RESUMEN
Mesonephric adenocarcinoma is a rare variant of cervical carcinoma with relatively few, well-documented cases reported. We describe the clinicopathologic and immunohistochemical features of 11 examples of this neoplasm, which occurred in women between the ages of 35 and 72 years (mean, 52 years). Most (64%) patients had abnormal vaginal bleeding. Eight tumors were stage IB, and one each was stage IIB and IVB; in one, the stage was unknown. Microscopically, the carcinomas showed various morphologies, most commonly a small tubular pattern or a ductal pattern resembling endometrioid adenocarcinoma; one tumor had an associated malignant spindle cell component. Ten neoplasms were adjacent to hyperplastic mesonephric remnants. Follow-up in 10 cases showed six patients to be alive without evidence of recurrence after a mean of 4.8 years. The patients with stage IIB and IVB disease had local recurrences after 2.2 and 0.7 years and died of progressive disease at 3.2 and 0.8 years, respectively. In a patient with stage IB disease, a mediastinal metastasis and a malignant pleural effusion developed 5.6 years after diagnosis, and the patient died of disease at 6.2 years. Another patient with stage IB disease and a positive vaginal cuff margin that recurred locally after 1.7 years received chemotherapy and was alive and clinically free of disease at 2.5 years. Mesonephric adenocarcinomas were immunoreactive for epithelial markers (AE1/3; CK1, CAM 5.2, cytokeratin 7, and epithelial membrane antigen) (100%), calretinin (88%), vimentin (70%), androgen receptor (33%), and inhibin (30%, focal staining). No immunostaining was detected with cytokeratin 20, estrogen receptor, progesterone receptor, and monoclonal carcinoembryonic antigen. This staining profile is similar to that of mesonephric remnants and may be useful in the distinction of mesonephric carcinoma from mullerian endometrioid adenocarcinoma, with which it may be confused.
Asunto(s)
Mesonefroma/patología , Neoplasias del Cuello Uterino/patología , Adulto , Anciano , Biomarcadores de Tumor/análisis , Carcinoma Endometrioide/diagnóstico , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Técnicas para Inmunoenzimas , Mesonefroma/química , Mesonefroma/mortalidad , Mesonefroma/cirugía , Persona de Mediana Edad , Proteínas de Neoplasias/análisis , Estadificación de Neoplasias , Tasa de Supervivencia , Neoplasias del Cuello Uterino/química , Neoplasias del Cuello Uterino/mortalidad , Neoplasias del Cuello Uterino/cirugíaRESUMEN
Glomus tumors involving the female genital tract are rare. Herein we report the case of a glomus tumor constituting the major component of a mature teratoma of the ovary. This lesion represented an incidental finding in a 43-year-old woman who underwent bilateral salpingo-oophorectomy at the time of detection of locally recurrent squamous carcinoma of the cervix. The glomus tumor was initially interpreted as a metastasis due to its superficial morphologic resemblance to the recurrent carcinoma in the vagina. It was, however, morphologically similar to glomus tumors that classically arise in the extremities. The diagnosis was supported by immunohistochemistry and ultrastructural examination. To our knowledge, no similar tumor has been described in the ovary or in teratomas at any other site.
