Comparison of cryobiopsy and forceps biopsy for the diagnosis of mediastinal lesions: A randomised clinical trial.

INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard approach for lung cancer staging. However, its diagnostic utility for other mediastinal diseases might be hampered by the limited tissue retrieved. Recent evidence suggests the novel sampling strategies of forceps biopsy and cryobiopsy as auxiliary techniques to EBUS-TBNA, considering their capacity for larger diagnostic samples. METHODS: This study determined the added value of forceps biopsy and cryobiopsy for the diagnosis of mediastinal diseases. Consecutive patients with mediastinal lesions of 1 cm or more in the short axis were enrolled. Following completion of needle aspiration, three forceps biopsies and one cryobiopsy were performed in a randomised pattern. Primary endpoints included diagnostic yield defined as the percentage of patients for whom mediastinal biopsy led to a definite diagnosis, and procedure-related complications. RESULTS: In total, 155 patients were recruited and randomly assigned. Supplementing EBUS-TBNA with either forceps biopsy or cryobiopsy increased diagnostic yield, with no significant difference between EBUS-TBNA plus forceps biopsy and EBUS-TBNA plus cryobiopsy (85.7 % versus 91.6 %, P = 0.106). Yet, samples obtained by additional cryobiopsies were more qualified for lung cancer molecular testing than those from forceps biopsies (100.0 % versus 89.5 %, P = 0.036). When compared directly, the overall diagnostic yield of cryobiopsy was superior to forceps biopsy (85.7 % versus 70.8 %, P = 0.001). Cryobiopsies produced greater samples in shorter procedural time than forceps biopsies. Two (1.3 %) cases of postprocedural pneumothorax were detected. CONCLUSIONS: Transbronchial mediastinal cryobiopsy might be a promising complementary tool to supplement traditional needle biopsy for increased diagnostic yield and tissue harvesting. TRIAL REGISTRATION: ChiCTR2000030373.

Pooling sputum samples for Xpert® MTB/RIF and Xpert® Ultra testing for TB diagnosis.

BACKGROUND: The use of molecular amplification as-says for TB diagnosis is limited by their costs and cartridge stocks. Pooling multiple samples to test them together is reported to have similar accuracy to individual testing and to save costs. METHODS: Two surveys of individuals with presumptive TB were conducted to assess the performance of pooled testing using Xpert® MTB/RIF (MTB/RIF) and Xpert® Ultra (Ultra). RESULTS: A total of 500 individuals were tested using MTB/RIF, with 72 (14.4%) being MTB-positive. The samples were tested in 125 pools, with 50 pools having ⩾1 MTB-positive and 75 only MTB-negative samples: 46/50 (92%, 95% CI 80.8-97.8) MTB-positive pools tested MTB-positive and 71/75 (94.7%, 95% CI 86.9-98.5) MTB-negative pools tested MTB-negative in the pooled test (agreement: 93.6%, κ = 0.867). Five hundred additional samples were tested using Ultra, with 60 (12%) being MTB-positive. Samples were tested in 125 pools, with 42 having ⩾1 MTB-positive and 83 only MTB-negative samples: 35/42 (83.6%, 95% CI 68.6-93.0) MTB-positive pools tested MTB-positive and 82/83 (98.8%, 95% CI 93.5-100.0) MTB-negative pools tested MTB-negative in the pooled test (agreement: 93.6%, κ = 0.851; P > 0.1 between individual and pooled testing). Pooled testing saved 35% (MTB/RIF) and 46% (Ultra) of cartridges. CONCLUSIONS: Pooled and individual testing has a high level of agreement and improves testing efficiency.

