Human telomerase reverse transcriptase (hTERT) expression in borderline ovarian tumors: an immunohistochemical study.

OBJECTIVE: To investigate the expression of human telomerase reverse transcriptase (hTERT) in epithelial borderline ovarian tumor (BOT) by immunohistochemistry with correlation to clinicopathologic variables. MATERIAL AND METHOD: Paraffin-embedded tissue sections of 62 borderline ovarian tumors (47 mucinous, 14 serous, and 1 clear cell) and 12 epthelial ovarian carcinomas were immunostained with antibodies to hTERT. The intensity and quantity of the immunostaining was determined and analyzed with clinicopathological characteristics. RESULTS: hTERT expression was detected in 48.4% of BOT and all cases of epithelial ovarian carcinoma. In immunoreactive BOT 50% of cases were scored as high expression. Serous BOT had the highest rate of hTERT expression. There was no significant statistical difference of hTERT immunoreactivity between histologic types of BOT. No hTERT immunoreactivity was observed in the benign parts of the same slides of each immunoreactive case. hTERT immunoreactivity was positively correlated with FIGO stage (p = 0.04), but not with other variables. The mean follow-up time of BOT cases was 81.63 months and no recurrence or death was noted. CONCLUSION: hTERT expression was found in half of BOT and all of epithelial ovarian carcinoma. High hTERT expression was associated with FIGO stage.

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.

Comparison between adenocarcinoma in both endocervical and endometrial specimens from fractional curettage and pathologic findings in subsequent hysterectomy specimens.

OBJECTIVE: To evaluate the hysterectomy specimen findings in the patients who underwent fractional curettage (F&C) with presence of adenocarcinoma in both endocervical and endometrial specimens. MATERIAL AND METHOD: Forty-one patients who had adenocarcinoma in both endocervical and endometrial specimens from F&C and underwent subsequent hysterectomy for surgical staging without pre-operative radiotherapy or chemotherapy at King Chulalongkorn Memorial Hospital between 1999 and 2007 were evaluated Histologic slides from both F&C and hysterectomy specimens were reviewed and assessed All cases of endometrial adenocarcinoma with cervical involvement (stage 2) in hysterectomy specimens were also assessed and compared to the results in F&C specimens. RESULTS: Fifteen patients (36.6%) with both positive endocervical and endometrial specimens from F&C were diagnosed as endometrial adenocarcinoma within uterine cavity with lower uterine segment involvement. Only 34.1% of cases were endometrial carcinomas with cervical involvement. In the 35 cases with endometrial carcinoma stage 2, 60% had adenocarcinoma in both endocervical and endometrial specimens from F&C. CONCLUSION: In the patients who had adenocarcinoma in both endocervical and endometrial specimens from fractional curettage, the most common final pathological diagnosis from hysterectomy specimens was endometrial adenocarcinoma within uterine cavity with lower uterine segment involvement. Therefore, only 60% of endometrial carcinoma stage 2 revealed positive adenocarcinoma in both endocervical and endometrial specimens from fractional curettage.

Detection of PTEN immunoreactivity in endometrial hyperplasia and adenocarcinoma.

OBJECTIVE: To investigate PTEN (phosphatase and tensin homolog deleted on chromosome 10) expression in endometrial hyperplasia and adenocarcinoma as analyzed by immunohistochemistry. MATERIAL AND METHOD: PTEN protein expression was evaluated by immunohistrochemical study of 70 paraffin-embedded curettage endometrial tissue samples (10 normal endometrium, 55 endometrial hyperplasia, and 15 endometrial adenocarcinomas) selected from surgical pathology files of the Division of Gynecologic Pathology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, from 2001 to 2004. Intensity of epithelial staining of PTEN immunoreactivity in different histologic types was determined. RESULTS: Absence of PTEN protein expression was detected in 60% of endometrial carcinoma, 60% of atypical endometrial hyperplasia, and 24% of typical endometrial hyperplasia. In endometrial hyperplasia without atypia group, the majority of cases revealed moderate to strong PTEN expression, with 70% in simple hyperplasia and 47% in complex hyperplasia. There is a significant statistical difference of PTEN immunoreactivity among proliferative endometrium, endometrial hyperplasia and endometrial carcinoma group (p = 0.004). CONCLUSION: Complete loss of PTEN protein expression was most commonly found in endometrial carcinoma and hyperplasia with cytologic atypia.

Lack of prognostic significance of HER-2/neu in early epithelial ovarian cancer.

A total of 74 patients with apparent early stage epithelial ovarian cancer who underwent exploratory laparotomy at King Chulalongkorn Memorial Hospital or other hospitals and were referred for further treatment, were evaluated. Formalin fixed paraffin-embedded ovarian tissue specimens were collected and immuno-stained with HER-2/neu antibodies for comparison with clinicopathologic data after median follow up of 46 months (range 3 - 83 months). The prevalence of HER-2/neu overexpression in these patients was 10.2%. No significant correlation between HER-2/neu overexpression and clinicopathological parameters (stage, ascites, capsular rupture, capsular adherence, histological subtype and histological grade) was found. Disease free survival and overall survival did not statistically differ between those with lesions positive or negative for HER-2/neu overexpression.

Prevalence of BRCA1 expression in epithelial ovarian cancer: immunohistochemical study.

The 99 formalin fxed paraffin-embedded ovarian tissue specimens of Epithelial Ovarian Cancer (EOC) patients treated at the Gynecologic Oncology Unit, King Chulalongkorn Memorial Hospital between January 1, 1996 and December 31, 1999, were immuno-stained with BRCA antibody using the immunohistochemical method. According to the criteria for BRCA1 immunohistochemical evaluation (neoplastic nuclear staining more than 10%), 12 (12.1%) of the 99 specimens showed positive BRCA1 expression. No associated statistical significance between clinicopathological variables and BRCA expression was detected. Survival analysis was performed in 87 patients who were followed-up for more than 6 months and recent status were available. During a median follow-up of 43 months, median survival time was 46 months (range 6-84 months). No association between BRCA1 expression and survival outcomes was found (Disease free survival and overall survival) in the presented patients.

Cesarean section scar endometriosis: a case report and review of the literature.

Cesarean section scar endometriosis is a rare event. The reported incidence is 0.03-1.7 per cent. Herein, the authors report a case of a 35-year-old woman, G1P1, who presented with cyclic pain at the left lateral edge of the pfannenstiel scar. The skin of this edge had also become dark brown. She had undergone a cesarean section for cephalopelvic disproportion four years previously. Physical examination revealed only mild tenderness and a dark brown nodule at the left lateral edge of the scar. Pre-operative diagnosis was scar endometriosis, surgical excision was performed and the tissue pathology confirmed the characteristic features of endometriosis. The post-operative course was uneventful, and no recurrence was found during the two-year follow-up period. The literature regarding cesarean section scar endometriosis was reviewed.