SOX3 duplication in a boy with 46,XX ovotesticular disorder of sex development and his 46,XX sister with atypical genitalia: Probable germline mosaicism.

Ovotesticular disorders of sex development (OT-DSD) are characterized by ovarian follicles and seminiferous tubules in the same individual, with a wide range of atypical genitalia. We report on two sibs with atypical genitalia and SRY-negative 46,XX DSD, OT-DSD was confirmed only in the boy, while the girl had bilateral ovaries. Chromosome microarray analysis (CMA) showed a 737-kb duplication at Xq27.1 including the entire SOX3 gene in both sibs, which was confirmed by quantitative real time PCR. Also, X chromosome inactivation assay showed random inactivation in both sibs. Whole exome sequencing revealed no pathogenic or likely pathogenic variant. CMA of the parents showed normal results for both, suggesting that germline mosaicism could be the reason of recurrence of this duplication in the siblings. Our results support a pathogenic role of SOX3 overexpression in 46,XX subjects leading to variable DSD phenotypes.

CAISMOV24, a new human low-grade serous ovarian carcinoma cell line.

BACKGROUND: The spontaneous immortalization of primary malignant cells is frequently assigned to their genetic instability during in vitro culturing. In this study, the new epithelial ovarian cancer cell line CAISMOV24 was described and compared with its original low-grade serous ovarian carcinoma. METHODS: The in vitro culture was established with cells isolated from ascites of a 60-year-old female patient with recurrent ovarian cancer. The CAISMOV24 line was assessed for cell growth, production of soluble biomarkers, expression of surface molecules and screened for typical mutations found in serous ovarian carcinoma. Additionally, comparative genomic hybridization was employed to compare genomic alterations between the CAISMOV24 cell line and its primary malignant cells. RESULTS: CAISMOV24 has been in continuous culture for more than 30 months and more than 100 in vitro passages. The cell surface molecules EpCAM, PVR and CD73 are overexpressed on CAISMOV24 cells compared to the primary malignant cells. CAISMOV24 continues to produce CA125 and HE4 in vitro. Although the cell line had developed alongside the accumulation of genomic alterations (28 CNV in primary cells and 37 CNV in CAISMOV24), most of them were related to CNVs already present in primary malignant cells. CAISMOV24 cell line harbored KRAS mutation with wild type TP53, therefore it is characterized as low-grade serous carcinoma. CONCLUSION: Our results corroborate with the idea that genomic alterations, depicted by CNVs, can be used for subtyping epithelial ovarian carcinomas. Additionally, CAISMOV24 cell line was characterized as a low-grade serous ovarian carcinoma, which still resembles its primary malignant cells.

Analysis of Conservative Surgical Treatment and Prognosis of Microinvasive Squamous Cell Carcinoma of the Cervix Stage IA1: Results of Follow-Up to 20 Years.

OBJECTIVE: The aim of this study was to evaluate the prognosis and recurrence of microinvasive squamous cervical (MIC) cancer stage IA1 in women treated conservatively or by hysterectomy, and followed-up to 20 years. METHODS: It was studied in a cohort of 139 women with MIC, 41 definitively managed by conization and 98 by hysterectomy from January 1994 to December 2003 and followed-up until 2013. The definitive treatment, age, conization technique (loop electrosurgical excision procedure or cold knife conization), cone margin, residual disease in hysterectomy specimen, and the association with recurrence (intraepithelial cervical neoplasia grade 3/intraepithelial vaginal neoplasia grade 3 or worse, and microinvasive or worse) were analyzed. RESULTS: There were 2.5 times more conservative treatment in younger women than older (>40 years), and high proportion of residual disease in hysterectomy specimens (67% of intraepithelial cervical neoplasia grade 3 or worse), more common if positive cone margin (74% vs 35%, P < 0.002). There were 2.3% (3/133) recurrences detected as microinvasive or worse, and 6% (8/133) recurrences detected as intraepithelial cervical neoplasia grade 3/intraepithelial vaginal neoplasia grade 3 or worse: 7.3% (3/41) in the conization group and 5.4% (5/92) in the hysterectomy group (P = 0.701). Almost all recurrences (88%, 7/8) were diagnosed until 36 months after treatment, and they were not associated with conization technique. There were no differences in risk of recurrence and overall disease-free survival time related to type of treatment. CONCLUSIONS: This study demonstrates the good prognosis of MIC, regardless the treatment. When fertility is not a concern, hysterectomy should be considered as definitive treatment to avoid the risk of residual disease. Regular follow-up for a long period should be maintained.

