Expression of E-cadherin in primary endometrial carcinomas: clinicopathological and immunohistochemical analysis of 30 cases.

INTRODUCTION: Decreased expression of E-cadherin has been associated with poorly differentiated endometrial carcinomas and poorer outcomes. AIM: The purpose of this study was to examine the distribution of E-cadherin immunohistochemical expression in specimens from primary endometrial carcinomas and its relation to classical clinicopathological prognostic factors. MATERIALS AND METHODS: Surgically-resected tissues of 30 patients with primary endometrial carcinomas were studied. Histological type and grade, depth of myometrial invasion, lymph-vascular space invasion, fallopian tube or ovarian invasion, and the presence of tumoral necrosis were evaluated. Immunohistochemical examination was performed on deparaffinized four-microm-thick sections. RESULTS: The mean age of patients was 65 years (+/- 11.41). The 63.54% of carcinomas were moderately/poorly differentiated. No statistical correlation was found between the score or intensity of E-cadherin immunohistochemical staining (strong or moderate positive expression) and the clinicopathological factors tested. CONCLUSIONS: The association of E-cadherin immunoreactivity with the standard clinicopathological factors seemed to be contradictory. The classical clinicopathological factors remain the most important prognostic parameters.

Gastric calcifying fibrous tumor: a very rare case report.

Calcifying fibrous tumor is a very rare benign mesenchymal tumor which shows a predilection for soft tissue, mesentery and peritoneum. Up to date only 7 cases have been reported in the literature confined to the gastric wall. We report a rare case of a calcifying fibrous tumor of the stomach in a 60-year-old man who presented with dyspepsia, flatulence and feeling weight. A clinical and laboratory investigation was performed with normal results. Gastroscopy revealed a bulge in the gastric body measuring 1 cm with normal overlying mucosa, and mucosal biopsies showed chronic gastritis. Endoscopic ultrasound of the gastric bulge showed a 1 × 0.8 cm hypoechoic lesion involving the gastric wall. After the above finding a wedge resection of the stomach was performed. Microscopically the lesion consisted of well-circumscribed hypocellular hyalinized fibrosclerotic tissue with lympoplasmatic infiltrates, lymphoid aggregates and psammomatous calcifications. Lesional cells were positive for vimentin and factor XIII and negative for actin, desmin, S100p, CD117, CD34, CD31 and ALK-1. The lesion involved the muscularis propria with variable submucosal extension. Calcifying fibrous tumor has shown an excellent prognosis with recurrences being rare and showing the same morphology as the primary lesion.

Synchronous primary adenocarcinoma and ancient schwannoma in the colon: an unusual case report.

Gastrointestinal schwannomas are uncommon stromal tumors of the intestinal tract and colon schwannomas are extremely rare. We report a rare case of ascending colon schwannoma with associated synchronous adenocarcinoma of the sigmoid colon. A 68-year-old man presented with a 20-day history of bleeding per rectum. Colonoscopy revealed a mass of 4.2 cm in diameter with endoluminal protrusion in the sigmoid colon and a second submucosal tumor in the ascending colon. Surgical intervention was suggested and ileo-hemicolectomy was done. Microscopically, the submucosal tumor of 4 cm in diameter showed features of schwannoma with degenerative change (ancient schwannoma). Lesional cells were positive for S100p and negative for actin, desmin, CD34, CD117, and pankeratin. The mass showed features of an invasive moderately differentiated adenocarcinoma. Colon schwannoma is a rare submucosal tumor, and the incidental occurrence with adenocarcinoma has not been well described in the literature.

Borderline clear cell adenofibroma of the ovary associated with ovarian endometriosis: a case report.

Clear cell tumours of the ovary are relatively uncommon. Most of them are clear cell carcinomas. Benign and borderline clear cell tumours are extremely rare and almost always fibromatous. We report a case of a 34-year-old woman. Ultrasound and computed tomography showed a right ovarian mass 8 cm in diameter. The patient underwent right salpingo-oophorectomy. Microscopic examination revealed glands and cysts different in size and shape within an abundant stromal component without evidence of stromal invasion. Many cysts and glands were lined by a single layer of flattened, cuboidal or hobnail cells with mild to moderate cytologic atypia and prominent nucleoli. Psammomatous calcifications were occasionally indentified. Features of endometriosis were also present adjacent to the tumour. Lesional cells were positive for Ker 7 and CA125. Staining for p53 was focally positive. Based on the above characteristic morphologic and immunohistochemical findings a diagnosis of borderline clear cell adenofibroma was made. The patient was free of recurrence four years after surgery.

