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PubMed1997

Microcystic adnexal carcinoma with extensive sebaceous differentiation.

We report two cases of microcystic adnexal carcinoma showing extensive sebaceous differentiation. Multiple cellular nests and strands within a moderately sclerotic stroma involving the full thickness of the dermis were observed. Clusters of basaloid cells with extensive sebaceous differentiation were present. Foci of sebaceous ductal differentiation were observed in the more superficial areas. Neither strikingly atypical cells nor mitotic figures were present. Perineural invasion was present in the deep areas of both tumors. Clinically, the lesions were solitary whitish-pink papules with a central dell on the faces of 2 men (aged 78 and 73 years old). We propose a relationship between these tumors and other cytologically bland but locally aggressive adnexal carcinomas. Sebaceous differentiation itself in a poorly circumscribed neoplasm does not indicate conventional extraocular sebaceous carcinoma. We propose a simple classification of locally aggressive adnexal carcinomas that takes into account the full range of adnexal differentiation that can occur in such lesions.

Aged↗
PubMed2001

Microcystic adnexal carcinoma: an immunohistochemical study including markers of proliferation and apoptosis.

Microcystic adnexal carcinoma (MAC) is the prototype for a subset of locally aggressive adnexal carcinomas (LAACs). Ultraviolet radiation (UVR) and UVB signature p53 mutations are implicated in the etiology of the most common cutaneous carcinomas. However in MACs, the role of UVR and p53 mutations is unknown. In addition, controversy still exists regarding the patterns of differentiation within these tumors. The objective of this study was to determine the expression patterns of immunohistochemical markers for p53, Ki-67, c-erbB-2, and Bcl-2 in MACs, and to compare these patterns with two MAC histologic stimulants: sclerosing type basal cell carcinomas (sBCCs) and desmoplastic trichoepitheliomas (dTEs). Other objectives were to compare expression patterns of cytokeratin (CK) AE1/AE3, CK7, CD20, endothelial membrane antigen (EMA), Ber-EP4, CD34, alpha-smooth muscle actin (SMA), and S-100 protein in MACs with its histologic simulators, and to determine the usefulness of all the immunohistochemical studies in diagnosis. Immunohistochemical markers were performed on 10 MACs, 10 sBCCs, and four dTEs. They included p53, Ki-67, c-erbB-2, Bcl-2, CK AE1/AE3, CK7, CD20, EMA, Ber-EP4, CD34, S-100 protein, and alpha-SMA. MACs expressed p53 in less than 25% of the tumor cells in only two cases (20%), and both cases showed only moderately intense staining, whereas 80% of the sBCCs were positive and showed intense staining, and all dTEs were negative. In MACs, less than 5% of the tumor cells were Ki-67 positive, whereas the sBCCs showed 20% to 40% Ki-67-positive tumor cells and dTEs showed rare Ki-67-positive cells. Bcl-2 was expressed focally in MACs, diffusely in sBCCs, and in scattered cells in dTEs. All tumors were negative for c-erbB-2. CD34, CK7, EMA, Ber-EP4, S-100 protein, and alpha-SMA all showed a distinctive pattern of staining in MACs. Although MACs arise commonly in chronically sun-exposed skin, increased expression of p53 is not found frequently. Overexpression of c-erbB-2 does not appear to be a factor in the development and progression of these adnexal tumors. Bcl-2 is expressed in MACs, but not diffusely as in sBCCs. The low level of Ki-67 supports a low proliferative rate, and other immunohistochemical markers support divergent patterns of adnexal differentiation in MACs. Immunohistochemical studies may help to differentiate MAC from sBCCs and dTEs.

Adult↗
PubMed2001

Sentinel node biopsy for orbital and ocular adnexal tumors.

