Accuracy of intra-operative frozen sections in the diagnosis of ovarian masses.

The accuracy of frozen section diagnosis in the intraoperative evaluation of ovarian masses is very important with regard to surgeon selection of appropriated operating procedures. For evaluation in our institute, the records of 127 patients with ovarian masses submitted for intraoperative frozen sections between January 2001 and December 2005 were reviewed. After exclusion of 4 completely infarcted masses and 11 cases with deferred frozen section diagnoses, 112 were analyzed for diagnostic accuracy by comparing with the final histologic results. We found sensitivity in the diagnosis of benign, borderline and malignant tumors to be 100%, 84%, and 92 %, respectively, with specificities of 92.7%, 97.9%, and 100%, respectively. The overall accuracy with frozen sections was 94 %. Among 18 patients with deferred or discordant diagnoses, mucinous tumors accounted for 72 % of cases. No over-diagnosis of malignancy or misdiagnosis of metastatic lesions as primary ovarian cancer by frozen sections was observed. In conclusion, the accuracy of intraoperative frozen section for the diagnosis of ovarian masses is high. Frozen sections also help in the evaluation of metastatic tumors to the ovary. Mucinous tumors constitute an important group causing diagnostic discrepancies.

Interobserver reproducibility in determining p16 overexpression in cervical lesions : use of a combined scoring method.

OBJECTIVES: To evaluate interobserver reproducibility of a combined scoring method for immunohistochemical interpretation of p16 overexpression in cervical lesions. MATERIALS AND METHODS: p16 immunostaining was performed in cervical samples from 183 patients, including 69 normal, 42 low grade squamous intraepithelial lesions(LSIL), 36 high grade SIL (HSIL), and 36 squamous cell carcinomas(SCCAs). Each case was evaluated by a combined scoring method based on the percentage of positive cells (score 0-3), the intensity of staining (score 0-3), and the distribution pattern (score 0-2). Immunoexpression for p16 was considered as positive when the combined score was 4-8 and negative with a score of 0-3. Ten pathologists with varied experience in interpretating p16 immunostains evaluated each slide independently. RESULTS: All normal cervical squamous epithelia (69/69) were uniformly negative for p16. All HSILs (36/36), all SCCAs (100/100), and all but one of the LSILs (40/41, 97.6%) showed positive expression. In 172 of 183 cases (93.9%), p16 interpretation was concordant with all pathologists. Eleven cases with discordant results included 10 LSILs and 1 normal mucosa sample. Percentage of agreement of each pathologist pair ranged from 96.7-100% (mean 98.1%) with mean kappa value of 0.96 (range 0.93-1.000). CONCLUSION: The proposed combined scoring method shows good reproducibility among the participating pathologists and good correlation with the histologic diagnosis. This method may be a useful guide in the interpretation of p16 expression in cervical epithelial lesions.

Interobserver reproducibility with LiquiPrep liquid-based cervical cytology screening in a developing country.

OBJECTIVE: A modified liquid-based techniques known as the "LiquiPrep (LP) system" requires neither expensive equipment nor complicated specimen preparation. The aim of this study was to assess the applicability of the LP for use in a developing country. METHODS: Cervical cytology specimens were collected from 777 women, using the Cervex-Brush. The brush was first smeared on a glass side for conventional Papanicolaou (CP) stain, and then immersed in preservation fluid for LP preparation. Cytologic interpretations were classified into four categories: 1) no atypical cells, 2) atypical squamous epithelial cells (ASC), 3) definite epithelial cell abnormality, and 4) unsatisfactory specimen. Interobserver variability was tested using weighted kappa statistics. RESULTS: An LP specimen cost $9 per case compared to $3 per case for a conventional Pap smear. The time to learn the technique was only a few days. Forty six (5.92%) specimens by LP were unsatisfactory. The overall agreement between cytopathologists was 96.7% (weight kappa=0.62), with 95.6% (weight kappa=0.44) for the cases enrolled earlier, increasing to 97.9% (weight kappa=0.78) for the cases enrolled later. CONCLUSIONS: In summary, after a short learning curve, interobserver reproducibility of LP smear was near perfect. This feature of the LP, together with the relatively low cost and simple protocol, makes it quite suitable for cervical cytology screening in developing countries. Moreover, with this technique, some of each sample can be reserved for additional studies such as HPV detection and subtyping.

Prognostic value of p53 expression in early stage cervical carcinoma treated by surgery.

OBJECTIVE: To evaluate the prognostic significance of p53 protein expression in patients with early stage cervical carcinoma treated by surgery alone in a well-controlled study. METHODS: A matched case-control study was performed in patients with stage Ib-IIa cervical carcinoma who underwent radical hysterectomy with pelvic lymphadenectomy. Patients had neither lymph node metastasis nor involvement of the parametrium and surgical margins, and did not receive any adjuvant treatment. Cases included 30 patients who had tumor recurrence within 5 years after surgery; controls included 60 patients who were disease-free for at least 5 years after surgery. Cases and controls were within 10 years of age, had the same stage and tumor type, and underwent surgery on as close to the same date as possible. The tumor sizes of cases and controls were within 1 cm of each other. Expression of p53 protein was studied by immunohistochemistry. Expression was considered positive when at least 10% of tumor cells showed nuclear staining. RESULTS: No significant difference of p53 expression was observed between the case group and the control group (33% versus 40%). High histologic grade of tumors and lymphovascular space invasion were significantly associated with tumor recurrence in multivariable analysis (p=0.012 and 0.014, respectively). CONCLUSION: In this study, expression of p53 did not correlate with tumor recurrence. Immunohistochemistry for p53 protein appears to provide no prognostic information in the patients with early stage cervical cancer treated by surgery.