Comparing the Copenhagen Index (CPH-I) and Risk of Ovarian Malignancy Algorithm (ROMA): Two equivalent ways to differentiate malignant from benign ovarian tumors before surgery?

AIM: To evaluate the prediction of malignancy in women with pelvic masses using the Copenhagen Index (CPH-I) and Risk of Ovarian Malignancy Algorithm (ROMA). PATIENTS AND METHODS: Three hundred eighty four women operated due to an ovarian mass were enrolled between January 2010 and June 2015. All patients had histopathological diagnosis, HE4 and CA125 measurement. CPH-I and ROMA were calculated and their performances compared in two distinct scenarios: 1) for the discrimination of benign ovarian disease from epithelial ovarian cancer (EOC), non-epithelial ovarian cancer, borderline ovarian tumors (BOT) and ovarian metastases, and 2) for the discrimination of benign disease from EOC. Receiver Operator Characteristics' Areas Under the Curves (AUC) were calculated for CPH-I and ROMA and compared. RESULTS: Of the 384 women, 224 presented a benign ovarian tumor, 32 BOT, 87 EOC, 26 non-epithelial ovarian cancer, and 15 had ovarian metastases. The best AUCs were obtained for the discrimination of EOC from benign tumors. CPH-I performed slightly better than ROMA, and both approached 89% sensitivity and 85% specificity. When all malignant tumors (EOC, BOT, ovarian metastases and non-epithelial ovarian cancer - entire cohort) were included, the performance of CPH-I and ROMA declined to nearly 72%, although the specificity remained close to 85%. CONCLUSION: CPH-I and ROMA performed similarly well for the discrimination of EOC from benign ovarian tumors. However, caution is necessary since, in practical situations, where all the histological possibilities for malignant ovarian tumors must be considered, the sensitivity of CPH-I and ROMA may not surpass 70%.

Prognosis determination of endocervical adenocarcinomas morphologically reclassified as HPV associated or HPV independent.

OBJECTIVE: To evaluate the prognosis of endocervical adenocarcinomas after reclassification according to the morphologic type based on the 2020 World Health Organization Classification. METHODS: A retrospective longitudinal study with cases admitted at the University of Campinas, Brazil, from 2013 to 2020. The sample included 140 cases morphologically reclassified: 100 cases as adenocarcinoma HPV-associated (HPVA), 17 as HPV-independent (HPVI), and 23 non-HPVA/HPVI. Clinic and pathologic variables were evaluated. Analyses were performed by χ2 , Fisher exact, and Mann-Whitney U tests, Kaplan-Meier curves, Log-rank test, and Cox regression. RESULTS: Compared with the HPVA group, advanced stage (FIGO Stage II+) was more frequent in the HPVI group (P = 0.009), which also showed older patients (P = 0.032), and a higher proportion of deaths (P = 0.006). The median overall survival (OS) differed between groups: 73.3 months in HPVA and 42.4 months in HPVI (P = 0.005). At the multivariate analysis, the risk of death was 6.7 (95% confidence interval 1.9-23.0) times higher in patients diagnosed in advanced stages. CONCLUSION: HPVI cases were more frequent in older patients, presenting at more advanced stages and with worse OS. The morphology-based approach of the new WHO classification appears to be prognostically valuable and applicable in lower- and middle-income settings.

Metastatic mucinous carcinomas in the ovary: a practical approach to diagnosis related to gross aspects and to immunohistochemical evaluation.