PURPOSE: To describe a technique for sentinel node mapping and biopsy in patients with orbital or adnexal tumors. METHODS: Five patients with orbital and adnexal tumors were studied. Two patients had malignant eyelid melanomas (one of the skin and one of the conjunctiva), one with orbital invasion. Two patients had sebaceous gland carcinoma, and one patient had a mucoepidermoid carcinoma of the conjunctiva; 500 microCi of Technetium-99m sulfur nanocolloid (Nycomed Amersham, Princeton, NJ) diluted to 1.0 mL was injected intradermally at the lateral canthus. The patients were positioned as they would be during surgery. Lymphoscintigraphy was performed by means of anterior, lateral, and oblique views. The tracer was followed to the first lymphatic basin, and the sentinel node was identified. Cutaneous markers were placed to denote the site. During surgery, lymphoscintigraphy scans and a hand-held gamma probe were used to locate the sentinel node. Once excised, the sentinel node was sent for histopathology. Frozen sectioning confirmed the presence of lymphoid tissue. Permanent sections with immunohistochemical markers were performed to examine for metastatic disease. RESULTS: The sentinel node biopsy technique was applied to 5 patients with orbital and adnexal tumors. All lymph nodes were free of tumor on histopathologic examination. CONCLUSIONS: Sentinel node mapping and biopsy are possible for orbital and adnexal tumors. The morbidity of elective lymph node dissection and adjuvant radiotherapy can be avoided. Our results are preliminary, and further work must be done to identify the lymphatic basins of the orbit and ocular adnexa.

Adenocarcinoma, Sebaceous↗
PubMed2006

Bowen's disease with invasive adnexal carcinoma: the pluripotential nature of Bowen's disease cells.

Bowen's disease rarely exhibits multiple combinations of premalignant and/or malignant skin lesions. Bowen's disease with invasive adnexal carcinoma was originally described by Kao, but is not well recognized by clinicians due to its rarity and lack of specific clinical features of this condition. Herein, we describe three unusual cases of Bowen's disease with invasive adnexal carcinoma. The two distinct neoplastic areas exhibited continuity both clinically and histologically. The plaque lesions possessed clinical features typical of Bowen's disease. In cases 1 and 3, we confirmed the adnexal tumor within tumors of Bowen's disease, the diagnosis of which is eccrine porocarcinoma. The tumor in case 2 was characteristic to trichilemmal carcinoma. Immunohistochemically, the tumor cells of Bowen's disease and the adnexal carcinoma differed in antigenicities. The present cases support a notion that Bowen's disease maintains a pluripotential nature.

Acrospiroma↗
PubMed2000

A retrospective survey of clinical, pathologic, and prognostic features of adnexal masses operated on during pregnancy.

OBJECTIVES: To evaluate retrospective data concerning patients with adnexal masses that were managed surgically during pregnancy and their effect on fetal outcome. METHODS: Data were reviewed concerning pregnant women who required surgery at our hospital between 1980 and 1997 for an adnexal mass. RESULTS: In the past 19 years at our hospital a total of 69 Japanese women aged 28.5 +/- 3.4 years (including 2 women with twin pregnancies) were diagnosed with adnexal masses that required surgery. The masses (10.2 +/- 4.5 cm in the largest diameter) were removed at 13.9 +/- 3.7 weeks of gestation. The pathologic features of the 69 lesions were as follows: 33 mature cystic teratomas, 13 functional cysts, 8 mucinous cystadenomas, 6 endometriotic cysts, 4 paraovarian cysts, 3 serous cystadenomas, and 2 malignant neoplasms. Of the 60 patients for whom the outcome of pregnancy was available, 7 (12%) gave birth before 37 weeks of gestation, while 2 (3.3%) experienced spontaneous abortions. There were 3 perinatal deaths among the 60 infants. Two of these 3 infants died due to major anomalies. CONCLUSIONS: Although larger studies are required for confirmation, our results suggest that an adnexal mass might be associated with an adverse fetal outcome. Surgical intervention at < 24 weeks of gestation per se might not have been related to the adverse outcomes. We emphasize that surgical intervention during pregnancy can be avoided in patients who have ultrasonographically pathognomonic features of benign cystic teratomas, which are the most common neoplasms operated on during pregnancy.

