Biomedical subjects

Elvio G Silva

Publications and source records attributed to Elvio G Silva.

15 recordsLinked to original sources

PubMed2003

Invasive micropapillary carcinoma of the breast metastatic to the urinary bladder and endometrium: diagnostic pitfalls and review of the literature of tumors with micropapillary features.

Carcinomas with micropapillary features have been described in the breast, urinary bladder, lung, and ovary. They are characterized by the presence of micropapillary tufts in clear spaces. Unequivocal vascular invasion is usually present at the periphery of the tumor. Consequently, these tumors have a high propensity for lymph node metastases and high-stage disease. The metastatic carcinoma can consist exclusively of the micropapillary component, which may elicit an erroneous diagnosis if located in the bladder or lung, as in the patient presented herein. We present a case of a 59-year-old woman with a history of bilateral breast carcinoma status post-bilateral mastectomy, chemotherapy, and tamoxifen therapy. She presented with urinary frequency, and a pelvic mass was noted. A biopsy of the endometrium revealed a poorly differentiated carcinoma. Urinary bladder biopsies showed a carcinoma with micropapillary features diagnosed as micropapillary transitional cell carcinoma. She presented to M.D. Anderson Cancer Center (Houston, TX) for further treatment recommendations. The urinary bladder and endometrial biopsies both contained carcinomas with micropapillary features. The mastectomy specimen showed an invasive ductal carcinoma with a significant micropapillary component. The tumor cells from the breast, endometrium, and urinary bladder were positive for cytokeratin (CK) 7 and estrogen receptor and negative for CK20. In view of the morphologic and immunohistochemical profile, the carcinoma in the endometrium and urinary bladder were interpreted as metastatic lesions from the breast primary. Carcinomas with a micropapillary component are morphologically identical in the breast, urinary bladder, and lung. However, micropapillary serous carcinoma has a different appearance more akin to borderline tumors of the ovary. Immunohistochemical stains are useful in distinguishing these lesions in that thyroid transcription factor-1 positivity suggests a lung primary, CK7 and estrogen receptor suggest a breast primary, and both CK7 and CK20 positivity suggest a urinary bladder primary. It is important to exclude metastatic carcinomas with micropapillary features before making a definite diagnosis of a primary tumor. Carcinomas with micropapillary features have a propensity for lymph node metastases and advanced stage disease. This article discusses the differential diagnosis of carcinomas with micropapillary features in different organs.

Biomarkers, Tumor↗

PubMed2003

Benign cystic mesothelioma of the peritoneum: a clinicopathologic study of 17 cases and immunohistochemical analysis of estrogen and progesterone receptor status.

Benign cystic mesothelioma (BCM) is an uncommon lesion of the peritoneum occurring predominantly in women of reproductive age. Although most patients are managed by surgical resection, a reported high incidence of cyst recurrence has led to the use of hormonal therapy in isolated cases in an attempt to control cyst size and relieve local symptoms. To date, the estrogen receptor (ER) and progesterone receptor (PR) status of BCM has not been evaluated. Here we present our experience with 17 cases (13 women, 4 men) of BCM seen over a 19-year period, including an immunohistochemical analysis of ER and PR status in 14 cases. All lesions showed typical morphological features of BCM, and calretinin immunostaining was positive in 14 of 14 cases. Five patients experienced either 1 or 2 tumor recurrences, and no patients died of disease. One case was diffusely positive for ER only, 1 case was focally positive for PR only, and 1 case was focally positive for both ER and PR. Although immunohistochemical detection of female sex hormone receptors in BCM is uncommon, the focal presence of ER and/or PR in some lesions does provide weak biologic support for the use of hormonal manipulation as a therapeutic option. Hum Pathol 34:369-374.

Adolescent↗

PubMed2003

Metastatic tumors of the vulva: a clinicopathologic study of 66 cases.

Metastatic tumors involving the vulva are rare, with only a few series and case reports published in the English literature to date. In this study, we present the clinicopathologic features of 66 cases of metastatic tumors of the vulva seen at the University of Texas M. D. Anderson Cancer Center from 1944 to 2001. The patients' age ranged from 18 to 84 years (mean 54.8 years). The most common presentations were vulvar nodules or a mass (39 cases), pain (7 cases), and ulceration (5 cases). In 46.9% of cases, the primary tumor was of gynecologic origin, whereas in 43.9% of cases the primary tumor was of nongynecologic origin. The remainder had unknown primaries. The site most frequently involved by metastasis was the labium majus (44 cases: 18 on the right, 13 on the left, 6 bilateral, and 7 unspecified side). Thirty percent of the patients received chemotherapy as treatment for the metastasis, 27% received radiotherapy, and the rest received some combination of chemotherapy, radiotherapy, and surgery. Of the 60 patients with available follow-up, 52 died of disease within 1-81 months (median 7.5 months) from diagnosis of the metastasis. Metastatic tumors of the vulva are rare; however, the diagnosis of these tumors is facilitated by the knowledge of a preexistent malignancy and the lack of a mucocutaneous intraepithelial lesion.

