A quality process study of lymph node evaluation in endometrial cancer.

Our objective was to analyze the reported lymph node counts between surgeons, histology prosectors, and pathologists using a cohort of patients enrolled on a national protocol that standardized surgical intent.This is a retrospective review of patients with uterine cancer who underwent a standardized formal staging procedure as dictated by a National Cancer Institute sponsored protocol. Patients were staged using the International Federation of Gynecology and Obstetrics 1988 guidelines. All patients required a hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic and para-aortic lymphadenectomy. Lymphadenectomy specimens were separated by the following regions: external iliac, obturator, common iliac, and periaortic. Lymph node counts were analyzed by region, surgeon, histology prosector, and pathologist.There were 78 patients enrolled in the protocol during the study period. Of them, 72 (92%) patients met the inclusion criteria. A total of 2397 lymph nodes were counted, with an average total number of 33 (SD=9) lymph nodes dissected per patient. Surgeons A, B, and C had an average lymph node count of 32, 33, and 35, respectively, with no significant difference in mean node count (P=0.66). Prosectors 1 to 4 dissected an average of 34, 33, 28, and 35 lymph nodes, respectively (P=0.091). There were 2 pathologists with ≥ 10 cases. Their mean lymph node counts were 35 and 30, respectively, with no significant difference in mean node count (P=0.079).This systematic review did not identify a discrepancy in nodal count among surgeons, prosectors, or pathologists at our institution. The methods used may be helpful in structuring interdepartmental reviews for completeness of nodal dissections in cases where surgical intent has been standardized.

Bilateral and multinodular signet-ring stromal tumor of the ovary.

BACKGROUND: Signet-ring stromal tumor of the ovary is a rare, benign sex cord stromal tumor that is typically unilateral. Its distinction from malignant signet-ring cell adenocarcinoma metastatic to the ovary (Krukenberg tumor), is critical. CASE: A 69-year-old gravida 5 woman presented with a 1-week history of right lower abdominal pain. Ultrasonography revealed a 4-cm right adnexal mass. Serum CA 125 and carcinoembryonic antigen were within normal limits. An exploratory laparotomy, partial omentectomy, bilateral salpingo-oophorectomy and peritoneal washing were performed. Solid multinodular masses in both ovaries were identified that histologically corresponded to bilateral signet-ring stromal tumors. CONCLUSION: We report a rare example of signet-ring stromal tumor that is bilateral and multinodular mimicking a Krukenberg tumor. Awareness of this unusual presentation can help prevent incorrect diagnosis.

Histological characteristics of singleton placentas delivered before the 28th week of gestation.

AIMS: The placenta is a record of the fetal environment and its examination may provide information about the baby's subsequent growth and development. We describe the histological characteristics of 947 singleton placentas from infants born between 23 and 27 weeks gestation. METHODS: Consent was obtained from mothers who delivered before 28 weeks (clinical estimate). We evaluated the gross and histopathological features of the placenta and assessed pair-wise correlations between variables. RESULTS: Lesions of uteroplacental circulation (abruption, extensive infarction or thrombosis, marked basal or perivillous fibrin deposition, increased syncytial knots) were inversely related to those associated with inflammation of the membranes and cord. Earlier age favoured inflammatory variables, while older age favoured characteristics attributed to impaired blood flow. We observed inflammation of the chorionic plate in 43%, the cord in 19%, and of chorionic plate vessels in 30%. Of the placentas with umbilical cord inflammation, 8% had no inflammation of the chorionic plate. CONCLUSIONS: This study population is unique in its size and recruitment by gestational age rather than birth weight. Inflammation occurred frequently, but not in placentas that had characteristics of vasculopathy. The prevalence of inflammation decreased with increasing gestational age, while vasculopathy increased. Funisitis need not be accompanied by chorionic inflammation.

Vascular and connective tissue histopathologic alterations of the female lower genital tract in scleroderma.

OBJECTIVE: It has been suggested that women with scleroderma (systemic sclerosis, SSc) have cervical changes that may lead to obstetrical or postoperative complications. We evaluate histopathologic features characteristic of SSc in cervicovaginal tissue from women with SSc and compare them to age matched controls. METHODS: Records from the Scleroderma Registry at Wayne State University were matched with surgical specimens in the anatomic pathology files at Hutzel Hospital. Five women with SSc (2 with limited SSc, 3 with diffuse SSc; mean age 49 yrs) were identified who had cervical or vaginal tissue specimens available for evaluation. Small arterioles and surrounding connective tissue in these specimens and those from 26 age matched controls (15 normotensive, 11 hypertensive) were evaluated in blinded fashion. RESULTS: The following specific histopathological features were evaluated in the SSc patients: duplication or disruption of the internal elastica in 5 (100%), medial hypertrophy in 5 (100%), adventitial changes in 3 (60%), connective tissue fibrosis in 1 (20%), and vasculitis in 1 (20%). There was no significant difference in the frequency of the histopathologic changes between SSc and control patients when evaluated independently. However, the presence of 3 or more features was significantly more frequent in the SSc patients (100%) than in the controls (38%) (p = 0.018). CONCLUSION: The histopathological features evaluated were collectively more frequent in SSc patients; however, many of the control patients also exhibited similar abnormalities. In the female lower genital tract these changes, previously attributed solely to SSc, may be related to other factors.