High-Risk Human Papillomavirus Detection via Cobas® 4800 and REBA HPV-ID® Assays.

Persistent infection with high-risk human papillomaviruses (HR-HPVs), particularly HPV16 and 18, has long been known to induce cervical cancer progression. However, given that a minority of HPV-infected women develop cancer, analysis of HR-HPV-infected women could help to predict who is at risk of acquiring cervical cancer. Therefore, to improve HR-HPVs detection, we used the FDA-approved cobas® 4800 HPV and REBA HPV-ID® HPV assays to detect HR-HPVs in colposcopy-derived cervical cells from 303 patients, detecting 72.28% (219) and 71.62% (217) of HR-HPVs positive cases, with HPV16 detection rates of 35.64% (108) and 30.69% (93), respectively. Of the HPV16-positive cases, cobas® 4800 and REBA HPV-ID® identified 28.81% (51) and 25.42% (45) of the CIN1 cases, and 55% (33) and 50% (30) of the 60 CIN2/3 cases, respectively. HPV-diagnostic concordance was 82.17% overall (kappa = 0.488), 87.45% for HR-HPVs (kappa = 0.689), and 88.33% for CIN2/3 (kappa = 0.51). The HR-HPVs detection rates of these assays were comparable. Our findings reveal that the FDA-approved HR-HPVs detection assay is appropriate for screening women with HR-HPVs infection, and for predicting increased risk of cervical cancer progression. REBA HPV-ID® can be used to detect low risk-HPV types in high-grade cervical lesions that are HR-HPV negative as well as in the distribution of HPV types.

MicroRNA Expression Profiling in Hydatidiform Mole for the Prediction of Postmolar GTN : MicroRNA Profile in Postmolar GTN.

Objectives: The primary aim of the study was to identify miRNAs that were differentially expressed between complete hydatidiform moles (CHMs) that turned out to be gestational trophoblastic neoplasia (GTN) [GTN moles] and CHMs that regressed spontaneously after evacuation [remission moles]. The secondary aim was to study the profiles of miRNA expressions in CHMs. Methods: A case-control study was conducted on GTN moles and remission moles. We quantitatively assessed the expression of 800 human miRNAs from molar tissues using Nanostring nCounter. Results: From a pilot study, 21 miRNAs were significantly downregulated in GTN moles compared to the remission moles. Five of them (miR-566, miR-608, miR-1226-3p, miR-548ar-3p and miR-514a-3p) were downregulated for >4 folds. MiR-608 was selected as a candidate for further analysis on 18 CHMs (9 remission moles and 9 GTN moles) due to its striking association with malignant formation. MiR-608 expression was slightly lower in GTN moles compared to the remission moles, that is, 2.22 folds change [p = 0.063]. Conclusion: We identified 21 miRNAs that were differentially expressed between GTN moles and remission moles suggesting that miRNA profiles can distinguish between the two groups. Although not reaching statistically significant, miR-608 expression was slightly lower in GTN moles compared to remission moles.

Determination of morphologic and immunohistochemical stain (p57 kip2) discrepancy of complete and partial hydatidiform mole by using microsatellite genotyping.

OBJECTIVE: to evaluate the role of microsatellite genotyping in discordant results between morphologic examination and p57Kip2 staining in hydatidiform mole. MATERIALS AND METHODS: 127 cases of hydatidiform mole who had morphologic examination and p57Kip2immunohistochemical staining were evaluated. Six discrepant cases between morphologic examination and p57Kip2 staining were recruited. DNA was extracted from chorionic villi and paired maternal decidual tissue in Formalin fixed paraffin embedded tissue sections. The STR DNA genotyping was performed by Applied Biosystems 3500 Genetic Analyzer. Genetic data analysis was performed by Gene mapper ID-X software. Three concordant cases were used as control. Results were compared to histopathology, p57Kip2 stain and development of post-molar GTN. RESULTS: All controlled cases were confirmed PHM. Two cases of histologic CHM with positive p57Kip2and 2 cases of PHM with negative p57Kip2 were reported as PHM from microsatellite. Other 2 cases of histologic diagnosis PHM with negative p57Kip2 reported as CHM from microsatellite test and both of them developed post-molar GTN. CONCLUSION: Microsatellite genotyping is a high accuracy method for differential diagnosis from complete and partial hydatidiform moles. However, cost of microsatellite genotyping is still too high to use routinely. Therefore, selected use in discrepancy cases may be suitable.