Adolescent↗

PubMed2003

Metastatic melanoma to the vagina: clinicopathologic and immunohistochemical study of three cases and literature review.

We report the clinicopathologic features of three cases of malignant melanoma metastatic to the vagina; only one similar case has been previously reported. The age of the patients ranged from 33 to 70 years; two presented with vaginal bleeding. Two patients had a history of a previous primary malignant melanoma, one a preauricular melanoma treated 7 years earlier and the other a vulvar melanoma treated 2 years earlier. In the third case, a primary malignant melanoma was found on the sole of the right foot after the patient had presented with the vaginal metastases. On gross examination, the vaginal tumors were polypoid; two were on the posterior wall and one was on the anterior wall. All were of epithelioid cell type and were positive with S-100 and microphthalmia-transcription factor. Tyrosinase was positive in two cases, HMB-45 was positive in one case, and MART-1 was focally positive in one case. One patient underwent wide local excision of tumor followed by chemotherapy, one patient had intracavitary radiotherapy, and one had palliative radiotherapy to the brain only. The patients died after a follow-up of 3, 14, and 48 months.

Adult↗

PubMed2003

Ovarian steroid cell tumors: an immunohistochemical study including a comparison of calretinin with inhibin.

Ovarian steroid cell tumors, not otherwise specified (SCTs, NOS) are uncommon sex cord-stromal tumors that may be difficult to distinguish from other oxyphilic or clear-cell neoplasms. Immunohistochemical staining for inhibin, although generally useful in the diagnosis of SCTs, NOS, is not positive in every case and not all laboratories have this marker available. Recently, it has been reported that calretinin is expressed by sex cord-stromal tumors. We studied six SCTs, NOS for both calretinin and inhibin expression to evaluate the sensitivity of calretinin in comparison to inhibin. We also tested for CD99, Melan-A (A103), and S-100, other markers reported to be positive in these tumors. HMB-45 and MART-1 (Ab3) completed our panel of markers. All six tumors were positive for both calretinin and inhibin. Calretinin positivity was present in 60% to >90% of tumor cells, whereas inhibin reactivity ranged from <5% to >90% of tumor cells. Membranous staining for CD99 was present in one tumor. S-100-positive cells were seen in two tumors, whereas four tumors were immunoreactive for HMB-45. All six tumors were positive for Melan-A (A103), but in general the staining was less diffuse than with calretinin. All of the tumors were essentially negative for MART-1 (Ab3). The consistent diffuse staining of the tumors in this study for calretinin, in comparison to inhibin and Melan-A (A103), suggests that it is a sensitive marker for SCTs, NOS. MART-1 (Ab3) immunostaining may be useful for cases in which melanoma is considered in the differential diagnosis.

Biomarkers, Tumor↗

PubMed2003

Tissue macroarray: a simple and cost-effective method for high-throughput studies.

The tissue microarray technique is a powerful technique that can examine many clinical specimens in a single slide. However, this technique requires a specialized instrument for the construction of tissue microarray block. The authors describe an alternative tissue macroarray technique for the simultaneous analysis of multiple clinical specimens on a single slide. As an example of this method, the authors assembled 12 tumor samples from 12 different paraffin blocks on a glass slide and then immunostained with hMLH1 antibody. This simple method does not need specialized equipment and should be an alternative efficient approach for large-scale clinical specimens.

Antibodies, Monoclonal↗

PubMed2003

Calcifications in ovary and endometrium and their neoplasms.

In this study, we investigated the role of hormones in the pathogenesis of calcifications in ovary and in endometrium and their neoplasms of the gynecologic tract and assessed the anatomic location and incidence of these calcifications. The study consists of three parts designed to investigate the pathogenesis, the location, and the incidence of calcifications in ovary and endometrium and their neoplasms. In the first part, 79 female guinea pigs were divided into 10 groups, and different hormones, given weekly for 12 months, were administered to the guinea pigs by group. A control group of 7 guinea pigs received sterile water. Calcifications developed in 5 of 7 guinea pigs treated with prolactin, 10 of 20 treated with human chorionic gonadotropin, 5 of 11 treated with estradiol, 3 of 7 treated with estrone, 1 of 6 treated with growth hormone, and 1 of 10 treated with testosterone; in 20 of the guinea pigs, the calcifications developed in the stroma of the endometrium, and in 5 guinea pigs, they developed in the ovary. The second part of the study consisted of an evaluation of the specific location of calcifications in 43 consecutive human surgical ovaries and endometria. Calcifications were seen only in the stroma in 100% of the ovarian serous adenofibroma specimens; in ovarian serous borderline neoplasms, the stroma contained 70 to 100% of the calcifications, and the epithelium had 0 to 30% of the calcifications. In ovarian serous carcinoma specimens, the calcifications were seen in the stroma in 50 to 60% of the cases, in the epithelium in 40% of the cases, and in areas of necrosis in 10% of the cases. The third part of the study was directed to determine the frequency of calcifications in ovarian lesions. We found that all cases of endosalpingiosis and ovarian low-grade serous carcinoma had calcifications, whereas 80% of the cases of serous borderline tumor had calcifications, and only 50% of the cases of ovarian high-grade serous carcinoma contained calcifications. The results of this study indicate that the majority of the calcifications in the ovary and the endometrium and their neoplasms are present in the stroma. This is most probably secondary to metabolic changes, which could be related to hormones and not caused by degenerative changes in epithelial cells.