Adnexa Uteri↗
PubMed2004

Metastatic microcystic adnexal carcinoma: an autopsy case.

BACKGROUND: Microcystic adnexal carcinoma is a clinically aggressive, local destructive sweat gland carcinoma with a high rate of recurrence, but regional or distant metastasis is quite rare. OBJECTIVE: The objective was to describe an autopsy case of microcystic adnexal carcinoma with hematogenous metastasis and perineural intracranial spreads. METHODS: This is an autopsy case of a 73-year-old woman with hematogenous metastasis of microcystic adnexal carcinoma followed for more than 20 years. RESULT: The autopsy study revealed that the metastatic lesions were located in the perineural intracranial spread, left clavicle bone, bilateral 12th ribs, and liver. CONCLUSION: Physicians should be aware that microcystic adnexal carcinoma is capable of metastasis to the liver and bones with intracranial spread along the optic nerve into the cranium.

Adenoma↗
PubMed1999

Microcystic adnexal carcinoma arising in the setting of previous radiation therapy.

While there are several reports of microcystic adnexal carcinoma developing in patients within sites of previous therapeutic irradiation, this relationship is not well described in the dermatologic literature. We report a case of a 42-year-old man with a remote history of therapeutic irradiation following surgical resection of periorbital rhabdomyosarcoma. Subsequently, he developed multiple basal cell carcinomas and a microcystic adnexal carcinoma within the field of irradiation. The histologic features were those of a classic microcystic adnexal carcinoma, with well differentiated nests and cords of keratinocytes displaying follicular and ductular differentiation infiltrating diffusely into the reticular dermis. Dense fibrosis was present surrounding the neoplastic keratinocytes. Nuclear atypia and mitotic figures were not identified. A carcinoembryonic antigen (CEA) stain demonstrated glandular differentiation. It is important for dermatologists to be aware of the apparent relationship between the rare microcystic adnexal carcinoma with its innocuous scar-like clinical appearance and prior local radiation therapy.

Adult↗
PubMed2000

Complex adnexal masses: detection and characterization with MR imaging--multivariate analysis.

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) imaging in the detection and characterization of complex adnexal masses, with particular reference to the findings predictive of malignancy, role of gadolinium-enhanced contrast material, and observer variability. MATERIALS AND METHODS: Preoperative MR imaging of the pelvis was performed in 128 consecutive patients with clinically or ultrasonographically detected complex adnexal masses. Histopathologic examination demonstrated 187 masses, 96 of which were malignant. MR imaging studies were prospectively and independently reviewed by two radiologists, one of whom reevaluated the studies after a 6-month interval. The predictive value of MR imaging findings was determined with multivariate logistic regression analysis. The value of gadolinium enhancement was assessed by using receiver operating characteristic analysis. Inter- and intraobserver variabilities were assessed by using weighted K statistics. RESULTS: Gadolinium-enhanced MR imaging depicted 176 (94%) of 187 adnexal masses, with an overall accuracy for the diagnosis of malignancy of 93%. The MR imaging findings that were most predictive of malignancy were necrosis in a solid lesion (odds ratio, 107) and vegetations in a cystic lesion (odds ratio, 40). Use of gadolinium-based contrast material contributed significantly to lesion characterization. Interobserver (K, 0.79-0.85) and intraobserver (K, 0.84-0.86) agreement were excellent. CONCLUSION: Gadolinium-enhanced MR imaging is highly accurate in the detection and characterization of complex adnexal masses, with excellent inter- and intraobserver agreement.

Adolescent↗
PubMed2005

Regression of ocular adnexal lymphoma after Chlamydia psittaci-eradicating antibiotic therapy.

