International Journal of Gynecological Pathology (INT J GYNECOL PATHOL)

Publisher: International Society of Gynecological Pathologists, Lippincott, Williams & Wilkins

Journal description

The International Journal of Gynecological Pathology provides complete and timely coverage of advances in the understanding and management of gynecological disease. Emphasis is placed on investigations in the field of anatomic pathology. Articles devoted to experimental or animal pathology clearly relevant to an understanding of human disease are published, as are pathological and clinicopathological studies and individual case reports that offer new insights.

Current impact factor: 1.63

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 1.631
2012 Impact Factor 1.413
2011 Impact Factor 1.453
2010 Impact Factor 2.076
2009 Impact Factor 2.074
2008 Impact Factor 1.766
2007 Impact Factor 1.748
2006 Impact Factor 2.184
2005 Impact Factor 1.817
2004 Impact Factor 1.544
2003 Impact Factor 2.159
2002 Impact Factor 1.848
2001 Impact Factor 1.454
2000 Impact Factor 1.508
1999 Impact Factor 1.76
1998 Impact Factor 1.509
1997 Impact Factor 1.204
1996 Impact Factor 1.465
1995 Impact Factor 1.5
1994 Impact Factor 0.978
1993 Impact Factor 1.061
1992 Impact Factor 1.192

Impact factor over time

Impact factor
Year

Additional details

5-year impact 1.66
Cited half-life 8.50
Immediacy index 0.18
Eigenfactor 0.00
Article influence 0.50
Website International Journal of Gynecological Pathology website
Other titles International journal of gynecological pathology, Journal of the International Society of Gynecological Pathologists
ISSN 0277-1691
OCLC 7520439
Material type Periodical, Internet resource
Document type Journal / Magazine / Newspaper, Internet Resource

