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Biomedical subjects

Oluwole Fadare

Publications and source records attributed to Oluwole Fadare.

At least 37 records · Page 2Linked to original sources
PubMed2005

Age dependent association of endometrial polyps with increased risk of cancer involvement.

BACKGROUND: Endometrial polyps (EMPs) are commonly encountered in routine surgical pathology practice, but opinions differ on whether they are intrinsically a marker for concurrent or subsequent malignancy. The objectives of the present study are 1) to investigate the age-group in which EMP are most commonly encountered 2) to document the age-group in which EMP are most commonly associated with malignancies 3) To investigate whether the age of diagnosis of the various carcinoma subtypes in EMPs is congruent with published data on similar malignancies arising in non-polypoid endometrium and 4) To investigate whether the histologic subtype distribution of malignancies associated with EMPs are similar or different from the distribution of malignancies arising from non-polypoid endometrium based on published data. PATIENTS AND METHODS: All cases of EMPs were retrieved from the files of Yale-New Haven Hospital for the period 1986-1995. The patients were divided into 5 age groups: Each group was further subclassified based on an association (or lack thereof) of EMPs with endometrial carcinoma. Chi-square test was used to compare the proportion of malignancy associated EMPs between the age groups. RESULTS: We identified 513 EMPs, of which 209 (41%) were from biopsy specimens and 304 (59%) from hysterectomy specimens. Sixty six (13%) of all EMPs were malignant. The 66 malignant EMPs included 58 endometrioid, 6 serous, 1 carcinosarcoma, and 1 clear cell carcinoma. In age group >35, only 1(2.5%) of 40 EMPs was associated with endometrial malignancy. In contrast, 37(32%) of 115 EMPs were associated with malignancy in the age group > 65. The frequency of malignant EMPs increased with age and reached statistical significance in the age group >65 (p < 0.001). The most common histologic type of malignancy was endometrioid adenocarcinoma. CONCLUSIONS: EMPs show statistically significant age dependent association with malignant tumor involvement. Careful search for malignancy, particularly in women with multiple risk factors is advised in daily practice. Additional studies are needed to address the histological features and immunohistochemical profiles in the context of association between endometrioid and high-grade endometrial carcinoma and endometrial polyps.

Journal Article↗
PubMed2005

Desmoplastic Infantile Ganglioglioma: cytologic findings and differential diagnosis on aspiration material.

BACKGROUND: Desmoplastic infantile ganglioglioma (DIG) is a rare WHO Grade I tumor of infancy that is characterized by large volume, superficial location, invariable supratentoriality, fronto-parietal lobe predilection and morphologically, by an admixture of astroglial and neuroepithelial elements in a desmoplastic milieu. With over 50 cases described, the histologic and radiographic spectrum of DIG has been well-characterized. The superficial location of DIGs may render them greatly amenable to preoperative assessment utilizing aspiration cytology; however, the cytologic features of this rare tumor have only been reported once previously. CASE PRESENTATION: We present herein cytomorphologic findings from the intraoperative aspiration of a typical case of DIG diagnosed in a 1-year-old male. As evaluated on a single liquid-based preparation, the specimen showed low cellularity and was comprised predominantly of a population of dispersed (occasionally clustered) large neuronal cells with eccentrically located hyperchromatic nuclei (which were occasionally binucleated) and abundant unipolar cytoplasm. Rare smaller astroglial cells were intermixed. Despite the tumor's characteristic desmoplastic histologic appearance, no stromal fragments were identified on the aspiration material. CONCLUSIONS: A differential diagnosis is presented and analyzed in detail and it is concluded that when these large neuronal cells are encountered in an aspirate of a brain mass in a child, a combination of clinical, radiologic and immunohistochemical parameters can eliminate most of the differential possibilities.

Journal Article↗
PubMed2005

An endometrial stromal tumor with osteoclast-like giant cells.

Endometrial stromal tumors (ESTs) of the uterine corpus have a striking propensity to display diverse morphological variations, including sex cord-like, smooth muscle, or skeletal muscle differentiation; fibrous change; myxoid change; or bland endometrioid-type glands. They may also contain rhabdoid, foam, clear, or epithelioid/granular cells among others. Recently, we have encountered an EST showing smooth muscle differentiation and osteoclast-like giant cells that were predominantly concentrated in the areas showing smooth muscle differentiation. Osteoclastlike giant cells have not been previously reported in EST to our knowledge; thus, this finding expands the morphological spectrum of these tumors. In addition, although the level of infiltration at the peripheries of the tumor exceeded that allowable under the Tavassoli and Norris criteria for stromal nodules, it did not reach the classic permeative infiltration generally associated with endometrial stromal sarcomas. Historical, prognostic, and diagnostic aspects of margins in EST, especially in those borderline cases such as ours, are also discussed.