PURPOSE: Some infectious agents contributing to lymphomagenesis have been considered targets for new therapeutic strategies. Chlamydia psittaci DNA has been detected in 80% of ocular adnexal lymphomas. The present pilot study was carried out to assess whether C psittaci-eradicating antibiotic therapy is associated with tumor regression in ocular adnexal lymphomas. PATIENTS AND METHODS: Nine patients with C psittaci-positive marginal-zone B-cell lymphoma of the ocular adnexa at diagnosis or relapse were treated with doxycycline 100 mg, bid orally, for 3 weeks. The presence of C psittaci DNA in peripheral-blood mononuclear cells (PBMCs) was also assessed before and after treatment in seven patients. Objective lymphoma regression was assessed 1, 3, and 6 months after therapy conclusion and every 6 months during follow-up. RESULTS: All patients completed antibiotic therapy with excellent tolerability. At 1 month from doxycycline assumption, chlamydial DNA was no longer detectable in PBMCs of all four positive patients. Objective response was complete in two patients, partial response (> 50%) was observed in two patients, and minimal response (< 50%) was observed in three patients. Duration of response in the seven responders was 12+, 29+, 31+, 8+, 7+, 2+, and 1+ months, respectively. CONCLUSION: C psittaci-eradicating antibiotic therapy with doxycycline is followed by objective response in patients with ocular adnexal lymphoma, even after multiple relapses of the disease. A confirmatory, large, phase II trial is warranted to confirm whether this fast, cheap, and well-tolerated therapy could replace other more aggressive strategies as first-line treatment against ocular adnexal lymphomas.

Administration, Oral↗
PubMed1997

Laparoscopic management of adnexal mass during pregnancy.

BACKGROUND: To assess the use of laparoscopy in the management of persistent adnexal mass during the second trimester of pregnancy. SUBJECTS: Six consecutive pregnant women undergoing laparoscopic surgery for persistent adnexal masses in the second trimester. RESULTS: Laparoscopic removal of an adnexal mass was successfully performed in all patients. The median operating time was 37.5 minutes. There were no intra- and post-operative complications. Tocolytic therapy was not required and no patients developed uterine contractions. All patients delivered normal infants vaginally at term without complications. CONCLUSION: With attention to the surgical technique, laparoscopic removal of persistent adnexal mass during the second trimester of pregnancy is safe and carries the same benefits over laparotomy as in non-pregnant women.

Adult↗
PubMed2002

Squamous cell carcinomas arising from adnexal ductal cysts.

Malignant tumors arising from adnexal cysts are rare. We report 2 cases of squamous cell carcinomas that developed within cystic structures arising from adnexal ducts. An in situ hybridization technique for human papillomaviruses (HPV)-6/11, -16, -18, and -31, and immunohistochemical staining for p53 were performed. Both tumors showed focal expression of HPV-16 within areas showing squamoid changes and diffuse expression of p53 within the areas of invasive squamous cell carcinoma. Although nuclear staining for HPV has been identified in tumors of adnexal origin, to our knowledge these are the first cases in which a highly oncogenic HPV subtype, HPV-16, has been identified within squamous cell carcinomas arising from adnexal ductal structures. These cases may help explain primary cutaneous squamous cell carcinomas with no epidermal origin.

Aged↗
PubMed1995

Color Doppler sonography of adnexal torsion.

The purpose of this study was to describe the color Doppler sonographic findings in adnexal torsion that distinguish viable from nonviable ovaries. We present the color Doppler sonographic features in 13 patients with surgically proved adnexal torsion that help determine whether or not the ovaries were viable or nonviable at the time of surgery. Eleven combined ovarian and tubal torsions and two isolated tubal torsions were studied. In 10 cases the ovaries were considered nonviable at the time of surgery and in three cases they were considered viable. Of the nonviable group, six showed absent arterial and venous flow centrally, but two had low velocity (< 5 cm/s) arterial flow peripherally in the region of the adnexal branch of the uterine artery or in the main ovarian artery, and two demonstrated absent or reversed diastolic arterial flow. None of the nonviable ovaries showed venous flow centrally. In contrast, all of the viable ovaries demonstrated venous flow centrally, and two had peripheral and central arterial flow. Although the CDS findings in adnexal torsion are variable, ovarian viability may be predicted if central venous flow is present.

