Fig. 1. Follicle cyst. Inner lining composed of granulosa cells with outer layer of luteinzed theca interna cells. (hematoxylin and eosin stain, x25) Volume 1, Chapter 17

Fig. 3. Benign cystic teratoma (dermoid cyst). Opened cyst containing hair and sebaceous material. Volume 1, Chapter 17

Infarction of a Dermoid Cyst (From Operational Obstetrics & Gynecology - 2nd Edition, The Health Care of Women in Military Settings, CAPT Michael John Hughey, MC, USNR, NAVMEDPUB 6300-2C, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C. 20372-5300, January 1, 2000. Original image courtesy Armed Forces Institute of Pathology)

Fig. 2. Benign cystic teratoma. Cyst lining composed of keratinizing squamous epithelium with sebaceous glands, smooth muscle, and sweat glands in the wall (hematoxylin and eosin stain, x60). Volume 1, Chapter 17

Fig. 28. Sectioned surface of dermoid cyst. Volume 4, Chapter 31

Fig. 29. Dermoid cyst with hair follicle ( left ), sebaceous glands, and sweat glands (magnification, ×80).(Serov SF, Scully RE, Sobin LJ: Histological Typing of Ovarian Tumours. Geneva, World Health Organization, 1973.) Volume 4, Chapter 31

Fig. 27. Mature teratoma (magnification, x50).(Serov SF, Scully RE, Sobin LH: Histological Typing of Ovarian Tumours. Geneva, World Health Organization, 1973.) Volume 4, Chapter 31

Fig. 30. Struma ovarii in wall of mucinous cystadenoma (magnification, ×80). The appearance is similar to that of a thyroid adenoma. Volume 4, Chapter 31

Fig. 26. Mature glial implants of immature teratoma on omentum (magnification, ×50).(Robboy SJ, Scully RE: Ovarian teratoma with glial implants on the peritoneum. Hum Pathol 1:643, 1970.) Volume 4, Chapter 31

Fig. 2. Immature teratoma. A. An immature teratoma is encapsulated and grossly similar to its benign counterpart, the mature teratoma. The main difference is the immature teratoma is solid rather than cystic. B. An immature teratoma reveals a variegated appearance with areas of necrosis and cystic changes. C. An immature teratoma reveals mixtures of mature and immature tissues reminiscent of the developing stages of embryonic tissues. The most common pattern is seen here (e.g., an immature neural epithelium [neuroepithelial rosettes]). Volume 4, Chapter 34

Fig. 25. Sectioned surface of immature teratoma. Volume 4, Chapter 31

Fig. 24. Immature teratoma (magnification, ×120). Immature glial with central area of necrosis contains neuroepithelial rosettes.(Scully RE: Recent progress in ovarian cancer. Hum Pathol 1:73, 1970.) Volume 4, Chapter 31

Fig. 4. Simple serous cystoma. Opened cyst demonstrating uniloculation with a smooth surface. Volume 1, Chapter 17

70 pound mucinous cystadenoma (From Operational Obstetrics & Gynecology - 2nd Edition, The Health Care of Women in Military Settings, CAPT Michael John Hughey, MC, USNR, NAVMEDPUB 6300-2C, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C. 20372-5300, January 1, 2000. Original image courtesy Michael John Hughey, MD. All rights reserved.)

Fig. 5. Mucinous cystadenoma. Cyst lining composed of a single layer of columnar cells with basal nuclei and cystoplasmic vacuoles containing mucin (hematoxylin and eosin stain, x125). Volume 1, Chapter 17

Fig. 6. Brenner tumor. Islands of uniform epithelial cells in dense fibrous stroma (hematoxylin and eosin stain, x125). Volume 1, Chapter 17

Fig. 14. Benign transitional cell (Brenner) tumor. Rounded nests of transitional-type epithelium are embedded in a fibrotic stroma resembling ovarian stroma. Volume 4, Chapter 30

Fig. 15. Benign transitional cell (Brenner) tumor. Ovoid nuclei with longitudinal grooves characterize the transitional cell type. Volume 4, Chapter 30

