Promising results using sentinel node biopsy as a substitute for radical lymphadenectomy in endometrial cancer staging.

INTRODUCTION: The objective of this study was to evaluate the efficacy of the sentinel node (SN) procedure in endometrial cancer patients. MATERIAL AND METHODS: This was a prospective follow-up study including patients referred to Herlev Hospital, Denmark, to be treated for endometrial cancer in the period from October 2005 to December 2008. Hysteroscopy was performed with a 4.5 mm hysteroscope. Injections of 100-150 MBq (99m)Tc-traced colloid were administered subendometrially, and a dynamic scintigram was made. SN(s) identified with a gammaprobe were resected at the operation, and frozen sections were performed, followed by radical pelvic and para-aortic lymphadenectomy. RESULTS: A total of 32 patients were included. Among patients without clinical macro-metastases (n = 27), the SNs were detected by gamma probe in 23 (85.2%), and in most patients (n = 17, 74.0%) one (n = 12) or two (n = 5) SNs were found. The consistency between the scintigram and peroperative findings increased from 50.0% to 78.9% when the dose of (99m)Tc was increased to 150 MBq, mostly because the detection failure rate was lower at the higher dose: 4.8% versus 18.2%. By frozen section all macro-metastases were confirmed, but only one micro-metastasis was diagnosed. All subsequent lymph node metastases found in the final histology were found in SNs, i.e. no false negative SNs were found. CONCLUSION: The SN procedure can be used for endometrial cancer and it has a high detection rate and no false negative SNs were detected. The sensitivity of the SN procedure may be increased by the use of single-photon emission computed tomography (SPECT)/computed tomography (CT) and peroperative cytokeratin (CK) staining of the SN(s). FUNDING: External funding was received from the following University Foundation, Copenhagen County Research, Manufacturer Einar Willumsen's Memorial Foundation, Toyota Foundation Denmark, Lilly Benthine Lund Foundation. TRIAL REGISTRATION: The study was registered with the Danish Data Protection Agency.

Primary malignant mixed müllerian tumor of the peritoneum a case report with review of the literature.

Malignant mixed Müllerian tumor is a rare malignancy of the genital tract and extremely uncommon in extragenital sites. This report describes a case of malignant mixed Müllerian tumor arising in the lower peritoneum of a 72-year-old female patient. The patient presented with ascites, lower abdominal mass and pleural effusion. The serum level of CA125 was elevated. At operation a diffuse carcinosis associated with tumor mass measuring 20 × 15 × 10 cm in the vesicouterine and Duglas' pouch were found. The uterus and the adnexa were unremarkable. Histopathology revealed a typical malignant mixed Müllerian tumor, heterologous type. The epithelial component was positive for cytokeratin 7 and vimentin whereas the mesenchymal component was positive for Vimentin, S100 and focally for CK7. The histogenesis of this tumor arising from the peritoneum is still speculative. Based on the previous reports and the immunohistochemical analysis of our case, we believe that this is a monoclonal tumor with carcinoma being the "precursor" element. Nevertheless, further molecular and genetic evidence is needed to support such a conclusion.

Immunostaining for p16INK4a used as a conjunctive tool improves interobserver agreement of the histologic diagnosis of cervical intraepithelial neoplasia.

The quality of cervical histopathology is critical to cervical cancer prevention, cancer treatment, and research programs. On the basis of the histology results further patient management is determined. However, the diagnostic interpretation of histologic hematoxylin-eosin (H&E)-stained slides is affected by substantial rates of discordance among pathologists. Overexpression of the cyclin-dependent kinase inhibitor p16INK4a, a cell cycle regulating protein, has been shown to be strongly correlated with dysplastic lesions of the cervix uteri. In this study, we assessed whether p16INK4a immunohistochemistry may increase the performance of pathologists in diagnosing squamous lesions in cervical punch and cone biopsies. When using a consecutive p16INK4a-stained slide in conjunction to the H&E-stained slide, interobserver agreement between 6 pathologists improved significantly for both cervical punch and cone biopsies (P < 0.001). For punch biopsies (n = 247), kappa value increased from 0.49 (moderate agreement) to 0.64 indicating substantial agreement, and interobserver agreement for cone biopsies (n = 249) improved from 0.63 (conventional H&E slide reading) to 0.70 when H&E-stained slides were read conjunctively with p16INK4a-stained slides. In comparison to a common consensus diagnosis established by 3 independent experts, 4 pathologists reached an improvement with the conjunctive p16INK4a test, 2 of them showing significantly better agreement (P < 0.001 and P = 0.002, respectively), p16INK4a immunohistochemistry as an adjunct to conventional H&E-stained specimens thus contributes to a more reproducible diagnosis of cervical intraepithelial neoplasia and may be a valuable aid for the interpretation of cervical histology.