Recent advances in immunohistochemistry in gynaecological pathology

Recent years have witnessed significant developments in the use of immunohistochemistry in diagnostic gynaecological pathology. This review details the most significant of these. In ovarian pathology, differential cytokeratin staining (CK7 and 20) assists in distinguishing between a primary ovarian adenocarcinoma and a metastatic adenocarcinoma, especially of colorectal origin. The development of markers characteristic of ovarian sex cord-stromal tumours (especially alpha-inhibin) facilitates diagnosis of these neoplasms which is often difficult by morphology alone due to the wide differential diagnosis. In the uterus, the distinction between a primary endometrial and endocervical adenocarcinoma may be facilitated by use of a small panel of antibodies, including CEA, ER and vimentin. Newly developed antibodies such as CD10 and h-caldesmon may be of use in the diagnosis of uterine mesenchymal lesions, especially in the distinction between endometrial stromal and smooth muscle lesions. Proliferation markers, such as MIB1, are of value in the cervix in the diagnosis of preinvasive squamous and glandular lesions. Recent studies have shown that cervical adenoma malignum exhibits a gastric phenotype. Advances have also been made in trophoblastic disease with the development of antibodies reactive against trophoblast such as alpha-inhibin, mel-Cam and p57. A newly developed monoclonal antibody HMGIC which is expressed in vulvovaginal aggressive angiomyxoma may prove to be of value in the often difficult distinction of this lesion from its histological mimics.     

Angiomyofibroblastoma of the vulva: A mitotically active variant?

A case of angbmyofibrobiastoma in a 48-yearold woman is reported. The tumor occurred as a left vulval mass and was treated by simple excision. It was located in the subcutaneous tissue of the left vuiva and was well circumscribed, measuring 2.8 × 2.7 × 2.5 cm. Microscop Ically, the tumor was composed of hypocellular and cellular arees with well-developed small vessels. Spindle or polygonal cells were arranged with perlvascular accentuation In an edematous or fibrocollagenous background. Some spindle-shaped or polygonal stromal cells were also arranged in epithelioid nests. In some areas, mitosas were frequent (maximum 3/10 high-power field). lmmunohistochemicaily, the stromal cells were positive for vimentln and desmin, but negative for α-smooth muscle actin, S-100, neurofilament, estrogen receptor, progesterone remptor, CD31 and CD34. The average labeling index of Kl-67 In stromal cells was 3.1%. Ultrastructural analysis demonstrated that the stromal cells adhered with primitive Junctions and contained lntermediate filaments with no focal density In the cytoplasm. These findings were consistent with anglomyofibrobiastoma, although previously reported cases did not show so many mitoses. Therefore, this case was suggested to be a mitotically active variant.     

Angiomyofibroblastoma of the vulva: Case report with immunohistochemical, ultrastructural and DNA ploidy studies and a review of the literature

A case of anglomyofibroblastoma of the vulva in a 49-year-old woman was examined. The tumor measured 3×2.5×2 cm and appeared light gray to tan In color on the cut surface. Light microscopic examinations revealed that spindle or oval shaped tumor cells were arranged in loose edematous stroma with numerous thin-walled vessels. Ultrastructurally, cell organellae were not well developed but intracytoplasmic filaments of intermediate size were abundant in the tumor cells. Desmin, CD34 and vimentin immunoreactivity were detected in almost all of the tumor cells. Both estrogen and progesterone receptors were diffusely expressed In the tumor, suggestive of the sex sterold-dependency of this tumor. The Ki-67 labeling index was less than 1% and the DNA content of the tumor cells, which was examined by image cytometry, demonstrated diploidy (DNA index=0.97). These findings may reflect the quiescent or slow growing features of angiomyofibroblastoma.     

