Binding of anti-EMA, AGF 4:48 and the lectin UEA-1 to human ovarian carcinomas: histological and clinical correlations

The staining reactions of the monoclonal antibodies anti-EMA, AGF 4:48 and the lectin UEA-1 from Ulex europaeus were investigated in formalin-fixed, paraffin-embedded sections of 36 primary ovarian carcinomas. The staining patterns were graded and related to tumour type, differentiation, FIGO stage and patient survival. Both antibodies and UEA-1 showed variations in their staining between and within tumours. The staining of mucinous tumours using anti-EMA was significantly less than in non-mucinous tumours. No other significant associations were found between staining grade and the different variables under study. The variations in staining were not demonstrated to have any prognostic significance.     

Binding of anti-EMA, AGF 4:48 and the lectin UEA-1 to human ovarian carcinomas: histological and clinical correlations

Summary. The staining reactions of the monoclonal antibodies anti-EMA, AGF 4:48 and the lectin UEA-1 from Ulex europaeus were investigated in formalin-fixed, paraffin-embedded sections of 36 primary ovarian carcinomas. The staining patterns were graded and related to tumour type, differentiation, FIGO stage and patient survival. Both antibodies and UEA-1 showed variations in their staining between and within tumours. The staining of mucinous tumours using anti-EMA was significantly less than in non-mucinous tumours. No other significant associations were found between staining grade and the different variables under study. The variations in staining were not demonstrated to have any prognostic significance.     

Accuracy of frozen section in the diagnosis of ovarian tumours

The purpose of our retrospective study was to assess the accuracy of intraoperative frozen section diagnosis compared to final paraffin diagnosis in ovarian tumours at a gynaecological oncology centre in the UK. We analysed 66 cases and observed that frozen section consultation agreed with final paraffin diagnosis in 59 cases, which provided an accuracy of 89.4%. The overall sensitivity and specificity for all tumours were 85.4% and 100%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) were 100% and 89.4%, respectively. Of the seven cases with discordant results, the majority were large, mucinous tumours, which is in line with previous studies. Our study demonstrated that despite its limitations, intraoperative frozen section has a high accuracy and sensitivity for assessing ovarian tumours; however, care needs to be taken with large, mucinous tumours.     

Serous and seromucinous infantile ovarian cystadenomas--a study of 42 cases

The rarity of infantile ovarian cystadenoma (CA) accounts for the very little knowledge about their behaviour. The aim of this retrospective study is to highlight the modes of presentation and to evaluate the treatments and the recurrence risks of these benign tumours. Relation to adult epithelial ovarian tumours is discussed. The medical records and imaging studies of 42 CA in 31 children less than 16 years of age operated at our institution between 1985 and 2003 were retrospectively evaluated. Mean age of first surgery was 11.5 years. 7/31 girls (22.6%) presented with a bilateral CA, four of them were synchronous. 8/42 (19%) CA were in torsion at surgery, conservative management was possible in four cases. 31/42 (74%) CA were treated conservatively. 4/42 CA recurred 1-3.5 years after complete cyst removal. All were endocervical type CA, there was no intestinal type. The 42 CA were serous in 18/42, mucinous in 23/42 and unqualified in one. Mucinous epithelial cells were often sparse and focal along the cyst wall. Four CA presented with micropapillae in post-pubertal girls. No borderline tumours were observed. Mucinous cystadenomas (MCA) are better described as seromucinous cystadenoma (SMCA) because of the mucinous cells localisation. CA occurs early in life, we surmise that they may need hormonal stimulation to develop micropapillae. Complete removal of these potentially low-grade malignant ovarian tumours precursors is advocated. Conservative surgery is recommended to preserve ovarian function.     

Krukenberg tumor - common problem of gynecologists, surgeons oncologists and pathologists. Report of three cases and review of the literature

Ovarian cancer constitutes one of the most frequent malignant tumours in the female population not only in Poland. The screening of this tumour type is unsolved. The tumours are usually diagnosed in the advanced stage, thus the survival rate are usually poor. Their histopathological appearance has a wide variety, with the occurrence of numerous metastatic forms. Among the metastatic tumours, the primary tumours of the digestive tract occur the most frequently. They are known as the Krukenberg tumours. In these cases the choice of treatment is more difficult and prognosis is also worse in most cases with fatal outcome in one year. Early diagnosis and complete resection is the only possible hope. In this paper authors present three cases of Krukenberg tumour with nonspecific symptoms, difficulties during diagnostics, late beginning of treatment and poor prognosis.     

Granular cell tumour of the breast: case series and review of the literature

Granular cell tumours (GCTs) are uncommon rare neoplasms that may occur in any part of the body. Approximately 5-8% of granular cell tumours occur within the breast. Although nearly always benign in behaviour, granular cell tumours of the breast can often mimic breast malignancies both clinically and on the basis of imaging techniques. This article reports five cases of benign granular cell tumours appearing in the breast, mimicking a malignant breast lesion. In addition to reporting the cases, the relevant literature was reviewed.     

