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ANTECEDENTES: Los pólipos endometriales son sobrecrecimientos de la mucosa endometrial, una de las causas más comunes de hemorragia uterina anormal, pueden estar asociados con lesiones premalignas y malignas del endometrio. Existen características histeroscópicas que ayudan a diferenciar una lesión benigna o maligna. El pólipo metaplásico es un hallazgo histeroscópico caracterizado por superficies laminares e hiperqueratosis, con zonas blancas e hiperrefringentes. CASOS CLÍNICOS: Tres casos clínicos de pacientes menores de 40 años, con hemorragia uterina anormal donde el hallazgo histeroscópico común fue el pólipo metaplásico, hallazgo premaligno que se confirmó mediante el análisis patológico y la positividad del marcador de inmunohistoquímica p63. Caso 1. Paciente de 28 años, nulípara, obesa, con antecedente de síndrome de ovario poliquístico, con engrosamiento endometrial e histeroscopia, con pólipo con superficie hiperqueratósica, a manera de láminas irregulares, con excrecencias y lesiones exofíticas. Caso 2. Paciente de 25 años, con endometrio irregular engrosado e histeroscopia con hallazgo de pólipos transparentes, con cambios vasculares leves y superficie con zonas hiperrefringentes blanquecinas. Caso 3. Paciente de 38 años, con antecedente de síndrome de ovario poliquístico y obesidad. En la histeroscopia el endometrio se encontró hiperplásico, irregular, con cambios vasculares y pólipos con zonas superficiales hiperrefringentes, sólidas y blancas. CONCLUSIONES: En pacientes jóvenes, con hallazgo histeroscópico de pólipo metaplásico debe considerarse y descartar la enfermedad premaligna y maligna endometrial. El estudio debe completarse con marcadores de inmunohistoquímica (p63), específicos de la metaplasia escamosa.
Abstract BACKGROUND: Endometrial polyps are overgrowths of the endometrial mucosa, one of the most common causes of abnormal uterine bleeding and may be associated with premalignant and malignant endometrial lesions. There are hysteroscopic features that help differentiate a benign or malignant lesion. Metaplastic polyp is a hysteroscopic finding characterized by lamellar surfaces and hyperkeratosis, with white and hyperreflective areas. CLINICAL CASES: Three clinical cases of patients under 40 years of age, with abnormal uterine bleeding where the common hysteroscopic finding was metaplastic polyp, a premalignant finding that was confirmed by pathological analysis and positivity of the immunohistochemistry marker p63. Case 1. 28-year-old female, nulliparous, obese, with a history of polycystic ovary syndrome, with endometrial thickening and hysteroscopy, with polyp with hyperkeratotic surface, in the form of irregular sheets, with excrescences and exophytic lesions. Case 2. 25-year-old patient, with irregular thickened endometrium and hysteroscopy with finding of transparent polyps, with mild vascular changes and surface with whitish hyperrefringent areas. Case 3. 38-year-old patient with a history of polycystic ovary syndrome and obesity. At hysteroscopy the endometrium was found to be irregularly hyperplastic, with vascular changes and polyps with hyper-refringent, solid, white superficial areas. CONCLUSIONS: In young patients, with hysteroscopic finding of metaplastic polyp should be considered and premalignant and malignant endometrial disease should be ruled out. The study should be completed with immunohistochemical markers (p63), specific for squamous metaplasia.
