Endometrioid adenocarcinoma of the uterus with a minimal deviation invasive pattern.

AIMS: Minimal deviation adenocarcinoma of endometrioid type is a rare pathological entity. We describe a variant of typical endometrioid adenocarcinoma associated with minimal deviation adenocarcinoma of endometrioid type. METHODS AND RESULTS: One 'pilot' case of minimal deviation adenocarcinoma of endometrioid type associated with typical endometrioid adenocarcinoma was encountered at our institution in 2001. A second case of same type was received in consultation. We reviewed 168 consecutive hysterectomy specimens diagnosed with 'endometrioid adenocarcinoma' specifically to identify areas of minimal deviation adenocarcinoma of endometrioid type. Immunohistochemistry was done with the following antibodies: MIB1, p53, oestrogen receptor (ER), progesterone receptor (PR), cytokeratin 7 (CK7), cytokeratin 20 (CK20), carcinoembryonic antigen (CEA), and vimentin (VIM). Four additional cases of minimal deviation adenocarcinoma of endometrioid type were identified. All six cases of minimal deviation adenocarcinoma of endometrioid type were associated with superficial endometrioid adenocarcinoma. In two cases with a large amount of minimal deviation adenocarcinoma of endometrioid type, the cervix was involved. The immunoprofile of two representative cases was ER+, PR+, CK7+, CK20-, CEA-, VIM+. MIB1 immunostaining of four cases revealed little proliferative activity of the minimal deviation adenocarcinoma of endometrioid type glandular cells (0-1%) compared with the associated 'typical' endometrioid adenocarcinoma (20-30%). The same four cases showed no p53 immunostaining in minimal deviation adenocarcinoma of endometrioid type compared with a range of positive staining in the associated endometrioid adenocarcinoma. CONCLUSIONS: Minimal deviation adenocarcinoma of endometrioid type more often develops as a result of differentiation from typical endometrioid adenocarcinoma than de novo. Due to its deceptively benign microscopic appearance, minimal deviation adenocarcinoma of endometrioid type may be overlooked and may lead to incorrect assessment of tumour depth and pathological stage. There was a tendency for tumour with a large amount of minimal deviation adenocarcinoma of endometrioid type to invade the cervix.

Lack of expression of c-KIT in ovarian cancers is associated with poor prognosis.

The c-KIT protooncogene encodes a tyrosine kinase receptor, KIT, that is expressed in many normal and cancerous tissues. In this study, we have examined the expression of c-KIT and its ligand, stem cell factor (SCF), in human epithelial ovarian tumors, in normal ovaries and in cultured ovarian surface epithelium (OSE). Cultured cells, normal tissues and tumors were analyzed by Northern and Western blot analyses, reverse transcription-polymerase chain reaction and immunohistochemistry. Normal OSE expressed SCF, but not c-KIT; however, epithelial invaginations and inclusion cysts often expressed KIT protein. Of 15 benign ovarian tumors and tumors of low malignant potential, 87% expressed c-KIT, and 92% of these co-expressed SCF, suggesting the possibility of autocrine growth regulation. Of 35 malignant ovarian cancers, 71% expressed c-KIT (92% co-expressed SCF), with a trend for decreased c-KIT expression in advanced stage disease. Of 34 patients with malignant tumors for whom follow-up information was available (median follow-up time of 24 months), 9 had tumors that did not express c-KIT, 8 (89%) of whom have died and the remaining 1 has recurrent disease. Of the 25 patients with tumors expressing c-KIT, 56% are still alive. Eight of the patients have no evidence of disease and all had KIT-expressing tumors. Statistical analysis indicated that patients whose tumors did not express c-KIT had a significantly shorter (p < 0.05) disease-free survival time than patients who had KIT-expressing tumors. Our results suggest that c-KIT may play a role in early ovarian tumorigenesis, and that loss of c-KIT expression is associated with poor prognosis.

Regional activation of L-type voltage-sensitive calcium channels in experimental thiamine deficiency.

