Placental site trophoblastic tumor in the pelvic wall: a case report and review of the literature.

Extra-uterine placental site trophoblastic tumor (PSTT) is extremely rare. To our knowledge, PSTT that occurs in the pelvic wall has not yet been reported. A 29-year-old woman presented with amenorrhea and irregular vaginal bleeding of 1 month. A solid tumor mass was detected by ultrasonography in the right pelvic wall. The tumor was comprised of large, polygonal tumor cells, with brisk mitosis and obvious vascular invasion. Immunohistochemical staining demonstrated that tumor cells were positive for human placental lactogen, CD146, cytokeratin, placental alkaline phosphatase, human chorionic gonadotropin were positive, the Ki-67 proliferative index was about 80%. The pathological diagnosis was PSTT. After the operation, the patient was treated with six cycles of etoposide, methotrexate, actinomycin, cyclophosphamide, and vincristine. The patient was followed for 18 months without recurrence. The report shows that extra-uterine PSTT is extremely rare and may have a good prognosis; surgical resection and adjuvant chemotherapy are good options. However, further experience to diagnose and cure this rare tumor is warranted.

Granular cell tumor of the uterine cervix. A case report.

BACKGROUND: Granular cell tumor (GCT) is a relatively rare and nearly always benign neoplasm that has been described in many sites and organs including the tongue, skin, subcutaneous tissue, breast, and vulva. However, it is rarely seen in the uterine cervix. CASE: We report a case of granular cell tumor of the cervix in a 38-year-old woman. Upon microscopic examination the tumor was found to comprise large polygonal cells with an abundant eosinophilic granular cytoplasm and round to oval nuclei. Upon immunohistochemical staining the large cells showed S-100, neuron specific enolase, and CD68 positive in the cytoplasm. Clinical presentation of the patient, histopathological features of the lesion, and treatment approach are discussed. CONCLUSION: GCTs of the cervix are extremely rare. To the best of our knowledge this report is the first Chinese case of cervical GCT in the English-language literature. GCTs should always be considered during the diagnosis process with large cell lesions of the cervix. Extensive surgical resection appears to be adequate for most GCTs. Because of the unpredictable clinical outcome of this tumor, strict and long-term follow-up are recommended.

[Primitive neuroectodermal tumor in female genital tract: a clinicopathologic study].

OBJECTIVE: To study the clinicopathologic features of primitive neuroectodermal tumor (PNET) in female genital tract. METHODS: Six cases of PNET arising in female genital tract were retrospectively reviewed. The clinicopathologic features, immunohistochemical findings and EWS gene translocation study results were analyzed. RESULTS: The age of patients ranged from 10 to 27 years (mean = 20 years). The sites of involvement included ovary (1 case), uterus (1 case), vulva (2 cases) and vagina (2 cases). The greatest diameter of the tumor ranged from 2 to 10 cm (mean = 5.4 cm). The tumor had nodular appearance and showed grayish-pink fleshy cut surface, accompanied by foci of hemorrhage and necrosis. Histologically, the tumor was composed of malignant small round cells with indistinct cell borders, hyperchromatic nuclei, dense chromatin, tiny nucleoli and scanty cytoplasm. The tumor cells were arranged in sheets or lobules. Homer-Wright rosettes were identified in 1 case. Immunohistochemical study showed that the tumor cells were positive for CD99, FLI-1 and CD56 (6/6). Focal expression of vimentin (5/6), NSE (5/6), nestin (4/6), synaptophysin (4/6), S-100 protein (2/6) and chromogranin A (1/6) was also demonstrated. EWS gene translocation was detected in 5 cases studied. Follow-up information was available in 2 patients (7 and 17 months of follow up, respectively). One of them died of tumor metastasis 17 months after diagnosis. The other patient was still alive. CONCLUSIONS: PNET arising in female genital tract is rare. It mainly involves ovary, uterus, vulva and vagina. Immunohistochemical study using a panel of antibodies and fluorescence in-situ hybridization play an important role in definitive diagnosis of this rare malignancy.

[Malignant transformation of ovarian endometriosis: a clinicopathologic analysis of 49 cases].