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Objectives?The idiopathic group is a significant cause of chronic kidney disease (CKD) in developing countries. Literature available on ocular surface changes has predominantly been reported in patients undergoing hemodialysis. Little is known about the changes in patients undergoing peritoneal dialysis. The present study aimed to identify ocular surface changes in an idiopathic group of CKD undergoing dialysis. Aim?To compare tear film disorders and the severity of ocular surface changes (goblet cell density, squamous metaplasia, and corneoconjunctival calcification) in patients of idiopathic etiology with CKD undergoing hemodialysis and peritoneal dialysis. This is an analytical study. Materials and Methods?Asymptomatic adult patients of idiopathic CKD, on treatment with dialysis underwent comprehensive ophthalmic examination, including best-corrected visual acuity, slit-lamp examination, and a dilated fundus examination. Dry eye assessment was done by ocular surface staining score, Schirmer test, and tear breakup time (TBUT). Conjunctival impression cytology was studied to assess changes on ocular surface. Chest X-rays for aortic calcification were reviewed and data analyzed. Results?Both eyes of 76 patients of hemodialysis and 32 patients of peritoneal dialysis were studied. Ocular surface staining (OSS) scores were low. Impression cytology showed a drop in goblet cell density, presence of squamous metaplasia, and conjunctival keratinization significantly more in the hemodialysis group. No correlation was seen between the presence of conjunctival calcification and aortic calcification. Conclusion?The hemodialysis group had mild subclinical dry eye but keratinization of conjunctiva was seen. Similarly, advanced squamous metaplasia was seen in the peritoneal dialysis group. These changes were positively correlated to decrease in goblet cell density.
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Objective To systematically evaluate the prognostic significance of lymphovascular invasion (LVI) in pT1 stage bladder urothelial carcinoma with squamous differentiation. Methods The clinical and patholog-ical data of 105 patients with pT1 stage urothelial carcinoma with squamous differentiation and transurethral resec-tion of bladder tumor (TURBT) were retrospectively analyzed. Hematoxylin-eosin staining and immunohistochemical staining were used to determine the presence of LVI in tumor tissues. All patients were divided into LVI-negative group and LVI-positive group according to LVI. The relationship between LVI and clinicopathological features and 5-year cancer-specific survival (CSS) rate was analyzed. Patients with relapse were divided into TURBT group and radi-cal cystectomy (RC) group according to the surgical method, and the effects of the methods on CSS were compared. Results There are 57 patients (27.6％) had LVI. In the LVI-negative group, the 5-year CSS was 84.9％, while that in the LVI-positive group was 58.4％, the difference was statistically significant(P<0.05). Univariate analysis showed that tumor multiple appearance, tumor size, recurrence and LVI were significantly correlated with CSS (all P<0.05). Multivariate analysis showed that tumor size and LVI had significant effects on CSS (all P<0.05). In the relapsed pa-tients with LVI-positive, RC had a higher CSS than TURBT (P=0.042). In the relapsed patients with LVI-negative, the difference between the two methods was not statistically significant (P=0.692). Conclusions LVI is an important prognostic factor in pT1 stage urothelial carcinoma with squamous differentiation. Patients with LVI and tumor size>3 cm have a higher risk of death. Patients with pT1 stage urothelial carcinoma with squamous differentiation, espe-cially those with LVI, should be treated with RC as soon as possible.
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Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. Histologically, squamous metaplasia has been reported in PA, but has rarely been documented as being extensive enough to cause significant misdiagnosis. Here, we present an unusual case of PA in a 50-year-old female patient presenting with swelling on the postero-lateral aspect of the palate for a week. Histopathologically, the tumor exhibited the features of conventional PA with extensive squamous metaplasia and giant keratotic lamellae in cyst-like areas. Such exuberant squamous metaplasia and keratin can be a diagnostic and prognostic pitfall and lead to overtreatment of the patient.
Subject(s)
Female , Humans , Middle Aged , Adenoma, Pleomorphic , Diagnostic Errors , Medical Overuse , Metaplasia , Palate , Pathology , Salivary GlandsABSTRACT
Objective To investigate the human papillomavirus 16/18 (HPV16/18) infective status and its relationship with the expression of p16,CK17,Ki-67 in immature squamous metaplasia(IM),cervical intraepithelial neoplasia (CIN) and cervical carcinomas (CC).Methods In situ hybridization (ISH) and immunohistochemistry were applied to detect the expression of HPV16/18,p16,CK17,Ki-67 on tissues from 30 IM,60 CIN and 30 CC.Results The expression rates of HPV16/18 in LSIL,HSIL and CC were 30 ％ (9/30),60 ％ (18/30) and 77 ％ (23/30),higher than that in IM [6.7 ％ (2/30)].HPV16/18 was positively expressed with the progression of cervical squamous epithelial lesions.The expression rates of CK17 in IM was 90 ％ (27/30),higher than that in LSIL,HSIL and CC [17 ％ (5/30),10 ％ (3/30),6.7 ％ (2/30)].The expression rates of p16,Ki-67 were 83 ％ (25/30) and 87 ％ (26/30) in LSIL,90 ％ (27/30) and 93 ％ (29/30) in HSIL,97 ％ (29/30) and 97 ％ (29/30) in CC,higher than that in IM [13 ％ (4/30) and 10 ％ (3/30)].The expression of p16,Ki-67 were particularly seen in HPV16/18-positive HSIL and CC,and the correlation were observed.Conclusion HPV16/18 infection is highly associated with the degree of squamous intraepithelial neoplasia and carcinomas of cervix and upregulated p16 and Ki-67,which suggested that HPV16/18 maybe cause mutation of p16 gene.With the progression of cervical squamous epithelial lesions,positive expression rates of CK17 were decreased compared with increased of HPV16/18,p16,Ki-67.Combined detection of HPV16/18,p16,Ki-67 is helpful for diagnosis and classification of cervical squamous epithelial lesions.