Fig. 7. Fibroma. Solid circumscribed tumor composed of firm, uniform white tissue. Volume 1, Chapter 17

Fig. 8. Ovarian fibroma. Spindle-shaped cells in a collagenous stroma (hematoxylin and eosin stain, x125). Volume 1, Chapter 17

Fig. 5. Sectioned surface of fibroma with areas of cystic degeneration.(Scully RE: Sex cord-stromal tumors. In Blaustein A [ed]: Pathology of the Female Genital Tract, pp 505–526. New York, Springer-Verlag, 1977.) Volume 4, Chapter 31

Fig. 6. Fibroma (magnification, ×325).(Serov SF, Scully RE, Sobin LH: Histological Typing of Ovarian Tumours. Geneva, World Health Organization, 1973.) Volume 4, Chapter 31

Fig. 7. Sectioned surface of thecoma within ovary with attached fallopian tube.(Scully RE: Sex cord-stromal tumors. In Blaustein A [ed]: Pathology of the Female Genital Tract. New York, Springer-Verlag, 1977.) Volume 4, Chapter 31

Fig. 8. Thecoma (magnification, ×130).(Morris JM, Scully RE: Endocrine Pathology of the Ovary. St. Louis, CV Mosby, 1958.) Volume 4, Chapter 31

Fig. 9. Luteinized thecoma (magnification, ×430). A nest of lutein cells is surrounded by fibroblasts. Volume 4, Chapter 31

Theca Lutein Cyst (From Operational Obstetrics & Gynecology - 2nd Edition, The Health Care of Women in Military Settings, CAPT Michael John Hughey, MC, USNR, NAVMEDPUB 6300-2C, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C. 20372-5300, January 1, 2000. Original image courtesy Armed Forces Institute of Pathology)

Fig. 10. Sertoli-Leydig cell tumor, well differentiated (magnification, ×100). (Morris JM, Scully RE: Endocrine Pathology of the Ovary. St. Louis, CV Mosby, 1958.) Volume 4, Chapter 31

Fig. 11. Sertoli-Leydig cell tumor of intermediate differentiation (magnification, ×240).(Morris JM, Scully RE: Endocrine Pathology of the Ovary. St. Louis, CV Mosby, 1958.) Volume 4, Chapter 31

Fig. 33. Gonadoblastoma with calcification (magnification, ×130).(Serov SF, Scully RE, Sobin LH: Histological Typing of Ovarian Tumours. Geneva, World Health Organization, 1973.) Volume 4, Chapter 31

Fig. 34. Gonadoblastoma with dysgerminoma (magnification, ×160).(Serov SF, Scully RE, Sobin LH: Histological Typing of Ovarian Tumours. Geneva, World Health Organization, 1973.) Volume 4, Chapter 31

Fig. 7. Granulosa cell tumor. A. Tumor is usually solid but may be cystic. Primarily areas of a solid tumor are shown with areas of hemorrhage. B. Large, round and ovoid nuclei with a longitudinal groove arranged in patterns are referred to as Call-Exner bodies (microglandular pattern). C. Similar cells in a stromal matrix are arranged in cords and ribbons (trabecular pattern). D. A variation of cells shows some cellular atypia (sarcomatoid pattern). Volume 4, Chapter 34

Fig. 1. Sectioned surface of granulosa cell tumor with solid and cystic components.(Scully RE: Ovarian tumors with estrogenic manifestations. Contemp Ob Gyn 10:83, 1977.) Volume 4, Chapter 31

Fig. 2. Granulosa cell tumor, microfollicular pattern with Call-Exner bodies (magnification, ×290).(Scully RE, Morris JM: Functioning ovarian tumors. In Meigs JV, Sturgis SH [eds]: Progress in Gynecology, Vol 3. New York, Grune & Siralton, 1957, by permission.) Volume 4, Chapter 31

Fig. 3. Granulosa cell tumor, trabecular pattern (magnification, ×200).(Serov SF, Scully RE, Sobin LH: Histological Typing of Ovarian Tumours. Geneva, World Health Organization, 1973.) Volume 4, Chapter 31

