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1.
Pathologe ; 39(5): 431-444, 2018 Sep.
Article in German | MEDLINE | ID: mdl-30135973

ABSTRACT

Ectopic pregnancies are the main sources of pregnancy-related morbidity and mortality in the first trimester. They are usually located in the ampullary part of the fallopian tube and the incidence increases in the setting of assisted reproductive techniques, older age at the time of the first pregnancy, and prior adnexal procedures. The clinical aspects and diagnostic challenges of an ectopic pregnancy for the pathologist are to be outlined. A review of the relevant literature was performed. Proof of gestational tissue is of utmost importance in the pathological-anatomical evaluation of an ectopic pregnancy. A complete evaluation of the specimen of a presumed tubal abruption or after milking out should be performed. Abnormal placentations (blighted ovum, embryonal molar pregnancy) as well as gestational trophoblastic disease (GTD, e.g., partial/complete molar pregnancy, choriocarcinoma) can occur in the setting of an ectopic pregnancy. Caution must be taken to differentiate a trophoblast hyperplasia secondary to the tubal microenvironment from GTD. p57 immunohistochemistry can help exclude a molar pregnancy. Only 50% of ectopic pregnancies are associated with tubal pathologies (e. g. inflammation, tubal adhesions). Chorionic villi and trophoblast epithelia can demonstrate regressive changes after prior methotrexate treatment. Rarely, immunohistochemistry with GATA-3, p63, ß­HCG, PAX-8, and WT-1 can be used in the differential diagnosis of trophoblastic epithelium. Ectopic pregnancies are associated with significant morbidity and mortality. A thorough evaluation of the specimen can help guide management and follow-up.


Subject(s)
Abortion, Spontaneous , Choriocarcinoma , Hydatidiform Mole , Pregnancy, Ectopic , Animals , Fallopian Tubes , Female , Humans , Pregnancy
2.
Pathologe ; 37(6): 542-548, 2016 Nov.
Article in German | MEDLINE | ID: mdl-27766382

ABSTRACT

The World Health Organization (WHO) classification from 2014 differentiates between different subtypes of mucinous adenocarcinoma of the uterine cervix. A gastric subtype was recently described that showed no association with high-risk human papillomavirus (HPV) infections, has a poor prognosis, is mainly diagnosed in women of Asian origin and can occur in patients with Peutz-Jeghers syndrome. Although no clear grading system has been recommended in the WHO classification, it is likely that grading of adenocarcinomas of the uterine cervix will partly be based on the different patterns of invasion. Deep stromal infiltration of macroinvasive carcinomas is defined as an infiltration of >66 % of the cervical stroma. In the near future a maximum tumor size of 2 cm could act as a discriminator for planning of less radical surgery. Parameters of the histopathological report that are relevant for the prognostic assessment as well as the choice of adjuvant treatment and function as quality indicators during certification are described. The histological type of an adenocarcinoma alone is of no predictive or prognostic relevance for patients undergoing primary surgical treatment, neoadjuvant chemotherapy, combined chemo-radiotherapy or treatment with angiogenesis inhibitors. Currently, molecular parameters and biomarkers are of no relevance.


Subject(s)
Adenocarcinoma, Mucinous/classification , Adenocarcinoma, Mucinous/pathology , Cervix Uteri/pathology , Uterine Cervical Neoplasms/pathology , Uterine Neoplasms/classification , Uterine Neoplasms/pathology , World Health Organization , Adenocarcinoma, Mucinous/therapy , Biomarkers, Tumor/analysis , Combined Modality Therapy , Female , Human papillomavirus 16/pathogenicity , Humans , Neoplasm Grading , Neoplasm Invasiveness , Papillomavirus Infections/classification , Papillomavirus Infections/pathology , Papillomavirus Infections/therapy , Pathology, Molecular , Prognosis , Quality Indicators, Health Care , Uterine Cervical Neoplasms/classification , Uterine Cervical Neoplasms/therapy , Uterus/pathology
3.
Pathologe ; 37(6): 526-533, 2016 Nov.
Article in German | MEDLINE | ID: mdl-27738814

ABSTRACT

The majority of precancerous lesions of the lower female genital tract (intraepithelial neoplasia, IN) are caused by human papillomavirus (HPV) infections resulting in cellular atypia and in turn an altered tissue architecture. Depending on the pathogenesis, a distinction is made between vulvar intraepithelial neoplasia (VIN) classified as classical VIN associated with high-risk HPV infections (u-VIN) and differentiated VIN (d-VIN), which is associated with lichen sclerosus et atrophicus and p53 alterations. In the current World Health Organization (WHO) classification a novel grading system for squamous cell precancerous lesions of the lower female genital tract has been proposed, differentiating low grade squamous intraepithelial lesions (L-SIL) including condyloma and HPV-associated alterations plus VIN 1, vaginal intraepithelial neoplasia (VaIN 1) and cervical intraepithelial neoplasia (CIN 1) from high grade squamous intraepithelial lesions (H-SIL) with VIN 2 and 3, VaIN 2 and 3 as well as CIN 2 and 3. The use of p16 immunohistochemistry can assist the differentiation. The new binary classification, however, contradicts the German cytological nomenclature (Munich nomenclature III), which differentiated three grades of dysplasia in order to avoid overtreatment of patients with moderate IN. The individual nomenclatures are compared to each other. It is recommended to report the grade of precancerous lesions in addition to the SIL classification of the WHO.