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Introduction: Fine-needle aspiration cytology (FNAC) of the salivary gland is a sensitive and specific technique used in the diagnosis of lesions of the salivary gland. On FNA, adequately cellular aspirates make distinction easy in most cases. However, sparse cellularity makes diagnosis difficult partly due to lack of observer familiarity with the different patterns. The diagnosis of pleomorphic adenoma (PA) can be made accurately but this common salivary gland neoplasm can be diagnostically challenging, causing pitfalls in cytodiagnosis. Material And Methods: A 26-year-old male presented with a firm, painless, mobile slowly-growing mass in the right preauricular region of three years duration. Fine needle aspiration (FNA) was done. A diagnosis of pleomorphic adenoma suspicious of malignancy was given due to the presence of isolated squamous cells, occasional cluster of basaloid cells, occasional giant cells and hyaline globules. Histology confirmed a pleomorphic adenoma with marked squamous metaplasia and keratin cyst formation without evidence of malignancy. A 52-year-old male presented with a firm, painless, mass in the right preauricular region of five months duration. FNAC smears were cellular and showed a hemorrhagic background. Numerous single anucleate and nucleate squamous cells, myoepithelial cell clusters and epithelial cell aggregates were seen. Few foamy cells, giant cells and hyaline globules were noted. Characteristic metachromatic fibrillary chondromyxoid stroma which is usually seen in pleomorphic adenoma was absent. A diagnosis of pleomorphic adenoma suspicious of malignancy was given. The patient was lost to follow up and hence details regarding the histopathological status of his preauricular swelling were not known. Results: Here we illustrate that PA with squamous metaplasia, basaloid cells and hyaline globules can be misinterpreted as carcinoma on cytology and discuss the various pitfalls of cytology. Conclusion: FNAC is a good pre-operative procedure for the diagnosis of PA. One should be aware of the cytological variations to avoid diagnostic errors. When one is uncertain about classification of a salivary gland tumour the cytopathologist should leave the diagnosis open with a few suggested differential diagnoses rather than issuing a misleading report.
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Intestinal metaplasia of the stomach is a common metaplastic lesion associated with chronic gastritis and mucosal atrophy. However, squamous metaplasia is a comparatively rare condition. On endoscopy, squamous metaplasia is usually observed as a whitish mucosal lesion in the lesser curvature of the cardiac region of the stomach. When Lugol's iodine solution is applied, the lesion stains brown in the same way as normal esophageal mucosa. We report a case of 79-year-old man with a whitish flat lesion in the lesser curvature of the cardiac region on surveillance endoscopy after endoscopic treatment of gastric adenoma. The endoscopic biopsy showed stratified squamous epithelial mucosa.
