Serous Papillary Type Research Articles

Study of expression of cyclin D1 in endometrial lesions

Background: Cyclin D1, a member of the cyclin protein family is instrumental in the cell cycle due to its influence on the progression from G1 to the S phase. Its overexpression causes reduced doubling time and is also associated with clonogenic growth. Aim of the study: The purpose of the present study was to assess cyclin D1 expression in patients with endometrial lesions. Methods: Prospective study in the department of pathology at A.C.S Medical College and Hospital on 210 patients with cyclin D1 marker was done. Results: Majority of the cases were endometrial hyperplasia without atypia constituting 21.4%, followed by Disordered proliferative endometrium occupying 20.4% , Secretory endometrium 17.7%, Atypical endometrial hyperplasia and Proliferative endometrium constituted 16.6% each, Endometrial carcinomas 7.1%. Among 15 cases of endometrial carcinomas, majority of carcinomas were of endometrioid type 66% (10/15) followed by adenosqamous 13.3% (2/15), serous papillary type of carcinomas 20% (3/15). Conclusion: Cyclin D1 expression is significantly higher in patients with endometrioid endometrial carcinoma. The extent of cyclin D1 expression is strongly correlated with nuclear and histological grade, myometrial invasion, lymphovascular invasion and lymph node invasion in patients with endometrioid endometrial carcinoma.

Functional polymorphisms in monocyte chemoattractant protein-1 are associated with increased susceptibility to ovarian cancer.

Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system. Monocyte chemoattractant protein-1 (MCP-1) is highly expressed in various malignancies and promotes carcinogenesis. The aim of the study was to investigate the association between MCP-1 genetic polymorphisms and the susceptibility to ovarian cancer. MCP-1 rs1024611A/G and rs3760396C/G polymorphisms were examined in 257 ovarian cancer patients and 273 healthy controls. We found that distributions of rs1024611GG genotype and rs3760396GG genotype were clearly increased in ovarian cancer cases compared to healthy donors (odds ratio [OR]=1.93, 95% confidence interval [CI]: 1.13-3.29, p=0.015; OR=3.89, 95% CI: 1.63-9.33, p=0.001). Stratification analyses revealed that patients with serous papillary type had further increased percentage of rs3760396GG genotype than those with other types (OR=3.89, 95% CI: 1.11-13.66, p=0.024). In addition, we evaluated the possible effect of MCP-1 polymorphisms on gene expression by examining the serum level of MCP-1 in patients and controls. Data revealed that subjects carrying rs1024611AG and GG genotypes had a significantly higher serum level of MCP-1 than those with AA genotype. These data suggest that MCP-1 rs1024611A/G and rs3760396C/G polymorphisms are associated with increased susceptibility to ovarian cancer, in which rs1024611A/G may increase serum level of MCP-1 in the Chinese population.

Genetic variations in monocyte chemoattractant protein-1 and susceptibility to ovarian cancer.

Monocyte chemoattractant protein-1 (MCP-1) is a chemokine which plays critical roles in regulating host immune responses. Researches have shown that MCP-1 may greatly participate in the development of different cancers. In the current study, we investigated the effect of MCP-1 on ovarian cancer by examining the association between MCP-1 genetic polymorphisms and the susceptibility to ovarian cancer. MCP-1 -2158A/G and MCP-1 -362C/G polymorphisms were examined in ovarian cancer patients and healthy controls by using polymerase chain reaction-restriction fragment length polymorphism analysis. Results showed that percentages of MCP-1 -2158GG genotype and G allele were significantly higher in ovarian cancer patients than in controls (odd ratio (OR) = 1.87; 95% confidence interval (CI), 1.19-2.76; P = 0.012 and OR = 1.47; 95% CI, 1.11-1.79; P = 0.003; data were adjusted for age and smoking status). The MCP-1 -362GG genotype also revealed increased number in patients. Stratification analyses presented that ovarian cancer cases with serous-papillary type had significantly increased percentage of -362GG genotype than those with other types (13.1 versus 5.0%, P = 0.032; data were adjusted for age and smoking status). Also, we evaluated the relation between these two polymorphisms and serum level of MCP-1. We identified that the subjects with MCP-1 -2158AG and GG genotypes had clearly increased serum level of MCP-1 than those with AA genotype. These data suggest that MCP-1 may be involved in the pathogenesis of ovarian cancer.

