Senija Eminović

Frequency and distribution of lymph node metastases in epithelial ovarian cancer : Significance of Serous Histology

Background: The aim of this retrospective study was to evaluate the incidence and distribution of nodal metastases in relation to the serous versus nonserous histological subtypes of epithelial ovarian cancer. Methods: Patients were treated primarily with upfront surgery, including pelvic and para-aortic systematic lymphadenectomy, up to the level of the left renal vein, before any kind of chemotherapy administration. Patients were classified according the tumor histology into 2 groups: serous (including the cases of mixed histology with a serous component) and nonserous group. Results: A total of 173 patients fulfilled the inclusion criteria; 76 and 97 patients had serous and nonserous ovarian carcinoma, respectively. Positive lymph nodes were found in 59.3% (45/76) and 14.4% (14/97) of patients in the serous and nonserous histology groups, respectively. There was no difference in positive node distribution in 3 regions (pelvic and para-aortic regions, below and above the inferior mesenteric artery) between these 2 groups. Early spread including 1 or 2 positive lymph nodes was predominantly found in the para-aortic region in both groups, serous and nonserous, whereas distribution of positive nodes in patients with 3 or more lymph nodes shows equal presence in pelvic and para-aortic regions. Conclusions: Serous ovarian carcinomas are much more prone to metastasize to lymph nodes than nonserous histological types. However, the pattern of lymph node distribution did not differ between these 2 groups and was similar in the pelvic and para-aortic regions.

Heat-Shock Proteins 70 Induce Pro-Inflammatory Maturation Program in Decidual CD1a(+) Dendritic Cells.

The aim of the study was to assess possible binding of a mixture of constitutive Hsc70 and inducible Hsp70 forms (HSP70) to Toll‐like receptor (TLR) 4 and CD91 receptors on decidual CD1a+ dendritic cells (DCs) and their influence on DCs maturation status.

The Significance of Heat-Shock Protein GP96 and its Receptors' CD91 and Toll-Like Receptor 4 Expression at the Maternal Foetal Interface

Differences in the expression of gp96 and its receptors were analysed in normal and pathological human pregnancy.

Treatment and outcome of stage Ia1 squamous cell carcinoma of the uterine cervix

To evaluate the treatment and clinical outcome of patients with FIGO stage IA1 cervical squamous cell carcinoma (SCC).

Primary Carcinosarcoma of the Vagina Associated With Differentiated Squamous Intraepithelial Neoplasia in a Patient With Complete Uterine Prolapse: Case Report and Review of the Literature

Vaginal carcinosarcomas (VCSs) are rare and clinically aggressive neoplasms. Primary vaginal malignancies are among the rarest malignant tumors, so clear management guidelines and optimal therapy, especially in the presence of significant pelvic organ prolapse, has not been determined. Here, we present a case of primary VCS closely associated with differentiated squamous intraepithelial neoplasia (DSIN), from which it appeared to have arisen in a postmenopausal patient with complete uterine prolapse. The unusual presentation of our case with DSIN in the adjacent vaginal epithelium with possible diagnostic pitfalls emphasizes the need for systemic presentation of these cases to help pathologists and clinicians know that such lesions can initially present in a patient with complete uterine prolapse. To our knowledge, this is the first case of vaginal DSIN described in the literature to date.

Adult Granulosa Cell Tumors of the Ovary: A Retrospective Study of 36 FIGO Stage I Cases with Emphasis on Prognostic Pathohistological Features

Objective Adult granulosa cell tumors (AGCTs) represent 2%–5% of all ovarian malignancies. The aim of this study was to analyze clinical and pathohistological parameters and their impact on recurrence, overall, and disease-free survival in FIGO stage I AGCT patients. Methods The tumor specimens analyzed in this retrospective study were obtained from a total of 36 patients with diagnosis of ovarian AGCT surgically treated at the Department of Gynecology, Rijeka University Hospital Centre, between 1994 and 2012. Clinical, pathological, and follow-up data were collected. Results The mean age at diagnosis was 54.5 years with a range of 24–84. The majority of the patients, 30 (83%), were in FIGO stage IA, 3 (8%) in stage IC1, 1 (3%) in stage IC2, and 2 (6%) in stage IC3. During follow-up period (median 117.5 months, range 26–276), recurrence occurred in 4 patients (12%) with 2 deaths of the disease recorded. In univariate analysis, the 5-year survival rates were significantly shorter in patients with FIGO substage IC (p = 0.019), with positive LVSI (p = 0.022), with presence of necrosis (p = 0.040), and with hemorrhage (p = 0.017). In univariate analysis, the 5-year disease-free survival rates were significantly shorter in patients treated with fertility surgery (p = 0.004), with diffuse growth pattern (p = 0.012), with moderate and severe nuclear atypia (p = 0.032), and with presence of hemorrhage (p = 0.022). FIGO substage IC proved to be independent predictor for recurrence (OR = 16.87, p = 0.015, and OR = 23.49, p = 0.023, resp.) and disease-free survival (p = 0.0002; HR 20.84, p = 0.02) at the uni- and multivariate analyses. Conclusions FIGO substage IC is predictive of recurrence and disease-free survival in patients with early-stage AGCTs. LVSI, presence of necrosis and hemorrhage, diffuse growth pattern, and nuclear atypia in AGCTs seem to be associated with overall and disease-free survival, so these pathological features should be taken into consideration when managing patients with AGCT.