Aged↗
PubMed2005

Upstaging based solely on positive peritoneal washing does not affect outcome in endometrial cancer.

Surgical staging of endometrial carcinoma includes the collection of peritoneal washings in the abdomen and pelvis. A positive finding upstages patients to International Federation of Gynecology and Obstetrics stage IIIA. However, the prognostic significance of such an upstaging, and thus the justification for the routine performance of this procedure, is unclear. This 5-year retrospective study was conducted to determine the frequency and prognostic significance of upstaging of endometrial carcinoma based solely on positive washings. The cohort for the study was collected by review of pathology reports of all washings that were performed prior to hysterectomies for suspected endometrial carcinomas over a 5-year period (01/1995-12/1999). Cases with positive cytology were selected if there was no grossly apparent intraperitoneal disease, no histologic evidence of extra-uterine tumor and the cases would otherwise have been considered stage I or II (case group). An age-matched control group was selected of stage I and II patients with the same histologic subtypes and negative washings (n=19). Of 220 endometrial carcinomas, peritoneal washing cytology was abnormal in 19 (8.6%) and was solely responsible for upstaging only 10 patients (4.5% of all cases, eight-endometrioid, one-serous, one-mixed; nine stage IA or IB and one stage IIB). Adjuvant therapy was administered in 90% of the case group and 74% of the control group. After a median follow-up of 51 months (case group) and 63 months (control group), we found only a single patient with progression of disease (recurrence, metastases or death) in the control group. It is concluded that abnormal cytology without other evidence of extrauterine disease leads to upstaging of a minority of endometrial carcinoma patients (4.5%), but does not appear to affect their overall outcome. Although this is a small single site study, it raises questions about the value of this procedure in patients with endometrial cancer.

Adult↗
PubMed2005

The significance of benign endometrial cells in cervicovaginal smears.

The success of the routine Papanicolaou (pap) smear in reducing the incidence and mortality of cervical cancer has been chronicled extensively. Unfortunately, endometrial cancer, the most common malignancy of the gynecologic tract, continues to lack a screening modality of comparable efficacy. It is generally accepted that the Papanicolau test has a low sensitivity for detecting endometrial disease. Nonetheless, it remains true that endometrial cells are not uncommonly identified on routine cervicovaginal smears and along with each case comes an associated responsibility for pathologists to assess cytologic features, assign a potential clinical significance, and make a decision on reporting this finding. When endometrial cells with an entirely normal cytologic appearance are identified on an otherwise unremarkable cervicovaginal smear, the central question raised is whether such cells are exfoliating physiologically or whether their exfoliation is pathologic in response to an underlying endometrial disease. Additionally, in the former scenario, could subsets of patients be defined in which the reporting of this finding is deemed unnecessary in the cytologic report? In this contribution, we explore the clinical significance of finding normal endometrial cells in cervicovaginal smears based on a review of the medical literature of the last half-century. The historical and evidentiary basis for the Bethesda 2001 recommendations, which calls for the reporting of cytologically benign endometrial cells only in patients 40 years and older, is reviewed in detail.

Endometrial Neoplasms↗
PubMed2005

Tumor-to-tumor metastasis to a thyroid follicular adenoma as the initial presentation of a colonic adenocarcinoma.

The incidence of thyroid involvement by metastatic disease from distant organs ranges from an average of 3.1% in surgical series to 5.3% in autopsy series. However, the metastasis of one tumor into another (traditionally referred to as 'tumor-to-tumor metastasis') is distinctly uncommon. Typically, they are identified as new manifestations or necropsy findings of a known, pre-existing donor tumor. Herein is described the case of a 59-year-old woman whose thyroid nodule (a follicular adenoma) was resected and found to contain foci of a well-differentiated adenocarcinoma with a morphologic and immunohistochemical profile consistent with origination from the lower gastrointestinal tract. Subsequent diagnostic work-up revealed a sigmoid colon tumor with metastases to the liver. This is, to the authors' knowledge, the first reported example of a colon adenocarcinoma whose initial clinical manifestation was a metastasis to a thyroid neoplasm and only the third reported example of a colonic adenocarcinoma metastatic to a thyroid tumor. In a review of previously reported examples of tumor-to-tumor metastases involving a thyroid neoplasm as the recipient, the following features were present in the majority: (i) multifocality of the metastatic tumor aggregates; (ii) a total lack of, or only minimal amounts of reaction (desmoplastic, inflammatory or myxoid) of the recipient tumor to the metastatic deposits; and (iii) retention of the histopathologic characteristics of the donor tumor in the metastatic deposits. In general, strikingly divergent morphologic features in an otherwise typical thyroid neoplasm should elicit a differential diagnosis that takes into consideration the possibility of metastasis.

