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.

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

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

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.

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.

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.

Estudo histológico das alteraçöes inflamatórias da tuba uterina em mulheres assintomática / Histological study of tubal inflammatory in assymptomatic women

Determinar a frequência de lesSes inflamatórias da tuba uterina em mulheres assintomáticas e de fertilidade comprovada. Avaliar a acurácia do achado operatório frente a salpingite e identificar fatores associados às mesmas. Pacientes e Métodos: Foram examinadas e classificadas histologicamente, as trompas de 97 pacientes submetidas à laqueadura tubária. Os achados clínicos foram comparados com os achados histológicos das trompas, para verificar a acurácia. Resultados: a Histologia mostrou presença de processo inflamatório em 19 por cento dos casos; sendo, 12 por cento de salpingites crônicas inespecíficas e 7 por cento de salpingites crônicas ativas. No achado operatório 12 por cento apresentaram alteraçSes, dos quais, 50 por cento eram aderências, 16 por cento edema, 8 por cento superficie irregular e 25 por cento exsudato. A observaçÝo cirúrgica na identificaçÝo de processo inflamatório, revelou: sensibilidade 35 por cento, especificou 92 por cento, VPP 50 por cento e VPN 87 por cento. Dos fatores estudados, o uso prévio de dispositivos intra-uterino foi o único significativamente associado à salpingite crônica (X2 = 4,66/p < 0,04). ConclusSes: É expressivo o número de mulheres assintomáticas que apresentam salpingites crônicas. Existe grande discrepância entre o reconhecimento per-operatório de uma salpingite crônica pelo cirurgiÝo e o achado histológico. O uso prévio de DIU esteve significativamente associado à salpingite crônica

Blastoma pulmonar: relato de um caso / Pulmonary blastoma: case report

Os autores fazem o relato de um caso e revisäo da literatura acerca do blastoma pulmonar, neoplasia de ocorrência bastante rara e de histogênese discutida

Grande cisto luteinizado solitário do ovário; próprio do período gravídico ou puerperal: descriçäo de dois casos / Large solitary luteinized ovarian cyst: a report of 2 cases

Säo descritos dois casos de cisto luteinizado gigante do ovário, próprio do período gravídico ou puerperal. É entidade anatomoclínica pouco freqüênte, de patogênese discutida, provavelmente relacionada a estímulo pelas gonadotrofinas coriônicas (HCG) ou hipofisárias (FSH e LH). A importância do seu conhecimento está principalmente relacionada ao diagnóstico diferencial com as neoplasias ovarianas