Carcinoma cuniculatum: not a verrucous carcinoma.

BACKGROUND: Carcinoma cuniculatum and verrucous carcinoma are both very well differentiated forms of squamous carcinoma and thus difficult to separate histologically from pseudocarcinomatous hyperplasia. The diagnosis of each often requires clinical-pathologic correlation. METHODS: We reviewed the literature on cases reported as carcinoma cuniculatum and compared these to the cases originally reported by Aird et al. In addition, we report an additional case of this entity that we encountered in our practice. RESULTS: In reviewing the literature it is evident that most authors consider carcinoma cuniculatum and verrucous carcinoma to be synonymous even though Aird's original two cases had no verrucous features. The lack of a clear conceptual distinction between these two entities may cause diagnostic confusion. CONCLUSION: The purpose of this report is to record a case of carcinoma cuniculatum which the authors believe to be similar to those reported by Aird et al., to emphasize the differences between carcinoma cuniculatum and verrucous carcinoma, and to explain how the lack of a clear conceptual distinction between these two tumors can lead to further delay in an already difficult diagnosis.

The stromal component of large endometrial polyps.

Benign endometrial polyps belong in the differential diagnosis of adenofibroma and adenosarcoma. There is, however, little information about the range of stromal mitotic activity, stromal cellularity, and stromal atypia in benign endometrial polyps, rendering the differential diagnosis with the aforementioned tumors problematic. In this study, the stroma of 66 polyps 1 cm or more in greatest dimension from 56 patients was analyzed for stromal mitotic activity, cellularity, and atypia. Sixteen (24%) had an almost completely fibrotic stroma that had rare mitoses, little cellularity, and no atypia. However, 50 polyps (76%) had stroma that was predominantly endometrial or was a mixture of endometrial-type stroma and fibrous stroma. In these polyps stromal mitoses were relatively common, averaging 1.2/10 MFs/HPFs (range, 0-5.8 MFs/10 HPFs). Stromal cellularity was frequently equal to or mildly increased over adjacent nonpolypoid endometrial stroma and mild nuclear atypia (enlarged stromal nuclei) was also common. Twelve polyps (24%) from the group of 50 had two or more MFs/10 HPFs, a mitotic rate present in some adenosarcomas. None of these polyps had other features necessary for the diagnosis of adenofibroma or adenosarcoma and follow-up in all patients was uneventful (average follow-up, 96 months). It is concluded that benign polyps that retain areas of endometrial-type stroma often have mitotic activity and that significant stromal mitotic activity (> or = 2 MFs/HPFs) is relatively common. These polyps do not have significant stromal atypia nor do they have a marked increase in stromal cellularity. Thus, in the absence of other supportive features, stromal mitotic activity alone should not be regarded as a worrisome finding.

Focal necrotizing endometritis: a clinicopathologic study of 15 cases.

From routine sign-out of endometrial biopsy specimens, a group of 15 endometria were identified that have a characteristic histologic pattern of inflammation that is not included in present classifications of endometritis. All but one of the women were premenopausal, and all presented with abnormal vaginal bleeding. The lesion is characterized by a patchy, focal inflammation, usually composed of lymphocytes with a variable number of neutrophils and rare macrophages centered around endometrial glands and extending into the glandular lumen with disruption and partial or subtotal necrosis of the endometrial glandular epithelium. These foci were widely dispersed, never confluent, and could be overlooked easily. Plasma cells were not found in any of the endometrial specimens despite methyl green pyronine staining of the samples. Based on the histologic characteristics of this process we have designated it focal necrotizing endometritis. The clinical significance, if any, of focal necrotizing endometritis is currently unknown.

Conjunctival melanoma in the black population.

Melanoma of the conjunctiva is a rare, unilateral malignancy primarily affecting middle-aged whites; the annual average age-adjusted incidence rate is 0.012 per 100,000 population. Although conjunctival melanoma in the black population is extremely rare, cases have been reported. Melanoma of skin in blacks has a predilection for nonsun-exposed, nonpigmented sites such as mucous membranes, palms, and soles. Primary acquired melanosis may lead to the development of melanoma even in blacks. Primary acquired melanosis in the black population may be difficult to differentiate from racial melanosis clinically and histopathologically. Early diagnosis through awareness and education can help improve the survival of black patients with conjunctival melanoma.

Expression and prognostic significance of estrogen and progesterone receptors in adenocarcinoma of the uterine cervix. An immunocytochemical study.