Publisher details

Lippincott, Williams & Wilkins

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo
  • Conditions
    • Some journals have separate policies, please check with each journal directly
    • Pre-print must be removed upon acceptance for publication
    • Post-print may be deposited in personal website or institutional repository
    • Publisher's version/PDF cannot be used
    • Must include statement that it is not the final published version
    • Published source must be acknowledged with full citation
    • Set statement to accompany deposit
    • Must link to publisher version
    • NIH authors will have their accepted manuscripts transmitted to PubMed Central on their behalf after a 12 months embargo (see policy for details)
    • Wellcome Trust and HHMI authors will have their accepted manuscripts transmitted to PubMed Central on their behalf after a 6 months embargo (see policy for details)
    • Publisher last reviewed on 19/03/2015
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Vulvar acanthosis with altered differentiation is an uncommon proliferation of the vulvar squamous epithelium that is typically seen in association with verrucous carcinoma, and may represent an early phase of non-HPV-related squamous neoplastic transformation. We report a case of vulvar acanthosis with altered differentiation that, over a 5-yr period, progressed first to verrucous carcinoma in association with well-differentiated invasive squamous cell carcinoma and then, after treatment with radiotherapy, to poorly differentiated carcinoma with a component of anaplastic carcinoma. This case supports the concept of vulvar acanthosis with altered differentiation as a premalignant lesion, with potential to progress to invasive carcinoma. (C)2015International Society of Gynecological Pathologists
    International Journal of Gynecological Pathology 07/2015; 34(4). DOI:10.1097/PGP.0000000000000182
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    ABSTRACT: http://journals.lww.com/intjgynpathology/Citation/publishahead/Fanning_the_Flames_in_Anti_N_methyl_D_aspartate.99495.aspx
    International Journal of Gynecological Pathology 05/2015; 34(4). DOI:10.1097/PGP.0000000000000186
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    ABSTRACT: Distant metastasis of rare malignant struma ovarii (MSO) has been reported for cases associated with papillary thyroid cancer but few with follicular thyroid cancer. A 38-yr-old woman with struma ovarii that was initially diagnosed as "benign" presented pulmonary metastasis and coughing 17 yr later. The lungs lesions were confirmed to be follicular thyroid cancer by biopsy. Rereview of the initial surgical ovary specimens confirmed the condition to be MSO with follicular thyroid cancer. The patient was treated with total thyroidectomy, which showed no thyroid malignancy, followed by 131I (iodine-131) treatments. Dramatic reduction was observed in both the stimulated thyroglobulin level and the size of the pulmonary metastases over 1 yr. During the following 3-yr follow-up, the patient remained clinically well, with undetectable thyroglobulin (<1 ng/mL) and small stable pulmonary lesions. This is an exceedingly rare case of MSO with follicular thyroid cancer metastasized to the lungs presenting with a late onset but a fortunate excellent response to multidiscipline treatments. It is advisable that struma ovarii be carefully examined to avoid missing malignancy and patients be clinically followed up even with a benign initial diagnosis. (C)2015International Society of Gynecological Pathologists
    International Journal of Gynecological Pathology 05/2015; 34(5). DOI:10.1097/PGP.0000000000000178
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    ABSTRACT: The objective of this study was to identify the tumor characteristics associated with mismatch repair deficiency in young patients with endometrial carcinoma. Young patients (45 yr old or younger) with endometrial carcinoma treated by hysterectomy in our institution between July 2001 and June 2009 were identified. The clinical and pathologic data were obtained by review of clinical records. Among the 122 cases identified, paraffin sections were available in 67 cases for immunohistochemical staining and frozen tissue available in 62 cases for microsatellite instability (MSI) analysis. Both paraffin sections and frozen tissue were available in 36 cases. Among the 67 cases with immunohistochemical staining, 22 (32.8%) showed loss of expression of at least 1 mismatch repair protein. Defective MLH1 or MSH2 expression was associated with poor prognostic factors, including a higher incidence of pelvic lymph nodes metastasis (P=0.018) and higher stage (P=0.022) for MLH1, and an increased risk of lymphovascular permeation (P=0.015) for MSH2. On the contrary, defective MSH6 protein expression was associated with a lower incidence of high-grade tumors (P=0.04). Among the 62 cases with MSI analysis, 12 (19.4%) tumors were classified as microsatellite-high (MSI-H), whereas 2 (3.2%) were classified as microsatellite-low (MSI-L). There was no difference in the pathologic characteristics between MSI-stable and MSI-H tumor. We concluded that defective mismatch repair expression is important in young patients with endometrial carcinoma, with MSH6 protein being most commonly affected. The phenotype resulting from defective MSH6 expression was different from that caused by MLH1 or MSH2 loss. (C)2015International Society of Gynecological Pathologists
