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Ben Davidson

The role of immunohistochemistry in surgical pathology of the uterine corpus and cervix, vagina and vulva

Handout (pdf 74p)

Handout (pdf 19p)

Abstract:

The female genital tract is affected by a large variety of neoplastic and non-neoplastic conditions which may pose considerable diagnostic difficulty. The uterine body and cervix, the vagina and the vulva share some of these conditions, but each of these anatomic sites has its own unique disease profile, particularly pertaining to the nature and incidence of neoplasia. Immunohistochemistry has long been regarded as the most important ancillary method employed in diagnosing these diseases.

The vulva shares many of the pre-malignant and malignant conditions affecting skin at other, non-genital anatomic locations, though with its unique relation to HPV. Conditions to be discussed in the lecture include vulvar intraepithelial neoplasia, carcinomas (squamous cell carcinoma, Paget disease and invasive adenocarcinoma), melanoma, and soft tissue tumors.

The primary neoplastic processes which most frequently involve the vagina are squamous intraepithelial neoplasia and squamous cell carcinoma, with other malignancies, including adenocarcinoma, melanoma, mesenchymal tumors and hematological cancers being less common. Metastases, most frequently from gynecological carcinomas, are an important differential diagnosis, as is direct invasion of primary tumors in the urinary or gastrointestinal tract. This disease spectrum is by-and-large also the one found in the uterine cervix. However, adenocarcinoma of different histological type and carcinomas with neuroendocrine differentiations are more prevalent at the latter anatomic site. These conditions will be discussed, with relevant immunohistochemistry demonstrated.

The uterine corpus presents with its own unique disease profile, which in fact most closely resembles that of the ovary. The most common processes involving the epithelium encountered in this part of the female genital system are hyperplasia and adenocarcinoma, the latter consisting predominantly of endometrioid, mucinous, clear cell and serous carcinoma, with mixed forms and tumors combining features of more than one histological type in the same cells not infrequently seen. Other entities include neuroendocrine carcinoma, dedifferentiated carcinoma and undifferentiated carcinoma, as well as carcinosarcomas, currently considered to be metaplastic carcinomas. Benign and malignant mesenchymal tumors, of which the most frequent are leiomyoma and leiomyosarcoma, respectively, constitute another common finding, with clear predominance of benign lesions. Other sarcomas or mixed tumors with a sarcomatous component (endometrial stromal sarcoma, adenosarcomas), hematological cancers and metastases (most commonly from the ovary) are additionally encountered. Examples of these entities and relevant immunostains will be discussed.

CV

Present position: Senior Pathologist and Head of Research, Department of Pathology, Oslo University Hospital; Professor, Faculty of Medicine, University of Oslo

Education:

2003-2004: Post-doctoral fellow at NCI/NIH, Bethesda MD

1998-2001: Ph.D. program, Norwegian Radium Hospital; Thesis defended 23/8/01

1986-1992: Medical studies in Sackler School of Medicine, Tel-Aviv University

Brief Chronology of employment

2002-present: Staff pathologist, Department of Pathology, Norwegian Radium Hospital, Oslo, Norway; Sub-specialist in cytopathology and gynecologic pathology

1998-2001: Resident (combined with PhD program), Department of Pathology, Norwegian Radium Hospital, Oslo, Norway

1994-1998: Resident, Department of Pathology, Sheba Medical Center, Tel Hashomer, Israel

Membership in professional and scientific societies

1. The American Association for Cancer Research

2. The International Academy of Pathology (Norwegian division)

3. The European Society of Pathology

4. The International Society of Gynecological Pathology

5. Nordic Society of Gynecologic Oncology

Scientific appointments

2012-: Editorial board member in Gynecologic Oncology

2011-: Associate Editor, Frontiers in Women’s Cancer

2011-: Editorial board member in Human Pathology

2010-: Editorial board member in Virchows Archiv

2010: Associate Editor, Journal of Oncology, Special issue titled Molecular Genetic Markers in Female Reproductive Cancers

2006-2013: Member of the grant application committee, Norwegian Cancer Society

2005-2012: Section Editor in Diagnostic Cytopathology

Invited speaker and Reviewer

- Reviewed a large number of manuscripts for leading international peer-reviewed journals, including Nature Reviews Cancer, Lancet Oncology, Cancer Research, Clinical Cancer Research, Molecular Cancer Research, Annals of Oncology, The American Journal of Pathology, Oncogene and Cancer.

- Invited speaker in 26 sessions in international conferences in 2004-2014

Publications (excluding abstracts) in peer-reviewed journals: 258 per January 2015

In addition, Editor of a book on serous effusions with Springer and author of 5 chapters in other books.

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KONXION A/S