Asunto(s)
Carcinoma de Células Escamosas/patología , Tumor Glómico/patología , Neoplasias Primarias Múltiples , Neoplasias Ováricas/patología , Teratoma/patología , Neoplasias del Cuello Uterino/patología , Adulto , Carcinoma de Células Escamosas/cirugía , Diagnóstico Diferencial , Femenino , Tumor Glómico/cirugía , Humanos , Histerectomía , Inmunohistoquímica , Escisión del Ganglio Linfático , Microscopía Electrónica , Invasividad Neoplásica , Recurrencia Local de Neoplasia , Neoplasias Ováricas/cirugía , Ovariectomía , Teratoma/cirugía , Neoplasias del Cuello Uterino/cirugía , Neoplasias Vaginales/patología , Neoplasias Vaginales/cirugíaAsunto(s)
Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Luxaciones Articulares/cirugía , Huesos Metatarsianos/lesiones , Articulación Metatarsofalángica/lesiones , Hilos Ortopédicos , Fijación Interna de Fracturas/instrumentación , Fracturas Óseas/complicaciones , Humanos , Luxaciones Articulares/complicaciones , Huesos Metatarsianos/cirugía , Articulación Metatarsofalángica/cirugíaRESUMEN
AIMS: Pleomorphic carcinoma is a poorly described entity whose phenotype is not well recognized as within the morphological spectrum of breast carcinoma. The purpose of this report is to describe the clinicopathological features of this tumour, and to promote its recognition as an unusual high-grade morphological variant of mammary ductal carcinoma. METHODS AND RESULTS: Histological slides of breast carcinomas (N = 64) coded between 1978 and 1995 as having pleomorphic or anaplastic features were reviewed. Pleomorphic carcinoma (N = 26) was diagnosed when > or = 50% of the tumour manifested a pleomorphic cell population (> sixfold variation in nuclear size). Tumours of lobular origin were excluded. All neoplasms occurred in women with a mean age of 53 years. Patients underwent biopsy and/or mastectomy (n = 24) or lumpectomy (n = 2). The tumours' mean size was 54 mm. All were high-grade neoplasms. The pleomorphic cell population comprised 50-100% of the tumour; 31% had a prominent spindled morphology. Fifty-eight per cent of the tumours were initially misclassified by referring pathologists as sarcomas or carcinomas, possibly metastatic. Adjacent DCIS or a transition to classic ductal carcinoma was present in 73%. Five (19%) patients were stage I and three (12%) had stage IV disease. Axillary dissections yielded > or = 3 (mean 7.2) positive lymph nodes in 52%. Most (68%) tumours were aneuploid; a high S-phase (> 10%) was present in 63%. All neoplasms were ER negative and all but one were PR negative. p53 expression was present in 71%; none expressed bcl-2. c-erbB-2 was detected in four (19%) node-positive and in 0 (0%) node-negative cases (P = 0.01). Of 16 patients with follow-up, 6 (38%) were disease-free (mean, 74 months), four (25%) alive with disease (mean, 33 months) and six (38%) dead of disease at a mean of 22 months. CONCLUSIONS: Pleomorphic carcinoma is a prognostically unfavourable lesion and represents the extreme end of the morphological spectrum of grade III infiltrating ductal carcinoma.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/patología , Adulto , Anciano , Anciano de 80 o más Años , Aneuploidia , Biomarcadores , Neoplasias de la Mama/genética , Neoplasias de la Mama/metabolismo , Carcinoma Ductal de Mama/genética , Carcinoma Ductal de Mama/metabolismo , Diagnóstico Diferencial , Femenino , Citometría de Flujo , Humanos , Inmunohistoquímica , Queratinas/análisis , Antígeno Ki-67/análisis , Metástasis Linfática , Persona de Mediana Edad , Mucina-1/análisis , Estadificación de Neoplasias , Fenotipo , Receptor ErbB-2/análisis , Receptores de Progesterona/análisis , Proteínas S100/análisis , Proteína p53 Supresora de Tumor/análisis , Vimentina/análisisRESUMEN
Two cases of extraosseous Ewing's sarcoma/peripheral neuroectodermal tumor arising in unusual, superficial sites are reported. One tumor involved the vaginal wall of a 35-year-old woman, and the other neoplasm arose in the dermis of the vulva in a 28-year-old woman. The tumors showed characteristic microscopic features of Ewing's sarcoma/peripheral neuroectodermal tumor with nodular monotonous proliferations of undifferentiated, small, round, hyperchromatic cells with a low mitotic index. Rare rosette-like formations were apparent only in the vulvar neoplasm. The tumors displayed intense immunoreactivity in a membranous pattern for CD99, the cell surface glycoprotein encoded by the MIC2 gene. Genetically, the tumors expressed the EWS/FLI-1 chimeric transcript, derived from the t(11;22)(q24;q12) chromosomal translocation. Both patients had localized disease treated with wide local excision; one received postoperative chemotherapy, and the other received chemotherapy and radiotherapy. To date, 18 and 19 months after diagnosis, neither patient has had clinical evidence of local recurrence or metastasis. To our knowledge, these are the first reported cases of vaginal and vulvar Ewing's sarcoma/peripheral neuroectodermal tumor, confirmed with molecular genetic analysis, in the English literature.
