Androgen receptors are acquired by healthy postmenopausal endometrial epithelium and their subsequent loss in endometrial cancer is associated with poor survival.

BACKGROUND: Endometrial cancer (EC) is a hormone-driven disease, and androgen receptor (AR) expression in high-grade EC (HGEC) and metastatic EC has not yet been described. METHODS: The expression pattern and prognostic value of AR in relation to oestrogen (ERα and ERß) and progesterone (PR) receptors, and the proliferation marker Ki67 in all EC subtypes (n = 85) were compared with that of healthy and hyperplastic endometrium, using immunohistochemisty and qPCR. RESULTS: Compared with proliferative endometrium, postmenopausal endometrtial epithelium showed significantly higher expression of AR (P < 0.001) and ERα (P = 0.035), which persisted in hyperplastic epithelium and in low-grade EC (LGEC). High-grade EC showed a significant loss of AR (P < 0.0001), PR (P < 0.0001) and ERß (P < 0.035) compared with LGEC, whilst maintaining weak to moderate ERα. Unlike PR, AR expression in metastatic lesions was significantly (P = 0.039) higher than that in primary tumours. Androgen receptor expression correlated with favourable clinicopathological features and a lower proliferation index. Loss of AR, with/without the loss of PR was associated with a significantly lower disease-free survival (P < 0.0001, P < 0.0001, respectively). CONCLUSIONS: Postmenopausal endometrial epithelium acquires AR whilst preserving other steroid hormone receptors. Loss of AR, PR with retention of ERα and ERß may promote the unrestrained growth of HGEC. Androgen receptor may therefore be a clinically relevant prognostic indicator and a potential therapeutic target in EC.

MGMT promoter hypermethylation and K-RAS, PTEN and TP53 mutations in tamoxifen-exposed and non-exposed endometrial cancer cases.

BACKGROUND: Tamoxifen has anti-oestrogenic and anti-tumour activity in the breast, but is oestrogenic and carcinogenic in the endometrium. It can induce experimental tumours by both hormonal and DNA-damaging mechanisms, but its carcinogenic mode of action in human endometrium remains unclear. METHODS: We investigated whether an epigenetic mechanism, involving promoter hypermethylation of the gene for the DNA repair enzyme MGMT (O6-methylguanine DNA methyltransferase), was associated with K-RAS, TP53 and PTEN mutations in endometrial tumours from women treated with tamoxifen (TAM, n=30) or unexposed to the drug (EC, n=38). RESULTS: There were significant (P<0.05) differences in tumour grade between the TAM and EC groups, with more favourable morphology in the latter. K-RAS mutations, predominantly G>A, occurred in small numbers in both groups. TP53 mutations were of mainly A>G, C>T and indel modifications in both groups, but more frequent in TAM cases. PTEN mutations dominated in EC tumours and were of the type that has large impact on protein function, such as indel or nonsense mutations. These observations alongside the mutational spectrum in PTEN suggest that the malignancies arise from different backgrounds, hence pointing to an effect of tamoxifen. Both groups displayed MGMT promoter hypermethylation. This coincided with mutations more frequently in the TAM (78%) than in the EC (50%) group, even though there were significantly (P<0.05) fewer mutations and methylations in TAM cases. CONCLUSIONS: Although the difference in coincidence did not reach significance with the current sample size, the findings suggest that epigenetic processes may play a role in the way tamoxifen induces endometrial cancer.

Infrared spectroscopy with multivariate analysis to interrogate endometrial tissue: a novel and objective diagnostic approach.

BACKGROUND: Endometrial cancer is the most common gynaecological malignancy in the United Kingdom. Diagnosis currently involves subjective expert interpretation of highly processed tissue, primarily using microscopy. Previous work has shown that infrared (IR) spectroscopy can be used to distinguish between benign and malignant cells in a variety of tissue types. METHODS: Tissue was obtained from 76 patients undergoing hysterectomy, 36 had endometrial cancer. Slivers of endometrial tissue (tumour and tumour-adjacent tissue if present) were dissected and placed in fixative solution. Before analysis, tissues were thinly sliced, washed, mounted on low-E slides and desiccated; 10 IR spectra were obtained per slice by attenuated total reflection Fourier-transform IR (ATR-FTIR) spectroscopy. Derived data was subjected to principal component analysis followed by linear discriminant analysis. Post-spectroscopy analyses, tissue sections were haematoxylin and eosin-stained to provide histological verification. RESULTS: Using this approach, it is possible to distinguish benign from malignant endometrial tissue, and various subtypes of both. Cluster vector plots of benign (verified post-spectroscopy to be free of identifiable pathology) vs malignant tissue indicate the importance of the lipid and secondary protein structure (Amide I and Amide II) regions of the spectrum. CONCLUSION: These findings point towards the possibility of a simple objective test for endometrial cancer using ATR-FTIR spectroscopy. This would facilitate earlier diagnosis and so reduce the morbidity and mortality associated with this disease.