Adenocarcinoma↗
PubMed2005

Identification of mislabeled specimen by molecular methods: case report and review.

Specimen misidentification is a common cause of errors in surgical pathology. We report a case where bone-marrow biopsies from patients of different genders were mislabeled and molecular methods were applied to resolve the identity. A short tandem repeat (STR)-polymerase chain reaction-based assay, commonly used in paternity testing, was employed in an attempt to assign the correct identity to the specimens. However, the specimens had been processed by decalcification and the DNA yield was poor. One of the markers in the assay is the non-STR amelogenin locus that distinguishes the X and Y chromosomes. This amelogenin marker results in a product of low molecular weight, enabling unequivocal resolution of identity despite a poor DNA yield. The prevalence of errors in pathology due to specimen misidentifications is reviewed.

Bone Marrow Cells↗
PubMed2005

Pathology of the NovaSure (radio-frequency) impedance-controlled endometrial ablation system.

The widespread use of increasingly novel diagnostic and neoadjuvant therapeutic modalities necessitates that contemporary pathologists familiarize themselves with the spectrum of tissue derangements that may be seen in the eventual surgical specimens. In the management of endometrial lesions, for example, a variety of endometrial ablation technologies, such as cryosurgery, balloon therapy, microwave, hot circulating saline, and bipolar impedance technology, have been introduced in the past decade and are being utilized with increasing frequency. We describe herein pathologic changes associated with one such technology, the NovaSure impedance-controlled endometrial ablation system. The US Food and Drug Administration approved NovaSure in 2001 for ablation of the endometrial lining in premenopausal women with menorrhagia. The ablation is accomplished by the delivery of radio-frequency energy for a period of approximately 90 seconds through a device inserted transcervically into the endometrial cavity. Our patient, a 54-year-old with menorrhagia, had undergone the NovaSure ablative treatment 38 days prior to her eventual hysterectomy. The resultant changes were quite distinctive: in a uterine wall that was 20 to 30 mm thick, a 3- to 6-mm-thick, hyalinized, subendometrial bandlike zone was apparent throughout the uterus even on macroscopic examination of the slides. This zone was sharply demarcated from the subjacent myometrium and from the endometrium; the latter displayed severe stromal fibrosis, some myxoid change, and sparse glands that were largely confined to the basalis. Paradoxically, scattered aggregates of stromal cells in the endometrium remained relatively viable. Adenomyotic aggregates and leiomyomata in the myometrium beneath the hyalinized zone were unaffected by this treatment. Practitioners evaluating hysterectomy specimens should be aware of changes such as those described herein, not only to better understand the specimens they evaluate but to avoid potentially misinterpreting grotesque alterations caused by benign processes.

Catheter Ablation↗
PubMed2004

Anti-Ri antibodies associated with short-term memory deficits and a mature cystic teratoma of the ovary.

BACKGROUND: The IgG autoantibody ANNA-2 (anti-Ri) is a type 2 antineuronal antibody that has been found to bind to highly conserved and widely distributed adult brain proteins encoded by the Nova-1 and Nova-2 genes. Anti-Ri antibodies are typically detected in the serum and cerebrospinal fluids of patients with neurological disorders such as opsoclonus/myoclonus and cerebellar ataxia and in association with gynecologic and breast malignancies. CASE PRESENTATION: This report describes an unusual example of a 33-year-old female patient who developed short-term memory deficits over a 3-month period. An extensive neurological work-up, including a panel of paraneoplastic markers was negative with the exception of a high titer serum Anti-Ri (1:15,3600). A large left ovarian mass was palpated, surgically resected and eventually diagnosed as a mature cystic teratoma. Post-operatively, memory deficits had disappeared within 1 month and serum Anti-Ri titers had decreased significantly to 1:256. An extensive diagnostic work-up for other malignancies was negative. CONCLUSION: Although, Anti-Ri antibodies are typically associated with malignancies, this case illustrates the potential association between benign tumors and this autoantibody.

