Presence Of Mitotic Figures Research Articles

A Rare Case Report of Intrabdominal Fibrosarcoma in a German Shepherd Dog

The purpose of this study is to present an intra-abdominal fibrosarcoma in a canine and its histopathological findings. An eight years old female german shepherd was brought to department of Veterinary Clinical Complex, LUVAS, Hisar. The dog was anorectic with dull and depressed condition. Physical examination showed pale mucous membranes and distended abdomen. There was decrease in haemoglobin progressively. On Palpation of the abdomen a painless mass of hard consistency and irregular surface was felt. Serum biochemical abnormalities included increased SGOT, SGPT and alkaline phosphatise but plasma total protein, globulin and albumin was within normal range. The case was diagnosed with the help of radiography and ultrasonography. Thus, an exploratory laparotomy was performed, identifying a multinodular mass in the omentum and mesentery attached to a portion of the stomach and small intestine. An eight kilogram firm mass with irregular surface and great vascularisation was excised. On histopathology, the tumourous mass was found to be fibrosarcoma characterized by spindle shaped neoplastic cells arranged in interwoven pattern and presence of mitotic figures.

Low-grade sinonasal non-intestinal-type adenocarcinoma: a rare case report and literature review

Abstract Sinonasal non-intestinal-type adenocarcinoma is a rare but important differential diagnosis in patients presenting with recurrent, unexplained epistaxis. Low-grade types have a more favourable prognosis as opposed to the more aggressive high-grade. Symptoms include nasal obstruction and epistaxis that can last up to 5 years. We report a case of a rare low-grade sinonasal non-intestinal-type adenocarcinoma in a 43-year-old male who is frequently exposed to wood and dust particles. Endoscopy revealed right nasal mass occupying the entire nasal cavity as well as inferior turbinate hypertrophy and mass attached to the nasal septum on computed tomography. Biopsy confirmed the diagnosis and was classified as pT1NX with the presence of mitotic figures, which are more commonly present in the high-grade subtype.

Interval Sentinel Lymph Nodes With the Use of Routine Lymphoscintigraphy in Extremity Melanoma

IntroductionLymphoscintigraphy (LS) helps identify drainage to interval (epitrochlear or popliteal) lymph node basins for extremity melanomas. This study evaluated how often routine LS evaluation identified an interval sentinel lymph node (SLN) and how often that node was found to have metastasis. MethodsA single institution, retrospective study identified patients with an extremity melanoma who underwent routine LS and SLN biopsy over a 25-y period. Comparisons of factors associated with the identification of interval node drainage and tumor status were made. ResultsIn 634 patients reviewed, 5.7% of patients drained to an interval SLN. Of those biopsied, 29.2% were positive for micrometastases. Among patients with biopsies of both the traditional and interval nodal basins, nearly 20% had positive interval nodes with negative SLNs in the traditional basin. Sex, age, thickness, ulceration, and the presence of mitotic figures were not predictive of identifying an interval node on LS, nor for having disease in an interval node. Anatomic location of the primary melanoma was the only identifiable risk factor, as no interval nodes were identified in melanomas of the thigh or upper arm (P ≤ 0.001). ConclusionsDistal extremity melanomas have a moderate risk of mapping to an interval SLN. Routine LS should be considered in these patients, especially as these may be the only tumor-positive nodes. However, primary extremity melanomas proximal to the epitrochlear or popliteal nodal basins do not map to interval nodes, and improved savings and workflow could be realized by selectively omitting routine LS in such patients.

Inclusion of fibroblasts and collagen fibrils in the cytologic grading of canine cutaneous mast cell tumors.

