Gynecologic

2008 Laboratory Investigation  
to selected 48 cases of renal carcinomas of various subtypes, 7 oncocytomas and 13 normal kidney. Histological examination focused on the presence of small branching glands, stromal cellularity, ovarian-type stroma, prominent vessels and estrogen and progesterone receptors. Results: This study included 26 CN and 13 MEST. Patient' age (53.2 vs 53.8 years) and tumor size (6.5 vs 6.8 cm) were similar between CN and MEST. CN predominantly affected women (male/female=2/24), while MEST exclusively
more » ... ected female. CN and MEST had many similar histological features, including size of cysts, stromal cellularity, presence of ovarian-type stroma, calcification and hemorrhage. ER and PR were positive in 4/5 (80%) and 3/5 (60%) CN, and 5/8 (62.5%) and 5/7 (71.4%) MEST. However, prominent vessels (4/13, 30.8%) and small branching glands (53.8%) were exclusively seen in MEST (p=0.000). Clustering analysis demonstrated that CN and MEST had very similar molecular profiles (Figure 1 ) that were distinct from other renal tumors. Of differentially expressed genes that best distinguish CN/MEST from other subtypes of kidney tumors, the highest and lowest differentially expressed genes are insulin-like growth factor 2 and carbonic anhydrase II, respectively. Conclusions: CN and MEST are related lesions as they share similar clinical, histological and molecular characteristics. Background: Choriocarcinoma is a rare germ cell tumor of the testis. Previous studies have been based on small series or case reports. We aim to study pathological and clinical features in a large series of testicular choriocarcinoma. Design: We searched our pathology files from 1986 to 2007 and identified 65 patients with choriocarcinoma involving the testis. The H and E slides and clinicopathological data including follow-up were reviewed. Results: The average age of the patients was 29.5 years (range: 14-71). The mean tumor size was 4.5 cm (range 1.0 to 9.0 cm). Only five of these cases were pure choriocarcinoma, the other 60 cases had choriocarcinoma mixed with other germ cell tumors types. The associated germ cell tumors included embryonal carcinoma (n=48), teratoma (n=42), yolk sac tumor (n=40) and seminoma (n=16). Thirty-one tumors had lymphovascular invasion (LVI). Seventeen tumors did not exhibit any LVI. Based on the percentage of choriocarcinoma in the tumor, the tumors were divided into four arbitrary groups: group I: 0-5% (30); group II: 6-20% (13); group III: 21-50% (10); and, group IV: 51-100% (12). The mean pre-operative β-human chorionic gonadotropin (β-hCG) levels were 2919, 8679, 48366, 244394 (mIU/ml) in Groups I-IV, respectively. Clinical follow-up was available for 49 patients with an average of 39.6 months (range: 1 to 192 months). In cases where choriocarcinoma was less than 50% (Groups I to III), 20 of 40 patients developed distant metastasis. In cases where choriocarcinoma accounted for more than 50% (Group IV), 8 of 9 patients developed distant metastasis. Four patients died of disease at a mean of 18 months (range: 12 to 36); all patients had distant metastases, but the choriocarcinoma component accounted for less than 10% of the total tumor volume in these patients. Conclusions: Choriocarcinoma is often present as a minor component (< 5%) in germ cell tumors. High volume of choriocarcinoma (>50%) in mixed germ cell tumors is associated with high β-hCG level and increased propensity for distant metastasis. However, in our series the four patients who died of disease had a low volume of choriocarcinoma. Background: Heat-shock protein (HSP) group is overexpressed in several malignancies and has been studied more extensively in uterine endometrioid adenocarcinomas (EC) than in uterine papillary serous carcinomas (UPSC). Expression of HSP70 correlates with poor prognosis while HSP90 expression is seen in well differentiated EC. This study evaluates HSP expression HSP27, HSP70 and HSP90 in UPSC. Design: We identified cases diagnosed as UPSC or mixed EC and UPSC from 1996-2006. We included 7 EC and 6 clear cell carcinoma (CCC) as controls. 17 cases consisted predominantly of UPSC with only 1 mixed EC and UPSC. Immunohistochemical stains were performed using monoclonal antibodies to HSP27 (Abcam), HSP70 (Abcam) and HSP90 (Abcam) in all 31 cases. Staining was graded based on the intensity and percentage of tumor cells positive as negative (0), 1+, 2+ or 3+. Results: Immunohistochemical stain results for HSP27, HSP70 and HSP90 are summarized in table 1. HSP27 was positive in 17 of 18 UPSC (94.4%); 5 of 6 CCC (83.3%), and 7 of 7 EC (100%). HSP70 was strongly positive in all cases of UPSC, EC and CCC. HSP90 showed mostly 1-2+ positivity in 16 of 18 UPSC (89%), 4 of 7 EC (57%) and 6 of 6 CCC (100%). Conclusions: Our study found overexpression of HSP27 and HSP70 and comparatively weak HSP90 staining in UPSC similar to that reported in poorly differentiated endometrial carcinomas. The overexpression of HSPs in UPSC could be a potential target for therapy with anti-HSP inhibitors. 