Stromal Atypia Research Articles

間質細胞に強い異型を認めた小児鼻腔内ポリープ

We report a case of nasal polyps with stromal atypical cells in a 5-year-old boy, whose cytologic features simulated rhabdomyosarcoma. A polypoid lesion of the left nasal cavity grew rapidly and showed a necrotic, hemorrhagic surface. Aspiration cytology showed spindle to polygonal cells with 1 or 2 oval nuclei in the necrotic and hemorrhagic background. Conspicuous nucleolei were observed in these cells. Cytologically, possible embryonal rhabdomyosarcoma was initially suspected. However, histology disclosed a few atypical cells without mitosis scattered in edematous stroma, and finally was interpreted as nasal polyps with stromal atypia. It was suggested that the number of atypical cells, low mitotic rate, and absence of intracytoplasmic glycogen in atypical cells are important in cytologically differentiating this from rhabdomyosarcoma.

The stromal component of large endometrial polyps.

Benign endometrial polyps belong in the differential diagnosis of adenofibroma and adenosarcoma. There is, however, little information about the range of stromal mitotic activity, stromal cellularity, and stromal atypia in benign endometrial polyps, rendering the differential diagnosis with the aforementioned tumors problematic. In this study, the stroma of 66 polyps 1 cm or more in greatest dimension from 56 patients was analyzed for stromal mitotic activity, cellularity, and atypia. Sixteen (24%) had an almost completely fibrotic stroma that had rare mitoses, little cellularity, and no atypia. However, 50 polyps (76%) had stroma that was predominantly endometrial or was a mixture of endometrial-type stroma and fibrous stroma. In these polyps stromal mitoses were relatively common, averaging 1.2/10 MFs/HPFs (range, 0-5.8 MFs/10 HPFs). Stromal cellularity was frequently equal to or mildly increased over adjacent nonpolypoid endometrial stroma and mild nuclear atypia (enlarged stromal nuclei) was also common. Twelve polyps (24%) from the group of 50 had two or more MFs/10 HPFs, a mitotic rate present in some adenosarcomas. None of these polyps had other features necessary for the diagnosis of adenofibroma or adenosarcoma and follow-up in all patients was uneventful (average follow-up, 96 months). It is concluded that benign polyps that retain areas of endometrial-type stroma often have mitotic activity and that significant stromal mitotic activity (> or = 2 MFs/HPFs) is relatively common. These polyps do not have significant stromal atypia nor do they have a marked increase in stromal cellularity. Thus, in the absence of other supportive features, stromal mitotic activity alone should not be regarded as a worrisome finding.

Malignant phyllodes tumours of the breast display increased stromal p53 protein expression

To determine the variation in p53 protein expression in phyllodes tumours and fibroadenomas of the breast. Fifteen phyllodes tumours (six malignant, nine benign) and 20 fibroadenomas were examined for p53 expression by immunohistochemistry. Five of the six malignant phyllodes tumours showed moderate or strong p53 positivity at sites of peri-epithelial stromal condensation and atypia. All 20 fibroadenomas, nine benign phyllodes tumours and one malignant phyllodes tumour showed either negativity or focal weak nuclear positivity of scattered stromal cells. Increased p53 immunoreactivity is present in malignant phyllodes tumours in contrast to benign phyllodes tumours and fibroadenomas. Malignant phyllodes tumours display a distinctive pattern of p53 immunostaining which may be of diagnostic value. These findings suggest that p53 protein may be important in the progression of benign to malignant phyllodes tumours.

Uterine and extrauterine Mullerian adenosarcoma: a histopathologic and flow cytometric study

