Ovarian endometrioid carcinoma with yolk sac tumor component in a postmenopausal woman.

Yolk sac tumor (YST) coexisting with a variety of histologic patterns have been described, but with an epithelial malignant component is extremely rare. It has been suggested that this rare tumor represents an adenocarcinoma with aberrant differentiation because it occurs in the same age range as epithelial ovarian carcinoma and shows an aggressive behavior and poor prognosis. Although chemotherapy is effective for pure YST, YST with endometrioid adenocarcinoma does not respond to chemotherapy. Here the authors report a postmenopousal women with ovarian endometrioid adenocarcinoma (OEC) associated with YST.

Uterine extra gastrointestinal stromal tumor presenting as intramural leiomyoma.

Extra gastrointestinal stromal tumors (EGIST) are reported in different sites and organs. This tumors are rare in gynecologic apparatus. Here the authors report an uterine unique tumor represented as intramural leiomyoma. Because of different treatment options, clinicians should be aware of this rare tumor which may be located in uterus and confused with a smooth muscle tumor.

Borderline ovarian tumors: outcomes of fertility sparing surgery.

AIM: Borderline ovarian tumors(BOT) account for ten to 20 percent of all epitelial ovarian carcinomas and often occur in reproductive ages. The aim of this study was to evaluate the clinical and reproductive outcomes of patients who were diagnosed with BOT and underwent fertility sparing surgery. MATERIALS AND METHODS: Patients younger than 40 years who underwent fertility sparing surgery for BOT from 2004 to 2012 were reviewed retrospectively and were evaluated according to the reproductive and clinical outcomes. RESULTS: Twenty-eight patients younger than 40 years with BOT underwent fertility sparing surgery. Median follow up time was 42 +/- 28.1 months. During the follow up period, two patients (7.1%) developed recurrence at 35 and 36 months, respectively. Five (17.9%) out of 28 patients became pregnant during the follow up period. CONCLUSION: Fertility sparing surgery should be the first choice for the treatment of BOT in patients who wish to preserve fertility.

Peritumoral allergic response in epithelial ovarian carcinoma.

AIMS: Desmoplasia, intratumoral lymphocyte infiltration, and calcification within the tumor and peritoneum are quite common in advanced epithelial ovarian carcinoma. Peritumoral inflammatory reactions associated with hematologic paraneoplastic syndrome are extremely rare. MATERIALS AND METHOD: We describe in detail two cases of epithelial ovarian carcinoma associated with proliferation of Russell bodies and Mott cells in desmoplastic tumor stroma. RESULTS: In the first case, monoclonal proliferation was diagnosed with intranuclear inclusions (Dutcher bodies) in plasma cells. Dutcher bodies were seen both in the tumoral tissue and bone marrow. Monoclonal gammopathy of undetermined significance (MGUS) was diagnosed with an IgM level less than 3 g/l and clonal paratrabecular lymphoplasmocytoid infiltrate less than 10% in the bone marrow. There were no light chain restrictions. Elevated beta 2 microglobulin level and anemia complicated the patients' survival. In the second case, because of desmoplasia the tumor volume did not decrease after the standard chemotherapy although a significant portion of the carcinomatous tissue disappeared. In this study, we checked the role of peritumoral allergic response prospectively in five epithelial ovarian carcinoma cases by actin, desmin, and lambda light chain immunohistochemical staining of the omentum. CONCLUSIONS: Further studies are necessary to show the relation between peritumoral hypersensivity reaction and HLA 1 antigen processing machinery to improve disease-specific survival in epithelial ovarian carcinoma.

Ichthyosis uteri: report of two cases.

Extensive keratinizing squamous change in endometrium, namely ichthyosis uteri, is an uncommon condition. It is considered a benign lesion but its association with malignancy has been reported in the literature. Here, we present two cases of ichthyosis uteri that were both diagnosed in the curettage material. If widespread squamous epithelium covering the entire endometrial surface is detected in the curettage, an advanced examination should be done because of the possibility of the underlying malignancy association.

Comparison of histopathologic classification and surgical stage by cytokeratin 8 and cytokeratin 18 in endometrial cancer.