Asunto(s)
Antígenos CD/análisis , Moléculas de Adhesión Celular/análisis , Tumores Neuroectodérmicos/diagnóstico , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Sarcoma de Ewing/diagnóstico , Neoplasias Vaginales/diagnóstico , Neoplasias de la Vulva/diagnóstico , Antígeno 12E7 , Adulto , Antineoplásicos/uso terapéutico , Cromosomas Humanos Par 11 , Cromosomas Humanos Par 22 , Femenino , Humanos , Inmunohistoquímica , Tumores Neuroectodérmicos/genética , Tumores Neuroectodérmicos/terapia , Radioterapia , Sarcoma de Ewing/genética , Sarcoma de Ewing/terapia , Procedimientos Quirúrgicos Operativos , Translocación Genética , Neoplasias Vaginales/genética , Neoplasias Vaginales/terapia , Neoplasias de la Vulva/genética , Neoplasias de la Vulva/terapiaRESUMEN
Originating from post-meiotic germ cells, mature ovarian teratomas (MOT) are genetically homozygous tumors within heterozygous hosts. MOT may be associated with malignant tumors of a non-germ cell phenotype (so-called malignant transformation). Based on the presence of in situ changes, some cases have been hypothesized to arise from teratomatous tissue. However, other malignancies associated with mature teratomas, such as sarcomas, may originate from either teratomatous elements or preexisting somatic ovarian tissue. Eight cases of MOT containing various histologic types of malignancy, including four squamous cell carcinomas, two sarcomas, one thyroid carcinoma, and one carcinoid tumor, were selected for study. Using selective tissue microdissection and PCR-based analysis of the extracted DNA, we compared the genotypic pattern of the mature teratomatous components to the associated malignant neoplasm with a random panel of highly informative genetic markers for different chromosomes. In all eight cases, genetic analysis of the malignant component revealed a homozygous genotype. In seven cases, the genetic profiles of mature teratomas and the associated malignant tumors were identical, suggesting a direct pathogenetic relationship between these lesions. In one case, the malignant component revealed homozygosity of different alleles compared with mature teratoma, suggesting independent teratomatous growth processes. This finding indicates that some ovarian malignancies of the non-germ cell phenotype arise in teratoma and fall into the spectrum of germ cell tumors.
Asunto(s)
Neoplasias Ováricas/genética , Teratoma/genética , ADN de Neoplasias/genética , Femenino , Genotipo , Humanos , Neoplasias Ováricas/patología , Fenotipo , Teratoma/patologíaRESUMEN
Extrarenal malignant rhabdoid tumors have been reported in a variety of anatomic sites but infrequently in the female genital tract. In the uterus, they have been described as a pure tumor, in association with endometrial stromal sarcomas, and as a component of a malignant mullerian mixed tumor. This study reports an unusual uterine neoplasm in a 49-year-old woman, in which a malignant rhabdoid tumor occurred as a collision tumor with a well-differentiated endometrioid adenocarcinoma. The tumor was a 14-cm polypoid mass that filled the endometrial cavity. The two neoplastic components were distinct on microscopic and immunohistochemical examination. Ultrastructural examination confirmed the rhabdoid phenotype of the sarcomatous component. The patient died of disease 4 months after diagnosis with progression of the malignant rhabdoid tumor. The highly aggressive behavior of the rhabdoid (i.e., nonepithelial) component in this collision tumor lends support for a distinction of this neoplasm from a malignant mullerian mixed tumor, with which it may be confused.