Uterine adenosarcoma is a rare tumor of Mullerian origin and is characterized by a benign glandular component and a sarcomatous usually low-grade, stroma, We examined 11 cases of Mullerian adenosarcoma, eight cervical, two uterine and one of the peritoneum. Tissue protruding from the cervix and an initial diagnosis of a cervical polyp were common findings for most patients with uterine adenosarcoma. On repeated examination these cases were re-evaluated as Mullerian adenosarcomas. Histologic examination revealed benign glands with a sarcomatous stroma, which typically formed periglandular cuffs of increased cellularity. The saromatous stroma was homologous in four cases but contained heterologous elements, such as striated muscle, lipoblasts and cartilage in three cases; in one case a sarcomatous overgrowth of stromal elements was found. The question of a Mullerian adenofibroma vs adenosarcoma was raised in three cases. According to stromal cellularity, stromal atypia and mitotic rate, the cases were classified as adenosarcomas. Sarcomatous overgrowth, presence of heterologous elements and high mitotic rate seem to indicate poor prognosis. Flow cytometry showed a predominantly diploid population of cells in eight cases of adenosarcoma. An aneuploid cell population was seen in three cases of adenosarcoma and in all but one case of carcinosarcoma studied as controls. Gynecologists and pathologists should be aware of the difficulties and delay in the diagnosis of Mullerian adenosarcoma in cases when the tumor presents as a benign looking cervical polyp. Flow cytometric DNA analysis might serve as a useful tool in the diagnosis of Mullerian adenosarcoma vs carcinosarcoma and contribute to the prognostic evaluation in different histologic subsets of the tumor.

A CASE OF RECURRENT MALIGNANT PHYLLODES TUMOR OF THE BREAST WITH FEATURES OF MALIGNANT FIBROUS HISTIOCYTOMA

We have encountered a rare case of recurrent malignant phyllodes tumor of the breast with features of malignant fibrous histiocytoma. A 53-year-old woman underwent a resection and transposition of the latissmus dorsi muscle for a benign phyllodes tumor in the breast. Three months later, a painful induration was observed into the wound. Fine-needle aspiration cytology was carried out three times and showed only blood. There was a suspicion of hematoma on ultrasonography and computed tomography. Soon, redness and induration at the punctured skin were observed and thus a biopsy was conducted. Moderate mitotic activity and stromal atypia were revealed and the tumor was diagnosed as borderline phyllodes tumor. Clinically, infiltration into the pectralis major muscle was suspected, and a mastectomy was added to the patient. Histopathologically, spindle shaped cells were arranged in a storiform pattern and tumor cells were pleomorphic with benign duct epithelium. Cellularity and mitotic activity were considered high. The tumor was diagnosed as malignant phyllodes tumor with features of malignant fibrous histiocytoma. Pathological fracture of the humerus occurred 3 months after the operation and metastases to the lung and liver were found. The patient did not respond to chemotherapy and died 8 months after the operation.

Breast masses in adolescent females.

In a retrospective study of 38 adolescent females operated on for mammary masses, 42 fibroadenomata (FA), 2 fibrous scars around abscesses, and one papilloma were found. All were postmenarchal. Clinical and pathological features were reviewed and the patients reexamined or interviewed. FA were mostly asymptomatic and removed a few weeks after incidental discovery. They were often seen in Jewish girls of parents born in North Africa and the Middle East, and were more frequently located in the outer superior quadrant of the left breast. New FA appeared in almost half of the cases later on in the same breast, as well as in the other breast, or bilaterally. Necrosis occurred in three FA and was unrelated to the size of the tumor. There was no correlation between the size of FA, multiplicity, or necrosis, nor between increased stromal or epithelial atypia, cellularity, or mitotic activity. One explanation for the high rate of multiplicity might be related to this neoplasm occurring in an actively developing organ under hormonal control. There was no increased breast carcinoma apparent in the family history. Therefore, except in cases of fast-growing tumors, a conservative approach is recommended because of the frequency of multiple FA as well as aesthetical postoperative complications.

Bilateral fibroepithelial polypi of labium minus with atypical stromal cells

A case of fibroepithelial polyp of labium minus with stromal atypia is described. This unusual tumor has only recently been reported occurring in the vulva. The tumor measured 12 cm in maximal diameter and its cut surface was soft and myxoid. After fixation the tumor was considerably smaller in size. The light microscopic findings were of a loose acellular myxoid stroma, traversed by thin walled dilated vascular spaces and covered by stratified squamous epithelium and with sparse fibroblast-like cells dispersed throughout. This case is unusual as fibroepithelial polyps with stromal atypia are an uncommon tumor of the vulva, are rarely bilateral and in this site no lesion previously has exceeded 4.0 cm in diameter.

Prognostic factors in giant cell tumor of bone. A modified histological grading system useful as a guide to prognosis.

