Where Morphological and Molecular Classifications Meet: The Role of p53 Immunohistochemistry in the Prognosis of Low-Risk Endometrial Carcinoma (GLAMOUR Study).

No prospective study has validated molecular classification to guide adjuvant treatment in endometrial cancer (EC), and not even retrospective data are present for patients with morphological low-risk EC. We conducted a retrospective, multicenter, observational study including 370 patients with low-risk endometrioid EC to evaluate the incidence and prognostic role of p53 abnormal expression (p53abn) in this specific subgroup. Among 370 patients, 18 had abnormal expressions of p53 (4.9%). In 13 out of 370 patients (3.6%), recurrences were observed and two were p53abn. When adjusting for median follow-up time, the odds ratio (OR) for recurrence among those with p53abn versus p53 wild type (p53wt) was 5.23-CI 95% 0.98-27.95, p = 0.053. The most common site of recurrence was the vaginal cuff (46.2%). One recurrence occurred within the first year of follow-up, and the patient exhibited p53abn. Both 1-year and 2-year DFS rates were 94.4% and 100% in the p53abn and p53wt groups, respectively. One patient died from the disease and comprised p53wt. No difference in OS was registered between the two groups; the median OS was 21.9 months (16.4-30.1). Larger multicenter studies are needed to tailor the treatment of low-risk EC patients with p53abn. Performing molecular classification on all EC patients might be cost-effective, and despite the limits of our relatively small sample, p53abn patients seem to be at greater risk of recurrence, especially locally and after two years since diagnosis.

Palisading adenocarcinoma. Case report on a newly recognized tumor in the salivary glands.

A palisading adenocarcinoma arising in the left submandibular salivary gland in a 65-year old woman is presented here. This tumor has been identified only very recently and its recognition as a true entity in the list of salivary gland tumors is still pending. Its distinct clinical-pathological context includes a predilection for women, sublingual or submandibular gland involvement, low-grade cytology with pseudo-neuroendocrine features, and sharp immunohistochemical expression.

Tumor-to-Tumor Metastases Involving Clear Cell Renal Cell Carcinomas: A Diagnostic Challenge for Pathologists Needing Clinical Correlation.

Tumor-to-tumor metastasis is a rare event which it is specifically up to pathologists to bring to light correctly. The histological identification of such tumor-to-tumor cases is simple when the respective histologies are different but can be problematic if the case includes two carcinomas with similar cytoarchitecture viewed one inside the other under the microscope. We report four cases of this condition in which clear cell renal cell carcinoma is involved, either as a receptor or as a donor, and remark on the difficulties in recognizing some of them. Appropriate clinical-pathological correlation, including a review of the patient's antecedents and radiological exams, would be a great help in routinely identifying tumor-to-tumor metastases.

Anaplastic carcinoma in mucinous ovarian tumors: a clinicopathologic study of 34 cases emphasizing the crucial impact of stage on prognosis, their histologic spectrum, and overlap with sarcomalike mural nodules.

Several types of mural nodules may develop in the wall of mucinous tumors of the ovary. The histopathologic features and prognosis of foci/nodules of anaplastic carcinoma are not well known. Although they were first thought to carry an invariably unfavorable prognosis, recent data indicate that this does not necessarily apply to stage Ia tumors. Slides from 34 consultation cases of mucinous ovarian tumors with foci/nodules of anaplastic carcinoma were reviewed and classified on the basis of their morphologic features. Cytokeratin stains were done in selected cases. Staging, treatment, and follow-up information were obtained. The foci/nodules of anaplastic carcinoma were classified histologically into 3 groups: (a) rhabdoid (n=12) having a diffuse arrangement of cells with large, bright, eosinophilic cytoplasms, eccentric nuclei, and one or more prominent nucleoli; (b) sarcomatoid (n=10) characterized by a spindle cell proliferation, with atypical and vesicular nuclei often with herringbone pattern; and (c) pleomorphic (n=12) exhibiting overlapping features of the first 2 categories. International Federation of Gynecology and Obstetrics (FIGO) stage was available in 31 cases: 15 were stage Ia, 6 stage Ic, 2 stage II, 7 stage III, and 1 stage IV. Follow-up was obtained in 21 cases. Seven patients died of the disease after a median time of 8 months: 3 stage IC, 1 stage II, 1 stage III, 1 stage IV, and the other was unstaged. Ten patients were alive and clinically free of disease after a median follow-up of 5 years: they were all stage Ia. Three patients (2 stages III and 1 stage IV) were alive with disease at 3 years, 9 months, and 7 months. The other patient (stage Ia) died of an unrelated cause. Thus, only 1 patient with stage Ia disease died, and she died of causes other than ovarian cancer. The presence of foci/nodules of anaplastic carcinoma in unruptured stage I mucinous tumors of the ovary does not necessarily carry an adverse prognosis. These foci/nodules may exhibit rhabdoid, sarcomatoid (spindle cell), or pleomorphic features.

Correlation between chromogranin-A expression and pathological variables in human colon carcinoma.

BACKGROUND: The possible association between neuroendocrine pattern and cancer prognosis could have substantial clinical implications, but the studies performed have generated conflicting results. As chromogranin-A (CGA) and dense-core granules are expressed concordantly, CGA expression may be used as a marker for cells expressing the complete neuroendocrine cell phenotype. MATERIALS AND METHODS: Fifty-six patients with primary colon carcinoma who underwent potentially curative surgery were analyzed. For immunohistochemical study a monoclonal antibody specific for human chromogranin A was used. The tumor was considered positive when the number of CGA cells was higher than 10% in the section. The relation between CGA-positivity and depth of parietal invasion, lymph-node status and differentiation grade was examined. RESULTS: We observed positive immunostaining in 22 cases out of 56 (39.3%). Significant association was found between CGA-positivity and lymph-node metastasis. CONCLUSION: CGA overexpression could reflect a more aggressive tumor. If our results are confirmed, we should consider the CGA + colon cancer patients at risk for lymph-node disease and therefore include them in a adjuvant chemotherapeutic protocol.