Characterization of the vaginal and endometrial microbiome in patients with chronic endometritis.

OBJECTIVE: To compare the endometrial and vaginal microbiome of women with and without chronic endometritis. STUDY DESIGN: A cohort study with 60 patients undergoing assisted reproductive treatment with their own or donated gametes was undertaken. Vaginal and endometrial samples were taken in the cycle prior to embryo transfer. The endometrial and vaginal microbiome was analysed by mass sequencing of the V3V4 region of 16S rRNA gene. Bioinformatics analysis was performed using QIIME2 and MicrobiomeAnalyst packages. Alpha diversity, beta diversity and taxonomic characterization were compared between samples that tested positive and negative for chronic endometritis on CD138 immunohistochemistry. RESULTS: Different bacterial communities were detected when vaginal and endometrial samples were analysed in patients with and without endometritis diagnosed using CD138 immunohistochemistry. In patients with endometritis, a higher alpha-diversity index was found in vaginal samples (p = 0.15 for the Shannon index) and significant differences were found in endometrial samples (p = 0.01 for the Shannon index). In the beta-diversity analysis, no significant differences were observed between the groups with and without endometritis. Vaginal and endometrial samples from women with endometritis showed a microbiome pattern that was not dominated by Lactobacillus spp. Relative abundance analysis identified Ralstonia and Gardnerella spp. in endometrial samples, and Streptoccoccus and Ureaplasma spp. in vaginal samples of patients diagnosed with chronic endometritis on CD138 immunohistochemistry. When comparing endometrial and vaginal samples diagnosed with endometritis on CD138 immunohistochemistry, both alpha diversity (p = 0.06 for the Shannon index and p = 0.08 for the Simpson index) and beta diversity (p < 0.001) showed significant differences. Lactobacillus spp. (p = 3.76E-4), Ralstonia spp. (p = 8.19E-4), Delftia spp. (p = 0.004) and Anaerobacillus spp. (p = 0.004) were identified in these sample groups. CONCLUSION: These results demonstrate the existence of a characteristic vaginal and endometrial microbiota in patients with chronic endometritis. Different genera and species were identified in patients with and without chronic endometritis depending on whether the sample was endometrial or vaginal. There is a clear relationship between changes in the vaginal microbiome and chronic endometritis. The microbiota is a continuum throughout the female reproductive tract, so study of the vaginal microbiota could be useful for the diagnosis of diseases of the upper reproductive tract, such as chronic endometritis.

El cáncer de mama: un desafío para el patólogo / No disponible

Los importantes cambios que se están produciendo en eldiagnóstico y tratamiento del cáncer de mama hacen necesario,además de los parámetros morfológicos convencionales,una mayor precisión en la información aportada por el patólogorelacionada con parámetros biológicos. La utilización deprocedimientos normalizados que garanticen la reproductibilidady fiabilidad de los resultados y su integración con las característicasclinicorradiológicas en el seno de unidades multidisciplinaresha contribuido a mejorar la calidad deldiagnóstico anatomopatológico. La aplicación clínica de nuevasherramientas biológicas en desarrollo, como las basadasen el estudio de perfiles de expresión génica (PEG) y su incorporacióna los procedimientos de evaluación rutinarios permitevislumbrar un futuro inmediato en el que la información biológicavalorada en el contexto clínico y patológico contribuiráa una mejor selección de las herramientas terapéuticas de formaindividualizada. Finalmente, los Servicios de Anatomía Patológicatienen un papel fundamental en la custodia del tejidotumoral parafinado y congelado, como fuente de informacióncon valor clínico y de investigación, y deben contribuir a su desarrolloe integración en redes que faciliten una adecuada explotaciónde la información generada(AU)

The significant changes currently occurring in the diagnosisand therapy of breast cancer require, in addition to conventionalmorphological parameters, a greater accuracy in the informationprovided by pathologists regarding biological findings.The use of standard procedures assuring resultreproducibility and reliability, as well as result integration withclinico-radiographic characteristics in the setting of multidisciplinaryunits, has helped improve the quality of pathologicaldiagnoses. The clinical application of novel biological toolscurrently under development, including those based on thestudy of gene expression profiles (GEP), and their incorporationinto routine assessment procedures allows a glimpse intothe near future, where biological information evaluated in theclinical and pathological setting will contribute to an improvedselection of therapeutical tools on an individual basis. Finally,Pathology departments play a fundamental role in watchingover frozen, paraffin-embedded tumor tissue as a source ofvaluable clinical and investigational information, and shouldcontribute to its development and integration into networks tofacilitate an adequate exploitation of data obtained(AU)

An isolated pituitary metastasis as presentation of a differentiated hepatocellular carcinoma mimicking a nonfunctioning macroadenoma.