An analysis of 26 patients with giant cell tumor of bone was carried out to determine the clinical and pathological factors affecting the prognosis of the tumor, with a follow-up program of more than 3 years. The physical characteristics of the pathological features were measured objectively using an image analyzer. A significant correlation between the therapeutic procedures and recurrence of the tumor was found, but no pathological variables were significantly correlated. Excision or resection en bloc should be performed for the initial treatment of the tumor. Local recurrence could not be predicted on the basis of histological grading. Stromal cell atypia was significantly correlated with metastasis, but multinucleated giant cells bore no correlation to either recurrence or metastasis. The use of a modified histological grading system based not on variations of the stroma and giant cells but only on the atypia of mononuclear stromal cells, either malignant or classical, is recommended for the clinical assessment of the tumor.

Recurrent and metastatic cystosarcoma phyllodes

During a 30 year period (1950 to 1980), 42 patients with cystosarcoma phyllodes were seen at the Mayo Clinic. Ten patients (24 percent) had recurrence or metastasis. The malignant or metastatic potential could not be identified or predicted by histologically evaluating tumor contour, stromal atypia, or mitotic activity. Spread was chiefly by a hematogenous route, and no patient with metastasis survived. Five of the 10 patients died from their disease 2 to 7 years after treatment. Simple mastectomy appears to be the surgical treatment of choice.

Malignant cystosarcoma phylloides: Treatment and prognosis

Twenty-six cases of malignant cystosarcoma phylloides treated at The Charity Hospital of Louisiana were reviewed. No metastases to axillary lymph nodes were observed. The lesion appears to metastasize seldom, if ever, to lymphatics, and axillary dissection is seldom required. Local recurrence was common, however, and justifies wide resection of the primary. Mortality was related more to the size of the lesion than to other findings such as skin or muscle involvement. No lesion with less than three mitoses per ten high power fields and minimal stromal atypia proved fatal. Associated neoplasia was common, particularly in the opposite breast.

Cystosarcoma phyllodes.A clinicopathologic analysis of 42 cases

A retrospective clinicopathologic evaluation of 42 patients with cystosarcoma phyllodes was undertaken to determine if tumor size, contour, degree of stromal atypia and mitotic activity were reliable indicators of clinical behavior. Excluding size, the latter three determinants showed a positive correlation with prognosis and served as the basis of a classification in which 18 benign, 5 borderline and 19 malignant cystosarcomas were diagnosed. The tumors occurred in women averaging 44.3 years of age who most often presented with a palpable occasionally painful mass with a median diameter of 5 cm. Excision or simple mastectomy were the more frequent forms of therapy. Local recurrences were experienced by 6 patients and occurred in all 3 categories of tumor. Only malignant neoplasms developed systemic metastases which was observed in 4 patients 3 of which have died. On borderline tumor recurred 14 times and eventually proved fatal as a result of contiguous pulmonary involvement. A plea is made to label the stroma of malignant cystosarcomas as to the cell(s) of origin so future investigators may evaluate the effect of various soft tissue patterns on prognosis.

Sarcomas of the breast: a clinicopathologic analysis of ten cases.

The clinical and pathologic features of ten mammary sarcomas are discussed. Tumor size, contour, degree of cellular atypia, and mitotic activity were specifically evaluated to determine if they are important indiced of clinical behavior. Results indicate that infiltrating margins, 2-3+ stromal atypia, and eight or more mitoses per 10 HPF are characteristics of neoplasms associated with a poor prognosis. Tumor size was an unreliable criterion. A classification of breast sarcomas is presented with an appeal to avoid use of the term "stromal sarcoma" as a specific pathologic diagnosis. Since a diagnosis based upon cell of origin and correlated with the above morphologic features is fundamental to an intelligent therapeutic approach to this rare group of neoplasms, future reports dealing with this subject should include these details.

Stromal atypia in anal papillae.

This report describes the occurrence of stromal atypia in anal papillae. The atypia occurred in two of 15 papillae studied and was present in the larger ones. The stromal atypia is similar to that described to occur in vaginal polyps and in entities such as pseudosarcomatous fasciitis, atypical fibroxanthomas of the skin, radiation dermatitis, and giant-cell cystitis. The atypia is considered to be reactive or reparative.