During pyrithiamine-induced thiamine deficiency (PTD), specific regions of the brain develop histological damage. The basis of this selective vulnerability is unknown but the mechanism may involve a glutamate-mediated excitotoxic process in affected structures, leading to alterations in membrane potential and disturbances in calcium homeostasis. In this study, we have examined the volume of distribution of [3H]nimodipine, an L-type voltage-sensitive calcium channel (VSCC) antagonist, in the brain of the PTD rat. An increase in specific binding of [3H]nimodipine was detected only in the posterior thalamus at the symptomatic stage, immediately following the loss of righting reflexes (P < 0.0001). There was also an increase in nonspecific binding in the medial geniculate and inferior colliculi. Replenishment with thiamine at the symptomatic stage returned [3H]nimodipine binding to normal levels. These findings provide evidence that depolarization and activation of L-type VSCCs occur in the posterior thalamus and may contribute to the appearance of histological lesions in this structure during experimental thiamine deficiency.

Ultrasonographic appearance of uterine lipoleiomyoma.

A uterine lipoleiomyoma in a 43-year-old woman is described and pathological correlation of the diagnosis provided. The lesion appeared in transabdominal ultrasonography (US) scans as highly echogenic areas producing the marked attenuation typical of a lipomatous tumour of the uterus. In this case US alone was specific enough to allow tissue characterization and establish an accurate preoperative diagnosis.

Ectopic pregnancy: evolution after treatment with transvaginal methotrexate.

A prospective study was performed with 25 patients with ectopic pregnancies (EPs) who underwent treatment with transvaginal administration of methotrexate. Nineteen patients (76%) had positive responses to this treatment, and six (24%) had to undergo surgery: five because of increasing abdominal pain and one because of vaginal bleeding. The ultrasonographic (US) resolution of the EP was long and lagged behind the resolution at testing of levels of beta subunit of human chorionic gonadotropin (beta-hCG) in all patients. The fallopian tube in 12 (63%) of the responding group initially increased in diameter from a mean of 2.22 cm to a mean of 3.84 cm. In 13 (68%) of the responding group, it became more vascular at color Doppler examination. Eleven (92%) of the 12 EPs that increased in size also became more vascular. The increase in tubal size and vascularity, in spite of the falling beta-hCG level, represents a healing process and should cause no concern about the follow-up of these patients.

Computed tomographic detection of skeletal muscle calcifications in rhabdomyolysis.

The authors report a case of rhabdomyolysis with extensive calcification of the paravertebral muscles secondary to ingestion of desipramine hydrochloride, a tricyclic antidepressant. Computed tomography (CT) and isotope scanning were performed, and pathological confirmation of the condition was obtained. The extent of the calcification was probably due to the administration of supplementary calcium to correct hypocalcemia. The authors discuss the correlation between the CT and isotope scan findings.

Transvaginal US-guided aspiration of ovarian cysts and solid pelvic masses.

Sixty-eight transvaginal ultrasound (US)-guided aspirations or biopsies were performed in 61 patients, of whom 48 had ovarian cysts and 13 had solid pelvic masses. In one patient with an ovarian cyst, aspiration revealed malignancy. Thirty-six of the 48 cysts were drained transvaginally in 23 premenopausal and 13 postmenopausal women, with recurrence rates of 48% and 80%, respectively. In seven cases a cyst was aspirated twice. In the 13 patients with solid pelvic lesions, 11 lesions proved to be malignant, with positive biopsy results in nine (sensitivity, 82%). Two benign lesions were correctly identified. No major complication was observed. The authors conclude that the transvaginal route offers simple access to pelvic lesions in pre- and postmenopausal patients. For women with a solid pelvic lesion, transvaginal aspiration biopsy with endovaginal US guidance is a safe and effective alternative to surgery, especially for patients with previously diagnosed malignant disease.

Ovarian cysts in postmenopausal women: preliminary results with transvaginal alcohol sclerosis. Work in progress.

Seven patients with a recurrent ovarian cyst after transvaginal needle aspiration underwent alcohol sclerosis of the cyst. The cysts had the appearance of simple cysts at ultrasound (US). Sclerosis, an outpatient procedure, was performed with a transvaginal approach under continuous endovaginal US guidance. After aspiration of the cyst contents, approximately two-thirds of the aspirated fluid was replaced with 100% alcohol that was left in place for 20 minutes and then aspirated. No complication was observed. Four cysts had not recurred at follow-up examinations performed 2, 5, 7, and 12 months, respectively, after sclerosis. One patient underwent surgery because mucinous material was found on analysis of the specimen, which was proved to be a benign cystadenoma. The two other cysts recurred, and one patient underwent surgery. Alcohol sclerosis of ovarian cysts may have a role in the treatment of postmenopausal women with ovarian cysts with a low risk of malignancy.

