Stromal invasion pattern identifies patients at lowest risk of lymph node metastasis in HPV-associated endocervical adenocarcinomas, but is irrelevant in adenocarcinomas unassociated with HPV.

OBJECTIVE: The Silva invasion pattern-based classification system stratifies endocervical adenocarcinomas (ECAs) into 3 categories corresponding to risk of metastasis and recurrence, but has only been evaluated for HPV-associated ECAs of usual type. We examined whether the Silva system is applicable to all endocervical adenocarcinomas, especially those not associated with HPV. METHODS: Complete slide sets from 341 surgical specimens of ECA were collected from 7 institutions worldwide. All specimens were associated with clinical records covering at least 5 years of follow-up. Tumors were classified as HPV-associated (HPVA) or not (NHPVA) by both morphology and detection of HPV using in situ hybridization. Recurrence and survival were analyzed by multivariate Mantel-Haenszel methods. RESULTS: Most specimens (292; 85.6%) were HPVA, while 49 (14.3%) were NHPVA. All NHPVAs were Silva pattern C, while 76.0% of HPVAs were pattern C, 14.7% pattern A, and 9.3% pattern B. Including both HPVAs and NHPVAs, lymphovascular invasion (LVI) was detected in 0% of pattern A, 18.5% of pattern B and 62.6% of pattern C cases (p < 0.001). None of the pattern A or B cases were associated with lymph node metastases (LNM), in contrast to pattern C cases (21.8%). Among patients with Silva pattern C ECA, those with HPVA tumors had a lower recurrence rate and better survival than those with NHPVA; however, when adjusted for stage at diagnosis, the difference in recurrence and mortality was small and not statistically significant. CONCLUSIONS: Application of the Silva system is only relevant in HPVA cervical adenocarcinoma.

[Axillary lymph node metastases in breast cancer. Anatomo-clinical correlation and surgical approach]. / Metastazele ganglionare limfatice axilare în cancerul mamar. Corelatii anatomo-clinice si atitudine chirurgicala.

AIM: To establish the incidence of the axillary lymph node metastasis in breast cancer and some anatomo-clinical correlations useful for surgical act orientation. MATERIAL AND METHOD: The data from 450 patients, who underwent surgery for breast cancer between 2000 and 2007, were analyzed statistically according to some parameters: the age of the patients, the size and the location of the tumor, the hystopathological type, the elapsed time from the discovery of the tumor until surgery. RESULTS: The tumoral stage was: stage 0--1.1%, I--7.11%, II--50.67%, III--33.78%, IV--7.33%. From the total amount of patients who underwent surgery, only 56.44% had axillary lymph node metastasis. The patients in the forth decade of life had more frequently axillary lymph node involvement, and also those from rural habitat (65.88%). The correlation between tumor dimension and lymph node involvement was: <2 cm--1.36%, 2-5 cm--48.71%, >5 cm--86.67%. The palpation of the armpit was associated in almost a quarter of cases with false negative or false positive diagnosis. There are a lot of locally advanced cases without axillary lymph node metastases. CONCLUSIONS: Axillary lymph node status is strongly correlated with the tumor dimension and the elapsed time between diagnosis and treatment. The numerous cases of axillary lymphadenectomy without lymph node metastases (43.55%), even in locally advanced cases, advocate for a wider application of lymphatic mapping and sentinel lymph node biopsy, to avoid the pathology associated with those axillary dissections.

Uterine adenosarcomas overgrown by sex-cord-like tumour: report of two cases.

Müllerian adenosarcomas are tumours of low malignant potential with proliferation of benign glands and low grade endometrial stromal sarcoma (LGESS). Unusually, the latter may include foci of uterine tumours resembling ovarian sex-cord tumours (UTROSCT). Two cases of uterine adenosarcomas massively overgrown by UTROSCT are reported, for the first time. The patients, aged 71 and 64, one receiving tamoxifen, presented with intracavitary polypoid adenosarcomas; each was overgrown by an immunopathologically characteristic UTROSCT that constituted more than 75% of its volume. Periglandular CD10+LGESS represented less than 25%. Both are alive and well after 5 and 3 years, respectively. Compared to the poor prognosis of adenosarcomas overgrown by high grade sarcomata, the cases reported here had a benign behaviour. Quantitative assessment of volume percentage of the potentially aggressive LGESS, CD10+ areas should be considered as a relevant prognostic histological parameter in these tumours.

[Rare association--luetic interstitial keratitis and sarcoidosis granulomatous uveitis. Case report]. / Asociere rara--cheratita interstitiala sifilitica si uveita granulomatoasa sarcoidozica. Caz clinic.

The goal of this article is to present a clinical case, being particular by the existence of keratitis at a patient who was diagnosed after histological exam of the ocular contents with sarcoidosis granulomatous uveitis. We try to review some aspects characteristic to sarcoidosis, disease which returns in our attention due to the high frequency of uveitis and that's why it deserves a special place in etiology of uveitis.

[Orbital mesenchymal tumors--orbital fibrous histiocytoma. Their clinical and histopathological aspects]. / Tumori mezenchimale orbitare--histiocitomul fibros orbitar. Aspecte clinice si histopatologice.

Histiocytoma is a tumor with mesenchymal etiology, whose primary orbital form is very rare. (1) Although it is a benign tumor, there have been written--in a few cases--it's metastatic forms too. This article describes the case of a female patient with this tumor which had been extirpated successfully and without any recurrences till now. The disease had been appeared with a chronic sphenoidal and maxillary sinusitis. At the same time there are described the latest concepts about these tumors' etiology, classification and their treatment.

[The relationship between benign breast proliferation (fibrocystic mastopathy) and the appearance of breast carcinoma]. / Corelatia între leziunile proliferative benigne ale sânului (mastopatia fibrochistica) si aparitia carcinomului mamar.

Fibrocystic mastopathy (FM), a benign lesion, is considered by many author like a premalignant lesion. Breast carcinoma (CA) represents the most frequent female tumor and the second mortality cause through cancer, after the bronchopulmonary cancer. At the Department of Pathology from Tg. Mures, we selected 190 cases, for 10 month: 102 presented FM, 41 CA and 47 CA + FM. In every case, we have examined 2 slides stained with HE. In difficult cases, we performed special stains (van Gieson, H-PAS, Alcian). We studied the pulmonary tumor, adjacent mammary tissue and axillary lymph nodes. The present data of literature and the experience of the Department of Pathology from Tg. Mures showed a strong relationship between the presence of FM and the appearance of CA: both lesions have a common field of hormonal disfunction and intraductal and intralobular hyperplasia (an microscopic feature of mastopathy) increase the risk of CA.