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Objective To investigate the relationship between various loop electrosurgical excision procedure (LEEP) margin status and residual high grade squamous intraepithelial lesion (HSIL) or worse at hysterectomy following conization. Methods The relevant clinicopathological data were collected in the Obstetrics and Gynecology Hospital, Fudan University from Jan. 2014 to Dec. 2015, including 947 cases who underwent hysterectomy within 6 months of LEEP. The residual HSIL or worse at hysterectomy were analyzed among the groups. (1) Clear margins, involved margins, and without 1 mm negative margins. (2) Only one positive margin, two positive margins and three positive margins. (3) A positive margin of internal ostium of cervix, of external ostium of cervix and of the basement. Results (1) The histological evaluation of the uterine specimens showed residual HSIL or worse in 234 cases (24.7％, 234/947). The proportion of residual lesions was 7.3％ (21/286) in population with clear margins, 33.2％ (211/635) with involved margins, 7.7％ (2/26) without 1 mm negative margins, respectively. The positive margins group had significant difference at the aspect of residual rate in contrast to the negative margins group and the without 1 mm negative margins group (P<0.01). Further studies conclusively showed that the proportion of residual lesions was very similar between the negative margins group and the without 1 mm negative margins group (P>0.05). (2) The involved margins were interpretable in 621 cases. This was detected in 25.3％(111/438) patients with only one positive margin, 47.4％(74/156) with two positive margins and 77.8％(21/27) among three positive margins, respectively (P<0.01). (3) Furthermore, there were 418 cases only one positive margin was definite, and the proportion of residual lesions was 31.0％(62/200) in population with a positive margin of internal ostium of cervix, 18.2％(31/170) of external ostium of cervix and 33.3％(16/48) of the basement. The residual rates were higher in the endocervical and basal margin groups than that in the ectocervical margin group, and the differences were significant (P<0.05). Conclusions The risk of residual HSIL or worse is significantly greater with involved margins at hysterectomy following LEEP. Both the positive endocervical and basal margin are excellent predictors of residual diseases, while the without 1 mm negative margin may be not. Clinicians should avoid treating it as positive margin and prevent overtreatment.
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Objective@#To investigate the clinical and pathological characteristics and prognosis of ovarian clear cell borderline tumor.@*Methods@#A total of 12 cases of ovarian clear cell borderline tumors recorded were collected from May 2011 to December 2017 at Obstetrics and Gynecology Hospital, Fudan University.Clinical histories were retrieved and pathological slides were reviewed.@*Results@#The age of the patients ranged from 35 to 65 years with a mean age of 52 years. Seven cases were associated with cystic endometriosis of the ovary. All tumors consisted of irregular and crowded glands or cysts embedded in a fibromatous stroma. The cysts and glands were lined by mild to moderate atypical cells.CK7 and HNF-1β were expressed in all cases, and Naspin A was expressed in 11 cases. ARID1A expression was absent in 5 cases and p53 showed wild-type expression. None of the cases developed recurrence during follow-up ranging from 7 to 79 months.@*Conclusions@#Ovarian clear cell borderline tumor may be associated with endometriosis and tumor suppressor gene ARIDA. The tumor has a good prognosis without recurrence and progression to carcinoma.