    International Journal of Gynecological Pathology 05/2015; 34(5). DOI:10.1097/PGP.0000000000000174
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    ABSTRACT: We report 2 cases of growing teratoma syndrome (GTS) in patients who had been treated with surgery and chemotherapy for immature ovarian teratoma. One of the patients presented with probable paraneoplastic encephalitis. Resection of "recurrences" in both patients showed deposits of mature teratoma and extensive gliomatosis peritonei. It is important for both pathologists and clinicians to be aware of this uncommon entity to avoid misdiagnosis of GTS as recurrence of immature teratoma and disease progression, and to avert unnecessary continuation of chemotherapy. GTS may occur several years after diagnosis of the primary tumor, and rarely develop in treated patients who have become pregnant. Surgical debulking is the optimal modality of treatment as GTS is not chemosensitive. If surgical debulking of GTS is incomplete, long-term follow-up with imaging is required to avoid complications such as bowel obstruction and the sequelae of pressure effects (such as vascular thrombosis, fistula formation, etc.) from bulky deposits of mature teratoma/GTS and gliomatosis peritonei. (C)2015International Society of Gynecological Pathologists
    International Journal of Gynecological Pathology 05/2015; 34(5). DOI:10.1097/PGP.0000000000000180
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    ABSTRACT: Inflammatory myofibroblastic tumor has been described in a wide variety of anatomic sites, although in the gynecologic tract, it has mostly been documented in the uterus, and has never been described in the placenta. Two patients presented with well-circumscribed placental masses that showed classic histologic features of inflammatory myofibroblastic tumor including a proliferation of myofibroblastic cells, a mixed inflammatory infiltrate, and a myxoid background. One case was positive by immunohistochemistry for anaplastic lymphoma kinase (ALK-1), whereas the other was negative by immunohistochemistry and fluorescent in situ hybridization. Inflammatory myofibroblastic tumors should be differentiated from other more aggressive uterine tumors that may involve the placenta by direct extension/metastasis because they can be managed conservatively, and in these 2 cases, did not seem to affect the course of the patient's pregnancies. (C)2015International Society of Gynecological Pathologists
    International Journal of Gynecological Pathology 05/2015; 34(5). DOI:10.1097/PGP.0000000000000175
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    ABSTRACT: Leiomyosarcoma is the most common histotype of uterine sarcoma and usually displays a typical morphology. Heterologous leiomyosarcoma is the rarest variant, in which the neoplasia contains liposarcomatous, osteosarcomatous, or rhabdomyosarcomatous components. We have investigated the largest series of uterine leiomyosarcoma with rhabdomyosarcomatous component and we have disclosed the molecular basis, which concurs to the process of transdifferentiation from smooth muscle into striated muscle phenotype. The surgical specimens of 5 rare cases of uterine leiomyosarcoma with rhabdomyosarcomatous component were formalin fixed and then paraffin embedded. In addition to hematoxylin/eosin, phosphotungstic acid hematoxylin stain, immunohistochemistry, and a methylation-specific polymerase chain reaction for CDKN2A promoter region were performed. Leiomyosarcomatous cells were found to be strongly immunoreactive for both desmin and [alpha]-smooth muscle actin. Rhabdomyosarcomatous cells were immunoreactive for sarcomeric actin, desmin, vimentin, CD10, and p16. The methylation-specific polymerase chain reaction revealed the presence of a methylated allele and an unmethylated allele in the microdissected samples, coming from leiomyosarcomatous cells. On the contrary, 2 unmethylated alleles, molecular expression of a loss of heterozygosity, were detected in all the microdissected samples in rhabdomyosarcomatous cells. The loss of heterozygosity methylation in the promoter region of the CDKN2A gene, occurred only in the rhabdomyosarcomatous cells, increases both p16 and p14 levels. This event stimulates an inhibition of cdk4/cdk6 activity, stabilizes the tumor suppressor protein p53, and concurs to the transdifferentiation from smooth muscle into striated muscle oncotype. (C)2015International Society of Gynecological Pathologists
    International Journal of Gynecological Pathology 05/2015; DOI:10.1097/PGP.0000000000000181
