Terrence A. Wesseler

Predictive value of cone margins and post-cone endocervical curettage with residual disease in subsequent hysterectomy

In 51 of 106 patients (48%) residual disease was identified in hysterectomy specimens performed following cervical conization. Invasive squamous cell carcinoma was found in one patient in spite of clear cone margins. Thirty-nine of sixty-three patients (62%) with cervical intraepithelial neoplasia (CIN) involving the inner (endocervical) margin of the cone biopsy had residual disease. When both the inner margin and post-cone endocervical curettage (ECC) were involved, residual disease was present in 24 of 30 (80%) hysterectomy specimens. When the inner margins of the cone were involved with CIN-III and the post-cone ECC was negative, 36% of hysterectomy specimens contained residual disease compared to 88% when post-cone ECC was positive. These findings indicate that post-cone endocervical curettage has significant predictive value with respect to the presence or absence of residual disease in patients with CIN involving the inner margins of the cervical cone.

Giant Cell Reparative Granuloma of the Ethmoid Sinus

This article represents the fourth and fifth reported cases of GCRG that involve the ethmoid sinus. The problems encountered in establishing the diagnosis are emphasized, as are the features that differentiate it from the giant cell tumor, aneurysmal bone cyst, and hyperparathyroidism, the conditions with which it is most commonly confused. The unusually aggressive behavior, as demonstrated by these two cases, is highlighted.

Vulvar intraepithelial neoplasia: A clinicopathological study of carcinoma in situ of the vulva

Thirty-two patients with carcinoma in situ of the vulva were analyzed with respect to age-specific incidence rates, associated human papilloma virus (koilocytosis and condyloma) changes, and multifocal, unifocal distribution of the lesions. The association of koilocytosis and condyloma changes in the neoplastic epithelium correlated with a younger mean age compared to those without human papilloma virus (HPV) changes (39 versus 67 years). Also, patients with multifocal disease were found to have a younger mean age compared to those with unifocal disease (31 versus 61 years). Carcinoma in situ of the vulva appears to be a disease that affects two patient population groups. Patients with coexistent HPV infection usually are younger and have multifocal disease, and those patients with a variable history of HPV infection usually are older and have unifocal disease.

Neuroendocrine (Merkel cell) carcinoma of the vulva

The clinical, histopathologic, and ultrastructural features of a primary cutaneous vulvar neuroendocrine neoplasm (Merkel cell carcinoma) are presented. This recently described tumor arises in the dermis and is often aggressive with metastasis to regional lymph nodes. Ultrastructural study of this case reveals morphologic similarities to normal cutaneous Merkel cells, including peripherally located dense-core neurosecondary-like granules, and immunohistochemical studies revealed ACTH within neoplastic cells. By light microscopy this tumor is readily confused with other primary or metastatic cutaneous neoplasms; therefore, the importance of electron microscopic examination is emphasized for definitive diagnosis of this unusual tumor.

HPV changes and their significance in patients with invasive squamous cell carcinoma of the vulva: A clinicopathologic study

Records of 28 patients with invasive squamous cell carcinoma of the vulva were analyzed with regard to age-specific incidence rate, associated human papillomavirus (HPV) changes, multifocal and unifocal distribution of the lesions, and incidence of nodal metastasis. The presence of HPV changes (koilocytosis and condyloma) around the neoplastic epithelium correlated with a mean age group younger than that of those without HPV changes (47 vs 77 years). All multifocal cancers were associated with HPV changes while only 35% of unifocal lesions were so associated. Patients with multifocal disease were found to have a mean age younger than that of those with unifocal disease (44 vs. 67). When patients with microinvasion were excluded, no patients with multifocal invasive cancer and HPV changes were found to have nodal metastases. In contrast, nodal metastases were present in 59% of patients with unifocal invasive cancer.

Significance of positive endocervical curettage in predicting endocervical canal involvement in patients with cervical intraepithelial neoplasia

A total of 108 patients with positive endocervical curettage who underwent cone biopsy were carefully examined to determine the accuracy of endocervical curettage (ECC) in predicting endocervical canal involvement with cervical intraepithelial neoplasia (CIN). The data suggest a 63% correlation between positive ECC and endocervical canal involvement: 72.4% of patients with CIN III on cervical biopsy had endocervical canal involvement compared to 27.3% who had CIN I. Two patients with positive ECC were found to have invasive cancer on cone biopsy.

Prognostic factors and the significance of cytologic grading in invasive squamous cell carcinoma of the vulva: A clinicopathologic study

Clinical staging, tumor size, histologic differentiation, cytologic grading, depth of stromal invasion, and vascular channel involvement by tumor cells were studied in 42 patients with invasive squamous cell carcinoma of the vulva who were treated with radical vulvectomy and inguinal-femoral lymphadenectomy. All parameters were found to correlate well in predicting groin node metastasis. Cytological grading was found to be more significant compared to histologic grading in regard to nodal metastasis (P less than 0.02). No patient with cytologic or histologic grade 1 tumor and less than 5 mm stromal invasion was found to have nodal metastasis.

Significance of lymphoplasmocytic infiltration around tumor cell in the prediction of regional lymph node metastases in patients with invasive squamous cell carcinoma of the vulva: A clinicopathologic study

Abstract Histologic material from 42 patients treated for invasive squamous cell carcinoma of the vulva was studied to determine the prognostic significance of lymphoplasmocytic infiltration around tumor cells in the prediction of regional lymph node metastases. No correlation was found between lymphoplasmocytic infiltration and nodal metastasis with respect to degree of tumor differentiaton, stage of disease, and vascular channel involvement. The presence or absence of lymphoplasmocytic infiltration around tumor cells appears to have no prognostic value in predicting nodal metastases.