Epidemiologic study of 112 osteosarcomas in Chiang Mai University Hospital, Thailand.

OBJECTIVE: To summarize the epidemiologic features of osteosarcoma. MATERIAL AND METHOD: One hundred and twelve cases of osteosarcoma were collected retrospectively from the Pathology Department of the Chiang Mai University Hospital, Thailand between 1995 and 2005. RESULTS: From the present study, there were 14 cases in average, annually, since 2002. Seventy-seven percent of cases were from the upper north Thailand, the region serviced by Chiang Mai University Hospital. The male:female ratio was 1.3:1 and 86% of cases occurred within the first three decades of life. The majority of cancer was found in the long bones (83%) and the majority of lesion was around the knee (68%). Conventional and telangiectatic osteosarcoma accounted for 85% and 8% of cases, respectively. CONCLUSION: The authors have summarized some epidemiologic features of osteosarcoma. The authors found the relatively high frequency of telangiectatic osteosarcoma around the upper part of north Thailand These results give an initial picture to the national health provider section for planning personnel, medical and supportive equipment, and funding for the care of osteosarcoma patients. Nationwide co-operation in registering osteosarcoma patients would provide more complete data on this tumor in Thailand and promote the establishment of standardized treatment protocols.

Spectrum of bone tumors in Chiang Mai University Hospital, Thailand according to WHO classification 2002: A study of 1,001 cases.

OBJECTIVE: The aim of the present study was to determine the spectrum, frequency and demographics of bone tumors. MATERIAL AND METHOD: A retrospective study of the 1,001 bone tumor specimens from the files at the Pathology Department of the Chiang Mai University Hospital, Thailand from 2000 to 2004. RESULTS: From the study, 41 were non-neoplastic mass lesions, and 960 were neoplastic, with 856 (89%) as primary and 104 (11%) as metastatic tumors. In the primary tumor group, 654 (76%) cases were of hematologic origin, and 202 (24%) were non-hematologic. The most common benign bone tumors were giant cell tumor (n = 37), osteochondroma (n = 25), and chondroma (n = 15). The most common malignant bone tumors were lymphoma-leukemia (n = 583), metastatic malignancy (n = 104), plasma cell myeloma (n = 71), and osteosarcoma (n = 58). CONCLUSION: The present study showed a higher frequency of osteosarcoma (68%), lower frequencies of chondrosarcoma (12%) and Ewing sarcoma (4%) among primary non-hematologic malignant bone tumors when compared with similar studies based on Western patients. Whether these differences reflect differences in the ethnic population or in practice patterns remains to be determined

Cytological diagnosis of lung cancer in Chiang Mai, Thailand: cyto-histological correlation and comparison of sensitivity of various methods.

To evaluate the role of cytology of sputum, bronchial brushing (BB), bronchial washing (BW), bronchoalveolar lavage (BAL) and fine needle aspiration cytology (FNA) in the diagnosis of lung cancer using histological material as a gold standard, a retrospective study was performed on cytological materials obtained from 243 patients with possible lung cancer. Of these, 160 had been confirmed histologically to have lung cancer. Cytological materials included in the study were 31 sputa, 123 BWs, 11 BBs and 36 BALs. Meanwhile, FNAs and concurrent gun biopsies (GBs) were performed on 23 patients clinically and histologically proved to have lung cancer. The overall sensitivity of sputum, BW and BAL was 0.222, 0.455 and 0.361, respectively. BB provided a significantly far superior sensitivity (0.800) than those of three former methods with p<0.05 by Fisher's exact test. FNA and GB seemed to provide greater sensitivity of 0.913 and 0.783, respectively. Although the complimentary role of various conventional cytological techniques is well recognized, bronchial brushing is the only single technique that significantly improved diagnostic yield. FNA and GB techniques should be encouraged due to their superior sensitivity.

Carcinoma of the breast with unusual clinical presentation: a case report.

A common presentation of breast cancer is a palpable or non-palpable breast mass that might or might not demonstrate clinical signs of skin and/or nipple involvement. These malignant lesions frequently receive correct diagnosis only by physical examination under modestly experienced observers. We, hereby, reported the case of a 66-year-old woman who presented with a rapidly growing skin lesion at the left breast for three months. A 3.6x3x2.5 cm reddish, shiny, rubbery, sessile mass was seen on the upper outer quadrant of her left breast. The cytologic and histologic features of the tumor were typical for infiltrating ductal carcinoma. This case demonstrated a very unusual clinical presentation of breast cancer. No similar clinical feature of such cancer was mentioned in the reviewed literature.

Intraosseous proliferative sparganosis: a case report and review of the literature.

Intraosseous proliferative sparganosis is an extremely rare parasitic disease in which the larvae of incomplete differentiated sparganum proliferate in the human bone. We present the first case of intraosseous proliferative sparganosis arising in the long bone. The patient was a 51-year-old man who complained of a slow growing painful mass on his right leg. The radiographic findings showed an infiltrative osteolytic lesion with speckled calcification at the proximal tibia the clinical diagnosis of which favored chondrosarcoma. Incisional biopsy revealed an innumerable number of small globular shapes, whitish parasites. Histologically, the parasites were composed of a few layers of smooth muscle and several calcerous bodies that were enclosed within a single row of tegumental cells. The latter exhibited a wavy appearance and coated with microvilli. These morphologic findings confirmed the nature of these maldifferentiated larvae. The patient was treated by partial resection of the lesion. This should remind clinicians that parasitic infection of the bone can produce a tumor-like lesion.