[Detection of lymphovascular invasion in urothelial carcinoma of the bladder through D2-40 immunostaining]. / Detektion der lymphovaskulären Invasion mit D2-40-Immunhistochemie beim Urothelkarzinom der Harnblase.

BACKGROUND: Lymphovascular invasion (LVI) represents a surrogate marker for micrometastatic urothelial carcinoma of the bladder (UCB). OBJECTIVES: We evaluated whether D2-40 immunhistochemistry (IHC) alters detection of LVI when compared to conventional HE (hematoxylin-eosin) staining of UCB specimens in a blinded fashion. MATERIAL AND METHODS: HE- and D2-40-IHC-stained representative sections of 80 patients after radical cystectomy (RC) were re-reviewed. LVI detection rates were recorded and compared after blinded evaluation. RESULTS: LVI was present in 53 patients (66.3%) in HE-stained sections and in 44 patients (55%) in D2-40 stainings. In 13 patients, LVI (16.3%) was found in HE stained sections but not confirmed when IHC was applied (false positive when using IHC as a reference standard). D2-40 IHC identified LVI in 4 additional patients (5%) who were classified as LVI negative in conventional HE staining (false negative). 52 patients (65%) were lymph node negative (pN0), 21 of whom (40.4%) were LVI positive in conventional HE sections and 16 of whom (30.8%) were LVI positive in IHC. In 9 pN0 patients (17.3%), LVI was diagnosed in HE sections but not confirmed by IHC (false positive). D2-40 IHC identified LVI in 4 additional patients (7.7%) who were node negative and classified as LVI negative in conventional HE staining (false negative). In patients who experienced recurrence (n=35) and who were classified as pN0 at the time of RC, HE staining resulted both in false-positive (n=2; 5.7%) and false-negative (n=3; 8.6%) findings. CONCLUSION: Different detection rates of LVI were observed when using IHC with D2-40 in UCB patients compared to conventional HE staining. The routine use of D2-40 IHC should be considered in clinical trial design to improve risk stratification of pN0 patients after RC.

Atypical polypoid adenomyoma of the uterus. A case report and a review of the literature.

Atypical polypoid adenomyoma (APA) is a rare, benign lesion. The tumor occurs in nulliparous women aged 22-48 years (average 33 years) and it has been suggested as being related to prolonged estrogenic stimulation. We describe a case of a 72-year-old woman who presented at our hospital with persistent, worsening urinary incontinence and pelvic pain. Physical examination and pelvic ultrasound disclosed uterine enlargement, a mass in the endometrial cavity and multiple small myomas. Total hysterectomy with bilateral salpingo-oophorectomy was performed. The histological diagnosis for the mass of the endometrial cavity was atypical polypoid adenomyoma. APA should be distinguished from endometrial carcinoma and other malignant uterine neoplasms such as adenofibroma, adenosarcoma and malignant mixed mullerian tumor. The immunohistochemical panel which usually includes alpha smooth muscle actin, desmin, Ki67 and recently CD10 is often helpful in establishing the diagnosis. The treatment may vary depending on the patient's age, her desire to preserve fertility, and the severity of her symptoms.

Pure Sertoli cell tumor. a case report and review of the literature.

Pure Sertoli cell tumor (SCT) is a rare sex cord tumor and a subtype of Sertoli-Leydig cell tumors according to the WHO Classification. They lack a Leydig cell component and do not contain the immature neoplastic stroma found in the neoplasms of the Sertoli-Leydig cell category. The age of the patients ranges between two and 79 years. Sertoli cell tumors occur in women of reproductive age but a few can also occur in children. The most common clinical presentation when occurring in children is isosexual pseudoprecocity. Women of reproductive age and postmenopausal women frequently present with abdominal pain, swelling and menstrual abnormalities. Occasionally SCTs occur in patients who have Peutz-Jeghers syndrome. The tumors are hormone functional in 40-60% of cases. They are often estrogenic, occasionally also androgenic or rarely both. Grossly they are usually yellow to brownish, solid or with several cystic areas. Microscopically they show always almost a tubular growth pattern, but they may also have other growth patterns which can be extensive, making the correct diagnosis difficult. These histologic patterns may result in SCTs mimicking other ovarian tumors. The immunohistochemical panel which usually includes EMA, inhibin, chromogranine, CD99 and calretinin is often helpful in establishing the diagnosis. Most SCTs are Stage I, unilateral, cytologically bland, and clinically benign, but occasional examples are high stage. About 11% of Stage I tumors have worrisome histologic features that may portend an adverse outcome.

