Mediastinal mixed dendritic cell sarcoma with hybrid features

This report describes a recurrent sarcoma involving the soft tissues of the posterior mediastinum with features of both follicular dendritic and interdigitating dendritic cells. Histologically, the tumour, which was a recurrent neoplasm 19 years after the initial removal, was composed of bland spindle shaped cells with interspersed inflammatory cells, predominantly lymphocytes. Immunohistochemically, the spindle cells were positive for S100 protein, CD45, CD68, and vimentin, but negative for CD21 and CD35 (markers of follicular dendritic cells). The immunophenotype was in keeping with interdigitating dendritic cells. However, ultrastructural examination demonstrated elongated cell processes joined by desmosome-like junctions-features in keeping with follicular dendritic cells. Follicular dendritic cell sarcoma and interdigitating dendritic cell sarcoma are rare neoplasms and a high index of suspicion is required to make a correct diagnosis. Immunohistochemistry and/or electron microscopy are required for a definitive diagnosis. This case shows that hybrid neoplasms can occur, which have features of both follicular and interdigitating dendritic cells.     

Oestrogen receptor protein and mRNA in adenocarcinoma of the uterine cervix.

We have investigated the oestrogen receptor (ER) status of 20 cervical adenocarcinomas by immunocytochemistry for ER protein and non-isotopic in situ hybridisation for ER mRNA. Both methods, which are applicable to paraffin sections, were developed and validated in breast carcinomas with known ER content. Six cervical adenocarcinomas contained immunocytochemically demonstrable ER protein; all contained ER mRNA, but staining was less intense in poorly differentiated areas of four tumours. This disparity between protein and mRNA detection needs further investigation as does the possibility that oestrogens may play a role in the pathogenesis of cervical adenocarcinoma.     

Asbestos-related deaths

Over many thousands of years, millions of individuals have been exposed to asbestos. Deaths relating to asbestos continue to be a major problem in developed and developing countries and are due to three diseases, namely malignant mesothelioma, lung cancer and asbestosis. Medico-legal (personal injury) compensation claims due to asbestos represent the most common industrial disease. However, only a small proportion of persons exposed to asbestos develop asbestos-related disease. It should be realized that almost everyone is exposed to environmental background asbestos and asbestos can usually be identified in the lungs of most persons at post-mortem examination by special analytical techniques (mineral analysis).This paper provides an overview for the pathologist of issues related to asbestos-related deaths. Basic mineralogical considerations and exposure patterns are detailed. The spectrum of asbestos-related conditions are described together with their common mimics. The review addresses issues relating to the handling of the ‘industrial’ autopsy examination and provides guidelines for the attribution of asbestos-induced disease, including application of mineral analysis.     

Primary adenocarcinoma of the cervix. A clinicopathologic study of prognostic variables in 55 cases

Fifty-five primary invasive adenocarcinomas of the cervix, presenting over a 20-year period, were retrospectively studied with particular reference to clinical and pathologic prognostic indicators. Mean age at presentation was 54.5 years (range 27–91), with an age distribution showing two incidence peaks of equal size in the 31–35 and 61–65 groups, respectively. Twenty-four patients died of the disease and the remaining patients were followed up for a mean of 4.9 years (range 1–17). The results were analyzed using a Cox's proportional hazards survival model. The independent good prognostic indicators were early tumor stage ( P < 0.001). and young patient age ( P < 0.001) at presentation. The presence within the tumor of numerous intraepithelial lymphocytes and the concomitant occurrence of background in situ carcinoma were also good prognostic indicators, although these did not operate independently of stage and age. Histologic tumor subtype and grade of tumor differentiation were not significant prognostic factors. Treatment did not have a significant independent effect on survival. No definite conclusions could be drawn about the effect of oral contraceptives on the disease process.     

Primary malignant gonadal mesotheliomas and asbestos

AIMS: The clinicopathological, immunohistochemical and aetiological aspects, with respect to asbestos, of seven primary gonadal mesotheliomas (three intratesticular, four ovarian) are described and compared. These tumours are extremely rare, poorly described and the knowledge of their natural history is very limited. METHODS AND RESULTS: The cases were collated from the UK Health and Safety Executive Mesothelioma Register over a 24-year period (1968-91). Primary mesotheliomas of the tunica vaginalis and ovary comprised 0. 09% (10 cases) and 0.03% (three cases) of mesothelioma deaths, respectively. No primary intratesticular (non-tunica vaginalis) malignant mesotheliomas have been described. In this study, we present seven (three intratesticular, four ovarian) primary malignant gonadal mesotheliomas. In both genders the tumours show a similar age distribution (with median onset in the sixth decade), a similar association with asbestos (in approximately 50% cases), a diverse histological spectrum (with predominantly tubulopapillary epithelial subtype tumours) and an immunophenotype that is comparable with malignant pleural and peritoneal mesothelioma. The clinical course appears variable (mean, 26 months; range, 9-50 months). All tumours in the study presented as localized masses and their prognosis appeared more favourable than that of diffuse pleural and peritoneal cases. CONCLUSIONS: An awareness of the existence of these rare forms of malignant mesothelioma is important to prevent misdiagnosis. Immunohistochemistry has an important role in confirmation of the diagnosis. The accurate diagnosis of primary gonadal mesothelioma has potentially important medicolegal compensation considerations as a significant proportion of these cases are associated with asbestos.