Luisanna Bosincu

Adenomatoid tumors of the uterus: an analysis of 60 cases.

Sixty cases of uterine adenomatoid tumors (ATs) are reported. All except four were incidental findings in hysterectomy specimens, three of these being discovered preoperatively as large multicystic tumors. ATs were classified into two distinctive macroscopic patterns: small, solid tumors and large, cystic ones. The 56 small, solid ATs ranged from 0.2 to 3.5 cm, (average 2.1 cm); 48 were nodular and 8 diffuse. The four large, cystic tumors ranged from 7 to 10 cm. Inflammation occurred in 65% of the tumors, and a smooth muscle reaction, identified by an increased Ki-67 index, was present in most cases. Both types were histologically similar except for the presence of short papillae in cystic tumors, which also showed serosal involvement. Both were immunoreactive for cytokeratins, calretinin, HMBE-1, and vimentin. Estrogen and progesterone nuclear receptors and EMA were negative. These tumors represent a spectrum ranging from small and solid to large and cystic ATs in the female genital tract, whereas outside the genital tract they are morphologically similar to multicystic mesothelioma. Although a reactive origin for ATs often seems plausible, especially when inflammation is present, their neoplastic nature should not be ignored.

Perivascular epithelioid cell (PEC) tumors of the uterus: a clinicopathologic study of two cases with aggressive features

We report the clinicopathologic, immunohistochemical and ultrastructural features of two unusual tumors of the uterus composed of spindle and epithelioid cells strongly positive for HMB45. The two patients of 56 and 48 years of age had, respectively, hemoperitoneum and abnormal uterine bleeding. Morphologically, both tumors showed atypia and extensive necrosis. The neoplastic cells express immunohistochemically both melanogenesis (HMB45) and smooth muscle markers (actin). Ultrastructural analysis showed the presence of intracytoplasmic membrane-bound granules. We viewed these neoplasms as perivascular epithelioid cell (PEC) tumors with aggressive features. Follow-up has shown the death of one patient whereas the other is alive without disease 36 months after the surgery. The two patients were evaluated for signs of tuberous sclerosis complex, and findings were negative.

Angiosarcoma of the thyroid: A light, electron microscopic and histoimmunological study

A histologic, histoimmunological, and ultrastructural study of a primary angiosarcoma of the thyroid gland is reported. The occurrence of neoplastic cells positive for Factor VIII-related antigen and Ulex Europaeus Agglutinin-I and the presence in their cytoplasms of Weibel-Palade bodies are consistent with this diagnosis. These findings further support the view that primary angiosarcoma of the thyroid is a distinct pathological entity and should no longer be interpreted as a variant of a poorly differentiated carcinoma.

Rectal endometrial stromal sarcoma arising in endometriosis: report of a case.

PURPOSE: Endometriosis of the rectovaginal septum can harbor different types of secondary tumors that may involve the rectal wall and protrude into its lumen, thus making diagnosis difficult. Extrauterine low-grade endometrial stromal sarcoma may rarely arise in endometriosis. The purpose of this article was to present the third case of this association. METHOD: This was a clinicopathologic study. RESULTS: A 42-year-old female presented with abdominal pain and fever. Laparotomy revealed a large pelvic mass involving the rectovaginal septum and the colonic wall and which protruded into the lumen forming endoluminal polypoid masses. Concomitant peritoneal nodules and a metastatic paracolic lymph node were also found. Histopathologically, primary endometriotic foci were found in close relationship with an endometrial stromal sarcoma which invaded the rectal wall. The female genital tract had no endometriotic lesions. The patient was treated by surgery and subsequent chemotherapy and was alive and well 20 months later. CONCLUSIONS: Endometriosis and its possible malignant changes should be taken into account in the differential endoscopic diagnosis of rectal masses in females.

Tyrosine kinase receptor status in endometrial stromal sarcoma: an immunohistochemical and genetic-molecular analysis.

