RESUMEN
Tumor cells are occasionally observed in the lumen in histologic sections of the fallopian tube from women with gynecologic cancer. There is some evidence that this finding may be important in endometrial cancer, but its significance is unknown in women with extrauterine pelvic serous carcinomas (tubo-ovarian high-grade serous carcinoma). Fallopian tube sections from 213 women with extrauterine pelvic serous carcinoma were reviewed, and luminal tumor cells were correlated with clinical and pathologic features. Intraluminal tumor cells were found in 84 patients (39%). The presence or absence of luminal tumor cells correlated significantly with serous tubal intraepithelial carcinoma (52% and 33%, respectively, P=0.004), tubal lymphatic invasion (32% and 12%, respectively, P=0.0002), and number of tube sections reviewed (6.6 and 4.9 for lumen-positive and lumen-negative cases, respectively, P=0.0056). There was no correlation with the presence of ascites, peritoneal cytopathologic findings, lymph node metastases, or FIGO stage. In the setting of pelvic serous carcinoma, a substantial portion of fallopian tube tissue is often distorted, fibrotic, and difficult to identify. Since the identification of luminal tumor cells, serous tubal intraepithelial carcinoma and tubal lymphatic invasion all depend on identification of fallopian tube tissue, these correlates with luminal tumor cells could be a result of a higher likelihood of their observation when tubal tissue can be more readily identified and may not necessarily reflect a biologically important phenomenon. It remains unclear whether and in what proportion this finding reflects an artifact of specimen handling.
Asunto(s)
Carcinoma in Situ/patología , Neoplasias de las Trompas Uterinas/patología , Neoplasias Ováricas/patología , Neoplasias Pélvicas/patología , Artefactos , Trompas Uterinas/patología , Femenino , Humanos , Metástasis Linfática , Pelvis/patologíaRESUMEN
The majority of extrauterine high-grade serous carcinomas are believed to arise in the fallopian tube as serous tubal intraepithelial carcinomas. The primary mode of metastasis is intraperitoneal, and patients usually present with peritoneal carcinomatosis. Although the tubes have a rich lymphatic network, tubal lymphatic invasion is observed in only a minority of cases. Fallopian tube sections from 222 patients with advanced stage high-grade extrauterine serous carcinoma were reviewed and lymphatic invasion within the lamina propria and myosalpinx were assessed. Seventeen patients were FIGO stage II, 162 stage III, and 43 stage IV. Tubal lymphatic invasion was identified in 44 cases (19.7%). Among the cases with lymphatic invasion, nonfimbrial lamina propria, fimbrial lamina propria, and myosalpingeal lymphatic invasion were present in 23 (52%), 21 (48%), and 21 (48%), respectively. Among cases with lymphatic invasion, 16 (36%) were FIGO stage IV, while among cases without lymphatic invasion, 27 (15%) were stage IV (P=0.0014, χ). In summary, in women with advanced stage high-grade extrauterine serous carcinoma, lymphatic invasion in the fallopian tube is uncommon, and is more than twice as likely to be associated with distant metastases as compared with those without tubal lymphatic invasion.
