Small cell carcinoma of the hypercalcemic type in the ovary.
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Adult↗
Biomedical subjects
R E Scully
Publications and source records attributed to R E Scully.
Uterine papillary serous carcinoma (UPSC): a clinicopathologic study of 30 cases.
Between 1975 and 1989, 896 patients were treated for endometrial carcinoma at the Massachusetts General Hospital. Thirty patients were identified from the tumor registry as having uterine papillary serous carcinomas. The survival for all patients and for groups of patients stratified on clinical and pathological parameters was examined in the Kaplan-Meier survival curves. Curves for the different strata were compared using the logrank test. The 5-year survival for the 30 patients was 30% +/- 9%. Patients with surgical stage I and II tumors had a 5-year survival rate of 79% +/- 14% compared to 25% +/- 10% in patients with stage III and IV tumors (P = 0.02). Clinical stage, depth of myometrial invasion, lymph-vascular space invasion, tumor grade, and DNA aneuploidy were not found to significantly impact on survival. However, a survival advantage was seen in patients diagnosed with early surgical stage tumors, reinforcing the need for thorough staging at the time of laparotomy.
Aged↗
Early de novo ovarian cancer and cancer developing in benign ovarian lesions.
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Adult↗
Struma ovarii simulating ovarian tumors of other types. A report of 30 cases.
Thirty cases of struma ovarii with unusual microscopic features are described. They occurred in women 23 to 71 (average 49) years of age. Most of the patients had the usual symptoms and signs of an adnexal mass. Three patients had ascites and two had Meigs' syndrome. The tumors, all unilateral and confined to the ovary, ranged from 4 to 25 (average 12) cm in greatest dimension. They were typically predominantly solid and red-brown but cysts were present within foci of struma in several cases; an associated dermoid cyst was noted grossly in nine cases. Microscopic examination showed a prominent diffuse pattern in 21 cases, prominent microfollicles imparting in many cases a pseudotubular appearance in 20 cases, abundant eosinophilic cytoplasm in nine cases, and abundant clear cytoplasm in four cases. A contiguous dermoid cyst which had not been recognized on gross examination was documented in five cases. The typical paucity of thyroid follicles in cellular areas of these tumors often caused either a failure to consider a diagnosis of struma ovarii or led to serious consideration of other diagnoses. Clues to the correct diagnosis were the presence of rare typical thyroid follicles in foci that were predominantly diffuse or pseudotubular, the presence of larger areas of typical struma in 22 cases, and the association with a dermoid cyst in 14 cases. Immunohistochemical staining for thyroglobulin confirmed the nature of the tumor in all five cases in which it was performed. The diagnosis of struma should be entertained when one is examining an ovarian neoplasm with solid or pseudotubular patterns or a content of oxyphilic or clear cells. A careful search for thyroid follicles should be undertaken to establish the diagnosis and immunohistochemical staining for thyroglobulin performed to confirm it in problematic cases.
Adult↗
Cellular benign mesenchymal tumors of the uterus. A comparative morphologic and immunohistochemical analysis of 33 highly cellular leiomyomas and six endometrial stromal nodules, two frequently confused tumors.
