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.

Heterologous type of malignant mixed Müllerian tumor of the uterus presenting as a vulvar mass.

Carcinosarcoma is a rare, extremely aggressive tumor of the uterus with a poor prognosis. The authors describe a case of a 78-year-old woman who presented with a giant mass protruding through the cervix, vagina, and vulva. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The histopathological examination of the surgical specimen revealed a malignant mixed Müllerian tumor. The clinical and pathological features, molecular data, and prognosis of this aggressive neoplasm are discussed. Although uterine carcinosarcomas are extremely rare, when a postmenopausal woman with a vulvar mass is admitted to the gynecology clinic, the physician should consider that the mass may be a carcinosarcoma.

[Tamoxifen and endometrial pathology]. / Tamoxifenul si modificarile endometriale.

UNLABELLED: Tamoxifen is a non-steroid antiestrogen, used as adjuvant therapy for breast carcinoma in women with positive estrogen receptor (ER+). In this report we evaluated endometrial histological changes in women treated with Tamoxifen for ER+ breast carcinoma. MATERIAL AND METHOD: We performed transvaginal ultrasonography for the endometrial thickness and biopsy of endometrium on a group of 125 symptomatic women with Tamoxifen therapy for ER+ breast carcinoma. The endometrial specimens were histologically processed for histological diagnosis. RESULTS: Of all patients, 49.6% had endometrial pathology (women with functional hemorrhage), and 32% had atrophic endometrium. Endometrial pathology was represented by endometrial simple hyperplasia 17.6%, and endometrial complex hyperplasia 8.8%. Endometrial complex hyperplasia with atypia was found in 5.6%, endometrial polyps in 11.2%, endometrial carcinoma in 4.8% and müllerian mixt tumor in 1.6%. CONCLUSIONS: Endometrial pathology was more likely to be diagnosed in gynecological symptomatic postmenopausal and premenopausal women with breast carcinoma treated with Tamoxifen. Therefore, it is necessary that these patients to be supervise, first, with transvaginal ultrasonography for endometrium, and after, with biopsy of endometrium. All patients on long-term Tamoxifen therapy should be annually screened by endometrial biopsy for endometrial pathology.