Unusual nonrefractile eosinophilic crystal in breast ducts in a patient with invasive mucinous carcinoma.

A 72-year-old, G4P2 white woman presented with a recent abnormal mammogram showing a nodule at 8 o'clock of her right breast and indeterminate calcification in the subareolar region. An initial stereotactic core followed by wide local excision and sentinel node biopsy showed a pT1aN0(sn)M(na) low-grade invasive mucinous carcinoma. In dilated benign ducts, adjacent to the carcinoma, numerous eosinophilic, nonrefractile crystals were identified.

Clear cell carcinomas of the mullerian system: does the pathogenesis vary depending on their nuclear grade and their association with endometriosis? An immunohistochemical analysis.

UNLABELLED: Clear cell carcinomas (CCC) of the mullerian system are considered high grade tumors, but morphologically, the cells of CCC show both low and high grade features. The aims of the current study were to categorize CCC into low and high nuclear grade types, correlate their association with endometriosis, and then observe possible variations in pathogenesis based on their expression of p53 and Ki-67. We studied 41 pure mullerian CCCs and designated each as either a high (HNG) or low (LNG) nuclear grade tumor. Morphologically, 17 (41%) CCCs were LNG and 24 (59%) were HNG. Nine (38%) HNG and 2 (12%) LNG tumors showed positive immunostaining with p53. Endometriosis was associated with 8 (47%) LNG tumors and 8 (33%) HNG CCCs. Of the 11 cases with p53 alteration, 4 (1 LNG and 3 HNG) were associated with endometriosis. CONCLUSIONS: HNG CCCs, irrespective of their association with endometriosis, have alterations of p53. In general, LNG ovarian and endometrial CCCs, irrespective of their association with endometriosis/adenomyosis, are less likely to show p53 alteration. It appears that mullerian CCCs may have variable pathogenesis depending on their nuclear grade and association with endometriosis. A larger study is needed to validate these findings.

For women receiving chemotherapy for clinically apparent early ovarian cancer, is there a benefit to surgical staging?

BACKGROUND: For women with early stage ovarian cancer (ESOC), comprehensive staging is the standard of care and studies suggest that these patients may not require further treatment. For women with incidentally diagnosed ovarian cancer there is a lack of consensus as to whether surgical staging be performed, particularly if chemotherapy is recommended. OBJECTIVE: We performed this retrospective study to determine the outcomes of women treated with chemotherapy for clinically apparent ESOC, stratified by whether staging was performed or not. METHODS: This study was approved by institutional review board. All patients presenting to the Multidisciplinary Gynecologic Oncology Tumor Board between 1998 and 2005 with a consensus opinion of having clinically apparent ESOC were identified. Staging (partial or complete) was determined by a study pathologist and patients were stratified as being staged or unstaged. Survival was estimated using the Kaplan-Meier method. STATA 8.0 was used for all calculations. RESULTS: Eighty-eight patients were identified: 52 (59%) were staged and 36 (31%) were not. Median follow-up was 50 and 59.5 months, respectively. The majority of patients received carboplatin and paclitaxel in both cohorts with a median of 6 cycles. Five-year Disease Free Survival was 85% versus 80%, respectively (P = 0.54). Five-year Overall Survival was 85% versus 88% (P = 0.688). CONCLUSION: For women presenting with a clinically apparent ESOC in whom chemotherapy is administered, there does not seem to be an additional benefit to surgical staging. A prospective trial of women with clinically apparent ESOC to test this hypothesis should be considered.