Subject(s)
Carcinoma, Squamous Cell/pathology , Epithelial Cells/pathology , Genital Neoplasms, Female/pathology , Precancerous Conditions/pathology , Terminology as Topic , Uterine Cervical Dysplasia/pathology , World Health Organization , Carcinoma, Squamous Cell/classification , Cervix Uteri/pathology , Female , Genital Neoplasms, Female/classification , Humans , Papillomaviridae/pathogenicity , Papillomavirus Infections/classification , Papillomavirus Infections/pathology , Precancerous Conditions/classification , Vagina/pathology , Vaginal Neoplasms/classification , Vaginal Neoplasms/pathology , Vulva/pathology , Vulvar Neoplasms/classification , Vulvar Neoplasms/pathology , Uterine Cervical Dysplasia/classification
4.
Pathologe ; 35(4): 336-47, 2014 Jul.
Article in German | MEDLINE | ID: mdl-24859239

ABSTRACT

The distinction between primary and secondary (metastatic) ovarian tumors is essential for the selection of appropriate surgical interventions, chemotherapeutic treatment and prognostic evaluation for the patient. Metastatic tumors of the ovary range between 5 % and 30 %. The majority of ovarian metastases in Europe and North America derive from colorectal (25-50 %) and breast cancers (8-25 %). A major issue is the differential diagnosis of mucinous tumors. Major features favoring metastasis include bilaterality, size < 10 cm, ovarian surface involvement, extensive intra-abdominal spread, and infiltrative growth within the ovary involving the corpus albicans and corpora lutea. An algorithm using bilaterality and tumor size (cut-off 10 cm) allows correct categorization in approximately 85 % of the cases. Although immunohistochemistry (especially CK7 and CK20 in mucinous tumors) using a panel of antibodies plays a valuable role and is paramount in the diagnosis, the results must be interpreted with caution and within the relevant clinical and histopathological context. It is necessary to note that the correct diagnosis of ovarian metastases always needs interdisciplinary and multidisciplinary approaches.


Subject(s)
Cystadenocarcinoma, Mucinous/pathology , Cystadenocarcinoma, Mucinous/secondary , Neoplasms, Multiple Primary/pathology , Ovarian Neoplasms/pathology , Ovarian Neoplasms/secondary , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/pathology , Colorectal Neoplasms/therapy , Combined Modality Therapy , Cooperative Behavior , Cystadenocarcinoma, Mucinous/therapy , Diagnosis, Differential , Female , Humans , Interdisciplinary Communication , Neoplasm Invasiveness/pathology , Neoplasms, Multiple Primary/diagnosis , Neoplasms, Multiple Primary/therapy , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/therapy , Ovary/pathology , Prognosis , Tumor Burden
5.
Methods Find Exp Clin Pharmacol ; 30(2): 129-33, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18560628

ABSTRACT

The antimicrobial activity of new tetracationic and water-soluble meso-substituted tetrahydroporphyrin tetratosylat (BL1065) and of dicationic water-soluble chlorine e6 Photolon (BLC1013) is described. The dark toxicity and photosensitizing potentials of both photosensitizers were tested on Gram-positive (Staphylococcus aureus and MRSA) and Gram-negative (Escherichia coli and Pseudomonas aeruginosa) bacteria in phosphate-buffered saline (PBS, pH 7.4), PBS + horse serum (HS) and PBS + sheep blood (SB). The results show that BLC1065 and BLC1013 did not inhibit the growth of S. aureus in the dark, but efficiently inactivated this Gram-positive bacterium after illumination. Contrary to BLC1013, BLC1065 has a photodynamic activity toward Gram-negative bacteria as well, at least in PBS. Results suggest that tetracationic BLC1065 can bind better to both Gram-positive and Gram-negative bacterial cell envelope than the dianionic chlorine BLC1013 resulting in better efficiency of photoinactivation.


Subject(s)
Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Mesoporphyrins/pharmacology , Methicillin Resistance , Photosensitizing Agents/pharmacology , Porphyrins/pharmacology , Chlorophyllides , Dose-Response Relationship, Drug , Magnetic Resonance Spectroscopy , Photochemotherapy
7.
Harefuah ; 130(3): 185-90, 1996 Feb 01.
Article in Hebrew | MEDLINE | ID: mdl-8682397
8.
Harefuah ; 126(8): 486-8, 1994 Apr 15.
Article in Hebrew | MEDLINE | ID: mdl-8070731
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