Treatment Outcome of the Combination Therapy of High-dose rate Intracavitary Brachytherapy and Intensity-modulated Radiation Therapy With Central-shielding for Cervical Cancer.

BACKGROUND/AIM: This study aimed to evaluate the clinical outcome of intensity-modulated radiation therapy (IMRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) in uterine cervical cancer (UCC). IMRT consisted of whole-pelvic radiation therapy (WPRT) and sequential WPRT with central-shielding (WPRT-CS). PATIENTS AND METHODS: Thirty UCC patients treated with IMRT using TomoTherapy, were retrospectively analyzed. RESULTS: The median dose of WPRT and WPRT-CS was 36 and 14.4 Gy and the median total dose of these was 50 Gy in 25 fractions (Fr). Median HDR-ICBT dose/Fr to Point A was 25 Gy/5 Fr. Median 2 Gy per fraction-equivalent dose (EQD2) of combined WPRT and HDR-ICBT to Point A (α/ß=10) was 71.0 Gy. The 3-year local control, disease-free survival, and overall survival rates were 89.9%, 83.3%, and 86.3%. CONCLUSION: IMRT of WPRT and WPRT-CS given in combination with HDR-ICBT was a feasible therapy resulting in good disease control and tolerance in patients with UCC.

Spontaneous uterine laceration in labor: a type of intrapartum uterine injury different from the classical uterine rupture.

Uterine rupture, a complete disruption of uterine wall, is synonymously used of intrapartum uterine corpus injuries. However, uterine laceration, partial and minor myometrial tear, is not well characterized. A 35-year-old Japanese woman with unscarred uterus was delivered of a baby at 38 gestational weeks. Shortly after delivering the placenta, she complained of severe lower abdominal pain with shock vitals. Exploratory laparotomy revealed a partial and shallow myometrial and serosal tear with massive hemoperitoneum. Despite its shallow and minor nature of the injury, uterine laceration can cause a catastrophic massive hemoperitoneum and should be noted as a type of intrapartum uterine injury in clinical practice.

Secretory breast carcinoma: unique, triple-negative carcinoma with a favorable prognosis and characteristic molecular expression.

Secretory carcinoma is a rare but distinct subtype of breast carcinoma, with characteristic histomorphology and generally favorable prognosis. Although it was originally described as a juvenile breast carcinoma, occurring in young children, most cases have been reported in adults of both sexes. As the name implies, the characteristic histomorphology is the presence of a large amount of intracellular and extracellular, eosinophilic secretion material that stains positive for periodic acid-Schiff. Most tumors stain positive for S100 and negative for estrogen receptor, progesterone receptor, and ERBB2 (formerly HER2/neu) (ie, triple negative). In addition, some secretory carcinomas demonstrate a basal-like immunoprofile. Recent studies have shown the characteristic molecular feature: a balanced translocation t(12;15), resulting in an ETS variant 6-neurotrophic tyrosine kinase receptor type 3 (ETV6-NTRK3) fusion gene encoding a chimeric tyrosine kinase. Although rare events of axillary lymph node or distant metastases have been documented, the prognosis is generally excellent. The methods of surgical treatment and the role of adjuvant therapy, particularly for young patients, remain controversial.

Signet ring squamous cell carcinoma--the forgotten variant: case report and review of the literature.

Squamous cell carcinoma is one of the commonest skin cancers. In most instances, histological diagnosis is straightforward and does not pose any diagnostic challenge to the handling pathologist. We report a rare case of signet ring squamous cell carcinoma (SRSCC) occurring in an 84-year-old woman who presented with a sore on the upper lip. Excision of the lesion showed signet ring carcinoma within a scar and surface ulceration. Deeper sections showed focal area of squamous differentiation. Although rare, consideration of squamous cell carcinoma as a diagnosis of primary skin tumors with signet ring morphology, especially in the absence of history of adenocarcinoma, may prevent missing rare cases of SRSCCs.

Pemphigus vulgaris of the vagina--its cytomorphologic features on liquid-based cytology and pitfalls: case report and cytological differential diagnosis.

Pemphigus vulgaris is an autoimmune bullous disease that involves skin and mucous membrane. Although the female genital tract is rarely affected, its cytomorphologic features on a conventional cervicovaginal smear have been notoriously described with a possibility of being misdiagnosed as neoplastic lesions. Its cytological mimicry for squamous cell carcinoma has been described as having serious misdiagnostic potential, particularly if appropriate clinical information is not provided. We report a case of pemphigus vulgaris involving the vagina diagnosed on a liquid-based cervicovaginal smear Thin Prep(R) (TP). The smear was initially reported as squamous cell carcinoma. However, re-evaluation of the TP smear raised the suspicion of pemphigus, which was supported subsequently by clinical information and tissue biopsy confirmation. We described the cytologic features of pemphigus vulgaris on a TP smear and compared them with those of neoplastic conditions. Pemphigus cells on a TP smear exhibit similar cytomorphologic features to those on a conventional smear. Recognizing euchromatin pattern and smooth nuclear contours which may be better appreciated on a TP can prevent overdiagnosis.

Mammaglobin expression in the female genital tract: immunohistochemical analysis in benign and neoplastic endocervix and endometrium.

