The prognostic value of nuclear morphometric analysis in serous ovarian carcinoma.

The objective of this study was to determine whether nuclear morphometric data can predict survival, disease progression, and chemotherapeutic response in ovarian serous carcinoma. Nuclear morphometric parameters were determined from archival hematoxylin and eosin sections of 132 serous tumors. Clinicopathologic and morphometric parameters were evaluated as to their individual and independent prognostic value and prediction of chemotherapy response. Nuclear parameters were found to strongly correlate with extent of disease residuum, tumor grade, and FIGO stage. Univariate analysis revealed stage, grade, preoperative CA125, presence of ascites, extent of disease residuum, standard deviation of nuclear area (SDNA), nuclear perimeter (NP), SDNP, nuclear length (NL), nuclear breadth (NB), orthoferet, and equivalent diameter (ED) to be significant predictors of overall survival (OS) and disease-free survival (DFS). Grade, stage, extent of disease residuum, presence of ascites, SDNA, NP, NL, NB, and orthoferet were found to be significant predictors of chemotherapy response. Multivariate analysis revealed extent of disease residuum (P

P53 and bcl-2 assessment in serous ovarian carcinoma.

The study objective was to determine the prognostic value of assessment of staining of p53 and bcl-2 in a well-selected group of serous ovarian carcinomas. Immunohistochemical detection was used to identify both p53 and bcl-2 positive tumors. One hundred thirty-two tumors were analyzed for positivity of staining, grade of staining intensity, and for p53 alone, percent expression rates. These were analyzed alongside traditional clinicopathologic parameters for their ability to predict overall survival (OS), disease-free survival (DFS), and response to chemotherapy (CR). Univariate COX analysis revealed percent p53 expression (P = 0.012) and p53 grade (P = 0.01) to be significant predictors of DFS. Neither the p53 nor bcl-2 measurement parameters were found significant for OS or prediction of CR. On multivariate analysis, incorporating clinicopathologic parameters, p53 parameters did not retain independent significance for any outcome measure. As in primary reported studies, bcl-2 was not found to be of clear independent prognostic value in this group of ovarian tumors. If mutation of p53 and its consequent overexpression is an early event in ovarian tumorigenesis, then p53 assessment may prove useful prognostically in the assessment of either low-grade ovarian carcinomas, as a possible indicator for progression, or in early-stage ovarian tumors, as a marker of tumor aggression or likelihood of recurrence. p53 analysis of a larger group of stage I ovarian tumors would be desirable to further explain the potential association with DFS.

Spiral organisms in endoscopic biopsies of the human stomach.

A retrospective light microscopic study of 310 consecutive endoscopic gastric biopsy specimens was performed. Spiral bacteria were found in 42% of cases and, apart from occasional organisms in parietal cell canaliculi, were confined to the surface of the glands and epithelium. Electron microscopic study of selected cases showed the bacteria to be approximately 6 micron maximum length and 0.7 micron diameter with a spiral periodicity of 1.2 micron. A significant association between the occurrence of spiral bacteria and gastritis was noted but not with carcinoma, peptic ulceration, or high pH of the gastric aspirate.

Immunohistochemical and electron microscopic findings in benign fibroepithelial vaginal polyps.

Eleven classic benign "fibroepithelial polyps" of the vagina were examined using a panel of immunocytochemical agents. Two were also examined electron microscopically. In all cases the stellate and multinucleate stromal cells characteristic of these lesions stained strongly for desmin, indicating muscle intermediate filament production. In common with uterine fibroleiomyomata, numerous mast cells were also often seen. Myoglobin staining was negative. Electron microscopical examination confirmed that the stromal cells contained abundant thin filaments with focal densities and also showed the ultrastructural features usually associated with myofibroblasts. It is concluded that these tumours would be better designated polypoid myofibroblastomas in view of the above findings.

Nucleolar organiser regions in adenocarcinoma in situ of the endocervix.

The AgNOR technique was used to analyse 11 cases of adenocarcinoma in situ of the endocervix and five examples of healthy cervices to assess whether areas of "increased nuclear activity" could be located adjacent to the malignant tissue. Areas of adenocarcinoma in situ had significantly more AgNOR staining dots than apparently normal bordering areas ("transitional areas") and areas of endocervical epithelium remote from adenocarcinoma in situ. There were no significant differences between AgNOR counts in transitional areas and areas remote from adenocarcinoma in situ, and between these areas and histologically normal cervices. These observations provide no support for the hypothesis that areas of glandular atypia of lesser severity or zones of "increased nuclear activity" exist adjacent to adenocarcinoma in situ.

Use of a histopathology data pool for epidemiological analysis.

Data from the Birmingham Histopathology Data Pool of surgical pathology on the age, sex, and site distributions of various cutaneous and hepatic lesions have been analysed, and the results have been compared with data from the Regional Cancer Registry. Analysis of malignant neoplasms shows that there is no significant difference between the two sources. The results are discussed with reference to the potential use of histopathology data banks for quality assurance in histopathology and epidemiological analysis.