PURPOSE OF INVESTIGATION: The aim of the study was to show the role of the cytoskeletal proteins CK8 and CK18 in endometrial cancer invasion and to histopathologically classify endometrial cancer patients. METHODS: This study was a prospective analysis of 49 histologic samples of consecutively surgically operated endometrial cancer patients. After histopathologic classification the most invasive tumor area was selected for immunohistochemistry. Monoclonal antihuman keratin Ab-4 and keratin Ab-1 were applied. RESULTS: CK8 and CK18 stained tumoral tissue and tumoral cell debris in the lymphovascular space were significantly correlated with stage (p < or = 0.005). CONCLUSIONS: To understand the causes of early treatment failure in endometrial cancer patients, further studies are needed to show the role of enhancing factors of endometrial cancer invasion.

Successful treatment of nephrotic syndrome due to systemic AL amyloidosis after autologous stem cell transplantation: renal response is an important therapeutic end point.

Primary systemic (AL) amyloidosis involves vital organs from the early phase of illness, resulting in poor prognosis. Today, high-dose melphalan followed by autologous peripheral blood stem cell transplantation is an effective treatment for systemic AL amyloidosis. We report a patient with nephrotic syndrome due to systemic AL amyloidosis, who was successfully treated with autologous peripheral blood stem cell transplantation. At follow-up 36 months from ASCT, the patient showed a significant improvement in the signs of peripheral neuropathy and reduction in proteinuria without further organ involvement. Due to poor prognosis with conventional therapy, autologous stem cell transplantation should be considered for treatment in patients with systemic AL amyloidosis, and favorable outcome is ensured with achievement of renal response after ASCT.

Prognostic significance of fascin expression in endometrioid carcinoma.

PURPOSE OF INVESTIGATION: Actin bundling protein fascin has been previously associated with tumor progression in human cancers. We evaluated whether fascin also plays a role in endometrioid carcinomas. METHODS: Cases of 28 proliferative and hyperplastic endometrium and 43 endometrioid carcinomas were examined by immunohistochemistry using antihuman fascin antibody. RESULTS: Weak fascin expression in glandular epithelium was observed in 39% of non-neoplastic samples and various degrees of fascin expression were observed in 74% of neoplastic samples. The number of positively stained samples and intensity of epithelial staining were significantly higher in endometrioid carcinoma compared to the non-neoplastic group (p < 0.001). The number of positively stained samples and total fascin scores of stroma were significantly higher in proliferative and hyperplastic endometrium biopsies compared to the endometrioid carcinoma (p < 0.001). Higher grade endometrioid carcinoma cases had significantly increased total epithelial fascin scores (.042, p < 0.05). There was also a significant difference between tumor grade and patient survival (.040, p < 0.05). There was a significant correlation between microvessel count and disease-free survival (r = .412, p = .006). In the proliferative and hyperplastic endometrial biopsies microvessels stained homogeneously in all cases (28/28), but in the endometrioid carcinoma group eight out of 43 cases showed heterogeneous fascin staining of microvessels. The difference was significant (.019, p < 0.05). CONCLUSIONS: Our study supported the dynamic role of actin bundling protein fascin in generating and maintaining endometrial neoplasms. It also showed that in the development of neoplasia, stromal fascin expression decreases but epithelial fascin expression up-regulates.

Actin bundling protein fascin expression in ovarian neoplasms: comparison of histopathologic features of tumors obtained by the first and secondary cytoreduction surgeries.