Primary cutaneous apocrine carcinoma of sweat glands: a rare case report.

Cutaneous apocrine gland carcinoma, a subtype of sweat gland carcinoma, is a very rare malignancy, and only few cases have been reported in the literature. Many of these carcinomas are indolent and slowly developing, but some are rapidly progressive. The treatment of choice is wide local excision with clear margins, with or without lymph node dissection. We report a case of a 67-year-old man who came to our hospital with an ulcerated nodule in the right axilla measuring 1 × 0.8 cm. Histological evaluation showed features of an apocrine gland carcinoma arising in an area of high apocrine gland density.

Intravascular T-cell lymphoma of the vulva, CD30 positive: a case report.

Primary non-Hodgkin's lymphoma involving the vulva is very rare. It affects predominantly the labia major but it can also present as a clitoral mass or can even be located in the Bartholin's gland. Vulvar lymphoma is an aggressive disease. We describe a case of a 48-year-old woman who presented to our hospital with fever and a slow growing mass in the vulva. She had no other clinical symptoms. CT-scan showed no evidence of disease in any other organ or lymph node tissue. A local excision of the mass followed and the final diagnosis was primary intravascular vulvar lymphoma, of T-cell origin, CD30 positive. In general, intravascular lymphomas are clinically and immunophenotypically heterogenous and may represent more than one entity. They are predominantly of B cell lineage, involving most commonly the skin and rarely other systems or organs. Because of the fact that the vulva is a cutaneous site the development of intravascular lymphoma in this region is possible.

Combined carcinoid and mixed (composite) glandular - endocrine cell carcinoma of the stomach in atrophic gastritis.

We describe a case of gastric carcinoid and inflammatory fibroid polyp concomitant with a composite tumor of the gastric antrum composed of poorly differentiated adenocarcinoma - endocrine carcinoma with immunohistochemical documentation of endocrine and non endocrine differentiation in a 67-year-old man with atrophic gastritis and intestinal metaplasia. When gastrectomy was carried out, two lymph nodes along the greater curvature harbored metastasis from carcinoid. The same occurrence is reported in several cases in the literature, which suggests that the association of gastric carcinoid to adenocarcinoma could point to the malignant nature of carcinoid. Furthermore, the findings in this patient reinforce the concept that the epithelial and neuroendocrine cells of the gastrointestinal tract both result from multidirectional differentiation of a primitive cell.

Glomus tumor of the stomach: a case report.

Glomus tumors are relatively uncommon benign neoplasms, most common in the skin and subcutaneous tissue, but can also occur in the viscera, most often in the stomach. Preoperative diagnosis, when the tumor occurs in the stomach, seems difficult but is important, since glomus tumors of the stomach are essentially benign and amenable to conservative excision, contrary to aggressive gastric neoplasms. We describe the case of a 75-year-old man presented to the emergency department with gastrointestinal bleeding and epigastric pain. Gastroscopy revealed a submucosal mass in the antrum of the stomach in correspondence to the lesser curvature. Biopsies taken from the lesion showed morphological and immunohistochemical [positivity for alphasmooth muscle actin (alpha-SMA) and vimentin, negativity for CD34, CD117, chromogranin, synaptophysin, desmin and S-100 protein] characteristics attributable to glomus tumor. The patient underwent a laparotomic antrotomy incision. Histological examination of the tumor confirmed the diagnosis of gastric glomus tumor.

Proliferative patterns of rectal mucosa as predictors of advanced colonic neoplasms in routinely processed rectal biopsies.