Fibroblasts and/or collagen fibrils have not been included in previous cytologic grading schemes of canine mast cell tumors (MCTs), and their association with biological behavior is broadly debated. This study aimed to evaluate the cytologic findings of canine MCT, with emphasis on the microenvironment, and propose a novel cytologic grading system correlated with mortality and histologic grade. Cytology smears of canine cutaneous MCTs were retrospectively reviewed and compared with their histopathologic counterparts using Cohen´s Kappa test. One-year survival rates were also compared with the cytologic and histopathologic variables using Pearson´s correlation test. From 92 first-occurrence canine cutaneous MCTs, the five features most associated with mortality were selected for a new grading system. The five features were cytoplasmic granulation, fibroblast and/or collagen fibril concentrations, and the presence of mitotic figures, multinucleation, and karyomegaly. Among concordant histopathologic and cytologic cases (ie, the same grades using both systems), mortality rates were 2.6% (1/38) for low-grade and 71.4% (10/14) for high-grade cases (P<0.001, chi-square). For false-negative and false-positive results, mortality rates were 33% (1/3) and 45% (5/11), respectively (P=0.707). Unlike the Camus cytologic grading system, the present amendment excluded binucleation and included fibroblasts and/ or collagen fibrils, which in higher concentrations were associated with increased survival and a low histopathologic grade. Cytologic grading with the inclusion of fibroblast and collagen fibril concentrations correlated with survival, as did the Camus cytologic and Kiupel histopathologic grades; however, further studies are needed to confirm the prognostic value of this novel cytologic grading scheme.

Frozen section diagnosis of gastrointestinal poorly cohesive and signet-ring cell adenocarcinoma: useful morphologic features to avoid misdiagnosis.

Frozen section examination of adenocarcinomas with poorly cohesive growth, including signet-ring cell carcinoma, is challenging. Due to their diffuse morphology, the tumor cells may be indistinct and difficult to distinguish from inflammatory or stromal cells. Misdiagnosis may result in significant adverse clinical outcome. We performed a detailed retrospective analysis of such cases to identify features that are helpful to avoid misdiagnosis at the time of frozen section. We reviewed the original frozen section slides from 50 patients with poorly cohesive carcinoma (PCC) including 32 with positive and 18 with negative frozen section slides. Tumor cells and inflammatory cells were evaluated for 17 distinct cytologic and nine architectural or stromal features. Features with 100% specificity and positive predictive value (PPV) for carcinoma included the presence of cells with a single distinct cytoplasmic mucin vacuole, focal gland formation, and perineural invasion. Features with high specificity, sensitivity, PPV, and negative predictive value (NPV) (all > 75%) included irregular nuclear contours, large nuclear size with many nuclei > 4× the size of a small lymphocyte, and disruption/obliteration of normal structures. Other features with high specificity and PPV (both ≥ 85%) but relatively low sensitivity and NPV-included crescent-shaped/indented nuclei, prominent nucleoli, anisonucleosis (> 4:1 difference in nuclear size), multinucleation, and the presence of mitotic figures. We characterized useful histologic features of poorly cohesive carcinoma that may serve to distinguish carcinoma cells from benign inflammatory or stroma cells. Knowledge of the relatively specific features in particular may help surgical pathologists avoid false-negative interpretation resulting in significant clinical morbidity.