PURPOSE OF INVESTIGATION: The aim of the study was to compare the fascin expression pattern and histopathologic features of malign epithelial ovarian tumors obtained by the primary and secondary surgeries. METHODS: The samples of 94 epithelial ovarian carcinomas, 35 secondary surgeries for ovarian carcinomas, 13 borderline epithelial ovarian tumors, 25 cystadenomas and four normal ovarian tissues were stained by means of fascin immunohistochemistry. Secondary surgeries included in the study were secondary cytoreduction at the time of second-look laparotomy (SLL), interval debulking surgery after neoadjuvant chemotherapy or secondary cytoreductive surgery in patients with recurrent epithelial ovarian carcinoma. RESULTS: Mean rank value of the stromal fascin score was higher in 94 cases of malign epithelial ovarian carcinomas than borderline epithelial tumors, cystadenomas and normal ovaries (.000, p < 0.001). There was no significant difference in terms of total epithelial fascin score (.685, p > 0.05) and total stromal fascin score (.572, p > 0.05) between the primary and the secondary surgeries of epithelial ovarian carcinomas. CONCLUSIONS: Regarding the results of stromal fascin expression in 94 epithelial ovarian carcinomas, we hypothesized that cell-matrix interaction was an important step in the progression of malign epithelial ovarian neoplasms. Our study showed that the initial tumorigenic phenotype did not change with time and use of cisplatinum-based combination chemotherapy. Further studies with close follow-up of patients are necessary to reveal the role of fascin on matrix degradation mechanisms which might be the cause of the recurrences in ovarian neoplasms.

The role of actin bundling protein fascin in the progression of ovarian neoplasms.

PURPOSE OF INVESTIGATION: The aim of the study was to investigate the role of fascin in tumor progression and to investigate the role of fascin on endothelial cell migration and angiogenesis in ovarian neoplasms. METHODS: In the study, 94 malign epithelial ovarian neoplasms, 13 borderline epithelial ovarian neoplasms, 25 serous and mucinous cystadenomas and four normal ovarian tissues were examined by means of immunohistochemistry, using monoclonal antihuman fascin antibody, clone IM20. RESULTS: Total stromal fascin score in cases of borderline and malign epithelial ovarian tumors was significantly higher compared to normal ovaries and benign epithelial ovarian tumors (.000, p < 0.001). There was no statistically significant difference in terms of total epithelial fascin scores of samples between groups (.080, p > 0.05). Presence of vascular invasion (.000, p < 0.001), psammomatous calcifications (.001, p = 0.001), and lymphocytic infiltration (.000, p < 0.001) were significantly higher in malign neoplasms. There was no significant difference in terms of mean microvessel count and homogeneous or heterogeneous fascin expression of microvessels between the benign and malign groups (respectively p = .228 and p = .143). CONCLUSIONS: This study suggests that up-regulation of fascin in tumoral tissue may promote invasion of ovarian carcinoma by cell-matrix adhesion.

Fascin, an actin-bundling protein expression in cervical neoplasms.

PURPOSE OF INVESTIGATION: Our objectives were (1) to examine expression of fascin in cervical tissues with chronic inflammation, intraepithelial neoplasms and invasive carcinomas, and (2) to investigate the role of fascin on endothelial migration and angiogenesis in cervical neoplasms. METHODS: In this study we investigated by means of immunohistochemistry fascin expression in 92 cervical biopsy samples representative of chronic inflammation (n=13), squamous intraepithelial lesions (SILs, n = 33) and invasive carcinomas (n = 46). RESULTS: Various degrees of fascin expression were observed in 94% of the samples of SILs, in 67% of the samples of invasive cervical carcinoma and in 69% of the samples of chronic inflammation. Total epithelial fascin scores of samples were significantly higher in high-grade (H)SILs compared to low-grade (L)SILs, invasive carcinoma and chronic inflammation of the cervix (p < 0.05). Mean microvessel count was 55.00 +/- 5.17 in HSILs, 40.76 +/- 3.57 in LSILs, 37.11 +/- 2.91 in carcinoma and 25.69 +/- 3.98 in chronic inflammation. We found a significantly higher microvessel count in HSILs compared to invasive carcinoma and chronic inflammation (respectively, p = .004, p = .000). CONCLUSION: Epithelial fascin expression up-regulated when the malignant tumor cell phenotype had occurred in the cervix. Similarly, microvessel count increased with the beginning of cervical tumorigenesis.

Massive ovarian edema: a case report.

Massive ovarian edema is considered a non-neoplastic lesion characterized by a tumor-like enlargement of one or occasionally both ovaries secondary to an accumulation of edema fluid within the stroma. It is an uncommon entity that usually leads to oophorectomy as an unnecessary treatment in children, adolescents and young women. A diagnostic wedge resection with subsequent frozen section is essential. A definitive diagnosis of massive ovarian edema can not be made on preoperative imaging. In this article a case of massive ovarian edema in a 15-year-old female thought to be a solid neoplasm in the preoperative period is described.