CONTEXTE: Le coût et les stocks de cartouches des tests d'amplification moléculaire limitent leur utilisation pour le diagnostic de la TB. Regrouper plusieurs échantillons afin de les tester en même temps aurait une précision similaire à celle des tests individuels et permettrait de réaliser des économies. MÉTHODES: Deux enquêtes ont été menées auprès de personnes avec une TB présumée afin d'évaluer la performance des tests groupés en utilisant le test Xpert® MTB/RIF (MTB/RIF) et le test Xpert® Ultra (Ultra). RÉSULTATS: Au total, 500 personnes ont été testées par test MTB/RIF, dont 72 (14,4%) étaient MTB-positives. Les échantillons ont été testés dans 125 groupes, dont 50 groupes avaient ⩾1 échantillons MTB-positifs et 75 uniquement des échantillons MTB-négatifs : 46/50 (92% ; IC 95% 80,8­97,8) groupes MTB-positifs ont été testés MTB-positifs et 71/75 (94,7% ; IC 95% 86,9­98,5) groupes MTB-négatifs ont été testés MTB-négatifs dans le test groupé (concordance : 93,6% ; κ = 0,867). Cinq cents échantillons supplémentaires ont été testés par test Ultra, dont 60 (12%) étaient MTB-positifs. Les échantillons ont été testés dans 125 groupes, dont 42 avaient ⩾1 échantillons MTB-positifs et 83 uniquement des échantillons MTB-négatifs : 35/42 (83,6% ; IC 95% 68,6­93,0) groupes MTB-positifs ont été testés MTB-positifs et 82/83 (98,8% ; IC 95% 93,5­100,0) groupes MTB-négatifs ont été testés MTB-négatifs dans le test groupé (concordance : 93,6% ; κ = 0,851 ; P > 0,1 entre les tests individuels et groupés). Les tests groupés ont permis d'économiser 35% (MTB/RIF) et 46% (Ultra) des cartouches. CONCLUSIONS: Les tests groupés et individuels présentent un niveau élevé de concordance et améliorent l'efficacité des tests.

Acute phase proteins and IP-10 as triage tests for the diagnosis of tuberculosis: systematic review and meta-analysis.

OBJECTIVES: We examined the data reported in studies for diagnostic purposes and to discuss whether their intended use could be extended to triage, as rule-in or rule-out tests to select individuals who should undergo further confirmatory tests. METHODS: We searched Scopus, PubMed and Web of Science with the terms 'acute phase proteins,' 'IP-10,' 'tuberculosis,' 'screening' and 'diagnosis,' extracted the sensitivity and specificity of the biomarkers and explored methodologic differences to explain performance variations. Summary estimates were calculated using random-effects models for overall pooled accuracy. The hierarchical summary receiver operating characteristic model was used for meta-analysis. RESULTS: We identified 14, four and one studies for C-reactive protein (CRP), interferon γ-induced protein 10 (IP-10) and alpha-1-acid glycoprotein (AGP). The pooled CRP sensitivity/specificity (95% confidence interval) was 89% (80-96) and 57% (36-65). Sensitivity/specificity were higher in high-tuberculosis-burden countries (90%/64%), HIV-infected individuals (91%/61%) and community-based studies (90%/62%). IP-10 sensitivity/specificity in TB vs. non-TB studies was 85%/63% and in TB and HIV coinfected vs. other lung conditions 94%/21%. However, IP-10 studies included diverse populations and a high risk of bias, resulting in very low-quality evidence. AGP had 86%/93% sensitivity/specificity. CONCLUSIONS: Few studies have evaluated CRP, IP-10 and AGP for the triage of symptomatic patients. Their high sensitivity and moderate specificity warrant further prospective studies exploring whether their combined use could optimize performance.

The minimal important difference for target lobe volume reduction after endoscopic valve therapy.

Objective: Endoscopic valve therapy aims at target lobe volume reduction (TLVR) that is associated with improved lung function, exercise tolerance and quality of life in emphysema patients. So far, a TLVR of >350 mL was considered to be indicative of a positive response to treatment. However, it is not really known what amount of TLVR is crucial following valve implantation. Patients and methods: TLVR, forced expiratory volume in 1 second (FEV1), residual volume (RV) and 6-minute walk distance (6-MWD) were assessed before and 3 months after valve implantation in 119 patients. TLVR was calculated based on computed tomography (CT) scan analysis using imaging software (Apollo; VIDA Diagnostics). Minimal important difference estimates were calculated by anchor-based and distribution-based methods. Results: Patients treated with valves experienced a mean change of 0.11 L in FEV1, -0.51 L in RV, 44 m in 6-MWD and a TLVR of 945 mL. Using a linear regression and receiver operating characteristic analysis based on two of three anchors (ΔFEV1, ΔRV), the estimated minimal important difference for TLVR was between 890 and 1,070 mL (ie, 49%-54% of the baseline TLV). Conclusion: In future, a TLVR between 49% and 54% of the baseline TLV, should be used when interpreting the clinical relevance.

Clinical and radiological outcome following pneumothorax after endoscopic lung volume reduction with valves.