Asunto(s)
Cistadenocarcinoma Seroso/patología , Neoplasias de las Trompas Uterinas/patología , Metástasis Linfática/patología , Invasividad Neoplásica/patología , Femenino , Humanos , Estudios RetrospectivosRESUMEN
Noninvasive ovarian low-grade serous tumors [atypical proliferative serous tumor (APST)/serous borderline tumor] appear to progress to invasive low-grade serous carcinoma (LGSC) at a low but regular rate. The underlying biology of this phenomenon is unknown. We studied 18 patients with 30 ovarian tumors (12 bilateral), including APST, noninvasive LGSC and invasive LGSC, who also had low-grade serous carcinomatosis. Tumors were evaluated for microinvasion (usual eosinophilic cell type), microinvasive carcinoma (<5 mm invasion of micropapillary nests), and overt carcinoma (≥5 mm invasion of micropapillary nests). Tumors were evaluated based on the original numerical order of sections under the hypothetical scenarios in which sampling was stopped at 1 section/cm and 2 sections/cm. Sampling based on 1 section/cm of greatest tumor dimension identified invasion of any type in 21 tumors (70%). Among these 21 tumors, 10 had microinvasive carcinoma, and 11 overt carcinoma. Sampling based on 2 sections/cm identified microinvasive carcinoma in 9 tumors and overt carcinoma in 14 tumors. With increased sampling from 1 to 2 sections/cm, the diagnosis in 3 tumors would have changed from microinvasive carcinoma to overt carcinoma, and in an additional 2 tumors from APST to APST with microinvasive carcinoma. Sampling based on >2 sections/cm changed the diagnosis in 1 additional case of APST with microinvasive carcinoma to overt carcinoma. These findings support that undetected (unsampled) occult invasion in the primary ovarian tumors is a likely explanation for some cases of apparent progression of noninvasive low-grade serous ovarian tumors to invasive LGSC. To minimize undetected occult invasion, consideration of sampling noninvasive low-grade ovarian serous tumors with at least 2 sections/cm of maximum tumor diameter may be warranted. The eosinophilic cell type of microinvasion, or microinvasive carcinoma, regardless of size, should prompt further sampling to identify overt carcinoma. The eosinophilic type of microinvasion was never seen alone in this cohort and by itself may be biologically insignificant.
Asunto(s)
Cistadenoma Seroso/genética , Cistadenoma Seroso/secundario , Neoplasias Ováricas/genética , Neoplasias Ováricas/patología , Neoplasias Peritoneales/genética , Neoplasias Peritoneales/secundario , Adulto , Anciano , Biopsia , Progresión de la Enfermedad , Femenino , Heterogeneidad Genética , Humanos , Persona de Mediana Edad , Clasificación del Tumor , Invasividad Neoplásica , Estadificación de NeoplasiasRESUMEN
Ovarian epithelial inclusions lined by mucinous epithelium are rare and of uncertain origin. Ovaries containing such inclusions were studied in 42 women. The inclusions were divided into 3 groups: serous epithelial lined with typical ciliated morphology but with distinct basophilic cytoplasmic mucin in some or all of the lining cells, those lined by typical mucinous epithelium, and those lined by a combination of typical mucinous epithelium and serous epithelium. The mean patient age was 61.5 years. Pure mucinous inclusions were found in 27 patients, serous-type inclusions with cytoplasmic mucin in 20, and mixed type in 10. All 3 types of inclusions were found in 1 patient. Two types of inclusions were found in 13. Four patients had associated mucinous neoplasms (1 mucinous cystadenoma, 1 atypical proliferative seromucinous tumor, and 2 seromucinous cystadenomas), and 11 patients (26%) had endometriosis. The fallopian tubes in 4 patients (9.5%) also displayed mucinous metaplasia; this was not significantly different from the 3.1% we found in our previously reported series of unselected tubes from the same population. These findings suggest that mucinous inclusions may arise as a direct metaplastic change in serous-type inclusions. Other possible origins of mucinous inclusions in the ovarian cortex include endometriosis and Brenner (transitional cell) nests. Whether such inclusions can be a source of mucinous ovarian neoplasms as are Brenner tumors and mature cystic teratomas is unknown and may warrant further investigation.
Asunto(s)
Cuerpos de Inclusión/patología , Ovario/patología , Adulto , Anciano , Anciano de 80 o más Años , Cistoadenoma Mucinoso/patología , Hiperplasia Endometrial/patología , Hiperplasia Endometrial/cirugía , Neoplasias Endometriales/patología , Neoplasias Endometriales/cirugía , Epitelio/química , Epitelio/patología , Trompas Uterinas/patología , Femenino , Humanos , Cuerpos de Inclusión/química , Persona de Mediana Edad , Mucinas/análisis , Neoplasias Ováricas/patología , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/cirugíaRESUMEN
Most non-neoplastic lesions of the ovaries have not been comprehensively examined in the contemporary literature. We evaluated completely embedded ovaries from 403 unselected, consecutive patients who had grossly normal adnexa. These included prophylactic specimens in high-risk women with BRCA mutations (38 women) and women with a personal history of breast cancer or a family history of breast and/or ovarian cancer (79 women). Transitional cell (Brenner) nests were found in 9.1%; 31% of these lesions were smaller than 1 mm, and 8 were solitary nests. Cortical granulomas were found in 20.5%, fatty metaplasia in 5.3%, mucinous metaplasia of surface epithelial inclusions in 5.5%, and smooth muscle stromal metaplasia in 2%. One or more types of stromal hyperplasia were found in 24.3%. Endometriosis was found in 22% of adnexa. There were no significant differences in the findings in high-risk women compared with non-high-risk except those attributable to age differences between the groups. These findings establish baseline frequencies for non-neoplastic ovarian lesions, and suggest that transitional cell nests are so common that they can be regarded as a normal finding.