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    ABSTRACT: Epithelial-mesenchymal transition is a key process influencing cancer progression and metastasis. The purpose of this study was to investigate the expression of epithelial-mesenchymal transition-related factors in chorionic villi and decidual cells in adherent placenta. The current study included 19 patients diagnosed with adherent placenta after hysterectomy. The expression of E-cadherin, Vimentin, Snail, and transforming growth factor-[beta] in placental tissues was analyzed by immunohistochemical staining. Immunostaining intensity was semiquantitatively evaluated using the HSCORE algorithm. In the chorionic villi of invasive part (placenta with invasion into myometrium), E-cadherin expression was significantly lower than that in noninvasive part (placenta with no invasion). In the decidual cells of invasive part, expression of transforming growth factor-[beta] and Snail significantly increased. These results suggest that epithelial-mesenchymal transition may contribute to excessive trophoblast invasion into the myometrium in adherent placenta. (C)2015International Society of Gynecological Pathologists
    International Journal of Gynecological Pathology 05/2015; DOI:10.1097/PGP.0000000000000190
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    ABSTRACT: The levonorgestrel-releasing intrauterine system (L-IUS) is widely used in contraception and in the treatment of menorrhagia, dysmenorrhea, adenomyosis, and endometriosis. L-IUS is also increasingly considered in the management of endometrial neoplasia and its precursors. Histologic changes in the endometrium can be due to the effects of high-dose progestogen or may be caused by the local irritant or mechanical effects of an intrauterine foreign body. In the present study, we describe a novel endometrial alteration associated with L-IUS that most closely resembles synovial metaplasia reported at other extra-articular anatomic sites. Eleven cases were identified with a mean age of 49.6 yr. In most patients L-IUS was used for management of menorrhagia or endometrial hyperplasia. Endometrial synovial-like metaplasia was always a focal finding and was associated with areas of surface epithelial erosion. The synovial-like cells showed a distinctive palisaded arrangement with orientation perpendicular to the endometrial surface. Multinucleate cells were present in 2 cases, but granulomas were not identified. The synovial-like cells were vimentin immunoreactive and a variable proportion of cells expressed CD68. Only focal CD10 staining was seen and there was no expression of estrogen receptor, progesterone receptor, or cytokeratin. In summary, L-IUS may be associated with a distinctive synovial-like metaplastic alteration which most likely represents a stromal reaction to an intrauterine foreign body following endometrial surface erosion. The synovial-like cells appear to comprise histiocytes and modified fibroblasts or stromal cells similar to this process in other sites. (C)2015International Society of Gynecological Pathologists
    International Journal of Gynecological Pathology 05/2015; DOI:10.1097/PGP.0000000000000183
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    ABSTRACT: A 36-year-old gravida 4, para 2 African-American woman, presented at three months postpartum with a right ovarian mass identified on a lumbar spine MRI as part of a neurology workup for persistent lower back pain. A follow-up pelvic ultrasound noted a 7.0x6.1x3.8 cm septated mixed cystic and solid mass. Exploratory laparoscopy and right ovarian cystectomy yielded a final pathologic diagnosis of intermediate grade myxoid liposarcoma, confirmed with DDIT3 gene rearrangement studies. (C)2015International Society of Gynecological Pathologists
    International Journal of Gynecological Pathology 03/2015; 34(3). DOI:10.1097/PGP.0000000000000145
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    ABSTRACT: Mural nodules, which may be benign or malignant, are well recognized in ovarian mucinous neoplasms, especially of borderline type. Malignant mural nodules most commonly comprise anaplastic carcinoma but sarcomas of various types have been reported. We report 2 cases of osteosarcoma occurring in young women (aged 18 and 34) as malignant mural nodules in a Grade 1 ovarian mucinous carcinoma of intestinal type and a borderline mucinous tumor of intestinal type. Primary osteosarcomas of the ovary have been described either arising within a teratoma or as a pure neoplasm but, to the best of our knowledge, osteosarcoma occurring as a mural nodule in an ovarian mucinous neoplasm has not been reported. In both our cases, the tumor was Stage 1 at presentation and the patients were treated with surgery without adjuvant chemotherapy. Both patients are free of disease with follow-up of 12 and 18 mo.
    International Journal of Gynecological Pathology 03/2015; 34(4). DOI:10.1097/PGP.0000000000000153