BRCA immunohistochemistry for screening of BRCA mutation in epithelial ovarian cancer patients.

To evaluate BRCA1/2 immunohistochemistry (IHC) as a screening test for germline BRCA1/2 in epithelial ovarian cancer (EOC), tumor tissue from 105 EOC patients who had germline BRCA mutations, including 9 BRCA1 mutations, 6 BRCA2 mutations and 90 no BRCA mutations, were studied. Paraffin-embedded tissue blocks were stained for BRCA1 and BRCA2. Tumors were indicated as a loss of BRCA expression when neoplastic nuclear stained less than 10%. Loss of BRCA1 and/or BRCA2 expression was found in 36 patients (34.3%). BRCA1 IHC loss was found in 21 patients (20%) while 24 patients (22.9%) had BRCA2 IHC loss. There were no significant differences in patient characteristics between both groups. Loss of BRCA1 expression had 66.7% sensitivity, 84.3% specificity, 28.6% positive predictive value (PPV), and 96.4% negative predictive value (NPV) for detection of germline BRCA1 mutation. Meanwhile, loss of BRCA2 expression had 50% sensitivity, 78.8% specificity, 12.5% PPV, and 96.3% NPV for detection of germline BRCA2 mutation. There was no significant difference in survival outcomes between both groups. Based on high NPV, BRCA IHC may be useful to exclude patients without BRCA dysfunction if IHC showed intact expression. Only patients with BRCA IHC loss should be offered further genetic testing.

BRCA mutation in high grade epithelial ovarian cancers.

OBJECTIVE: To identify the frequency of BRCA mutation in patients with high grade epithelial ovarian cancer (EOC). METHODS: Patients with EOC included fallopian tube cancer or peritoneal cancer with high grade serous or high grade endometrioid were recruited. BRCA1 and BRCA2 mutations were tested and analyzed by next generation sequencing system. RESULTS: A total of 87 patients were recruited; majority of them (88.5%) were EOC, 5.7% fallopian tube cancer, 4.6% peritoneal cancer, and 1.1% synchronous primary ovarian and endometrial cancer. Seventy-four patients (85.1%) had high grade serous carcinoma and 13 patients (14.9%) had high grade endometrioid carcinoma. Germline BRCA mutation was detected in 19 patients (21.8%); 14 patients (16.1%) had BRCA1 mutation and 5 patients (5.7%) had BRCA2 mutation. All BRCA mutations were found in patients with high grade serous carcinoma (25.7%) but none in high grade endometrioid carcinoma. Six from 19 patients (31.6%) who had BRCA mutation had no family history of breast and ovarian cancers. Higher frequency of BRCA mutation was detected in patients with fallopian tube cancer; 3 in 5 patients (60%) followed by peritoneal cancer; 2 in 4 patients (50%), and EOC; 14 in 77 patients (18.2%). CONCLUSION: The frequency of BRCA mutation in high grade serous carcinoma was 25.7%, none was found in high grade endometrioid carcinoma. High cost, unavailability of genetic testing, limited number of geneticists, may be barriers in limited resource countries. Selected patients especially high grade serous carcinoma should be considered initially.

Role of P57KIP2 Immunohistochemical Expression in Histological Diagnosis of Hydatidiform Moles.