Prognostic significance of Bcl-2 and p53 protein expression in stage IIB and IIIB squamous cell carcinoma of the cervix

Cervical cancer is the most common cancer among women in South India. More than 70% of the cases present in stage IIB and IIIB and of these more than 50% fail conventional treatment. The purpose of the present study was to determine the prognostic significance of Bcl-2 and p53 expression in squamous cell carcinomas of the cervix. Using immunohistochemistry, 40 cases of stage IIB and IIIB squamous cell carcinomas of the cervix treated with radiotherapy were studied for the expression of Bcl-2 and p53 protein and their prognostic value ascertained. Bcl-2 was expressed in 65% (n=26) of the tumours. There was a statistically significant association (p=<0.025) between Bcl-2 expression and poorer DFS and OS in stage IIB cases. In stage IIIB, these associations were not obvious probably due to additional genetic events overshadowing the significance of Bcl-2 expression. Only 4/40 (10%) of the cases were positive for p53 protein expression and there was an inverse correlation between p53 expression and Bcl-2 expression. This study suggests that Bcl-2 can be a useful marker to identify the poor prognostic group in stage IIB cases and needs to be confirmed in a larger series.     

Proliferative and malignant Brenner tumours (BT) and their differentiation from metastatic transitional cell carcinoma of the bladder: a case report and review of the literature

Up to now 110 cases of malignant Brenner tumour (BT) and 45 cases of proliferative BT have been reported in the accessible literature. To delineate the diagnostic criteria and to determine the differences between these tumours and metastatic tumours of the urinary tract, 94 cases of malignant BT and 37 cases of proliferative BT were reviewed. The difficulties encountered in determining these differences are illustrated by means of a case history.     

Oestrogen Receptor Studies in Carcinoma of the Endometrium, Carcinoma of the Uterine Cervix and other Gynaecological Malignancies

The tissues from 30 cases of endometrial cancer and 44 cases of cervical cancer were examined for oestrogen receptor activity. Twenty of the endometrial and 9 of the cervical tumours contained oestrogen receptor levels above 4 fmol/mg protein. The proportion of oestrogen receptor-positive tumours was significantly greater in adenocarcinomas of the cervix than in squamous carcinomas of the cervix. Tissues from 3 mixed mesodermal tumours of the uterus, 2 carcinomas of the vagina, a carcinoma in situ of the cervix and a carcinoma in situ of the endometrium were receptor-negative. One ovarian carcinoma and a single case of uterine sarcoma were receptor-positive. The implications of these findings in relation to hormonal therapies are discussed.     

Granular Cell Tumours of the Vulva

Granular cell tumours occur in a variety of sites, including the vulva. Origins from myogenic, histiocytic, fibroblastic and neurogenic elements have been proposed. Female preponderance suggests that oestrogenic hormones are involved. Seven cases of granular cell tumours of the vulva have been studied. In none was the correct diagnosis made preoperatively. They were solitary lesions and local excision was curative. Paraffin sections of these cases were studied by peroxidase-antiperoxidase method for myoglobin, lysozyme, alpha-1-antitrypsin and S-100 protein localization. Antimyoglobin, antilysozyme and anti-alpha-1-antitrypsin antibodies were not localized in these tumours; however, S-100 protein was localized in all of them. These results agree with previous data that suggest a neurogenic origin for granular cell tumours.     

Occurrence of Bone in Serous Cystadenocardnoma of the Ovary

Summary: Psammoma bodies are relatively common in papillary serous tumours of the ovary, but bone formation in these tumours is rare. The occurrence of such a change in 3 papillary serous cystadenocarcinomas of the ovary in 2 patients is reported. According to the authors' knowledge, these are the first documented cases with such a change.     

Developments in the pathology of ovarian tumours

The understanding of the pathogenesis and pathology of ovarian tumours is constantly evolving. Dominant themes in recent studies of ovarian tumours include prognostic features in borderline tumours, molecular events in the pathogenesis of ovarian tumours, the assessment of tumour features that may have prognostic or treatment implications, and the development of techniques that may enhance diagnostic accuracy. The literature has been reviewed with an aim to identifying those studies that can potentially impact practice and improve patient care. The most noteworthy developments include: the understanding that so-called 'tumours of low malignant potential' are virtually always benign, and that one can identify those rare cases with malignant potential; the importance of the recognition of micropapillary serous carcinomas; an improved understanding of early invasive carcinomas and their impact on screening practices; an understanding of the association of endometriosis with ovarian cancer; further awareness of factors in ovarian tumours that influence prognosis, such as refinements in grading and molecular markers such as P27; and refinements in diagnosis so as to distinguish primary from metastatic cancer and benign lesions from malignant tumours more effectively.     