Asunto(s)
Anexos Uterinos/patología , Enfermedades del Ovario/epidemiología , Enfermedades del Ovario/patología , Adulto , Distribución por Edad , Anciano , Femenino , Humanos , Incidencia , Persona de Mediana EdadRESUMEN
Serous tubal intraepithelial carcinoma (STIC), the putative precursor of the majority of extrauterine high-grade serous carcinomas, has been reported in both high-risk women (those with a germline BRCA mutation, a personal history of breast carcinoma, and/or family history of breast or ovarian carcinoma) and average risk women from the general population. We reviewed grossly normal adnexal specimens from 388 consecutive, unselected women undergoing surgery, including those with germline BRCA mutation (37 patients), personal history of breast cancer or family history of breast/ovarian cancer (74 patients), endometrial cancer (175 patients), and a variety of other conditions (102 patients). Among 111 high-risk cases and 277 non-high-risk cases, 3 STICs were identified (0.8%), all in non-high-risk women (high risk vs. non-high risk: P=not significant). STIC was found in 2 women with nonserous endometrial carcinoma and 1 with complex atypical endometrial hyperplasia. Salpingoliths (mucosal calcifications), found in 9% of high-risk cases, and fimbrial adenofibromas in 9.9% of high-risk cases, were significantly more common in high-risk as compared with non-high-risk women (1.8% and 2.5%, respectively; P<0.007). Mucinous metaplasia was found in 3.1%, salpingitis isthmica nodosa in 3.4%, hemosiderin or pseudoxanthoma cells in 4.9%, and fibrous luminal nodules in 4.1%. None of these latter features differed significantly in the high-risk versus non-high-risk groups. These findings suggest a possible association between STIC and endometrial hyperplasia and carcinoma, and clarify the frequency of non-neoplastic tubal findings in grossly normal fallopian tubes.
Asunto(s)
Carcinoma in Situ/diagnóstico , Enfermedades de las Trompas Uterinas/diagnóstico , Neoplasias de las Trompas Uterinas/diagnóstico , Trompas Uterinas/patología , Adulto , Anciano , Neoplasias de la Mama/patología , Carcinoma in Situ/genética , Carcinoma in Situ/patología , Neoplasias Endometriales/diagnóstico , Neoplasias Endometriales/patología , Enfermedades de las Trompas Uterinas/patología , Neoplasias de las Trompas Uterinas/genética , Neoplasias de las Trompas Uterinas/patología , Femenino , Humanos , Hallazgos Incidentales , Metaplasia/diagnóstico , Metaplasia/patología , Persona de Mediana Edad , Mutación , Neoplasias Ováricas/patología , Estudios ProspectivosRESUMEN
Malakoplakia involving the genitourinary tract is a rare inflammatory disorder that presents a diagnostic challenge. Renal parenchymal involvement is particularly uncommon. We report a case of bilateral renal malakoplakia that presented with acute renal failure and simulated xanthogranulomatous pyelonephritis (XGP). The etiology, clinical course, and management of malakoplakia are reviewed, emphasizing the distinct characteristics of the disease that lead to its accurate diagnosis.