Journal Article↗
PubMed2004

Perivascular epithelioid cell tumor (PEComa) of the uterine cervix associated with intraabdominal "PEComatosis": A clinicopathological study with comparative genomic hybridization analysis.

BACKGROUND: The World Health Organization recently recognized a family of neoplasms showing at least partial morphological or immunohistochemical evidence of a putative perivascular epithelioid cell (PEC) differentiation. These tumors include angiomyolipoma (AML), clear cell "sugar" tumors of the lung (CCST), lymphangioleiomyomatosis (LAM), clear cell myomelanocytic tumors of the falciform ligament and distinctive clear cell tumors at various other anatomic sites. CASE PRESENTATION & METHODS: A 41-year old gravida-1 para-1 with tuberous sclerosis presented with an incidentally identified 2.2 cm mass. The morphology and immunohistochemical profile was consistent with PEComa. Distinct aggregates of HMB-45 epithelioid cells were present in an occasionally distinctive perivascular distribution in the myometrium, small bowel lamina propria and ovarian hila. These distinctive aggregates, for which we propose the designation "PEComatosis" based on their intraabdominal distribution, did not display cytological atypia, mitotic activity or necrosis. CGH and DNA ploidy analysis showed a balanced chromosomal profile and diploid nuclei, respectively. There was no recurrence or metastases at 35 months' follow-up. Fifty-one previously reported cases of non-AML, LAM and CCST PEComas [perivascular epithelioid cell tumors- not otherwise specified (PEComa-NOS)] are reviewed. CONCLUSIONS: The lesions may be a reflection of tumor multicentricity, in which each may be a potential nidus for the development of future more well-developed tumors. Alternatively, they may be a manifestation of a poorly understood "field effect", in which there is an increased propensity to develop tumors of this type throughout the abdomen. Finally, and least likely in our opinion, they may represent tumor spread from its primary site.

Journal Article↗
PubMed2004

Synchronously diagnosed pre-sacral neurofibroma and cutaneous spitzoid melanoma: a fortuitous association?

BACKGROUND: At a U.S prevalence of 1 in 3000, Neurofibromatosis type-1 (NF-1) is a relatively common disorder. Amongst a variety of others, occurrence of 2 or more neurofibromas in the same patient represents one of the major diagnostic criteria for this disorder. Rarely, ocular, cutaneous or anorectal malignant melanomas may be identified in patients with NF-1, This rare association has caused controversy as to whether patients with NF-1 have an inherently higher risk for melanomas or whether the associations can be explained by chance alone. CASE PRESENTATION: The purpose of this report is to highlight the unusual confluence of rare clinicopathologic features in a patient without NF-1. The patient was diagnosed with an 8.5 cm pre-sacral neurofibroma and was shortly thereafter diagnosed with a cutaneous malignant melanoma showing spitzoid features. Pre-sacral neurofibromas are rare in patients without NF-1; likewise, malignant spitzoid melanoma, a controversial histopathological entity, is distinctly uncommon. CONCLUSIONS: The synchronous diagnoses of these neural crest derived tumor entities in a patient without neurofibromatosis lends credence to the view that when these two lesions occur in patients with NF-1, the association is coincidental.

Journal Article↗
PubMed2004

The histologic subtype of ovarian tumors affects the detection rate by pelvic washings.