Ovarian mucinous carcinomas are uncommon, and the differential diagnosis is metastatic carcinoma mainly from the gastrointestinal tract. The aim was to verify the importance of immunohistochemical reactions and the algorithm described in literature on the basis of laterality and tumor size. Twenty-five cases identified as metastatic mucinous adenocarcinomas were reviewed, along with clinical records; a tissue microarray was created, and immunohistochemical reactions for CK7, CK20, Ca125, hormonal receptors, WT1, DPC4, ß-catenin, and Cdx2 were determined. The median age was 51, and only 9 patients had a history of cancer. Sixteen patients (64%) had bilateral tumors, with sizes ranging from 5 to 36 cm (average, 20.5 cm); 9 (36%) had unilateral tumors varying from 5.5 to 38 cm (average, 21.8 cm). Algorithm agreement was 76%; most unilateral tumors were >13 cm. Common positive markers were Dpc4 (88%), Cdx2 (68%), CK20 (60%), and CK7 (44%). The useful markers were CK7, CK20, and Cdx2, although there were cases with overlapping results. The most common primary tumor was of colorectal origin (14 cases). The mean survival age was 32.6 mo. Although the proposed algorithm and immunohistochemical reactions are useful tools for diagnosis, some mucinous tumors cannot be definitively classified as primary or metastatic without further clinical evaluation, emphasizing the limits of this challenging diagnosis.

Preoperative Differentiation of Benign and Malignant Non-epithelial Ovarian Tumors: Clinical Features and Tumor Markers.

OBJECTIVE: To evaluate the role of clinical features and preoperative measurement of cancer antigen 125 (CA125), human epididymis protein (HE4), and carcinoembryonic antigen (CEA) serum levels in women with benign and malignant non-epithelial ovarian tumors. METHODS: One hundred and nineteen consecutive women with germ cell, sex cord-stromal, and ovarian leiomyomas were included in this study. The preoperative levels of biomarkers were measured, and then surgery and histopathological analysis were performed. Information about the treatment and disease recurrence were obtained from the medical files of patients. RESULTS: Our sample included 71 women with germ cell tumors (64 benign and 7 malignant), 46 with sex cord-stromal tumors (32 benign and 14 malignant), and 2 with ovarian leiomyomas. Among benign germ cell tumors, 63 were mature teratomas, and, among malignant, four were immature teratomas. The most common tumors in the sex cord-stromal group were fibromas (benign) and granulosa cell tumor (malignant). The biomarker serum levels were not different among benign and malignant non-epithelial ovarian tumors. Fertility-sparing surgeries were performed in 5 (71.4%) women with malignant germ cell tumor. Eleven (78.6%) patients with malignant sex cord-stromal tumors were treated with fertility-sparing surgeries. Five women (71.4%) with germ cell tumors and only 1 (7.1%) with sex cord-stromal tumor were treated with chemotherapy. One woman with germ cell tumor recurred and died of the disease and one woman with sex cord-stromal tumor recurred. CONCLUSION: Non-epithelial ovarian tumors were benign in the majority of cases, and the malignant cases were diagnosed at initial stages with good prognosis. The measurements of CA125, HE4, and CEA serum levels were not useful in the preoperative diagnosis of these tumors.

OBJETIVO: Avaliar o papel das características clínicas e a medida pré-operatória dos níveis séricos de CA125, HE4, e CEA em mulheres com tumores de ovário não epiteliais benignos e malignos. MéTODOS: Cento e dezenove mulheres consecutivas com tumores ovarianos de células germinativas, do cordão sexual-estroma, e miomas ovarianos foram incluídas neste estudo. Os níveis pré-operatórios dos biomarcadores foram medidos, a cirurgia e a análise histopatológica foram realizadas. Informações sobre tratamento e recorrência da doença foram obtidas dos prontuários médicos das pacientes. RESULTADOS: Nossa amostra incluiu 71 mulheres com tumores de células germinativas (64 benignos e 7 malignos), 46 com tumores do cordão sexual-estroma (32 benignos e 14 malignos), e 2 com leiomiomas ovarianos. Entre os tumores benignos de células germinativas, 63 eram teratomas maduros, e, entre os malignos, quatro eram teratomas imaturos. Os tumores mais comuns do grupo do cordão sexual-estroma foram fibromas (benignos) e tumores de células da granulosa (malignos). Os níveis séricos dos biomarcadores não diferiram entre os tumores de ovário não epiteliais benignos e malignos. A cirurgia preservadora de fertilidade foi realizada em 5 (71,4%) mulheres com tumores malignos de células germinativas. Onze (78,6%) mulheres com tumores do cordão sexual-estroma malignos foram tratadas com cirurgia preservadora de fertilidade. Cinco (71,4%) mulheres com células germinativas e apenas 1 (7,1%) com tumor do cordão sexual-estroma foram tratadas com quimioterapia. Uma mulher com tumor de células germinativas recidivou e morreu da doença. Uma mulher com tumor do cordão sexual-estroma recidivou. CONCLUSãO: Os tumores de ovário não epiteliais foram benignos na maioria dos casos e os malignos foram diagnosticados em estágios iniciais, com bom prognóstico. A medida dos níveis séricos de CA125, HE4, e CEA não foram úteis no diagnóstico pré-operatório desses tumores.