BACKGROUND: Adenocarcinoma of the uterine cervix typically is an aggressive neoplasm with a propensity for early invasion and dissemination. Little data are available correlating histologic, histochemical, or immunocytochemical parameters with the biologic behavior of this neoplasm. Specifically, the implication of expression of estrogen and progesterone receptors in cervical adenocarcinoma is essentially undefined. METHODS: An immunocytochemical hormone receptor assay using specific monoclonal antibodies against estrogen receptors (ER) and progesterone receptors (PgR) was used to study paraffin-embedded specimens from 54 patients with primary cervical adenocarcinomas. The specimens were evaluated for heterogeneity and intensity of staining. An attempt also was made to study the relationship between the pattern of hormone receptor expression and other established prognostic indicators. RESULTS: In all patients, diffuse positive staining of benign endocervical epithelial or stromal cells was observed. Positive immunostaining was seen in the adenocarcinoma specimens of 16 of 54 (30%) patients for ER and 19 of 54 (35%) patients for PgR. Expression of ER and PgR statistically correlated with each other (P = 0.0001). Endocervical-type adenocarcinoma had the highest degree of staining for both ER and PgR. Clear cell carcinomas and intestinal-type carcinomas were negative for both receptors. Positivity for ER and PgR inversely correlated with histologic grade as defined by the International Federation of Gynecology and Obstetrics (FIGO). The relationship between hormone receptor expression and FIGO stage was not statistically significant. Survival was associated with clinical stage (P = 0.004) and with immunocytochemical status of ER expression (P = 0.032) and PgR expression (P = 0.009). CONCLUSIONS: This study of 54 specimens from patients with cervical adenocarcinoma suggests that positive expression of ER and PgR is associated with prolonged survival.

Endocervical gland atypia secondary to Arias-Stella change.

Arias-Stella change of the endocervix is relatively common if a systematic search can be made. However, the change has rarely been described in cervical/endocervical biopsy material. Five additional biopsy cases of the Arias-Stella change of the endocervix are documented, briefly discussed, and compared with other endocervical gland abnormalities. The Arias-Stella change of the endocervix is important to recognize because of its atypical appearance that, in this location, can be mistaken for premalignant, malignant, or other glandular abnormalities, especially if the pathologist is not aware of the patient's pregnancy.

Comparing the case materials available from a teaching hospital's autopsies in 1968 and 20 years later.

The Accreditation Committee on Graduate Medical Education requires both sufficient volume and variety of necropsy material for training in anatomic pathology. Since the number of autopsies has declined markedly in the last 20 years, the author sought to determine whether the variety of case material available from the autopsies performed at his teaching hospital had changed during that time span. Major diagnoses were abstracted from the reports of 200 autopsies of adults performed in 1968 and from a period 20 years later (1987, 1988, and part of 1989). Comparison between the two eras' diagnoses revealed very few changes in the incidences of various diseases. This was true even though the racial mix of patients had changed markedly. While declining autopsy rates are of concern, this study suggests that medical educators may not need to be concerned over the variety of autopsy case material. The author makes several suggestions for maximizing the teaching impact of each autopsy.

Human papillomavirus in prostatic cancer: no evidence found by in situ DNA hybridization.

Human papillomavirus has been associated with benign squamous tumors, intraepithelial neoplasia, and invasive squamous cancer. The role of human papillomavirus as the most likely precursor of cervical dysplasia is well studied. We know of no available information as to the possible role of human papillomavirus in prostatic hyperplasia and cancer. We studied formalin-fixed paraffin-embedded tissues of 20 cases of glandular hyperplasia and 20 cases of prostatic cancer by in situ DNA hybridization for human papillomavirus using commercially available biotinylated DNA probes detected by an avidin-biotin peroxidase technique. We found no evidence of DNA hybridization to human papillomavirus-6, -11, -16, -18, -31, -33, or -35 in prostate tissue. Our results show no association between prostatic cancer or hyperplasia and the human papillomavirus genomes that were studied.

Diethylstilbestrol-associated vaginal adenosis followed by clear cell adenocarcinoma.