BACKGROUND & OBJECTIVE: Ovarian endometriosis is a common and benign, but progressive disease. We aimed to investigate the clinicopathologic of ovarian endometriosis with malignant transformation and to evaluate the expression differences of estrogen receptor (ER) and progesterone receptor (PR) between ovarian endometriosis samples with and without malignant transformation. METHODS: Clinicopathologic data of 49 ovarian endometriosis patients with malignant transformation were reviewed. The expression of ER and PR in the 49 specimens of ovarian endometriosis with malignant transformation (transformation group) and 49 specimens of ovarian endometriosis without malignant transformation (control group) were detected by immunohistochemistry and compared statistically. RESULTS: The 49 ovarian endometriosis patients were aged of 29-70 years with a median of 49 years. The major initial manifestation was pelvic masses. B-ultrasound examination showed mixed cystic and solid masses in the pelvic cavity. Macroscopically, the ovarian masses were cystoid and parenchymal with diameters of 4.0-20.0 cm; the cysts possessed thick and fibrous walls (in brown or yellow) and contained chocolate-like fluid or semi-fluid materials; the parenchymal part was tender papillary nodules with diameters of 0.5-15.0 cm. Microscopically, the ectopic endometrium proliferated and transformed to atypical hyperplasia and carcinoma. The positive rates of ER and PR proteins were significantly lower in transformation group than in control group (20.4% vs. 95.9%, 14.3% vs. 95.9%, P < 0.05). CONCLUSIONS: The malignant transformation of ovarian endometriosis is likely to occur in peri-menopausal women. Clinical manifestations, B-ultrasound examination and pathologic examination are valuable for diagnosis. The absence of ER and PR protein expression in endometriosis may help to diagnose malignant transformation of ovarian endometriosis.

[Relation between the expression of hypoxia inducible factor-1alpha and angiogenesis in ovarian cancer using tissue microarray].

OBJECTIVE: To study the relation between the expression of hypoxia inducible factor-1alpha (HIF-1alpha)and angiogenesis in ovarian cancer. METHODS: The expressions of HIF-1alpha mRNA, vascular endothelial growth factor (VEGF), and CD(34) in 295 patients with epithelial ovarian tumors were analyzed by tissue microarray technology, in situ hybridization and immunohistochemistry, and compared with those of 13 normal ovarian tissue samples. RESULTS: The expressions of HIF-1alpha mRNA were observed in 0, 13.2%, 42.1% and 81.9% of normal ovarian tissue, benign, borderline and malignant ovarian tumors respectively. Expression rates of HIF-1alpha mRNA in borderline and invasive tumors were significantly higher than those in normal ovarian tissues and benign tumors (P < 0.01). Statistical analysis revealed that the expression of HIF-1alpha mRNA was not related to surgical stages and histological subtypes. Close positive relation was observed between the expression of HIF-1alpha mRNA and tumor histological grade (r = 0.246, P < 0.01). There were significant correlations between the expression of HIF-1alpha mRNA and VEGF (r = 0.206, P = 0.01) and microvessel density (MVD) level (r = 0.451, P < 0.01). CONCLUSION: HIF-1alpha may play a role in angiogenesis of ovarian carcinoma, and may promote the development of the carcinoma.

[The expression of matrix metalloproteinase-2 and -9 in cervical cancer and a study of their relationship].

OBJECTIVE: To detect the expressions of matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) in cervical cancer and their correlation with clinicopathologic features. METHODS: With the use of specific monoclonal antibody to human MMP-2 and MMP-9, the formalin-fixed and paraffin-embedded specimens of 62 invasive carcinomas of cervix uteri, 5 carcinomas in situ, 10 normal cervical epithelia and 10 lymph node metastases were detected by immunohistochemical method. RESULTS: MMP-2 and MMP-9 protein expressions in tumor and peritumoral stromal cells were enhanced in invasive carcinoma, compared to those in carcinoma in situ and controls (P < 0.05). There was a low correlation between MMP-2 and MMP-9 (r = 0.34, P < 0.01); the expression level of MMP-9 was higher than MMP-2. The protein expressions of MMP-2 and MMP-9 did not correlate with tumor stage, histological grade or pathological subtype. MMP-9 was correlated with lymph node metastasis and lymphovascular space invasion. CONCLUSION: The over-expression of matrix metalloproteinase-2 and -9 was correlated with invasive behaviour of cervical cancer, MMP-9 was significantly correlated with the lymph node metastasis, it might become a useful prognostic indicator for early cervical cancer.