Stage and histology of cervical cancer in women under 25 years old.

OBJECTIVE: To evaluate the histological and stage characteristics of cervical cancer in women under 25 years old, and to compare them with older women. METHODS: Cross-sectional study of cases from the Hospital Cancer Registry of São Paulo State/Brazil from 2000 to 2015. Variables were age, International Federation of Gynecology and Obstetrics stage and histological type. Prevalence ratio (PR) and its 95% confidence interval (CI) were calculated. RESULTS: Out of 18,423 cervical cancer cases 204 (1.1%) were in women under 25 years old. The most frequent stage was stage I in women under 25 (36.2%) and between 25 and 34 (43.4%), and stage III in older women (31.8%). No statistically significant difference was observed in stages by age group. Squamous carcinomas were the most frequent in 73.5% of women under 25 and 78.5% of older women. In women under 25 the following histological types were more frequent: neuroendocrine carcinomas (PR=6.10, 95% CI=2.03-18.35), malignant germ cell tumors (PR=54.98, 95% CI=26.53-113.95), mesenchymal tumors (sarcomas) (PR=5.67, 95% CI=2.58-12.45) and hematopoietic/lymphoid tumors (PR=0.72, 95% CI=2.90-36.69). CONCLUSION: In women under 25 years old cervical cancer was an uncommon diagnosis and in about one third occurred at early stage. Squamous carcinoma was the most frequent histological type regardless age, but rare histological types were more frequent in young women.

45,X/46,XY ovotesticular disorder of sex development revisited: undifferentiated gonadal tissue may be mistaken as ovarian tissue.

BACKGROUND: The 45,X/46,XY karyotype has been associated with mixed gonadal dysgenesis (MGD) and ovotesticular disorder of sex development (DSD). Our aim was to revise the diagnosis of ovotesticular DSD in two patients in the context of a retrospective study of 45,X/46,XY subjects with genital ambiguity. CASE PRESENTATION: Patient 1 had a left streak gonad; the right one was considered an ovotestis. Patient 2 had a right testis; the left gonad was considered an ovary. Revision of the histological sections was performed. Both the "ovarian" part of the right gonad of patient 1 and the left "ovary" of patient 2 contained ovarian-type stroma with clusters of sex-cordlike structures and rare germ cells, compatible with undifferentiated gonadal tissue (UGT). Misdiagnosis of ovarian tissue in patients with 45,X/46,XY mosaicism or its variants could also be found in six published case reports. CONCLUSIONS: A distinction between 45,X/46,XY ovotesticular DSD and MGD should be made on past and future cases keeping in mind that UGT may be mistaken as ovarian tissue.

Underdiagnosis of cervical intraepithelial neoplasia (CIN) 2 or Worse Lesion in Women with a Previous Colposcopy-Guided Biopsy Showing CIN 1.

Objective Expectant follow-up for biopsy-proven cervical intraepithelial neoplasia (CIN) 1 is the current recommendation for the management of this lesion. Nevertheless, the performance of the biopsy guided by colposcopy might not be optimal. Therefore, this study aimed to calculate the rate of underdiagnoses of more severe lesions in women with CIN 1 diagnosis and to evaluate whether age, lesion extent and biopsy site are factors associated with diagnostic failure. Methods Eighty women with a diagnosis of CIN 1 obtained by colposcopy-guided biopsy were selected for this study. These women were herein submitted to large loop excision of the transformation zone (LLETZ). The prevalence of lesions more severe than CIN 1 was calculated, and the histological diagnoses of the LLETZ specimens were grouped into two categories: "CIN 1 or less" and "CIN 2 or worse." Results The prevalence of lesions diagnosed as CIN 2 or worse in the LLETZ specimens was of 19% (15/80). Three women revealed CIN 3, and 1 woman revealed a sclerosing adenocarcinoma stage I-a, a rare type of malignant neoplasia of low proliferation, which was not detected by either colposcopy or previous biopsy. The underdiagnosis of CIN 2 was not associated with the women's age, lesion extension and biopsy site. Conclusions The standard methods used for the diagnosis of CIN 1 may underestimate the severity of the true lesion and, therefore, women undergoing expectant management must have an adequate follow-up.

