Apocrine metaplasia: a new type of müllerian metaplasia.

Apocrine differentiation was an incidental finding in an ovarian cyst. This is considered to be a further example of Müllerian metaplasia that has not been described before and which, theoretically, could occur in any organ of Müllerian derivation (ovary, uterus, cervix or fallopian tube). It is suggested that sites of such metaplasia could in turn be the origin of primary apocrine carcinoma in any of the above locations.     

The hormonal receptor status of uterine carcinosarcomas (mixed müllerian tumours): an immunohistochemical study.

AIM: To investigate the role of oestrogen and progesterone receptor status in uterine carcinosarcomas (mixed Müllerian tumours) to see whether the receptors were identifiable, and if so whether they were of significance clinically. METHODS: 11 cases of uterine carcinosarcoma were identified from clinical and pathology records. An immunohistochemical method was used to demonstrate oestrogen and progesterone hormone receptors on paraffin embedded material, with suitable tissue controls, staining being recorded. RESULTS: 10 of 11 cases showed staining for one or both hormone receptors in normal tissue adjacent to tumour. In four carcinosarcoma cases, staining for one or both receptors was shown within the epithelial component (appearing to correlate with the degree of epithelial differentiation); two of these cases had staining within sarcomatous areas. Two of the three patients still alive had epithelial hormone receptor positivity. CONCLUSIONS: Receptors for oestrogen and progesterone were found in four of 11 cases of uterine carcinosarcoma, using paraffin embedded material. There may be an association between hormone receptor positivity and clinical outcome.     

Alpha-fetoprotein production by a hepatoid adenocarcinoma of the uterus.

A case of a 62 year old Japanese woman with an endometrial adenocarcinoma producing alpha-fetoprotein (AFP) is described. Microscopically, the tumour was composed of a major medullary portion and a minor tubular adenocarcinoma which had invaded the myometrium, the myometrial lymphatics and blood vessels. Neoplastic cells in the medullary portion were polygonal with glycogen-rich cytoplasm. Vascular permeation by neoplastic cells was prominent. Extensive hepatoma-like features were observed. The tumour cells lacked features suggestive of a diagnosis of embryonal carcinoma or endodermal sinus tumour. The production of AFP by the tumour cells was demonstrated immunohistochemically using the PAP technique. Only two cases of AFP producing endometrial adenocarcinomas have been reported previously.     

Benign and low grade variants of mixed Müllerian tumour of the uterus

The clinico-pathological features of 11 examples of a rare group of uterine neoplasms composed of both epithelial and stromal components are reported. The patients complained of abnormal vaginal bleeding or discharge. Two of the tumours arose in the cervix, seven in the endometrium and two from both, forming large polypoid masses projecting from the cervix and/or filling the uterine cavity. Microscopically, the epithelial elements ranged from benign to adenocarcinoma. A similar range of stromal elements was also seen, varying from entirely bland to low grade to high grade sarcoma. The variable histology of the tumours is reflected in their biologic behaviour. Of the three tumours with the highest histological grade of malignancy, one recurred and killed the patient. One tumour, in which both components were regarded histologically as benign, recurred twice before hysterectomy. Our findings lend support to the concept that these tumours are variants of mixed Müllerian tumour. We advocate the acceptance of the latter term so that all grades of this tumour can be accommodated under one designation.     

Malignant mixed Müllerian tumour of the fallopian tube

We report two cases of primary heterologous malignant mixed Müllerian tumour of the Fallopian tube. One of these was bilateral, a finding which, as far as we know, has not been reported before.     

Spontaneous malignant mixed müllerian tumors and rhabdomyosarcoma of the uterus in rats

Five malignant mixed müllerian tumors and one rhabdomyosarcoma were observed in LEWIS rats. Heterologous müllerian neoplasms (cases 1-4) consisted of epithelial and mesenchymal elements including squamous epithelium, glandular epithelium and sarcomatous, rhabdomyosarcomatous, cartilaginous as well as osseous parts. All the heterologous tumors revealed undifferentiated areas with an anaplastic appearance. The homologous müllerian tumor (case 5) was composed of glandular epithelium embedded in sarcomatous tissue. The rhabdomyosarcoma (case 6) consisted of bundles of elongated strap-like cells mixed with cells resembling rhabdomyoblasts.     