Asunto(s)
Lesión Renal Aguda/etiología , Malacoplasia/complicaciones , Malacoplasia/diagnóstico por imagen , Lesión Renal Aguda/tratamiento farmacológico , Lesión Renal Aguda/cirugía , Anciano , Antibacterianos/uso terapéutico , Biopsia , Diagnóstico Diferencial , Femenino , Humanos , Riñón/patología , Malacoplasia/patología , Nefrectomía , Pielonefritis Xantogranulomatosa/diagnóstico por imagen , Pielonefritis Xantogranulomatosa/patología , Tomografía Computarizada por Rayos X , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
INTRODUCTION: The 2 most common histologic variants of papillary carcinoma are pure papillary carcinoma (PTC) and follicular variant of papillary thyroid carcinoma (FVPTC). The purpose of this study is to compare the presentation and short-term response to therapy of these variants and to determine if FVPTC is a more aggressive form of thyroid cancer that warrants intensive therapy. METHODS: A retrospective chart review of patients treated for PTC and FVPTC between 1996 and 1999 was performed. Clinical variables were compared with the Wilcoxon Rank-Sum test or the Fischer's Exact Test. RESULTS: Of 160 patients with papillary thyroid carcinoma included, 114 (71%) had PTC and 46 (29%) had FVPTC. Mean follow-up was 38.6 months. FVPTC presented with larger tumors (median 1.5 cm vs 1.0 cm, P = 0.007) and higher tumor stage than PTC. PTC patients were more likely to present with local invasion and to have local recurrence (9.65% vs 0% for both variables). There were no significant differences in patient age, gender, vascular invasion, lymph node or distant metastases, surgical treatment, radioactive iodine therapy, remission, or mortality. CONCLUSION: FVPTC presented with larger original tumor size and higher tumor stage but a lower local invasion rate and recurrence rate than patients with PTC despite similar therapies. These data suggest that FVPTC and PTC carry similar prognoses in early stages and that FVPTC may have a reduced predilection for local invasion. Although further studies with longer follow-up are required, these results do not suggest that FVPTC warrants more aggressive therapy than PTC.
Asunto(s)
Carcinoma Papilar Folicular/cirugía , Carcinoma Papilar/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Adulto , Carcinoma Papilar/patología , Carcinoma Papilar Folicular/patología , Femenino , Humanos , Radioisótopos de Yodo/uso terapéutico , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Neoplasias de la Tiroides/patologíaRESUMEN
A 26-year-old woman with a complicated urological and gynecological history with uterine didelphys with bilaterally inserting intravesical cervical oses presented with cyclical haematuria. Work up revealed a mass in the ectopic cervical os and adjacent bladder wall. Subsequent resection confirmed a clear cell adenocarcinoma of urological origin with invasion into neighbouring os.
Asunto(s)
Adenocarcinoma de Células Claras/diagnóstico , Cuello del Útero/patología , Síndrome del Abdomen en Ciruela Pasa/patología , Neoplasias de la Vejiga Urinaria/diagnóstico , Vejiga Urinaria/patología , Anomalías Urogenitales/patología , Neoplasias del Cuello Uterino/diagnóstico , Abdomen/patología , Adenocarcinoma de Células Claras/patología , Adulto , Femenino , Hematuria/diagnóstico , Hematuria/etiología , Humanos , Síndrome del Abdomen en Ciruela Pasa/complicaciones , Neoplasias de la Vejiga Urinaria/patología , Anomalías Urogenitales/complicaciones , Neoplasias del Cuello Uterino/patologíaRESUMEN
This short review is dedicated to a precise pathologic characterization of 2 uncommon and poorly defined lesions of the spleen and to their distinction from histologically similar processes. Splenic hamartoma represents an abnormally formed red pulp and is characterized by the presence of sinus-like structures lined by CD8(+) endothelia. The great variety of its morphologic appearances may result from the preponderant growth of one or another of the several components of the red pulp, ie, CD34(+) capillaries, myoid cells and macrophages. Therefore, it is proposed that "cord capillary hemangioma," myoid angio-endothelioma, and histiocyte-rich tumors are part of the spectrum of splenic hamartoma. Inflammatory pseudotumor (IPT) of the spleen is a reactive lesion, probably of multiple etiologies, characterized by a mixture of inflammatory cells and a minor, disorganized component of spindle cells. The latter include fibroblasts, SMA(+) myofibroblasts, and CD68(+) spindled histiocytes, establishing a close similarity with the IPT of the lymph node. This benign process needs to be distinguished from 2 others that have a predominant spindle cell component arranged in parallel bundles: the IPT-like follicular dendritic cell tumor, which is consistently associated with Epstein-Barr Virus; and the inflammatory myofibroblastic tumor, also often Epstein-Barr Virus-related and similar to those of the soft tissues, lung and other organs. These 2 lesions are neoplastic and therefore have a potentially worse prognosis than IPT.