Underdiagnosis of cervical intraepithelial neoplasia (CIN) 2 orWorse Lesion inWomenwith a Previous Colposcopy-Guided Biopsy Showing CIN 1 / Subdiagnóstico de neoplasia intraepitelial cervical (NIC) 2 ou lesão mais grave emmulheres combiópsia dirigida por colposcopia prévia mostrando NIC 1

Abstract Objective Expectant follow-up for biopsy-proven cervical intraepithelial neoplasia (CIN) 1 is the current recommendation for the management of this lesion. Nevertheless, the performance of the biopsy guided by colposcopy might not be optimal. Therefore, this study aimed to calculate the rate of underdiagnoses of more severe lesions in women with CIN 1 diagnosis and to evaluate whether age, lesion extent and biopsy site are factors associated with diagnostic failure. Methods Eighty women with a diagnosis of CIN 1 obtained by colposcopy-guided biopsy were selected for this study. These women were herein submitted to large loop excision of the transformation zone (LLETZ). The prevalence of lesions more severe than CIN 1 was calculated, and the histological diagnoses of the LLETZ specimens were grouped into two categories: "CIN 1 or less" and "CIN 2 or worse." Results The prevalence of lesions diagnosed as CIN 2 or worse in the LLETZ specimens was of 19% (15/80). Three women revealed CIN 3, and 1 woman revealed a sclerosing adenocarcinoma stage I-a, a rare type of malignant neoplasia of low proliferation, which was not detected by either colposcopy or previous biopsy. The underdiagnosis of CIN 2 was not associated with the women's age, lesion extension and biopsy site. Conclusions The standard methods used for the diagnosis of CIN 1 may underestimate the severity of the true lesion and, therefore, women undergoing expectant management must have an adequate follow-up.

Resumo Objetivo O seguimento de mulheres com neoplasia intraepitelial cervical (NIC) 1 comprovada por biópsia é atualmente a recomendação de conduta para esta lesão. Entretanto, o desempenho da biópsia guiada por colposcopia pode falhar. Assim, este estudo teve como objetivo estimar a taxa de subdiagnóstico de lesões mais graves em mulheres comdiagnóstico de NIC 1 e avaliar se a idade, a extensão da lesão e o local da biópsia são fatores associados à falha do diagnóstico. Métodos Foram selecionadas 80 mulheres com diagnóstico de NIC 1 obtido por biópsia dirigida por colposcopia. Estasmulheres foramsubmetidas a excisão da zona de transformação por alça diatérmica (EZTAD). A prevalência de lesões mais graves do que NIC 1 foi calculada, e os diagnósticos histológicos feitos nas amostras obtidas por EZTAD foram agrupados em duas categorias: "NIC 1 ou menos grave" e "NIC 2 ou mais grave". Resultados A prevalência de lesões diagnosticadas como NIC 2 ou mais grave nas amostras de EZTAD foi de 19% (15/80). Três mulheres apresentaram NIC 3, e uma mulher revelou adenocarcinoma esclerosante estágio I-a, um tipo raro de neoplasia maligna de baixa proliferação, que não foi detectado por qualquer exame de colposcopia ou biópsia anterior. O subdiagnóstico de NIC 2 não foi associado à idade, à extensão da lesão ou ao local da biópsia. Conclusão Os métodos de referência utilizados para o diagnóstico da NIC 1 podem subestimar a gravidade da lesão verdadeira e, portanto, as mulheres submetidas a conduta expectante devem ter um seguimento adequado.