The differential diagnosis of sellar masses may be complex. Metastatic disease constitutes 1% of all pituitary lesions and sometimes mimics the clinical-radiological presentation of pituitary adenoma. The definitive diagnosis usually relies on histology, but occasionally even histological features of pituitary metastasis may resemble those of adenomas. We present a patient initially diagnosed with pituitary adenoma, but whose clinical course finally revealed pituitary metastasis of a hepatocellular carcinoma. The existing literature on this topic is reviewed.

Polyethylene flock-associated interstitial lung disease in a Spanish female.

This case study presents a female aged 54 yrs with a 12 months history of progressive pulmonary impairment after a 7-yr period of occupational exposure to rotary-cut polyethylene. An open lung biopsy revealed the histopathology of follicular bronchiolitis that is viewed as a stereotypical feature for flock worker's lung. It seems to be the first case of plastic flock-associated interstitial lung disease reported outside North America.

Mesectodermal leiomyoma of ciliary body.

A 37-year-old woman had a mass in her left ocular globe. Uveal melanoma was suspected and enucleation was performed. Microscopically, the lesion proved to be a typical case of mesectodermal leiomyoma of the ciliary body. According to some authors, the peculiar neural appearance of this tumor could be the reflection of its probable origin from mesectodermal smooth muscle. Immunohistochemical analysis showed reactivity for muscle-specific actin and negativity for desmin, S-100 protein, HMB-45, EMA, and GFAP. Our results do not support the proposed neuroectodermical origin of this tumor, since coexpression of muscular and neural markers was not observed.

Phyllodes tumor of the breast with actin inclusions in stromal cells: diagnosis by fine-needle aspiration cytology.

The occurrence of hyaline inclusions in stromal cells in fibroepithelial tumors of the breast is very uncommon. These inclusions, characteristic of infantile digital fibromatosis, are comprised of actin filaments. This report illustrates a case of a benign phyllodes tumor of the breast with inclusion bodies, identified by fine-needle aspiration. Histologically, many of the stromal cells contained round intracytoplasmic inclusions, with positivity for smooth muscle actin.

Phyllodes tumor in ectopic breast tissue of the vulva.

Phyllodes tumor arising from ectopic breast tissue of the vulva is an extremely rare occurrence. A case is reported in a 34-year-old nulligravida woman, presenting as a nodule on the left labium majus. A simple excision was carried out, and no recurrence has been detected after 18 months of follow-up.

Microadenoma hipofisario secretor de TSH: estudio morfológico tras tratamiento con lanreótido / TSH secreting pituitary microadenoma: Morphological study following treatment with lanreotide

Los adenomas hipofisarios secretores de TSH son muy infrecuentes. Los pacientes presentan concentraciones elevadas de TSH, clínica de hipertiroidismo y tumor hipofisario, habitualmente un macroadenoma. El presente trabajo describe el caso de un microadenoma hipofisario secretor de TSH tratado con análogos de somatostatina (lanreótido) y posteriormente con cirugía transesfenoidal. El estudio patológico confirmó un adenoma hipofisario con positividad inmunohistoquímica para TSH y subunidad alfa. Un hallazgo relevante fue la presencia de abundante fibrosis tumoral. La fibrosis es un fenómeno frecuente en los tirotropinomas, por lo que resulta difícil establecer su relación con el tratamiento con lanreótido (AU)

Leiomiosarcoma infantil con células gigantes de tipo osteoclástico / Infantile leiomyosarcoma with osteoclast-like giant cells

El presente artículo describe el caso de un paciente de siete años intervenido por tumoración de 3 cm en la pared abdominal. El estudio anatomopatológico demostró un leiomiosarcoma de grado bajo con células gigantes de tipo osteoclástico. La presencia de células gigantes de tipo osteoclástico en el leiomiosarcoma ha sido excepcionalmente descrita, lo que unido a la rareza de eta neoplasia en la edad infnatil puede plantear problemas de diagnóstico diferencial con otros tumores de partes blandas infantiles benignos o malignos, especialmente con la miofibromatosis infantil. La hibridación in situ no demostró que el virus de Epstein-Barr estuviera implicado en la patogénesis de este caso (AU)

Giant adrenal cortical carcinoma, clinically "nonfunctional": report of a case containing cytoplasmic hyaline globules of vimentin.

