New pattern-based personalized risk stratification system for endocervical adenocarcinoma with important clinical implications and surgical outcome.

We present a recently introduced three tier pattern-based histopathologic system to stratify endocervical adenocarcinoma (EAC) that better correlates with lymph node (LN) metastases than FIGO staging alone, and has the advantage of safely predicting node-negative disease in a large proportion of EAC patients. The system consists of stratifying EAC into one of three patterns: pattern A tumors characterized by well-demarcated glands frequently forming clusters or groups with relative lobular architecture and lacking destructive stromal invasion or lymphovascular invasion (LVI), pattern B tumors demonstrating localized destructive invasion (small clusters or individual tumor cells within desmoplastic stroma often arising from pattern A glands), and pattern C tumors with diffusely infiltrative glands and associated desmoplastic response. Three hundred and fifty-two cases were included; mean follow-up 52.8 months. Seventy-three patients (21%) had pattern A tumors; all were stage I and there were no LN metastases or recurrences. Pattern B was seen in 90 tumors (26%); all were stage I and LVI was seen in 24 cases (26.6%). Nodal disease was found in only 4 (4.4%) pattern B tumors (one IA2, two IB1, one IB not further specified (NOS)), each of which showed LVI. Pattern C was found in 189 cases (54%), 117 had LVI (61.9%) and 17% were stage II or greater. Forty-five (23.8%) patients showed LN metastases (one IA1, 14 IB1, 5 IB2, 5 IB NOS, 11 II, 5 III and 4 IV) and recurrences were recorded in 41 (21.7%) patients. This new risk stratification system identifies a subset of stage I patients with essentially no risk of nodal disease, suggesting that patients with pattern A tumors can be spared lymphadenectomy. Patients with pattern B tumors rarely present with LN metastases, and sentinel LN examination could potentially identify these patients. Surgical treatment with nodal resection is justified in patients with pattern C tumors.

Invasive endocervical adenocarcinoma: proposal for a new pattern-based classification system with significant clinical implications: a multi-institutional study.

The management of endocervical adenocarcinoma is largely based on tumor size and depth of invasion (DOI); however, DOI is difficult to measure accurately. The surgical treatment includes resection of regional lymph nodes, even though most lymph nodes are negative and lymphadenectomies can cause significant morbidity. We have investigated alternative parameters to better identify patients at risk of node metastases. Cases of invasive endocervical adenocarcinoma from 12 institutions were reviewed, and clinical/pathologic features assessed: patients' age, tumor size, DOI, differentiation, lymph-vascular invasion, lymph node metastases, recurrences, and stage. Cases were classified according to a new pattern-based system into Pattern A (well-demarcated glands), B (early destructive stromal invasion arising from well-demarcated glands), and C (diffuse destructive invasion). In total, 352 cases (FIGO Stages I-IV) were identified. Patients' age ranged from 20 to 83 years (mean 45), DOI ranged from 0.2 to 27 mm (mean 6.73), and lymph-vascular invasion was present in 141 cases. Forty-nine (13.9%) demonstrated lymph node metastases. Using this new system, 73 patients (20.7%) with Pattern A tumors (all Stage I) were identified. None had lymph node metastases and/or recurrences. Ninety patients (25.6%) had Pattern B tumors, of which 4 (4.4%) had positive nodes; whereas 189 (53.7%) had Pattern C tumors, of which 45 (23.8%) had metastatic nodes. The proposed classification system can spare 20.7% of patients (Pattern A) of unnecessary lymphadenectomy. Patients with Pattern B rarely present with positive nodes. An aggressive approach is justified in patients with Pattern C. This classification system is simple, easy to apply, and clinically significant.

[Plasmoblastic lymphoma initially recognized as ovarian tumor]. / Presentación inicial de un linfoma plasmablástico como tumor ovárico.

Plasmablastic lymphoma is an uncommon B-cell lymphoma representing <3% of all non-Hodgkin lymphoma associated with human immunodeficiency virus infection. It displays a distinctive affinity for extranodal presentation in the oral cavity. The case of a plasmablastic lymphoma present in the ovary, cervix and soft thigh tissues of a 27-year-old woman with human immunodeficiency infection is reported.