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Objective To clarify the clinicopathological features of ovarian clear cell carcinoma derived from endometriotic cyst (EC-OCCC).Methods Totally 54 cases of EC-OCCC were recruited in the current retrospective study.The relation between ages, clinical symptoms and signs, surgical and pathological stages, serum CA125, findings of ultrasound, treatments and the sites of tumors, macro-and micro-features and expression of immunostainings were analyzed.Results (1) Clinical features: the ages of patients were (50±6) years old (range 31-62 years old).Pelvic mass was the major complaint of 50 patients (93％, 50/54).Forty-five cases belonged to International federation of Gynecology and Obstetrics (FIGO) stage Ⅰ, 4 cases were stage Ⅱ and another 5 cases were stage Ⅲ.Serum CA125 was elevated in 21 cases (54％, 21/39) before therapy.Doppler ultrasound showed 46 cases (85％, 46/54) had solid masses in pelvis.(2) Pathological findings: 52 cases (96％, 52/54) had their tumor unilaterally, and 2 cases (4％, 2/54) occurred bilaterally.The maximal diameters of endometriotic cyst (EC) ranged from 1.5 to 23.0 cm and maximal diameters of ovarian clear cell carcinoma (OCCC) components were from 0.5 to 12.0 cm.Fifty-one cases (94％, 51/54) had their tumor within EC, which showed focally irregular protrudings, grey-white papillae or solid nodules attached to the cyst wall.Three cases (6％, 3/54) appeared as irregular thickened wall of the cysts, ranged from 1.5 to 6.0 cm in the maximal length, with the microscopic features of EC and OCCC and the transitional areas between the 2 morphologies.All cases expressed cytokeratin (CK) 7 and pan-CK AE1/AE3, 17 cases (33％, 17/51) expressed ER and 5 cases (10％, 5/51) expressed PR.TP53 showed mutational phenotype in 19 cases (36％, 19/53).Sixteen cases (30％, 16/54) combined with uterine adenomyosis and 25 cases (46％, 25/54) with endometriosis at other sites.(3) Survival survey: during the period of 39.1 months follow-up, 3 cases relapsed and 2 cases died.(4) There was a significant difference of serum CA125 between patients of early-and advanced-stages (P=0.049).There were no differences identified in ages, diameters of EC and OCCC, the expression level of ER, PR and TP53, the co-existence of adenomyosis and endometrosis, as well as ultrasonic findings (P＞0.05).Conclusion EC-OCCC could be recognized in early stage by symptoms and ultrasound due to accompanied endometriotic cysts, resulting in relatively good prognosis.
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Purpose To improve the early correct diagnosis and avoid misdiagnosis of cervical mucinous adenocarcinoma.Methods Twenty-one cases of cervical mucinous adenocarcinoma were reviewed and analyzed retrospectively.The expression of CEA and Ki-67 was detected in the tumor by immunohistochemical staining (LABC method).Results Of the twenty-one cases, three cases (14.3%) were missed out, in which one was missed out by TCT and the others by biopsy; four cases (19.0%) were diagnosed by biopsy as adenocarcinoma in situ with invasion not be excluded, and then further confirmed as invasive adenocarcinoma by LEEP; one case (4.8%) was diagnosed as cervicitis at first and was further detected as adenocarcinoma by LEEP; twelve cases (57.1%) were directly diagnosed as adenocarcinoma by biopsy; one case (4.8%) was diagnosed as adenocarcinoma with unknown origin, and then as cervical adenocarcinoma after hysterectomy. Immunohistochemically, ten cases were CEA positive (47.6%) and the expression of Ki-67 was increased (>20%).Conclusions Understanding of the cytologic and histologic features of adenocarcinoma in cervix might improve its early detection and correct diagnosis, so that timely treatment is guaranteed for patients.
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Objective To clarify the features of malignant ovarian neoplasms arising from ovarian endometriosis Methods A total of 26 women with malignant ovarian neoplasms arising from ovarian endometriosis were analyzed retrospectively Results Dysmenorrhea and pelvic mass were the most common clinical features Among 18 cases who underwent B ultrasound or color doppler ultrasound examination, solid foci in the pelvic masses were found in 10 cases The main histologic types of ovarian malignancy were endometrioid adenocarcinoma and clear cell carcinoma Microscopically atypical endometriosis with the tumors were found in 15 cases International Federation of Gynecology and Obstetrics stage:stage Ⅰ 21(81%)cases,stage Ⅱ 3(12%)cases,stage Ⅲ 2 (8%)cases Conclusions Clinical diagnosis of malignant ovarian neoplasms arising from ovarian endometriosis in early stage is difficult, and B ultrasound examination is more valuable for diagnosis It is suggested that close serutiny of endometrial hyperplasia, cellular atypia and malignancy in ovarian endometriosis be essential to understand the origin and development of malignant neoplasms arising from ovarian endometriosis