Oncocytic adrenocortical neoplasm arising from adrenal rest in the broad ligament of the uterus.

Oncocytic adrenocortical neoplasm is characterized by abundant eosinophilic cytoplasm containing mitochondria, occasional nuclear atypia and diffuse growth pattern. Oncocytic adrenocortical neoplasm arising in adrenal rest is, however, extremely rare. We report a case of oncocytic adrenocortical neoplasm arising in adrenal rest of the broad ligament with associated marked lipomatous metaplasia. A well circumscribed tumor was accidentally detected in the pelvic cavity of a 29 year old Japanese woman, adjacent to the broad ligament of the uterus. The tumor was composed of large eosinophilic cells associated with diffuse growth pattern and abundant mature adipose tissue admixed with foci of clear cells. Both steroidgenic factor 1 (SF-1) and alpha-inhibin were immunohistochemically positive in tumor cells. Abundant mitochondria detected by immunohistochemical and electron microscopic examination confirmed the diagnosis of oncocytic adrenocortical neoplasm. The absence of necrosis, capsular and vascular invasion as well as the low mitotic index indicated the benign potential of this tumor. The tumor cells were also positive for dehydroepiandrosteron-sulfotransferase (DHEA-ST), 17ß-hydroxysteroid dehydrogenase type 5 (17ß-HSD5), 3ß-hydroxysteroid dehydrogenase (3ß-HSD) and steroid 17α-hydroxylase (P450-c17), suggesting a possible production of testosterone of this tumor. This is the first reported case of oncocytic adrenocortical adenoma arising in adrenal rest of the broad ligament.

Morphological features of lymphatic and mesothelial communications in the broad ligament of the pig.

The broad ligament containing uterine, paraovarian, and oviduct lymphatics was examined in the pig in various phases of the estrous cycle using light, scanning and transmission electron microscopy. The architecture of these regions differed and was independent of the lymphangions of the precollector and collector lymphatic vessels. Lymphangions were separated from mesothelium by connective tissue and/or muscle layers; however, in the vicinity of the thin walled paraovarian sac, large lymphangions were often compressed between two epithelial layers. Numerous lymphatic lacunae were in direct contact with the peritoneal and paraovarian sac cavities. The mesothelial lining of the broad ligament and the external and internal epithelium of the pig paraovarian sac displayed two distinct cell types. Only smaller cuboidal cells with prominent microvilli extended above the lymphatic endothelium. The surfaces of these cells were discontinuous and showed: 1) lymphatic stomata, 2) small pores or fenestrae, 3) a superficial network of epithelial-free communications with underlying connective tissue to the paraovarian sac in the postovulatory period independent of the lymphatic vasculature, and 4) endothelial (instead of epithelial) cells with crevice-like discontinuities in large portions of the internal sac surface during the follicular phase of estrus. Numerous lymphatic stomata had orifices composed of flattened cuboidal cells while lymphatic endothelial cells were characterized by macula or zonula adherent connections formed within rims of various sizes (up to 50 microns in diameter). During estrus, there were circular (0.5-2.0 microns) and irregular (to 10 microns) interendothelial openings in stomatal orifices with migrating cells. These morphologic findings suggest that absorption and passage of fluid, particles and cells between cavities and the lymphatic lumen in areas of the paraovarian lymphatic plexus in the pig is feasible.

Adrenal rest tumor of the broad ligament: case report with immunohistochemical study of steroidogenic enzymes.

An adrenal rest tumor of the broad ligament was studied in a 43-year-old woman. The tumor measuring 6 x 3 x 3 cm and appearing as golden-yellow on the cut surface was incidentally discovered during a total hysterectomy due to uterine leiomyoma. The encapsulated tumor was predominantly composed of pale and lipid-rich cells arranged in alveolar clusters or short blunt cords. Electron microscopic examination revealed mitochondria with tubulo-vesicular cristae and abundant lipid droplets. Adrenal 4-binding protein, a transcriptional factor of steroidogenesis, was present in almost all of the tumor cells, suggestive of steroidogenic features in the lesion. Immunoreactivity of steroidogenic enzymes involved in adrenocortical steroid production was detected in the tumor cells, suggesting that tumor cells had the potential to synthesize adrenocortical steroids. A relatively low Ki-67 labelling index (3.20 +/- 1.15 per 100 tumor cells) and an absence of necrosis and vascular and/or capsular invasion suggest benignity of the lesion.