PURPOSE: To determine the significance of P57KIP2 immunohistochemistry expression in the histopathological diagnosis of hydatidiform mole. MATERIALS AND METHODS: Hydatidiform mole patients at King Chulalongkorn Memorial Hospital between January 1999 and December 2011 were recruited. Two gynecologic pathologists reviewed histopathologic slides to confirm diagnosis. Formalin-fixed, paraffin-embedded tissue sections were stained using a bstandard immunostaining system with monoclonal antibodies against P57KIP2 protein. Correlations among pathological features, immunohistochemical expression and clinical data were analyzed. RESULTS: One hundred and twenty-seven hydatidiform mole patients were enrolled. After consensus review, 97 cases were diagnosed as complet (CHM) and 30 cases as partial (PHM). Discordance between the first and final H and E diagnoses was found in 19 cases (14.9%, k= 0.578). Significant pathological features to classify the type of hydatidiform mole are central cisterns, trophoblastic proliferation, trophoblastic atypia, two populations of villi, fetal vessels and scalloped borders. After performing immunohistochemistry for P57KIP2, 107 cases were P57KIP2 negative and 20 cases positive. Discordant diagnoses between final H and E diagnosis and P57KIP2 immunohistochemistry was identified in 12 cases (9.4%). Sensitivity of final H and E diagnosis for CHM was 89.7%; specificity was 95.0%. PHM sensitivity and specificity of final H and E diagnosis was 95.0% and 89.7%, respectively. CONCLUSIONS: Histopathological diagnosis alone has certain limitations in accurately defining types of hydatidiform mole; P57KIP2 immunohistochemistry is practical and can be a useful adjunct to histopathology to distinguish CHM from non-CHM.

LINE-1 Methylation Patterns as a Predictor of Postmolar Gestational Trophoblastic Neoplasia.

OBJECTIVE: To study the potential of long interspersed element-1 (LINE-1) methylation change in the prediction of postmolar gestational trophoblastic neoplasia (GTN). METHODS: The LINE-1 methylation pattern from first trimester placenta, hydatidiform mole, and malignant trophoblast specimens were compared. Then, hydatidiform mole patients from 11999 to 2010 were classified into the following 2 groups: a remission group and a group that developed postmolar GTN. Specimens were prepared for a methylation study. The methylation levels and percentages of LINE-1 loci were evaluated for their sensitivity, specificity, and accuracy for the prediction of postmolar GTN. RESULTS: First, 12 placentas, 38 moles, and 19 malignant trophoblast specimens were compared. The hydatidiform mole group had the highest LINE-1 methylation level (p = 0.003) and the (u)C(u)C of LINE-1 increased in the malignant trophoblast group (p ≤ 0.001). One hundred forty-five hydatidiform mole patients were classified as 103 remission and 42 postmolar GTN patients. The %(m)C(u)C and %(u)C(m)C of LINE-1 showed the lowest p value for distinguishing between the two groups (p < 0.001). The combination of the pretreatment ß-hCG level (≥100,000 mIU/mL) with the %(m)C(u)C and %(u)C(m)C, sensitivity, specificity, PPV, NPV, and accuracy modified the levels to 60.0%, 92.2%, 77.4%, 83.8%, and 82.3%, respectively. CONCLUSIONS: A reduction in the partial methylation of LINE-1 occurs early before the clinical appearance of malignant transformation. The %(m)C(u)C and %(u)C(m)C of LINE-1s may be promising markers for monitoring hydatidiform moles before progression to GTN.

Comparison of Unsatisfactory Rates and Detection of Abnormal Cervical Cytology Between Conventional Papanicolaou Smear and Liquid-Based Cytology (Sure Path®).

