Bilateral Salpingo-oophorectomy Specimens Research Articles

Study of significance of p53 expression in primary ovarian tumour

The purpose of the study was to understand the molecular changes that happen in human cancer, P53 gene mutation. Here, with respect to P53 immunohistochemical staining were taken into consideration as the surrogate for the mutational analysis. This was used for the diagnosis of ovarian cancer. The main aim of the study was to evaluate the immunohistochemical frequency of the P53 and to correlate its expression with the prognosis. In the current study 107 cases associated with ovarian cancer were studied. The samples received were hysterectomy as well as unilateral and bilateral salpingo-oophorectomy specimens, which were fixed in 10% neutral buffer formalin and processed routinely. 68.7% of the patients showed P53 malignant ovarian tumours. In the benign, it was considered as negative or in the position of borderline tumour. No statistically significant correlation was shown between the age and P53 expression. There was statistically significant difference between borderline, benign and the malignant tumors. It was also assessed that there was a statistically significant difference between P53 expression and serous carcinoma in the current study. The present study concludes that P53 tumor gene was found to be mutated in more than the 50% of the human cancer and was expressed as the aberrant form of protein. The study also concludes that in borderline tumor, P53 rarely mutates and is results in poor prognosis.

Histologic Features of Hysterectomy Specimens From Female-Male Transgender Individuals.

Histologic changes in the female genital tract after prolonged androgen stimulation have been described in the past. However, these changes have not been systematically addressed in hysterectomy specimens from subjects undergoing surgical gender-reassignment, typically after treatment with exogenous androgens. The current study aims to provide practicing pathologists with a list of expected histologic features in hysterectomy specimens from female-male transgender individuals. Twenty-seven hysterectomy with bilateral salpingo-oophorectomy specimens were identified from our Laboratory Information System. Slides were retrieved and reviewed for features associated with androgen exposure. Clinical information for the 27 subjects (20-46 yr old, mean=29 yr) was obtained from the electronic medical records. Twenty-four subjects had received androgen 19 mo to 24 yr preoperatively. Focal decidua-like endometrial stromal change with glandular paucity was present in 16/27 (59%) uteri associated with predominantly inactive endometrial glands. Ectocervical or transformation zone transitional cell metaplasia was present in 17/27 (63%) subjects. Bilateral cystic follicles were present in all 23 subjects who underwent bilateral salpingo-oophorectomy and had preoperative androgen exposure. In these ovaries, follicular density appeared higher than that expected for age with counts ranging from 1.5 to 32.5 follicles/mm (average=10.7 follicles/mm). Predominantly inactive, sparse endometrial glands with focal decidua-like stromal change, cervical transitional cell metaplasia, bilateral cystic follicles and higher follicular density are observed in the majority of specimens from female-male transgender individuals. These histologic changes correlate with prolonged preoperative androgen administration. The significance of these findings relies on recognizing the spectrum of androgen-related histologic alterations and not confusing transitional cell metaplasia with cervical dysplasia.

Age of Salpingo-Oophorectomy and Risk of Peritoneal Carcinomatosis in Patients with a BRCA Mutation

Background: Women with BRCA1/2 germline mutations who undergo bilateral salpingo-oophorectomy (BSO) are left with a residual risk of peritoneal serous carcinoma (PSC). We aimed to identify the incidence and risk factors for the development of PSC after BSO in BRCA1/2 mutation carriers. Methods: One-hundred-seventeen BRCA1/2 mutation carriers who underwent BSO were evaluated for further development of PSC. The BSO specimens were evaluated for occult Fallopian tube carcinoma (FTC), ovarian carcinoma (OVC) and serous tubal intraepithelial carcinoma (STIC) in all patients. P53-signature was available in 58 patients. Clinical data was obtained from patients’ charts. We calculated the association between clinical, pathological and molecular risk factors of PSC after BSO. Results: Analysis of BSO specimens revealed occult FTC in 1 woman (0.8%), STIC in 2 women (1.7%), and 6/58 women (10.3%) had a positive “p53 signature”. Older age at menopause (p=0.007) and shorter oral contraceptive use (p<0.001) were associated with FTC and STICs. The incidence of PSC after BSO was 1.7% (two patients). Both were BRCA2 mutation carriers and one had a history of STIC. The only risk factor identified for PSC after BSO was older age at surgery (63.5 years for patients with PSC vs. 48.6 years for patients without PSC, p<0.001). Conclusions: The incidence of PSC after BSO in our series is 1.7% and it is associated with an older age at BSO. Earlier menopause and oral contraceptive use seem to be associated with a decrease in the prevalence of occult FTC and STICs.

