Ablation of metastatic ovarian carcinoma with the argon beam coagulator: pathologic analysis of tumor destruction.

OBJECTIVE: The aim of this study was to characterize the histopathologic effects of electrosurgical tumor destruction of metastatic ovarian carcinoma using the argon beam coagulator (ABC) and evaluate the depth of tissue damage produced by a range of power settings and tissue interaction times. METHODS: Epithelial ovarian carcinoma tumor specimens (1 cm(3)) were harvested intraoperatively. Following surgical excision, electrosurgical destruction of tumor was effected using the ABC at three power settings (60, 80, and 100 W) and three tissue interaction time intervals (1, 3, and 5 s), yielding nine experimental groups of 16 samples each (n = 144). Samples were formalin-fixed, cross-sectioned, stained with hematoxylin and eosin, and examined microscopically for histologic characteristics and depth of tissue destruction. RESULTS: Microscopic evaluation revealed that the total depth of destruction (TDD) produced by the ABC was composed of three distinct zones of tissue injury: vaporization, carbonized eschar (ESC), and coagulative necrosis (NEC). For each power setting, the mean TDD increased in a linear fashion as the interaction time interval increased from 1 to 5 s (60 W, 1.71 to 2.43 mm; 80 W, 2.24 to 3.69 mm; 100 W, 3.21 to 5.58 mm). By regression analysis, both power setting and tissue interaction time were independently associated with increasing TDD, with power having the strongest effect. At all power settings and interaction time intervals, the incremental change in TDD was primarily a function of the degree of tissue vaporization, which increased from 0.59 mm at 60 W (1 s) to 3.22 mm at 100 W (5 s). For all experimental groups, the ratio of NEC/ESC was highly consistent, ranging from 1.03 to 1.33 (P > 0.05, Bonferroni multiple comparisons procedure), and demonstrated that for each resulting ESC, an equivalent or greater degree of underlying NEC was also present. CONCLUSIONS: The destruction of ovarian carcinoma tumor tissue produced by the ABC is dependent upon both power setting and tissue interaction time. Increasing depth of destruction is due predominantly to a deeper level of tissue vaporization. The NEC/ESC ratio provides a reliable means of estimating the true depth of tumor destruction produced by the ABC and may contribute to increased safety and efficacy of electrosurgical cytoreduction of using this technique.

Comparative analysis of sampling methods for grossing radical prostatectomy specimens performed for nonpalpable (stage T1c) prostatic adenocarcinoma.

Scant data are available comparing sampling methods of radical prostatectomy specimens performed for clinical stage T1c (nonpalpable) cancer. Seventy-eight stage T1c radical prostatectomies that had 1 or more of the following adverse pathologic findings-Gleason score > or = 7, positive margins, and extraprostatic extension-were compared using 10 different sampling techniques. Of the 78 entirely submitted cases, 52 had Gleason score > or = 7, 14 had positive margins, and 54 had extraprostatic extension (mean 34 slides). Of the partial sampling methods, we favor the following two methods. The first is submitting every posterior section plus 1 midanterior section from right and left sides; if either of these anterior sections show sizeable tumor, all ipsilateral anterior slides are examined. This method detects 98% of tumors with Gleason score > or = 7, 100% of positive margins, and 96% of cases with extraprostatic extension (mean 27 slides). The second method is to use the above method but restrict it to sections ipsilateral to the previous positive needle biopsy. This method detects 92% of tumors with Gleason score > or = 7, 93% of positive margins, and 85% of cases with extraprostatic extension (mean 17 slides). Partial sampling can detect important prognostic parameters. By balancing the extra expense and time involved to process and examine additional sections with the risk of missing important prognostic parameters, pathologists can decide which sampling method to use.

Refined diagnostic criteria for implants associated with ovarian atypical proliferative serous tumors (borderline) and micropapillary serous carcinomas.

Characterization of invasive peritoneal implants from patients with noninvasive serous ovarian tumors has important prognostic and treatment implications, but the criteria for distinguishing invasive and noninvasive implants vary among investigators and can be difficult to apply. The authors studied 148 implants from 60 patients, 33 with primary atypical proliferative serous tumor, and 27 with primary noninvasive micropapillary serous carcinoma, with a mean follow-up of 62 months (median follow-up, 52 months). Previously reported and newly proposed histologic features for implant classification were evaluated and correlated with clinical outcome. Three criteria were applied for the diagnosis of "invasive" implants: invasion of underlying normal tissue, micropapillary architecture, and solid epithelial nests surrounded by clefts. Implants displaying any one of these three features were classified as "invasive," whereas those lacking all three features were classified as "noninvasive." Sixty-six implants were invasive and 82 were noninvasive. Of the 31 patients with invasive implants, six were dead of disease (DOD), 13 were alive with progressive disease (AWPD), and 12 were alive with no evidence of disease (NED). Of the 29 patients with noninvasive implants, two were DOD, one was dead of uncertain causes, one was AWPD, and 25 were alive with NED. Eighty-nine percent of invasive implants had a micropapillary architecture and 83% had solid epithelial nests surrounded by clefts. A minority of invasive implants (14% of those with underlying normal tissue) demonstrated invasion of normal underlying tissue. Nuclear atypia, mitoses, calcification, necrosis, and identification of individual cells "infiltrating" the stroma did not correlate with implant type. The proposed criteria permitted recognition of implants that correlated strongly with adverse outcome. Sixty-one percent of patients with implants displaying any one of the three features used to diagnose invasive implants were AWPD or DOD compared with 10% of patients whose implants lacked these features (p = 0.00001). Because implants associated with an adverse outcome can be identified before they invade underlying normal tissue, the term invasive implant to describe them is inaccurate and misleading. These implants resemble patterns of growth in micropapillary serous carcinoma of the ovary and the recurrent tumor that is obvious carcinoma. Accordingly, we propose that these extraovarian lesions be designated "well-differentiated serous carcinoma."

Problems with proper completion and accuracy of the cause-of-death statement.

BACKGROUND: Mortality statistics are largely based on death certificates, so it is important that the data on the death certificate is accurate. At our institution, clinicians complete cause-of-death statements (CODs) prior to autopsy. Since May 1995, separate CODs have been included in autopsy face sheets. METHODS: Clinical and autopsy-based CODs filled out separately on 494 cases between June 1995 and February 1997 were compared for proper reporting and accuracy using the published guidelines and definitions of immediate, intermediate, and underlying causes of death put forth by the College of American Pathologists and the National Center for Health Statistics. RESULTS: Of the 494 death certificates, 204 (41%) contained improperly completed CODs. Of these, 49 (24%) contained major discrepancies between clinicians' and pathologists' CODs. Of the 494 death certificates, 290 (59%) had properly completed CODs. Of the 290 properly completed CODs, 141 (49%) contained disagreements: 73 (52%) on underlying CODs; 44 (31%) on immediate CODs; and 47 (33%) on other significant conditions (part II). CONCLUSIONS: The reliability and accuracy of CODs remain a significant problem. Despite its limitations, the autopsy remains the best standard against which to judge premortem diagnoses. The CODs of the death certificate may be improved if death certificates are completed in conjunction with the postmortem examination and amended when the autopsy findings show a discrepancy.