外阴硬化性苔癣与T淋巴细胞免疫的关系

目的 :探讨外阴硬化性苔癣与免疫功能的关系。方法 :采集患者静脉血 ,检测血清中CD3+ 、CD4 + 、CD8+ 、CD16 + T细胞水平 ;对照组采用正常献血妇女静脉血。结果 :患者组CD4 + T/CD8+ T细胞比值明显低于正常对照组 ,且差异有显著性。结论 :硬化性苔癣的患者体内存在免疫应答过度 ,且造成机体自身组织的损伤。     

超声治疗外阴白色病变30例临床分析

目的 :探讨超声治疗外阴白色病变的临床疗效。方法 :收治外阴白色病变 6 0例 ,随机分为 :超声治疗组 30例 ,微波治疗对照组 30例。观察其临床症状、体征和组织学变化。结果 :超声治疗组 30例患者的外阴瘙痒症状基本消失 ,患处上皮不同程度地恢复正常 ,显效率达 90 %。不同的病理类型间疗效的比较 ,差异无显著性 (P >0 .0 5 )。结论 :用超声治疗外阴白色病变效果明显     

Recurrent primary vulvovaginal malignant melanoma arising in melanoma in situ– the natural history of lesions followed for 23 years

Multifocal melanoma and melanoma in situ of the vulva and vagina are uncommon lesions, and our understanding of their natural history is limited. Vulvovaginal melanoma appears to be biologically different from cutaneous melanoma and has more in common with mucosal melanoma. A 60-year-old woman presented in 1977 with a pigmented vulvar lesion. Histologic examination revealed melanoma in situ associated with focal invasive melanoma. She re-presented with recurrent primary melanomas arising in melanoma in situ in 1990 and 1998 and died of widespread metastatic melanoma in 2000. Melanoma in situ of the vulva and vagina is rare and appears to have a relatively slow but definite progression to invasive melanoma. All suspicious pigmented lesions in this region should be biopsied, and if multifocal in situ melanoma is identified, vulvo(vagin)ectomy should be considered.     

A rare association of synchronous intraductal carcinoma of the breast and invasive carcinoma of ectopic breast tissue of the vulva: case report and literature review

Abstract.   Intra M, Maggioni A, Sonzogni A, De Cicco C, Machado LS, Sagona A, Talakhadze N. A rare association of synchronous intraductal carcinoma of the breast and invasive carcinoma of ectopic breast tissue of the vulva: case report and literature review. Int J Gynecol Cancer 2006; 16(Suppl. 1): 428–433.
Only 17 cases of breast carcinoma arising in vulvar ectopic mammary tissue have been reported. We present a unique case of synchronous pure intraductal carcinoma of the breast (DCIS) and invasive carcinoma of ectopic breast tissue of the vulva. A 53-year-old woman presented with a 2-cm nodule in left labium major of the vulva. A surgical biopsy revealed an invasive carcinoma of ectopic mammary tissue. The mammography showed irregular microcalcifications of the right breast. The patient underwent left hemivulvectomy, bilateral inguinal sentinel lymph node biopsy, and radioguided breast resection (radioguided occult lesion localization) of the microcalcifications. The definitive histology revealed negative inguinal sentinel nodes, no further residual tumor in the vulva, and a high-grade (grade 3) DCIS in the breast. The synchronous occurrence of primary breast carcinoma and ectopic breast tissue carcinoma in the vulva is an extremely rare finding, only once previously being reported and leading to unsolved problems of differential diagnosis. The presence of a pure DCIS of the breast makes this case really unique, definitively confirming the independent primary origin of both mammary tumors. The inguinal sentinel node biopsy avoided a bilateral inguinal dissection.     

黄酮外用酊剂治疗外阴白斑的药效学研究

目的：探讨黄酮外用酊剂治疗外阴白斑的药效学.方法：将黄酮提取物配成0.2%（含25%乙醇）的酊剂.通过体外抑毒实验,小鼠抗炎、止痛、止痒实验,大鼠肉芽肿实验,及初步临床治疗116名外阴白斑患者,探讨了黄酮酊剂与治疗外阴白斑有关的药理机制和初步临床疗效.结果：该药具有明显止痛、止痒、促进损伤组织愈合、抗慢性肉芽肿、抗急性炎性渗出和抗病毒的功效.结论：黄酮酊剂治疗外阴白斑药效确实,见效快,使用方便,安全、不良反应少,值得临床进一步使用.     

中蒙医药结合治疗外阴白斑50例疗效分析

目的:观察女性外阴白色病变用中蒙药结合的治疗效果.方法:采用中药汤剂、散剂内服；中药粗粉剂冲泡外洗；蒙药制成膏剂外敷；阴道放药等综合治疗方法,对女性外阴白色病变进行治疗观察.结果:治疗50例,痊愈20例,显效23例,有效5例,无效2例.结论:采用中蒙药结合,内外同治的综合方法治疗女性外阴白色病变,疗效满意.