Mimicry of sugar tumor and minute pulmonary meningothelial-like nodule to metastatic lung deposits in a patient with rectal adenocarcinoma

Several reports have described different lung lesions mimicking primary or metastatic neoplasms. In this paper, we describe the different features of two uncommon and benign lung lesions mimicking metastasis from a primary large bowel adenocarcinoma. Our patient is a 75-year old female with a history of invasive rectal adenocarcinoma. One month after her surgery, she started complaining of coughing and shortness of breath. Clear cell sugar tumor and minute meningothelial-like nodules had been found incidentally and simultaneously during her chest x-ray. The diagnosis had been made based on morphology and was supported by a positive staining to a panel of immunohistochemical stains including CD34, vimentin, HMB45, melan A and S100. An ultra-structural examination was also performed and confirmed the presence of melanosomes in sugar tumor. The coexistence of lung sugar tumor and minute pulmonary meningothelial-like nodules has never been reported in the literature and an awareness of these lesions is essential to correctly diagnose and stage patients.

Papillary serous carcinoma in situ in ovarian endometriosis in an MSH2 mutation carrier

Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is an autosomal dominant cancer caused by a germline mutation of mismatch repair (MMR) genes [1]. It is characterized by an early onset of colorectal, endometrial, and ovarian cancer as well as cancers of the gastrointestinal and upper urinary tracts, brain, and skin. The risk of gynecologic cancer in women with HNPCC equals or even exceeds that of colorectal cancer [1]. Typically, HNPCC-associated ovarian cancers are of nonserous histologies, such as endometrioid, mucinous, and clear cell types [1]. We report a unique case of noninvasive serous carcinoma that developed in an endometriotic cyst of the ovary in an MSH2 mutation carrier. A 47-year-oldwoman (G3P3)with a strong family history of cancer underwent surgery and adjuvant chemotherapy at age 42 for a welldifferentiated adenocarcinoma of the colon (stage pT3 pN1). This was subsequently identified to be HNPCC with an MSH2 mutation. An endometrial biopsy was negative for cancer. Pelvic sonography suggested ovarian endometriosis, CA125 level was 86 U/mL (normal b35 U/mL), CEAwas 0.6 ng/mL (normal b3.0 ng/mL), and the patient's Pap test was normal. At pathological inspection of the hysterectomy and bilateral salpingo-oophorectomy specimens, the adnexae and uterus appeared normal. The right ovary (4×2×2 cm) contained a 2.3×2.0×1.8 cm cyst filled with bloody fluid. The left ovary (2×1×0.8 cm) contained a few minute cystic structures filled with blood. Microscopically, both ovaries contained several foci of endometriosis. The cystic structure in the right ovary was lined by tuboendometrial type epithelium and focally displayed a papillary growth pattern and severe cytonuclear and nucleolar atypia, in all respects similar to high grade serous papillary carcinoma of the ovary or endometrium (Fig. 1). There was no invasion of the underlying endometrial type cellular stroma. By immunohistochemistry, the serous carcinoma in situ cells stained for p53 (30% of cells), p16 (90% of cells), and Ki-67, but not for estrogen/progesterone (ER/PR) and Wilms tumor 1 (WT1). The fimbriated segment of both tubes contained p53-negative epithelial hyperplasia without atypia. To the authors' knowledge, this is the first reported case of occult serous carcinoma in situ arising in cystic ovarian endometriosis in an HNPCC patient who underwent risk-reducing robotic hysterectomy and salpingo-oophorectomy. Both the light microscopic and immunophenotypic characteristics supported a serous rather than an endometrioid histotype of the atypical cells. Furthermore, consistent with the histological origin of the lesion together with positive immunoreactivity for p53 and p16 but not for WT1, the malignant cells were presumably of endometrial rather than ovarian serous phenotype. According to current concept, WT1 is a more reliable immunomarker of ovarian serous differentiation than p16 [2]. Also, WT1 is generally negative in serous carcinoma of the endometrium. The association of serous carcinoma in situ within endometriosis presents a management challenge. On the one hand, similar lesions in the endometrium are treated with chemoradiation for they are known to carry a potential for disseminatedmalignant disease [3]. On the other hand, there is no information on the clinical behavior of a case like ours, and preoperative cytology was negative for malignant cells. Hence, we elected a tight surveillance scheme rather than postoperative chemotherapy. The patient is well, without disease clinically, radiologically,

