Biphasic tumors of the female genital tract.
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A 83-year-old woman received bilateral salpingo-oophorectomy and hysterectomy due to a provisional diagnosis of ovarian cystic tumor. The tumor had a unilocular cystic cavity demonstrating serous cystadenoma and a solid mural nodule representing a biphasic pattern with mesenchymal and glandular components. The glandular elements were composed of benign serous cells, whereas the mesenchymal components consisted of an admixture of fibromatous stromal cells without atypia and sarcomatous overgrowth. The area of transition from a fibromatous component to sarcomatous overgrowth was identified. After a 2-year follow-up, there were no signs of tumor recurrence or systemic disease. To the authors' knowledge, this is the first reported case of adenofibrosarcoma originating from a mural nodule of ovarian serous cystadenoma.
Successful cytogenetic analysis was performed on short-term cultures of 62 malignant ovarian tumors from 42 patients. Twenty-three tumors from 18 patients revealed clonal chromosome abnormalities. Five cases showed nonclonal chromosome changes. In the remaining 19 cases, a normal female karyotype was found. Numerical or single structural changes were found in only 11 carcinomas from nine patients. Trisomy 12 and 7 were each the sole abnormality in two cases a piece. One tumor showed a trisomy 6 as the only karyotypic change. Four tumors revealed simple translocations and deletions affecting the chromosomes X, 1, 2, 6, and 7. Twelve of the cytogenetically abnormal tumor samples showed complex karyotypes with both numerical and structural aberrations leading to hyperdiploid, near-triploid, and near-tetraploid stemlines. The recurrent numerical imbalances were losses of the chromosomes 1 (N = 5), X (N = 3), and 17 (N = 3), and gains of the chromosomes 12 (N = 5) and 20 (N = 3). Regarding structural rearrangements, the chromosome bands 11p13-14 and 19p13 were the most frequently affected regions. 11p13-14 was rearranged in four tumors. In two cases, a deletion 11p13-14 was found. Two tumors revealed a nonreciprocal translocation involving 11p13-14 and leading to the loss of distal 11p material. The most consistent finding was a 19p+ marker chromosome, which was present in five different ovarian carcinomas. Our results are in accordance with a recent cytogenetic report describing a 19p+ marker and loss of 11p material as consistent cytogenetic aberrations in human ovarian carcinomas.
The results of treatment of diffuse forms of rectal cancer with the use of a preoperative course of endolymphatic polychemotherapy (fluorouracil and platidiam) and local SHF-hyperthermia are presented. The most pronounced effect of treatment was noted in patients with metastases to the regional lymph nodes. The method suggested is effective in treatment of all the types of adenocarcinoma. All the patients survived for 2 years.
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In conclusion, the diagnosis of endometrial pathology is changing rapidly as our understanding of the pathogenesis of endometrial lesions expands. Increasingly, recognition of new lesions and further subclassification of well-described entities will become more important in patient care.
Most malignant epithelial tumors of the gallbladder are heterogenous and classified as adenocarcinomas. The authors report a previously unrecognized group of unusual gallbladder carcinomas including two cases of signet ring cell carcinoma in situ, three of cribriform invasive adenocarcinoma, and one of adenocarcinoma with pseudoangiosarcomatous features. In addition, the authors review their material and update the information on clear cell, small cell, and undifferentiated carcinoma of the gallbladder. A new morphologic variant of undifferentiated carcinoma mimicking lobular carcinoma of the breast is identified. The clinical, morphologic, and immunohistochemical features of these unusual neoplasms are emphasized.
OBJECTIVE: To evaluate the symptoms, diagnostic procedures, and treatment by transduodenal excision, of tumours in the ampulla of Vater. DESIGN: Open study of consecutive patients. SETTING: University hospital, Denmark. SUBJECTS: Six patients with tumours in the ampulla of Vater. INTERVENTIONS: Ultrasonography, duodenoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic biopsy if tumour was visible at the papilla. Transduodenal excision of the ampulla and anastomoses of the common duct and pancreatic duct to the duodenum. MAIN OUTCOME MEASURES: Postoperative complications and survival. RESULTS: None of the tumours could be seen on ultrasonography. All the tumours were diagnosed on duodenoscopy with ERCP. The histopathological diagnoses of the endoscopic biopsy specimens were adenoma (n = 3), suspicion of adenocarcinoma (n = 2), and adenocarcinoma (n = 1). Curative resection by transduodenal excision of the ampulla of Vater was possible in all cases. Pathological examination of the surgical specimens showed three adenomas and three adenocarcinomas. One patient had a recurrence after 2.5 years and had a further resection. Three patients died after one, three, and nine years, respectively; two had no recurrence and one was suspected of having one. The other three patients were alive 8-20 months after the operation. CONCLUSION: The procedure is recommended for small and probably benign tumours and, when technically possible, in malignant tumours in patients at high operative risk. Close postoperative follow-up with duodenoscopy and ERCP is recommended.
Frequency and characteristics of mixed mesodermal tumors (MMT) and some terminology disparities in the comparatively scarce literature are discussed. The low frequency of MMT described and difficulties in diagnosing have been pointed out. A final diagnosis can be made on operative material only, since curettage contains one (more often the epithelial) of the components of biphase tumorous. The authors emphasize on guided attention to MMT, as well as the necessity of serial sections. The most important factor is depth of invasion.
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