PURPOSE: To compare unsatisfactory rates and detection of abnormal cervical cytology between conventional cytology or Papanicolaou smear (CC) and liquid-based cytology (LBC). MATERIALS AND METHODS: A total of 23,030 cases of cervical cytology performed at King Chulalongkorn Memorial Hospital during 2012-2013 were reviewed. The percentage unsatisfactory and detection rates of abnormal cytology were compared between CC and LBC methods. RESULTS: There was no difference in unsatisfactory rates between CC and LBC methods (0.1% vs. 0.1%, p = 0.84). The detection rate for squamous cell abnormalities was significantly higher with the LBC method (7.7% vs. 11.5%, p < 0.001), but those for overall abnormal glandular epithelium were similar (0.4% vs. 0.6%, p = 0.13). Low grade squamous lesion (ASC-US and LSIL) were more frequently detected by the LBC method (6.1% vs. 9.5%, p < 0.001). However, there was no difference in high gradd squamous lesions (1.1% vs. 1.1%, p = 0.95). When comparing between types of glandular abnormality, there was no significant difference the groups. CONCLUSIONS: There was no difference in unsatisfactory rates between the conventional smear and LBC. However, LBC could detect low grade squamous cell abnormalities more than CC, while there were similar rates of detection of high grade squamous cell lesions and glandular cell abnormalities.

Proportion of ovarian cancers in overall ovarian masses in Thailand.

BACKGROUND: The primary objective of this study was to assess the proportion of malignancies in ovarian masses during 1st January 2002, to 31st December 2011 at the Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital. A secondary objective was to evaluate associations with patients' clinical characteristics and ovarian malignancy proportion and subtypes. MATERIALS AND METHODS: Retrospective descriptive study analyzed data of ovarian masses larger than 3 centimeters in maximal diameter, from the division of Gynecologic Cyto-Pathology at KCMH. SPSS software version 17 (SPSS, Inc, Chicago, IL, USA) was used. RESULTS: A total number of 6,115 patients were included. Among the total ovarian masses studied, 13.7% were malignant. After the age of sixty, the proportion reached almost 40%. It was also above 20% in women younger than 20 years old. During premenarche period, proportion of ovarian malignancies was 50%. Only 1% of ovarian masses were found to be malignant during the pregnancy and post-partum periods. Parity decreasedthe probability of ovarian malignancy during postmenopausal years. Period of menopause did not have any impact on this probability. During the first two decades of life, germ cell malignancy dominated. As the age increased, the percentage of surface epithelial-stromal malignancy increased with a peak at the fifth decade. In contrast, malignant sex cord-stromal cell tumors occurred at a constant rate in each age group after the thirties. CONCLUSIONS: Proportion of ovarian cancers in each age group, menstrual and pregnancy status are similar. However there are differences in the distribution of ovarian subtypes especially for the surface epithelial- stromal category.

Use of human papillomavirus DNA, E6/E7 mRNA, and p16 immunocytochemistry to detect and predict anal high-grade squamous intraepithelial lesions in HIV-positive and HIV-negative men who have sex with men.

BACKGROUND: Men who have sex with men (MSM) are at high risk of having anal cancer. Anal high-grade squamous intraepithelial lesion (HSIL) is the precursor of anal cancer. We explored the use of different biomarkers associated with human papillomavirus (HPV) infection and HPV-mediated cell transformation to detect and predict HSIL among HIV-positive and HIV-negative MSM. METHODOLOGY/PRINCIPAL FINDINGS: A total of 123 HIV-positive and 123 HIV-negative MSM were enrolled and followed for 12 months. High-resolution anoscopy (HRA) with biopsies were performed at every visit along with anal sample collection for cytology, high-risk HPV DNA genotyping, HPV E6/E7 mRNA, and p16 immunocytochemistry. Performance characteristics and area under the receiver operator characteristics curve were calculated for these biomarkers at baseline, and Cox regression compared the usefulness of these biomarkers in predicting incident HSIL. High-risk HPV DNA, E6/E7 mRNA, and p16 immunocytochemistry each identified 43-46% of MSM whose baseline test positivity would trigger HRA referral. E6/E7 mRNA had the highest sensitivity (64.7%) and correctly classified the highest number of prevalent HSIL cases. With the exception of p16 immunochemistry, most tests showed significant increases in sensitivity but decreases specificity versus anal cytology, while the overall number of correctly classified cases was not significantly different. Baseline or persistent type 16 and/or 18 HPV DNA was the only test significantly predicting incident histologic HSIL within 12 months in models adjusted for HIV status and low-grade squamous intraepithelial lesions at baseline. CONCLUSIONS/SIGNIFICANCE: Countries with a high HIV prevalence among MSM and limited HRA resources may consider using biomarkers to identify individuals at high risk of HSIL. E6/E7 mRNA had the highest sensitivity for prevalent HSIL detection regardless of HIV status, whereas type 16 and/or 18 HPV DNA performed best in predicting development of incident HSIL within 12 months.

