Tumor-Like Reaction to Polypropylene Mesh from a Mid-Urethral Sling Material Resembling Giant Cell Tumor of Vagina.

BACKGROUND: Polypropylene material is widely used in gynecological surgery. There are few reports regarding its carcinogenic potential. There is lack of evidence supporting tumor formation directly attributed to the use of polypropylene material. CASE: This patient is a 49-year-old woman with a history of stress urinary incontinence which required a MiniArc® Sling who presented with a hard, tender, immobile mass on the anterior vaginal wall. Pathological analysis of the mass revealed a tumor-like reaction to the polypropylene material that resembled a giant cell tumor of soft tissue. CONCLUSION: The use of polypropylene in surgery is ubiquitous across disciplines; thus consideration for a tumor-like reaction to the material should exist for patients who present with a mass near the surgical site.

Evolution of terminology for human-papillomavirus-infection-related vulvar squamous intraepithelial lesions.

OBJECTIVE: The aim of this study was to review the nearly 100-year evolution of terminology applicable to oncogenic human papillomavirus (HPV)-related vulvar intraepithelial squamous lesions and present current consensus terminology. METHODS: An extensive literature search of the English language was performed, which included articles that reviewed French and German publications, from 1922 to 2012. The database search was assisted by representatives of the American Society for Colposcopy and the College of American Pathologists as part of a comprehensive study and consensus effort to achieve unified terminology among gynecologists, dermatologists, pathologists, and other related experts to develop for reporting female and male lower genital and anal HPV related squamous lesions. This was done by the committee referred to as the "LAST" Committee. Some of the results and conclusions have been previously presented and published. This presentation is specifically related to vulvar squamous intraepithelial lesion (SIL)/vulvar intraepithelial neoplasia terminology. RESULTS: This work will review past terminology related to HPV-related vulvar SIL, beginning in 1922. The most current terminology will be presented as proposed by the LAST Committee and considered by the World Health Organization this year in accord with the US-Canadian Academy of Pathology. CONCLUSIONS: A consensus of terminology for HPV-related vulvar SIL has been sought for some time, and currently, some consensus has been achieved. The term "squamous intraepithelial lesion" is favored over "intraepithelial neoplasia." A 2-tier classification, of "high grade (HSIL)" or "low grade (LSIL)," is favored over a 3- or 4-tier classification. The application of this terminology will be discussed.

Gynecologic Cancer Intergroup (GCIG) consensus review for ovarian germ cell tumors.

Most women diagnosed with malignant ovarian germ cell tumors have curable disease and experience excellent survival with manageable treatment-associated morbidity, related both to tumor biology and improvements in treatment over the last 4 decades. Malignant ovarian germ cell tumors occur predominantly in girls, adolescents, and young women and are often unilateral tumors of early stage, although advanced-stage disease occurs in approximately 30% of patients. Tumors are usually chemosensitive, thereby allowing fertility-sparing surgery in most women with high chance of cure. Differences in practice do exist among providers in various subspecialties and geographic areas. In most settings, collaborative efforts among specialties allow the optimal treatment of women with these rare tumors, and implementation of standard guidelines at an international level should translate to effective clinical trial design, rapid accrual to clinical trials, and universally improved patient outcomes. This consensus guideline represents a summary of recommendations for diagnosis and management that has been agreed upon by cooperative groups worldwide. It builds upon individual publications including previously published summary documents and provides the most current practice standards validated worldwide.

A tissue basis for colposcopic findings.

Colposcopic changes are related to the variable degrees of white light that are absorbed and reflected by the cervix. The interface between the surface and the underlying vascular stroma consists of cells with variable amounts of nuclei and cytoplasm. Changes in the cell microanatomy, as well as microvessel growth related to different normal and abnormal cervical environments will dictate the color and vascular appearance of the colposcopically viewed cervix.

A brief history of lower genital tract screening.

The history of lower genital tract screening covers discoveries that occurred in the middle of the last century and involves methodologies (cytologic and non-cytologic techniques) that, for decades, were independently used by different global regions. At present, cytologic testing has become an initial screening test, and non-cytologic testing (colposcopy and iodine application) has evolved into the secondary diagnostic test for selected individuals. In the future, tests that are less subjective and more specific may enhance or eventually replace these methodologies, whereas prevention may become as important as screening.

Primary synovial sarcoma.