Clinicopathological aspects and their relation to prognosis in adult-type granulosa cell tumor of the ovary / Aspectos clinicopatológicos e sua relação com o prognóstico em tumor de células da granulosa do tipo adulto do ovário

INTRODUCTION AND OBJECTIVE: The adult granulosa cell tumors (AGCT) correspond to less than 5 percent of ovarian neoplasias. They are considered low malignant potential tumors and may recur after many years. The differential diagnosis must be made with other primary or metastatic ovarian neoplasias. The aim was to analyze clinical and pathological aspects of AGCT and relate them to its evolution. METHOD: in a 10- year (1995-2004) review of the files from University of Campinas Clinical Hospital, Brazil, 20 AGCT cases were found. The clinical records and slides were reviewed and age, symptoms, macro and microscopic aspects, diagnostic staging and recurrence were considered. When there was intraoperative biopsy, its accuracy was evaluated. RESULTS: Age ranged from 27 to 79 years (mean: 53) and the follow-up from 12 to 96 months (mean: 42). The main symptoms were post-menopause bleeding (45 percent), abdominal pain (35 percent) and palpable mass (25 percent). Most tumors were yellowish (60 percent) and the solid aspect (40 percent) was more common than the cystic or solid-cystic. The histological patterns were 40 percent solid, 15 percent macrofollicular and 45 percent combined forms. All of them with low mitotic index. Only three out of nine intraoperative frozen sections were accurately diagnosed. The clinical staging was 13 cases in Ia (65 percent), one case Ic and 6 IIIc. In three out of 14 hysterectomies there was simple endometrial hyperplasia with no atypia. Only the disease staging was significantly associated with recurrence (p < 0.0001). CONCLUSION: ACGT generally occurs after menopause and intraoperative biopsies are commonly inconclusive. Only advanced staging was related to the worst prognosis.

INTRODUÇÃO E OBJETIVO: O tumor de células da granulosa tipo adulto (TCGA) corresponde a menos de 5 por cento das neoplasias ovarianas. São de baixo potencial de malignidade, podem recorrer depois de muitos anos, e o diferencial deve ser feito com outras neoplasias primárias ou metastáticas. Analisamos os aspectos clínicos e patológicos do tumor, relacionando-os à evolução. MÉTODOS: Na revisão de 10 anos dos arquivos do laboratório de Anatomia Patológica do Hospital das Clínicas da Universidade de Campinas (UNICAMP), 20 casos de TCGA foram encontrados. Os prontuários e as lâminas foram revisados e considerados: idade, sintomas, aspectos macro e microscópicos, estádio ao diagnóstico e à recidiva. Quando houve biópsia intraoperatória, sua acurácia foi avaliada. RESULTADOS: A idade variou de 27 a 79 anos (média: 53); o seguimento de 12 a 96 meses (média: 42). Os sintomas principais: sangramento pós-menopausa (45 por cento), dor abdominal (35 por cento) e massa palpável (25 por cento). A maioria era amarelada (60 por cento), o aspecto sólido mais comum (40 por cento) que o cístico ou sólido-cístico. Os padrões histológicos foram: 40 por cento sólido, 15 por cento macrofolicular e 45 por cento de formas combinadas, todos com baixo índice mitótico. Apenas três de nove casos submetidos à biópsia intraoperatória foram diagnosticados corretamente. O estádio clínico foi: 13 casos Ia (65 por cento), um caso Ic e seis, IIIc. Em três de 14 histerectomias analisadas, havia hiperplasia endometrial simples sem atipia. Apenas o estádio da doença foi significativamente associado à recidiva (p < 0,0001). CONCLUSÃO: TCGA geralmente ocorre após a menopausa, as biópsias intraoperatórias são mais comumente inconclusivas e apenas o estádio avançado esteve relacionado com o pior prognóstico.

Microglandular hyperplasia of the cervix: frequency in cone specimens, histological patterns, clinical aspects and immunohistochemical markers for differential diagnosis with adenocarcinoma

Although endocervical microglandular hyperplasia (MGH) is a common diagnosis, it can be confused with adenocarcinoma (ACa), mainly of the clear cell type. OBJECTIVES: Evaluate the frequency of MGH diagnosis in conization specimens, their histological patterns and characterize the differential diagnosis between MGH and ACa through immunohistochemical markers, as well as some clinical aspects. METHODS: We reviewed 223 cervical cones and 50 ACa in cervical biopsies in order to: 1) assess the frequency of MGH in cones; 2) verify immunohistochemical expression of p53, carcinoembryonic antigen (CEA) and Ki67 in both lesions; 3) correlate the findings to age, parity and hormonal status. RESULTS: We found 35 cases of MGH (15.7 percent), of the following patterns: 21 glandular (60 percent); 7 reticular (20 percent); 6 trabecular (17.1 percent) and one solid (2.8 percent). Average age was 36 years and mean parity was three children. Of the MGH patients, 51.42 percent were pregnant or made use of some hormonal therapy. ACa occurred in older patients (mean: 53 years), multiparous and with no hormonal history. CEA was negative in MGH and positive in 62 percent of ACa. Ki67 was weakly positive (5 percent-10 percent stained nuclei) in 8.6 percent of MGH and strong (> 40 percent stained nuclei) in 80 percent of ACa. p53 expression was negative in MGH and only present in 10 percent of ACa. CONCLUSIONS: MGH was common in cones, mainly in young women. Half of the cases were associated with hormonal therapy or pregnancy. CEA and Ki67 were useful but p53 expression was not important for the differential diagnosis with adenocarcinoma.