Thirty-three highly cellular leiomyomas of the uterus from patients 29 to 65 (mean, 46) years of age and six endometrial stromal nodules from patients 41 to 53 (mean, 46) years of age are described. The patients usually presented with irregular uterine bleeding. Twenty-eight of the leiomyomas were intramural and five, submucosal. Eleven of 18 whose consistency is known were soft, fish-flesh, or rubbery, 10 were yellow or yellow-tan; one had a prominent cystic component. The tumors ranged from 0.5 to 15 cm (mean, 4.6 cm) in maximum dimension. On microscopic examination, they were densely cellular and composed of cells that ranged from round to spindle-shaped and had scanty cytoplasm. A focal fascicular pattern was present in all of the cases. Blood vessels were typically large; thick muscular walls and focally dilated lumens were a conspicuous feature of the majority of the neoplasms. Arterioles were evident focally in most of the tumors but were prominent in only one of them. Cleft-like spaces, some representing compressed vessels, others due to internodular edema, were present in 24 of the tumors and were conspicuous in 15 of them. The neoplasms typically exhibited focal irregular extension into the adjacent myometrium, and this feature was conspicuous in 18 of them. They often merged almost imperceptibly with the adjacent myometrium. All tumors were immunoreactive for desmin and 32 of 32 for alpha-smooth muscle actin. Two of the stromal nodules were polypoid intracavitary masses, three were submucosal, and one intramural. Five were completely or predominantly solid with cysts present focally in three of them; one tumor was predominantly cystic. The solid tissue was frequently yellow. Microscopic examination disclosed a diffuse growth of closely packed small cells with scanty cytoplasm and nuclei that lacked atypia. Three neoplasms contained cells with abundant foamy cytoplasm that were immunoreactive for CD68, indicating that they were histiocytes and not neoplastic cells. All the neoplasms had a prominent component of arterioles, which in one tumor had hyalinized walls. Five tumors were entirely well circumscribed and one predominantly well circumscribed with limited extension into the adjacent myometrium. The tumors were immunohistochemically negative for desmin.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Malignant mesothelioma of the tunica vaginalis. A clinicopathologic analysis of 11 cases with review of the literature.
Eleven malignant mesotheliomas of the testicular tunica vaginalis occurred in patients aged 12 to 76 (mean, 54.1) years. Hydrocele, with or without an associated mass, or appreciation of a paratesticular mass accounted for the clinical presentation. One patient had a history of asbestos exposure. Grossly, the tumors typically presented as multiple nodules studding a hydrocele sac, frequently associated with a mass infiltrating the spermatic cord or adjacent testis. Microscopically, five tumors were epithelial and six biphasic, with the typical architectural and cytologic features of mesothelioma. Mixtures of papillary, tubular, and solid patterns predominated in the epithelial areas; interlacing fascicles of spindle cells with scanty stroma characterized the sarcomatous components. All eight of the tumors that were stained for keratin (AE1/AE3) were positive, four of five for epithelial membrane antigen, and four of five for vimentin. Seven of seven tumors were carcinoembryonic antigen negative and five of five B72.3, Leu-M1, and Ber-Ep4 negative. Follow-up ranging from 1 to 15 (mean, 4.3) years was available for seven patients. Three died of disease after 4, 4, and 3 years, and three are alive with disease 2, 2, and 15 years after diagnosis. Two of the latter three patients had extensive local recurrences, one 15 years after the diagnosis of a well-differentiated papillary mesothelioma, the other 2 years following treatment with hydrocelectomy only. One patient who has been followed for only 1 year has no evidence of disease. This series emphasizes a number of important features of testicular mesothelioma; (a) a wide age range with occasional occurrence at a young age, (b) a wide morphologic spectrum with regard to degree of differentiation, and (c) an aggressive natural history with a potential for late recurrence or metastasis of even well-differentiated tumors, suggesting the need for initial aggressive surgical treatment.
Adult↗
Malignant mesonephric neoplasms of the uterine cervix. A report of eight cases, including four with a malignant spindle cell component.
Eight mesonephric adenocarcinomas of the uterine cervix, four of which had a malignant spindle-cell component, occurred in women aged 34 to 71 (median 43, mean 54.5) years, bringing to 14 the number of cervical mesonephric carcinomas in the literature. The tumors with a malignant spindle-cell component ("malignant mesonephric mixed tumors") are, with one possible exception, the first reported examples at this site. The patients, almost all of whom presented with vaginal bleeding, underwent hysterectomy; five also had a pelvic lymph node dissection. The tumors were all stage IB, although microscopic lymph node metastases were found in two cases. Gross examination revealed an invasive cervical mass in each case. On microscopic examination, seven tumors were adjacent to mesonephric hyperplasia, which in five cases was florid and focally atypical; in the remaining case, occasional non-neoplastic mesonephric tubules were found only within the tumor. The adenocarcinomas typically exhibited a variety of patterns, including a ductal pattern resembling endometrioid adenocarcinoma, a small tubular pattern, a retiform pattern, a solid pattern, and a sex-cord-like pattern. These disparate patterns frequently caused diagnostic difficulty. The spindle-cell component generally resembled endometrial stromal sarcoma or a nonspecific spindle-cell sarcoma; one tumor also contained multiple foci of osteosarcoma and another, a single chondroid focus. Immunohistochemical staining for a variety of antigens failed to reveal a distinctive profile, although all the carcinomas were immunoreactive for vimentin. Follow-up in six cases revealed three patients to be alive without evidence of recurrence at postoperative intervals of 2 to 3 years. Recurrent tumor developed in a fourth patient 1 year after hysterectomy; she was treated with chemotherapy and was alive and free of disease at 2 years. Another patient had intra-abdominal recurrences (including liver metastases) at 9 and 11 years and was alive with tumor at 13 years. Death at 8.5 months in a final patient was probably due to an independent stage IIc ovarian clear-cell carcinoma. These and prior observations in the literature suggest that malignant mesonephric tumors of the cervix may be more indolent than their müllerian counterparts, from which they should be distinguished. Mesonephric carcinomas in this site should also be distinguished from florid mesonephric hyperplasia, with which they are usually associated.
