Ram Dgani

Immunocytochemical study of an endometrial diffuse clear cell stromal sarcoma and other endometrial stromal sarcomas

Intermediate filament composition was studied in the following endometrial stromal tumors: low‐grade stromal sarcoma (endolymphatic stromal myosis), high‐grade stromal sarcoma with an associated adenocarcinoma (collision tumor), diffuse clear cell stromal sarcoma and a mesodermal mixed tumor (carcinosarcoma). The tumor cells of the stromal tumors as well as the mesenchymal elements of the mixed mesodermal tumor were decorated exclusively with antibodies to vimentin. Desmin was not demonstrated in these tumor cells. A biochemical study of the cytoskeletal filaments present in the low‐grade stromal sarcoma revealed, in addition to vimentin, β and γ actin as seen in normal endometrial stroma. Cytokeratins were only identified in epithelial components which were present in some of these tumors. Intermediate filament typing in these endometrial neoplasms contributes to the elucidation of histogenetic problems, may delineate mesenchymal from epithelial elements, may separate muscle from stromal lesions and in one instance helped to define a hitherto unreported diffuse clear cell stromal sarcoma.

Basal cell carcinoma of the vulva

Vulvar basal cell carcinoma (BCC) accounts for 7% of all vulvar cancers at two hospitals in the south of Israel. The purpose of this study was to investigate the clinical findings, treatment and outcome of patients with vulvar BCC treated at these institutions.

Ovarian Carcinoma Masquerading as Ovarian Hyperstimulation Syndrome

Two patients receiving ovulation‐inducing drugs were found to have ovarian carcinoma. Since patients receiving such medication are prone to develop enlarged ovaries with or without the fully developed hyperstimulation syndrome, the diagnosis of ovarian tumors in such patients may be delayed or missed. It is therefore being suggested that an ovarian enlargement persisting for more than 4 weeks, or the finding of ovarian solid masses by sonography in patients receiving ovulation‐inducing drugs, should lead to a thorough work‐up for neoplasia, sometimes including even laparotomy.

Uterine papillary serous carcinoma: study of 19 cases

OBJECTIVE Uterine papillary serous carcinoma (UPSC) is an uncommon highly malignant variant of endometrial carcinoma that histologically and clinically resembles ovarian papillary serous carcinoma. The purpose of this study was to present the conjoined experience of two regional hospitals in the south of Israel (Soroka Medical Center, Beer-Sheva and Kaplan Hospital, Rehovot) of handling this tumour. STUDY DESIGN Data from the files of 19 patients with UPSC who were managed at these hospitals between July 1991 and June 1997 were evaluated. RESULTS The three-year survival rate was 57.3% overall; 83.3% for Stage I and 21.2% for Stages II, III, and IV combined (P<0.02). Eighteen patients had primary surgery which included total abdominal hysterectomy and bilateral salpingo-oophorectomy and 15 (83.3%) of them received postoperative adjuvant therapy which included radiotherapy and/or systemic chemotherapy. CONCLUSIONS The prognosis of patients with UPSC is worse than that of patients with other forms of endometrial carcinoma. Primary surgery comprised of total abdominal hysterectomy, bilateral salpingo-oophorectomy and staging is the mainstay of treatment. The type of postoperative treatment is not consistent. By and large, adjuvant pelvic radiotherapy is usually given in early-stage disease and adjuvant systemic chemotherapy is usually prescribed in advanced-stage disease.

The role of laparoscopy in ovarian tumors of low malignant potential and early-stage ovarian cancer.

Although it is feasible today to perform laparoscopic surgical staging and treatment of ovarian low malignant potential tumors and early-stage ovarian cancer safely, it is still generally agreed that a patient with ovarian cancer should have a laparotomy. Concerns related to laparoscopy in managing gynecologic malignancy include the accuracy of intraoperative diagnosis, inadequate resection, significance of tumor spillage, improper or delay in surgical staging, delay in therapy, and the possibility of port-site metastasis. On the other hand, laparoscopy has the advantages of being a minimally invasive surgery, with shorter hospitalization, decreased postoperative pain, and quicker return to normal daily activities. We review the current literature discussing the consequences of laparoscopic surgery in ovarian tumors of low malignant potential and early-stage ovarian cancer. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to list the concerns related to laparoscopic management of ovarian malignancies, to outline the accuracy of the diagnosis of low malignant potential (LMP) ovarian tumors on frozen section, and to summarize the data on the effect of capsule rupture on overall prognosis for patients with ovarian cancer.

Ovarian mucinous cystadenoma with leiomyomatous mural nodule.

A case of an ovarian mucinous cystadenoma with a leiomyomatous mural nodule is described. The diagnosis was confirmed by immunohistochemical methods. This is the first report of a mural nodule of leiomyomatous nature, thus widening the histologic spectrum that may be encountered in these lesions.

Lupus-like syndrome in a mother and newborn following administration of hydralazine; a case report

A very-low-birth-weight infant died from pericardial effusion and cardiac tamponade confirmed by the post-mortem findings. The mother suffered from lupus-like syndrome consequent to hydralazine treatment for pregnancy-induced hypertension. The possible relationship between mother-infant pathology and hydralazine administration is discussed.

Unsuspected involvement of the female genitalia in pemphigus vulgaris

A 56-year-old woman had erosions due to pemphigus vulgaris in the inner thighs and perineum. The cutaneous lesions cleared following intramuscular gold therapy. However, because of complaints of dyspareunia, a colposcopic examination was performed and involvement of the cervix was demonstrated. The need for a vaginal examination in the monitoring of pemphigus vulgaris is emphasized.

Primary ovarian carcinoid with marked heterogeneity of microscopic features

A primary ovarian carcinoid tumor in a 54‐year‐old patient with the carcinoid syndrome is reported. On histologic examination there were, in addition to typical insular and atypical ribbon‐like areas, solid and papillary growth patterns with pleomorphic and clear cells, some with anaplastic features. The heterogeneity seen in this case has not been reported in an ovarian carcinoid. However, since argentaffine and some argyrophil granules were demonstrated by special stains and ultrastructural studies in all of the various cellular elements, it was concluded that the entire tumor represented a carcinoid. This case demonstrates that ovarian carcinoids are not necessarily insular, trabecular, or mixtures thereof, but can also be extremely heterogenous. In order to identify more tumors of this kind and also to avoid a diagnosis of an anaplastic or unclassifiable carcinoma in such cases, it is recommended that special stains for neurosecretory granules and electron microscopic examination be carried out in a larger number of poorly differentiated ovarian neoplasms, especially in those in which some of the microscopic features are suggestive of a carcinoid.

Granular cell myoblastoma of the vulva. Report of 4 cases.

Abstract. Granular cell myoblastoma is a rare tumor, for which the vulvar area is one site of predilection. It occurs at any age as a firm, rounded nodule, usually not exceeding 3 cm in diameter (10). The current view is that this tumor may be derived from Schwann cells (4, 8). Only 49 cases of granular cell myoblastoma of the vulva have so far been reported (3, 6).