Subject(s)
Adenoma , Atrophy , Biopsy , Coloring Agents , Endoscopy , Gastritis , Iodides , Iodine , Metaplasia , Mucous Membrane , StomachABSTRACT
We report a fibroadenoma with extensive squamous metaplasia in the breast. A 21-year-old woman presented with a mass of the left breast. Breast ultrasonography showed a 1.8x1.7 cm sized, well-circumscribed mass in left subareolar region. The mass was excised. Grossly, the mass was well circumscribed and the cut surfaces were grayish-white in color and elastic in consistency. Microscopically, the breast lesion showed the histological features of fibroadenoma. There were areas of extensive squamous metaplasia seen as isolated clusters or involving duct. But some metaplastic clusters surrounded by fibrous stroma were compressed and distorted and separation of cells into isolated clusters mimicked invasive carcinoma. Co-expression of CK 5/6, high molecular weight CK and p63 in areas of squamous metaplasia and normal myoepithelial cells supported myoepithelial cell origin of metaplastic cells.
Subject(s)
Female , Humans , Young Adult , Breast , Carcinoma, Squamous Cell , Fibroadenoma , Metaplasia , Molecular Weight , Ultrasonography, MammaryABSTRACT
PURPOSE: The diffuse sclerosing variant of papillary thyroid carcinoma (DSPTC) is a rare histological subtype characterized by unique morphological features and aggressive behavior. The aim of this study was to evaluate the clinocopathologic features and outcome of DSPTC over 17 years. METHODS: Twenty-six cases of DSPTC (0.5%) were identified among 5,527 patients with papillary thyroid carcinoma treated between July 1990 and June 2007 at the Department of Surgery, Yonsei University College of Medicine. The clinicopathological features and outcome of these patients with DSPTC were evaluated. The median follow-up period was 46 months (range, 1~202 months). RESULTS: Twenty patients were females and 6 were males, the age ranged from 5 to 70 years (median 30.5 years). Histologically, most of the patients demonstrated diffuse involvement of one or both lobes of the thyroid, variable degree of lymphocytic infiltration, squamous metaplasia, psammoma bodies, extensive sclerosis and extracapsular extension, along with a high incidence of lateral neck node metastases (17/26, 65.4%). Treatment was by complete surgical resection by means of a total thyroidectomy (24/26, 92.3%), modified radical neck dissection (17/26, 65.4%) and postoperative radioactive iodine therapy (22/26, 84.6%). Recurrences were noted in 6 cases (5 locoregional recurrence and 1 distant metastasis in bone). One patient died of an unrelated disease. The 10-year overall survival and disease specific survival rates were 83.8% and 100%, retrospectively, but disease free survival was 48.0%. CONCLUSION: DSPTC showed an unfavorable clinical course with a low overall disease free survival. An aggressive therapeutic approach and close follow-up are recommended.
Subject(s)
Female , Humans , Male , Carcinoma , Disease-Free Survival , Follow-Up Studies , Incidence , Iodine , Metaplasia , Neck , Neck Dissection , Neoplasm Metastasis , Recurrence , Retrospective Studies , Sclerosis , Survival Rate , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
El ojo seco se caracteriza por una deficiencia en la cantidad o calidad de la película lagrimal, que conlleva a cambios histológicos en la superficie ocular como la metaplasia escamosa. Objetivo: Determinar el grado de metaplasia escamosa de la superficie conjuntival en pacientes con ojo seco con diferentes grados de severidad clínica. Metopdología: A 63 ojos de pacientes con diagnóstico clínico de ojo seco, clasificados como leve, moderado y severo, se les tomó citología de impresión en la conjuntiva bulbar temporal y nasal, con membranas de biopore (Millipore PICM012550 poro 0.4m). Las membranas se fijaron con etanol al 96 por ciento y colorearon con ácido periódico de Shiff- hematoxilina, y se montaron entre lámina y laminilla con Entellan. El grado de metaplasia escamosa se determinó de acuerdo al número de las células caliciformes (contadas con rejilla calibrada a 40X) y a los cambios morfológicos de las células epiteliales, utilizando la graduación de Murube y Rivas (2002). Resultados: Aproximadamente la mitad de los pacientes con ojo seco leve (49 por ciento ) presento grado 1 de metaplasia escamosa, el 53,8 por ciento de los pacientes con ojo seco moderado presentó grado 2 y el 57.1 por ciento de los pacientes con ojo seco severo presentó grado 3. Conclusiones: El grado de metaplasia escamosa por citología de impresión es fácilmente evidenciado en pacientes con ojo seco moderado y severo contribuyendo a la confirmación del diagnóstico clínico y seguimiento de la enfermedad.