INTRODUCTION: Valve implantation has evolved as a therapy for patients with advanced emphysema. Although it is a minimally invasive treatment, it is associated with complications, the most common being pneumothorax. Pneumothorax occurs due to the rapid target lobe volume reduction and may be a predictor of clinical benefit despite this complication. OBJECTIVE: The objective of this study was to conduct an exploratory data analysis of patients who developed a pneumothorax following endoscopic valve therapy for emphysema. MATERIALS AND METHODS: This study performed a retrospective evaluation of pneumothorax management and the impact of pneumothorax on clinical outcomes in 70 patients following valve therapy in 381 consecutive patients. RESULTS: Pneumothorax rate following valve therapy was 18%. Pneumothorax management consisted of chest tube insertion, valve removal, and surgical intervention in 87% (61/70), 44% (31/70), and 19% (13/70) of the patients, respectively. Despite pneumothorax, patients experienced modest but significant improvements in lung function parameters (forced expiratory volume in 1 second: 55±148 mL, residual volume: -390±964 mL, total lung capacity: -348±876; all P<0.05). Persistent lobar atelectasis 3 months after recovering from pneumothorax, which was associated with relevant clinical improvement, was observed in only 21% (15/70) of the patients. CONCLUSION: Pneumothorax is a frequent severe complication following valve therapy that requires further intervention. Nevertheless, the pneumothorax does not impair the clinical status in the majority of patients. Patients with lobar atelectasis benefit after recovering from pneumothorax in terms of lung function parameters.

Levels of prostaglandin E(2) and Cysteinyl-leukotrienes in sputum supernatant of patients with asthma: the effect of smoking.

BACKGROUND: Smoking is associated with worse asthma outcomes and may modify airway inflammation. Such modification may be mediated through an effect on prostaglandin E(2) (PGE(2)) and cysteinyl leukotrienes (Cyst-LTs). OBJECTIVE: We aimed to determine the levels of both PGE(2) and Cyst-LTs in sputum supernatants of patients with asthma and to investigate the effect of smoking habit as well as their associations with inflammatory cells, bronchial hyperresponsiveness (BHR) and lung function. METHODS: Ninety-eight patients to asthma (47 smokers) and 40 healthy subjects (20 smokers) were studied. All subjects underwent sputum induction for cell count identification, PGE(2) and Cyst-LTs levels measurement in supernatants, pulmonary function tests and BHR to methacholine. RESULTS: Patients with asthma had significantly higher levels of both Cyst-LTs and PGE(2) in sputum supernatants compared to healthy subjects [median (interquartile ranges) 432 (287, 575) vs. 91.5 (73.5, 111) pg/mL and 654 (456,789) vs. 117.5 (92,157) pg/mL, respectively, P < 0.001 for both comparisons]. Smoking asthmatics had significantly higher Cyst-LTs and PGE(2) levels compared to non-smoking asthmatics. Cyst-LTs levels in sputum supernatant of smoking asthmatics presented a significant positive association with sputum eosinophils, while PGE(2) levels were positively associated with sputum neutrophils. CONCLUSIONS: The increased concentrations of PGE(2) and Cyst-LTs in sputum supernatants of smoking asthma are consistent with an up-regulation of these two mediators in this specific phenotype of asthma. Furthermore, Cyst-LTs are associated with eosinophilic inflammation, while PGE(2) is associated with the presence of neutrophilic inflammation in smoking asthma.

Exhaled breath condensate in asthma: from bench to bedside.

The need for non-invasive assessment of airway inflammation is imperative, since inflammatory airway diseases, such as asthma and COPD, are characterized by variation in their clinical presentation throughout their course. Exhaled breath condensate (EBC) collection represents a rather appealing method that can be used to conveniently and noninvasively collect a wide range of volatile and non-volatile molecules from the respiratory tract, without affecting airway function or inflammation. Although promising, EBC is currently used only as a research tool, due to the lack of appropriate standardization and the absence of reference values. A large number of mediators of inflammation, oxidative and nitrosative stress, including adenosine, ammonia, hydrogen peroxide, isoprostanes, leukotrienes, prostanoids, nitrogen oxides, peptides and cytokines, have been studied in EBC. This review focuses mainly on the presentation of the above biomarkers in asthma as well as on the effect of various factors on their concentrations. Concentrations of such mediators have been shown to be related to the underlying asthma and its severity and to be modulated by therapeutic interventions. Despite the encouraging positive results up-to-date, the introduction of EBC in everyday clinical practice requires the work-out of some methodological pitfalls, the standardization of EBC collection, and finally the identification of a reliable biomarker which is reproducible, has normal values and provides information for the underlying inflammatory process and the response to treatment. So far none of the parameters studied in EBC fulfils the aforementioned requirements.