High prevalence and incidence of high-grade anal intraepithelial neoplasia among young Thai men who have sex with men with and without HIV.

BACKGROUND: Men who have sex with men (MSM) are at elevated risk of having anal cancer. However, the prevalence and incidence among MSM of high-grade anal intraepithelial neoplasia (HGAIN), the putative precursor of anal cancer, is understudied, particularly in Asians. METHODS: A total of 123 HIV-positive and 123 HIV-negative MSM were enrolled at the Thai Red Cross AIDS Research Centre in Bangkok, Thailand, and followed for 12 months. Anal sample collection for human papillomavirus (HPV) genotyping and high-resolution anoscopy (HRA) with biopsies were performed at every visit. RESULTS: Mean age at enrollment was 28.9 years. HIV-positive MSM were more commonly infected with high-risk HPV types in the anus than HIV-negative MSM (57.5 vs. 36.6%; P  =  0.001). The prevalence of HGAIN was 18.9% in HIV-positive and 11.4% in HIV-negative MSM (P  = 0.1). The incidence of HGAIN at 12 months was 29% in HIV-positive and 8% in HIV-negative MSM (P  =  0.001). The hazard ratios for incident HGAIN in multivariate models were 5.16 [95% confidence interval (CI) 1.89-14.08, P  < 0.001] in MSM with persistent HPV 16 and/or 18 infection and 2.62 (95% CI 1.04-6.61, P  =  0.042) in HIV-positive MSM. CONCLUSIONS: Approximately one-third of HIV-positive MSM developed incident HGAIN within 12 months. Given the relative increased prevalence of HIV among MSM worldwide, local HGAIN data are needed to guide practitioners, policy makers, and communities in planning for strategies to screen for and treat HGAIN in this population.

HOXA10 protein expression in the endometrium of normally menstruating women after receiving GnRH antagonist.

OBJECTIVE(S): To compare HOXA10 protein expression in the endometrium between natural control cycles and GnRH antagonist-treated cycles obtained during the window of implantation of normally menstruating women. STUDY DESIGN: This study was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Thirty-five volunteers were recruited into this prospective, self-controlled study, which was divided into two cycles, the first a natural control cycle and the second a GnRH antagonist-treated cycle. The two cycles were separated by one resting cycle. In the GnRH antagonist-treated cycle, when the leading follicle was 15 mm, ganirelix (Orgalutran®) 0.25mg was administered daily. In both cycles, ovulation was induced when the largest follicle reached 18 mm in diameter. Finally, endometrial biopsy was performed on day 6 after documented ovulation, which corresponds to the window of implantation. Endometrial HOXA10 protein expression, a marker of endometrial receptivity, was analyzed by immunohistochemistry. The protein expression was compared between the two cycles regarding their percentage of immunostained cells and IHC-scores (percentage of stained cells×intensity of nuclear staining). RESULTS: HOXA10 protein was exclusively localized in the stromal compartment of the endometrium. The percentage of HOXA10 nuclear staining in the endometrium collected from GnRH antagonist-treated cycles was higher than that of the natural cycles, whereas the IHC-scores showed no difference between the two cycles. CONCLUSION(S): GnRH antagonists may have no effect on HOXA10 protein expression in the endometrium obtained during the implantation window of normally menstruating women.