Embora a hiperplasia microglandular da endocérvice (MGH) seja um diagnóstico freqüente, algumas vezes pode ser confundida com adenocarcinoma (ACa), principalmente de células claras. OBJETIVOS: Avaliar a freqüência da MGH em cones de colo uterino, seus padrões histológicos e o diagnóstico diferencial entre MGH e ACa, através de marcadores imuno-histoquímicos e de alguns aspectos clínicos. MÉTODOS: Foram revisados 223 cones, bem como 50 biópsias cervicais com o diagnóstico de adenocarcioma para: 1) verificar a freqüência de MGH nos cones; 2) avaliar a expressão de p53, antígeno carcinoembrionário (CEA) e Ki67 nas lesões; 3) correlacionar as lesões com idade, paridade e estado hormonal. RESULTADOS: MGH ocorreu em 35 cones (15,7 por cento), com os padrões glandular (21 [60 por cento]); reticular (7 [20 por cento]); trabecular (6 [17,1 por cento]) e sólido (um [2,8 por cento]). A média de idade foi 36 anos e de paridade, três filhos; 51,42 por cento estavam grávidas ou usavam terapia hormonal. O ACa ocorreu em pacientes mais velhas (média: 53 anos), multíparas e sem história hormonal. CEA foi negativo em todas MGH e positivo em 62 por cento dos ACa. Ki67 apresentou reatividade baixa (5 por cento a 10 por cento dos núcleos corados) em 8,6 por cento das MGH e alta (> 40 por cento dos núcleos corados) em 80 por cento dos ACa. p53 foi negativo na MGH e positivo em apenas 10 por cento dos ACa. CONCLUSÃO: MGH foi freqüentemente encontrada em cones, principalmente em jovens, sendo metade dos casos associada a terapia hormonal ou gravidez. As expressões do CEA e do Ki67 foram importantes no diagnóstico de ACa, porém o p53 não contribuiu para diferenciar as lesões.

Epithelial phenotype of cultured ovarian tumor cells

Epithelial differentiation is an early or predisposing step in epithelial ovarian carcinogeneses which occurs in pre-neoplastic lesions, benign tumors and normal ovarian surface epithelium (OSE) of women with a familial history of ovarian cancer. During neoplastic progression, OSE acquires a more epithelial aspect, including the expression of CA125 protein and other epithelial markers, whereas mesenchymal characteristics diminish. In this study, we investigated 26 primary cell cultures, including benign and malignant OSE neoplasms, obtained from women who underwent surgical removal of the ovaries at the university hospital of the State University of Campinas (Campinas, SP, Brazil). Cell morphology was assessed from the time of cell adhesion to the substrate up to the third of fourth passage. CA125 was detected byimmunohistochemistry at each passage. Serum CA125 levels were obtained from clinical records and heredograms were constructed using the information about the recurrence of familial cancer provided by the patients. Seventy-eight percent of the malignant OSE tumors analyzed showed an epithelial cell phenotype and 71 percent were positive for CA125. Benign and normal OSE cultures had a fibroblast-like cell phenotype, a negativa CA125 expression and an inexpressive history of recurrent familial cancer, compared to malignant OSE tumors. We concluded that the expression of an epithelial phenotype in vitro may serve as an important tumor marker in malignant OSE neoplasms. In certain cases, this marker may be more reliable than the determination of serum CA125 levels. However, the relationship between the expression if the epithelial phenotype in vitro and a familial predisposition to tumors development remains to be determined.

p53, estrogen and progesterone receptors in diagnostic curettage for endometrial adenocarcinoma and their correlation with morphological data and disease stage at hysterectomy