Granulosa cell tumors of the ovary: a clinicopathologic and immunohistochemical study of 21 cases.

PURPOSE: To further study the clinicopathologic and immunohistochemical features of ovarian granulosa cell tumors (GCTs). METHODS: We retrospectively studied all cases of GCTs diagnosed in our laboratory over the last 10-year period. Immunohistochemistry for inhibin, vimentin, cytokeratin, Ki-67 and p53 was performed on archival paraffin blocks. Pathologic and immunohistochemical findings were correlated with the clinical records of the patients. RESULTS: Twenty-one cases (15 of the adult and 6 of the juvenile type) were retrieved. All patients were FIGO Stage I at the time of diagnosis. Recurrent disease was detected in four patients (19%) during a median follow-up of 36 months (range 2-26 years). Pathology revealed a concomitant theca-cell component in three cases, a Sertoli-Leydig component in one case, and a thecoma in one case. Archival tissue material was available in 12 cases. Immunohistochemistry was positive for: beta-inhibin in 12/12 cases (100%), vimentin in 11/12 cases (91.7%), cytokeratin in 3/12 cases (25%), CD34 in 0 cases (0%), and p53 in 2/12 cases (16.7%). The Ki-67 index was < 5% in 12/12 cases (100%). No significant correlations were observed between the pathologic and immunohistochemical parameters examined and the clinical outcome. CONCLUSIONS: Despite the relatively indolent nature and favorable prognosis of most GCTs, late recurrences are not a rare event even in Stage I patients, necessitating a close and long-term follow-up. The identification of novel prognostic markers, in addition to our traditional staging parameters such as clinical staging, is needed in order to more accurately predict probabilities of recurrence in these patients.

The use of comet assay in measuring DNA damage and repair efficiency in child, adult, and old age populations.

In the present study, we used the Comet assay to estimate basal DNA damage in three distinct populations aged 5-10, 40-50, and 60-70 years old. The DNA damage induced by hydrogen peroxide and gamma-irradiation in the lymphocytes of these populations, as well as their repair activity, was also studied. Finally, we measured apoptosis and necrosis after the effect of these agents. Our results indicate that the older population (60-70 years old) showed higher basal levels of DNA damage and was more sensitive to the effects of the DNA-damaging agents than the adult one (40-50 years old), who, in turn, was more sensitive than the younger population (5-10 years old). A decline of the repair efficiency with age to the DNA damage induced by the two agents was also observed. Apoptosis and necrosis were also affected by age.

Measuring the effects of pesticides on occupationally exposed humans with the comet assay.

In this study we examine the effects of a mixture of pesticides on occupationally exposed agricultural workers. The study was performed on 149 people, 84 agricultural workers and 65 healthy men from the same area, who served as the control group. The exposed group was divided into a subgroup with 65 individuals moderately exposed (39 men and 26 women) and a highly exposed subgroup consisted of 19 men. The statistical analysis of the comet assay results showed that there were no significant differences in basal DNA damage between pesticide-exposed workers and the control group nor between moderately and highly exposed ones. In addition, exposure of peripheral blood lymphocytes to hydrogen peroxide or gamma-irradiation led to a similar degree of DNA damage and subsequent repair for all the studied populations.

CD56: a useful tool for the diagnosis of small cell lung carcinomas on biopsies with extensive crush artefact.

BACKGROUND/AIMS: The diagnosis of small cell lung carcinoma (SCLC) on bronchial biopsy is often problematical as a result of intense crush artefact. Several antibodies are now available to help in the diagnosis of SCLC and their value was assessed in this clinical situation. METHODS/RESULTS: Twenty cases of SCLC and 10 control cases (one non-Hodgkin lymphoma, three non-small cell carcinomas, one follicular reactive hyperplasia, and five chronic non-specific inflammations) with extensive crush artefact were stained using antibodies to CD56, MNF116, thyroid transcription factor 1 (TTF-1), and CD45. All SCLCs showed strong positive staining for CD56 in 75-100% of recognisable tumour cells, even in areas where there was extensive crush artefact. Eighteen of 20 cases were positive for TTF-1 and 16 of 20 were positive for MNF116 in the tumour cells, but both of these antibodies showed little or no staining in areas of crush artefact. Control cases comprising lymphoid cells were positive for CD45 in areas of crush artefact, but all cases of SCLC were negative. CONCLUSION: CD56, along with markers for cytokeratins-TTF-1, and CD45-are useful in the diagnosis of SCLC in biopsies with extensive crush artefact and can help confirm the diagnosis in cases where features are equivocal.