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    ABSTRACT: Pseudomyxoma peritonei is a clinical condition characterized by the presence of mucinous ascites, usually with variable amounts of neoplastic enteric-type mucinous epithelium, and most commonly secondary to spread from a low-grade appendiceal mucinous neoplasm. We report 2 cases of pseudomyxoma peritonei associated with low-grade appendiceal mucinous neoplasms where there was colonization of the endometrium (both cases) and cervical mucosa (1 case) by low-grade atypical enteric-type mucinous epithelium (CK20 positive and CK7 negative). The patients had symptoms of mucoid vaginal discharge and endometrial biopsies in both (1 patient had multiple endometrial biopsies over a period of 11 mo) and were initially interpreted as representing mucinous metaplasia. Pseudomyxoma peritonei may rarely result in endometrial and cervical mucosal involvement, presumably secondary to transtubal spread.
    International Journal of Gynecological Pathology 03/2015; 34(3). DOI:10.1097/PGP.0000000000000149
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    ABSTRACT: We sought to evaluate the rate of cervical intraepithelial neoplasia (CIN)≤1 in loop electrosurgical excision procedure (LEEP) specimens after the treatment of biopsy-proven CIN 2-3, and to identify factors that are associated with the rate of CIN≤1, especially focusing on the time interval between biopsy and LEEP. The goal of this research is to reduce the overtreatment of women with CIN 2-3. This was a retrospective study performed on women undergoing LEEP for biopsy-proven CIN 2-3 in Qilu hospital in Shandong, China. Patients were separated according to LEEP pathology (CIN≤1 vs. CIN 2-3), and compared using the χ test and Student t test. The main outcome measures were pathologic discrepancy (defined as CIN 2-3 at biopsy, but CIN≤1 at excision). Of the 391 women with biopsy-proven CIN 2-3, 26.9% had LEEP specimens with CIN≤1 histologies. The likelihood of a CIN≤1 LEEP specimen increases for greater biopsy-LEEP intervals (odds ratio, 1.374; 95% confidence interval, 1.089-1.735; P=0.008). Cases in younger women and biopsy-assessed CIN 2 cases were both more likely to have CIN 1 or negative LEEP specimens. The rate of spontaneous histologic regression (defined as CIN≤1 at resection) was 26.9%. These low-grade lesions were more common in LEEP specimens from young women with CIN 2 at biopsy, and who underwent LEEP later after the initial biopsy.
    International Journal of Gynecological Pathology 03/2015; 34(3). DOI:10.1097/PGP.0000000000000152
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    ABSTRACT: Iron is a well-documented carcinogen based on both animal models and observational studies in humans. There are limited published data on pseudoxanthomatous salpingitis, an uncommon condition characterized by the accumulation of histiocytes containing iron and iron-related compounds-lipofuscin and hemosiderin-in the lamina propria of the fallopian tube. The clinical and pathologic features of 49 consecutive cases were evaluated. The mean patient age was 53. A history of endometriosis was found in 20%, infertility in 17%, and tubal ligation in 7%. Thirteen (27%) had endometrial cancer and 2 patients had prior radiation therapy for cervical carcinoma. Histologic evidence of endometriosis other than tubal pigment deposition was identified in 65%, and in the fallopian tubes in 35%. Pigment deposition was unilateral in 65% and multifocal or diffuse in 80%. Plasma cells, eosinophils, and neutrophils were present in the tubal lamina propria in 57%, 18%, and 24%, respectively. Hydrosalpinx was present in 51%. An iron stain was positive in pseudoxanthoma cells lacking hemosiderin in 14 of 18 cases (78%). By immunohistochemistry, 2 of 22 cases displayed p53 signatures. The Ki67 proliferation index was elevated (>10%) in 11 of 22 cases, with a mean index of 32% in those cases. An elevated proliferation index did not correlate with inflammation. In summary, these findings characterize the clinical and pathologic features of pseudoxanthomatous salpingitis and confirm its close association with endometriosis, occasional association with radiation therapy, and the presence of iron in the histiocytes. In view of the evolving paradigm shift implicating the fallopian tubal epithelium as the site of origin of high-grade extrauterine serous carcinoma, the presence of iron and iron-related compounds in the fallopian tube provides an opportunity to study the early events in high-grade serous carcinogenesis in a setting characterized by a well-documented carcinogen in close anatomic proximity to the putative epithelium of origin.
    International Journal of Gynecological Pathology 03/2015; 34(3). DOI:10.1097/PGP.0000000000000154