Expression of epithelial membrane and 3-fucosyl-N-acetyllactosamine antigens in cervix uteri with particular reference to adenocarcinoma in situ.

The staining patterns obtained with antiepithelial membrane antigen (anti-EMA) and the monoclonal antibody to 3-fucosyl-N-acetyllactosamine (AGF 4:48) in the uterine cervix in intraepithelial and invasive neoplasia were compared to determine a possible role in differential diagnosis of reactive and neoplastic conditions. Both early invasive and in situ adenocarcinoma stained equally intensely with both agents and both antibodies stained diffusely tubal metaplasia, endometrial lined glands, and even occasional areas of normal endocervical mucosa. It is concluded that these agents are unlikely to be of use in the routine histological differentiation of glandular and squamous cervical dysplasia or neoplasia, but immunostaining with anti-EMA may help differentiate between reactive and metaplastic changes in endocervical glands and adenocarcinoma in situ.

Atypical polypoid adenomyoma--clinical histological and immunocytochemical findings.

The clinico-pathological features of four examples of a distinctive benign uterine neoplasm are presented which has previously been titled atypical adenomyoma. The patients were all nulliparous and premenopausal. All presented with menstrual disturbances. No tumour has recurred after hysterectomy (follow-up between 10 years and 10 months). All tumours arose from the corpus, three were localised lower segment polyps, one a diffuse polypoid involvement of the endometrium. Histologically all of the tumours showed very similar appearances with closely packed, regular, tubular glands lined by low columnar epithelium, resembling most closely basal endometrial glands and surrounded by benign connective tissue which by simple tinctorial methods appeared to be largely smooth muscle. No heterologous components were seen. In two cases squamous metaplasia was extensive, in one microcalcification was present. The histological appearances favour a type of benign mixed Mullerian tumour but the appearances are not typical of Mullerian adenofibroma. Immunocytochemistry performed on 3 cases confirmed that the stroma was in large part smooth muscle, though much of the stroma stained only weakly with monoclonal antidesmin antibody.

Mitotically active haemorrhagic cellular (apoplectic) leiomyoma.

Apoplectic leiomyoma is a distinctive smooth muscle tumour usually occurring in women either taking oral contraceptives or who are pregnant or recently postpartum. Most of these tumours show 0-2 mitoses per 10 high power fields, but a mitotic index of up to 8 per 10 high power fields is allowed in such tumours. We describe an apoplectic leiomyoma with a number of atypical features including a high mitotic index (up to 20 per 10 high power fields) in a 47-year-old woman. Follow-up clinically and by computerised tomography (CT) for 3 years demonstrates no recurrence.

Loop diathermy excision of the cervical transformation zone in patients with abnormal cervical smears.

OBJECTIVE: To determine the efficacy and morbidity of fine loop diathermy excision of the cervical transformation zone as applied to the management of outpatients with abnormal cervical smears. DESIGN: Prospective programme trial with six month follow up. SETTING: Two hospital based colposcopy clinics. PATIENTS: 616 Patients aged 16-60 with abnormal cervical smears. INTERVENTIONS: After colposcopic and cytological assessment excision of the cervical transformation zone by fine loop diathermy under local anaesthesia in the outpatient department. MAIN OUTCOME MEASURES: Time to complete the treatment, immediate morbidity in terms of discomfort and bleeding, and cytological and colposcopic findings at six months. RESULTS: Treatment was completed in a mean of 3.47 minutes (SD 1.99). Immediate morbidity was minimal, and histological specimens were adequate in over 90% of cases. Almost two thirds of patients were treated at their first visit to the clinic. 58 Patients (9.4%) failed to attend for follow up at six months and one had had a hysterectomy. Of the 557 patients who attended for colposcopic and cytological follow up at six months, 506 (91%) were normal cytologically and 19 (3.4%) had histologically confirmed persistence of cervical intraepithelial neoplasia. The overall confirmed failure rate of the technique was 4.4%. CONCLUSION: Loop diathermy excision is an effective treatment with low morbidity and is an appropriate modality for patients with abnormal cervical smears.

Invasive cervical cancer after laser vaporization for cervical intraepithelial neoplasia: a 10-year experience.

The treatment of cervical intraepithelial neoplasia by laser vaporization has been in progress at the Birmingham and Midland Hospital for Women since September 1977. In this interval, 3182 patients have been treated. Seven women have developed invasive cancer at intervals 4-34 months postlaser. The lesions diagnosed were stage Ia (3), Ib (1), IIb (1), IIIa (1), and IV (1). These case histories are presented. On retrospective assessment, there were contraindications to local destructive treatment in six of seven cases. This series emphasizes the need for thorough evaluation of patients before embarking on local destructive treatments and emphasizes the need for careful follow-up of treated patients.

Atypical mucinous metaplasia and intraepithelial neoplasia of the female genital tract--a case report and review of the literature.