Pre and Intraoperative Diagnosis of Ovarian Tumours: How Accurate Are We?

Summary: In the assessment of malignant potential of ovarian tumours, frozen section has been found to be accurate in 97.1% (168 of 173) of cases. The positive predictive value of frozen section in the diagnosis of a malignant lesion was 100% (34 of 34). Errors were mainly made in the diagnosis of borderline tumours with a predictive value of 87.5% (7 of 8). The negative predictive value was 98.4% (127 of 129). Frozen section however, was less accurate in the diagnosis of specific histological type with an accuracy rate of 91.9% (159 of 173). Macroscopic features were found to be useful in the intraoperative prediction of malignant potential. Completely cystic tumours were benign in 96.4% (108 of 167) of cases. Solid/cystic tumours were malignant in 69% (27 of 38) of cases. Completely solid tumours were malignant in 56% (9 of 16) of cases. Frozen section in completely cystic tumours only marginally improved the clinical macroscopic diagnosis of malignancy. The sensitivity and specificity of ultrasound scan in the diagnosis of malignant/borderline tumours were 82% and 86% respectively. The false negative rate of 7% makes laparoscopic excision of unsuspected malignant ovarian cyst a significant possibility. The predictive value of ultrasound scan in the diagnosis of malignant ovarian tumour was 62% (26 of 42). In the preoperative assessment of malignant potential of ovarian tumours, this study shows that ultrasound scan has a high false positive and a significant false negative rate. Careful intraoperative assessment of gross features and the use of frozen section especially in those with solid/cystic and solid tumours will help achieve a high accuracy rate in the assessment of ovarian tumours.     

Malignant Müllerian tumours of the uterus

Summary Thirty-two cases of malignant Müllerian tumours of the uterus of the mixed mesodermal type were investigated. Histological examinations were performed on tissue obtained during curettage or biopsy and/or surgical removal of the uterus; in 4 cases postmortem examination was also carried out. The biphasic tumours of the uterus were classified into four groups and comprised 44% of alle uterine sarcomas. In 10 of the 28 cases in which uterine curettage or cervical biopsy was carried out, the final diagnosis was clarified when the tumorous uterus was removed. The prognosis was poorer for heterologous than for homologous tumours. In the heterologous group, the prognosis was better for the form with chondrosarcomatous features (2 patients are still alive after more than 5 years) than for the form containing striated muscle tissue (all 5 patients died within 1 year). Attention is drawn to the fact that the adenosarcoma should be considered a separate type; its prognosis was relatively good (2 such patients are still alive after more than 5 years).     

The influence of ovarian tumour histopathological diagnosis on prognostic values of the sonomorphological index

OBJECTIVES: The purpose of the study was to evaluate the helpfulness of sonomorphological index in preoperative diagnosis of ovarian tumours. Material and method: 686 patients diagnosed and treated because of adnexal tumours were analyzed. At the admission day the patient underwent an ultrasonographical examination that stated morphology of tumour using the sonomorphological index (SM). RESULTS: The sonomorphological index demonstrated high prognostic values: accuracy - 80.6%; sensivity - 86.7%; specifity - 77.0%. During the study, histopathological types of ovarian tumours with the lowest prognostic values were appointed. Among malignant tumours the lowest sensitivity of the test corresponded with: dysgerminoma and folliculoma. Among benign tumours the lowest helpfulness in preoperative diagnosis of ovarian tumours the sonomorphological index demonstrated in following histopathological types: mucinouse cystadenoma and adult teratoma. Particular histopathological diagnosis is the tubo-ovarian abscess--all analyzed cases had a false positive result in the test. CONCLUSIONS: In all histopathological types of malignant and benign tumours mentioned above, the use of the sonomorphological index require caution. To increase accuracy of preoperative diagnosis based on ultrasonographical examination, additional Doppler examination and also biochemical markers concentration should be considered.     

Clinical analysis of synchronous primary neoplasms of the female reproductive tract

OBJECTIVES: In this study, a histopathologic review of synchronous primary neoplasms including gynecologic malignancies is presented, and the possible correlation among discrete tumor subsets, natural history, and survival is evaluated. METHODS: Between the years 2000 and 2005, 20 patients suffering from synchronous primary cancers of gynecologic malignancy were identified. Clinical and pathologic information was obtained from medical records. Kaplan-Meier survival analyses were conducted. RESULTS: Patients with synchronous primary malignancies constituted 0.63% of all genital malignancies. The most frequently observed synchronous neoplasm was ovarian cancer coexistent with endometrial cancer (40%). The mean age of patients suffering from synchronous ovarian and endometrial cancer was 45.2 years. All patients with synchronous primary genital malignancies underwent hysterectomy with bilateral salpingo-oophorectomy and/or adjuvant therapy. The mean duration of survival was 57 months (S.E.: 10.0; 95% confidence interval: 37-77). CONCLUSION: Patients suffering from primary genital malignancies are sometimes co-afflicted with other primary cancers. Synchronous ovarian and endometrial cancer constitutes the most common of these cases, and is detected at a relatively early age, with generally favorable prognoses.     