Adult↗
Carcinoma in mesonephric remnants.
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Carcinoma in Situ↗
Endometrioid carcinoma of the ovary with a prominent spindle-cell component, a source of diagnostic confusion. A report of 14 cases.
Fourteen endometrioid carcinomas of the ovary with a prominent component of spindle-shaped epithelial cells are reported. Eleven were initially misdiagnosed as sexcord stromal tumors, malignant mesodermal mixed tumors, tumors of probable wolffian origin, or metastatic carcinomas. All of the tumors, however, had one or more features establishing them as endometrioid carcinomas, including (a) glands typical of endometrioid adenocarcinoma, (b) foci of squamous differentiation, and (c) an adenofibromatous component. Six cases were examined immunohistochemically, and the epithelial nature of the spindle cells was supported by immunostaining for keratin and epithelial membrane antigen. The patients ranged in age from 42 to 89 years (mean, 61). Four cases were stage I, five stage II, and three stage III. Follow-up information was available in seven cases. Five patients were free of disease at 8, 11, 32, 56, and 103 months, and two patients were alive with disease at 10 and 20 months. The age of the patients, clinical presentation, tumor stage, and gross appearance were similar to those of typical endometrioid carcinomas. It is important that this tumor be distinguished from other ovarian neoplasms with a spindle-cell component because of differences in treatment and prognosis.
Adult↗
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.
Adolescent↗
Alveolar soft-part sarcoma of the female genital tract: a report of nine cases and review of the literature.
Nine alveolar soft-part sarcomas of the female genital tract (four previously reported) occurred in patients 14-38 (mean 29) years of age. The most common clinical presentation was abnormal uterine bleeding. Two tumors were located in the vagina, three in the cervix or lower uterine segment, three in the uterine corpus, and one in the broad ligament. The tumors were solid and well circumscribed, ranging in maximum dimension from 1 to 9.8 (average 3.6) cm and had the characteristic histologic features of alveolar soft-part sarcoma. Granules that were diastase resistant and positive by periodic acid-Schiff (PAS) were present in all the tumors, and PAS-positive, diastase-resistant crystals were present in eight of them. Follow-up information ranging from 9 months to 17 years (average 62 months) was available for all the patients. One patient died of metastatic disease 25 months after diagnosis; eight other patients had uneventful follow-up periods ranging from 9 months to 17 years (average 67 months). The differential diagnosis of these tumors is discussed and the literature reviewed.
Adolescent↗
Practice protocol for the examination of specimens removed from patients with ovarian tumors. A basis for checklists. Cancer Committee, College of American Pathologists. Task Force on the Examination of Specimens Removed from Patients with Ovarian Tumors.
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Biopsy↗
"Adenoid cystic" and basaloid carcinomas of the ovary: evidence for a surface epithelial lineage. A report of 12 cases.