Renal involvement in primary antiphospholipid syndrome and its response to immunosuppressive therapy.

Antiphospholipid syndrome (APS) is the association between antiphospholipid antibodies, venous and arterial thrombosis and pregnancy morbidity. Although the kidney may be affected in APS, the treatment of renal involvement is yet to be elucidated. This report describes the clinical and laboratory features of four patients with primary APS nephropathy, and the beneficial effect of immunosuppressive therapy accompanied by warfarin and angiotensin-converting enzyme inhibitor. We also briefly discuss the possible mechanisms of the beneficial effects of immunosuppressives on primary APS nephropathy.

Prognostic value of matrix metalloproteinase-9 (gelatinase-B) expression in epithelial ovarian tumors.

PURPOSE OF INVESTIGATION: To determine the expression of matrix metalloproteinase-9 (MMP-9) expression in malignant and borderline ovarian tumors and its correlation to prognosis. METHODS: Forty-five patients with primary epithelial ovarian tumors were enrolled in this retrospective study from 1988 to 2002. Only malignant (n = 30) and borderline (n = 15) ovarian tumors constituted the study group. All cases were surgically staged according to FIGO criteria. Patient characteristics and clinico-pathological findings were obtained from hospital records. Paraffin-embedded tissue blocks were treated with MMP-9 immunohistochemical stain. The percentage of the total number of tumors staining positively was categorised and awarded a score of 0 to 4: < 5% as 0, < or = 6-25% as 1, 26-50% as 2, 51-75% as 3 and 76-100% as 4. The intensity of immunostaining was scored on a 3-point scale: 1, weak; 2, moderate and 3, intense. A weighed score for each tumor specimen was produced by multiplying the percentage score with the intensity score and was defined as the 'epithelial MMP-9 score'. Stromal staining was also assessed as weak, moderate and intense. Cases with final epithelial MMP-9 scores < or = 6 and > 6 were then recategorised into two groups, accordingly. Based on degree of stromal staining, cases were recategorised into two final groups as mildly stained and intense or moderately stained. Tumor stages were regrouped as early (Stage I-II) and late (Stage III-IV), respectively. RESULTS: Mean ages of cases with malignant and borderline ovarian tumors were 57.2 +/- 3.1 and 49.7 +/- 2.1 years, respectively. Epithelial MMP-9 scores were higher in malignant tumors compared to borderline tumors (p = 0.014). However, with regard to stromal MMP-9 staining, no significant difference was observed among malignant and borderline tumors (p = 0.113). Among malignant ovarian tumors, epithelial MMP-9 scores did not differ between early versus late-staged and well versus poorly differentiated tumors. Median survival time of cases with epithelial MMP-9 scores < or = 6 and > 6 were 24 months and 32 months, respectively (log-rank: 0.93, p = 0.335). Cases with weak stromal MMP-9 staining had a longer median survival (48 months) compared to cases with moderate or intense stromal MMP-9 staining (24 months, log-rank: 4.46, p = 0.03). CONCLUSION: Epithelial MMP-9 expression generally appears in the malignant form of ovarian tumors compared to borderline tumors. MMP-9 expression in the stroma but not in the epithelium contributes to poor survival in ovarian cancers.

p53 overexpression as a prognostic indicator in endometrial carcinoma.

