Gestation is the period of time between conception and birth. During this time, the baby grows and develops inside the mother’s womb. Gestational age is the common term used during pregnancy to describe how far along the pregnancy is. It is measured in weeks, from the first day of the woman’s last menstrual cycle to the current date. A normal pregnancy can range from 38 to 42 weeks. Infants born before 37 weeks are considered premature. Infants born after 42 weeks are considered postmature. Gestational age can be determined before or after birth. Before birth, your health care provider will use ultrasound to measure the size of the baby’s head, abdomen, and thigh bone. This provides a view on how well the baby is growing in the womb. After birth, gestational age can be measured by looking at the baby’s weight, length, head circumference, vital signs, reflexes, muscle tone, posture, and the condition of the skin and hair.

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Vaginal intraepithelial neoplasia (VAIN) is a condition that frequently poses therapeutic dilemmas for gynecologists. VAIN represents dysplastic changes to the epithelium of the vaginal mucosa, and like cervical neoplasia, the extent of disease is characterized as levels I, II, or III dependent upon the depth of involvement in the epithelial layer by dysplastic cells. While VAIN itself typically is asymptomatic and not a harmful condition, it carries a 12% risk of progression to invasive vaginal carcinoma, so accurate identification, thorough treatment, and ongoing surveillance are essential. vaginal intraepithelial neoplasia (VaIN) has increased steadily over the past several decades as a result of heightened awareness, expanded cytologic screening, and the liberal use of colposcopy. The relative rarity of VaIN, which is far less common than cervical intraepithelial neoplasia (CIN) or vulvar intraepithelial neoplasia (VIN), is an impediment to a thorough understanding of the disease process and its natural course. As a result, much of this information is an extrapolation of our knowledge of the pathophysiology of cervical and vulvar intraepithelial neoplasia.

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Uterine carcinosarcoma (USC) is a cancer that develops in the uterus. Carcinosarcoma signifies that, when looked at under a microscope, the tumor displays histological features of both endometrial carcinoma and sarcoma. Most patients with advanced or recurrent uterine sarcoma experience disease progression and ultimately die.  This is the first reported case in the literature of cured metastatic uterine carcinosarcoma to lungs, with long-term survival of 5 years. Carcinosarcoma of the uterus (also known as malignant mixed Mullerian tumor, MMMT) is a highly aggressive form of uterine cancer.1-3 Even though it constitutes about 3-4% of uterine malignancy overall, it accounts for a disproportionate percentage of mortality associated with uterine malignancy. As its name implies, this is a biphasic (two-component) tumor which contains an admixture of carcinoma (cancer showing epithelial differentiation) and sarcoma (cancer showing mesenchymal differentiation) components. In the great majority of uterine carcinosarcoma, both the carcinoma and the sarcoma components are histologically high-grade. While a number of groups have previously demonstrated that the carcinoma and the sarcoma components represent the same disease based on X-chromosome inactivation pattern and TP53 hotspot mutation sequencing studies

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A struma ovarii (literally: goitre of the ovary) is a rare form of monodermal teratoma that contains mostly thyroid tissue, which may cause hyperthyroidism. Despite its name, struma ovarii is not restricted to the ovary. The ultrasound (US) features of struma ovarii are nonspecific, but a heterogeneous, predominantly solid mass may be seen. US demonstrates a complex appearance with multiple cystic and solid areas, findings that reflect the gross pathologic appearance of the tumor. Magnetic resonance imaging findings may be more characteristic: The cystic spaces demonstrate both high and low signal intensity on T1- and T2-weighted images. Some of the cystic spaces may demonstrate low signal intensity on both T1- and T2-weighted images due to the thick, gelatinous colloid of the struma. No fat is evident in these lesions.

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Borderline tumors of the ovary (also called tumors of low-malignant potential) are a heterogeneous group of lesions defined histologically by atypical epithelial proliferation without stromal invasion. The epidemiology, diagnosis, and treatment of borderline ovarian tumors are reviewed here. Borderline ovarian epithelial neoplasms are noninvasive neoplasms that occasionally have intraperitoneal spread. This group of neoplasms exhibit behavior that is intermediate between benign cystadenomas and invasive carcinomas. These have been referred to by different terms, including: borderline, atypical proliferative, and tumors of low-malignant potential. Borderline neoplasm is currently the most widely used designation by pathologists, gynecologists, and oncologists, and has been adopted into the World Health Organization classification. Borderline tumors account for 14 to 15 percent of all primary ovarian neoplasms

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Peritoneal cancer is a rare cancer. It develops in a thin layer of tissue that lines the abdomen. It also covers the uterus, bladder, and rectum. Made of epithelial cells, this structure is called the peritoneum. It produces a fluid that helps organs move smoothly inside the abdomen. Peritoneal cancer is not the same as intestinal or stomach cancer. Nor is it to be confused with cancers that spread (metastasize) to the peritoneum. Peritoneal cancer starts in the peritoneum, and hence is called primary peritoneal cancer.

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With increasing use of first trimester aneuploidy screening, the incidental discovery of adnexal masses during early gestation is a clinically relevant problem that requires careful consideration. The purpose of this review is to summarize pertinent clinical issues surrounding women diagnosed with adnexal masses during pregnancy. The liberal use of prenatal ultrasound for evaluation of the fetus has also resulted in increased detection of asymptomatic adnexal masses during pregnancy. Although the vast majority of these masses are benign, the possibility of cancer must be considered.

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The vaginal epithelium is responsive to sex steroids, particularly estrogen, and undergoes predictable changes through the cycle in response to changes in blood concentrations of ovarian hormones. Rising levels of estrogen cause the vaginal epithelium to become “cornified” – the surface cells become large and flattened, with small or absent nuclei. In essence, vaginal cytology is a type of endocrine assay. Tracking changes in the morphology of desquamated vaginal epithelial cells provides a convenient means of assaying changes in estrogen levels.

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Fertility-sparing surgery may be an option in women who want to have children at a later date and who have early cancer in only one ovary. For this procedure, gynecologic oncologists remove the cancerous ovary and connected fallopian tube, which carries the egg to the uterus. They also remove a sample of the surface of the uterus in a procedure called dilation and curettage to ensure no cancer is present there. To ensure that fertility-sparing surgery is a safe option, our gynecologic oncologists carefully confirm that the cancer has not spread beyond one ovary. They perform one or more biopsies, which are the removal of tissue from the pelvic and abdominal cavities for evaluation under a microscope for signs of cancer. They may remove area lymph nodes, and may sample or remove the omentum, a layer of fatty tissue that covers the abdomen, to examine these areas for cancer.

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Equipment and techniques for office-based endometrial sampling has generally replaced the need for diagnostic dilation and curettage performed in the hospital. These techniques provide a minimally invasive option for diagnosis of endometrial cancer, hyperplasia, and other endometrial pathology. Techniques for office procedures for endometrial sampling will be reviewed here. Dilation and curettage and an overview of the diagnostic approach to endometrial evaluation for neoplasia, including both noninvasive and invasive methods. New techniques may replace direct sampling of the endometrium. These include peripheral blood sampling for circulating tumor cells or cell free DNA. Uterine lavage with molecular testing of the sample is also being investigated.

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