A young woman was examined because of a history of in utero exposure to diethylstilbestrol and was identified as having vaginal adenosis. Fourteen months later, on routine follow-up, a small vaginal clear cell adenocarcinoma was recognized. She refused any therapy other than wide local excision. She was seen intermittently for several years with no recurrence. Five and one-half years after initial diagnosis she was found to have multiple sites of clear cell adenocarcinoma in the upper third of the lateral and anterior vaginal walls. Cases of vaginal adenosis followed later by the development of clear cell adenocarcinoma (metachronous cases) are distinctly unusual. The authors have collected the other recorded cases in the literature or in the Registry for Research on Hormonal Transplacental Carcinogenesis and have attempted to compare these cases with the larger group of patients who present with clear cell adenocarcinoma and have associated vaginal adenosis (synchronous cases). The authors have found few differences between the two groups. Most of the differences can be accounted for by the close follow-up of patients with known vaginal adenosis. However, it has been noted that the location of the clear cell adenocarcinoma is apparently different in the two groups. The reasons for this apparent difference are briefly discussed.

Keratoacanthoma of the vulva.

A 65-year-old white woman noted a "pea-sized" lump of the right labium majus. At the initial examination a few weeks later, the mass was 1.5 cm in maximum diameter. An excisional biopsy was interpreted as well-differentiated squamous cell carcinoma. The biopsy material was subsequently reviewed prior to recommended radical surgery. Upon review, the lesion was interpreted as a keratoacanthoma. No further surgery was performed and the patient has remained free of recurrent disease for over 2 years. This case is presented in an effort to alert gynecologic oncologists and pathologists of the possibility of this lesion occurring on the vulva.

Coexisting adenocarcinoma and cystadenofibroma (malignant cystadenofibroma) of the ovary.

We have described an adenocarcinoma observed as a grossly discrete area within a cystadenofibroma of the ovary. Fewer than 35 cases of malignant cystadenofibroma have been reported. We find our observations lend support to the prevailing thought that these neoplasms most often originate from preexisting cystadenofibromas.

The normal parathyroid and the borderline with early hyperplasia: a light microscopic study.

The light microscopical appearance of the normal parathyroid gland based on an autopsy study of 138 glands from 38 adults without evidence of hyperparathyroidism, is described. It differs from earlier descriptions in that we found less adipose tissue in the glands of many normal adults than had been reported. This observation is in keeping with several other recent reports. Other features of the normal gland are also described. This study suggests that at times, a distinction between normal and early hyperplasia cannot be made, especially if the distinction is based solely on the amount of stromal adipose tissue present. Histological features which appear to indicate abnormality are cytological atypia, chief cell nodularity and diminished intracytoplasmic lipid. A gland which is equivocally enlarged but which has minimal stromal adipose tissue and one or more of the above features is most likely to be abnormal.

Follicular adenoacanthoma of the thyroid gland.

A 67-year-old euthyroid black woman presented with a painful palpable thyroid nodule. Microscopic examination revealed an extensively infarcted follicular carcinoma with minimal capsular and vascular invasion and advanced squamous metaplasia. From the regions of squamous metaplasia, ultrastructural analysis demonstrated both squamous and adenomatous features within the same individual cells. We stress the prognostic importance of histologic distinction between adenoacanthomas and adenosquamous or squamous cell carcinomas. The literature is reviewed and the aetiology, pathology, classification and prognosis of primary thyroid cancers with squamous epithelium are discussed.

Metaplastic papillary tumor of the fallopian tube--a distinctive lesion of pregnancy.

The clinical and pathologic features of four examples of a distinctive intraluminal papillary epithelial tumor of the fallopian tube are described. All four cases occurred in fallopian tubes removed in the immediate postpartum period. The nature of this lesion and its relationship to previously described epithelial lesions of the fallopian tube are discussed.

Pneumococcal endocarditis in infants.

A case of pneumococcal endocarditis in an infant is reported together with a review of seven cases previously described in the literature. The prominent presenting symptoms of this usually fatal disease consisted of tachycardia, tachypnea, and cardiomegaly. A new murmur was heard in six of the eight patients. Fever was infrequent. Blood cultures were positive when done. The mitral valve was the site of infection in seven of the patients. In contrast to adult patients, pneumonia and meningitis are rarely encountered in children with pneumococcal endocarditis. The disease was fatal in all four patients before the penicillin era and in three of four patients who received penicillin.

Mucosal hyperplasia in clonic diverticula.

Benign, nonpolypoid mucosal hyperplasia has been consistently observed adjacent to colonic carcinomas. In order to determine the specificity of this association we looked for this type of mucosa in diverticulosis with or without diverticulitis, a disease thought not to be causally related to carcinoma. Nonpolypoid mucosal hyperplasis was frequently found within diverticula suggesting that this mucosal abnormality is, in some instances, unrelated specifically to malignancy.