Satellitosis and CD117 immunohistochemical expression correlates with poor outcome in thick vulvar melanoma.

BACKGROUND: Melanoma of the vulva is the second most common vulvar cancer after epidermoid carcinoma. Patients suffering from this disease usually present with a late-stage disease with a poor prognosis. The prognostic factors reported in previous studies are not homogeneous and the clinical/pathogenic role of c-KIT expression is not clear. Breslow staging currently is the most accurate predictor factor. METHODS: A clinicopathological study with literature review was performed to identify predictors of prognosis and survival in melanoma of the vulva and investigated the expression of c-KIT (by immunohistochemistry) in 10 patients from the National Institute for Cancer Research (Mexico City). RESULTS: The 10 patients enrolled were all older women with delayed presentation, high-stage disease and limited response to treatment. Five patients (50%) were found to have c-KIT expression; 4 of them recurred (P=0.01), and ultimately 3 died (P=0.038). We identified satellitosis and c-KIT expression as prognostic predictors for death. CONCLUSIONS: We conclude that c-KIT expression is a valuable predictor of prognosis and survival, especially in thick (>4 mm) melanomas.

Reproducibility of the EGFR immunohistochemistry scores for tumor samples from patients with advanced non-small cell lung cancer.

Epidermal growth factor receptor (EGFR) is overexpressed in >60% of non-small cell lung cancer (NSCLC) cases. In combination with radiotherapy or chemotherapy, first-line treatments with antibodies against EGFR, including cetuximab and necitumumab, have demonstrated benefits by increasing overall survival (OS), particularly in patients who overexpress EGFR. The present study evaluated the interobserver agreement among three senior pathologists, who were blinded to the clinical outcomes and assessed tumor samples from 85 patients with NSCLC using the H-score method. EGFR immunohistochemistry was performed using a qualitative immunohistochemical kit. The reported (mean ± standard deviation) H-scores from each pathologist were 111±102, 127±103 and 128.53±104.03. The patients with average H-scores ≥1, ≥100, ≥200 and between 250-300 were 85.9, 54.1, 28.2 and 12.9, respectively. Patients who had an average H-score >100 had a shorter OS time compared with those with lower scores. Furthermore, patients with EGFR mutations who were treated with EGFR-tyrosine kinase inhibitors (TKIs) and had an average H-score >100 had a longer OS time compared with those with an average H-score <100. The interobserver concordance for the total H-scores were 0.982, 0.980 and 0.988, and for a positive H-score ≥200, the interobserver concordance was 0.773, 0.710 and 0.675, respectively. The determination of EGFR expression by the H-score method is highly reproducible among pathologists and is a prognostic factor associated with a poor OS in all patients. Additionally, the results of the present study suggest that patients with EGFR mutations that are treated with EGFR-TKIs and present with a high H-score have a longer OS time.

Invasive endocervical adenocarcinoma: a new pattern-based classification system with important clinical significance.

A new 3-tier pattern-based system to classify endocervical adenocarcinoma was recently presented. In short, pattern A tumors were characterized by well-demarcated glands frequently forming clusters or groups with relative lobular architecture. Pattern B tumors demonstrated localized destructive invasion defined as desmoplastic stroma surrounding glands with irregular and/or ill-defined borders or incomplete glands and associated tumor cells (individual or small clusters) within the stroma. Tumors with pattern C showed diffusely infiltrative glands with associated extensive desmoplastic response. In total, 352 cases (all FIGO stages) from 12 institutions were identified. Mean patient age was 45 years (range, 20 to 83 y). Forty-nine (13.9%) cases demonstrated lymph nodes (LNs) with metastatic endocervical carcinoma. Using this new system, 73 patients (20.7%) were identified with pattern A tumors (all stage I); none had LN metastases and/or recurrences. Ninety patients (25.6%) were identified with pattern B tumors (all stage I); only 4 (4.4%) had LN metastases; 1 had vaginal recurrence. The 189 (53.7%) remaining patients had pattern C tumors; 45 (23.8%) of them had LN metastases. This new classification system demonstrated 20.7% of patients (pattern A) with negative LNs, and patients with pattern A tumors can be spared of lymphadenectomy. Patients with pattern B tumors rarely presented with metastatic LNs, and sentinel LN examination could potentially identify these patients. Aggressive treatment is justified in patients with pattern C tumors.