Intravascular T-cell lymphoma of the vulva, CD30 positive: a case report.

Primary non-Hodgkin's lymphoma involving the vulva is very rare. It affects predominantly the labia major but it can also present as a clitoral mass or can even be located in the Bartholin's gland. Vulvar lymphoma is an aggressive disease. We describe a case of a 48-year-old woman who presented to our hospital with fever and a slow growing mass in the vulva. She had no other clinical symptoms. CT-scan showed no evidence of disease in any other organ or lymph node tissue. A local excision of the mass followed and the final diagnosis was primary intravascular vulvar lymphoma, of T-cell origin, CD30 positive. In general, intravascular lymphomas are clinically and immunophenotypically heterogenous and may represent more than one entity. They are predominantly of B cell lineage, involving most commonly the skin and rarely other systems or organs. Because of the fact that the vulva is a cutaneous site the development of intravascular lymphoma in this region is possible.

Hepatoid carcinoma of the ovary. A case report and review of the literature.

Hepatoid carcinoma (HCO) is a rare ovarian tumor and is thought to be a different subtype from hepatoid-type yolk sac tumor based on its pathologic features. In contrast to hepatoid yolk sac tumor in which the patients are usually young, patients with HCO are elderly with a peak incidence during the sixth decade of life. None of the patients with HCO have had gonadal dysgenesis or recognizable germ cell components within the tumors. We describe a case of a 42-year-old woman who presented to our hospital complaining of abdominal pain. Physical examination and CT scan revealed a large tumor in the left adnexa. She underwent total hysterectomy and bilateral salpingo-oophorectomy with omentectomy. A left ovarian mass measuring 11 cm in diameter was found. Histological diagnosis was hepatoid carcinoma of the left ovary. Immunohistochemical findings suggest that hepatoid carcinoma of the ovary is probably a most likely variant of a common epithelial carcinoma by a process of neometaplasia or transdifferentiation.

Malignant adenomyoepithelioma of the breast--case report.

Malignant adenomyoepithelioma (MAME) of the breast is a rare tumor characterized on the basis of histologic, immunohistochemical and ultrastructural features by malignant proliferation of the epithelial and myoepithelial cells. We report a case of an 80-year-old woman with malignant adenomyoepithelioma of the breast, one of the oldest patients described up to today. A primary tumor in the left breast grew within a short period of time. A modified mastectomy with sampling of the axillary lymph nodes was performed. The lymph nodes did not include any metastatic lesions. In this case the malignancy was evidenced by the presence of a high mitotic rate, several nuclear atypia, necrosis, and local invasion. The tumor was associated with adenosis and in adjacent positions to the infiltrating portions a circumscribed nodule with histological features of benign adenomyoepithelioma was present. Reviewing the literature MAME has been reported in women aged between 26-76 years. The metastatic potential of this entity is not well studied. It appears to have hematogenous rather than lymphatic spread and usually occurs in primary tumors more than 2 cm in size.

Bilateral primary breast lymphoma--case report.

Primary lymphoma of the breast is an uncommon malignant breast tumor which is seldom distinguished preoperatively from other more common forms of breast cancer. Bilateral breast lymphoma affects younger women especially during pregnancy or postpartum. We report a case of a 55-year-old woman who was admitted to our hospital with painless bilateral breast enlargement. A bilateral radical mastectomy with bilateral axillary lymph node dissection was performed. The histology of the surgical specimen was non-Hodgkin's malignant lymphoma of the diffused large B cell type. Most of the neoplastic cells resembled large centrocytes and sometimes blast cells showing some degree of plasmacytoid differentiation. Foci with a sufficient number of immunoblasts were also noted. The patient was also found to have a bilateral axillary lymph node metastasis. After additional clinical and laboratory screening, there was no other evidence of lymphatic disease at other sites. The patient was submitted to the anticancer hospital for further treatment. She was free of recurrence two years after surgery. The rarity of the disease, lack of uniform classification and variable treatment modalities make prognostic predictions of breast lymphoma difficult.