Sclerosing stromal tumor of the ovary: a case report and review of the literature.

Sclerosing stromal ovarian tumor is an extremely rare neoplasm occurring predominantly in the second and third decades of life. It presents most often with non-specific symptoms. We describe a new case occurring in a young woman presenting with infertility and irregular menses. Ultrasound examination showed a left heterogenous ovarian mass without focal calcifications. Histological features included a pseudolobular pattern with focal areas of sclerosis, prominent vascularity and a two-cell population of spindled and polygonal cells. Immunohistochemical analysis for actin, vimentin, laminin, vascular epidermal growth factor (VEGF), oestrogen and progesterone receptors using formalin-fixed and paraffin-embedded materials showed predominant positivity for a-smooth muscle actin and consistent positivity for laminin and vimentin. The epidermal VEGF demonstrated rich tumor vascularity. Oestrogen and progesterone receptors were not expressed. suggesting hormonally independent development. Menstrual cycle disturbances, however, were corrected following extirpation of the tumor, indicating some endocrine involvement. In addition, the patient became pregnant ten months after the operation. The differential diagnosis is discussed.

Immunohistochemical detection of estrogen receptors on paraffin sections of normal, hyperplatic and carcinomatous endometrium.

The present study is the first dealing with the demonstration of estrogen receptors (ER) in up to 8-year-old paraffin blocks of endometrial curettage samples routinely fixed in 10% formalin. The Mab ER-ICA was used in a modified peroxidase-antiperoxidase method after pretreatment of paraffin sections with pronase. Eleven cases with proliferative, 11 cases with secretory endometrium, 20 cases with adenocystic, 21 with adenomatous hyperplasia and 27 endometrial adenocarcinomas were tested. The two main parameters, namely the percentage of ER-positive cells and the intensity of the immunostaining, were higher in the proliferative phase followed in a declining sequence by adenocystic hyperplasia, adenomatous hyperplasia, adenocarcinomas and the secretory phase of endometrium. Interestingly, the intensity of the immunostaining showed a positive relationship to the percentage of ER-positive cells (r = 0.93, p less than 0.001). It seems that the immunohistochemical demonstration of ER in paraffin sections of uterine specimens is an easy and reliable method for the mapping of the heterogeneous expression of ER and their comparative study with the well preserved histopathological features even in old archival paraffin-embedded material.

Nucleolar organizer regions in the normal, hyperplastic and carcinomatous epithelium of endometrium.

A silver colloid technique to identify nucleolar organizer region associated protein (AGNORs) has been applied to paraffin sections in a total of 43 endometrial hyperplasias (24 adenomatous and 19 adenocystic) 26 endometrial carcinomas and 22 normal endometria (11 of proliferative and 11 of secretory phase). A morphometric analysis of highly magnified photographic images of AGNORs in light microscopic preparations was performed. Malignant tumor cells showed significantly higher AGNOR numbers, maximum diameter and mean area compared with normal and hyperplastic endometrium, with the exception of adenocystic hyperplasia whose Dmax and mean area were significantly larger. Regarding the distribution pattern of AGNOR dots in the cases studied, it was found that normal and hyperplastic endometrium had a mainly clustered distribution while endometrial adenocarcinomas revealed a scattered one. The significant differences observed in the number of AGNORs, their size and mean area between benign and malignant endometrial epithelia suggest that the AGNOR staining technique is of diagnostic importance in distinguishing between these two groups.