Adolescent↗
PubMed2001

[Adnexal findings].

The female small pelvis is usually explored by conventional clinical examination. Adnexal masses found are assessed first by ultrasound. Thereby, sonographic findings should be documented and committed in a purely descriptive manner. It is not advisable to establish a histopathologic diagnosis, but to assign sonographic findings to one of the following three major groups: "simple cyst", "benign lesion", "malignant lesion". The SGUMGG recommends the Mainz-Score for the assessment of adnexal tumours, performed by transvaginal ultrasonography. Usually, a new adnexal tumour without symptoms may be evaluated after an interval of approx. six weeks without additional danger for the patient. A comprehensive Swiss guideline to adnexal tumours is in preparation by the Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe. Its release is expected to be in the ongoing year 2001.

Endosonography↗
PubMed1998

[A study on diagnosis of ocular adnexal lymphoid hyperplasia by polymerase chain reaction amplified IgH CDR-III sequence].

OBJECTIVE: To study the diagnosis and classification of ocular adnexal lymphoid hyperplasia and investigate its cell origin by using some molecular biological techniques. METHODS: 29 cases (31 eyes) of ocular adnexal lymphoid hyperplasia were examined for immunoglobulin heavy-chain (IgH) gene rearrangements by means of polymerase chain reaction (PCR) to amplify the complementarity determining region III (CDR-III) with formalin-fixed and paraffin-embedded tissue combining with histopathologic examination and immunophenotypic analysis. RESULTS: 17 eyes of malignant lymphoma and 5 eyes of reactive lymphoid hyperplasia demonstrated clear single band of the rearranged gene for the IgH chain between 100 bp. to 120 bp. The bilateral ocular adnexal lymphoma occurring simultaneously in 4 eyes (two individuals) exhibited identical band. 1 eye of malignant lymphoma, 8 eyes of atypical lymphoid hyperplasias and 6 eyes of reactive lymphoid hyperplasia showed no band or a smear band. CONCLUSIONS: The results show that this method can determine the clonality of the lymphoid hyperplasias. It may be as well in the examination of small monoclonal B cell populations for which immunophenotypical analysis is difficult. The method is an objective, accurate and useful approach for the diagnosis of ocular adnexal lymphoid hyperplasias.

Complementarity Determining Regions↗
PubMed2002

[Three dimensional sonography and 3D power angiography in differentiation of adnexal tumors].

BACKGROUND: Three-dimensional sonography is a novel diagnostic method proposed to be an additional non-invasive tool in the assessment of ovarian tumors. OBJECTIVE: To study diagnostic potential of 3D sonography and power Doppler angiography in the preoperative differentiation of adnexal masses. MATERIAL AND METHODS: One hundred twenty-eight women with tumors thought to be of adnexal origin were examined preoperatively. Following morphological (papillae, septae, tumor size and volume) and color Doppler (PI, RI, Vmax and TAMX) assessment, 3D ultrasound of adnexal tumors according to Kurjak et al. (2000) was performed. Various scanners were used and included: ATL 5000 HDI (Phillips, USA) and Combison 530 and Voluson 730 (Kretztechnik, Austria) machines. Following variables were studied: inner wall structure, presence of papillae, thickening > 3 mm of septa as well as vascular branching pattern, number and localization of small blood vessels and the presence of vascular anastomoses. RESULTS: Twenty-one tumors were malignant (3 FIGO stage I) and 101 masses were benign. Power Doppler combined with 3D sonography predicted malignancy with a sensitivity of 92.6% (25 of 27 patients). Commonly used morphological and Doppler criteria produced lower sensitivity, the values being in range of 45% to 87.5%. Negative predictive value of 97.2% was the highest for 3D sonography (> 7 points in Kurjak's scale). CONCLUSIONS: Selective use of 3D ultrasound and power Doppler angiography could be used to better characterize adnexal tumors. Detailed 3D sonography may help to identify women who, if needed, may have less invasive surgical procedure such as laparoscopy or be referred to gynecological oncologist.