Adrenal cortical carcinoma (ACC) is a rare neoplasm that affects all age groups, with a bimodal peak of incidence, in young individuals in the first decade or two of life and in older subjects in the fifth to seventh decades. It may be clinically "functional" with Cushing's syndrome, virilization, or feminization, or it may be "nonfunctional." We report on the case of a 42-yr-old woman who complained of abdominal pain and a large adrenal tumor measuring 20 cm in size. No endocrine symptoms were observed. Laboratory tests showed increased levels of adrenocorticotropic hormone (ACTH), serum cortisol, and urinary free cortisol. Cytohistologic features were typical of ACC. A striking presence of hyaline cytoplasmatic globules was seen in cytologic smears and histologically, being immunoreactive for vimentin, consistent with an intracellular store of intermediate filaments. The tumor showed high proliferative activity (40%) with Ki-67 and negativity for p53, cerbB2, and bcl-2. Although hyaline globules are more frequent in pheochromocytomas and other neoplasms, they may also be present in ACC. These globules may be observed in cytologic smears. Also, the identification and immunohistochemical characterization of these hyaline globules in metastases may be useful in determining the origin of primary occult tumors. Diagn. Cytopathol. 1999;21:394-397.

Multicentric oncocytoma of the lung diagnosed by fine-needle aspiration.

A 50-yr-old man presented with dyspnea. On chest X-ray, multiple pulmonary nodules were observed. Fine-needle aspiration biopsy (FNAB) showed tridimensional aggregates of atypical round epithelial cells, containing numerous cytoplasmic granules. The tissue fragment confirmed the presence of an epithelial tumor composed of trabecular sheets of clear cells, with numerous cytoplasmic granules which stained with phosphotungstic acid hematoxylin (PTAH). Immunohistochemically, the tumor cells were positive for cytokeratins and antimitochondrial antigen, whereas chromogranin, synaptophysin, S-100 protein, and HMB-45 were negative. Clinical and tomographic studies ruled out any tumor mass elsewhere. The rarity of this lesion in the lung and the potential difficulties for its diagnosis prompted us to report the clinical, cytological, and immunohistochemical findings in this case.

Nodular fasciitis of the vulva. Report of a case with immunohistochemical study.

Nodular fasciitis (NF) is a tumor-like condition composed of fibroblasts and myofibroblasts, usually located in the subcutaneous tissue of the extremities. Histologically, it can mimic a myogenic sarcoma because of its hypercellularity, brisk mitotic rate and the presence of actin. NF of the vulva is rare with only eleven cases reported in the English literature. A 40 year-old woman developed a nodule in labium majus that was surgically excised. Microscopical examination revealed a typical example of NF with occasional multinucleated giant cells. The immunohistochemical study showed positivity for vimentin and muscle-specific actin in the spindle cells. The multinucleated cells stained with CD68. MIB-1 was positive in less than 5% of the cells which indicated a low proliferative activity. The patient has been followed for 5 years and no relapses occurred. The rarity of this lesion in the vulva and the potential difficulties for its diagnosis led us to report the clinical and immunohistochemical study of this case.

Adenomyoepithelioma of the breast: report of two cases with prominent cystic changes and intranuclear inclusions.

Adenomyoepithelioma is a rare breast tumor. Histologically it may disclose different patterns of growth, and some additional features may result in diagnostic errors. We describe 2 cases of adenomyoepithelioma of the breast initially examined by fine-needle aspiration biopsy (FNAB). Cytologic features included hypercellularity, clusters of epithelial and myoepithelial cells with occasional intranuclear inclusions, prominent apocrine metaplasia, and foam cells. Histologically, both tumors were diagnosed as adenomyepithelioma tubular-variant, with prominent myoepithelial clear cells, apocrine metaplasia, and foci of squamous metaplasia. Immunohistochemically, the tumors showed strong positivity for keratins CAM 5.2, AE1/AE3, and EMA in the epithelial component, while the myoepithelial cells reacted with muscle-specific actin (A14 and HHF35) and S-100 protein. We point out that FNAB in this rare tumor may exhibit a varied spectrum of cells that may result in confusion with other lesions, and we call attention to the presence of intranuclear inclusions. The latter observation in the present cases by cytologic and histologic assessment provides and additional feature to the morphological characteristics of adenomyoepithelioma of the breast.

Cellular proliferation in breast ductal infiltrating carcinoma. Correlation with clinical and histopathological variables.

To evaluate four methods to study cellular proliferation (mitotic count, mitotic index, PCNA and MIB1) in a series of breast ductal invasive cancer NOS, and the possible correlations between these different methods and other pathological variables, we studied 110 ductal invasive carcinomas NOS specimens. Mitoses per 1000 tumor cells and per 10 HPF, and immunostaining for PCNA and MIB1 were evaluated. Other accepted prognostic factors such as tumor size, histologic grade, estrogen and progesterone receptors measured by immunostaining and axillary status were obtained. Correlation between the four methods to evaluate cellular proliferation and these other variables was performed. Mitotic count, mitotic index, PCNA and MIB1 showed a good rate of correlation (r = 0.71-0.53, p < 0.05), with the exception of MIB1-mitotic index which was weak (r = 0.38, p < 0.05). A strong association between cellular proliferation, with independence of the method applied, and histologic grade, ER and PR was obtained. No association was observed with tumor size and lymph node involvement. In conclusion, there was a strong correlation between the four methods to evaluate cellular proliferation. Mitotic count (per 10 HPF) and MIB1 show a better correlation with other morphological variables. None of the evaluated methods are associated with the tumor size and axillary status, suggesting that mitotic count is the most accurate method to analyse cellular proliferation in routine practice.