The volume of the surgical treatment and follow-up of patients with malignant ovarian tumors in the first stages

From 1987 till 1997 110 patients with stage-I ovarian malignant tumors were treated and follow-up at the Department of Gynaecological Oncology, National Oncological Center. Papillifery-adenocarcinoma were in 40 cases, serous carcinoma were in 26 cases, mucinous carcinoma were in 15 cases, malignant granulosa cell tumor were in 14 cases, endometrioid carcinoma were in 6 cases, dysgerminoma were in 6 cases, Teilum's tumour were in 2 cases, and 1 case of ovary sarcoma were detected. Radical operated on the first operation were 69 patients (62.8%), and in 37 cases (33.6%) second operation for radicality were performed. In 4 cases only adnexectomy were done. In all cases post operative adjuvant chemotherapy were used. The patients were follow-up by tumour markers, sonography and CT. Follow-up period is from 5 months till 11 years. Alive were 80 patients (73%), and 30 patients (27%) were died. The patients with stage Ic and those nonradical operated in the first operation have worst prognosis then patients with stage Ia and stage Ib. The patients with ovarian tumours must be operated only in the hospitals with possibility of urgent hystological diagnosis for better prognosis in the cases of stage-I malignant ovarian tumours.     

Endometrial stromal lesions: a morphological and immunohistochemical study of short series

Background Endometrial stromal tumours are rare and constitute less than 5% of uterine tumours. This study presents our experience of endometrial stromal tumours and their immunohistochemical profile. Methods All cases reported as endometrial stromal tumors from January 2001 to December 2004 were extracted from the files of pathology department. Hematoxylin and eosin stained slides were reviewed and immunohistochemical staining for vimentin, desmin and cytokeratin was done in all cases. Results In all five cases of endometrial stromal tumors were retrieved from the records and constituted 0.3% of endometrial neoplasms. One case was diagnosed as endometrial stromal nodule and four cases were diagnosed as low-grade endometrial stromal sarcoma. Four out of five cases were confined to the uterine corpus. Only one case showed spread to the cervix and the fallopian tube. All tumors were negative for desmin and cytokeratin and showed only focal vimentin postivity. Conclusions The diagnosis rests on morphological features mainly while immunohistochemical profile of these tumours is rather inconsistent.     

DNLC2A基因在卵巢恶性肿瘤组织中的表达及临床意义

目的 :研究DNLC2A基因在人卵巢恶性肿瘤组织中的表达及其与卵巢恶性肿瘤临床病理特征的关系。方法 :采用半定量逆转录 聚合酶链反应 (RT PCR)法检测 4 2例卵巢恶性肿瘤组织和 4 2例正常卵巢组织中DNLC2AmRNA的表达。结果 :DNLC2AmR NA在卵巢恶性肿瘤组织中的表达显著高于正常卵巢组织 (P <0 .0 5 ) ,在晚期恶性卵巢肿瘤中的表达显著高于早期者 (P <0 .0 5 ) ,但在各组织类型中的表达无显著性差异 (P >0 .0 5 ) ,且与肿瘤细胞分化程度无关 (P >0 .0 5 )。结论 :DNLC2A基因的变异参与了卵巢癌的发病机制 ,并且可能在卵巢恶性肿瘤的发展过程中进一步发挥作用     

Prevalence of endometriosis in malignant epithelial ovary tumours

OBJECTIVE: To determine the prevalence of ovarian endometriosis in malignant epithelial ovarian tumours. STUDY DESIGN: A retrospective analysis of 160 malignant and 23 borderline ovarian tumours during the period 1995-2001. RESULTS: Fourteen (7.7%) of the tumours contained endometriosis. This affected 22% of the endometrioid and 10.8% of the mixed adenocarcinomas. The mean age of the ovarian endometriosis patients was 43+/-13 range 26-70 years. The incidence in borderline tumours 13% (3/23) was higher than that in ovarian cancer 6.9% (11/160) (P>0.05). Eight (57%) of cases were classified as atypical and six (43%) as typical endometriosis. Nine cases were FIGO (International Federation of Gynaecology and Obstetrics) stage I and 5 stage III. CONCLUSIONS: Both malignant and borderline ovarian tumours are associated with ovarian endometriosis. In addition, atypical endometriosis was found associated with endometrioid and mixed epithelial ovarian tumours.