Twelve ovarian neoplasms resembling salivary gland carcinomas and cutaneous basal cell carcinomas were studied and assigned to two groups: six with an exclusive or conspicuous component resembling adenoid cystic carcinoma and six with an exclusive or predominant component resembling basal cell carcinoma. The patients whose tumors simulated an adenoid cystic carcinoma presented at 60 to 78 (mean, 67) years of age. The adenoid cystic-like pattern was present in the primary ovarian tumor in five cases and four of these tumors had an additional surface epithelial-stromal component (serous adenocarcinoma in two, endometrioid adenocarcinoma in one, and mixed clear cell/endometrioid adenocarcinoma in one). The one patient with a Stage Ia tumor was free of disease at 37 months. Of the four patients whose tumors were Stage IIIc, two died of tumor at 13 and 123 months, respectively; another was alive with tumor at 27 months; and one was lost to follow-up. In the sixth case, an adenoid cystic-like pattern was present in a recurrent tumor in a patient from whom an ovarian endometrioid adenocarcinoma had been excised 11 years earlier. The patients whose carcinomas were predominantly or entirely basaloid presented at 19 to 65 (mean, 49) years of age. Three of these tumors had prominent squamous differentiation and gland formation, suggesting a relation to endometrioid carcinoma; three other tumors had an ameloblastoma-like pattern, with focal squamous differentiation in one, and a minor component of endometrioid adenocarcinoma adjacent to another. The four patients in the basaloid carcinoma group with Stage Ia tumors were alive without tumor at 16 to 71 (mean, 35) months.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Early de novo ovarian carcinoma. A study of fourteen cases.
BACKGROUND: The search for methods of early detection of ovarian carcinoma in recent years has emphasized the lack of information regarding the histologic features of early carcinoma or its precursor lesions; few examples of early de novo ovarian carcinoma have been reported. METHODS: The clinicopathologic features of 14 cases of early ovarian carcinoma detected as microscopic findings in grossly normal ovaries retrieved from a consultation practice and the files of the Massachusetts General Hospital were reviewed. RESULTS: The patients ranged in age from 27-65 years (mean, 50 years). Three women had a family history of ovarian carcinoma and six did not. The tumors ranged from microscopic to 7 mm in greatest dimension; all were unilateral and four were multifocal. One tumor involved the surface and its crypts; four, the surface and superficial cortex; eight, the superficial cortex only; and in one, surface involvement was not ascertainable. Ten carcinomas were serous; one, endometrioid; one, clear cell; and two, poorly differentiated, of undetermined cell type. Severe atypia of the noncarcinomatous surface epithelium or its inclusion cysts was additionally present in three cases. Among the seven patients whose diagnoses were made at the time of oophorectomy who had follow-up data of at least 2 years or until recurrence or death, five were alive without recurrences, one was alive with recurrence, and one died of tumor. Two of the three women died whose ovarian tumors were diagnosed retrospectively on discovery of subsequent peritoneal carcinomatosis, and the third was alive with recurrent tumor. No relation between any clinical or pathologic feature and survival was apparent in this small series except for a suggestion that well differentiated tumors had a good prognosis. CONCLUSIONS: These findings document that at least a subset of ovarian epithelial cancers develops de novo. The guarded prognosis associated with these tumors despite their minute dimensions raises questions about the value of current screening techniques for early detection of ovarian cancer.
Adult↗
Human parathyroid hormone-related protein in ovarian small cell carcinoma. An immunohistochemical study.
BACKGROUND: Small cell carcinomas (SCC) are the most common ovarian tumors associated with hypercalcemia. Parathyroid hormone-related protein (PTHrp) is the most frequent cause of hypercalcemia of malignancy. METHODS: The presence of PTHrp in SCC has been studied by immunohistochemistry in formalin fixed, paraffin embedded tissues. A polyclonal antibody against a synthetic peptide corresponding to the first 36-N terminal amino acid residues of PTHrp was used. Normal dog skin, which is rich in PTHrp, was used as a positive control. Absorption tests using the synthetic peptide as antigen were done in all the cases. RESULTS: Immunoreactivity for PTHrp was found in five of seven cases of SCC. The serum calcium levels were elevated in two of these cases, normal in two, and unknown in one. The two negative cases were associated with high serum calcium levels. CONCLUSION: The lack of correlation between immunoreactivity and serum calcium levels can be explained on the basis that immunohistochemistry is dependent on the peptide content of cells rather than on the capability for hormone production and/or release. The results suggest that PTHrp plays a role in the development of hypercalcemia in patients with SCC of the ovary.
Adult↗
Deoxyribonucleic acid flow cytometry of testicular Leydig cell tumors.