PTEN and MDM2 expression in the prediction of postmolar gestational trophoblastic neoplasia.

OBJECTIVE: To investigate the role of PTEN and MDM2 expression in hydatidiform mole in the prediction of postmolar gestational trophoblastic neoplasia (GTN). STUDY DESIGN: A total of 145 cases of hydatidiform mole were diagnosed at the King Chulalongkorn Memorial Hospital from 1999 to 2010. Patients were classified into 2 groups: spontaneous remission and patients with postmolar GTN. Clinicopathologic features and immunohistochemical staining by PTEN and MDM2 were reviewed. The results were analyzed in correlation to the clinical characteristics and outcomes. RESULTS: Of 145 recruited cases, 128 (88.3%) cases were complete hydatidiform mole (CHM) and 17 (11.7%) cases were partial hydatidiform mole (PHM). Postmolar GTN was clinically diagnosed in 42 cases (28.9%). The incidences of postmolar GTN following CHM and PHM were 29.7% and 23.5%, respectively. Mean age of the postmolar GTN group was significantly older than that of the remission group (31.2 vs. 27.8, p = 0.04). There was no significant difference of pathologic features between cases with remission and postmolar GTN. Immunoreactivity of PTEN and MDM2 were similarly present in trophoblastic cells of both CHM and PHM groups without significantly different patterns. CONCLUSION: Immunohistochemical expression of PTEN and MDM2 in hydatidiform mole cannot predict molar malignant transformation.

Obstetric and perinatal complications in placentas with fetal thrombotic vasculopathy.

Fetal thrombotic vasculopathy (FTV) is a placental lesion characterized by regionally distributed avascular villi and is often accompanied by upstream thrombosis in placental fetal vessels. Previous studies, using preselected populations, have shown associations of this lesion with adverse neurodevelopmental outcomes and potentially obstructive lesions of the umbilical cord. We investigated the prevalence of obstetric complications, perinatal disease, and placental abnormalities in cases with FTV. One hundred thirteen cases of placentas with FTV were identified in our pathology database over an 18-year period. Two hundred sixteen placentas without the diagnosis of FTV, frequency matched on year of birth, were selected as controls. Electronic medical records and pathology reports were used to extract maternal and gestational age, method of delivery, neonatal outcome, lesions of the umbilical cord, obstetric complications, and fetal abnormalities. Placentas with FTV were associated with a 9-fold increase in rate of stillbirth and a 2-fold increase in intrauterine growth restriction. The increase in pregnancy-induced hypertension/preeclampsia was not significant when adjusted for maternal and gestational age. Although the rate of potentially obstructive cord lesions was similar in both groups, there was an almost 6-fold increase in the presence of oligohydramnios in FTV placentas, compared with controls. Finally, FTV was associated with a 6-fold increase in fetal cardiac abnormalities. Fetal thrombotic vasculopathy is associated with a significantly higher rate of obstetric and perinatal complications. This study points to abnormal fetal circulation, either in the form of congenital heart disease or oligohydramnios predisposing to cord compression, as a risk factor for FTV.

Combination of cor triatriatum sinistrum and hypoplastic left heart syndrome in Meckel-Gruber syndrome: a case report.

Meckel-Gruber syndrome (MKS) is a fatal, autosomal recessive disorder characterized by malformation of central nervous system, particularly occipital encephalocele, bilateral renal dysplasia, and polydactyly. However, the clinical findings of this syndrome encompass various organ abnormalities as a result of genetic heterogeneity. The associated heart anomaly in MKS is inconstant. Its prevalence is rare and no striking or specific cardiac defects have been documented. We present a case of MKS with combined cor triatriatum sinistrum (left atrium divided into upper and lower compartment by a thin membrane) and hypoplastic left heart syndrome (underdeveloped mitral valve, left ventricle, and aorta) in a 33-week male fetus that was ultrasonographically detected and confirmed by autopsy. In addition to the cardiac defects, the patient was found to have postaxial polydactyly of 4 extremities, Dandy-Walker malformation, bilateral renal cystic dysplasia, and hepatic plate malformation. To the best of our knowledge, this is the first time that a combination of cor triatriatum sinistrum and hypoplastic left heart syndrome in MKS has been reported in the literature.