Serum human chorionic gonadotropin is associated with angiogenesis in germ cell testicular tumors.

BACKGROUND: Germ cell testicular tumors have survival rate that diminishes with high tumor marker levels, such as human chorionic gonadotropin (hCG). hCG may regulate vascular neoformation through vascular endothelial growth factor (VEGF). Our purpose was to determine the relationship between hCG serum levels, angiogenesis, and VEGF expression in germ cell testicular tumors. METHODS: We conducted a retrospective study of 101 patients. Serum levels of hCG, alpha-fetoprotein (AFP), and lactate dehydrogenase were measured prior to surgery. Vascular density (VD) and VEGF tissue expression were determined by immunohistochemistry and underwent double-blind analysis. RESULTS: Histologically, 46% were seminomas and 54%, non-seminomas. Median follow-up was 43 +/- 27 months. Relapse was present in 7.5% and mortality in 11.5%. Factors associated with high VD included non-seminoma type (p = 0.016), AFP > or = 14.7 ng/mL (p = 0.0001), and hCG > or = 25 mIU/mL (p = 0.0001). In multivariate analysis, the only significant VD-associated factor was hCG level (p = 0.04). When hCG levels were stratified, concentrations > or = 25 mIU/mL were related with increased neovascularization (p < 0.0001). VEGF expression was not associated with VD or hCG serum levels. CONCLUSION: This is the first study that relates increased serum hCG levels with vascularization in testicular germ cell tumors. Hence, its expression might play a role in tumor angiogenesis, independent of VEGF expression, and may explain its association with poor prognosis. hCG might represent a molecular target for therapy.

Carcinoma de plexos coroides, informe de dos casos y revisión de la literatura / Carcinoma of the choroid plexus. A report of two cases and review of the literature

Se presenta el estudio clínico-patológico de dos casos de carcinoma de plexos coroides. El primero es de una niña de tres años con padecimiento final de tres meses de evolución caracterizado por convulsiones tónico-clónicas y signos meníngeos debidos a un tumor en el ventrículo lateral derecho con dilatación del sistema ventricular. En la autopsia se corroboró la presencia del tumor, algunos implantes subaracnoideos fueron más grandes que la estructura en que se asentaron, en especial el del puente y los de la médula espinal. El carcinoma de plexos coroides estaba en continuidad con un teratoma maduro. El segundo caso es un niño de ocho meses con inicio de síntomas desde el nacimiento, se le practicó derivación ventrículo-peritoneal y craneotomía fronto-parietal derecha con resección parcial de un tumor en el ventrículo lateral derecho; falleció pocos días después de la cirugía por hemorragia intraventricular y úlceras agudas gástricas con hemmoragia masiva. En la autopsia se encontró muy poco tumor residual. Se discuten los criterios de diagnóstico anatomo-patológico

Carcinoma adenoideo quístico originado en bronquio principal derecho: informe de un caso / Adenoid cystic carcinoma of the main bronchus: a case report

El carcinoma adenoide quístico primario del arbol bronquial es una neoplasia poco frecuente en esta localización. Se presenta el caso de un hombre de 40 años con antecedentes de tabaquismo y tosedor crónico, quien presentó dos meses antes de su muerte disnea progresiva y hemoptisis. En la fibrobroncoscopía se encontró un tumor nodular endobronquial que obstruía el 70-80 por ciento de la luz, con extensa invasión de la pared, se tomó biopsia sin poder establecer un diagnóstico. Se presentó sangrado masivo del tumor y el paciente falleció en estas condiciones. La autopsia corroboró la presencia de un tumor en bronquio principal derecho de base ancha con extensa invasión local y metástasis en varios órganos. Histológicamente el tumor correspondió a un carcinoma adenoideo quístico, en el cual predominó un patrón de crecimiento sólido. Esta variedad histológica presenta en un alto porcentaje de recurrencia local, metástasis tempranas y corta sobrevida