AGUS in cervical endometriosis.

OBJECTIVE: To evaluate cervical endometriosis as a source of abnormal glandular cells in cervicovaginal smears. STUDY DESIGN: Histologically documented cases of cervical endometriosis with concurrent cervicovaginal smears were reviewed. The cytologic specimens were evaluated for the presence of glandular abnormalities. RESULTS: There were eight cases of superficial endometriosis (five of which had concurrent tuboendometrioid glandular metaplasia) and two cases of deep endometriosis in this series. Five of the eight cases of superficial endometriosis had abnormal glandular cells in the smears; neither of two cases of deep endometriosis had glandular abnormalities. Four of the eight cases of superficial endometriosis had previously undergone conization for cervical intraepithelial neoplasia (CIN) (squamous intraepithelial lesion [SIL]) and were being monitored for recurrence. Of the five cases of atypical glandular cells of unknown significance (AGUS), one case had concurrent high grade CIN (SIL). Another case was originally misinterpreted as recurrent glandular dysplasia. CONCLUSION: Physicians monitoring patients after treatment for CIN need to be aware that endometriosis and tuboendometrioid metaplasia may be the source of atypical glandular cells and on occasion may be subject to misinterpretation.

Calcifying amyloidoma of the breast.

In this case, a distinctive amyloid tumor of the breast clinically simulated carcinoma, although the patient related onset to trauma. Hepatosplenomegaly, elevated globulins, and anemia led to identification of large amounts of monoclonal IgG-kappa production. The patient died of renal failure within several months despite chemotherapy. The matrix of the breast tumor was tinctorially characteristic of amyloid light chain (AL) protein. The mass contained islands of plasma cells that morphologically suggested local production of amyloid matrix. Moreover, plasma cell and matrix immunohistochemically displayed reactivity of IgG-kappa protein, indicating a clonal plasma cell infiltrate. Pseudo-acinar arrangement of plasma cells may be misinterpreted as epithelial cells in needle biopsy specimens. The notion that some amyloidomas may represent in situ production of protein by clonal immunocytes ("secretory immunocytomas") should be further studied.

Calcium pyrophosphate arthropathy of the spine: case report and review of the literature.

Calcium pyrophosphate deposition disease is a relatively uncommon arthropathy characterized by the clinical features of pseudogout, the radiographic manifestations of chondrocalcinosis, and the pathological deposition of calcium pyrophosphate crystals in both hyaline and fibrocartilage. Symptomatic involvement of the spine by calcium pyrophosphate deposition disease is rare except by nodular deposition in the ligamentum flavum and atlanto-occipital ligament. We report a 50-year-old woman who presented with an acute herniated disc syndrome secondary to an intraspinal inflammatory calcium pyrophosphate deposition disease mass at the level of the L4-L5 interspace. The magnetic resonance image and histopathological features of the case are also discussed.

Analysis for steroid production of a Sertoli-Leydig cell tumor.

Sex cord stromal tumors of the ovary can be characterized by the production of virilizing steroid hormones. The authors present a case of a poorly differentiated Sertoli-Leydig cell tumor in which ascitic fluid was found to have a high concentration of androgenic hormones and precursors from the delta steroid pathway (17-OH progesterone, testosterone, and androstenedione). These values correlated with samples taken from the right ovarian vein, draining the ovarian neoplasm, but not with those taken from the left ovarian vein or the peripheral blood sample. Selective peritoneal fluid sampling may aid in the diagnosis of hormonally active tumors.

Pathologic correlation in mammographically directed breast biopsies.

In a series of 1137 diagnostic breast biopsy specimens in a 2-year period, nearly half (n = 534) underwent specimen mammography. Calcifications were found in 48% of the specimen mammograms. In a quarter of the cases, calcification was a marker either for carcinoma or a significant precursor lesion. Moreover, in the majority of these malignancies, calcifications were markers of preinvasive carcinoma. In another quarter of cases, some form of proliferative ductal hyperplasia accounted for calcifications, and in the remainder, cysts and miscellaneous other conditions accounted for calcifications. The yield of malignancy was much lower in noncalcified specimens (12%). A nodular or asymmetric density proved to be a fibroadenoma in 30% of cases. However, the majority of cases had less well-defined changes, probably representing some form of lobular fibrosis. We found submission of a duplicate specimen mammogram with the breast biopsy specimen to pathology to be a significant adjunct to correlation. The abnormal area is marked on the mammogram by the radiologist for the pathologist. This is particularly helpful for localizing noncalcified stromal abnormalities. Calcifications are most easily and reliably isolated by serial slicing and performing another radiograph of the slices.

Prognostic value of pathologic features and DNA analysis in endometrial carcinoma.