Asymptomatic Giant-Cell (Temporal) Arteritis Involving the Bilateral Adnexa

Giant-cell arteritis involving the bilateral adnexa was identified incidentally in a bilateral salpingo-oophorectomy specimen obtained as a result of an ovarian cyst in a 75-year-old woman. Although the patient was asymptomatic, extensive giant-cell arteritis was present in the ovaries, paraovarian tissue, and fallopian tubes along with Brenner tumors of the ovaries. This finding prompted a temporal artery biopsy that revealed typical temporal arteritis. Giant-cell arteritis rarely involves the female genital tract and may present as an isolated form or a part of systemic disease. We discuss female genital tract giant-cell arteritis with a review of the English literature.

Selective vessel ligation in the pelvis: an invaluable tool in certain surgical procedures

While developing the technique of abdominal radical trachelectomy for conservative cervical cancer management, the vascular supply of the uterus was thoroughly examined. The question of how many vessels the uterus requires to ensure its viability arose. Following an abdominal radical trachelectomy for stage IB cervical carcinoma, blood supply of the body of the uterus is successfully maintained by only the two infundibulopelvic vessels (n= 34). Pregnancy has resulted following this technique (n= 2). Selective ligation of the pelvic vasculature has been utilized in the abdominal radical trachelectomy procedure. The objectives of this study were to investigate the vasculature of the infundibulopelvic and broad ligaments, to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion, and to consider the clinical applications of selective pelvic vessel ligation. Ten fresh dissections of the infundibulopelvic vessels, broad ligaments of benign total abdominal hysterectomy, and bilateral salpingo-oophorectomy specimens were performed. Perfusion index (PI) and oxygen saturation (O(2)Sat) measurements using a modified probe were taken at specified intervals at the uterine cornu during ten routine benign abdominal hysterectomies to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion and the concepts studied were utilized in certain gynecological procedures. The ovarian/infundibulopelvic vessels course medially through the broad ligament toward the uterine cornu and consistently give off a branch to the ovary on its lateral border. In addition, further vessels were noted to run laterally from the uterine cornu along the ovarian ligament to the medial aspect of the ovary. PI and O(2)Sat measurements imply that the uterine and ovarian vessels contribute almost equally to uterine perfusion. Clinical application by selective ligation of the pelvic vasculature has been utilized in certain gynecological procedures often prone to torrential life-threatening uterine hemorrhage. Selective temporary ligation of the uterine and ovarian vessels has proven useful in the surgical management of chemoresistant gestational trophoblastic disease, in the Strassman procedure, fertility-sparing surgery in ruptured cornual ectopic pregnancies, and unrelenting postpartum hemorrhage. Of the six supplying vessels (ovarian, uterine, and vaginal) to the uterus only two (ovarian or uterine or a combination thereof) are required for uterine viability.

Nodular histiocytic hyperplasia of the endometrium.