Tumor of the broad ligament in von Hippel-Lindau disease of probable mullerian origin.

A rare neoplasm seen in women with von Hippel-Lindau disease is the papillary cystadenoma of the broad ligament, only three cases of which have been reported. All three exhibited characteristic histologic features identical to those of epididymal tumors that occur in affected patients, and were presumed to be of wolffian origin. This is the case of a broad ligament tumor in a woman with von Hippel-Lindau disease that had features more consistent with a mullerian rather than wolffian origin. This is the first report of a broad ligament tumor of probable mullerian origin in von Hippel-Lindau disease.

Vasa vasorum of blood and lymph vessels in the broad ligament of the sheep uterus analyzed by scanning electron microscopy.

The morphology of vasa vasorum of the blood and lymph vessels in the broad ligament of the uterus was examined in 12 adult ewes. The technique of vascular corrosion casts with the usage of Mercox resin allows multiple surveys of a three-dimensional organization of vascular networks under a scanning electron microscope (SEM). The study was appended by tissue pieces dried by the critical point method for SEM and semi-thin sections stained with toluidyne blue for light microscopy. Vasa vasorum surrounded both the larger vessels and the lymph vessels emanating from the ovary and the uterus. Significant differences in location and intensity of vasa vasorum in blood vessels were observed. They were less developed in the first part of the ovarian and the uterine arteries than in their smaller branches. Significantly large, two- or even three-layer vasa vasorum surrounded the ovarian and the uterine branches of the ovarian artery as well as the ovarian veins in the area of mesovarium. In the other areas of the broad ligament of the uterus, arterial vessels of similar sizes usually had a single-layer vasa vasorum. The lymph vessels leaving the ovary and uterus were surrounded by dense, although usually single-layed, microvascular network. The presence of vasa vasorum on relatively small blood and lymph vessels of the broad ligament of uterus indicates their particular functions that are probably connected with the estrous cycle or pregnancy and changes of blood flow rate entering the ovary and uterus. However, the presence of significantly developed, multi-layer vasa vasorum networks on only some of the blood vessels indicates that it is probably one of the vessels morphological adaptations to serve the counter-current transfer of biologically-active regulators in the area of the broad ligament of the sheep's uterus.

Broad ligament mucinous and serous cystadenomas of borderline malignancy.

The clinical and pathological findings including light microscopic and ultrastructural features of two cases of borderline mucinous and serous cystadenomas that originated in the broad ligament are reported. The tumors did not involve the oviduct or ovary. They probably arose in pre-existing cysts of mesothelial and paramesonephric (primary Müllerian) origin. These rare tumors bear a close resemblance to the borderline epithelial tumors of the ovary and the same prognostic criteria may be applicable to the lesions presented here.

Choriocarcinoma of the mesosalpinx masquerading as congestive heart failure: ultrastructural observations of the tumor.

A 45-year-old woman suffered from hypertension and congestive heart failure for 5 months. She was found to have a choriocarcinoma of the left mesosalpinx. The final event was, in all probability, a massive pulmonary tumor embolus which occurred shortly after removal of the uterus and adnexae. The tumor was studied by immunohistochemical methods as well as ultrastructurally, and the findings are illustrated and described.

The origin of the extrinsic adrenergic innervation to the rat ovary.

Cutting the suspensory ligament reduced the ovarian content of norepinephrine (NE) to less than half that of controls and only a few blood vessels had perivascular fibers and an occasional nerve remained in the interstitial gland. Cutting the ovarian plexus had a less drastic, but similar effect on the ovarian content of NE and on the pattern of ovarian adrenergic nerves. Cutting both the suspensory ligament and ovarian plexus eliminated visualization of ovarian adrenergic nerves, but some ovarian NE was still measurable. Fluorescence and electron microscopic studies of the suspensory ligament revealed a large adrenergic nerve embedded in smooth muscle of the ligament. The nerve was also acetylcholinesterase-positive. Cutting the celiac plexus or incising a small nerve lateral to the plexus and medial to the origin of the suspensory ligament, had the same effect on the ovarian adrenergic nerves as cutting the suspensory ligament. It is concluded that the extrinsic adrenergic nerves to the rat ovary reach the organ by two routes: one via the nerve in the suspensory ligament (superior ovarian nerve), and one via the traditionally described ovarian plexus along the ovarian artery.