Asunto(s)
Carcinoma Endometrioide/patología , Neoplasias Primarias Múltiples/patología , Tumor Rabdoide/patología , Neoplasias Uterinas/patología , Biomarcadores de Tumor/biosíntesis , Carcinoma Endometrioide/metabolismo , Carcinoma Endometrioide/ultraestructura , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Tumor Mulleriano Mixto/patología , Neoplasias Primarias Múltiples/metabolismo , Neoplasias Primarias Múltiples/ultraestructura , Tumor Rabdoide/metabolismo , Tumor Rabdoide/ultraestructura , Neoplasias Uterinas/metabolismo , Neoplasias Uterinas/ultraestructuraRESUMEN
Osteosarcomatous differentiation in phyllodes tumors is uncommon. The clinicopathologic features of 22 such cases in our files were retrospectively reviewed to evaluate the prognostic significance of this rare neoplasm. All patients were women between 40 and 83 years of age (mean, 60 years). Most (73%) presented with a palpable mass. None had prior irradiation to the breast or chest region. Patients were treated with excisional biopsy (N = 4), partial mastectomy (N = 1), or mastectomy (N = 17). All axillary nodes, dissected in 11 patients, were free of tumor. Two patients had extramammary spread at diagnosis. The neoplasms measured 1.9-15 cm (mean, 6.4 cm); 54% were grossly circumscribed or multilobulated. The osteosarcomatous component was classified as fibroblastic (N = 11), osteoclastic (N = 6), or osteoblastic (N = 5) and occupied a variable percentage of the phyllodes' stroma ranging from -25% to essentially 100% of the neoplasm. Of 21 patients with available follow-up, 11 (52%) were alive at a median follow-up of 44 months. Nine patients (43%) developed locally recurrent (N = 1) or metastatic (N = 8) disease. Metastases were clinically apparent within 1 year of diagnosis in all eight patients; seven died within 12 months of detection of initial metastasis. By univariate analysis, gross tumor size and osteosarcoma subtype significantly correlated with prognosis. In a multivariate analysis, neither of these factors were independent prognosticators. Phyllodes tumors with an osteosarcomatous component are potentially aggressive neoplasms, particularly when large (>5 cm) or associated with an osteoclastic or osteoblastic osteosarcoma. Complete excision without axillary dissection is advised.
Asunto(s)
Neoplasias de la Mama/patología , Tumor Mixto Maligno/patología , Neoplasias Primarias Secundarias/patología , Osteosarcoma/patología , Tumor Filoide/patología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Tumor Mixto Maligno/mortalidad , Neoplasias Primarias Secundarias/mortalidad , Osteosarcoma/mortalidad , Tumor Filoide/mortalidad , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Wolffian adnexal tumor (WAT) is a rare neoplasm believed to originate from wolffian remnants on the basis of its location in areas where these remnants are abundant. To study its histogenesis, the immunoprofile of 25 WATs was compared with that of 10 cervical and vaginal mesonephric remnants and 12 rete ovarii. WATs were unilaterally located in the broad ligament (n = 10), mesosalpinx (n = 9), ovarian hilus (n = 5), and pelvis, not otherwise specified (n = 1). They showed varying morphologies with solid (spindle cells), tubular (lined by columnar cells), retiform and multicystic (spaces lined by cuboidal and attenuated cells) patterns. WATs were immunoreactive for pan-cytokeratin (AE1/3, CK1) (100%), CAM 5.2 (100%), cytokeratin 7 (CK7) (88%, focal staining), keratin 903 (17%), epithelial membrane antigen (EMA) (12%), estrogen receptor (28%), progesterone receptor (24%), androgen receptor (78%), inhibin (68%), calretinin (91%), and vimentin (100%). No immunostaining was detected with monoclonal carcinoembryonic antigen and cytokeratin 20. The pattern of staining was nearly identical to that of the rete ovarii and differed somewhat from mesonephric remnants, which were diffusely immunoreactive for CK7, immunopositive for EMA (apical staining), and nonreactive for inhibin. Our findings provide immunohistochemical support for the derivation of WATs from wolffian remnants, in particular from the rete ovarii. Because of immunoreactivity for inhibin and calretinin in a significant number of WATs, our results further show that these immunostains alone do not allow absolute distinction of WATs from sex cord-stromal tumors and adenomatoid tumors, respectively, with which they may be confused.
