The most important discoveries of the past 50 years in gynaecological pathology

The field of gynaecological pathology has grown from its infancy to a mature subspecialty over the last 50 years. What discoveries have led the way in this evolution? On the basis of personal experience and a survey of expert gynaecological pathologists, the following discoveries have been most impactful: (i) identification of the role of human papillomavirus in the aetiology of carcinoma of the lower genital tract; (ii) the emergence of international classification systems for gynaecological cancers (with cervical adenocarcinoma being the most recent example of this); (iii) the development of reliable immunohistochemistry as a diagnostic adjunct; (iv) discoveries around the aetiology and the relationship between serous carcinoma of the tube/ovary and the endometrium; and (v) identification of the role of oestrogen in the development of endometrial carcinoma and histological recognition of the precursor lesion atypical hyperplasia/endometrial intraepithelial neoplasia, and how recognition of the role of diethylstilboestrol in the aetiology of vaginal clear cell carcinoma led directly to this discovery. The history of each discovery and how it changed diagnostic pathology will be discussed in this review.