889 Serous and Endometrioid Components of Mixed Endometrial Adenocarcinoma Show Similar Immunostaining Profiles RA Albannai, A Alkushi, CB Gilks. University of British Columbia, Vancouver, BC, Canada; King Fahad National Guard Hospital, Riyad, Saudi Arabia. Background: Mixed endometrial adenocarcinoma is a tumor with two or more cell types present with each comprise at least 10% of the tumor. Mixed adenocarcinomas account for approximately 10% of cases of endometrial adenocarcinoma. Design: To determine whether there are consistent differences in immunostaining between the endometrioid and serous components of mixed endometrial adenocarcinoma, and whether the components of mixed carcinomas are similar to pure endometrioid or serous carcinoma, ten cases of mixed endometrial adenocarcinoma with endometrioid and serous components were stained for PTEN, ER, p53, and ki-67. The results were compared to the staining of pure endometrioid (n=139) and serous (n=11) carcinomas of the endometrium. Results: PTEN immunostaining was significantly less common in the serous component of mixed endometrial adenocarcinoma (3/10) than in pure serous adenocarcinoma (10/11, p=0.007). The staining of the endometrioid and serous components of mixed adenocarcinomas were otherwise not signficantly different than pure endmetrioid and serous carcinomas, respectively. Conclusions: The immunophenotype of endometrioid and serous components of mixed endometrial adenocarcinoma are similar in most cases, with the notable exception of high proliferative index being characteristic of the serous component. The loss of PTEN staining in the serous component is significantly different from pure serous carcinoma, and similar to that of pure endometrioid carcinoma, where loss of PTEN is a common early event during. This suggests that the serous component of mixed endometrial adenocarcinoma arises through progression from the endometrioid component. 890 Clinicopathologic Characterization of Myxoid Mesenchymal Neoplasms of the Uterus V Anandan, C Moosavi, M Miettinen. Armed Forces Institute of Pathology, Washington, DC. Background: Relatively few data exist on myxoid neoplasms of the uterus, and diagnostic criteria suggested for myxoid leiomyosarcomas are based on relatively small series. Little immunophenotypic data exist on these neoplasms. Design: In this study, we evaluated 30 uterine myxoid neoplasms variably designated as myxoid leiomyomas, smooth muscle tumors, or leiomyosarcomas. Sixteen otherwise typical leiomyomas with minute myxoid foci and 7 inflammatory myofibroblastic tumors were excluded from the study. Immunohistochemical stains were performed, and assessed specifically for the myxoid component only. Results: The median age of the patients was 44 years (range, 19-78 years). All tumors had extensive myxoid matrix comprising 40-95% of tumor area. Tumor size varied from 3.5-17.5 cm (median, 10 cm). Six tumors were intracavitary or protruded through the cervix, and the others were myometrial. Mitotic rate varied from 0-33 per 10 HPFs, and moderate atypia was present in 11 cases and severe atypia in 4 cases. Coagulative necrosis was present in 8 tumors. Immunohistochemically, only a portion of cases showed definitive smooth muscle differentiation in the myxoid component, including two cases with epithelioid and myxoid morphology. 12/17 cases studied were positive for SMA, 8/17 for desmin, 1/14 for caldesmon, and 5/13 for estrogen receptor. Nine of 19 patients with follow-up either developed metastases or died of tumor. These included 5/8 patients with tumor necrosis, 4/11 patients without tumor necrosis, and 4/7 patients with mitotic 1-5/10 HPFs, and 5/6 patients with mitotic activity >5/10 HPFs. However, all 6 patients with no detectable mitotic activity with follow-up data had a metastasisfree survival, or died of unrelated causes. Metastasis rate by degree of atypia was: 0/5 for no atypia, 2/5 for mild, 5/6 for moderate, and 2/3 for severe atypia. Conclusions: Myxoid uterine neoplasms, excluding typical leiomyomas with myxoid foci and inflammatory myofibroblastic tumors, have metastatic risk even with mitotic rate of 1/10 HPFs. Degree of atypia and presence of tumor necrosis have a vague correlation with tumor behavior that cannot be fully elaborated on this small material. Myxoid uterine mesenchymal