IMPORTANT HISTOLOGICAL AND IMMUNOCHEMICAL PARAMETERS FOR CLASSIFICATION OF CANINE MAST CELL TUMORS

Mast cell tumors (MCTs) are one of the most common neoplasms indogs. They originate from the bone marrow. Several criteria have been proposedfor their classification, including histological grading and cell proliferation markers.The mitotic index, multiple nuclei, cells with bizarre nuclei and karyomegaly are themost important parameters for the classification of MCTs on high and low-grademalignancy. For the confirmation of MCT malignancy grade it is also important todetermine the expression of the transmembrane kinase (KIT) receptor that has asignificant role in the growth and differentiation of mast cell tumors. In high-grademalignancy MCTs in addition to membrane expression of the KIT receptor, aberrantcytoplasmic expression can be also observed. Fifty-two MCTs and 12 controlsamples of skin from dogs without MCTs were examined. Routinely processed tissuesamples were stained with hematoxylin-eosin. Expression of KIT receptor wastested immunohistochemically. The classification of MCTs on high and low-grademalignancy was performed according to the Kiupel’s 2-tier classification and theexpression of KIT receptors. Sixteen of 52 MCTs were of a low-grade malignancy,while thirty-six were classified as a high-grade malignancy of which 19 MCTsshowed aberrant cytoplasm labelling of KIT receptor. All 16 low-grade malignancyMCTs had only membrane expression of KIT receptor. Most high-grade malignancyMCTs showed cytoplasmic KIT expression indicating the link between aberrantKIT expression and increased cell proliferation. The presence of mitotic figures,multinucleated cells, bizarre nuclei and karyomegaly, as well as KIT receptorexpression pattern are the most important prognostic factors in dogs with mast celltumor.

Management of hemorrhage in gastrointestinal stromal tumors: a review.

Gastrointestinal stromal tumors (GISTs) are relatively common mesenchymal tumors. They originate from the wall of hollow viscera and may be found in any part of the digestive tract. The prognosis of patients with stromal tumors depends on various risk factors, including size, location, presence of mitotic figures, and tumor rupture. Emergency surgery is often required for stromal tumors with hemorrhage. The current literature suggests that stromal tumor hemorrhage indicates poor prognosis. Although the optimal treatment options for hemorrhagic GISTs are based on surgical experience, there remains controversy with regard to optimum postoperative management as well as the classification of malignant potential. This article reviews the biological characteristics, diagnostic features, prognostic factors, treatment, and postoperative management of GISTs with hemorrhage.

Feulgen stain as a special stain for mitotic figures and apoptotic bodies in oral squamous cell carcinoma

Background: Oral cancer is one of the most prevalent cancers worldwide. The oral squamous cell carcinoma (OSCC) is graded for the proper treatment planning, and it has been a subjective phenomenon. This grading depends on several features, of which the presence of mitotic figures and apoptotic bodies is one of the important criteria. The routine hematoxylin and eosin (H and E) staining may help in identifying the mitotic figures and apoptotic bodies, but it is difficult to identify accurately. Thus, an attempt was made to evaluate the efficacy of crystal violet and Feulgen stain in identifying the mitotic figures and apoptotic bodies and to observe any variation in different grades of carcinoma. Aims: This study was aimed at using crystal violet and Feulgen stain in identifying mitotic figures and apoptotic bodies in different grades of OSCC. Materials and Methods: Fifteen diagnosed cases of OSCC were retrieved and stained with routine H and E, crystal violet stain, and Feulgen stain. All the sections were scanned for mitotic figures and apoptotic bodies. Apoptotic index (AI) and mitotic index (MI) were calculated. AI and MI were expressed as the average of a total number of apoptotic and mitotic cells counted in ten high-power fields. Results: A significant increase in MI and AI was found in Feulgen stain than crystal violet and H and E stain. Conclusion: Feulgen stain can be considered as the best, cost-effective, relatively cheap stain to visualize mitotic figures and apoptotic bodies.

Weineke criteria, Ki-67 index and p53 status to study pediatric adrenocortical tumors: Is there a correlation?