In a series of 38 nonmetastasizing and 29 metastasizing endometrial cancers, histologic subtype, aneuploidy, nuclear grade, and depth of myometrial invasion were the features most distinctly separating these two groups of patients. The most important factor was histologic type: papillary, papillary serous, adenosquamous, clear cell, and diffusely infiltrating carcinomas were strongly correlated with metastasis using chi square analysis. Nuclear grade 3 and deep myometrial invasion were similar to each other in sensitivity and predictive value, and both were also strongly correlated with metastatic risk. Aneuploidy, also correlated with metastasis, was similar to nuclear grade 3 and deep myometrial invasion in predictive value but was more sensitive. DNA analysis appeared to be most useful when histologic studies were inconclusive in assigning a high degree of risk. Twice as many aneuploid carcinomas having nuclear grade 2 (intermediate risk) morphology proved to be metastatic. A similar relationship was found with deep myometrial invasion. A quantitative correlation between the DNA index and the risk of metastasis was found; a DNA index above 1.5 was a strong attribute of the metastatic group.

Use of the von Kossa stain in identifying occult calcifications in breast biopsies.

In a two-year series of more than 300 mammographic-directed biopsies with radiographic calcifications, calcium deposits could not be identified in approximately 10% with the use of routine hematoxylin and eosin (H and E) stains. In most of these cases, calcifications, sometimes in surprising amounts, could be identified by use of the von Kossa stain. These included calcium deposits in acinar secretions (nine), cyst fluid (four), ductal ectasia (six), and papillomatosis (five). It would appear that the von Kossa stain is more sensitive for calcium than hematoxylin and is a useful technique when combined with specimen radiography in providing satisfactory radiologic-pathologic correlation.

Feulgen cytometry in simultaneous endometrial and ovarian carcinoma.

The modal DNA value was measured in six patients with simultaneous endometrial and ovarian carcinoma by Feulgen static cytometry. One patient with low-grade endometrial and ovarian carcinoma manifested diploid indices at both sites. Another patient demonstrated aneuploid ovarian carcinoma and diploid endometrial carcinoma, indicating that these were separate neoplasms. The remaining four patients with Stage III disease had aneuploid endometrial and ovarian carcinomas with identical DNA indices. These data support a single neoplastic process with metastasis in the latter four patients. There was good correlation with the clinicopathologic impression on the likelihood of synchronous primaries versus metastatic neoplasms. It was concluded that DNA analysis is a useful adjunct in assessing the probability that spatially separate neoplasms represent metastasis.

Adenocarcinoma arising in Barrett's esophagus with Zollinger-Ellison syndrome.

A 61-year-old man with a 20-year history of recurrent gastric peptic ulcerations had an adenocarcinoma of the esophagus resected. The carcinoma was associated with columnar cell-lined (Barrett's) esophagus with carcinoma in situ. The patient had hypergastrinemia (gastrin level, 1,000 pg/dl), and at autopsy two months after the operation, a 3-mm pancreatic adenoma was discovered. In addition to the rarity of this clinical constellation, the case is of interest in suggesting that hypergastrinemia does not protect against peptic esophagitis and its sequelae.

The glycosaminoglycans of the human colon in inflammatory and neoplastic conditions.

The glycosaminoglycans from normal colonic mucosa and colons with a variety of inflammatory diseases, as well as benign and malignant neoplasms were analyzed. Normal colonic mucosa contains predominantly chondroitin sulfates and dermatan sulfate. Increases in the levels of hyaluronic acid and heparan sulfate, as well as substantial increases in the amount of total glycosaminoglycans were characteristic of invasive colonic adenocarcinoma. Lesser elevations in the amount of total glycosaminoglycans and hyaluronic acid and heparan sulfate were present in neonatal colonic mucosa, villous adenoma, ulcerative colitis, and mucosa adjacent to carcinoma. The degree of elevation was proportional to the dysplastic potential. Since dysplastic lesions have scant connective tissue, the epithelial component of colonic neoplasms may contribute to these neoplasm-related alterations in glycosaminoglycan composition.

Mucinous carcinoma of the colon and rectum.

The clinicopathologic significance of mucus production by adenocarcinoma of the colon and rectum was analyzed in retrospective study with stage matched non-mucus producing control carcinomas. Mucinous carcinoma of the colon and rectum comprised 132 (15%) of 893 cases of colorectal carcinoma. The rectum was the most common site (33% of cases). While 120 mucinous cancers had a poorer five-year survival than non-mucinous tumors (34% vs. 53%, p less than .005), these had a particularly bad prognosis in the rectum (18% 5 year survival vs. 49% for the non-mucinous tumor controls, p less than .00k). The theoretical basis for this location-dependent behavior is considered. From this study, distinctive clinico-pathologic features emerge. There were seven documented cases of ulcerative colitis and 8 additional patients gave a history of "colitis". An additional five patients had received prior pelvic irradiation. Of particular note was the fact that 31% of mucinous carcinomas were associated with villous adenomas, implying a histogenetic relationship. Moreover, this finding again emphasizes the neoplastic potential of the villous adenoma, especially in the rectum where the development of mucinous carcinoma is particularly ominous.