Well-Differentiated villoglandular adenocarcinoma of the uterine cervix: a report of 15 cases including two with lymph node metastasis.

Well-differentiated villoglandular adenocarcinoma is a recently described subtype of cervical adenocarcinoma. The tumor of this type is reported to have distinct clinicopathologic features and excellent prognosis. However, lymph node metastases of this tumor have been described in few reports. Fifteen cases of well-differentiated villoglandular adenocarcinoma treated at Maharaj Nakorn Chiang Mai Hospital were retrospectively reviewed for both clinical and histopathological features. All patients underwent radical hysterectomy with pelvic lymphadenectomy. In the cases with lymph node metastasis, adjuvant radiation therapy was also given. The patients ranged in age from 22 to 53 years (mean, 39.3). Fourteen patients were FIGO stage IB and one was stage IIA. All patients had exophytic friable cervical masses. Tumor size known in 14 cases ranged from 1.5 to 4 cm (mean, 2.3). Eleven tumors (73.3%) were confined to the inner third of the cervical stroma with 9 of these (60%) showing only superficial invasion (depth < or = 3 mm). The tumors invaded deeply to the middle third in 3 cases (20.0%), and to the outer third in one (6.7%). Lymphatic invasion was observed in 3 cases, two of them had pelvic lymph node metastasis. Both patients had tumors involving deeper than the inner third of the cervical wall. The follow-up duration ranged from 21 to 144 months (mean, 67.5). Four of thirteen cases without nodal metastasis were lost to follow-up 36 to 59 months after surgery. All patients showed no evidence of disease at the last visit. Presence of lymphatic invasion and deep stromal involvement appeared to be the risk factors for lymph node metastasis of well-differentiated villoglandular adenocarcinoma.

Loop electrosurgical excision procedure (LEEP) at Maharaj Nakorn Chiang Mai Hospital: problems in pathologic evaluation.

BACKGROUND: Loop electrosurgical excision procedure (LEEP) is widely used in diagnosis and management of cervical lesions. Difficulties in histopathologic evaluation of LEEP specimens, particularly for the margin status, have been reported to be a significant disadvantage of the procedure. METHOD: The histologic slides of the specimens from 163 patients who underwent LEEP at Maharaj Nakorn Chiang Mai Hospital from August 1995 to November 1997 were retrospectively reviewed for the degree of thermal artefact and the margin status. Follow-up data after a 6-month-period were correlated with the margin status. RESULTS: Thermal artefact was present in all cases (mild 51.5%, moderate 36.2%, and severe 12.3%). In only one case, histologic diagnosis of the lesion was not possible due to severe thermal artefact. Nine cases (5.5%) had non-evaluable margins due to either thermal artefact (7 cases) or improper orientation of fragmented tissue (2 cases). Of 90 cases with subsequent surgical specimens, residual diseases were present in 4 of 21 (19.0%) with negative LEEP margins, in 31 of 64 (48.4%) with positive margins, and in 4 of 5 (80.0%) with non-evaluable margins. CONCLUSIONS: Pathologic evaluation of the specimens from LEEP was limited in only a minority of cases. Thermal artefact was not a critical disadvantage of LEEP. The positive or negative margin status was correlated with the risk of residual disease.

Prenatal diagnosis of VACTERL association: a case report.

A prenatal diagnosis of VACTERL association, a combination of vertebral (V), anal (A), cardiac (C), tracheoesophageal (TE), renal (R) and limb (L) anomalies was made at 30 weeks of gestation, based on the sonographic demonstration of vertebral defects, bilateral renal agenesis, and left lower limb defects. Additionally, severe oligohydramnios and fetal growth restriction were also documented. After proper counseling, elective termination of pregnancy was done, resulting in a stillborn infant with multiple malformations compatible with the VACTERL association. The postnatal X-ray and autopsy revealed verterbral defects, anorectal atresia with undetermined sex, cardiac defect of ventricular septal defect, tracheal agenesis with distal atresia of esophagus, bilateral renal agenesis, and limbs defects. The chromosomal study revealed normal, 46,XY. This report emphasizes the important role of prenatal ultrasound in the diagnosis and management of this disorder.

Muscular hamartoma of the breast: a rare breast lesion containing smooth muscle.

Hamartoma of the breast is an uncommon entity, usually presenting as a well-demarcated breast mass. Microscopically, the lesion is composed of mammary glandular component, fibrous stroma, adipose tissue, and smooth muscle in variable proportions. Among the variants of breast hamartoma, muscular hamartoma is rare. This lesion should be differentiated from other breast tumors that contain smooth muscle element. We report a breast lesion of a 36-year-old woman diagnosed as a muscular hamartoma in which the muscular component is cellular and some mitotic figures are present. The criteria to distinguish between benign and malignant smooth muscle lesions in the breast, emphasizing mitotic count, are also discussed.

Immunohistochemical characterization of a new monoclonal antibody reactive with dengue virus-infected cells in frozen tissue using immunoperoxidase technique.

This paper presents a novel monoclonal antibody shown to react with cytoplasmic antigens in various dengue infected human frozen organs from autopsy and necropsy specimens. Strong reactivity was found in hematopoietic cells, including immunoblasts, lymphocytes, plasma cells and macrophages of spleen, lymph node, lung, kidney and stomach. Strikingly, strong positivity was demonstrated in cerebral cortex neurones, Purkinje cells, choroid plexus and blood vessels in addition to astrocytes and microglia. Neurotropism of the virus could explain the meningitis, encephalitis, mononeuropathy and polyneuropathy observed by direct toxicity, but noted especially after an activation of mononuclear phagocytes and amplification of the immune response with subsequent vascular inflammation and formation of immune complexes.