PurposeAdrenocortical tumors (ACTs) are rare in pediatric age group. Pediatric ACTs behave differently from their histologically similar adult counterparts and Weiss criteria often cannot accurately predict their clinical behavior. Wieneke et al. proposed a set of 9 macroscopic and microscopic criteria for diagnosis of malignancy in pediatric ACTs. The aim of the present study was to validate the Wieneke criteria in pediatric ACTs and to correlate Ki-67 labeling index and p53 expression with the Wieneke score. MethodsOur study comprised 17 cases of pediatric ACTs more than 11years, from January 2005 to December 2015. Relevant clinical features were obtained from records. Comprehensive analysis of gross and microscopic features was performed, according to the criteria proposed by Wieneke et al. Each tumor was categorized as benign, intermediate for malignancy or malignant. Ki-67 and p53 immunostaining was done in all cases. The patients were followed-up over a period of 6months to 60months. ResultsApplying Wieneke criteria, there were 9 benign and 7 malignant cases, and 1 case was assigned as intermediate for malignancy. The most significant markers in favor of malignancy were capsular and venous invasion, followed by the presence of mitotic figures >15/20 HPF. p53 was over-expressed in 86% of the carcinomas. We found a significant correlation between Ki-67 index and Wieneke scoring system. All cases of adenoma achieved complete remission, while 3 patients with carcinoma died. ConclusionOur study validates the utility of Wieneke criteria in differentiating adrenocortical carcinomas from adenomas in pediatric age group. Moreover, Ki-67 index and p53 status can be used as supplementary tools in distinguishing adrenocortical carcinomas from adenomas.

Kit Receptor Expression in Canine Cutaneous Mast Cell Tumors (CMCTs) Without C-Kit Mutation

Abstract Histopathological examination, grading, immunohistochemical staining and molecular genetic examinations are the proposed criteria that should be used for cutaneous mast cell tumors (CMCTs) classification. The presence of aberrant CD117 expression and mutations of the c-kit proto-oncogene could be an indicative parameter for final histological grading. Determination of the connection between the localization of KIT receptor expression and the histological grade of CMCTs without c-kit proto-oncogene mutations was the main goal of this study. The study included twenty four CMCTs and six control skin samples from 30 dogs of different ages, breed and sex. Formalinfixed and paraffin-embedded tissue samples were stained with hematoxylin-eosin and toluidine blue and immunohistochemically tested for CD117 expression. DNA was extracted from the same paraffin blocks and subsequent polymerase chain reaction amplification was performed using PE1 and PE2 primers. Degree of malignancy was determined based on the presence of mitotic figures, multinucleated cells, bizarre nuclei and karyomegaly in 10 high power fields. Based on histological features, fourteen of 24 CMCTs were of a high histological grade, while ten were classified as a lowgrade malignancy. CD117 cytoplasmic expression was observed in nine of fourteen high-grade malignancy CMCTs, which confirms the link between the aberrant CD117 expression and increased cell proliferation.

Prognostic factors and staging systems in parathyroid cancer: A multicenter cohort study

Parathyroid carcinoma (PC) is an uncommon disease that generally is detected postoperatively and traditionally is associated with a poor prognosis. Our purpose was to evaluate treatment outcomes, prognostic factors, and usefulness of some proposed staging systems for this disease. A multicenter review of patients with surgically resected PC was performed, led by the Spanish Association of Surgery. All surgical units affiliated with its endocrine surgery section were invited to answer a questionnaire that collected several hospital-related, clinical, biochemical, operative, pathologic, and follow-up data. Their relationships with prognosis were assessed by both univariate and multivariate analysis, as well as the effectiveness of three staging systems for parathyroid carcinoma. Of the 6,863 patients undergoing parathyroidectomy, 62 (0.9%) had PC. Of them, 12 (19.3%) died, in 5 cases (8%) because of disease, and 14 (22.6%) suffered recurrence, after a median follow-up of 55 months. The most predictive independent variables on tumor recurrence were intraoperative tumor rupture (hazard ratio [HR] 6.22; 95% confidence interval [CI] 1.19-32.36; P = .030); the presence of mitotic figures within tumor parenchyma cells (HR 4.76; 95% CI 1.24-18.21; P = .022); and allocation in class III according to Schulte differentiated staging classification (HR 5.23; 95% CI 1.41-19.31; P = .013). As to disease-specific survival, poor outcomes were associated with intraoperative tumor rupture (HR 58.71; 95% CI 2.39-1,439.96; P = .013) and distant recurrence (HR 38.74; 95% CI 3.44-435.62; P = .003). In addition to factors associated with tumor histopathology and stage, prognosis of PC is greatly influenced by surgeon's performance, which emphasizes the importance of preoperative diagnosis.