The role of omental biopsy in endometrial cancer staging

Omental biopsy is not part of FIGO staging for endometrial cancer. The few studies that have looked into this matter have had conflicting results. This is the largest study in terms of the number of cases studying the incidence of omental involvement in endometrioid and non-endometrioid endometrial cancer. A retrospective study assessing 248 cases of endometrial cancer with omental biopsy at the time of primary surgical treatment for endometrial cancer at the Gynaecological Oncology Centre, Norfolk and Norwich University Hospital between January 2004 and May 2008. Demographic, clinico-pathologic and surveillance data were collected from hospital records, operative notes and histopathology results. The histology included tumour type, stage, grade and omental biopsy. All histological types were included in the study. Two hundred and forty eight patients had an omental biopsy at the time of primary surgical treatment for endometrial cancer during the study period. Of them, 187 cases were stage I, 27 stage II, 27 stage III and seven stage IV. According to histological type, 202 (81.4%) had endometrioid, 20 (8.0%) serous papillary, 20 (8.0%) malignant mixed Mullerian tumour (MMMT), three (1.2%) clear cell and three (1.2%) sarcoma. Overall, six cases (2.4%) had omental involvement, 4/202 (1.98%) with endometrioid type, 1/20 (5.0%) with serous papillary type and 1/20 (5.0%) MMMT. Eighty four percent of omental metastases (five cases) were macroscopic and noted at operation .The overall risk of omental metastases is 2.4% and in the absence of gross lesions the risk is around 0.4%. Most omental metastases can be diagnosed by careful inspection and palpation of the omentum. The possibility of missing microscopic disease is low. Based on these figures and possible increase in morbidity and operative time, omental biopsy cannot be justified as a standard procedure in endometrial cancer staging.

Primary peritoneal anaplastic giant cell carcinoma: case report of an unusual and highly malignant müllerian neoplasm.

Abstract Virtually all primary peritoneal carcinomas (PPCs) are of serous papillary type. We report an unusual histologic type of PPC composed of anaplastic giant cells, which exhibited an aggressive clinical course. A 72-year-old woman presented with lower abdominal pain. Computed tomography showed a diffuse omental thickening. The patient underwent an exploratory laparotomy with omentectomy, total hysterectomy, bilateral salpingo-oophorectomy, and appendectomy. Pathologic examination revealed extensive omental replacement by tumor but only superficial surface cortical involvement of both ovaries, a disease distribution consistent with a typical mullerian-derived PPC. However, this neoplasm was composed of diffuse anaplastic tumor giant cells, rather than serous carcinoma, which is the usual histologic type encountered in PPC. The patient died within 1 month after surgery. We report this unusual histologic variant of PPC to raise awareness that anaplastic giant cell carcinoma may arise in the pelvic peri...

Primary Peritoneal Anaplastic Giant Cell Carcinoma: Case Report of an Unusual and Highly Malignant Müllerian Neoplasm

Virtually all primary peritoneal carcinomas (PPCs) are of serous papillary type. We report an unusual histologic type of PPC composed of anaplastic giant cells, which exhibited an aggressive clinical course. A 72-year-old woman presented with lower abdominal pain. Computed tomography showed a diffuse omental thickening. The patient underwent an exploratory laparotomy with omentectomy, total hysterectomy, bilateral salpingo-oophorectomy, and appendectomy. Pathologic examination revealed extensive omental replacement by tumor but only superficial surface cortical involvement of both ovaries, a disease distribution consistent with a typical müllerian-derived PPC. However, this neoplasm was composed of diffuse anaplastic tumor giant cells, rather than serous carcinoma, which is the usual histologic type encountered in PPC. The patient died within 1 month after surgery. We report this unusual histologic variant of PPC to raise awareness that anaplastic giant cell carcinoma may arise in the pelvic peritoneum as a primary tumor.

Paratesticular serous papillary carcinoma. A report of six cases.

Six intrascrotal, invasive epithelial neoplasms of serous papillary type arose in the paratesticular region of patients 16 to 42 (mean, 30.8) years of age. Five patients, one with an associated hydrocele, presented with a testicular mass and one with a hydrocele only. The serum CA-125 level was elevated in one of the two patients in whom it was measured. Grossly, the tumors were solid, white, or tan, poorly circumscribed, often gritty masses. Four tumors involved primarily the soft tissue between the testis and epididymis (testiculoepididymal groove) and one, the paratesticular soft tissue. The sixth tumor was confined to the visceral tunica vaginalis at the inferior pole of the testis. The most common microscopic pattern was characterized by invasive, well-formed papillae lined by serous cuboidal or columnar cells with eosinophilic cytoplasm and malignant nuclear features. Psammoma bodies were abundant in all the cases. Areas of borderline serous tumor were present in two tumors and predominated in one. Five of five tumors were positive for keratin (AE1/3), S-100, epithelial membrane antigen, and Ber-EP4; three of five for Leu M1 and B72.3; two of five for carcinoembryonic antigen and placental alkaline phosphatase; and one in five for vimentin. Ultrastructural examination in one case demonstrated gland formation with delicate luminal microvilli and cilia. Follow-up information was available in five cases: Three patients are without evidence of disease after relatively short postoperative intervals of 1, 1, and 3 years, although one of these patients has had a persistently elevated CA-125 level. Two patients had recurrence of their tumors 4 and 7 years after diagnosis, one with diffuse abdominal spread, the other in a cervical lymph node. The latter patient died of his disease 5 years after diagnosis.

