Mission
To provide excellent state-of-art diagnostic service to patients succumbing
to gynecologic diseases.
To educate our residents, fellows, and medical students in gynecologic
pathology with a focus on clinical application of newly developed bio-medical
scientific knowledge.
To develop and perform clinically oriented research projects in order
to improve pathology diagnosis, to better understand pathogenesis,
and to predict clinical outcomes for better clinical management of
gynecologic diseases.
General Information
The Yale Gynecologic Pathology Service encompasses the entire spectrum
of diagnostic services on biopsies and resections from the female genital
tract and external genitalia. The service provides specialized expertise
in the pathologic diagnosis of neoplastic and non-neoplastic conditions
of the gynecologic (GYN) pathology.
The service collaborates closely
with other specialized units within the Department of Pathology,
such as cytology
(review of Pap
smears, fine needle aspiration, and pelvic washing specimens), flow
cytometry (diagnosis of molar gestations), and other subspecialties,
to provide an exceptional level of the diagnosis. Our goal is to
provide outstanding service to patients through
accurate diagnosis, quick turn-around time and frequent personal communications.
HIGHLIGHTS
• Case load: An average of 10,000 to 11,000 GYN surgical cases every
year. Among them, approximately 3,000 to 4,000 are oncology cases.
•
Frequent communications with our GYN oncologists Drs.
Peter Schwartz, Setsuko
Chambers, and Tom Rutherford
•
All oncology cases are reviewed and presented in weekly GYN Tumor
Board Conference, which is multi-disciplinary management based
conference. We have an average of 25 cases per week.
•
Quick turnaround times for biopsy specimens (90% of biopsies turned
around in 2 days)
•
Availability of after hours, weekend, and rush biopsy processing
in appropriate medical circumstances
•
Use of advanced diagnostic techniques as needed
•
National and international consultations on outside pathologic material.
Consultation case should be sent to the following address:
Gynecologic Pathology Program
Department of Pathology
Yale University School of Medicine
20 York
Street, EP 2-608
New Haven, CT 06520-8070, USA
Tel: 203-785-2788
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Areas of Expertise
• Gynecologic cancers: Yale GYN Pathology has special expertise
in the diagnosis of gynecologic cancers including ovary,
fallopian tube, uterine wall, endometrium, cervix, vagina, vulva, peritoneum
and uterine-associated ligaments.
•
Precancers: Gynecologic epithelial malignancies mostly follow the process
of dysplasia to carcinoma in situ and then into invasive cancer.
Yale GYN pathologists have made special efforts to recognize cancer
precursor
lesions. Drs. Zheng and Parkash are pioneers defining some of the
endometrial and cervical precancers.
•
Pregnancy related diseases: Recurrent losses of pregnancy to gestational
neoplasia, including molar gestation, placental site trophoblastic
tumors, and epithelioid trophoblatic tumors. Dr. Hui has special interest
in the pathogenesis of placental trophoblastic diseases.
•
Pathology of the cervix: cervical intraepithelial neoplasia, adenocarcinoma
in situ and frank malignancies. Expert reviews are provided
with cytologic-histologic
correlation in cases of discrepancies between biopsies and cytology
specimens. Yale GYN pathologists pay special attentions to separate
early endocervical cancers from non-invasive cancer and cancer mimic
conditions.
•
Pathology of the vulva and vagina, including dermatologic conditions
•
Endometriosis: Yale GYN pathologists are currently defining the earliest
morphologic changes of endometriosis (initial endometriosis).
•
Tumor-like lesions in female genital tract. Correct recognition
of tumor-like lesions will help patients avoid unnecessary surgical
procedures.
•
Infertility related gynecologic diseases. Yale GYN pathologists provide
very accurate endometrial dating information for the patients who are
seeking pregnancy assistance. For those patients who show hormonal
imbalances, we provide probable clues of hormonal abnormalities from
submitted endometrial samples. These “clues” are critical
for gynecologists to treat patients correctly and efficiently.
About Tumors of the Female Genital
Tract
The female genital tract consists of the vulva, vagina, uterus (which
is divided into the upper corpus and the lower cervix), fallopian tubes,
and ovaries. Tumors of the female genital tract are very common.
The
most common tumor is a benign tumor of the uterine wall, called a
leiomyoma, commonly referred to as a fibroid. Leiomyomas occur in approximately
30% of women over the age of 35 but rarely produce symptoms if they
are small. Malignant tumors are cancerous and invade and destroy
normal
tissues. They can also spread to different parts of the body.
Gynecologic Cancer
The symptoms of gynecologic cancer are different depending on the
location of the tumor. Vulvar cancers affect older women and can generally
be
seen
or felt
as a mass or irregularity. Vaginal, cervical and uterine cancers may
present with abnormal vaginal bleeding, whereas tumors of the fallopian
tube and ovary are generally asymptomatic, though there may be abdominal
distension. A routine pelvic examination is very important to detect
abnormalities of the ovaries, fallopian tube and uterus. Early cervical
cancer may
be detected by a routine annual Pap test.
Diagnosis of Gynecologic Cancer
When a gynecologist suspects cancer, he/she will recommend a biopsy
which involves taking a sample of the suspected area. In the case of
suspected vulvar, vaginal, or cervical cancer, a small piece of tissue
is removed. In the case of suspected uterine cancer, a D&C is performed
in which the doctor widens the mouth (cervix) of the uterus and scrapes
the lining (the endometrium – tissue shed during menstruation).
The evaluation at this time for cancer cells is critical, and this
evaluation is done by pathologists. If cancer of the fallopian tube
or ovary is
suspected, a small needle (FNA) is inserted into the mass and the
aspirate examined for cancer cells. Sometimes these procedures are
not possible
(as in the ovary and fallopian tube) and the suspected organ has
to be removed.
If the biopsy shows cancer cells, surgery is generally performed
to try and remove the entire tumor. In the case of uterine, fallopian
tube, and ovarian cancers, this involves removal of the uterus, ovaries,
and fallopian tissue. Again, the pathologist evaluates this tissue
to determine how far the cancer has spread. Further treatment may be
necessary based on the pathologist’s evaluation.
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Frequently Asked Questions
What clinical information will assist in the evaluation of endometrial
biopsies?
Important clinical information such as the patients’ age, last
menstrual period, and hormone-taking histories are generally useful
in assisting in the interpretation of the endometrial biopsies in various
clinical settings.
Can the biopsy help to determine surgical range and medical therapy?
The biopsy dictates the next step in many cases. If an endometrial
sample harbors a malignancy, then the type of malignancy (primary
vs. metastatic, carcinoma vs. sarcoma), the grade of the malignancy
(differentiation),
and, occasionally, extent of disease (extension into surrounding
elements, e.g., endometrial carcinoma with involvement of cervical
tissues) are
reported on. This information is critical in determining the next
step and may obviate the need for additional procedures (such
as frozen
sections at the time of surgery), and may determine the type and
extent of surgery (an endometrioid endometrial carcinoma gets
a different
staging surgery from that done for serous endometrial carcinoma).
In the event of benign growths, an endometrial biopsy may not show
any significant abnormalities, allowing the patient and her physician
to choose from a range of treatment options depending on her
comfort level.
Yale Gynecologic Pathology Fellows:
2001-2002: Reena Jain, M.D.
2002-2003: Sharon Liang, M.D., Ph.D.
2003-2004: Roy Zhang, M.D.
• go to GYN
Pathology Fellowship Program
• go to GYN Teaching
• go to GYN Research Activities
• go to GYN Publications
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