Intra–muscular Nodular Fasciitis Presenting as Swelling in Neck: Challenging Entity for Diagnosis

The diagnosis of Nodular Fasciitis is a very challenging on cytological aspirations. Even in histopathological sections, it can be sometimes be mistaken for soft tissue sarcomas due to its high cellularity, presence of mitotic figures, poor circumscription and degenerative myxoid areas. Most commonly, nodular fasciitis is seen on extremities; and sub-cutaneous form is most common. We are hereby reporting a case of nodular fasciitis at a rare site (head and neck area) in its rare form (intra-muscular type: originating within sternocleidomastoid muscle), which was clinically suspected as a malignancy arising from solitary thyroid nodule. Cytological diagnosis was issued as benign spindle cell lesion (where chances of a misdiagnosis as malignant are very high), thereby preventing radical surgery. It was subsequently confirmed as intra-muscular nodular fasciitis after histopathological examination.

Presumptive synchronized nuclear divisions without cytokinesis in the Rhinosporidium seeberi parasitic life cycle

Despite numerous studies of the Rhinosporidum seeberi parasitic phase, the stages of its nuclear cycle leading to the formation of endoconidia have yet to be properly described. R. seeberi resists culture and can only be investigated on histological preparations. We have evaluated tissue sections collected from 35 host species with rhinosporidosis searching for the presence of mitotic figures during sporangia development. This study found that soon after endoconidia release, the prominent reddish vesicles typical of this stage vanished leading to the development of juvenile sporangia (JS) 12-70 µm in diameter. This stage possesses granular cytoplasm, a thick cell wall, and a central reddish nucleus with a conspicuous nucleolus. The first nuclear division takes place in the JS. It is a rarely encountered event characterized by the development of a distorted nucleus leading to the formation of two nuclei without cytokinesis. The finding of multiple nuclear divisions at prophase-, metaphase- and telophase-like stages without cytokinesis was detected in intermediate sporangia (IS). IS with multiple dividing nuclei seem to be at the same stage of nuclear partitioning, suggesting synchronized nuclear division. In these sporangia, the nuclei continue divisions without cytokinesis until the sporangia reach ≥300 µm in diameter. The last nuclear division prior to cytokinesis appears to take place in very large sporangia with thousands of nuclei. The build-up of cytoplasm around each nucleus and the formation of a thin cell wall lead to the formation of endoconidia. This study revealed the presence of several mechanisms of pathogenesis in R. seeberi that deserved further investigation.

Abstract 174: Calorie restriction decreases spontaneous mammary tumorigenesis and upregulates ER-β in MMTV-neu transgenic mice.