OBJECTIVES: We sought to determine whether the evaluation of rectal cell proliferation in routinely processed rectal biopsies of apparently normal mucosa can predict the presence of advanced colonic neoplasms. METHODS: Fifty consecutive patients, who did not meet any of the following exclusion criteria, underwent total colonoscopy. Patients with nonadvanced adenomas, inflammatory bowel disease, hereditary predisposition to colonic cancer, or a history of colonic neoplasms were excluded. Patients with neoplasms in the distal 40 cm of the large bowel were also excluded. An adenoma was considered advanced if it had a diameter > 1 cm, or villous or severe dysplasia histology were present. In 26 of the 50 patients (Group A: 16 men, 10 women; mean age, 65 yr) advanced colonic neoplasms (advanced adenomas or cancer) were detected; in the remaining 24 (Group B: 13 men, 11 women; mean age, 66 yr) the large bowel was free of neoplasms. In all patients the proliferative patterns of apparently normal rectal mucosa were evaluated using the monoclonal antibody MIB-1 to assess the expression of Ki-67 antigen in routinely processed tissues. Proliferation index for the entire crypt, as well as proliferation indices for each of the five equal compartments, into which the crypt had been divided longitudinally, were calculated for each patient. RESULTS: The mean proliferation indices were similar between the two groups compared. The mean proliferation index for the upper crypt compartments (4 + 5) in the Group A patients was significantly higher than for those of the Group B patients (p < 0.01). Multivariate stepwise logistic regression analysis revealed that among gender, age, and proliferative parameters, the pattern of cell proliferation in the upper rectal crypt (4 + 5) compartment was the only predictor of advanced colonic neoplasms (beta = 11.01, p < 0.001). CONCLUSIONS: Our data suggest that the evaluation of the upward expansion of the rectal crypt proliferative zone in routinely processed rectal biopsies of apparently normal mucosa appears to predict the presence of advanced colonic neoplasms. These preliminary results should be confirmed in larger studies.

Predictors of the early development of advanced metachronous colon adenomas.

BACKGROUND/AIMS: In order to reduce the number of colonoscopies performed for the surveillance of patients after polypectomy, suitable predictors of adenomas recurrence are needed. The aim of this study was to find predictors of the early development of metachronous adenomas and specifically of advanced ones. MATERIALS AND METHODS: Forty-four patients underwent total colonoscopy 24-26 months after initial endoscopic polypectomy. All polyps were endoscopically removed and an adenoma was considered as advanced if the diameter was > 1 cm and/or villous component and/or severe dysplasia were present. RESULTS: Metachronous adenomas were detected in 16 (36.4% patients. Five (11.4%) of them had advanced metachronous adenomas. Early recurrence of adenomas was significantly correlated with the total number of indices adenomas (p = 0.027). On the contrary, the presence of metachronous adenomas was not related to any of the patients' characteristics nor to the site and the histology of the indices adenomas. The development of advanced metachronous adenomas during the same period was significantly correlated with patients' age, as it was observed only in patients aged > or = 60 years (5/21 or 23.8%) and in none of the patients aged < 60 years (Odds ratio: 15.7, p = 0.02). Logistic regression analysis revealed that patient's age was the only significant predictor of the early development of advanced metachronous adenomas (beta = 0.40, p = 0.02) and that the number of the indices adenomas was the only significant predictor for the recurrence of all adenomas (beta = 1.59, p = 0.02). CONCLUSIONS: 1. Only patients aged > or = 60 years seem to develop advanced metachronous adenomas two years after polypectomy and 2. The likelihood for developing metachronous adenomas during the same period is related to the number of indices adenomas.

Proliferative activity in colonic adenomas as a predictor of metachronous adenomas as assessed by proliferating cell nuclear antigen immunohistochemistry.

OBJECTIVES: The aim of this study was to determine whether cell proliferation in colonic adenomas, as estimated by proliferating cell nuclear antigen (PCNA), predicts the development of metachronous colonic adenomas. METHODS: Forty patients who underwent prior endoscopic polypectomy for colonic adenomas were reevaluated by colonoscopy 2 yr later. The expression of PCNA was studied in all adenomas that were removed. A five-point semiquantitative scale of 1-5 was used to estimate the PCNA score by the percentage of positively stained cells. RESULTS: Among the 40 patients studied, 16 developed recurrent adenomas (group A) and 24 were free of adenomas (group B). At initial colonoscopy, a total number of 51 adenomas (25 in group A and 26 in group B), were found. The median PCNA score in group A and group B index adenomas was 4 (interquartile range, 3-5) and 2 (interquartile range, 1-3), respectively (p < 0.01, Mann-Whitney U-test). A stepwise logistic regression analysis showed that PCNA score is a significant risk factor (p = 0.007, odds ratio 15.8, 95% confidence interval 2.2-112.4) in predicting adenoma recurrence. The median PCNA score in metachronous adenomas was 2 (interquartile range, 1-3). The difference in the PCNA score between group A index and metachronous adenomas was again statistically significant (p < 0.01, Mann-Whitney U-test). CONCLUSIONS: We conclude that the increased expression of PCNA in colonic adenomas may be a predictor for metachronous adenomas.

Mixed ovarian neoplasm composed of struma ovarii and Brenner tumour. Report of a case.

The case is reported of a patient with a mixed lesion composed of struma ovarii and Brenner tumour. This is an extremely rare tumour and only two well documented cases were found in the English literature.