Endometrial cytopathology. An image analysis approach using the Ki-67 biomarker.

OBJECTIVE: To investigate the different identity and biological behaviour of endometrial benign epithelial and endometrial adenocarcinoma cell categories. METHODS: For this study, the imprint smears from three groups, 10 cases of disordered proliferative/benign hyperplastic endometrium, 21 cases of low-grade and eight cases of high-grade endometrial adenocarcinoma, were examined using image analysis and the Ki-67 biomarker. The plastic stem cell model was also applied. RESULTS: Among the examined groups, the nuclear area major axis ranged statistically different in the digitally measured Ki-67 positive endometrial epithelial and adenocarcinoma cells (P<.0001). Moreover, higher values of the cycling nuclear area major axis were observed in high-grade, as compared with the low-grade endometrial adenocarcinomas (P<.0001) and the cases of disordered/benign hyperplastic endometrium (P<.0001). Additionally, a Ki-67 increase pathway was observed in the benign endometrial lesions, and a relatively stable pathway was noticed in low- and high-grade endometrial adenocarcinomas. CONCLUSIONS: The different range of the nuclear area major axis among cycling endometrial epithelial and adenocarcinoma cells may correlate with their specific identity and biological behaviour. The different values of the cycling nuclear area major dimension may also be connected with the biological behaviour of the three examined groups. Moreover, the endometrial epithelial cells may follow a Ki-67 increase pathway, instead of the relatively stable pathway which the rapidly proliferating adenocarcinoma cells may use. Finally, the studied cell categories may exhibit different biology, because their stem cells may reside in different states of stemness.

Estimation of maspin's subcellular localization in invasive ductal breast cancer via light microscopy and computerized image analysis: a comparative study.

PURPOSE: Contradictory results have been reported concerning the role of maspin and its cellular distribution in breast cancer. The purpose of this study was to examine the subcellular localization (nuclear-cytoplasmic) of maspin in breast cancer and to compare the evaluation of maspin immunostaining via light microscopy (LM) to the estimation via computerized image analysis (CIA) system. We also examined correlations between maspin expression and several clinicopathological parameters. METHODS: The sample consisted of 48 primary invasive ductal carcinomas (IDC) of the breast. Maspin immunostaining was quantified and graded via LM by two pathologists, separately in the nuclear and cytoplasmic compartments. Total maspin expression was also estimated via CIA system. Univariate non-parametric statistics and stepwise multivariate ordinal logistic regression were performed. RESULTS: Both maspin components (nuclear and cytoplasmic) were closely associated with each other (p<0.001). Total maspin score was positively and closely associated with nuclear maspin (p<0.001) and cytoplasmic maspin (p<0.001). Total maspin , nuclear maspin and cytoplasmic maspin did not correlate significantly with either age, grade, T, N and M status, stage, micro vessel density (MVD) (CD34), ki-67, p53, estrogen receptor (ER) and HER-2 status, or with any of the 4 groups of the molecular classification. The only factor that showed a borderline inverse correlation with nuclear maspin (p=0.059) was progesterone receptors (PR) positivity. CONCLUSION: The cytoplasmic and nuclear fractions of maspin seem to be closely interwoven. Evidently, both mutually intertwined counterparts were independently reflected upon the total maspin levels measured by CIA. Future studies should ideally encompass all three approaches (nuclear, cytoplasmic, total) adopted herein.

Retroperitoneal synovial sarcoma: a clinicopathological study of 6 cases.

PURPOSE: Synovial sarcoma (SS) arising in the retroperitoneum is a rare tumor. In this location it can be confused with other biphasic tumors and with other spindle and round cell sarcomas. We report 6 cases of SSs with emphasis on their clinicopathological findings. PATIENTS AND METHODS: Six cases were studied, diagnosed as primary retroperitoneal SSs. Clinical, radiological and pathological findings were included in the study. Follow-up information was available in 5 out of 6 cases. RESULTS: The cases consisted of 5 males and 1 female (aged 27-42 years, median 34), who complained preoperatively for pain in the abdominal region (n=4) and dysuria (n=2). Clinical examination was negative. Abdominal X-ray showed a suspicious mass in 4 cases and computed tomography (CT) revealed the tumor mass in all cases. Surgical removal of the tumor was performed. Tumors ranged in size from 6.5 to 14 cm (median 11); histologically, all tumors were biphasic and 1 had poorly differentiated areas. Sarcomas were of high grade (n=3) and intermediate grade of malignancy (n=3). Immunohistochemical stains for cytokeratins AE1/AE3, CAM5.2, S-100, CD34, EMA, SMA and CD99 were performed. All tumors recurred or metastasized within the abdomen. Four patients died of disease within 8-38 months. CONCLUSION: Retroperitoneal SSs are very rare neoplasms that attain a large size, are difficult to excise and recur locally. Metastatic potential is low; however, mortality is very high.

Needle tract seeding after vacuum-assisted breast biopsy.

BACKGROUND: A matter of substantial concern regarding all needle biopsy techniques is seeding along the biopsy needle tract. PURPOSE: To assess cell seeding along the needle tract of vacuum-assisted breast biopsy (VABB). MATERIAL AND METHODS: The study included 21 patients with ductal carcinoma in situ (DCIS) and 10 patients with invasive ductal carcinoma (IDC) diagnosed by VABB for nonpalpable mammographic lesions. VABB (11G, on a Fischer table) was performed, and the duration of the procedure was measured. After surgery, the whole needle tract was embedded in paraffin blocks, stained with hematoxylin-eosin, and examined by a pathologist. RESULTS: Cases with dissemination of cancer cells in the needle tract were not observed (one-sided 97.5% CI 0-10.0%). In 2/31 (6.5%) cases (95% CI 0.8-21.4%), benign epithelial cell displacement was observed, and the duration of VABB was significantly longer in these two cases (52.5+/-3.5 min vs. 42.0+/-4.4 min for cases without benign cell displacement; P = 0.018, Mann-Whitney-Wilcoxon test for independent samples). CONCLUSION: No displacement of malignant cells within the 11G needle tract was documented. Benign cell displacement was associated with longer VABB duration. The phenomenon of tumor cell dissemination along the needle tract is of questionable clinical significance when the treatment guidelines are followed.

Incidental finding of a malignant peritoneal mesothelioma in an inguinal hernia sac: report of a case.

We report the case of a 46-year-old female who underwent a routine operation of herniorraphy for a right inguinal hernia. Physical findings revealed a moveable tender mass in the right lower inguinal area. Pathological examination revealed a mass with multiple nodules scattered in the inguinal hernia sac. The histological features of these nodules were compatible with malignant peritoneal mesothelioma (MPM). The incidental finding of MPM in the inguinal hernia sac is very rare. The incidence of this neoplasm is 2-2.6 cases per million annually, and the prognosis is very poor.

Ovarian neoplasm composed of an insular carcinoid tumor and a borderline mucinous cystadenoma arising in a mature cystic teratoma: a case report.

We report the case of a 57-year-old female patient with an ovarian neoplasm of insular carcinoid and mucinous cystadenoma of low malignant potential, arising in a cystic teratoma of the right ovary. Additionally, a mature teratoma of the left ovary was present. This is an extremely rare combination of primary tumors in the ovary. The possible common histogenesis of the afore-mentioned tumors is discussed.