Fig. 4. Granulosa cell tumor, diffuse pattern (magnification, ×200).(Scully RE: Ovarian tumors with estrogenic manifestations. Contemp Ob Gyn 10:83, 1977.) Volume 4, Chapter 31

Fig. 14. Sectioned surface of hilus cell tumor.(Scully RE: Sex cord-stromal tumors. In Blaustein A [ed]: Pathology of the Female Genital Tract. New York, Springer-Verlag, 1977.) Volume 4, Chapter 31

Fig. 15. Hilus cell tumor (magnification, ×320). Note large crystal of Reinke near center.(Scully RE: Androgenic lesions of the ovary. In Grady HG, Smith DE [eds]: The Ovary, International Academy of Pathology, Monograph no. 3. Baltimore, Williams & Wilkins, 1962.) Volume 4, Chapter 31

Fig. 16. Sectioned surface of dysgerminoma. Note lobulated appearance and foci of caseation-like necrosis.(Scully RE: Recent progress in ovarian cancer. Hum Pathol 1:73, 1970.) Volume 4, Chapter 31

Fig. 17. Dysgerminoma with lymphocytes in stroma (magnification, ×300).(Scully RE: Germ cell tumors of the ovary and fallopian tube. In Meigs JV, Sturgis SH [eds]: Progress in Gynecology, Vol 4. New York, Grune & Stratton, 1963, by permission.) Volume 4, Chapter 31

Fig. 1. Dysgerminoma. A. In situ picture of a unilateral dysgerminoma shows it is bosselated and surrounded by a dense capsule. B. Grossly, a cut surface of this dysgerminoma reveals a yellow-tan, soft, homogeneous, and brainlike consistency. C. Histologic picture of a dysgerminoma shows cells are analogous to the undifferentiated germ cells of an embryonal gonad (i.e., well-defined clusters of cells separated by a fibrovascular system, infiltration [lymphocytes]). Volume 4, Chapter 34

Fig. 18. Endodermal sinus tumor, reticular pattern with Schiller-Duval body (magnification, ×300).(Scully RE: Germ cell tumors of the ovary and fallopian tube. In Meigs JV, Sturgis SH [eds]: Progress in Gynecology, Vol 4. New York, Grune & Stratton, 1963, by permission.) Volume 4, Chapter 31

Fig. 19. Endodermal sinus tumor with hyaline bodies (magnification, ×750).(Serov SF, Scully RE, Sobin LH: Histological Typing of Ovarian Tumours. Geneva, World Health Organization, 1973.) Volume 4, Chapter 31

Fig. 20. Endodermal sinus tumor, polyvesicular vitelline pattern (magnification, ×190). Secondary yolk sac at right is budding from larger primary yolk sac.(Serov SF, Scully RE, Sobin LH: Histological Typing of Ovarian Tumours. Geneva, World Health Organization, 1973.) Volume 4, Chapter 31

Fig. 21. Sectioned surface of yolk sac tumor.(Scully RE: Recent Progress in Ovarian Cancer. Hum Pathol 1:73, 1970.) Volume 4, Chapter 31

Fig. 3. Yolk sac (endodermal sinus) tumor. A. Yolk sac tumor is classically yellow-red-gray, soft, and friable with multiple cystic areas representing areas of hemorrhage and necrosis. B. A pattern is shown of pleomorphic, poorly differentiated cells with papillary clusters and a pseudopapillary projection with a vascular component within the center (Schiller-Duvall body). Volume 4, Chapter 34

Fig. 2. External surface of a serous cystadenoma of low malignant potential showing a smooth, tense capsule with prominent veins and thickened fibrous areas.(Courtesy of Dr. Richard Stock, Naval Hospital, Portsmouth, VA.) Volume 4, Chapter 29

Fig. 3. Cystadenoma exhibiting lining consisting of cuboidal epithelium serous type ( top) and mucus-producing tall, columnar, endocervical-type epithelium with basally arranged nuclei ( bottom ). The mixture of epithelia frequently is found in serous or mucinous cystadenomas of the ovary (hematoxylin and eosin, 520). Volume 4, Chapter 29