A mixed mesodermal tumour in the uterus of a cat.

This paper describes a carcinosarcoma found in the uterus of a cat; comparison of this tumour with mixed mesodermal tumours as seen in woman is made and the pathogenesis is discussed.     

Testicular dysgenesis does not affect expression of anti-müllerian hormone by Sertoli cells in premeiotic seminiferous tubules.

Anti-Müllerian hormone (AMH) immunoreactivity was studied on paraffin sections obtained from archival testicular biopsies of 29 children with intersex disorders and of 22 controls. Strong AMH immunoreactivity was observed in Sertoli cell cytoplasm from 8 fetal weeks until puberty. During pubertal maturation, in both normal and intersex patients, AMH expression was present in premeiotic seminiferous tubules, but was no longer detected in neighboring tubules with meiotic development. AMH immunostaining was abolished in the testis of one patient with persistent Müllerian ducts due to a mutation of the AMH gene, but was conserved in the testes of two patients with mutations of the AMH receptor gene. Testicular dysgenesis usually results in sexual ambiguity, with low testosterone and AMH serum levels and persistence of Müllerian derivatives. AMH immunoreactivity was conserved in premeiotic seminiferous tubules of dysgenetic testes, and also in sex-cord cells of a gonadoblastoma. In patients with asymmetric gonadal differentiation, the streak gonad was AMH-negative. In conclusion, secretion of AMH is a constitutive feature of the immature Sertoli cell and its expression is altered only by mutations of the AMH gene, but not by gonadal dysgenesis. The degree of regression of Müllerian ducts and serum AMH levels reflect the number, not the functional value, of Sertoli cells present in the immature testis.     

Morphologic prognostic factors of malignant mixed müllerian tumor of the uterus: a clinicopathologic study of 58 cases

Sixty-one patients with malignant mixed müllerian tumor (MMMT) of the uterus were seen at L'H?tel-Dieu de Québec between 1950 and 1986, and the histopathologic material was available for review in 58 cases. Of the morphologic parameters studied, the histologic grade of both epithelial and mesenchymal components correlated with the initial stage. Patients with stages I and II disease had a significantly better survival rate than those with stages III and IV (P less than 0.006). Twenty-five patients with a minimum follow-up of two years were initially stage I or II. All six patients of this subgroup with an epithelial component of serous carcinoma type were dead of their disease at 2 yr. Although not statistically significant, tumor necrosis, the mode of tumor invasive (pushing and infiltrative), and the ratio of epithelial to mesenchymal components tended to influence the outcome. The mitotic rate, the type of mesenchymal components, and vascular and myometrial invasion were of no prognostic significance. We conclude that the outcome of patients with uterine MMMT is mainly influenced by the initial stage and the type of epithelial component. The influence of tumor necrosis, the ratio of epithelial to mesenchymal component, and the mode of tumor invasion deserve further studies.     

Eight cases of malignant mixed müllerian tumor (carcinosarcoma) of the uterus: Findings in surepath™ cervical cytology

Malignant mixed Müllerian tumor (MMMT)/carcinosarcoma is a rare neoplasm of the female genital tract characterized by a mixture of epithelial and mesenchymal components. There are published reports of conventional cervical smear findings in uterine MMMT, but to the best of our knowledge the cytomorphology of MMMT in SurePath? liquid‐based cytology samples has not been described. We present a series of eight cases of uterine MMMT in SurePath? cervical samples. The mean age of the women was 65.5 years (range, 60–82 years) and the most common presenting symptom was postmenopausal bleeding. Three out of the eight cases had both epithelial and sarcomatous elements in highly cellular cervical samples. In two cases, abnormal glandular cell clusters were closely associated with the mesenchymal component. The glandular component was usually represented by three‐dimensional clusters of malignant glandular cells and a dispersed population of large, round to oval malignant epithelial cells with single prominent nucleoli. Necrosis or tumor diathesis was not seen in any cases. Six out of the eight cases were initially reported as adenocarcinoma, endometrial type, and two cases as normal. Five cases had an atrophic background and tiny atypical glandular clusters that could easily be overlooked. Although cervical sample is not the method of choice for primary uterine carcinosarcoma screening, the possibility of the same should be kept in mind, when reporting a cervical sample from a woman with postmenopausal vaginal bleeding. Diagn. Cytopathol. 2014;42:165–169. © 2012 Wiley Periodicals, Inc.     