1,2-Dimethylhydrazine-induced nuclear aberrations in A/J and C57BL/6J mouse colonic crypts.

A single exposure to 1,2-dimethylhydrazine [(DMH) CAS: 540-73-8] produces several forms of aberrant nuclei in the crypts of the murine colon. The frequency of nuclear aberrations (NAs) was examined in the distal colonic crypts in DMH-sensitive A/J mice and relatively DMH-resistant C57BL/6J mice before and after a single exposure to DMH. NAs, mitotic figures, and crypt column heights were scored for all animals as a function of time following administration of DMH. In both strains there was a significant increase in the absolute and relative frequency of NAs by 12 hours, with a corresponding drop and subsequent overshoot in the mitotic index by 48 hours after DMH. The temporal changes in crypt column height correlate closely with the temporal changes in frequency of NAs in both strains. The results showed that both inbred strains respond to acute DMH exposure in a similar and parallel fashion over time. It was concluded that the NA index assay is a sensitive method for detecting early DMH exposure. However, this assay does not relate to ultimate outcome after chronic DMH exposure and should not be used as a predictor of eventual neoplastic transformation of colonic mucosa with this carcinogen.

Effect of long-term metronidazole (MTZ) therapy on experimental colon cancer in rats.

Current reports suggest a beneficial effect of long-term metronidazole ( MTZ ) therapy in Crohn's disease. Since Crohn's disease is associated with a higher risk of bowel cancer and long-term MTZ has been shown to have a tumorigenic potential in rodents and a cocarcinogenic effect in experimental colon cancer, more studies are required to explore this area. Eighty-one rats were divided into four groups. Group A served as a control, groups B and C were given MTZ in their food (50 mg/kg/day). In groups C and D, a 3-cm colonic segment was isolated and brought out as a blind loop fistula. All animals received 20 weekly sc doses of 1,2-dimethylhydrazine (DMH) and were killed 25 weeks after the first injection. The mean number of colon tumors per animal (+/- SEM) in MTZ groups B (1.65 +/- 0.29) and C (2.57 +/- 0.38) were higher than A (1.44 +/- 0.3) and D (1.18 +/- 0.21), but the increase was only significant for group C over groups A and D (P less than 0.05) and group B (P = 0.06). The mean number of tumors per animal in the isolated loop of group C (0.95 +/- 0.28) was similar to group D (0.68 +/- 0.16) P = 0.41, but the mean number of tumors in the functioning colon of group C (1.62 +/- 0.25) was higher than group D (0.5 +/- 0.12) P less than 0.001. These findings suggest that long-term MTZ increased the number of colon tumors per rat in the DMH model but a statistical significance (P less than 0.05) was only noted in the MTZ and surgery group.(ABSTRACT TRUNCATED AT 250 WORDS)

Histology, ultrastructure, and immunohistochemistry of strumal carcinoid: a case report.

A case of ovarian strumal carcinoid was studied by histochemistry, electron microscopy, and immunocytochemistry. The thyroid component of the tumor was micro-macrofollicular, whereas the carcinoid areas had a trabecular growth pattern. Carcinoid cells contained argyrophilic, dense-core secretory granules and were immunopositive for serotonin but not for calcitonin, somatostatin, or thyroglobulin. Follicular thyroid cells were positive for thyroglobulin, and were negative for calcitonin and somatostatin. Thyroglobulin and serotonin-containing cells were present in microfollicles adjacent to areas of trabecular carcinoid and struma ovarii. The data suggest that strumal carcinoids develop in close association with struma ovarii and represent a subset of ovarian teratomas. Current hypotheses on the cell of origin of strumal carcinoids are reviewed.

The fat/fiber antagonism in experimental colon carcinogenesis.

Current epidemiologic and experimental data emphasize the importance of nutrition in colon carcinogenesis. The interactions between dietary fat and dietary fiber were studied in the dimethylhydrazine model for colon cancer. A strict pair-feeding system was developed, and rats were fed one of five semisynthetic diets containing various amounts and types of fat and fiber. The incidence and number of tumors per animal were increased in all fat-fed groups. Adding fiber to the diets provided either partial (polyunsaturated fat) or complete (saturated fat) protection against the deleterious effect of fat. The antagonism between fat and fiber and the clinical relevance of these data are discussed.