PURPOSE: To describe the clinicopathologic and immunohistochemical features and treatment of a rare case of primary synovial sarcoma of the orbit. DESIGN: Retrospective interventional case report. PARTICIPANT: A 14-year-old young man with histologically proven synovial sarcoma of the orbit. The diagnosis was confirmed by demonstration of a specific chromosomal translocation by polymerase chain reaction studies. METHODS: The patient was treated with orbital exenteration and followed up for 18 months at regular intervals. RESULTS: The tumor was excised completely, and the patient has done well during the initial 1-year follow-up with no sign of recurrence. CONCLUSIONS: We report the fourth case of synovial sarcoma of the orbit and, at 14 years of age, the youngest patient reported.

Tubal gestation and schistosomiasis: a case report.

BACKGROUND: Schistosomal infections of the female reproductive tract are common in countries where the parasite is endemic. Serious complications, such as ectopic pregnancy and infertility, may arise in patients with gynecologic schistosomiasis. CASE: A primiparous, African woman presented with vaginal bleeding and was found to have an ectopic pregnancy. Laparoscopy revealed distorted pelvic anatomy due to dense adhesions. Pathologic examination confirmed an ectopic pregnancy and identified Schistosoma haematobium ova in the patient's fallopian tube. Urine examination was confirmatory, and the patient was treated and referred for fertility counseling. CONCLUSION: Clinicians should consider schistosomiasis as a possible etiology for gynecologic complaints, including serious complications such as ectopic pregnancy and infertility, in patients from endemic regions.

Randomized comparison of weekly cisplatin or protracted venous infusion of fluorouracil in combination with pelvic radiation in advanced cervix cancer: a gynecologic oncology group study.

PURPOSE: Concurrent chemoradiotherapy is the standard of care for locally advanced cervix cancer; the optimal chemotherapy regimen is not yet defined. This trial was designed to compare the outcome of protracted venous infusion (PVI) fluorouracil (FU) with standard weekly cisplatin and concurrent radiation therapy (RT). PATIENTS AND METHODS: Patients with stage IIB, IIIB, and IVA cervical cancer with clinically negative aortic nodes were eligible. Pelvic RT dose was 45 Gy with a parametrial boost to involved sides of 5.4 to 9 Gy, and high- or low-dose rate intracavitary brachytherapy. Standard therapy was weekly cisplatin 40 mg/m2, and experimental therapy was PVI FU 225 mg/m2/d for 5 d/wk for six cycles during RT. RESULTS: The study was closed prematurely when a planned interim futility analysis indicated that PVI FU/RT had a higher treatment failure rate (35% higher) and would, most likely, not result in an improvement in progression-free survival compared with weekly cisplatin/RT. The PVI FU/RT arm continues to show a higher risk of treatment failure (relative risk [RR] unadjusted, 1.29) and a higher mortality rate (RR unadjusted, 1.37). There was no difference in pelvic treatment failure between regimens, but there was an increase in the failure rate at distant sites in the PVI FU arm. CONCLUSION: In this study, PVI FU does not show improved outcome over weekly cisplatin. Future research should explore combinations of FU with cisplatin, new radiosensitizers, and active drugs combined with RT to reduce the high rate of pelvic and distant treatment failure still seen in advanced cervix cancer.

Lymphoblastic Leukemia With Mature B-Cell Phenotype in Infancy.

Lymphoblastic leukemias with surface immunoglobulin light chain expression and L1/L2 blast morphology (French-American-British Classification) are rare. The poor prognosis of lymphoblastic leukemia in children under 1 year of age is attributed largely to rearrangements involving the mixed lineage leukemia (mll, also known as all1, htrx, trx1, or hrx) gene that occur with increased frequency in this population. Mll-rearranged cases with a mature B-cell phenotype are rare. The authors describe an infant with mature B-cell lymphoblastic leukemia with an mll rearrangement and L1/L2 cytomorphology and discuss the clinical, genetic, and immunophenotypic features in the context of previously reported cases.

Lymphoblastic leukemia with mature B-cell phenotype in infancy.

Lymphoblastic leukemias with surface immunoglobulin light chain expression and L1/L2 blast morphology (French-American-British Classification) are rare. The poor prognosis of lymphoblastic leukemia in children under 1 year of age is attributed largely to rearrangements involving the mixed lineage leukemia (mll, also known as all1, htrx, trx1, or hrx) gene that occur with increased frequency in this population. Mll-rearranged cases with a mature B-cell phenotype are rare. The authors describe an infant with mature B-cell lymphoblastic leukemia with an mll rearrangement and L1/L2 cytomorphology and discuss the clinical, genetic, and immunophenotypic features in the context of previously reported cases.

Measurement of endocervical canal extension of the transformation zone on fresh hysterectomy specimens.