Adolescent↗
PubMed2003

Expression of inducible nitric oxide synthase in cutaneous adnexal tumours of the head and neck.

Adnexal tumours are a rare heterogeneous group of neoplasms, most commonly found in the head and neck region. Although most are benign, malignant adnexal tumours often behave aggressively, resulting in early metastasis. There is increasing interest in the role that nitric oxide (NO) plays in the behaviour of many cancers. It is thought that NO, produced by the enzyme inducible NO synthase (iNOS), facilitates tumour growth and dissemination. iNOS has been studied in the common skin cancers, where its expression correlates with tumour behaviour, but it has not been previously investigated in cutaneous adnexal tumours. An immunhistochemical study was performed using a monoclonal antibody to iNOS in 37 cases of adnexal tumours (19 benign, 18 malignant). iNOS expression was weakly expressed by basal keratinocytes of adjacent skin in all cases and it was variably expressed in the tumours. Malignant tumours had significantly increased iNOS expression when compared to both adjacent skin (P<0.001) and the benign tumour group (P<0.001). No significant difference was found between iNOS expression in benign tumour and adjacent skin (P=0.5). The role of iNOS in this rare group of tumours and the possibility of pharmacologically inhibiting it in the clinical setting warrants further investigation.

Adenocarcinoma, Sebaceous↗
PubMed2005

[Role of Ca-125 in the differential diagnosis of adnexal mass in breast cancer patients].

OBJECTIVES: Serum CA-125 is of value in differential diagnosis of benign and malignant adnexal masses, especially in postmenopausal women. In ovarian cancer preoperative CA-125 levels are related to tumor stage, histologic grade, but are not an independent prognostic factor. DESIGN: The aim of our study was to determine CA-125 serum level in women with ovarian tumor treated previously because of breast cancer. MATERIALS AND METHODS: Due to our research, we examined 51 women operated on for adnexal masses in the Department of Oncological Gynaecology in Bydgoszcz, 1996 - 2002. All those patients were treated because of breast cancer previously. RESULTS: In 19 women (37,3%) benign ovarian tumors were found, in 4 cases (7,8) - primary ovarian cancer whereas in 28 patients (54,9%) breast cancer metastases were detected. Based on CA-125 levels before surgery, correlation between CA-125 concentration and malignant histologic type was observed. CONCLUSIONS: 1. Higher CA-125 serum levels were found in a group of patients with metastatic adnexal masses compared to primary ovarian cancer. 2. In a group of women with breast cancer and ovarian tumor, metastatic adnexal masses were observed in more than 50% of cases.

Adult↗
PubMed1977

Fertility following adnexal surgery.

A total of 154 patients after adnexal operations between 1969-1973 were queried in order to establish fertility rate after operation. Out of the 154 questioned 122 submitted their reply. i.e. 69.2 per cent. These women were divided into three groups. The first one comprised 46 patients operated because of extrauterine pregnancy, the second consisted of 50 patients operated because of ovarian cyst and the third one included 18 women operated because of bilateral adnexal pathology. In the first group 90 per cent of the patients who desired so succeeded to become pregnant. In the second group 87 per cent succeeded and 66.6 per cent in the third group. The possible ethyological factors of sterility after adnexal operations were discussed and conservative operations were proposed as the most convenient policy in cases of bilateral adnexal pathology.

Adnexa Uteri↗