Novi model patogeneze karcinoma jajnika

Sažetak. Karcinom jajnika je vodeci uzrok smrti među zlocudnim novotvorinama ženskog spolnog sustava. Usprkos pokusajima razvoja programa probira s ciljem ranog otkrivanja bolesti, kao i novim terapijskim pristupima, mortalitet nije znacajno smanjen. Jedan od razloga ovog neuspjeha bio je slabo razumijevanje patogeneze karcinoma jajnika koji je smatran jedinstvenom bolescu. Nove spoznaje pokazuju da je karcinom jajnika vrlo heterogena bolest, koja se na temelju klinickopatoloskih karakteristika te molekularnih i genetickih promjena može podijeliti u dvije skupine: tip 1 i tip 2 tumori. Ovaj novi model patogeneze karcinoma jajnika danas ima važan klinicki i terapijski znacaj.

Uloga citologije u preoperativnoj dijagnostici primarnog karcinoma jajovoda: prikaz slučaja

Aim: To report a case of a patient with primary serous carcinoma of the fallopian tube, describe the diagnostic pathway and analyze the role of cytology in the detection of this tumor type. Case report: A 50-year-old patient was previously treated in another hospital for abdominal pain and radiologically confirmed enlargement of supraclavicular, aortocaval and iliac lymph nodes. A lymphoproliferative disorder was suspected and laparoscopic lymph node excision was performed. Histopathological and immunohistochemical analysis revealed a metastatic adenocarcinoma probably of gynecologic or breast cancer origin. Radiographic examination of the breast did not confirm any lesion suspicious for malignancy. Positron emission tomography/computed tomography observed increased radiotracer uptake involving the uterine cervix and corpus. Preoperative fine-needle aspiration cytology and immunocytochemical analysis of an enlarged supraclavicular lymph node was done and metastatic serous adenocarcinoma was confirmed. In the Pap smears malignant cells of equal morphology were found without tumor diathesis indicating an extra-uterine adenocarcinoma. It was suggested to consider a tumor of ovarian or fallopian tube origin. A total hysterectomy with bilateral salpingo-oophorectomy was performed. During surgery an enlargement of the *Dopisni autor: Roberta Rubeša-Mihaljević, dr. med. Zavod za kliničku citologiju, KBC Rijeka Cambierieva 17, 51 000 Rijeka e-mail: roberta.rubesa@gmail.com 1Zavod za kliničku citologiju, KBC Rijeka, Rijeka 2Zavod za patologiju i patološku anatomiju, Medicinski fakultet Sveučilišta u Rijeci, Rijeka 3Klinika za ginekologiju i porodništvo, KBC Rijeka, Rijeka Uloga citologije u preoperativnoj dijagnostici primarnog karcinoma jajovoda: prikaz slučaja The role of cytology in preoperative assessment od primary fallopian tube carcinoma: case report Roberta Rubeša-Mihaljević1*, Damjana Verša Ostojić1, Morana Dinter1, Snježana Štemberger-Papić1, Senija Eminović2, Ines Krištofić3, Danijela Vrdoljak-Mozetič1 Prikaz slučaja/Case report

Role of tumor-associated glycoprotein-72 in the progression of endometrial adenocarcinoma: A proposed study

Endometrial adenocarcinoma is on the basis of the molecular, immunohistological and clinicopathologic features broadly divided into two groups, referred as type I and type II. Type I appears more frequently and in principle patients have a good prognosis; however a significant number of patients develop local recurrences. We hypothesize that TAG-72, expressed on endometrial carcinoma binds and internalizes endocytic pattern recognition receptors on surrounding tissue antigen presenting cells (dendritic cells and macrophages), powers their anti-inflammatory maturation program and make them capable to elicit or modulated tolerogenic immune response mediated by local T and NK effectors. This could support uncontrolled local tumor growth, deeper tumor invasion into surrounding tissues, frequent local recurrences and/or lymph node metastasis. To test this hypothesis, we propose a semi-quantitative immunohistochemical analysis of TAG-72 expression in endometrial adenocarcinoma samples and to correlate the results with clinical and pathological parameters (age, type and histological grade of the tumor, estrogen and progesterone receptor expression, invasion into the myometrium and capillaries, presence of lymph node metastases, FIGO stage, and TNM classification). It would be worthwhile to investigate the local tissue immune response in the tumor environment using tissue samples removed during surgery. These studies could elucidate the underlying immunopathological mechanisms that govern the early recurrence and possibly distant metastases of TAG-72-expressing adenocarcinomas and might help in deciding the type of treatment to be applied in a selected group of cancer patients including application of biological therapy with anti-TAG-72 antibodies, according the principle of personalized oncology treatments.