Müllerian metaplasia of the female genital tract is usually of limited extent and subtype. We describe the replacement of the lining of the entire genital tract and much of the overlying pelvic serosa by metaplastic müllerian epithelium, in a nulliparous 65-year-old woman with cervical agenesis. She did not have Peutz-Jeghers syndrome and had not had any form of prior hormonal treatment. The metaplastic epithelium extended from the vagina to the serosal surface of the pelvic organs. Mucinous epithelium predominated. In addition, there was multifocal dysplasia of the metaplastic epithelium; this was most prominent in the fallopian tubes where there was marked papillation with cytoarchitectural features reminiscent of a borderline mucinous ovarian tumor. Although müllerian metaplasia is well recognized at different sites within the female genital tract, this highly unusual finding of multiple metaplastic epithelial subtypes and dysplasia involving the mucinous metaplastic epithelium along the entire genital tract and pelvic serosal surface has not, to the best of our knowledge, been reported previously in the absence of Peutz-Jeghers syndrome.

Superficial myofibroblastoma of the lower female genital tract: report of a series including tumours with a vulval location.

AIMS: To describe the clinical and pathological features of 12 further cases (in 11 patients) of superficial cervicovaginal myofibroblastomas (SCVM), rare tumours that hitherto have been described only in a single series of cases involving the cervix and vagina. METHODS AND RESULTS: The patients' ages ranged from 23 to 80 years. Ten tumours were located in the vagina and two in the vulva. Three patients had been taking tamoxifen. The tumours ranged in size from 2 to 45 mm and morphologically were well-circumscribed lesions composed of bland ovoid to spindle-shaped cells, often with wavy nuclei. These cells were arranged in a variety of architectural patterns and were set in a finely collagenous stroma. Five cases exhibited stromal oedema or myxoid change and in eight cases hyalinized areas with thick, dense collagen bundles were present. Immunohistochemically, there was positivity with vimentin (11 of 11 cases tested), CD34 (six of 12 cases), desmin (nine of 12 cases) and oestrogen receptor (nine of 11 cases). All cases tested were negative for smooth muscle actin, S100, h-caldesmon, HMB45, and CD31. In this study we expand on the morphological spectrum of these rare lesions and reiterate their association with tamoxifen. CONCLUSIONS: Since these lesions may occur on the vulva, as well as the cervix and vagina, we propose the term 'superficial myofibroblastoma of the lower female genital tract'.

Pregnancy following recurrent angiosarcoma of the ovary--a case report and review of literature.

BACKGROUND: Ovarian angiosarcomas are rare tumors which may to be distinguished from other unusual primary ovarian tumors such as clear cell carcinoma, yolk sac tumor and leiomyosarcoma on the basis of histological appearance and immunohistochemistry. Angiosarcomas of the ovary occur in all age groups but are more frequent in women of child bearing age (less than 40 years). Surgery and radiotherapy have been the traditional treatment modalities. CASE: The case we present is the only reported long-term survivor of recurrent ovarian angiosarcoma. Her initial treatment was surgical, both at presentation and relapse but since she wished conservation of fertility, radical surgery and radiotherapy were avoided and she underwent further adjuvant chemotherapy with doxorubicin and ifosfamide. She remains in remission 6 years after treatment of recurrence of the primary tumor and has had a successful pregnancy following treatment. CONCLUSION: Adjuvant chemotherapy of ovarian angiosarcoma with a combination of doxorubicin and ifosfamide appears effective and should be considered in women at risk of relapse who wish to conserve fertility.

Pathology of the uterine body.

In this review we look at recent developments in the pathology of the uterine body. Factors influencing the growth of leiomyomas are evaluated together with response to medical therapy and consequent histopathological changes. Further work on carcinosarcomas tends to support the common stem-cell theory of origin, which may also be true of other sarcomas, as common chromosomal abnormalities have been found. There has been continued work on prognostic factors in endometrial carcinomas with ploidy, hormone receptor status, HER-2/neu expression, and coexistent hyperplasia confirmed as independent prognostic factors, while clear cell and serous papillary carcinomas are confirmed as poor prognostic types. Finally, recent 'tumors' associated with tamoxifen are reviewed.

Argyrophilic cells in cervical intraepithelial glandular neoplasia.

Argyrophilic cells occur rarely in the normal cervix but are found in a variety of invasive tumours arising in the cervix. We searched for argyrophilic cells by using Grimelius staining in 25 cases of high-grade intraepithelial glandular neoplasia of the cervix and identified them in seven cases. This study shows that argyrophilic cells are also often found in preinvasive glandular lesions of the cervix.

Pulmonary artery rupture in pregnancy complicating patent ductus arteriosus.

Fatal haemopericardium in a 27 year old pregnant woman was caused by rupture of a dissecting aneurysm of the pulmonary artery. She had an uncorrected patent ductus arteriosus and severe pulmonary hypertension. The wall of the pulmonary artery showed atherosclerosis and cystic medionecrosis.