Human telomerase reverse transcriptase (hTERT) expression in borderline ovarian tumors: an immunohistochemical study.

OBJECTIVE: To investigate the expression of human telomerase reverse transcriptase (hTERT) in epithelial borderline ovarian tumor (BOT) by immunohistochemistry with correlation to clinicopathologic variables. MATERIAL AND METHOD: Paraffin-embedded tissue sections of 62 borderline ovarian tumors (47 mucinous, 14 serous, and 1 clear cell) and 12 epthelial ovarian carcinomas were immunostained with antibodies to hTERT. The intensity and quantity of the immunostaining was determined and analyzed with clinicopathological characteristics. RESULTS: hTERT expression was detected in 48.4% of BOT and all cases of epithelial ovarian carcinoma. In immunoreactive BOT 50% of cases were scored as high expression. Serous BOT had the highest rate of hTERT expression. There was no significant statistical difference of hTERT immunoreactivity between histologic types of BOT. No hTERT immunoreactivity was observed in the benign parts of the same slides of each immunoreactive case. hTERT immunoreactivity was positively correlated with FIGO stage (p = 0.04), but not with other variables. The mean follow-up time of BOT cases was 81.63 months and no recurrence or death was noted. CONCLUSION: hTERT expression was found in half of BOT and all of epithelial ovarian carcinoma. High hTERT expression was associated with FIGO stage.

Prenatal three-dimensional ultrasonography in a case of agnathia-otocephaly.

A case of prenatally diagnosed agnathia-otocephaly is reported. Agnathia is an extremely rare anomaly characterized by an absence or hypoplasia of the mandible and abnormal horizontal position of the ears. The targeted 2-D ultrasonography at 24 weeks of gestation revealed abnormal lower facial profile. Surface rendering 3-D ultrasonography was used to evaluate the facial feature, showing excellent image when compared to the fetal face at autopsy. The reported case is discussed with a short review of the literature.

Comparison between adenocarcinoma in both endocervical and endometrial specimens from fractional curettage and pathologic findings in subsequent hysterectomy specimens.

OBJECTIVE: To evaluate the hysterectomy specimen findings in the patients who underwent fractional curettage (F&C) with presence of adenocarcinoma in both endocervical and endometrial specimens. MATERIAL AND METHOD: Forty-one patients who had adenocarcinoma in both endocervical and endometrial specimens from F&C and underwent subsequent hysterectomy for surgical staging without pre-operative radiotherapy or chemotherapy at King Chulalongkorn Memorial Hospital between 1999 and 2007 were evaluated Histologic slides from both F&C and hysterectomy specimens were reviewed and assessed All cases of endometrial adenocarcinoma with cervical involvement (stage 2) in hysterectomy specimens were also assessed and compared to the results in F&C specimens. RESULTS: Fifteen patients (36.6%) with both positive endocervical and endometrial specimens from F&C were diagnosed as endometrial adenocarcinoma within uterine cavity with lower uterine segment involvement. Only 34.1% of cases were endometrial carcinomas with cervical involvement. In the 35 cases with endometrial carcinoma stage 2, 60% had adenocarcinoma in both endocervical and endometrial specimens from F&C. CONCLUSION: In the patients who had adenocarcinoma in both endocervical and endometrial specimens from fractional curettage, the most common final pathological diagnosis from hysterectomy specimens was endometrial adenocarcinoma within uterine cavity with lower uterine segment involvement. Therefore, only 60% of endometrial carcinoma stage 2 revealed positive adenocarcinoma in both endocervical and endometrial specimens from fractional curettage.