Mammaglobin (MGB), a secretory protein belonging to the uteroglobin/Clara cell protein family, is a sensitive marker for breast carcinoma, but is also reported to be expressed in the female genital tract and its neoplasms. Details of MGB expression pattern and its pathologic significance in the female genital tract have not been systematically studied. To investigate the potential use of MGB in gynecologic pathology practice, we tested MGB expression by immunohistochemistry on 47 endocervical adenocarcinomas (whole tissue sections of 13 invasive and 35 in situ) and 55 endometrial carcinomas (39 endometrioid and 16 nonendometrioid represented on a single tissue microarray). Nonneoplastic endocervical and endometrial tissues were also evaluated for MGB expression. MGB expression was detected in thirty (77%) of 39 of endometrioid endometrial adenocarcinomas compared with 4 (31%) of 13 endocervical adenocarcinomas. MGB was mostly negative in nonendometrioid endometrial carcinoma (negative in 14 [88%] of 16). Endocervical adenocarcinoma in situ (AIS) showed either weak (predominantly) or moderate (occasionally) expression in about 40% of the cases in comparison with strong positivity in benign endocervical glandular epithelium. Reduction of MGB staining was seen in transition from benign epithelium to AIS. These results confirm that MGB is not specific for breast carcinoma, but is also variably expressed in nonneoplastic and neoplastic endocervical and endometrial tissues. Frequent MGB expression in endometrioid endometrial adenocarcinoma is significantly different from nonendometrioid carcinoma. Hormone receptor status is not associated with MGB expression in endometrial carcinomas. Most endocervical adenocarcinomas are negative for MGB, in contrast to mostly positive endometrioid endometrial adenocarcinomas, however, MGB expression alone is not specific enough to distinguish these 2 tumor types. MGB expression is altered in neoplastic endocervical epithelium compared with normal, and may indicate its decreased expression in the process of early carcinogenesis. MGB may be a promising new adjunctive marker in gynecologic pathology.

Asymptomatic giant-cell (temporal) arteritis involving the bilateral adnexa: case report and literature review.

Giant-cell arteritis involving the bilateral adnexa was identified incidentally in a bilateral salpingo-oophorectomy specimen obtained as a result of an ovarian cyst in a 75-year-old woman. Although the patient was asymptomatic, extensive giant-cell arteritis was present in the ovaries, paraovarian tissue, and fallopian tubes along with Brenner tumors of the ovaries. This finding prompted a temporal artery biopsy that revealed typical temporal arteritis. Giant-cell arteritis rarely involves the female genital tract and may present as an isolated form or a part of systemic disease. We discuss female genital tract giant-cell arteritis with a review of the English literature.

Disseminated nocardiosis diagnosed by fine needle aspiration biopsy: quick and accurate diagnostic approach.

Nocardia is an uncommon pathogen in immunocompetent patients; however, it has been increasingly recognized as a significant opportunistic pathogen in organ transplant patients. Diagnosis of Nocardiosis is usually made by microbiologic culture or cytologic examination of pulmonary specimens including, sputum, and brushing/washings or by histologic evaluation of tissue biopsy material. We report a case of subcutaneous Nocardiosis diagnosed by Fine-needle aspiration biopsy (FNA). The patient is a 66-year-old man with a history of lung transplantation and posttransplant lymphoproliferative disorder who presented with subcutaneous masses in the right upper arm and the left shoulder. FNA was performed in an outpatient clinic setting, with immediate morphologic assessment revealing filamentous branching organisms suspicious for Nocardiosis. Subsequent examination with special stains and microbiologic culture confirmed the diagnosis. The quick and accurate diagnosis by FNA led to emergent and appropriate treatment.

Clinical implications of the diagnosis "atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion" in pregnant women.

BACKGROUND: Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) has a high predictive value for high-grade intraepithelial lesion (HSIL) in the general population. However, the significance of ASC-H in pregnant women remains to be elucidated. The objective of this study was to investigate the clinical implications and pathologic significance of ASC-H in pregnant women, so that these patients will be managed appropriately. METHODS: All Papanicolaou tests that were diagnosed as ASC-H in pregnant women over 1.5 years (total, 60 women) were reviewed and correlated with histologic and/or cytologic follow-up. High-risk type of human papillomavirus (HPV) status was also correlated with follow-up findings. The following cytomorphologic parameters were evaluated for each woman and were compared between the squamous intraepithelial lesion (SIL) follow-up group and the benign follow-up group: inflammatory background, the number of atypical cells, cell arrangement pattern, nuclear irregularity/grooves, hyperchromasia, and cell shape. RESULTS: Among 30 women who had histologic follow-up, 3 women (10%) had HSIL, and 13 women (43%) had low-grade intraepithelial lesion (LSIL). Among 32 women who had cytologic follow-up, 2 women (6%) had HSIL, 3 women (9%) had LSIL, 1 woman (3%) had ASC-H, and 3 women (9%) had atypical squamous cells of undetermined significance (ASCUS). HPV was detected in 24 of 43 women (56%). The cytomorphologic features were similar in the SIL follow-up group and the benign follow-up group. No specific cytomorphologic features that predicted underlying SIL were identified. CONCLUSIONS: ASC-H in pregnant women had a lower predictive value for an underlying HSIL compared with the general population. A positive HPV test result was not a good indicator for an underlying SIL, but a negative result appeared to be useful for ruling out an underlying HSIL. Because of low positive predictive value for HSIL and the difficult colposcopic examination, a more conservative follow-up may be reasonable for pregnant women who have a diagnosis of ASC-H. HPV testing may be used as an adjunctive test.