, Vol. 4, 1988. For
figure 2-8.

Massachusetts Medical Society:
N Engl J Med 1977;296:439-44. For figure 21-10.
N Engl J Med 1976;294:772-7. For figure 20-5.
N Engl J Med 1972;286:594-600. For figure 19-1.
N Engl J Med 1969;280:156-60. For figures 2-3
and 4-13.

Masson Publishing:
Bull du Cancer 1982;69:228-38. For figure 3-12.

Medical Economics:
Contemp Ob Gyn 1977;9:74-98. For figure 3-3.

Mosby-Year Book:
Acta Cytol 1974;18:108-17. For figure 2-4.
Acta Cytol 1973;17:316-9. For figure 2-5.
Am J Obstet Gynecol 1965;91:251-9. For
figures 22-29 and 22-30.
Am J Obstet Gynecol 1955;59:760-74. For
figure 5-17.
Anderson's Pathology, 3rd ed., 1957. For
figure 4-1.
Endocrine Pathology of the Ovary, 1958. For
figure 15-20.

Munksgaard Publishing:
Acta Pathol Microbiol Scand [A] Suppl
1972;233:56-66. For figures 7-5, 7-6, 7-14,
7-15, and 7-17.

Springer-Verlag:
Blaustein's Pathology of the Female Genital
Tract, 4th ed., 1994. For figures 9-19, 18-21,
18-35, and 18-36.
The Human Yolk Sac and Yolk Sac Tumors,
1993. For figures 13-21, 13-25, and 13-30.
Histological Typing of Ovarian Tumors,
International Histological Classification of
Tumours No. 9, 1973. For figures 3-10, 3-11,
3-30, 4-11, 4-15, 4-27, 4-39, 5-10, 5-28, 5-44,
5-45, 6-10, 7-9, 7-12, 10-6, 10-16, 10-17, 13-15,
13-17 through 13-19, 13-36, 13-37, 14-9, 14-12,
14-13, 14-16 through 14-18, 15-16, 15-18, 16-5,
16-6, 18-20, 18-22, 22-31, and 22-35.

WB Saunders:
The Pathology of Incipient Neoplasia, 1993. For
figures 2-10, 2-11, 3-20A, 5-3, 5-14, and 5-24.
Human Pathol 1990;21:397-403. For figure 3-20B.
Am J Surg Pathol 1985;9:205-14. For figures
5-8 and 5-12.
Human Pathol 1970;1:73-98. For figures
5-6, 13-11, 14-3, 14-5, and 18-19.
Human Pathol 1970;16:43-53. For figure 14-8.
Semin Diagn Pathol 1991;8:250-76. For figures
18-8, 18-15, 18-16, 18-23, 18-24, 18-27, 18-29,
18-34, 18-38, 18-39, 18-42, 18-44, 18-45, and
18-51.
Semin Diagn Pathol 1991;8:204-33. For figures
15-1, 20-2, 20-3, and 23-1.
Semin Diagn Pathol 1987;4:275-91. For figure
21-3.

Williams & Wilkins:
Pathology of Reproductive Failure, 1991. For
figures 21-1, 21-4, and 21-11.
Progr Gynecol 1963;4:335-47. For figure 13-16.

Yale University Press:
Embryology of the Ovary and Testis, Homo
Sapiens and Macaca and Mulatta, 1965. For
figures 1-1 through 1-4.

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