Microvessel quantitation in breast ductal invasive carcinoma. Correlation with proliferative activity, hormonal receptors and lymph node metastases.

To investigate the correlation between tumor angiogenesis with axillary metastasis in breast cancer, we analyzed a series of 130 cases of infiltrating ductal carcinoma N.O.S. Tissue sections were stained with factor VIII-RA and microvessel quantitation was performed at x 400 magnification in the most vascular areas and expressed in vessels per mm2. Other variables such as tumor size, histologic grade, mitotic count, tumor necrosis, vascular invasion, skin involvement, anti-P.C.N.A. (proliferative cell nuclear antigen) and estradiol and progesterone receptors measured by an immunohistochemical method were determined. Statistical analysis of variance (AN-OVA) and Pearson's correlation coefficient were applied. The average of vessels per mm2 in tumors with metastases (n = 70) was 82.0 (median 74, SD 37.5), whereas in tumors without metastases (n = 60), it was 67.1 (median 64, SD 28.1). The difference was statistically significant (p < 0.01). However, the significance was lost when tumor size was introduced as a co-factor in a multifactorial analysis of variance. The number of vessels was unassociated with menopausal status, histologic grade, mitotic count, tumor necrosis, vascular invasion, skin involvement, estradiol and progesterone receptors and proliferative activity measured with anti-P.C.N.A. We conclude that in breast ductal invasive carcinoma, when tumor size is taken into consideration, angiogenesis is not associated with axillary lymph node metastases.

[Peritoneal mesothelioma with elevated amylase in the ascitic fluid]. / Mesotelioma peritoneal con elevación de amilasa en líquido ascítico.

The case of a 42-year-old woman with no previous disease admitted for abdominal pain and ascites is presented. Analysis of the ascitic fluid demonstrated high concentrations of amylase with normal lipase. The diagnosis of peritoneal mesothelioma was obtained by laparotomy. This association has not been previously described. The authors suggest that this diagnostic possibility should be considered in patients without pancreatic disease and high amylase levels in ascitic fluid.

Oncocytic carcinoma of parotid gland: fine-needle aspiration and histologic findings.

A parotid gland mass in an elderly man was diagnosed as an oncocytic neoplasm with cellular pleomorphism and cytologic atypia by fine-needle aspiration. The histologic features showed a primary parotid malignant oncocytoma with metastasis in regional lymph nodes.

Hypercalcaemia in Hodgkin's disease related to prostaglandin synthesis.

A case of paraneoplastic hypercalcaemic syndrome is reported in a patient with Hodgkin's disease. This was detected eight months before widespread lymphadenopathy became apparent. Lymphocyte depleted Hodgkin's disease was diagnosed. PTH (parathyroid hormone) activity was suppressed and PTHRP (PTH related protein) was less than 5 pmol/l. 1,25(OH)2D3 was in the normal range. Plasma calcium values returned to normal after the administration of indomethacin. Thus the pathogenesis of the hypercalcaemia in this patient could be associated with the synthesis of prostaglandins.

Phyllodes tumor of the breast. An immunohistochemical study of 28 cases with special attention to the role of myofibroblasts.

The presence of myofibroblasts in the stroma of Phyllodes tumor of the breast has been documented in single cases by means of electron microscopy and immunohistochemistry. In this study, we re-evaluate the immunophenotype exhibited by 28 Phyllodes tumors (14 benign, 6 borderline and 8 malignant) in order to state the relevance of myofibroblasts as active stromal elements in these tumors. Vimentin showed positive immunostaining in the stroma of all the cases (100%), muscle-specific actin in 21 (75%), and desmin in 7 (25%). By contrast, stromal cells were uniformly negative for S-100 protein, keratins (AE1/AE3 and CAM 5.2), and epithelial membrane antigen (EMA). The epithelial component showed the typical two-layered arrangement of ducts in every case. Myoepithelial (outer) cells immunostained with muscle-specific actin and S-100 protein, and in some cases with EMA and keratins, whereas the epithelial (inner) layer did so with keratins and EMA. To conclude, we have found a prominent myofibroblastic differentiation in stromal cells of many of such tumors. Our results also prove that no differences in intensity or distribution of such actin-positive stromal cells are seen between benign, borderline or malignant counterparts.