The fate of spermatozoa deposited within the female reproductive tract has been described in the smoothhound, Mustelus canis. Evidence of uterine epithelial-sperm interaction is presented, as well as documentation of sperm storage specifically in the terminal zone of the oviducal gland. Sperm fate is correlated with morphology of the endometrial cycle and specificity of storage in the oviducal gland. The endometrium of M. canis undergoes dramatic tissue remodeling associated with gestation. In females harboring fertilized ova or preimplantation yolk-reliant embryos, the uterine epithelium is simple cuboidal with mucous droplets for lubrication. The presence of the embryo elicits a response from the uterus, which becomes modified for nutrient and respiratory exchange into vascular uterine attachment sites that abut the distal aspect of the yolk sac. Areas of the uterus adjacent to the uterine attachment sites are termed paraplacental sites. Uterine attachment sites are simple squamous while the paraplacental epithelium is simple columnar. Paraplacental cells have basal metachromatic vesicles and a dense array of apical cytoplasmic filaments. Immediately postpartum the uterine attachment sites, now termed uterine or placental scars, begin to remodel to a mucous epithelium for the next gestational cycle. Paraplacental cells slough off the apical filamentous portion, and sperm become embedded in the epithelium. Bundled sperm occur throughout gestation in the terminal zone of the oviducal gland. Sperm are not embedded in the terminal zone epithelium as in the uterus. Following sperm release from the uterus, the paraplacental epithelium reverts to a mucous epithelium for the next reproductive cycle. Fertilization is presumed to occur in the anterior oviduct above the oviducal gland. The physiological mechanisms that mediate sperm-uterus attachment, release, and storage in the terminal zone of the oviducal gland are currently under investigation.

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Casestudy: High-grade uterine sarcomas are rare mesenchymal tumors in which the underlying genetics of many have been recently elucidated. BCOR internal tandem duplications are present in a subset of high-grade uterine sarcomas. We report a diagnostically challenging case of a high-grade uterine sarcoma with a BCOR internal tandem duplication presenting with total uterine inversion. The case is that of a 24 year old G0P0 female with a four month history of intermittent diffuse abdominal pain and abnormal uterine bleeding. Pelvic examination revealed a mass protruding to the hymenal ring. The patient was suspected of having a prolapsed fibroid through the cervix, and a myomectomy was planned. During the procedure, total uterine inversion was noted as a result of a submucosal mass emanating from the uterine apex. The mass was removed off a broad base using sharp dissection, and the uterus was reverted in a subsequent procedure. Grossly, the mass was polypoid, rubbery, and measured 7 cm in greatest dimension. It was grey-white to red-brown, variegated, and fibrotic with focal hemorrhagic areas. Histologically, the neoplasm had variable cellularity with spindle cells and a myxoid background. There was diffuse mild to moderate cytologic atypia and areas of increased mitotic activity. Tongue-like growth was present at the interface of the tumor with the normal myometrium. The neoplastic cells showed strong immunoreactivity for cyclin D1, BCOR, and TRK. There was focal immunoreactivity for CD10, and ALK was negative. Next-generation sequencing was performed and demonstrated an insertion into the BCOR gene, consistent with a diagnosis of high- grade uterine sarcoma with BCOR internal tandem duplication. In conclusion, we report an interesting presentation of a high-grade uterine sarcoma with BCOR internal tandem duplication causing total uterine inversion. The morphologic features and immunohistochemical profile suggested the possibility of the entity, and next generation sequencing confirmed the diagnosis.

The current NCCN guideline for management of atypical ductal hyperplasia (ADH) diagnosed on a breast core needle biopsy (CNB) includes surgical excision, frequent follow-up with mammograms, and chemoprevention with selective estrogen receptor modulator (SERM). Studies have shown that histological differentiation between ADH and usual ductal hyperplasia (UDH) on a CNB can sometimes be challenging. In our institution, "abnormal epithelial proliferation" (AEP) is a term coined to identify a pathologically worrisome entity on CNB that falls short of a diagnosis of ADH, but warrants surgical excision for further analysis. The objective of this study was to compare the follow-up surgical excision diagnosed as AEP or ADH on CNB. Retrospective review of the institutional pathology database between January 2011 and December 2012 identified 82 cases of AEP and 60 cases of ADH diagnosed on breast CNB and surgically excised at our institution. Pathology reports of both CNB and excisional biopsy were reviewed. An upgrade was defined as a change to DCIS or invasive carcinoma. A downgrade was defined when benign lesions such as UDH were reported. Patients with AEP and ADH had a similar upgrade rate (24% vs 28%, P > .05), while downgrading rate was significantly higher in the AEP group (44% vs 2%, P < .001). If this were to be a single cohort, wherein all of these cases carried a diagnosis of ADH on CNB (AEP + ADH = ADH), 25% of these patients would have a diagnosis downgraded to benign. By using AEP terminology, we do not lose our ability to diagnose a higher-grade lesion in the final excision. Meanwhile, by deferring the definitive diagnosis of ADH to excisional biopsy in appropriate situations, a subset of patients (25% in our study) were spared from SERM treatment and possible associated side effects, and the lifelong mental anxiety of being labeled as "high risk."