CONTEXT: Diagnostic staging is an important prognostic factor for endometrial adenocarcinoma. Apart from the histological type and histological grade, some markers seem to be associated with the stage and biological behavior of the disease. Among these are p53, estrogen and progesterone receptors. OBJECTIVE: The objectives of the present study were: to compare histological type and grading of endometrial carcinoma in curettage and hysterectomy samples; to assess expression of p53, estrogen and progesterone receptors in curettage specimens; and to correlate these data with morphology and staging of the disease in hysterectomy specimens. TYPE OF STUDY: Retrospective. SETTING: Department of Pathology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. SAMPLE: Histological diagnosis from 51 consecutive files. PROCEDURES: Immunohistochemical reactions for p53, estrogen and progesterone receptors via the avidin-biotin-peroxidase method in 51 curettage samples endometrial carcinoma were compared with the morphological data and disease stage in hysterectomy. Marker expression was correlated with histological type and grade and the final stage of the disease. RESULTS: According to the histological type: 44 cases (86 percent) were of endometrioid and 7 (14 percent) non-endometrioid carcinoma. p53 expression was observed in 16 percent of endometrioid and 71 percent of non-endometrioid cases (p < 0.05). Although estrogen expression was more evident in endometrioid (54 percent) than non-endometrioid cases (29 percent), this was not statistically significant. Progesterone receptor expression was significantly higher in endometrioid than non-endometrioid cases (70 percent vs. 14 percent, p < 0.05). According to the histological grade: Estrogen and progesterone receptors were expressed more frequently in grade I endometrioid carcinoma, while p53 was mainly reported in tumor grades II and III. According to final disease stage: p53 and estrogen expression in curettage specimens was not related to stage; progesterone receptors, however, were expressed significantly less in advanced disease. CONCLUSION: p53 was observed in the majority of non-endometrioid and in high-grade endometrioid carcinoma, but was not related to stage. Estrogen and progesterone receptors were mainly found in grade I endometrioid carcinoma. The markers studied in curettage were no more valuable for predicting the disease stage than classical histological criteria

Primary melanoma of the uterine cervix figo stage III B

The primary malignant melanoma of the uterine cervix is rare, usually diagnosed at an advanced stage and with poor prognosis. The diagnosis is made through histological evaluation and confirmed by special staining procedures. Radical surgery has been used and advocated. However in its advanced stages chemotherapy, immunotherapy or radiotherapy can be employed. A case of a patient with malignant melanoma of the uterine cervix, Stage IIIb, is presented in addition to a clinical and pathological discussion.

Immunohistochemical study of basement membrane collagen IV in uterine cervix carcinoma

Context: The integrity of basement membrane (BM) is damaged during the evolution of a benign or potentially malignant lesion into a malignant one, in which it may undergo several degrees of discontinuity as a necessary condition for the invasive process. Immunostaining for collagen IV, which is exclusively found in BM, has been used to evaluate its formation in neoplastic and benign lesions of several organs. Objective: To investigate BM continuity pattern in squamous carcinoma "in situ" (CIS), microinvasive (MIC) and invasive (IC) squamous cell carcinoma of the uterine cervix, and to find out if BM expression could be useful in the diagnosis of early stromal invasion (MIC). Design: Archival material between 1988 and 1993 was studied at the Pathological Anatomy Department - Unicamp. Procedures: The selected cases, previously formalin fixed and paraffin embedded, were reviewed retrospectively by submitting them to immunohistochemical study via the avidin-biotin-peroxidase method using a monoclonal antibody anticollagen IV. Results: In all, 17 cases of CIS, 16 of MIC and 21 of IC were evaluated. All IC cases showed evident BM discontinuity, either focal or diffuse. In the CIS group, a continuous BM pattern was predominant, being focally disrupted in only 2/17 cases (11.8 per cent). The MIC group showed an intermediate pattern, but with a clear tendency to BM discontinuity in 10/16 cases (62.5 per cent). Inflammatory infiltrate, a variable also studied, cannot be considered responsible for BM discontinuity, since there was no statistical correlation between them. Conclusion: We conclude that immunostaining for collagen IV may contribute to the diagnosis of stromal invasion by BM discontinuity.

Tumores serosos borderline de ovário com implantes invasores e não invasores / Serous borderline ovarian tumors with invasive and noninvasive implants

Os tumores boderline de ovário compreendem 15 a 20