OBJECTIVE: Determine the extent of endocervical canal extension of the transformation zone on fresh hysterectomy specimens. MATERIALS AND METHODS: After removal for standard gynecologic indications, 201 uteri were evaluated in the pathology accessioning area of a community hospital before formalin fixation. Uteri were opened in standard fashion. The length of the endocervical canal and the distance from the external cervical os to the most cranial extension of the squamocolumnar junction (SCJ) into the canal were measured grossly to the nearest millimeter. Patient age, menopausal status, and indication for surgery were extracted from the pathology consultation sheet. RESULTS: The upper limit of the SCJ was located within the canal in 188 of 201 cases (93.5%), including 152 of 162 premenopausal cases (93.8%), 25 of 27 postmenopausal cases (92.6%), and 11 of 12 cases of unknown postmenopausal status (91.7%). The mean distance of SCJ extension was 3.8 mm (SD, 2.5 mm), with a trend toward a shorter distance in the postmenopausal women. The SCJ distance was > or =10 mm in 5 of 188 women (2.7%), all of whom were premenopausal, and > or =5 mm in 41 of 188 women (21.8%). Among women with SCJ extension into the canal, the mean canal length was 33.2 mm (SD, 5.4 mm) for the premenopausal women and 28.3 mm (SD, 5.6 mm) for the postmenopausal women (p < .001). CONCLUSIONS: Postmenopausal status and advancing age were not associated with an increased depth of the SCJ into the endocervical canal. The high rates of unsatisfactory colposcopy reported for postmenopausal women are more likely the result of anatomic changes precluding visualization of the canal rather than the skill of the colposcopist. A device designed to detect cervical intraepithelial neoplasia within the cervical canal should be capable of evaluating to a depth exceeding 5 mm.

Initial neural net construction for the detection of cervical intraepithelial neoplasia by fluorescence imaging.

OBJECTIVE: The aim of this study was to initiate neural net construction for the detection of cervical intraepithelial neoplasia by fluorescence imaging. STUDY DESIGN: Thirty-three women with abnormal Papanicolaou smears underwent fluorescence imaging during colposcopy. With the use of >4000 training pixels and >1000 test pixels, intrapatient nets were constructed from the spectral data of 17 women. An interpatient net that discriminated between cervical intraepithelial neoplasia 1 and normal tissue classes among patients was constructed with the use of >2300 training pixels and >2000 test pixels from 12 women. Average correct classification rates were determined. Sensitivities, specificities, and positive and negative predictive values for cervical intraepithelial neoplasia grade 1 and normal tissue classes were calculated. Extrapolated false-color cervical images were generated. RESULTS: Average correct classification rates were 96.5% for the intrapatient nets and 97.5% for the interpatient net. The sensitivity, specificity, and positive and negative predictive values for cervical intraepithelial neoplasia grade 1 were 98.2%, 98.9%, 71.4%, and 99.9%, respectively. CONCLUSION: Initial results suggest that neural nets that are constructed from fluorescence imaging spectra may offer a potential method for the detection of cervical intraepithelial neoplasia.

Discrepancy in the interpretation of cervical histology by gynecologic pathologists.

OBJECTIVE: To determine if subspecialty review of cervical histology improves diagnostic consensus of cervical intraepithelial neoplasia (CIN). METHODS: After routine histologic assessment within the hospital pathology department, 119 colposcopic cervical biopsies were interpreted by two subspecialty-trained gynecologic pathologists (GYN I and GYN II) blinded to each other's interpretations and to the interpretations of the hospital general pathologists (GEN). Biopsies were classified as normal (including cervicitis), low grade (LG, including CIN I and human papillomavirus changes), and high grade (HG, including CIN II/III). The interobserver agreement rates between GEN and GYN I, between GEN and GYN II, and between GYN I and GYN II were described using the kappa statistic. The proportions of biopsies assigned to each biopsy class were compared using McNemar test. RESULTS: Interobserver agreement rates between GEN and GYN I were moderate for normal (kappa = 0.53) and LG (kappa = 0.46) and excellent for HG (kappa = 0.76). There were no significant differences in the classifications between GEN and GYN I. Interobserver agreement rates between GEN and GYN II were moderate for normal (kappa = 0.50) and LG (kappa = 0.44) and excellent for HG (kappa = 0.84). Also, GYN II was significantly more likely to classify biopsies as normal (P <.001) and less likely to classify biopsies as LG (P <.001). The interobserver agreement rates between GYN I and GYN II were moderate for normal (kappa = 0.61) and LG (kappa = 0.41) and excellent for HG (kappa = 0.84). Also, GYN II was significantly more likely to classify biopsies as normal (P <.001) and less likely to classify biopsies as LG (P =.01). CONCLUSION: Interobserver agreement between two gynecologic pathologists was no better than that observed between general and gynecologic pathologists. Subspecialty review of cervical histology does not enhance diagnostic consensus of CIN.