Faculty Bibliography

BACKGROUND: Large cell variant of small cell carcinoma hypercalcemic type (SCC-HT) is extremely rare. All reported cases involved an ovary, and one with primary peritoneal origin has not been described. Also, convincing neuroendocrine granules have not been illustrated. CASE: A 35-year-old woman underwent an exploratory laparotomy for leiomyomas. Intraoperative impression of peritoneal carcinomatosis was confirmed on frozen section. TAH/BSO, debulking/omentectomy followed. The tumor was present on the pelvic/abdominal peritoneum. The normal-sized ovaries were free of tumor grossly. The tumor had features of large cell variant of SCC-HT, described in the ovary. Furthermore, unequivocal neuroendocrine granules were present. The patient received standard chemotherapy for SCC. At 22 months she is NED. CONCLUSION: SCC-HT should be considered in the differential diagnosis of primary neoplasms of the peritoneum

We managed two pregnancies in a woman with congenital afibrinogenemia with increasing amounts of cryoprecipitate to achieve a pre-infusion fibrinogen level of 60 mg/dL. The first pregnancy resulted in placental abruption at 36 weeks, in spite of recent cryoprecipitate infusion. Both placentas showed infarction. Post-partum ovarian and renal vein thromboses complicated the second pregnancy. Mean FVIII (344%) and vWF Antigen (323%) were elevated prior to cryoprecipitate infusion, with mean post-infusion levels of 367% and 363%. The clearance of fibrinogen after cryoprecipitate infusion increased during the course of pregnancy. A paradoxical prothrombotic state with embolization may play a role in the observed complications of pregnancy

Well-differentiated endometrial adenocarcinoma can be difficult to distinguish from complex atypical hyperplasia (CAH) in a curettage or biopsy specimen. When a focus of back-to-back glands or cribriforming smaller than 2.1 mm is seen in a biopsy, we make a diagnosis of adenocarcinoma in situ (AIS). Whether this diagnosis translates into a more frequent diagnosis of carcinoma on the hysterectomy specimen is unknown. The objective of this study was to compare follow-up hysterectomy findings in biopsies showing AIS in CAH with biopsies showing only CAH without AIS. Twelve biopsy/curettage cases diagnosed as endometrial AIS in CAH and 12 biopsy/curettage cases diagnosed as CAH only were reviewed and correlated with corresponding hysterectomy material. A diagnosis of AIS was designated on biopsy/curettings when a focus of back-to-back glands or cribriforming less than 2.1 mm was present. Hysterectomy specimens showed endometrial carcinoma in 6 (50%) of 12 cases of CAH with AIS, and in 2 (17%) of 12 cases diagnosed as CAH only. Endometrial carcinoma with myometrial invasion was identified in 5 (42%) of the cases showing AIS on biopsy, but in none of the 12 cases diagnosed as CAH only on biopsy. Identification of AIS in CAH cases provides useful prognostic information

The management of cervical dysplasia is determined by the grade of SIL (LSIL, conservative management; HSIL, ablative/excisional therapy). The grading, however, is subjective and its reproducibility is low. This study evaluates if quantitative differences in mitotic activity and MIB-1 expression (ME) in LSIL and HSIL are helpful in their discrimination. Twenty-seven cervical biopsies with LSIL and 16 with HSIL were immunostained for MIB-1. ME was evaluated in 100 contiguous cells of lesional squamous epithelium in basal layer, lower-third, middle-third, and upper-third, in areas with highest staining. Mitoses were counted in 10 contiguous high power fields in areas with the highest mitotic activity (mitotic index, MI). MI was significantly increased in HSIL (mean 27.5) as compared to LSIL (mean 14.3). MI at cut-off values < or =10 and > or =25, favored a diagnosis of LSIL, and HSIL, respectively. ME, in all four layers, was significantly greater in HSIL vs. LSIL. ME in the basal and the upper-third layer proved useful in grading SIL with equivocal MI: all LSIL cases with MI >10 had <30% of ME in the basal layer; and all, except one, had <30% of ME in the upper-third; all, except one HSIL cases with MI <25 had >30% of ME in either the basal or the upper-third layer. MI and ME (percentage) appear helpful in grading equivocal SIL cases

A tiny fragment of high-grade carcinoma was found in histologic sections and in the paraffin block of a benign cervical polyp from a patient with no clinical evidence of malignancy. Thus, it raised the suspicion of block contamination. No malignant tumor was processed the same day as the polyp; however, a similar tumor had been processed 6 days earlier. Multiplex DNA short tandem repeat analysis was applied to paraffin-extracted tissue samples obtained from the polyp, the suspected contaminant, the patient's additional cervical biopsy specimen, and the putative source of contamination. The results demonstrated that the suspected contaminant and the patient's cervical tissue could not have come from the same patient and that the suspected contaminant derived from the tumor processed earlier, without reasonable doubt. We hypothesize that this friable tumor escaped from cassettes into the processor and contaminated the polyp specimen. Multiplex DNA short tandem repeat analysis can be applied to determine the provenance of minute tissue samples in surgical pathology

OBJECTIVE: Immunohistochemical analysis of MIB1, p53, estrogen, and progesterone receptors can provide prognostic information in endometrial adenocarcinoma. Since predictors of recurrence for low-grade endometrial stromal sarcoma (LESS) are still unknown, a battery of immunostains was performed to find markers, which might be useful to predict prognosis. METHODS: Eleven patients with an average age of 43.8 years (range 27-76) were identified with stage I LESS. Immunostains, including MIB1, p53, ER, and PR, were evaluated by two pathologists, independently. RESULTS: All tumors were positive for ER and PR; 1/11 was positive for p53; MIB1 ranged from 0 to 20% positive tumor nuclei. Mitotic counts ranged from 0 to 7/10 hpf. Two patients developed recurrences. One had a pelvic recurrence 7 years after diagnosis. This tumor had a mitotic count of 1/10 hpf, MIB1 expression in 10% of nuclei, and focal p53 expression. A second patient developed pulmonary metastases 10.8 years after diagnosis; the tumor showed a mitotic count of 7/10 hpf and MIB1 expression in 20% of nuclei, but was negative for p53. There was a significant difference in MIB1 reactivity scores between patients who did or did not develop recurrence (P = 0.0303). A marginally significant association was detected between MIB1 (P = 0.0896) or p53 (P = 0.0833) positivity and length of recurrence-free survival. CONCLUSION: Although MIB1 and p53 appear to be useful prognostic markers, a larger study would be necessary to confirm their validity