Localized hyaline plaque of the diaphragmatic peritoneum: report of a rare entity mimicking a hepatic tumor.

A liver tumor (2.5x3 cm) with malignant features on computed tomography (CT) and magnetic resonance imaging (MRI) was detected in a 69-year-old man with hepatitis B virus (HBV)-associated cirrhosis. On exploratory laparotomy a mass at the right diaphragmatic dome adherent to the liver segment VIII was found. En-block resection of this segment and the part at diaphragm hosting the tumor was carried out. On histology the tumor was a diaphragmatic hyaline plaque while in the resected liver no tumor was found.

Outcome of patients with ovarian metastatic tumors. Report of 83 cases and review.

UNLABELLED: The aim of the study was to review patients with metastatic ovarian tumors in relation to their outcome and clinical characteristics. METHODS: It was a retrospective study including 83 patients with histopathological diagnosis of metastatic ovarian tumor. The examined parameters include age of the patients, origin of the tumor, consistency and appearance of the tumor, histological type and 5-year survival. RESULTS: The 5-year survival time of patients with metastatic ovarian tumors originating from the genital tract was 14.8% and for metastatic ovarian tumors originating outside the genital tract 5.4%. CONCLUSION: The presence of metastatic ovarian tumors should always be included in the differential diagnosis of a pelvic mass. Difficulties in identification of the primary tumor site are present mainly in cases of metastatic tumors from the colon, while metastasis to the ovary from the breast tends to form small nodules in the ovary.

Extraovarian mullerian-type cystic tumors of the female. A report of six cases and review of the literature.

Six cases of extraovarian cystic tumors of mullerian type are reported. Patient age ranged from 27-71 years. Tumor diameters were 5-11 cm and were located in the mesentery (4/6) and retroperitoneum (2/6). Four tumors were of mucinous type (1/4 of borderline malignancy) and two of serous type. These tumors clinically and histopathologically mimic other primary tumors of the peritoneum. The problems of differential diagnosis are discussed.

Clinicopathological study of vascular tumors of the breast: a series of ten patients with a long follow-up.

Ten cases of vascular tumors of the breast were examined in our laboratory during the last decade (1992-2001). Nine patients were female and one male (ages 31-77, average 52 years). Six patients presented parenchymal vascular lesions (1 angiosarcoma, 1 atypical hemangioma, 3 perilobular hemangiomas, 1 cavernous hemangioma) measuring 0.5-6 cm in the greatest diameter. Two lesions were accidental findings in lumpectomy specimens excised for fibrocystic disease with microcalcifications. Four patients presented non-parenchymal vascular lesions: three cavermous hemangiomas (one in a male patient) and one angiolipoma measuring 1-6 cm in diameter. All tumors were treated by lumpectomy with the exception of the atypical hemangioma which was treated by simple mastectomy. The patient with the angiosarcoma was treated by simple mastectomy, radiotherapy and chemotherapy and died with disseminated disease three years after initial diagnosis. All other patients are well up to date (follow-up 1-9 years).

A clinicopathological study of the relationship between adenomyosis and other hormone-dependent uterine lesions.

AIM: The aim of this study was to investigate the relationship between adenomyosis, endometrial adenocarcinoma, hyperplasia and uterine leiomyomas. MATERIAL AND METHODS: 135 consecutive hysterectomy specimens showing adenomyosis and 82 consecutive cases of endometrial adenocarcinoma were studied in our laboratory in the last 5-year period. The histological sections of all cases were reviewed and in the cases with adenocarcinoma, the type of cancer, the degree of differentiation and the depth of myometrial invasion were recorded. In the adenomyosis group the presence of any other lesions, the extension of adenomyosis and the morphology of the adenomyotic glands were recorded. In ten random cases of adenomyosis, the presence of estrogens and progesterone receptors was investigated by an immunohistochemical method of peroxidase-antiperoxidase and DAB chromogen. In ten cases of this group the expression of E-cadherin was studied immunohistochemocally by an avidin-viotin method and DAB chromogen. RESULTS: In 47/135 cases of adenomyosis adenomatous hyperplasia coexisted (34.8%) and in 86/135 cases of leiomyomas (63.7%). In 31/82 cases of adenocarcinoma there was adenomyosis as well (37.8%), in 4/82 cases malignant changes in foci of adenomyosis were observed and in 1/82 cases the malignancy arose in a focus of adenomyosis. Immunohistochemical studies showed the presence of progesterone receptors in the glandular cells of adenomyosis in 9/10 cases and of estrogen receptors in 2/10 cases. In all study cases (10/10) a positive membrane immunoreaction was observed; focal (6/10) and extensive (4/10). CONCLUSION: The high frequency of coexistence between adenomyosis and other hormone-dependent uterine lesions is indicative of the presence of a hormonal factor in the pathogenesis of adenomyosis.