MRI appearances of pelvic malakoplakia.

We report the MRI appearances in a patient with parametrial malakoplakia. The patient complained of pelvic pain and vaginal discharge. Physical examination revealed a "frozen" pelvis suggestive of malignancy. MRI showed bilateral parametrial "infiltration", but no overt primary pelvic tumour. The combination of these findings together with the inflammatory symptoms suggested an inflammatory condition. Malakoplakia was confirmed at resective biopsy.

A case of torted parafimbrial cyst on MRI: case report and review of the literature.

Para-ovarian cysts (POCs) are an occasional finding at surgery, although they are rarely appreciated on imaging studies. Accurate diagnosis depends upon the demonstration of a para-ovarian location. We present the MR appearances of a torted POC in a fimbrial location, resembling a dermoid cyst.

Solitary fibrous tumour arising in the nasal cavity: report of a case.

The nasal and the paranasal sinuses are a rare site for solitary fibrous tumours. There have been no previously reported cases in the English literature, with eight cases in the world literature (Witkin and Rosai, 1991; Zuckerberg et al., 1991). We present a case of a solitary fibrous tumour arising in the nasal cavity and review the previous reports.

Fine needle aspiration cytology of the breast. A review of 1,868 cases using the Cytospin method.

The Cytospin method of fine needle aspiration cytology includes flushing the aspirate into 10 mL of Cytospin fluid; the cytocentrifuge preparations are then safely and conveniently prepared in the laboratory. Slides are stained with Papanicolaou stain and hematoxylin and eosin. From November 1989 through October 1992, 1,868 breast aspirates from palpable lumps were examined by this method at our institution. The method detected 398 of 441 cancers (90.2%); of the 43 that were undetected, 16 had inadequate aspirates, and 27 were falsely reported as negative (for a false-negative rate of 6.0%). There were no false positives; the positive predictive value for malignancy was 100%. The inadequacy rate was 14.8%. Excluding inadequate samples, the complete sensitivity was 95.2%, with 96.5% specificity. The Cytospin method of processing breast aspirates from palpable breast lumps is an acceptable alternative to conventional fine needle aspiration using direct smears. It is also highly convenient as an outpatient procedure, obviating the need for skillful preparation of direct smears.

Pathological sequelae of "neglected" impacted third molars.

An NIH conference on "Removal of Third Molars" debated the need for removal of asymptomatic impacted teeth with no evidence of pathology but stressed the need for long-range studies. The assumption is that "neglected" impacted third molars (ITMs) will sometime cause serious pathology. Examination of panoramic radiographs of 11,598 patients revealed 1,756 patients with 3,702 impacted teeth; average age 47 years, and an average retention period approximately 27 years. Dentigerous cystic changes occurred in about 30 ITMs (0.81%), internal resorption in 16 (0.43%), periodontal ligament damage and bone loss distal to the 2nd molar 166 times (4.48%), and pressure resorption of the 2nd molar 113 times (3.05%). No great surge in pathology occurred with increasing age. Some type of pathological change can be expected eventually in approximately 12.0% of an impacted 3rd molar population and 1.82% of the general population. A reappraisal of routine removal of ITMs might be indicated.

Computer-based management of a clinical teaching program.

A management system is described that uses a computer to assist in the matching of patients and dental students, the monitoring of patient care, and the tracking of student clinical progress in a teaching environment that emphasizes the comprehensive patient care approach.

Direct pulp capping treatment: a long-term follow-up.

In reviewing 356 instances of pulp capping during the past 25 years, 149 cases were recalled with posttreatment intervals greater than five years. One hundred thirty teeth (87.3%) were still vital and functioning with an average posttreatment interval of 11.7 years. The criteria for pulp capping procedures are in need of revision. Restrictions based on tooth size and age of the patient are unfounded.