Abstract Obesity increases postmenopausal breast cancer risk and increases mortality in pre- and postmenopausal women. While the majority of breast cancers in obese women are estrogen receptor (ERα)-positive, ERα-negative tumors confer a much worse prognosis. The mechanism by which obesity affects ER-negative breast cancer risk and prognosis is not clear, and strategies for offsetting the negative effects of obesity are urgently needed. In this study, we utilized the MMTV-neu mouse model of luminal-type breast cancer to test the hypothesis that energy balance modulation, through diet-induced obesity (DIO) or calorie restriction (CR) regimens, alters mammary tumor development and progression through regulation of ER in the mammary epithelium. MMTV-neu mice form spontaneous mammary tumors that progress from an ERα-positive hyperplasia to aggressive ERα-negative ductal adenocarcinomas. Female MMTV-neu transgenic mice and non-transgenic host strain (FVB) mice (6-8 weeks old; n=90/genotype) were randomized (30/group) to receive: control diet (modified AIN-76A); a 30% CR regimen (isonutrient); or a DIO regimen. A subset of mice (n=4 per group) was killed at 1, 3, and 5 months following diet initiation, and tissues were collected for analysis; remaining animals were followed for a 60-week survival study. We found that, relative to control diet, the DIO regimen significantly increased body weight, percent body fat (p&amp;lt;0.0001), and obesity-associated serum hormones and growth factors (IGF-I, insulin, leptin, and estradiol; p&amp;lt;0.01 for all) in both MMTV-neu and FVB controls. Conversely, CR significantly decreased body weight, percent body fat (p&amp;lt;0.0001) and decreased serum hormones/ growth factors, while increasing adiponectin (each at p&amp;lt;0.01). Gene expression (qRT-PCR) and protein expression (immunohistochemistry) analysis revealed that loss of mammary ERα expression, known to occur by 8 weeks of age in control MMTV-neu mice, was accelerated by DIO and delayed by CR. Additionally, we found that CR (relative to control diet) significantly increased mammary ERβ expression (p&amp;lt;0.0001) and delayed the onset of hyperplasia (p&amp;lt;0.001) in both MMTV-neu and FVB mice. Importantly, we found that after 60 weeks of feeding, CR significantly increased tumor-free survival of MMTV-neu mice (p=0.01). CR tumor samples showed a decrease in vascularity and presence of mitotic figures. In conclusion, dietary energy balance modulation impacts spontaneous MMTV-neu mammary tumor development and ERα and ERβ levels in normal and tumor tissue. In addition, increased mammary ERβ expression may represent a novel mechanism underlying the anticancer effects of CR. Citation Format: Sarah M. Dunlap, Nikki A. Ford, Laura W. Bowers, Emily L. Rossi, Samantha Miller, Lucia J. Chiao, Powel H. Brown, Stephen D. Hursting. Calorie restriction decreases spontaneous mammary tumorigenesis and upregulates ER-β in MMTV-neu transgenic mice. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 174. doi:10.1158/1538-7445.AM2013-174

Morphologic features of endometriosis in various types of cytologic specimens

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. This study evaluates the cytomorphologic features of endometriosis in various cytologic specimen types [fine-needle aspiration (FNA), effusion cytology (EF), touch imprint (ToP), and cervical smear (PAP)], and assesses the key elements helpful in recognizing this lesion. A total of 18 cases (8 FNA, 4 EF, 5 ToP, and 1 PAP) of cytologically diagnosed and histologically/clinically confirmed endometriosis diagnosed between 1988 and 2006 comprises the material for this study. The morphologic features evaluated of the three components included: cellularity, presence of sheets of glandular cells, three-dimensional (3D) glandular clusters, tubular structures, single cells, syncytial groups of stromal cells, stromal cells entrapped within basement membrane (BM)-like material, cytologic atypia, presence of mitotic figures, and hemosiderin-laden histiocytes. Endometrial glands, stroma, and hemosiderin-laden histiocytes were all identified in 14/18 (77.8%) cases. FNA specimens were more cellular than that of both EF and ToP specimens. Tubular structures, 3D glandular clusters, stromal cells entrapped in BM and syncytial stromal groups were more common in FNAs, and ToPs compared with the EFs. The ratio of the endometrial glandular and stromal cells was similar in all specimen types. Atypia and mitotic figures were rarely encountered. Diagnosis of endometriosis could be made independently on either smears/ThinPrep(™) slides or on cell blocks in all cases where these preparations were available. On follow up, none of the patients developed malignancy. Endometriosis can be reliably and safely diagnosed in various cytologic materials. Cytologic atypia is uncommon. Components of endometriosis could show minor morphologic alterations in different specimen types.