PURPOSE: To investigate the prognostic value of p53 overexpression in endometrial adenocarcinoma cases of different stages and histologic subtypes. METHODS: One hundred and eleven surgically staged endometrial carcinoma (EC) cases from 1996 to 2000 constituted this retrospective study group. Prognostic factors determined through the evaluation of surgery specimens by co-author pathologist, were surgical stage, tumor size, histology, histologic and nuclear grade, myometrial invasion, adnexal/serosal metastasis, peritoneal cytology, retroperitoneal lymph node involvement p53 overexpression was assessed via immunohistochemical staining. Tissues that expressed p53 were considered as positive p53 staining. In terms of degree of staining, 1-29%, 30-90% and 80-100% of tumoral tissue stained with p53 were considered to be mild, moderate and high p53 staining, respectively. RESULTS: Mean age and follow-up period of the study group were 58.2 +/- 10.6 years and 33.4 +/- 2.7 months, respectively. Percentages of cases surgically staged as early (I-II) and advanced (III-IV) FIGO stages were 65.8% (n: 73) and 34.2% (n: 38), respectively. Cases with positive p53 staining had a significantly high mean survival period compared with those with negative p53 staining (86.6 +/- 6.0 vs 49.1 +/- 8.1, p < 0.001). p53 overexpression was statistically detected to be high in Stage III-IV tumors, non-endometrioid histologic subtypes (p = 0.019), histologic and nuclear grade 2-3 tumors (p < 0.001), adnexal/serosal metastasis (p = 0.001), lymph node involvement (p = 0.012), and positive peritoneal cytology (p = 0.017). The degree of p53 staining was remarkably correlated with survival. In cases with mild and high p53 staining, mean survival times were 47.1 +/- 7.0 months and 57.0 +/- 13.1 months, respectively (p = 0.0003) compared to those with high p53 staining. On univariate analysis, all of the prognosticators, including p53 staining (p < 0.001) and degree of p53 staining (p < 0.001) appeared to be independent risk factors for poor prognosis. On multivariate analysis, only pelvic lymph node involvement (p = 0.03), serosal/adnexal involvement (p = 0.004), and positive peritoneal cytology (p = 0.01) were found to be independent prognosticators of survival while p53 expression (p = 0.743) and degree of p53 staining (p = 0.802) were not detected as independent prognosticators. CONCLUSION: p53 overexpression is strongly related to poor prognostic indicators in endometrial adenocarcinoma. Although in this study p53 overexpression was not detected as an independent prognosticator, additional studies with large data set are needed to evaluate the prognostic value of p53 expression.

Should endometrial hyperplasia be regarded as a reason for abnormal uterine bleeding in users of the intrauterine contraceptive device?

OBJECTIVE: Histopathological evaluation of the endometrium in cases having an intrauterine device (IUD) removed for abnormal uterine bleeding. METHODS: Fifty-eight consecutive patients with a complaint of uterine bleeding leading to IUD removal were recruited for this study. Endometrial sampling, via Novak curette, was performed during IUD removal for histopathological evaluation of the endometrium. RESULTS: A total of 58 current IUD users, presenting with uterine bleeding, were retrospectively analyzed. Mean age of the women was 37.1 +/- 2.1 years (range 25-43). Mean duration of IUD use was 4.2 +/- 1.3 years (range 1-10). Out of 58 cases, 21 (36.2%) did not harbor any endometrial pathology. In eight cases (13.8%), hyperplastic endometrial changes were apparent, six of which were simple hyperplasia (four of them were focal). Two cases of complex hyperplasia were detected (one was diffuse with atypia and one was focal without atypia). In this series, there was one case with an endometrial polyp. Mean age of cases with hyperplastic endometrium was found to be statistically high compared to those with normal endometrial histology (42.4 +/- 3.2 vs. 37.6 +/- 2.1, p = 0.04). In cases with IUD use of > 5 years, chronic endometritis was more prevalent, compared to those with < 5 years of use (chi(2) 5.08, p = 0.02). CONCLUSIONS: IUD use is a risk factor for chronic endometritis. Nevertheless, in 13.8% of cases in this series, as a reason for abnormal uterine bleeding, other than endometritis, endometrial hyperplasia constituted the second most common endometrial pathology among cases over the age of 40, on current IUD use and having complaints of abnormal uterine bleeding. Hence, this finding should prompt the physician to perform endometrial sampling in users of an IUD over the age of 40, presenting with abnormal uterine bleeding.

Multidrug resistance gene-1 (Pgp) expression in epithelial ovarian malignancies.