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    ABSTRACT: Endometrial ablation is a minimally invasive alternative to hysterectomy for abnormal uterine bleeding. Although the failure rate is low, continued bleeding or development of pelvic pain after ablation does occur. We analyzed the clinicopathologic features of 164 hysterectomy specimens after endometrial ablation, 19 of which were performed for indications other than failed ablation (control cases). Pathologic findings included: dense fibrosis and hyalinization of the endometrial surface; ablative necrosis within the uterine cavity and adherent to the endometrial surface, persistent months after ablation; uterine cavity lined by superficial, large, congested, patent blood vessels with atherosis; ablation changes present only in the lower uterine segment; and residual endometrium present in the cornual regions. Patients with ablative necrosis underwent subsequent hysterectomy sooner than those without such debris (median of 5 vs. 23 mo, respectively). Patients with superficial abnormal vessels were also more likely to have a shorter ablation-hysterectomy interval than those without (median of 2 vs. 18 mo, respectively). Patients with associated adenomyosis or prior tubal ligation were significantly more likely to have continued bleeding. Possible sources of continued abnormal bleeding or pelvic pain include: the presence of ablative necrosis or superficial abnormal blood vessels, although the association did not reach statistical significance in this study; incomplete ablation, affecting only the lower uterine segment or sparing the cornual region; tubal endometriosis after ligation; and endometrial regeneration via adenomyosis.
    International Journal of Gynecological Pathology 03/2015; 34(3). DOI:10.1097/PGP.0000000000000147
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    ABSTRACT: The pathologic detection of microscopic omental metastases is important for the staging and treatment of ovarian and endometrial cancer. The question of how to sample grossly negative omentectomy specimens has not been adequately answered. We reviewed our institutional experience by retrieving a series of gynecologic cancer cases from 1998 to 2013 in which the omentum was grossly negative, but microscopically positive. There were 21 patients with ovarian carcinoma, 7 with ovarian borderline tumors, and 16 with endometrial carcinoma (44 patients in total). Cases in which the omentum was grossly abnormal or suspicious were excluded. A mean of 5.2 blocks were submitted per case (range, 4-15), of which a mean of 2.7 were positive for metastatic disease (range, 1-5). The distribution of cases by percentage of blocks positive was bimodal: some cases showed only 1 or 2 foci of disease in the entire sampled omentum, whereas in other cases nearly every block was positive. Only 3 cases had been sampled with >5 blocks. We used a series of simulated cases, bootstrapped on the retrospective series, to determine the additional sensitivity conferred by submitting >5 blocks. This model indicated that 5 blocks will, in fact, be insufficient to capture microscopic metastases in some cases. Examination of 5 blocks has an estimated sensitivity of 82%, whereas submission of 10 blocks raises the sensitivity to 95%. These results suggest that submission of 10 blocks should be considered for grossly negative omentectomy specimens when other staging is negative.
    International Journal of Gynecological Pathology 03/2015; 34(3). DOI:10.1097/PGP.0000000000000148
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    ABSTRACT: Primary fibrosarcoma arising from ovarian sex-cord stroma is a very rare neoplasm, with only a few reports in the literature. These tumors have been reported to express inhibin which allows their distinction from fibrosarcomas of soft tissue. Here, we report a case of a fibrosarcoma arising in the broad ligament. Despite being totally separate from the ovary, the tumor was diagnosed as of sex-cord stromal type on the basis of inhibin expression. Furthermore, this patient suffered a recurrence of her tumor in the pelvis, which showed both the fibrosarcomatous, as well as other sex-cord elements, confirming the sex-cord stromal differentiation of the sarcoma. To our knowledge, this is the first case of a sex-cord stromal fibrosarcoma arising from an extraovarian site. Furthermore, this is also the first case of a recurrent fibrosarcoma, which showed redifferentiation of the tumor into other sex-cord components.
    International Journal of Gynecological Pathology 03/2015; 34(4). DOI:10.1097/PGP.0000000000000151
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    ABSTRACT: Microcystic stromal tumor of the ovary is a very rare ovarian tumor with distinctive microcystic histologic features and a characteristic immunophenotype of stromal tumor. However, its origin, tumor pathogenesis, and prognosis have not been well established until now. We report a very unusual case of a microcystic stromal tumor of the ovary with a mutation in exon 3 of the β-catenin (CTNNB1) gene. Macroscopically, the fragmented ovarian tumor showed a diffuse solid mass. Microscopically, the tumor had a pathognomonic histologic pattern of solid and cellular areas with microcysts and fibrous hyalinized stroma. Immunohistochemical staining with CD10, vimentin, CD99, and β-catenin showed positive expression. However, α-inhibin and E-cadherin showed negativity. Mutational analysis revealed a point mutation in exon 3 of the β-catenin (CTNNB1) gene.
    International Journal of Gynecological Pathology 03/2015; 34(2):121-125. DOI:10.1097/PGP.0000000000000122