Asunto(s)
Enfermedades de los Anexos/patología , Conductos Mesonéfricos/patología , Enfermedades de los Anexos/metabolismo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/metabolismo , Femenino , Humanos , Inmunohistoquímica , Inhibinas/metabolismo , Queratina-7 , Queratinas/metabolismo , Persona de Mediana Edad , Conductos Mesonéfricos/metabolismoRESUMEN
Endometrial oncocytic carcinoma is an unusual neoplasm, with few cases reported. Endometrial curettage specimens coded as prominent oxyphilic metaplasia (N = 5) and oxyphilic or oncocytic carcinoma (N = 4) were reviewed, and hysterectomy slides from the four carcinomas were also examined. Immunohistochemical and ultrastructural analyses were performed in three of five metaplasias and in all four carcinomas. Most patients (89%) with oncocytic metaplasia and carcinoma had vaginal bleeding. Oncocytic metaplasia was characterized by a single layer of cells with abundant eosinophilic, granular cytoplasm, minimal pleomorphism, and rare mitotic activity. Carcinoma was diagnosed on the basis of an altered stroma (n = 2) and/or a confluent growth pattern (n = 4) and had a papillary (n = 4), glandular (n = 2), or solid (n = 1) morphology. Carcinomas showed a similar population of oncocytic cells as metaplasias, but with occasional nuclear stratification and greater pleomorphism and mitotic activity. Tumors were International Federation of Gynecology and Obstetrics (FIGO) grade 1 (n = 2) or 2 (n = 2) and FIGO stage Ib, Ic, IIb, and IIIc. Omental metastases developed in the patient with the stage III tumor at 13 months; the two patients with stage I tumors were alive with no evidence of disease at a mean of 29 months. All carcinomas expressed p53 and 75% and 100% were estrogen receptor (ER)- and progesterone receptor (PR)-negative, respectively, whereas all metaplasias were p53 negative- and ER- and PR-positive. Ki-67 labeling index was 1 to 3% in metaplasias and 14 to 33% in carcinomas. Oncocytic metaplasias and carcinomas contained abundant mitochondria and free ribosomes, accounting for the oncocytic appearance. Because oncocytic carcinomas frequently show deep myometrial invasion and require surgical staging, it is important to distinguish oncocytic metaplasia from carcinoma on biopsy material. Ki-67, p53, and ER and PR immunostains may assist in this potentially difficult differential.
Asunto(s)
Adenocarcinoma/patología , Neoplasias Endometriales/patología , Adenocarcinoma/química , Adenocarcinoma/ultraestructura , Adulto , Anciano , Neoplasias Endometriales/química , Neoplasias Endometriales/ultraestructura , Femenino , Humanos , Inmunohistoquímica , Metaplasia , Microscopía Electrónica , Persona de Mediana Edad , Receptores de Estrógenos/análisis , Receptores de Progesterona/análisisRESUMEN
Extraskeletal osteosarcomas are rare. Few primary mammary osteosarcomas have been reported; many of these have been described in association with a biphasic tumor. Fifty pure osteosarcomas of the breast, diagnosed between 1957 and 1995, were reviewed after excluding those of biphasic origin. The absence of epithelial differentiation was confirmed using a panel of immunohistochemical markers in 32 cases and using ultrastructural evaluation in an additional four cases. Tumors occurred in 49 women and one man; age ranged from 27 to 89 years (median, 64.5 years). One patient received radiotherapy for ipsilateral breast carcinoma 9 years before presentation. Patients were treated by excisional biopsy (n = 13), tylectomy (n = 5) or mastectomy (n = 32). All axillary nodes, dissected in 20 patients, were free of tumor. One patient had extramammary spread at diagnosis. The neoplasms were 1.4 cm to 13.0 cm (mean, 4.6 cm), and 60% were grossly circumscribed. Tumors were classified as fibroblastic (n = 28), osteoclastic (n = 14), or osteoblastic (n = 8). Of 39 patients with available follow-up information, locally recurrent (n = 11) and metastatic (n = 15) disease developed in 23 (59%) at a mean of 10.5 and 14.5 months from diagnosis. Eight (73%) patients in whom local recurrence developed were treated with excisional biopsy or tylectomy; of these, seven had a positive margin. Sixteen (41%) patients died of disease at a mean of 17.1 months, within 20 months of onset of metastases, most commonly to the lung. Mammary osteosarcomas are aggressive tumors with a propensity for blood-borne rather than lymphatic spread. Total excision without axillary dissection is advised.