A case of nodular histiocytic hyperplasia of the endometrium is described. A 45-year-old Japanese woman was found to have an enlarged uterus during her annual checkup. Hysterectomy and bilateral salpingo-oophorectomy specimens revealed uterine leiomyomas, adenomyosis, and acute salpingitis. A 5-mm, well-demarcated, elevated endometrial nodule (an incidental finding) was present and consisted of round or polygonal histiocytic cells with eccentric nuclei and pale or granular cytoplasm. The nuclei were ovoid, reniform, or crescent-shaped and had fine chromatin and inconspicuous nucleoli, and the cytoplasm contained single or multiple vacuoles. Immunohistochemically, the histiocytic cells were positive for vimentin, CD68, and lysozyme and were negative for cytokeratin, S100 protein, estrogen and progesterone receptors, and CD10. Nodular histiocytic hyperplasia in the endometrium is considered to be a reactive process. Differentiation from neoplasms, including signet-ring cell carcinoma, in curettage specimens is critical to avoid unnecessary surgical resection.

A Sertoli-Leydig Cell Tumor with Endometrial Hyperplasia in a Postmenopausal Woman

Sertoli-Leydig cell tumors (androblastomas) are sex-cord stroma-derived ovarian neoplasms and represent only 0.2% of all ovarian cancers. These tumors are almost always unilateral and occur most often in the third decade of life. Although many cases of Sertoli-Leydig cell tumor have been reported in the literature, incidental finding of this tumor without any clinical and laboratory evidence is rare. A well-differentiated Sertoli-Leydig cell tumor associated with endometrial hyperplasia detected during histopathologic examination of a hysterectomy and bilateral salpingo-oophorectomy specimen is reported, with a review of the recent literature.

Natural killer-cell lymphoma involving the gynecologic tract.

Non-Hodgkin lymphomas (NHL) can involve the gynecologic tract, most often as a manifestation of systemic involvement, and most cases reported have been of B-cell lineage. We describe 2 women with natural killer (NK)-cell lymphoma involving the gynecologic tract that initially presented with vaginal bleeding. In case 1, the patient had a stage IE nasal-type NK-cell lymphoma involving the cervix. The tumor was composed of medium-sized, irregular lymphoid cells with angioinvasion and necrosis. In case 2, the patient had a stage IV blastoid NK-cell lymphoma/leukemia infiltrating all organs in a hysterectomy and bilateral salpingo-oophorectomy specimen. Subsequent biopsy specimens revealed that the bone marrow and lymph nodes were also involved. The neoplasm was composed of small to medium lymphoid cells with fine nuclear chromatin. Case 1 was assessed immunohistochemically and the neoplastic cells were positive for CD3, CD56, and TIA-1. Case 2 was analyzed using both immunohistochemical and flow cytometry methods. The neoplastic cells were positive for cytoplasmic CD3, CD4, CD7, CD43, CD45, and CD56 and were negative for surface CD3. Both cases were negative for Epstein-Barr virus (EBV) ribonucleic acid (RNA) and molecular studies showed no evidence of T-cell receptor gamma chain gene rearrangements. The immunophenotype and absence of T-cell receptor gene rearrangements support NK-cell origin. We report these cases to illustrate that NK-cell lymphomas can involve, and rarely arise in, the gynecologic tract.

Posthysterectomy carcinoma of the fallopian tube presenting as vaginal adenocarcinoma: A case report

The clinical and pathological features of a case of adenocarcinoma of the fallopian tube with a unique presentation are described. The 68-year-old patient presented with vaginal bleeding 25 years after a vaginal hysterectomy. Pelvic examination revealed a 0.5-cm nodule of tumor involving the mucosa of the vaginal apex. At laparoscopy, the left fallopian tube was dilated and adherent to the vaginal vault. Pathological examination of the upper vaginectomy and bilateral salpingo-oophorectomy specimen revealed a primary papillary adenocarcinoma of the left fallopian tube that had invaded directly into the mucosa of the vaginal apex. Vaginal involvement, either at the time of presentation or subsequently in the course of the disease, is very rare in patients with carcinoma of the fallopian tube.