Blue nevus of the endocervix: Report of two cases and ultrastructure

Two cases of blue nevus of the endocervix are reported and the electron microscopic findings from one of them are discussed as related to their fine structural organization and possible histogenetic origin and development. Blue nevus cells of the endocervical mucosa are engaged in melanogenesis in all respects similar to that observed in blue nevus cells of the dermis and are regarded as their visceral counterparts. Their ultra-structural resemblance and close location to perineurial fibroblasts of nonmyelinated nerve bundles seem to suggest that at least in some instances the perineurial fibroblasts may be the most immediate neural crest precursors of blue nevus cells of the endocervix.     

Wertheim-operation: 5-year survival of 501 consecutive patients with cervical cancer

OBJECTIVE: The purpose of this study was to assess the 5-year survival and morbidity when radical hysterectomy and pelvic lymphadenectomy with pre- and postoperative radiation have been performed for IA2-IIB stage cervical cancer. STUDY DESIGN: During a 10 and a half year period between July, 1990 and December, 2000, 501 consecutive radical hysterectomies with bilateral pelvic lymphadenectomies were performed by the same gynecological surgeon for stage IA2, IB, IIA and IIB carcinoma of the cervix at the I. Department of Obstetrics and Gynecology, Semmelweis University Budapest. The patients were treated by pre- and postoperative irradiation as well. RESULTS: Perioperative complications apart from recurrence were minimal with no long-term morbidity. The absolute 5-year survival rates for the patients in stage IA2, IB1, IB2, IIA and IIB were 94,4%, 90,7%, 84,1%, 71,1% and 55,4%, respectively. The respective 5-year survival rates for patients without or with lymph node metastasis, were 94,5% and 33,3% in stage IB2, 81,7% and 48,7% in stage IIA and 70,2% and 36,5% in stage IIB, respectively. CONCLUSION: Nerve-sparing radical abdominal hysterectomy with pelvic lymph node dissection and pre- and postoperative irradiation remains the treatment of choice for most patients with early-stage and even in IIB-stage cervical cancer. The radicality and extent of lymph node dissection and parametrial resection should be individualized and tailored to tumor- and patient-related risk factors.     

Hereditary tumours of the endocrine pancreas

The pathogenesis, diagnosis and therapy of tumours originating from the endocrine pancreas represent one of the most exciting challenges of contemporary medicine. Some of these tumours appear as part of four hereditary syndromes (multiple endocrine neoplasia type 1 (MEN1), von Hippel-Lindau disease (VHL), neurofibromatosis type 1 and tuberous sclerosis) that are all inherited as autosomal dominant traits and result from mutations of tumour suppressor genes. Considering its clinical relevance, MEN1 appears to be the most important among these four syndromes. Tumours of the endocrine pancreas develop in 30-80% of patients carrying mutations of the MEN1 gene. Gastrinomas are the most frequent functioning tumours in MEN1 patients, followed by insulinomas, whereas other tumors e.g. glucagonoma, VIP-oma, GRF-oma and somatostatinoma occur very rarely. Tumours of the endocrine pancreas are infrequent in patients suffering from VHL, neurofibromatosis and tuberous sclerosis. In this review article, the authors present a synopsis of tumours of the endocrine pancreas related to these hereditary syndromes underlining the clinical characteristics, diagnostical and therapeutical possibilities.     

Possible applications of functional genomics in the study of the pathogenesis of adrenal and pituitary tumors

Functional genomics represents one of the most rapidly evolving fields of contemporary medical research. It is being more and more exploited in endocrinological research, as well, including studies on endocrine tumours. By comparing gene expression profiles of different tumour tissues or to their healthy counterparts, large amounts of information can be obtained that was unfeasible even until recently. There are only few data available on the pathogenesis of sporadic adrenal and pituitary tumours. Owing to recent studies applying functional genomics tools, novel genes were identified that could have pathogenetic relevance. Some of these genes may even be applicable in clinical practice, e.g. for the study of malignancy, determination of prognosis or the choice of therapy. In this short review, the authors attempt to present a synopsis of the possible applications of functional genomics in the field of endocrine tumours by summarizing recent studies on adrenal and pituitary tumours.     

Molecular pathology of tumor metastasis. II. Molecular staging and differential diagnosis

Molecular Pathology of Tumor Metastasis With the development of non-invasive methods, diagnosis of metastasis from various solid malignancies has become a routine task for diagnostic pathology. However, the differential diagnosis between primary and metastatic cancers and the precise identification of various metastatic cancer types requires the coordinated use of various morphological (light- and electron microscopic-), immunological and molecular techniques. The detection of the lymphatic spread of the primary tumor may now based on the sentinel lymph node technology while the identification of the hematogenous progression may be based on the analysis of the peripheral blood and the bone marrow. More and more frequently these techniques employ highly sensitive immunological and molecular techniques. Accordingly, clinical staging is now confronted with the results of molecular staging, where the only techniques which are able to detect cancer cells are immunocytochemistry or nucleic acid-based methodology. Although several clinical studies have provided evidences for the impact of the immunocytochemistry-based identification of micrometastases on the survival of patients with various type of cancers, none of these methods have become part of standard diagnostic protocols. Although more sensitive molecular techniques are being introduced to identify micrometastasis, their clinical significance is yet unknown. Multicentric clinical trials are now warranted to establish the clinical impact of molecular staging in various cancer types. Without the integration of these methods into the prognostic/predictive pathological protocols it is difficult to envision significant improvement in the results of cancer therapy.