OBJECTIVE: To assess the value of P-glycoprotein (Pgp) expression in advanced epithelial ovarian cancer with regard to clinicopathological findings and disease prognosis. METHODS: Twenty-four cases diagnosed as primary epithelial ovarian malignancies, between 1993-1999, were enrolled in this study. All of the cases had undergone cytoreductive surgery and an optimal staging procedure. Following cytoreductive surgery, in 18 patients, cisplatin+cyclophosphamide, and in six patients, cisplatin+paclitaxel combination chemotherapy regimens were initiated. After six courses of chemotherapy, cases were evaluated by pelvic examination, transvaginal ultrasound, pelvi-abdominal tomography and serum Ca-125 levels for the presence of residual disease. Following this evaluation residual tumor was detected in 14 cases and secondary cytoreductive surgery was undergone. In ten cases without any clinical and laboratory confirmation of the presence of tumor, second-look laparotomy was performed. In 24 epithelial ovarian cancer cases, both in primary or secondary cytoreductive surgery, Pgp expression was determined by immunohistochemical methods. RESULTS: Following primary surgery, in 25% (6/24) of cases, analysis of tumor specimens showed presence of Pgp expression. In cases recurring after first-line chemotherapy, Pgp expression was not statistically different in regard to chemotherapy regimen (p = 0.098). Pgp expression in tumoral tissues after chemotherapy did show a higher Pgp expression than before chemotherapy (p = 0.016). No significant correlation was relevant between Pgp expression and Ca-125 levels, histopathological differentiation, histologic subgroups of tumor, primary and residual tumor sizes and overall survival. CONCLUSION: In epithelial ovarian cancer, Pgp expression has no effect on overall disease survival.

Diffuse sclerosing variant of papillary thyroid carcinoma with primary squamous cell carcinoma.

A case of a very rare combination of diffuse sclerosing variant of papillary thyroid carcinoma (DSPC) and primary squamous thyroid carcinoma (PSC) is presented. A 25-yr-old woman with right-sided neck mass and hypothyroidism was admitted. US showed that the right lobe of the thyroid gland was enlarged with irregular margins and heterogen echogenity and there were multiple small punctate echogenic foci in the central portion. A scintigraphy with 99mTc showed decreased uptake in the right lobe. FNA of the right lobe induced us to consider the presence of follicular neoplasm. Chest roentgenogram was normal. Total thyroidectomy with right-sided modified radical neck dissection was performed. Findings related to Hashimoto's thyroiditis and abundant psammoma bodies were observed in the frozen sections. Histopathologic findings demonstrated the coexistence of DSPC and PSC in both lobes and 16 lymph nodes metastases and soft tissue infiltration. Radioiodine was administered to ablate residual thyroid tissue. She was given T4 suppression therapy. At the 44th month of follow-up, she remains well without recurrences and metastases. The coexistence of DSPC and thyroiditis or PSC is still under debate. Very few cases with the combination of papillary thyroid carcinoma and PSC have been reported previously, thus we discuss the clinico-pathologic features and possible explanation for this unusual coexistence of malignancies.

The significance of local cellular immune response of women 50 years of age and younger with endometrial carcinoma.

OBJECTIVE: Local cellular immune response and traditional histopathologic parameters in endometrial carcinoma patients 50 years old and younger were compared with those of patients older than 50 years of age. MATERIALS AND METHODS: We retrospectively compared the clinicopathologic factors and outcomes of 24 younger and 82 older women who were operated on for endometrioid type endometrial carcinoma at our institution. RESULTS: No significant difference was determined in survival with respect to age and menopausal status in patients with endometrial carcinoma. Younger and older age groups had a similar distribution of most pathologic features including myometrial invasion, cervical involvement, lymph node metastasis, vascular invasion, perivascular lymphocytic infiltrates and tumor infiltrating lymphocytes. While older women had higher-grade tumors, younger women had more frequent ovarian metastasis. Tumor infilrating lymphocytes were seen more frequently in the postmenopausal group than those of the premenopausal group. CONCLUSION: The distribution of local cellular immune response, most histopathologic parameters and survival were the same for younger and older women.

Pelvic tuberculosis mimicking signs of abdominopelvic malignancy.

We discuss the clinical presentation and consequences of pelvic tuberculosis in the context of 3 cases having developed typical signs and symptoms of ascites and abdominal mass. These cases are reported to emphasize the difficulty of early diagnosis and treatment of the disease.