We analyzed by flow cytometry the deoxyribonucleic acid content of 13 paraffin embedded, formalin-fixed Leydig cell tumors of the testis. Of the tumors 10 were clinically benign (9 diploid and 1 aneuploid) and 3 were malignant (aneuploid). The benign aneuploid tumor showed moderate cellular atypia and a low mitotic count (less than 2 per 10 high power fields). Our study suggests that the majority of Leydig cell tumors are diploid and the less common malignant tumors are typically aneuploid, and that deoxyribonucleic acid flow cytometric findings can be useful as a prognostic indicator in these tumors.
Adult↗
p53 expression in ovarian borderline tumors and stage I carcinomas.
Seventy-nine ovarian serous and mucinous borderline tumors, 36 stage I carcinomas and 39 stage II-IV carcinomas were studied for p53 protein accumulation with monoclonal antibody PAb1801.p53 protein was expressed in 14% of borderline tumors, 36% of stage I carcinomas, and 64% of higher stage carcinomas. All immunopositive carcinomas accumulated p53 protein in the primary tumor, and 95% of them showed concordance in staining among different tissue blocks. A difference in frequency of p53 protein accumulation between stage I and higher stage serous carcinomas was not statistically significant. p53 positivity was associated with microinvasion, microcarcinoma and coexistent carcinoma in mucinous borderline tumors (P = .025). An association between p53 protein expression and poor tumor differentiation in Stage I carcinomas as statistically significant (P = .03). p53 positivity was observed in a poorly differentiated endometrioid carcinoma as well as in adjacent benign endometriotic tissue. These results suggest that p53 abnormalities may be early events in ovarian cancer, possibly contributing to malignant transformation of some borderline tumors, endometriosis and other carcinoma precursors.
Adenocarcinoma, Mucinous↗
Sclerosing peritonitis associated with luteinized thecomas of the ovary. A clinicopathological analysis of six cases.
Six cases of a distinctive ovarian lesion associated with sclerosing peritonitis were found in patients 13 to 76 years of age. Five patients presented with abdominal swelling; on examination, three were found to have unilateral or bilateral pelvic masses, one had ascites and evidence of small bowel obstruction, and one had ascites alone. The sixth patient presented with small bowel obstruction. At operation, 1 to 9 L of ascitic fluid were found in five patients. Five patients with bilateral ovarian enlargement underwent bilateral oophorectomy or, in one case, bilateral ovarian wedge resection. The sixth patient had unilateral ovarian enlargement treated by unilateral oophorectomy. All had fibrotic thickening of the peritoneum, most prominently involving the omentum and small bowel, four at initial operation and two at a second operation performed shortly thereafter. One or more episodes of small bowel obstruction subsequently occurred in three of the five patients with follow-up. One woman died of pulmonary embolism 2 months after her initial operation; four were alive without clinical evidence of disease 8 months to 6 years postoperatively. Gross examination revealed unilateral (one case) or bilateral (two cases), predominantly solid ovarian tumors 12 to 31 cm in maximum dimension in three cases and slight enlargement and nodularity of both ovaries in the other three cases. Microscopic examination of the ovaries revealed a cellular proliferation of spindle cells with focal differentiation into nests of luteinized or partially luteinized cells; one case also had occasional foci of sex cord elements. The process was confined to the ovarian cortex in the three cases with slight ovarian enlargement. Residual ovarian follicles were entrapped by the proliferation in three cases, but were prominent in only one of them. Additional features included brisk mitotic activity, predominantly in the spindle cells, in three cases, and striking edema in the three cases with significant ovarian enlargement. The ovarian lesions were interpreted as luteinized thecomas, although a closely related hyperplasia with luteinization, instead of early neoplasia, cannot be excluded in the three cases with only slight ovarian enlargement (and in one, prominent entrapment of follicles). The peritoneal process consisted of a variably cellular proliferation of fibroblasts and myofibroblasts separated by collagen, fibrin, and occasional chronic inflammatory cells. These cases and two similar cases from the literature suggest a unique association between some luteinized thecomas (or a closely related proliferative lesion of the ovary) and sclerosing peritonitis, although the relation between the ovarian and peritoneal processes is presently enigmatic.
Adolescent↗