Asunto(s)
Granuloma de Células Plasmáticas/patología , Hamartoma/patología , Enfermedades del Bazo/patología , HumanosRESUMEN
A retrospective analysis of factors influencing survival in patients with primary lymphoma of bone (PLB) treated at a single institution was performed. The records of 30 eligible patients were evaluated for overall survival (OS) as related to age, sex, stage, International Prognostic Index (IPI) score, number of sites involved and type of treatment. There was a significant difference in OS in patients with IPI scores of low (L) and low intermediate (LI) versus high intermediate (HI) (P = 0.0035), regardless of stage. Sex, age, stage and number of sites did not have a significant influence on OS. There was a statistically significant difference in OS favouring use of combined chemotherapy (with or without rituximab) and radiation compared with either modality alone (P = 0.02). The addition of rituximab resulted in a non-significant trend towards improved OS (P = 0.11). With a median follow up of 49 months, 73% of patients are alive 5 years from diagnosis.
Asunto(s)
Neoplasias Óseas/diagnóstico , Linfoma/diagnóstico , Factores de Edad , Neoplasias Óseas/mortalidad , Neoplasias Óseas/terapia , Terapia Combinada , Femenino , Humanos , Linfoma/mortalidad , Linfoma/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores Sexuales , Análisis de SupervivenciaRESUMEN
External quality assurance (EQA) is an important component of the total quality assurance program of a clinical hemostasis laboratory. The College of American Pathologists (CAP) helps meet this requirement by providing a proficiency testing program that evaluates a broad range of hemostasis methods and analytes. This article reviews the published experience of the CAP proficiency testing program in hemostasis. The purpose is to formulate general conclusions about the benefits of EQA. Between 1963 and 2006, the performance characteristics of a variety of tests have been evaluated, including the prothrombin time, activated partial thromboplastin time, coagulation factor activity assays (e.g., fibrinogen, factor [F] VIII, FIX, FXI), von Willebrand factor assays, unfractionated heparin monitoring, lupus anticoagulant testing, and platelet function. Based on the results of these evaluations, the major benefits of EQA are to (1) enhance patient care and safety through improved laboratory testing; (2) characterize test accuracy and precision across multiple methods; (3) correlate specific method variables with accuracy and precision; (4) identify interfering substances and quantify their effects across multiple methods; (5) identify clinical laboratories that are at risk for poor performance so that their performance can improve; and (6) satisfy accreditation and regulatory requirements.
Asunto(s)
Plaquetas/metabolismo , Hemostasis , Patología/métodos , Patología/normas , Pruebas de Coagulación Sanguínea , Química Clínica/métodos , Técnicas de Laboratorio Clínico , Factor IX/biosíntesis , Factor VIII/biosíntesis , Factor XI/biosíntesis , Fibrinógeno/biosíntesis , Heparina/biosíntesis , Humanos , Control de Calidad , Estados Unidos , Factor de von Willebrand/biosíntesisRESUMEN
The U.S. College of American Pathologists (CAP) has conducted a focused study of the proficiency testing for von Willebrand disease (vWD) analysis from 2003 to 2005. This report summarizes the findings regarding the accuracy and precision of the various assays at different analyte levels, as well as the influence of the reference material used to construct the assay standard curve. The results show that testing of von Willebrand factor (vWF):antigen (vWF:Ag) and ristocetin cofactor activity (vWF:RCo) is reasonably accurate, with all-method mean values falling within 3.2 and 5.6%, respectively, of the International Society on Thrombosis and Haemostasis Secondary Coagulation Standard (lot 2) assigned values. vWF:Ag measurements are reasonably precise (all-method coefficients of variation [CVs] = 10.7 to 15.1%), even at lower levels of vWF. The highest precision was observed for immunoturbidometric assays (CVs, 6.3 to 9.7%). vWF:RCo measurements are less precise (all-method CVs, 23.3 to 30.9%). The reference materials used in the standard curves for immunoturbidometric vWF:Ag assays appear to have accurately assigned vWF values for the majority of commercial suppliers.