Asunto(s)
Neoplasias de la Mama Masculina/patología , Neoplasias de la Mama/patología , Osteosarcoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/cirugía , Neoplasias de la Mama Masculina/metabolismo , Neoplasias de la Mama Masculina/cirugía , Femenino , Humanos , Inmunohistoquímica , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Osteosarcoma/metabolismo , Osteosarcoma/cirugía , Reoperación , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
BACKGROUND: The natural history of patients with intraductal carcinoma (DCIS) and microinvasion is poorly defined, and the clinical management of these patients, with particular reference to management of the axilla, has been controversial. Previous studies of this lesion have used varied and/or arbitrary criteria for the evaluation of microinvasion. METHODS: Thirty-eight DCIS lesions with microinvasion (n=29) or probable microinvasion (n=9), diagnosed during the period 1980-1996, were retrospectively analyzed after cases not treated with mastectomy and axillary lymph node dissection were excluded. Microinvasion was defined as a single focus of invasive carcinoma < or = 2 mm or up to 3 foci of invasion, each < or =1 mm in greatest dimension. RESULTS: The patients were all females with a mean age of 56.4 years. DCIS was of comedo (n=31) or papillary (n=7) subtype. Microinvasion was often associated with an altered, desmoplastic stroma (55%) or a lymphocytic infiltrate (39%). The foci of microinvasion ranged from 0.25 to 1.75 mm (mean, 0.6 mm), with an aggregate mean size of 1.1 mm (range, 0.25-2.25 mm). Foci of microinvasion, ranging from 1 to 3 (mean, 1.7), were adjacent to DCIS in 95.3% of cases. The extent of DCIS did not correlate with the number of foci of microinvasion. Axillary lymph node dissections yielded a mean of 19.3 lymph nodes (range, 7-38), and all lymph nodes were negative for metastasis. None of 33 patients, followed for a mean of 7.5 years (range, 1.0-14.4 years), developed local recurrence or metastasis. CONCLUSIONS: The cases of microinvasive carcinoma examined in this study, as defined above, were not associated with axillary lymph node metastases and appeared to be associated with an excellent prognosis. Further study is indicated to determine the appropriate management and long term prognosis of patients with this lesion.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma in Situ/patología , Carcinoma Ductal de Mama/patología , Ganglios Linfáticos/patología , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Invasividad Neoplásica , Pronóstico , Estudios RetrospectivosRESUMEN
The detection of foam cells in cervicovaginal smears obtained from postmenopausal women suggests the possibility of an endometrial lesion. Ultrastructural studies have suggested that foam cells represent endometrial stromal cells but the histogenesis of these cells has not been firmly established. To investigate the origin and diagnostic significance of foam cells, we analyzed the morphology and immunophenotype of these cells in endometrial tissue specimens and correlated the findings with cervical smears obtained within the preceding 6 months. Selected biopsies containing foam cells were evaluated using four well-characterized macrophage markers: KP-1(CD68), HAM 56, MAC 387, and lysozyme. Foam cells were found in 11 (38%) of 29 simple hyperplasias, 7 (50%) of 14 complex hyperplasias, 6 (50%) of 12 complex atypical hyperplasias, 21 (70%) of 30 adenocarcinomas, 1 (4%) of 25 samples with stromal breakdown, and 0 of 30 specimens showing normal cycling endometrium. Foam cells were also found in smears preceding the histologic diagnosis of 2 (13%) simple hyperplasias, 2 (25%) complex hyperplasias, 3 (43%) complex atypical hyperplasias, 5 (28%) adenocarcinomas, 5 (28%) cases of stromal breakdown, and 0 of 8 normal tissue specimens examined. Foam cells were immunoreactive with at least 2 of the 3 macrophage-specific antibodies in all 21 biopsies studied. Our results suggest that foam cells phenotypically represent macrophages and not endometrial stromal cells. Foam cells are identified in a significant percentage of cervical smears and endometrial tissue specimens obtained from women with endometrial pathology. The morphology and immunophenotype of foam cells, however, does not appear to be useful in distinguishing benign endometrial stromal breakdown, endometrial hyperplasia, and endometrial adenocarcinoma.