Dry eye is characterized by a deficiency in thequantity or quality of the lachrymal film, whichimplies histological changes in the surface of the eyesuch as squamous metaplasia. The purpose was todetermine the degree of the squamous metaplasiain the conjunctiva surface in patients with dry eyewith different degrees of clinical severity. Methods:63 eyes diagnosed with light, moderate and severedry eye and 20 eyes like controls subject were madeimpression cytology in the temporal and nasal bulbarconjunctiva with membranes of biopore (MilliporePICM012550). Membranes were fixed with ethanolat 96 percent and colored with periodic acid of Shiffhematoxylin,and they were mounted betweenslide and small slide with Entellan. The degree ofsquamous metaplasia was determined regarding thenumber of goblet cells and the morphologic changes ofepithelial cells, using the Murube and Rivas grading.Results: approximately half of the patients with lightdry eye (49 percent) presented a degree 1 of squamousmetaplasia, 53.8 percent of the patients with moderatedry eye presented a degree 2 and the 57.1 percent of thepatients with severe dry eye presented a degree 3.Conclusions: the degree of squamous metaplasia bycytology of impression is easily evidenced in patientswith moderate and severe dry eye, which contributesto the configuration of the clinical diagnosis and thefollow up of the disease.
Subject(s)
Goblet Cells , Membranes , MetaplasiaABSTRACT
PURPOSE: Deterioration of local immunity in the adenoids may make them vulnerable to infection by microorganisms, resulting in otitis media with effusion. To determine the factors associated with this condition, we evaluated adenoid size, mucosal barrier, squamous changes of ciliated epithelium, IgA secretion, and BCL-6 expression in adenoids. MATERIALS AND METHODS: Seventeen children diagnosed with otitis media with effusion (OME group) and 20 children without any history of OME (control group) were enrolled. Their adenoids were sized by lateral view X-ray and stained with hematoxylin and eosin to detect squamous metaplasia. The adenoids were also stained with cytokeratin to evaluate mucosal barriers, and with anti- IgA antibody and anti- BCL-6 antibody to determine expression of IgA and BCL-6. RESULTS: The OME group showed greater incidence of squamous metaplasia, fewer ciliated cells, and lower expression of BCL-6 (p 0.05). IgA secretion and adenoid size were the same for the OME and the control groups. CONCLUSION: These results suggest that increased squamous metaplasia and lower BCL-6 expression in adenoids may be associated with increased susceptibility to OME.
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Adenoids/chemistry , Immunoglobulin A/analysis , Immunohistochemistry , Keratins/analysis , Metaplasia , Mucous Membrane/chemistry , Otitis Media with Effusion/metabolism , Proto-Oncogene Proteins c-bcl-6/analysisABSTRACT
We report a case of Warthin's tumor of the parotid gland in a 53?year?old man, which is incorrectly diagnosed as squamous cell carcinoma. Fine needle aspiration cytology(FNAC) smear obtained from the right parotid gland revealed scattered epithelial cell clusters or nests in a diffuse inflammatory and necrotic background. Some epithelial cells had squamoid appearance showing variable sized bizarre shaped nuclei. They had abundant of dense eosinophilic keratinized cytoplasm. Occasionally, parakeratotic cells were also present. These cytologic findings with significant atypia and necrotic background made diagnosis as squamous cell carcinoma. But, the resection specimen from this patient showed classic Warthin's tumor in addition to abundant areas of inflammation and squamous metaplasia. Metaplastic or infarcted Warthin's tumor in the salivary gland may be confused with false positive diagnosis of malignancy on FNAC. Therefore, cytopathologist should have adequate awareness of potential of erroneous diagnosis in FNAC of Warthin's tumor.