Evaluation of seroprevalence and clinical and laboratory findings of patients admitted to health institutions in Gümüşhane with suspicion of Crimean-Congo hemorrhagic fever

Background/aimTo determine the seroprevalence and evaluate clinical findings and laboratory results of patients prediagnosed with Crimean-Congo hemorrhagic fever (CCHF) in Gümüşhane.Materials and methodsIncluded in the cross-sectional study were 362 patients (162 female, 200 male) between 0 and 94 years of age, who were followed up after receiving a preliminary diagnosis of CCHF between January 2011 and December 2019. Anamnesis, age, sex, clinical findings, laboratory results, epidemiological and clinical evaluations, severity criteria, risk factor reviews, and a comparison of the suspected negative cases with positive cases were analyzed retrospectively. Patients included in the study were evaluated as RNA-positive by polymerase chain reaction (PCR) or IgM-positive by ELISA.ResultsOf the 362 patients admitted to health institutions with a preliminary diagnosis of CCHF, 242 were diagnosed as CCHF-positive (66.9%). Moreover, 196 of those CCHF-positive patients (81%) were admitted to health institutions during the summer months. Statistical analyses revealed a significant relationship between the incidence of CCHF and patients who had been in contact with animals, lived in rural areas, and had engaged in farming and animal husbandry. In addition, fever, headache, diffuse bodily pain, nausea and vomiting, diarrhea, fever of 38 °C or higher, tachycardia, elevated ALT/AST, creatine kinase (CK), and lactate dehydrogenase (LDH) levels, leukopenia, and thrombocytopenia were detected in the CCHF-positive patients. Significant relations were found between this disease and these symptoms. However, there was no significant relationship between the statistical evaluation of the disease and bloody diarrhea, bodily bruises, rash, unconsciousness, gingival bleeding, hypotension, epistaxis, petechiae, splenomegaly, ecchymosis, hematuria, maculopapular rash, gastrointestinal system complaints, anemia, or elevation of the international normalized ratio and activated partial thromboplastin time duration, separately. ConclusionOf the 362 patients, 66.9% (242) of those who received a preliminary diagnosis of CCHF were indeed CCHF-positive in Gümüşhane. It was concluded that CCHF remains an important endemic disease in Gümüşhane. In addition, elevated ALT/AST, CK, and LDH levels, leukopenia, and thrombocytopenia in patients presenting with headache, fever, fever of 38 °C or higher, generalized body pain, nausea/vomiting, diarrhea, and tachycardia will play a pivotal role in the preliminary diagnosis of CCHF.     

Extragenital malignant mixed Müllerian tumor. Case report and review of the literature

The second case of extragenital malignant mixed Müllerian tumor, heterologous type, occurring in the posterior peritoneum, and confirmed at autopsy, is presented. The histogenesis of this tumor is discussed.     

Primary malignant mixed mesenchymal tumour of the heart in a dog

A case of primary malignant mixed mesenchymal tumour of the heart in an 8-year-old golden retriever is described. The cardiac tumour, measuring 2.5 x 3 x 5 cm, was located in the posterior part of the atrial septum, extending into the surrounding region. Histologically, the tumour was composed of multiple mesenchymal elements of fibrosarcoma, rhabdomyosarcoma, liposarcoma and chondrosarcoma. No previous reports of such a tumour occurring in the heart of the dog were found in the literature.