BACKGROUND: Since its introduction more than 45 years ago, the pelvic wash has gained widespread acceptance and is used routinely use at most centers. However, widely varying figures have been reported regarding its sensitivity for peritoneal involvement in ovarian tumors. In the current study, the authors evaluated a consecutive group of pelvic (peritoneal or abdominopelvic) washings performed in the evaluation of adnexal masses to determine whether histologic subtype significantly affects the tumor detection rate using this procedure. METHODS: Reports from all washes performed over a 5-year period in the evaluation of adnexal masses were evaluated and correlated with those of the synchronously obtained histologic specimens. The sensitivity for each histologic subtype was calculated, with ovarian surface involvement and/or tumoral involvement of any peritoneal surface defined as the criterion standard. Cases with cytologic and histologic concordance were defined as true-positive or true-negative. Statistical significance was determined using the Fisher exact test. RESULTS: In the current study, 185 of 846 (21.9%) total washes were associated with malignant (n = 161) or borderline (n = 24) tumors involving the ovary. For the malignancies, the overall cytology detection rate was 25%. A comparison of the cytology detection rates for the individual histologic subtypes with the overall rate demonstrated that the serous carcinomas were more likely (P = 0.0144) and the clear cell carcinomas were less likely (P = 0.0452) to be detected in pelvic washings. Cytology detection rates for mucinous, endometrioid, and undifferentiated carcinomas did not appear to differ significantly (P > 0.05) from the average detection rate. The cytohistologic correlation rate (efficiency), sensitivity, and specificity for the 5 most common histologic subtypes (n = 130) were 79.23%, 50.77%, and 93.33%, respectively. Differences also were observed in the calculated sensitivity for each subtype: serous (n = 57), 71.4%; endometrioid (n = 30), 58.33%; clear cell (n = 19), 20%; mucinous (n = 13), 50%; and undifferentiated (n = 11), 50%. Borderline tumors demonstrated a sensitivity and specificity of 80% and 100%, respectively. CONCLUSIONS: In the current study, the pelvic wash was found to be a specific, but only moderately sensitive, technique for detecting peritoneal involvement in ovarian tumors. The histologic subtype of the underlying ovarian tumor was found to have an effect on the likelihood of detection of peritoneal involvement using this diagnostic assay.

Adenocarcinoma, Clear Cell↗
PubMed2004

Psammoma bodies in cervicovaginal smears: significance and practical implications for diagnostic cytopathology.

The traditional association of psammoma bodies with some malignancies of the gynecologic tract raises potentially significant management difficulties when such bodies are identified on routine cervicovaginal smears. This review summarizes the reported cases of psammoma bodies identified on cervicovaginal smears in the world literature (a total of 140 cases, 113 (81%) of which had sufficient clinicopathologic information). Our conclusions are as follows: (1) The finding of psammoma bodies in this setting is distinctly unusual with an incidence of less than 0.001% on consecutively screened smears. (2) On consecutively screened smears, patients with psammoma bodies have an associated malignancy or ovarian borderline tumor 0-22.7% of the time, depending on the series; this figure climbs to 38% when all the case reports and small series in the literature are included. (3) The most reliable predictor of a malignancy in these patients is the finding of cells on the smear that by themselves are diagnostic of malignancy on cytologic grounds. (4) Other factors that, on a purely statistical basis, appear to increase the likelihood of a synchronous or metachronous malignancy or borderline tumor include an older age at diagnosis and/or clinical presentations such as postmenopausal bleeding. (5) When 1 or more psammoma bodies are identified on a cervicovaginal smear, this finding should not be ignored and should generate some clinical investigation to identify its source.

Adolescent↗
PubMed2004

Flow cytometric DNA ploidy analysis of peripheral blood from patients with sezary syndrome: detection of aneuploid neoplastic T cells in the blood is associated with large cell transformation in tissue.

We reviewed and screened 219 cutaneous T-cell lymphoma (CTCL) cases for Sezary syndrome (SS); 63 met the criteria for SS. Of these, 17 (27%) demonstrated circulating aneuploid cells and 46 (73%) showed only euploid cells in blood samples. Of 17 aneuploid cases, DNA ploidy study was essential for initial blood-based diagnosis of SS in 4 (24%) and important in monitoring minimal residual disease after treatment in 9 (53%) in which neoplastic T cells showed otherwise unremarkable or nonspecific flow cytometric immunophenotypic findings. Tissue biopsy slides (predominantly skin and lymph node) at the time of DNA ploidy studies were available for 47 of 63 cases. Of 14 cases with circulating aneuploid cells, 11 (79%) showed large cell transformation (LCT; 6 [43%]) or markedly increased large cells (ILC; 5 [36%]) in tissue, whereas only 10 (30%) of 33 euploid cases showed LCT (4 [12%]) or ILC (6 [18%]) (P < .01). There was no significant difference in blood tumor burden, immunophenotype, or proliferation index between euploid and aneuploid groups or histologic high- and low-grade groups. DNA ploidy study by flow cytometry is important for blood-based diagnosis of SS and detection of minimal residual disease in aneuploid SS after treatment. Detection of aneuploid neoplastic T cells in peripheral blood samples of patients with CTCL is associated with LCT in skin, lymph node, or other tissues.

Aneuploidy↗