'Ciliated' tumour cells in ascitic fluid from two cases of cystadenocarcinoma of the ovary.

We report two cases of primary carcinoma of the ovary in which 'ciliated' adenocarcinoma cells were found in the ascitic fluid. Transmission electron microscopy revealed that these were not true cilia but rather a prolific growth of abnormal microvilli. The cytological findings were compared with the histological appearances of the primary tumour. No ciliated cells were seen in the primary tumour, suggesting that the formation of the microvilli represented an independent proliferation of the cells in the fluid. Special staining reactions for mucin, alkaline phosphatase and epithelial membrane antigen were identical in the primary tumour and the cells in the ascitic fluid.

Extrauterine müllerian adenosarcoma of the peritoneal mesothelium: a clinicopathologic and electron microscopic study.

An unusual case of a müllerian adenosarcoma of the peritoneal mesothelium in a 32-year-old pregnant woman is described. On emergency laparotomy, a tumor was found in the pelvis connected with the right broad ligament only, and was removed. Light and electron microscopic examination showed a rare example of an extrauterine müllerian adenosarcoma composed of a stromal sarcoma, muscle tissue resembling primitive myoblasts, and sex-cord-like tubular lumens. The patient was followed, and after 22 months the primary surgery was reexplored. On laparotomy, no evidence of disease was found, and the ovaries were tumor-free. Histologic examination of the pelvic peritoneum demonstrated small areas of adenosarcoma resembling elements of the previous tumor. Müllerian adenosarcoma is a rare tumor of müllerian origin, and its less aggressive behavior as compared with mixed müllerian sarcoma is warranted. The better prognostic outlook of müllerian adenosarcoma is probably related to the histologic structure, but depends in addition on the size of the tumor and the site of origin. No case of peritoneal origin of müllerian adenosarcoma has been previously reported; we discuss this unusual location.

Clinical and ultrastructural findings of an androgenizing Krukenberg tumor in pregnancy.

A clinical and ultrastructural study of an androgenizing Krukenberg tumor in pregnancy is presented. Ultrastructural observations suggested the abundant, hyperplastic, luteinized ovarian interstitial cells as the probable cause of elevated circulating levels of testosterone (5400 ng/dL). The unusual fine structure of these cells, which included large intramitochondrial lipid droplets and abundant smooth endoplasmic reticulum, was indistinguishable from that reported to occur in Leydig cells stimulated by exogenous gonadotropins.

A stromal Leydig cell tumor of the ovary occurring in a pregnant 15-year-old girl. Ultrastructural findings.

The first case of stromal Leydig cell tumor of the ovary occurring during pregnancy is reported. A 15-year-old girl presented in labor at 36.5 weeks of gestation. The tumor mass was obstructing labor and the patient had to be delivered by cesarean section. Unique features of this case included the young age of the patient, the large size of the tumor, and the associated pregnancy. The tumor was encapsulated and showed the typical histologic and ultrastructural features of ovarian stromal Leydig cell tumor. The literature is reviewed, and the differential diagnosis is discussed.

Pseudosarcoma botyroides in pregnancy: report of a case with ultrastructural observations.

A case of pseudosarcoma botryoides of the vagina diagnosed in advanced pregnancy is described. The cellular characteristics (atypical cells and abnormal mitoses) suggested malignancy, but ultrastructural studies demonstrated the fibroblastic nature of the cells, thus confirming the diagnosis of pseudosarcoma. Local excision and subsequent cesarean section was the method of treatment. Three years later, another pregnancy was terminated by repeat cesarean section and uncontrollable hemorrhage requiring emergency hysterectomy. The histologic study of the bleeding area revealed very edematous areas and lacunaelike endothelium-lined vessels. No cellular abnormalities were observed.

Primary malignant melanoma of the vulva associated with pregnancy: clinical, light and electron microscopic observations.

A case of primary malignant melanoma of the vulva associated with pregnancy in a 31-year-old patient is reported. The primary tumor was first found at week 14 of pregnancy and biopsied on delivery at week 41 of pregnancy. Microscopically, the depth of invasion was Level V. Radical vulvectomy and bilateral inguino-femoral lymphadenectomy were performed and the right inguinal lymph node was positive for metastatic tumor. Chemoimmunotherapy with DTIC, ACNU, VCR and OK432 was undertaken as treatment for this malignant melanoma. Moreover, a comparison of scanning and transmission electron microscopic studies of the original tumor was carried out. This patient is now living 23 months after diagnosis without clinical evidence of recurrence.

Peritoneal leiomyomatosis (leiomyomatosis peritonealis disseminata): a clinicopathologic study of 20 cases with ultrastructural observations.

Peritoneal leiomyomatosis (PL) occurs in women of reproductive age. Of 20 women with PL in this study, 10 were pregnant or immediately postpartum, and 7 were taking oral contraceptive steroids. Only three of the 20 women were not pregnant or taking exogenous hormones. All PL nodules were composed mainly of spindle cells, but decidual cells were admixed with the spindle cells in some of the nodules in six of the 10 pregnant and postpartum women. Electron microscopy was applied to the nodules from six women representing the three different hormonal backgrounds. All contained smooth muscle cells. One was composed exclusively of smooth muscle cells, while four of the six contained smooth muscle cells predominantly but were admixed with myofibroblasts or altered smooth muscle cells and fibroblasts. Decidual cells were conspicuous in the nodules examined ultrastructurally from a pregnant woman. Despite incomplete excisions, none of the 14 women with follow-up had progressive disease. Complete or partial regression of PL was verified by "second-look" laparotomy in four women, but a repeat cesarian section in a fifth woman revealed persistence (or recurrence) of PL 1.5 years after the initial diagnosis. PL probably results from an unusual predisposition, or selective sensitivity, of subperitoneal mesenchymal stem cells in some women to undergo metaplasia and differentiation to smooth muscle, fibroblasts, myofibroblasts, and decidual cells. In the majority of women, hormonal stimulation is an initiator or promoter of the process.