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ATLAS OF TUMOR PATHOLOGY

Third Series
Fascicle 3

TUMORS OF THE UTERINE CORPUS
AND
GESTATIONAL TROPHOBLASTIC DISEASE

by

STEVEN G. SILVERBERG, M.D.
Department of Pathology
George Washington University School of Medicine
Washington D.C. 20037

and

ROBERT J. KURMAN, M.D.
Department of Pathology
Johns Hopkins Hospital
Baltimore, Maryland 21205

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
1992

Accepted for Publication
1991

Available from the American Registry of Pathology
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000
ISSN 0160-6344
ISBN 1-881041-01-8

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


John G. Batsakis, M.D.
U.T. M.D. Anderson Cancer Center
Houston, Texas 77030

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

Glauco Frizzera, M.D.
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000

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

Lance A. Liotta, M.D., Ph.D.
National Cancer Institute
Bethesda, Maryland 20892

Paul Peter Rosen, M.D.
Memorial Sloan-Kettering Cancer Center
New York, New York 10021-6007

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

Sharon Weiss, M.D.
University of Michigan School of Medicine
Ann Arbor, Michigan 48109-0602


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.

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 classification of uterine corporeal tumors and gestational trophoblastic
disease presented in this text was developed between 1985 and 1988 by two
subcommittees of the Classification and Nomenclature Committee of the
International Society of Gynecological Pathologists, chaired by Dr. Robert E.
Scully, in conjunction with the World Health Organization. The chairman for the
subcommittee for the uterine corpus tumors was Dr. Steven G. Silverberg, who is
responsible for the discussion of that subject in the text. Dr. Robert J. Kurman
chaired the gestational trophoblastic disease subcommittee and is responsible
for those sections of the Fascicle. The other members of the uterine corpus
subcommittee were Drs. Gisela Dallenbach-Hellweg, Alexander Ferenczy, Harold
Fox, Claude Gompel, Richard L. Kempson, Frederick T. Kraus, Robert J. Kurman,
Alexander W. Miller, and Ichiro Taki. Drs. Shirley Driscoll, Harold Fox, Donald
P. Goldstein, Michael T. Mazur, William B. Ober, Kazuyosha Yamaguchi, A. E.
Szulman, and Leo B. Twiggs were the members of the gestational trophoblastic
disease subcommittee. All of the individual members of these subcommittees
contributed not only their expertise but in many instances also cases and
photographs that will appear in the World Health Organization publication
detailing the classification and in some instances appear in this Fascicle as
well.

Most of the photographs in the uterine corpus section of this Fascicle were
taken by Barbara Neuburger from cases originating either from the surgical
pathology files of the George Washington University Medical Center or the
pathology repository of the Gynecologic Oncology Group. Some of the color
photographs were contributed by our colleague at the George Washington
University, Dr. Lucien Nochomovitz. The photomicrographs in the gestational
trophoblastic disease section were taken by Mr. Luther Duckett at the Armed
Forces Institute of Pathology and Mr. Raymond Lund from the Johns Hopkins
Hospital. The material that was utilized was from the Armed Forces Institute of
Pathology, made available by Dr. Henry J. Norris, and from consultation material
that was sent to one of us (RJK). The electron micrographs used in the
gestational trophoblastic disease section were contributed by Dr. Michael T.
Mazur. Ms. Dorothy Molero played a key role in organizing the work of the
original uterine subcommittee and also typed the manuscript of that section of
this text. Ms. Sue Skierkowski provided excellent secretarial assistance for the
gestational trophoblastic disease section. Other colleagues, as well as our
wives Kiyoe and Carole, were understanding and patient as work on this project
took us away from other responsibilities. Equal patience, as well as useful
advice, came from the Editor of this Third Series, Dr. Juan Rosai, and my
editorial consultant, Dr. Leslie Sobin. Dr. Robert E. Scully deserves special
mention for his critical review of the gestational trophoblastic disease
section.

Finally, we are all the products of our personal and professional experience,
and we wish to thank our mentors, colleagues, and students over the years, all
of whom have contributed to the development of the experience and confidence
that have enabled us to undertake and complete a project of this magnitude.


Steven G. Silverberg, M.D.
Robert J. Kurman, M.D.


Permission to use copyrighted illustrations has been granted by:


Chicago Lying-In Hospital:
J Reprod Med 29:788-91, 1984. For figures 291 and
292.

JB Lippincott Company:
Cancer 37:1853-65, 1976. For figures 153 and 156.
Cancer 38:1214-26, 1976. For figures 341, 342, 345,
and 348.

John Wiley & Sons:
Surgical Pathology of the Uterus, 1977. For
figure 1.

Raven Press:
Am J Surg Pathol 14:415-38, 1990. For figure 131.
Diagnostic Surgical Pathology, vol. 2, 1989. For
Table 6.
Int J Gynecol Pathol 3:101-21, 1984. For Table 13
and figures 290 and 309.
Int J Gynecol Pathol 6:213-29, 1987. For Table 12.

Springer-Verlag New York, Inc.:
Blaustein's Pathology of the Female Genital Tract,
3rd ed., 1987. For Tables 7, 10, 11, and 15 and
figures 293, 303, 304, 312, 319, 321, 322, 331, 340,
and 347. Gestational Trophoblastic Disease,
1987. For Table 9.

WB Saunders Company:
Hum Pathol 20:370-81, 1989. For figures 333 and
351.
Placenta 5:349-70, 1984. For figures 275, 277, 278,
284, 285, 287, and 288.
Semin Diagn Pathol 5:135-53, 1988. For figures 16
and 56.

Williams & Wilkins Company:
The Pathology of Reproductive Failure, 1991. For
figures 271, 279, and 289.

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