Atypical Intradermal Smooth Muscle Neoplasms (Formerly Cutaneous Leiomyosarcomas)

Atypical intradermal smooth muscle neoplasms (AISMN, formerly known as cutaneous leiomyosarcomas) are uncommon neoplasms, which seem to be remarkable for their excellent prognosis in contrast to their deeper counterparts. The rarity of AISMN has posed a challenge for characterizing the morphologic spectrum, immunohistochemical staining pattern, and behavior. In this study we evaluated the histologic and immunohistochemical features of 20 cases of AISMN. Clinical follow-up was available on 19 out of 20 patients and ranged from 1 to 124 months with an average of 35 months and a median of 20 months with a male predominance (male to female ratio was 2.3:1). Our data show a wide variation in differentiation and atypical features. Among these, the presence of mitotic figures is diagnostically valuable in rendering the final diagnosis. A broad panel of immunohistochemical stains revealed that smooth muscle actin and muscle specific actin, when used in combination, identified smooth muscle differentiation in 100% of the cases. With some caveats, CD34, S100, and CK 5/6 were helpful in ruling out other important cutaneous spindle cell neoplasms. Significantly, loss of phosphatase and tensin homolog (PTEN) staining was seen in the majority of our cases (80%), supporting a role for PTEN loss in the etiology of these lesions. Logistic regression analysis revealed that positive margin status was helpful for predicting recurrence (100% sensitivity and 94% specificity). We conclude that AISMN can have significant morphologic variation and overlap with other spindle cell neoplasms of the skin and that a limited panel of key immunohistochemical stains should be used to distinguish this lesion. The different surgical measures such as wide excision versus Mohs procedure showed a similar clinical outcome. Although the significance of frequent PTEN loss supports a molecular mechanism of tumor genesis, the diagnostic utility of the stain remains to be determined.

Morphologic features of endometriosis in various types of cytologic specimens.

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. This study evaluates the cytomorphologic features of endometriosis in various cytologic specimen types [fine-needle aspiration (FNA), effusion cytology (EF), touch imprint (ToP), and cervical smear (PAP)], and assesses the key elements helpful in recognizing this lesion. A total of 18 cases (8 FNA, 4 EF, 5 ToP, and 1 PAP) of cytologically diagnosed and histologically/clinically confirmed endometriosis diagnosed between 1988 and 2006 comprises the material for this study. The morphologic features evaluated of the three components included: cellularity, presence of sheets of glandular cells, three-dimensional (3D) glandular clusters, tubular structures, single cells, syncytial groups of stromal cells, stromal cells entrapped within basement membrane (BM)-like material, cytologic atypia, presence of mitotic figures, and hemosiderin-laden histiocytes. Endometrial glands, stroma, and hemosiderin-laden histiocytes were all identified in 14/18 (77.8%) cases. FNA specimens were more cellular than that of both EF and ToP specimens. Tubular structures, 3D glandular clusters, stromal cells entrapped in BM and syncytial stromal groups were more common in FNAs, and ToPs compared with the EFs. The ratio of the endometrial glandular and stromal cells was similar in all specimen types. Atypia and mitotic figures were rarely encountered. Diagnosis of endometriosis could be made independently on either smears/ThinPrep™ slides or on cell blocks in all cases where these preparations were available. On follow up, none of the patients developed malignancy. Endometriosis can be reliably and safely diagnosed in various cytologic materials. Cytologic atypia is uncommon. Components of endometriosis could show minor morphologic alterations in different specimen types. Diagn. Cytopathol. 2013. © 2013 Wiley Periodicals, Inc.

Morphologic features of endometriosis in various types of cytologic specimens.