Asunto(s)
Adenocarcinoma/patología , Anticuerpos Monoclonales , Neoplasias Endometriales/patología , Endometrio/patología , Células Espumosas/inmunología , Células Espumosas/patología , Inmunofenotipificación , Adenocarcinoma/inmunología , Anticuerpos , Antígenos CD/análisis , Antígenos CD/inmunología , Antígenos de Diferenciación Mielomonocítica/análisis , Antígenos de Diferenciación Mielomonocítica/inmunología , Biopsia , Neoplasias Endometriales/inmunología , Endometrio/inmunología , Femenino , Humanos , Hiperplasia , Macrófagos/inmunología , Células del Estroma/inmunología , Células del Estroma/patología , Frotis VaginalAsunto(s)
Confidencialidad/legislación & jurisprudencia , Gobierno Federal , Privacidad/legislación & jurisprudencia , Derechos Civiles/legislación & jurisprudencia , Revelación/legislación & jurisprudencia , Humanos , Jurisprudencia , Registros Médicos/legislación & jurisprudencia , Relaciones Médico-Paciente , Gobierno Estatal , Decisiones de la Corte Suprema , Estados UnidosRESUMEN
Alteration of the retinoblastoma (RB) gene, located on chromosome 13q14, has been implicated in the pathogenesis and biological behavior of several human cancers. We investigated the RB gene status by Western blotting and immunohistochemical analysis, as well as loss of heterozygosity (LOH) at the RB locus in 21 primary human renal neoplasms (including 3 oncocytomas). In only 1 of 21 tumors was there a discrepancy between Western blot and immunochemical staining. Overall, LOH was noted in 6 of 12 informative cases. However, only one of the tumors with LOH at the RB locus had loss of RB protein expression by both Western blot and immunohistochemical analysis. Loss of RB function was found in 4 of 18 carcinomas and in none of 3 oncocytomas as determined by absent RB nuclear staining in tumor cells. LOH at chromosome 13q14 was more noted in high-grade, DNA aneuploid, high-stage tumors and in patients with poor outcome. These results imply that (1) there is likely another tumor-suppressor gene on chromosome 13 involved in renal carcinogenesis, (2) LOH at chromosome 13q loci may be associated with aggressive behavior, and (3) the loss of RB function may have a role in a subset of renal carcinomas.
Asunto(s)
Deleción Cromosómica , Cromosomas Humanos Par 13 , Genes de Retinoblastoma , Corteza Renal , Neoplasias Renales/genética , Adulto , Anciano , Western Blotting , Femenino , Heterocigoto , Humanos , Inmunohistoquímica , Neoplasias Renales/metabolismo , Masculino , Persona de Mediana Edad , Proteína de Retinoblastoma/genética , Proteína de Retinoblastoma/metabolismoRESUMEN
There continues to be confusion as to whether papillary adenocarcinoma (PA) of the lung is a specific histologic entity or simply a variant of bronchioloalveolar carcinoma (BAC). We reviewed our files from 1981 through 1993 for all cases (n = 155) of resected primary lung adenocarcinoma specifically diagnosed as having papillary or bronchioloalveolar features. In addition, a random 10% (n = 67) of all remaining lung adenocarcinomas were reviewed. True PA was diagnosed when > or = 75% of the neoplasm contained papillary structures supported by fibrovascular cores with complicated secondary and tertiary branches. Marked nuclear atypia was present in 100%, and psammoma bodies were seen in 42% of cases. In contrast to BAC, true PA filled and distorted or replaced air spaces in the lung. Thirty-one cases of true PA were found, including 19 men and 12 women (mean age, 64.5 years). The lesions were solitary (n = 27) or multifocal (n = 4) with a mean diameter of 4.1 cm. Forty-five percent of patients had bronchopulmonary lymph node involvement at diagnosis; another 10% had extensive intrapulmonary lymphatic permeation by tumor. Disease-free survival for stage I and II PA was 40% (n = 15) and 25% (n = 8), respectively, at a mean of 3.4 and 3.5 years. Papillary adenocarcinoma of the lung is a distinct clinicopathologic entity with considerably worse morbidity and mortality than BAC.