Endometrial stromal sarcomas (ESS) are rare uterine malignant mesenchymal neoplasms, which are currently treated by surgery, as effective adjuvant therapies have not yet been established. Tyrosine kinase inhibitors have rarely been applied in ESS therapy, with few reports describing imatinib responsivity. The aim of this study was to analyze the status of different tyrosine kinase receptors in an ESS series, in order to evaluate their potential role as molecular targets. Immunohistochemistry was performed for EGFR, c-KIT, PDGFR-&agr;, PDGFR-&bgr;, and ABL on 28 ESS. EGFR, PDGFR-&agr;, and PDGFR-&bgr; gene expression was investigated by real-time polymerase chain reaction (qRT-PCR) on selected cases. “Hot-spot” mutations were screened for on EGFR, c-KIT, PDGFR-&agr;, and PDGFR-&bgr; genes, by sequencing. All analysis was executed from formalin-fixed, paraffin-embedded specimens. Immunohistochemical overexpression of 2 or more tyrosine kinase receptors was observed in 18 of 28 tumors (64%), whereas only 5 tumors were consistently negative. Gene expression profiles were concordant with immunohistochemical overexpression in only 1 tumor, which displayed both high mRNA levels and specific immunoreactivity for PDGFR-&agr;, and PDGFR-&bgr;. No activating mutations were found on the tumors included in the study. This study confirms that TKRs expression is frequently observed in ESS. Considering that the responsiveness to tyrosine kinase inhibitors is known to be related to the presence of specific activating mutations or gene over-expression, which are not detectable in ESS, TKRs immunohistochemical over-expression alone should not be considered as a reliable marker for targeted therapies in ESS. Specific post-translational abnormalities, responsible for activation of TKRs, should be further investigated.

ARGYROPHILIC NEUROENDOCRINE CARCINOMA OF THE MALE BREAST

A case of breast carcinoma with neuroendocrine features occurring in an elderly male patient is reported. Histologically, the tumor was characterized by solid growth with nests and ribbons of small to medium-size uniform neoplastic cells. Argyrophilia, expression of chromogranins at both protein and gene level, and the presence of dense granules of the neurosecretory type by electron microscopy were demonstrated.

Regression of Henoch-Schönlein disease with intensive immunosuppressive treatment

To assess the results of a new immunosuppressive cycle, which had given favorable results in other immune‐mediated glomerulonephritides, in the treatment of Henoch‐Schönlein disease.

Immunosuppressive Treatment of Berger’s Disease

The aim of our study was to determine whether immunosuppressive treatment is effective in preventing and reversing the evolution of Bergers disease toward chronic renal failure.

Evidence for collagen fibrils inside the cells of granular cell myoblastomas.

An electron microscope study was performed on two cases of subcutaneous granular cell myoblastomas. Phosphotungstic acid staining reveals the intracellular formation of collagen fibrils both inside the granules and scattered outside them, but always in relation with ribosomes or ergastoplasmic sacs. Pericellular deposition of basal-membrane-like material is a constant feature; however it appears to be more a precollagen material, extruded by cells, than a true basal membrane. This observation strongly supports the view that granular cells in Abrikossoff tumors are fibroblasts of muscle (and nerve?) sheaths abnormally producing precollagen material.

Sertoli cell tumor with benign peritoneal implants associated with gonadoblastoma.

We present a unique case of bilateral gonadoblastoma in a 23-year-old patient with Swyer syndrome. The gonadoblastoma on both sides underwent synchronous neoplastic transformation, into a stage I germinoma in the right streak gonad and a highly differentiated Sertoli cell tumor in the left one. The latter was associated with a myriad of microscopic, Sertoli cell implants on the peritoneal surface, which were considered benign as they had a high grade of differentiation, minimal proliferative activity, and an absence of invasion. Most probably, the pathogenesis of this abdominal dissemination was iatrogenic, with implantation occurring mechanically as a result of the multiple laparoscopic biopsies performed on both of the streak gonads 2 months before the abdominal surgery. The pathogenesis of other benign abdominal implants is discussed.