Fig. 4. Serous cystadenoma of low malignant potential demonstrating an exuberant growth of papillary projections arising from the internal surface of the tumor. Bubbly serous fluid is present in the lumen.(Courtesy of Dr. Richard Stock.) Volume 4, Chapter 29

Fig. 5. External surface of an ovary showing a serous cystadenoma of low malignant potential exhibiting papillary growth. The lateral aspect of the uterus and the entire fallopian tube are seen clearly. The papillary growth does not represent invasion.(Courtesy of Dr. Richard Stock.) Volume 4, Chapter 29

Fig. 6. Photomicrograph of a serous cystadenoma of low malignant potential. The tumor is composed mainly of papillary structures of different sizes resting on stroma made up of fibrous tissue. Tufting is observed in the interpapillary space (100). Volume 4, Chapter 29

Fig. 7. Inner lining of a serous cystadenoma of low malignant potential showing papillations with epithelial pluristratification, hyperchromasia, and tufting; there is some degree of nuclear atypia (420). Volume 4, Chapter 29

Fig. 8. Serous cystadenoma of low malignant potential demonstrating papillae, stratification of epithelial lining, tufting, stromal edema with hyalinization, and focal acute inflammatory cell infiltrate. On the upper right-hand corner, a psammoma body is clearly seen (hematoxylin and eosin, 420). Volume 4, Chapter 29

Fig. 9. Photomicrograph of a serous tumor of low malignant potential showing a focus of microinvasion represented by small nests of tumor cells penetrating the tumor stroma near the epithelial-stromal interphase. The nests are surrounded by a small clear space that should be filled with serous fluid. There is no stromal necrosis or inflammation around the tumor nests (400). Volume 4, Chapter 29

Fig. 11. Omental invasive implants associated with a serous ovarian tumor of low malignant potential. The malignant histologic characteristics of the epithelium, its stromal invasion by single and papillary nests of cells, the inflammatory response, and the fibroblastic proliferation are evident (hematoxylin and eosin, 420). Volume 4, Chapter 29

Fig. 16. Uterus with bilateral ovarian mucinous cystadenomas of low malignant potential showing multioculations and thick cyst walls.(Courtesy of Dr. Richard Stock.) Volume 4, Chapter 29

Fig. 17. Gross appearance of a mucinous cystadenoma of low malignant potential. The external surface of the tumor is irregular and multilobulated. The lobules are of different size and shape. The tumor is reddish brown. The lobules were fluctuant on palpation. Some areas of the tumor are firm. On cut section, multiple mucus-filled cysts are seen. Numerous small tan papillary structures are present in the inner surface of some of the cysts. Volume 4, Chapter 29

Fig. 18. Mucinous cystadenoma of low malignant potential, endocervical or müllerian type. Observe the marked papillation similar to that seen in serous tumors. Tufting and inflammatory exudate in the cyst lumen are seen (hematoxylin and eosin, 212). Inset, upper left. Papillation and inflammatory exudate. Inset, lower right. Epithelial atypia of gland-like spaces (420). Volume 4, Chapter 29

Fig. 19. Mucinous cystadenoma of low malignant potential, endocervical type, exhibiting a filigree pattern, pluristratification with atypia, stroma with mucinous material and inflammatory cell infiltration at the upper right-hand corner, and cellular debris with inflammatory cell exudate in the lumen (hematoxylin and eosin, 520). Volume 4, Chapter 29

Fig. 20. Papillations and tufting in a mucinous cystadenoma of low malignant potential, intestinal type. Spaces are lined with a mixture of goblet cells and tall, columnar intestinal-type epithelium. The stroma is edematous and exhibits fine capillaries. Areas with metaplastic changes are present on the left side and upper right-hand corner (hematoxylin and eosin, 212). Inset. Higher magnification illustrating goblet cells (hematoxylin and eosin, 420). Volume 4, Chapter 29

