High-grade neuroendocrine carcinoma of uterus: a report of 25 cases and clinicopathological study / 临床与实验病理学杂志

Purpose To investigate the pathological morphology and diagnostic parameters in the high-grade primary neuroendocrine carcinoma (NECa) of the uterus.Methods The clinical manifestations,pathological morphology,and immunohistochemical features of 25 uterine high-grade primary NECa cases were analyzed,and the relevant literatures were reviewed.Results The age of the 25 patients ranged from 24 to 72 years (mean age,44 years).Clinically,most of them complained of the vaginal bleeding or occupying lesions.84％ cases displayed typical neuroendocrine architectures histologically,and neurosecretory granules were observed in the electron microscopy examination.The nucleus of the small-cell type and large-cell type NECa were typical.Additionally,the mitosis number was more than 20/10 HPF in 64％ cases,10 to 20/10 HPF in 28％ cases,and less than 10/10 HPF in 8％ cases.Furthermore,highgrade NECa was often accompanied with apoptosis (72％) and necrosis (92％).The diagnosis included 13 cases of small-cell carcinoma,5 cases of combined small-cell carcinoma (1 with cervical intraepithelial neoplasia 3,1 with squamous cell carcinoma,and 1 with adenocarcinoma),4 cases of large-cell NECa,and 3 cases of combined large-cell NECa (2 with squamous cell carcinoma,and 1 with adenocarcinoma).The neuroendocrine markers were positive with Syn (96％),CgA (70.5％) and CD56 (78.6％).76.9％ cases demonstrated CKpan positivity,with small foci or linetype of cytoplasmic immunostaining.The proliferation index of Ki-67 was ranged from 60％ to 90％.In this study,13 patients received the uterus excision with adjuvant chemotherapy,and 5 cases died within 2 years.Conclusion High-grade NECa of the uterus is rare,and the terminology is similar to that of the digestive tract and lung.Yet,the diagnostic parameters are slightly different to some extent.The therapy is the surgical resection followed by adjuvant chemotherapy.

Differentiation between Ovarian Fibroma and Subserosal Leiomyoma by MR Imaging

PURPOSE: To evaluate the findings and differential points of ovarian fibroma and subserosal leiomyoma, as seen on MR images. MATERIALS AND METHODS: The MR imaging findings of 31 surgically confirmed cases of ovarian fibroma(n=6) and subserosal leiomyoma (n=25 ; 28 lesions) were evaluated. Multiplanar T1- and T2-weighted and postcon-trast T1-weighted images were obtained using a 1.5T MR unit, and histologic examination was also performed. The MR findings were analyzed in terms of signal intensity, the presence and definition of margin, the histo-logic finding of hyperintense lesion on T2-weighted images, the presence of the bridging vessel sign, degree of enhancement, and the presence of ipsilateral ovary and ascites. RESULTS: Both fibromas and leiomyomas showed hypo-or isointensity compared with uterine myometrium on T1-weighted images and compared with skeletal muscle on T2-weighted images. The latter revealed intratu-moral hyperintense lesions in most cases of ovarian fibroma and subserosal leiomyoma. Three of four ovarian fibromas had a well defined margin after cystic change, but in 24 of 26 subserosal leiomyomas the margin was ill defined. The "bridging vessel sign" was visible only in subserosal leiomyomas (22/28), and in all cases the enhancement of ovarian fibromas were less than that of myomtetrium. Subserosal leiomyomas (12/28), seen on enhancement as isointense or hyperintense to myometrium, showed a greater degree of enhancement than ovarian fibromas (0/6). Ipsilateral ovary was rarely seen in ovarian fibromas (1/6), but commonly seen in sub-serosal leiomyomas (20/25). Ascites was present in one case of ovarian fibroma. CONCLUSION: A defined margin of an intratumoral hyperintense lesion, as seen on T2-weighted images, and the presence or absence of the "bridging vessel sign" and ipsilateral ovary are useful signs when differentiating be-tween ovarian fibromas and subserosal leiomyomas.

Primary Uterine Lymphoma: A Case Report

Primary lymphoma of the uterus is a rare disease, the reported characteristic MR imaging findings being homogeneous intermediate signal intensity of the indistinct mass on T1- and T2-weighted images, and the preservation of endome-trial lining and uterine architecture. We report a case of primary uterine lymphoma which showed tumoral necrosis, endometrial disruption and diffuse anterior vagi-nal wall involvement.