FIGURE 14.1

Macroscopic photograph showing an ulcerating vulval tumour (arrow). Histologically, this was an invasive squamous cell carcinoma.

FIGURE 14.2

Cytological appearances of herpes simplex virus infection with formation of multinucleated cells (arrow).

FIGURE 14.3

The cervix throughout reproductive life. In the prepubertal cervix (A), the ectocervix (long arrow) and endocervix (short arrow) meet at the external cervical os. With the onset of puberty, the endocervix everts (B) and undergoes squamous metaplasia (thick red line) (C). This area of metaplasia defines the transformation zone. After the menopause, the transformation zone recedes into the endocervical canal (D).

FIGURE 14.4

The spectrum of squamous neoplasia of the cervix. The grade of CIN is defined by the proportion of the epithelium occupied by immature cells (dark). Invasive carcinoma occurs when the abnormal cells invade through the basement membrane.

FIGURE 14.5

Cervical intraepithelial neoplasia (CIN) grade 3. Note that the basement membrane is intact (arrow).

FIGURE 14.6

A cervical smear showing severe dyskaryosis. This finding suggests the presence of CIN 3. In addition, small abnormally shaped, keratinizing (dark pink) cells are present, raising the possibility of invasive carcinoma.

FIGURE 14.7

Invasive cervical carcinoma. (A) Macroscopic appearance (arrow). (B) Microscopic features of invasive squamous cell carcinoma; note the presence of keratin pearls (arrows).

FIGURE 14.8

The major events in the menstrual cycle. The development of an ovarian follicle and its transformation into a corpus luteum is shown together with the endometrial thickness and the pattern of hormone secretion. LH = luteinizing hormone.

FIGURE 14.9

Macroscopic photograph of an invasive endometrial carcinoma (white). Note that the tumour is invading deeply into the myometrium (arrow).

FIGURE 14.10

A submucosal uterine leiomyoma (arrow) which protrudes into the endometrial cavity. Lesions in this position may be associated with abnormal vaginal bleeding and with infertility.

FIGURE 14.11

A benign serous cystadenoma. Note that the lesion is cystic and has smooth external and internal surfaces.

FIGURE 14.12

An invasive ovarian carcinoma. Note the presence of both solid and cystic areas. Histologically, this lesion was a serous carcinoma.

FIGURE 14.13

Microscopic appearance of a borderline serous tumour. The cells lining this cyst show cytological abnormalities, and numerous psammoma bodies are present (arrows).

FIGURE 14.14

Microscopic appearance of a dermoid cyst showing elements from all three germ cell layers. Note the presence of cartilage (mesoderm; short arrow); respiratory epithelium (endoderm; long arrow); and sebaceous areas (ectoderm; arrow head).

FIGURE 14.15

Macroscopic appearance of an ovarian thecoma. Note the yellow appearance, which is due to the presence of steroid hormone within the tumour cell cytoplasm.

FIGURE 14.16

Resolution after adnexal inflammation has led to the formation of adhesions and a hydrosalpinx. Note that the dilated fallopian tube is ‘kinked’ (arrow).

FIGURE 14.17

(A) Macroscopic involvement of the ovary often takes the form of ‘chocolate cysts’ (arrow). (B) Microscopically, both endometrial glands and stroma are present, often with associated inflammation.

FIGURE 14.18

A spontaneously aborted fetus showing hydropic changes. Cytogenetic analysis showed a karyotype of 45,XO, indicating Turner’s syndrome.

FIGURE 14.19

Ectopic pregnancy. In this case, the conceptus has developed in the lumen of the fallopian tube which has consequently ruptured. Note the presence of early placental tissue (arrow).

FIGURE 14.20

Macroscopic appearance of a classical hydatidiform mole.

FIGURE 14.21

Microscopic appearance of (A) a hydatidiform mole showing circumferential trophoblastic proliferation. There is early stromal degeneration. This contrasts with the appearance of normal chorionic villi (B) which have polar trophoblast (arrow).

FIGURE 14.22

FIGURE 14.22 Schematic representation of the putative molecular events involved in cervical human papillomavirus-associated squamous carcinogenesis. Low grade refers to low-grade squamous intraepithelial lesions which encompass HPV effect and CIN 1. High grade refers to highgrade squamous intraepithelial lesions which encompass CIN 2 and CIN 3.