Prognostic factors that predict pelvic lymph node metastasis from endometrial carcinoma

Recent reports indicate that certain pre- and intraoperatively determined risk factors are predictive of pelvic lymph node metastases from endometrial cancer, allowing selective pelvic lymph node dissection. The objective of this study was to evaluate the accuracy of pre-, pre-/intra- and postoperatively determined tumor characteristics. The study is based on 100 patients treated from 1987-1991 with total abdominal hysterectomy and bilateral salpingo-oophorectomy. In all patients thorough pelvic lymphadenectomies were performed (no sampling). These patients were evaluated according to different macroscopic and histologic tumor characteristics retrospectively in a blind fashion (the lymph node status was later determined separately). Multivariate analysis was applied and the results were compared using receiver operator characteristic curves. In 15 of 100 patients, pelvic lymph node metastases could be histologically demonstrated. Multivariate analysis of 22 tumor characteristics identified the following as being independent in relation to pelvic lymph node metastases: preoperatively determined characteristics: serous papillary tumor type, invasion of myometrium, and histologic grade (Christopherson); pre-/intraoperatively: serous papillary type, histologic grade (Christopherson), and cervical involvement; and postoperatively: lymphangiosis carcinomatosa and hemangiosis carcinomatosa. Receiver operator characteristic curves show that for pelvic node metastases the postoperatively determined histologic findings are more predictive than all other factors that can be evaluated pre- and/or intraoperatively. Pre- and intraoperative tumor characteristics can determine the individual risk for pelvic lymph node involvement, but additional studies addressing the therapeutic value of pelvic lymphadenectomy would be necessary to define a probability threshold for lymphadenectomy in a decision analysis.

Clinicopathological characteristics of p53 overexpression in endometrial cancers

Using immunohistochemical methods, we analyzed the association between nuclear p53 overexpression and various clinicopathological parameters in patients with endometrial cancers. Formalin-fixed and paraffin-embedded tissue sections from 139 cases of endometrial cancer (endometrioid type, 126; serous papillary type, 12; and clear-cell type, 1) were stained with anti-p53 monoclonal antibody (MAb) DO7. Overexpression of p53 was associated with high malignant potential, including extensive muscular invasion, advanced surgical stage, high histological grade, serous papillary type and a personal history of cancer. Lymph-node metastasis was also related to p53 overexpression with marginal significance. Survival curves determined by the Kaplan-Meier method and univariate analysis showed p53 overexpression to be associated with a poor outcome in endometrial cancer patients. However, multivariate analysis using the stepwise Cox proportional-hazard model showed that whereas lymph-node metastasis, a personal history of cancer and muscular invasion were related to poor survival rates, p53 overexpression was not. Consequently, p53 overexpression itself does not appear to be an independent prognostic factor in endometrial cancer, although a still larger sample of patient material would be required to assess this issue definitively.

Hereditary ovarian cancer: a clinicopathological study.

Hereditary ovarian cancer (HOC) is rare and little recognized. Over the years, we have identified 37 HOC patients from HOC syndrome kindreds with documented cancers of ovary, breast, colon, or endometrium in two or more first-degree relatives. The age and clinical stage at diagnosis and overall 5-year survival of HOC patients were compared with those of ovarian cancers in the unselected patients. The gross and microscopic features of the tumors are compared with a set of 34 consecutively chosen ovarian cancer cases with documented negative family histories. The mean age of HOC patients at diagnosis was significantly lower (50.2 years) than that of the unselected control population (59 years) (p less than 0.001). Detailed pedigree analysis breaks down the HOC group into (a) site-specific ovarian cancer, 5 cases, 56.4 years mean age; (b) breast-ovarian cancer syndrome, 28 cases, 50.46 years mean age; and (c) Lynch syndrome II (colon/endometrial cancer), 4 cases, mean age 41 years. The age differences were statistically significant (p = 0.050). The most prevalent International Federation of Gynecology and Obstetrics clinical stage at diagnosis of HOC (stage III) was the same as for the control group. Histologically, all (100%) HOC tumors were surface epithelial cancers with predominance of serous papillary type moderate to high grade (89 versus 71% in control, p = 0.07). No other pathologic features appeared to be significant. In conclusion, HOC is a serous papillary tumor and characterized by early age of onset and excess of breast/ovary/colon-endometrial cancers in first-degree relatives of patients with specific HOC syndromes.