Kouichi Nomura

Ovarian atypical endometriosis: its close association with malignant epithelial tumours

The incidence of ovarian atypical endometriosis and its association with malignant epithelial tumours in a consecutive series of cases during the period 1987 to 1995 were studied. Atypical glandular changes were observed in four (1.7%) of 255 ovarian endometriosis cases and one patient with ovarian atypical endometriosis developed subsequent endometrioid carcinoma in the abdominal wall. Fifty‐four (24.1%) of the 224 ovarian cancers were associated with ovarian endometriosis; 21 with typical and 33 with atypical endometriosis. Clear cell carcinomas and endometrioid carcinomas were most frequently associated with endometriosis, with 54% (27 of 50 cases) and 41.9% (13 of 31), respectively. Atypical endometriosis was found in 18 clear cell carcinomas, in seven endometrioid carcinomas, in four serous carcinomas, in three mucinous borderline tumours, and in one serous borderline tumour. In 13 cases, the atypical endometriosis was in contiguity with malignant epithelial tumours. We consider that atypical endometriosis possesses a precancerous potential or is most frequently associated with clear cell and endometrioid carcinomas. Close screening of cellular atypia or hyperplasia in ovarian endometriosis and careful long‐term follow‐up of patients with atypical endometriosis is required.

Solitary fibrous tumor of the nasal cavity and orbit

Solitary fibrous tumors (SFT) are rare spindle cell neoplasms generally associated with the serosal surface, especially the pleura. Two SFT are reported arising in the nasal cavity and orbit, occurring in a 33 year old female and a 21 year old male, respectively. The lesions lacked the characteristic features of other recognized neoplasms that occur in these regions. Immunohistochemically, the tumors cells were diffusely and strongly positive for vimentin and CD34 and some or many tumor cells expressed neuron‐speciflc enolase and Leu‐7. Ultrastructurally, the tumor cells showed no distinct features although they were suggested to be primitive mesenchymal or fibroblast‐like cells. Both tumors were diploid by flow cytometry. The two patients have had benign clinical courses with limited follow‐up. Our findings suggest that SFT is of mesenchymal cell origin and support another location for SFT, indicating additional evidence against mesothelial origin. SFT should be included in the differential diagnosis of spindle cell tumors arising in the nasal cavity and orbit.

Carcinosarcoma of the uterus with extensive neuroectodermal differentiation

A case of uterine carcinosarcoma with extensive neuroectodermal differentiation occurring in a 54‐year‐old woman is described. Microscopically, the endometrial tumour was predominantly composed of a sheet‐like proliferation of small‐ and medium‐sized cells. These cells were characterized by fibrillary cytoplasmic processes, rosette‐like formations, perivascular palisading patterns, and immunoreactivity for glial fibrillary acidic protein, synaptophysin, leu 7 and neuron‐specific enolase. In limited areas, features of conventional carcinosarcoma, including squamous cell carcinoma, leiomyosarcoma and islands of the above mentioned small‐to medium‐sized cells that were intermingled, were observed. The tumour was aneuploid by flow cytometry. The patient is alive with tumour for three months. It is suggested that at least some cases of uterine primitive neuroectodermal tumour may be explained by one‐sided neuroectodermal development within a carcinosarcoma.

Carcinosarcoma of the Liver Report of an Autopsy Case With Review of the Literature and Histogenetic Consideration

An autopsy case of carcinosarcoma of the liver in an 84-year-old man is described. The 14 x 6-cm solid tumor was located in the hilus to the left lobe and was grayish-white with some translucent areas. Histologically, the tumor consisted of an intimate mixture of adenocarcinomatous and chondrosarcomatous elements with transitional areas in between. Immunohistochemically, cells of the adenocarcinomatous elements were positive for cytokeratin but negative for S100 protein, whereas cells of the chondrosarcomatous elements showed the reverse staining pattern. Cells of transitional areas were positive for both cytokeratin and S100 protein. Most previously reported cases of carcinosarcoma of the liver have involved elderly men and have had a poor prognosis. The findings of the present case support the view that carcinosarcomas represent carcinomas that develop a sarcomatous element via metaplasia of the epithelial element.

SMALL CELL CARCINOMA OF THE OVARY : A CASE REPORT OF LARGE CELL VARIANT

An extremely rare case of large cell variant of ovarian small cell carcinoma is described. A 34‐year‐old woman (gravid 1. para 1) had a unilateral ovarian mass measuring 17 cm in great at diameter and a metastasis lesion in the omentum. Microscopically, the tumor showed a diffuse arrangement of large, closely packed epithelial cells with abundant eosino‐philic cytoplasm and large nuclei with prominent nucleoli. The tumor cells also were arranged in follicle‐like and trabe‐cular structures and cords. Immunohlstochemically, many tumor cells were diffusely positive for epithelial membrane antigen and some cells contained cytokeratin CAM5.2, valentine, neurofiiament, neuron‐specific enoiase, or alpha‐1 antitrypsn. However, no specific IIneage was detected. The tumor was aneuploid by flow cytometry. The patient received chemotherapy postoperatively. However, the patient showed metastases in the Inguinal and retruperitoneal lymph nodes. The aerum calcium level, which was not measured preoperatively, was mildly elevated postoperatively. The patient was well with no evidence of disease 17 months after diagnosis. This tumor must be distinguished from other primary or metelltatic ‘undifferentiated’ neoplasms, especially ovarian small cell carcinoma of pulmonary type and granulosa cell tumor.