Fig. 21. Stroma of an ovarian mucinous cystadenoma of low malignant potential showing pools of mucus and atypical mucus-producing columnar epithelial cells of intestinal type in the stroma. Goblet cells are seen easily. The mucus pools are mostly acellular, although three hyperchromatic atypical nuclei are seen at the upper right-hand corner (hematoxylin and eosin, 420). Volume 4, Chapter 29

Fig. 22. Photomicrograph of an endometrioid tumor of low malignant potential. The tumor is composed of endometrial-like glands simulating atypical complex hyperplasia. The glands are arranged in groups separated by dense fibrous stroma (100). Volume 4, Chapter 29

Fig. 23. Photomicrograph of an endometrioid tumor of low malignant potential. Glands similar to those observed in atypical complex, and atypical simple hyperplasia are observed. The glands are irregular. The epithelium form, in some areas, solid masses of atypical cells showing glands within glands. The stroma is formed by dense fibrous tissue. No stromal necrosis is observed (200). Volume 4, Chapter 29

Fig. 24. Photomicrograph of a clear cell tumor of LMP showing tubular structures lined by low columnar epithelium. The cytoplasm in most epithelial cells is clear. Some nuclei are hyperchromatic. The intertubular stroma is dense (200). Volume 4, Chapter 29

Fig. 25. Gross appearance an ovarian transitional cell tumor of low malignant potential (Brenner tumor of LMP). Notice irregular cystic spaces and two round-oval masses approximately 1.5 cm in diameter. These masses are solid. In the lower mass, a small cyst space is noted. The inner lining of the cystic spaces is shaggy. Volume 4, Chapter 29

Fig. 26. Papillations showing a thin, central fibrovascular core present in a proliferating Brenner tumor. The epithelial lining consists of 10 to 20 layers of transitional cell-type epithelium. The cellular atypia and pattern resemble those of transitional cell carcinoma (grades 1 to 2) of the urinary tract (hematoxylin and eosin, 400).(Courtesy of Dr. Laurence Roth.) Volume 4, Chapter 29

Fig. 27. Transitional cell-like epithelium of proliferating Brenner tumor showing atypical nuclear changes similar to those of transitional cell carcinoma of the urinary bladder (grades 1 to 2) (hematoxylin and eosin, 700).(Courtesy of Dr. Laurence Roth.) Volume 4, Chapter 29

Fig. 28. Section illustrating Brenner tumor of low malignant potential with histologic characteristics simulating a transitional carcinoma grade 3. Observe the number of layers, loss of polarity of nuclei, hyperchromasia, and abundant and abnormal mitosis (hematoxylin and eosin, 420). Volume 4, Chapter 29

Fig. 31. Gross appearance of a cystic adenofibroma of LMP. The tumor involves part of the ovary. It is slightly lobulated and made up of cystic and solid structures. The tumor is firm and hard on cut section. It is yellowish gray. The cystic spaces show a smooth inner lining. Volume 4, Chapter 29

Fig. 29. Cystadenofibroma with atypia. The stroma is composed of dense, fibrous tissue and dilated cyst-like glands lined with cuboidal epithelial cells. Papillary areas at the top demonstrate dense, fibrous stroma lined with atypical epithelial cells (hematoxylin and eosin, 170). Volume 4, Chapter 29

Fig. 30. Close-up of cystadenofibroma with atypia showing dense, fibrous stroma and dilated cystic glands lined with cuboidal epithelial cells showing nuclear hyperchromasia (hematoxylin and eosin, 420). Volume 4, Chapter 29

Fig. 38. Left. Histologic section of a borderline serous tumor. (Hematoxylin and eosin, × 520). Right. A cluster of small monomorphic cells from the neoplasm.(Papanicolaou, × 900). Volume 1, Chapter 29

Fig. 1. Atypical proliferative serous tumor. Hierarchical branching pattern with detachment of cell clusters and without invasion characterizes this tumor, which is also referred to as serous borderline tumor. Volume 4, Chapter 30