tumors show variable degree of smooth muscle differentiation, and often show ER-positivity indicating their composition of hormonally sensitive stromal cells. Background: Endometrial cancer is the most common gynecological cancer in the United States. The stage at diagnosis is one of the most important predictors of survival and treatment options. In this study, we compared cases of stage IC (invasion into outer half of myometrium) with stage II (cervical involvement, IIA: epithelia only, and IIB: stroma). It will be expected that stage IIB tumors will be of higher grade, deeply invasive and more aggressive neoplasms. Design: We searched the endometrial carcinoma database from Wayne State University and Karmanos Cancer Institute pathology department over a period of 5 years (1995)(1996)(1997)(1998)(1999)(2000). A total of 60 cases were recruited into this study including 29 from stage IC and 31 from stage IIA and IIB where staged in a similar way. Histological and clinical parameters were also recorded including patient's age, tumor size, FIGO grade, angiolymphatic invasion, follow up and incidence of recurrence. Results: A total of 60 cases were included in this study (29,IC; 21, IIA; and 10, IIB). The mean age of the groups ranged from 62 to 67 years. The mean maximum tumor dimension was 4.0 cm in stage IC, 4.2 cm in stage IIA and 3.0 cm in stage IIB. The grade of the tumor was predominantly low to intermediate in all three stages with only a minority of the cases being FIGO grade . The depth of myometrial invasion and angiolymphatic invasion was noted to be maximum in the stage IC group compared to the other groups. Also, no recurrence was noted in the stage IIB group while 2 of 29 cases in the stage IC group and of 21 cases in the stage IIA group recurred. 894 Clinicopathologic and Immunohistochemical Analysis of Mixed Epithelial Ovarian Tumors with a Clear Cell Carcinoma Component H Asad, RA Soslow. Memorial Sloan-Kettering Cancer Center, New York, NY. Background: The association of clear cell (CC) and endometrioid (EC) ovarian carcinomas is well known, but the occurrence of CC in the context of other types of epithelial ovarian neoplasms is poorly understood. Recent data have demonstrated that serous carcinomas containing foci resembling clear cell carcinoma are in most cases pure serous carcinomas. This study focuses on CCs associated with tumors diagnosed as ovarian mucinous neoplasms and evaluates the usefulness of hepatocyte nuclear factor 1ß (HNF) immunohistochemistry (IHC) for the distinction of CC and mimics thereof. Design: All CCs associated with tumors diagnosed between 1997 and 2006 as ovarian mucinous neoplasms were retrieved from our institutional files (n=7, 4 of which were consultation cases). 2 additional cases were reclassified as mixed epithelial borderline tumor (MEBT) associated with endometrioid carcinomas showing prominent secretory features and squamous metaplasia with glycogenated cytoplasm. Tissue microarrays (TMAs) representing 87 ovarian carcinomas (including all ovarian carcinoma subtypes and 8 CCs) and 4 of the study cases were evaluated immunohistochemically for HNF expression. Clinical data were abstracted from the medical record. Results: Patients' ages ranged from 29-65 years (mean 46) and the clinical presentation were non-specific. One tumor was stage IA, 3 IC, 2 IIB and 1 IIIA. 6 CCs, all papillary, were associated with MEBT and 1 with an endocervical-type mucinous cystadenoma. 5 patients had coexisting endometriosis. The MEBTs showed admixtures of endocervical-196A ANNUAL MEETING ABSTRACTS type mucinous, ciliated, eosinophilic and endometrioid cells, with endocervical-type mucinous cells predominating in most cases. Only CCs in the TMA showed diffuse, strong nuclear expression of HNF, as did the CC components of the 4 study cases evaluated. In addition, one mucinous borderline tumor in the TMA and scattered endocervical-type mucinous cells in MEBTs weakly expressed HNF. Clinical follow-up (4 months to 8 years) was available for 5 study patients, with 2 suffering recurrences. Conclusions: True CCs can rarely be associated with ovarian tumors containing a predominance of endocervical-type mucinous cells. The typical patient is younger than 50 years and has endometriosis, suggesting a kinship between MEBTs, pure endometrioid neoplasms and CCs. Accurate diagnosis can be enhanced using HNF IHC, which, when diffuse and strong, appears specific for CC. Pitfalls include HNF expression in endocervical-type mucinous cells. 895 Diagnostic Utility of Mammaglobin in Lesions of the Uterine Cervix M Assaad, CN Otis, S Marconi, L Pantanowitz.
doi:10.1038/sj.labinvest.3700732 fatcat:xp6ii4s7t5hf3bnbq25qqzpvzy