Immunohistochemical analysis of reserve cell-like cells of ovarian müllerian mucinous/mixed epithelial borderline tumor.

Summary: Ovarian mucinous borderline tumor of müllerian type (MMBT) and mixed epithelial borderline tumor of müllerian type (MEBT) are uncommon subtypes of ovarian surface epithelial tumors. Both are often associated with endometriosis, but their histogenesis is still debated. We have noticed occasional foci of subepithelial cuboidal cells resembling uterine cervical reserve cells (RCs) in MMBTs/MEBTs, which have not been documented in the literature to the best of our knowledge. This study was carried out to identify the presence of RC-like cells (RCLCs) in MMBTs/MEBTs and their immunohistochemical features in comparison to those of cervical RCs. We analyzed 10 consecutive cases of RC-like MMBTs/MEBTs, 6 of which were associated with endometriosis. Immunohistochemistry was performed for p63, cytokeratin 34BE12, cytokeratin 17 (CK17), and low-molecular cytokeratin CAM5.2. In 9 of 10 cases, RCLCs were appreciated in hematoxylin-eosin stain, although their amount in the tumor varied from case to case. Immunohistochemically, RCLCs were positive for p63 in 9 cases. They were positive for both 34BE12 and CK17 and were very weakly positive or negative for CAM5.2 in 8 cases. This immunohistochemical profile is similar to that seen in the cervical RCs. Reserve cell-like cells were also found in the foci of endometriosis coexisting with MMBTs/MEBTs in 1 of 5 cases examined. We draw attention to the existence of the RCLCs in MMBTs/MEBTs and in endometriosis. Their similarity to the cervical RCs may indicate their potential role as precursor cell that may subsequently differentiate into different müllerian cell types, thus merit further study.

Ovarian mucinous borderline tumors of intestinal type without intraepithelial carcinoma: Are they still tumors of low malignant potential?

The purpose of this study was to clarify whether ovarian intestinal‐type mucinous borderline tumors without intraepithelial carcinoma should still be considered tumors of low malignant potential. Fifty‐five intestinal‐type mucinous borderline tumors without intraepithelial carcinoma in which a section had been taken for each 2 cm or less of the tumors greatest diameter were selected. The International Federation of Gynecology and Obstetrics’ stage and follow‐up data of each case were examined. All 55 patients had stage I disease (including one with pseudomyxoma peritonei of superficial organizing type, according to Lee and Scullys classification). No patient had metastases or died from the tumor, although in one patient who underwent cystectomy, the disease recurred in the remaining ovary 5 years after surgery. However, the patient was alive and well after undergoing salpingo‐oophorectomy. The patient with pseudomyxoma peritonei had no recurrence and did not die from the tumor. These findings indicated that intestinal‐type mucinous borderline tumors, in which intraepithelial carcinoma has been ruled out with adequate histological sampling, are benign tumors, not tumors of low malignant potential. It is proposed here that these tumors should be designated as high‐grade mucinous adenoma. Unilateral salpingo‐oophorectomy is the recommended treatment because cystectomy alone may allow local recurrence in the remaining ovary.

A histogenetic consideration of ovarian mucinous tumors based on an analysis of lesions associated with teratomas or Brenner tumors

To Investigate the histogenesis of ovarian mucinous tumors, clinicopathologic and histologic studies of mucinous tumors associated with teratomas or Brenner tumors were performed. Of 458 ovarian mucinous tumors, 13 (2.8%) and 8 (1.7%) were associated wlth teratomas or Brenner tumors, respectively. Of patients younger than 40 years, 5.1% had teratomas. Of patients 50 years or older, 3.5% had Brenner tumors. Histologically, nine lesions with teratomas and six lesions with Brenner tumors showed transitions or intimate admixtures of both eiements. The findings of the present study suggest that teratomas and Brenner tumors make small contributions to the histogenesis of ovarian mucinous tumors but may give rise to some mucinous tumors, especially in younger patients and older patients, respectively.

Adenomyoepithelioma of the breast with exaggerated proliferation of epithelial cells: Report of a case

A case of adenomyoepithelioma of the breast in a 58‐year‐old woman Is described. The tumor was a solitary, solid mass measuring 35X30 mm. Hlstologically, the tumor was composed of a proliferation of both epithelial and myoeptthelial cell components. The epithelial cell component showed extensive columnar cell change with clear cytoplasm and focal exaggerated proliferation with cytologic atypia and increased mitotic figures. DNA ploldy analysis revealed aneuploidy. DNA ploldy analysis might be used to predict the biological behavior of adenomyoepithelioma.

Mucin histochemistry of ovarian mucinous cystadenomas expressing gastrointestinal characteristics

Fifty‐four cases of ovarian mucinous cystadenoma, including twa cases containing ciliated cells representing the müllerian epithelial origin, one case admixed with serous adenoma component and six cases associated with mature teratoma, were examined for the demonstration of gastrointestinal characteristics using periodic acid‐Schiff, alcian blue, galac‐tose oxidase‐Schiff, paradoxycal concanavalin A (ConA), Grimelius and Fontana‐Masson stains. Of 41 endocervical‐type mucinous cystadenomas not associated with teratoma, 34 cases (83%) showed ConA positivity, expressing gastrointestinal characteristics. As both cases with ciliated cells and the case with serous adenoma component exhibited ConA positivity, the ovarian surface epithelium is supposed to undergo mucinous metaplasia possessing gastrointestinal characteristics. As to the histogenesis of the ovarian mucinous tumors, the metaplasia theory is suggested.