Subject(s)
Humans , Biopsy, Fine-Needle , Carcinoma, Squamous Cell , Cytoplasm , Diagnosis , Eosinophils , Epithelial Cells , Inflammation , Metaplasia , Parotid Gland , Salivary GlandsABSTRACT
PURPOSE: The purpose of this study is to find out the relationship between clinical characteristics and pathologic findings of lacrimal sac in patients of primary acquired nasolacrimal duct obstruction. METHODS: This study reviewed medical records of 23 eyes of 21 patients who were received external dacryocystorhinostomy, and analyzed patients according to the obstruction patterns and locations on dacryocystography. The relationship between the pathologic degrees of lacrimal sac (inflammation, fibrosis, presence of goblet cells and squamous metaplasia) and clinical characteristics of the patients, was also evaluated. RESULTS: There were no significant relation between the pathologic degrees of lacrimal sac and clinical characteristics. From dacryocystography, the degree of fibrosis was 1.95 +/- 0.62 in complete obstruction, which was significantly higher than 1.00 +/- 0.82 in partial obstruction (p=0.015). In addition, the degree of fibrosis (2.20 +/- 0.63) was different depending on the location of the obstruction. In common canaliculus-obstruction group, it was 1.57 +/- 0.53 and in the nasolacrimal duct-obstruction group, it was 1.33 +/- 0.82 (p=0.041). However, there was no significant statistical difference between the patient's demographics and pathologic findings of lacrimal sac. CONCLUSIONS: The fibrosis of lacrimal sac mucosa is a major pathological finding of nasolacrimal duct obstruction and in particular, it is the characteristic of patients with lacrimal sac obstruction.
Subject(s)
Humans , Dacryocystorhinostomy , Demography , Fibrosis , Goblet Cells , Medical Records , Mucous Membrane , Nasolacrimal DuctABSTRACT
Endometrial mucinous adenocarcinoma occurs in 1-9% of endometrial adenocarcinomas and adenocarcinoma with squamous differentiation in approximately 25%. We report a rare case of mucinous adenocarcinoma with squamous differentiation in a 53-year-old woman. Curetting biopsies of the endometrial lesion were taken twice after hormone replacement therapy, which lasted for four months. Because the squamous differentiation was so extensive, the initial diagnosis based on each curetting specimen was squamous papilloma. A total hysterectomy was performed and the tumor was revealed to be a mucinous adenocarcinoma with squamous differentiation. We subsequently discussed the pathogenesis and prognosis of this type of tumor.
Subject(s)
Female , Humans , Middle Aged , Adenocarcinoma , Adenocarcinoma, Mucinous , Biopsy , Diagnosis , Endometrial Neoplasms , Hormone Replacement Therapy , Hysterectomy , Mucins , Papilloma , PrognosisABSTRACT
An eccrine squamous syringometaplasia (ESS) is defined as a mature squamous metaplasia of the eccrine ducts. The clinical and pathological features of an ESS are presented. Syringometaplasia is a rare lesion, mostly occuring in the extremities, and as far as we know, no report on the ESS has been published in Korean literature. We experienced a case of an ESS occured in a 15 year-old male, who had a tender erythematous plaque in the right knee. The histologic examination revealed some scattered nests of metaplastic squamous epithelium in the deep dermis, associated with acute nonspecific panniculitis. The importance of the ESS is that it histologically simulates the well differentiated squamous cell carcinoma. The histopathologic findings were discussed and a brief review of the literature was made.
Subject(s)
Adolescent , Humans , Male , Carcinoma, Squamous Cell , Dermis , Epithelium , Extremities , Knee , Metaplasia , PanniculitisABSTRACT
All epithelial cells express more than 2 cytokeratins, and their tissue distribution is determined by cellular types, location, and degree of differentiation. It is known that changes in cytokeratin expression accompany squamous metaplasia of the human nasal epithelium. We analysed cytokeratin expression patterns and their significance in normal nasal mucosae, nasal polyps, inverted papillomas, and maxillary squamous cell carcinomas using immunohistochemical staining with anti-CK4, CK8, CK10, CK13, CK17, CK18, and CK19. Nasal polyp showed the same pattern of cytokeratin expression as that of nasal mucosa. While CK10 expression was present only in the tissue of squamous cell carcinoma, CK18 and CK19 were not expressed. Specimens of Inverted papilloma expressed CK4 and CK13 only in the suprabasal layer, and CK17 in the basal and suprabasal layers. In contrast, normal epithelium expressed CK13 and CK17 only in the basal layer, and CK4 in the basal and suprabasal layers. CK8 and CK18 were less expressed in the specimen of inverted papilloma than in the normal nasal mucosa. The expression patterns of CK10 and CK19 suggest that they may play a role in determinating the malignant change of inverted papilloma and in investigating the pathogenesis of inverted papilloma and maxillary cancer.