Fig. 9. Disseminated peritoneal adenomucinosis. In this form of pseudomyxoma peritonei, large pools of acellular mucin dissect through tissues. Occasional mucinous glands, seen at upper left, display minimal cytologic atypia. Volume 4, Chapter 30

Fig. 10. Peritoneal mucinous carcinomatosis. In this form of pseudomyxoma peritonei, angulated glands with moderate-to-severe nuclear atypia invade tissues. Volume 4, Chapter 30

Fig. 39. Left. Histologic section of an invasive serous adenocarcinoma. (Hematoxylin and eosin, × 260). Right. A cluster of cells from the tumor, showing marked pleomorphism and nuclear atypia.(Papanicolaou, × 1200). Volume 1, Chapter 29

Fig. 6. Serous carcinoma. Markedly complex and stratified papillary proliferation with moderate-to-severe nuclear atypia. Volume 4, Chapter 30

Fig. 12. Gross view of an ovarian psammocarcinoma. Multiple tumor nodules are noted. The largest one is yellowish. The cut surface has a gritty and solid consistency. Volume 1, Chapter 29

Fig. 13. Serous psammocarcinoma of the ovary. The section shows numerous psammoma bodies in the stroma, cyst lumen, and papillae (hematoxylin and eosin, 85). Volume 1, Chapter 29

Fig. 14. Photomicrograph of a psammocarcinoma to illustrate psammoma bodies in the papillary component of the tumor. Atypical cuboidal epithelial cells with prominent nucleoli line the papillae (200). Volume 1, Chapter 29

Fig. 15. Serous psammocarcinoma. The epithelial component diffusely infiltrates the desmoplastic stroma. Few psammoma bodies are present (hematoxylin and eosin, 212). Inset. Section of a periaortic lymph node involved by tumor. Observe the atypical glandular epithelium. The glands in the center exhibit atypical papillary structures (hematoxylin and eosin, 212). Volume 1, Chapter 29

Fig. 11. Endometrioid carcinoma. Crowded, back-to-back glands lined by tall columnar epithelium resembling endometrial epithelium invade the stroma. Volume 4, Chapter 30

Fig. 12. Clear cell carcinoma. Sheets of cells with clear cytoplasm and mild-to-moderate nuclear atypia are characteristic. Volume 4, Chapter 30

Fig. 13. Clear cell carcinoma. Glands lined by epithelium displaying severe nuclear atypia and a hobnail pattern characterized by nuclei protruding into the lumena of the glands are present. In this pattern, clear cytoplasm is less conspicuous. Volume 4, Chapter 30

Fig. 22. Embryonal carcinoma with syncytiotrophoblast cells (magnification, ×34). AFIP Neg. 75-14208.(Kurman RJ, Norris HJ: Embryonal carcinoma of the ovary. A clinicopathologic entity distinct from endodermal sinus tumor resembling embryonal carcinoma of the adult testis. Cancer 38:2420, 1976.) Volume 4, Chapter 31

Fig. 4. Embryonal carcinoma. Histologic pattern resembles glomeruli, vacuolated cytoplasm, and glandlike spaces. Volume 4, Chapter 34

Fig. 23. Choriocarcinoma (magnification, ×350).(Serov SF, Scully RE, Sobin LH: Histological Typing of Ovarian Tumours. Geneva, World Health Organization, 1973.) Volume 4, Chapter 31

Fig. 5. Choriocarcinoma. Microscopic view of nongestational choriocarcinoma reveals cells resembling syncytiotrophoblasts and cytotrophoblasts. There is usually extensive hemorrhage and necrosis. Volume 4, Chapter 34

Fig. 6. Mixed germ cell tumor. A. A nondescript solid tumor has no defining characteristics. B. Dysgerminoma elements are associated with a yolk sac carcinoma. Volume 4, Chapter 34

Krukenberg Tumor (From Operational Obstetrics & Gynecology - 2nd Edition, The Health Care of Women in Military Settings, CAPT Michael John Hughey, MC, USNR, NAVMEDPUB 6300-2C, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C. 20372-5300, January 1, 2000. Original image courtesy Armed Forces Institute of Pathology)