Asunto(s)
Carcinoma Papilar/patología , Neoplasias Pulmonares/patología , Adenocarcinoma Papilar/patología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Although chromosome 3p regions are the most frequent site for genetic alterations in small-cell lung carcinoma (SCLC) and non-small-cell lung carcinoma (NSCLC), the extent of such abnormality in carcinoid tumors remained to be investigated. Moreover, the histogenetic and biological implications of these findings in non-carcinoid lung tumors remain unclear. We studied eight microsatellite loci on chromosome 3p regions by multiplex polymerase chain reaction in paired normal and tumor DNA from 17 carcinoid tumors, 5 SCLCs, and 38 NSCLCs to determine the histogenetic and the clinical significance of their alterations in these neoplasms. Our results revealed a lack of microsatellite abnormalities at all loci tested in both typical and atypical carcinoid tumors. SCLCs and NSCLCs showed loss of heterozygosity in 100% (5/5) and 58.0% (22/38), respectively. Loss of heterozygosity at more than two loci correlated significantly with poor histological differentiation and were preponderantly found in high proliferative index and DNA aneuploid NSCLCs. Microsatellite instability was noted in only one (1.7%) of the lesions. Our study suggests that 1) the difference in chromosome 3p alterations between carcinoid tumors and SCLCs favors a stochastic rather than linear evolution of these tumors, 2) 3p alterations may constitute an initial event in the development of small cell carcinomas, and 3) loss of heterozygosity at 3p loci is associated with aggressive tumor characteristics in non-small-cell carcinomas.
Asunto(s)
Tumor Carcinoide/genética , Carcinoma de Pulmón de Células no Pequeñas/genética , Carcinoma de Células Pequeñas/genética , Cromosomas Humanos Par 3/genética , Neoplasias Pulmonares/genética , Repeticiones de Microsatélite/genética , Adulto , Anciano , Anciano de 80 o más Años , Alelos , Tumor Carcinoide/patología , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Células Pequeñas/patología , ADN de Neoplasias/aislamiento & purificación , Femenino , Heterocigoto , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Cysticercosis is the most common parasitic infection of the central nervous system in the United States. CASE: A case of cerebral cysticercosis radiographically and pathologically mimicked a high grade glioma. A symptomatic solitary cerebral hemispheric lesion in a child, unknown at the time to have been born in Korea and adopted by U.S. residents, was initially evaluated by stereotactically guided needle biopsy and diagnosed as having malignant glioma in accord with the radiographic impression. The subsequently excised mass revealed cysticercus with an exuberant granulomatous inflammation and gliosis surrounding a fibrous-walled cyst. CONCLUSION: In the setting of a solitary parenchymal cyst, the radiographic differential diagnosis of neurocysticercosis often includes a primary neoplasm. However, to our knowledge, this is the first report of cysticercosis's also simulating a brain neoplasm pathologically.
Asunto(s)
Encefalopatías/patología , Cisticercosis/patología , Glioma/patología , Biopsia con Aguja , Encefalopatías/diagnóstico por imagen , Encefalopatías/cirugía , Niño , Cisticercosis/diagnóstico por imagen , Cisticercosis/cirugía , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Radiografía , Tomógrafos Computarizados por Rayos XRESUMEN
This report describes the diagnosis of progressive multifocal leukoencephalopathy (PML) in nine patients using cytopathologic and histopathologic examination of computed tomographically guided stereotactic brain biopsies in combination with immunostaining for SV-40-related antigen and the polymerase chain reaction (PCR) for the JC virus. In four patients the diagnosis of PML was based on the microscopic appearance of the biopsies and immunostaining for SV-40-related antigen. In one of these patients the diagnosis was also supported by PCR for the JC virus. In two patients whose biopsies were only suggestive of PML, a definitive diagnosis was possible utilizing immunohistochemistry and PCR. In another case the histopathologic features were atypical of PML, and the diagnosis was established with immunostaining and PCR. The diagnosis of PML was established by PCR alone in two patients whose biopsies showed only suggestive or nonspecific findings. We conclude that the accuracy of stereotactic biopsy in the diagnosis of PML is enhanced by using a combination of light microscopy, immunohistochemistry and PCR.