Malignant neoplasms arising in endometriosis: clinicopathological study of 14 cases.

During the last 15-year period in our laboratory, 14 cases of malignant change of endometriosis were diagnosed in women 37-70 years of age. Seven cases were adenocarcinomas, one case was an adenosarcoma and six cases presented the morphology of endometrial stromal sarcoma. Eleven cases developed in various sites of the genital system (5/11 in the ovaries, 3/11 in the uterus 2/11 in the vagina, 1/11 in the tubal wall) and three cases in extragenital sites (1/3 in the omentum, 1/3 in the pelvis, 1/3 in the colon). Immunohistochemical investigation for the expression of cytokeratines, vimentin, hormonal receptors, E-cadherin, desmine and smooth muscle actin was performed by a streptavidin-biotin method. The immunopathology profile and follow-up results after therapy are presented.

Prognostic predictors of gastrointestinal stromal tumors: a multi-institutional analysis of 102 patients with definition of a prognostic index.

AIMS: The aim of this study is to identify prognostic factors influencing survival in patients with gastrointestinal stromal tumors (GISTs) and to identify a mathematical model that can predict lifetime expectation. METHODS: One hundred and two patients with GISTs, were followed retrospectively for a median period of 32 months (from 1 to 82 months). Complete follow-up data were available in 72 cases. All tumors were surgically resected and examined by conventional light microscopy, immunohistochemistry and image analysis. The tumors' location, size, histologic characteristics, immunophenotype, proliferative activity index (assessed by proliferating cell nuclear antigen (PCNA) and Ki-67 immunoreactivity) and the apoptotic markers bcl-2 and bax, were considered as potential prognostic factors and were correlated with patient survival. RESULTS: Tumor size >8 cm (p<0.03), presence of necrosis (p<0.02), number of mitoses >5/10 HPF (p<0.01), metastasis (p<0.001), and PCNA index >10% (p<0.004) were significant predictors of poor survival. Bcl-2 protein (p<0.0007) was a favorable prognostic indicator. If all tumors were treated as of uncertain malignant potential, the following mathematic model named GISTs Prognostic Index (GPI), could be formed by the linear regression technique: GPI exp=(49.6 months-Status of metastasis x 22.9185-Size in cm x 0.6801+bcl-2 expression% x 0.2569) (r(2)=0.67) (Prob>F=0.0001). CONCLUSIONS: Tumors' size, necrosis, mitoses, metastasis and PCNA index are independent poor prognosticators, while bcl-2 protein is associated with favorable prognosis. An interesting equation for survival in patient with GISTs has been reported.

Immunopathological study of mesonephric lesions of cervix uteri and vagina.

Seventeen cases of mesonephric cervical remnants, four cases of mesonephric cervical carcinoma and nine vaginal Gardner cysts were studied by histochemical and immunohistochemical methods for the presence of mucin, proteoglucans, glucogen, CEA, cytokeratins, secretory component and vimentin. Mesonephric lesions in contrast to endocervical glandular lesions are negative for mucin, glucogen, CEA, and secretory component and positive for vimentin, and broad spectrum cytokeratins. Mesonephric carcinomas present certain immunopathological characteristics that permit their identification and proper treatment.

Vascular tumors of the female genital tract: a clinicopathological study of nine cases.

UNLABELLED: The aim of this study was to investigate the clinicopathological features of nine unusual vascular tumors of the female genital tract and to investigate the problems in the differential diagnosis from other genital lesions. MATERIAL-METHODS: In a review of 15,000 specimens of the female genital system examined in our Laboratory during the last decade, nine cases of vascular tumors were found. RESULTS: A capillary hemangioma of the endometrium, one capillary and one cavernous hemangioma of the cervix, six vulva lesions (one capillary, and one cavernous hemangioma and four angiokeratomas) and one hemangiosarcoma of the mons pubis in a 76-year-old patient were diagnosed. CONCLUSIONS: The differential diagnosis of the vascular tumors must be made mainly from endometriotic lesions and melanomas. Immunohistochemistry (S-100, CD31, CD34, CKS, EMA) aid in the diagnosis. Local excision is adequate for the benign vascular lesions.