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. This study evaluates the cytomorphologic features of endometriosis in various cytologic specimen types [fine-needle aspiration (FNA), effusion cytology (EF), touch imprint (ToP), and cervical smear (PAP)], and assesses the key elements helpful in recognizing this lesion. A total of 18 cases (8 FNA, 4 EF, 5 ToP, and 1 PAP) of cytologically diagnosed and histologically/clinically confirmed endometriosis diagnosed between 1988 and 2006 comprises the material for this study. The morphologic features evaluated of the three components included: cellularity, presence of sheets of glandular cells, three-dimensional (3D) glandular clusters, tubular structures, single cells, syncytial groups of stromal cells, stromal cells entrapped within basement membrane (BM)-like material, cytologic atypia, presence of mitotic figures, and hemosiderin-laden histiocytes. Endometrial glands, stroma, and hemosiderin-laden histiocytes were all identified in 14/18 (77.8%) cases. FNA specimens were more cellular than that of both EF and ToP specimens. Tubular structures, 3D glandular clusters, stromal cells entrapped in BM and syncytial stromal groups were more common in FNAs, and ToPs compared with the EFs. The ratio of the endometrial glandular and stromal cells was similar in all specimen types. Atypia and mitotic figures were rarely encountered. Diagnosis of endometriosis could be made independently on either smears/ThinPrep™ slides or on cell blocks in all cases where these preparations were available. On follow up, none of the patients developed malignancy. Endometriosis can be reliably and safely diagnosed in various cytologic materials. Cytologic atypia is uncommon. Components of endometriosis could show minor morphologic alterations in different specimen types. Diagn. Cytopathol. 2013. © 2013 Wiley Periodicals, Inc.

Incidental Prostatic Stromal Tumor of Uncertain Malignant Potential (STUMP): Histopathological and Immunohistochemical Findings

Stromal prostate tumors are rare neoplastic proliferative lesions that have been classified into prostatic stromal tumor of uncertain malignant potential (STUMP) and prostatic stromal sarcoma (SS) based on these criteria: stromal cellularity, presence of mitotic figures, necrosis, and stromal overgrowth. A prostatic stromal tumor of uncertain malignant potential (STUMP) is a non-epithelial, mesenchymal spindle-cell tumor that can be classified as a specialized stromal tumor of the prostate. STUMPs have the capability to diffusely infiltrate the prostate gland and extend into adjacent tissues. Furthermore, they often recur and this is why they are considered as neoplastic entities. STUMPs usually tend to be not aggressive, but occasional cases have been reported with an extension into adjacent tissues. A few cases develop a sarcomatous dedifferentiation. A 67-year-old male referred to the Department of Urology, Sapienza Rome University, with acute urinary retention (AUR) and bladder overdistention. Digital rectal examination (DRE) showed the presence of a severe prostatic hyperplasia and a transvesical prostatic adenomectomy (TVPA) was performed. The pathological evaluation performed at the Department of Pathology, Sapienza Rome University, revealed an incidental diagnosis of prostatic STUMP. The patient's follow-up is made every year with transrectal ultrasonography and nuclear magnetic resonance with spectroscopy, and every two years with a transperineal prostate biopsy to exclude a progression to a stromal sarcoma. After 5 years of follow-up the STUMP is still detectable but there is no sign of sarcoma. As a result of its relative rarity and lack of long-term follow-up, the prognosis of STUMP is unclear. Therapy varies from a wait-and-see approach to a radical retropubic prostatectomy.

Bone tumors: an overview

Note Primary skeletal neoplasms account for 0,2% of human tumors, whereas involvement of skeletal tissue by metastatic disease is much more common. Their soft tissue-related counterparts outnumber bone tumors by a margin of approximately 10:1. Because of their rarity, not much is known about the etiology and risk factors of bone tumors, although a difference in ethnical distribution has been observed. Bone tumors are mostly of mesenchymal origin, though for example Ewing sarcoma is thought to have neuroectodermal precursor cells. Classification of the World Health Organization will be followed in this overview. Grading of bone tumors is roughly based on the cellularity of the lesion compared to the amount of extracellulair matrix, nuclear features, the presence of mitotic figures and necrosis. Staging via the TNM system is normally not used, because metastases in lymph nodes are not frequent in these lesions. Therefore staging is based on degree of differentiation of the tumor tissue and local and distant spread of the tumor. Genetic information and references are provided for tumors investigated in more than a single case.