Subject(s)
Humans , Carcinoma, Squamous Cell , Epithelial Cells , Epithelium , Keratins , Metaplasia , Nasal Mucosa , Nasal Polyps , Papilloma, Inverted , Tissue DistributionABSTRACT
During evaluation of follow-up curettage of endometrial hyperplasia after progesterone treatment, we have noticed that the foci of squamous or morular metaplasia are persistent or even markedly increased after the hyperplastic glands have all disappeared. These observations have led us to study the histological changes of squamous or morular metaplasia in the hyperplastic endometrium after progesterone treatment and to examine the changes of estrogen receptors(ER) and progesterone receptors(PR) to find out, if there is any pathogenetic role of progesterone administration on the squamous or morular metaplasia. Squamous or morular metaplasia was associated in 21 cases (13.5 %) out of 156 endometrial hyperplasia during the study periods and all of them were associated with complex hyperplasia, but not associated with simple hyperplasia. At follow-up curettage after progesterone treatment, squamous metaplasia newly appeared in 3 cases(20 %), markedly increased in 4 cases(26.7%), persisted in 4 cases(26.7%) and decreased in 4 cases(26.7%), even after hyperplastic glands have all disappeared or were markedly decreased. On immunohistochemical staining, metaplastic foci showed ER- and PR- in 13 cases (87 %) in contrast to the surrounding endometrium and the remaining 2 cases showed minimal ER+ and PR+ confined to several nuclei. Intensity or staining pattern of ER and PR in metaplastic foci were not changed with progesterone treatment. In the background endometrium, intensity of glandular ER+ and PR + was higher than that of the stroma at the initial curettage, however, progesterone treatment predominantly down-regulated glandular ER+ more than stromal ER+. Increment or persistence of squamous metaplasia along the progesterone treatment seemingly would implicate hormonal influences as playing a significant role in the formation of squamous or morular metaplasia and the absence of cellular receptors for these hormones in the metaplastic foci may suggest qualitative changes in the receptors.
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We report a case of squamous metaplasia of the pleura observed in a 51 year old man. Squamous metaplasia of serosal surface, and in particular of the pleura, is uncommon. The pathogenesis of squamous metaplasia is obscure, but it may be associated with chronic irritation.
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The occurrence of squamous metaplasia(morule) in colorectal mucosa and adenocarcinoma, althrough rare, has been well documented. In contrast, very little mention has been given to mature squamous cells seen in colorectal polyps or adenomas. A 42-year-old woman presented with a 2-month history of diarrhea and melena. Proctosigmoidoscopy revealed a 4 cm-sized polypoid tumor 20 cm above the anal verge. Colonoscopic biopsy showed tubular adenoma, and a segmental resection of sigmoid colon was done. Microscopically, the tumor was c classical tubular adenoma containing multiple solid nests of squamous cells scattered only in the neoplasm; the squamous nests were generally small, and some showed direct continuity with adenomatous glands. The squamous cells were keratinizing and had regular nuclei with no mitotic activity. The importance of this phenomenon lies in its pathologic recognition, and the findings suggest that awareness of this rare occurrence in colorectal polyps should avert such overdiagnosis, and consequently prevents unnecessary radical surgery.
Subject(s)
Female , Humans , Adenoma , BiopsyABSTRACT
Keratinizing desquamative squamous metaplasia of the transitional epithelium occurs rarely in the upper urinary tract, especially in the ureter. It is associated in most cases with long-standing chronic inflammation but the exact pathogenesis is unknown, and the relationship to cancer has continued to be controversial. More cases should be accumulated for a better assessmnt of this lesion. Recently, we experienced a case of keratinizing desquamative squamous metaplasia in the renal pelvis, adjacent calyces and ureter following acute and chronic pyelonephritis. Herein, we are presenting our case with a review of literatures.