Animals↗

PubMed2003

Ovarian sex cord-stromal tumors: an immunohistochemical study including a comparison of calretinin and inhibin.

Because ovarian sex cord-stromal tumors (SCST) are morphologically heterogeneous neoplasms that are relatively infrequently encountered, their diagnosis can be difficult. Immunohistochemical staining may be useful for establishing the diagnosis in problematic cases. We studied 53 ovarian SCSTs to characterize their immunohistochemical staining pattern: 17 adult granulosa cell tumors (AGCTs), 4 juvenile granulosa cell tumors (JGCTs), 3 sex cord tumors with annular tubules (SCTATs), 9 Sertoli-Leydig cell tumors (SLCTs), 10 fibromas, 5 fibrothecomas (FTs), and 5 thecomas. In 8 of the 53 cases, the tissue studied was from a metastatic site. The immunopanel included calretinin, inhibin, WT1, cytokeratin cocktail, epithelial membrane antigen (EMA), and cytokeratin 5/6 (CK5/6). The fibromas and FTs were also tested with CD10. The extent of staining was assessed in a semiquantitative fashion and ranked on a scale of 0 through 4+. All of the tumors, except for 1 metastatic SLCT, were positive for calretinin. Forty-five of the cases (85%) stained for inhibin; 1 metastatic AGCT, 3 fibromas, and 4 FTs were negative. WT1 was present in 39 tumors (74%), with expression most prominent in the SLCTs. The cytokeratin cocktail stained 23 of the 53 tumors (43%), whereas just 1 tumor was positive for EMA (1+ in a JGCT). All tumors were negative for CK5/6, and the 15 fibromas and FTs were negative for CD10. We conclude that because cytokeratin is frequently expressed by SCSTs, in particular by granulosa cell tumors, SLCTs, and SCTATs, the inclusion of EMA in a panel may help to exclude epithelial neoplasms. In addition, WT1, present in normal granulosa cells, is expressed by a majority of SCSTs. Finally, these results demonstrate that calretinin is at least as sensitive as inhibin for ovarian SCSTs overall and that it is more sensitive than inhibin for fibromas and FTs.

Biomarkers, Tumor↗

PubMed2003

Uterine tumor resembling ovarian sex-cord tumor: report of a case mimicking cervical adenocarcinoma.

Uterine tumors resembling ovarian sex-cord tumors (UTROSCTs) are unusual neoplasms with histologic features that resemble those within ovarian Sertoli and granulosa cell tumors. We report the case of a 24-year-old woman with a UTROSCT presenting as a cervical mass, which on initial evaluation was thought to represent cervical adenocarcinoma. The patient's cervical biopsy specimen contained epithelioid cells arranged in tubules and anastomosing cords, without significant cellular atypia or mitotic activity. Because this morphology elicited a broad differential diagnosis, immunohistochemical studies were performed. The tumor was found to be diffusely positive for cytokeratin cocktail, calretinin, and desmin, focally positive for CK7 and SMA, and negative for EMA, CEA, inhibin, CD10, CK20, chromogranin, and synaptophysin. Ultrastructural examination revealed occasional gland-like lumens with cells joined by desmosomes and a continuous basal lamina. UTROSCTs have features that may cause them to be confused with more common tumors, especially in limited biopsy samples, and should be included in the differential diagnosis when a gland-forming neoplasm with an unusual appearance is identified in a cervical or endometrial biopsy specimen.

Actins↗

PubMed2002

Response and survival in patients with progressive or recurrent serous ovarian tumors of low malignant potential.

OBJECTIVE: To evaluate the response to therapy and survival of patients with progressive or recurrent serous ovarian tumors of low malignant potential. METHODS: Fifty-three patients with progressive or recurrent serous ovarian tumors of low malignant potential were identified. Response was assessed and progression-free and overall survival were analyzed. The influence of clinicopathologic factors on survival was determined. RESULTS: In 49 patients with known histology of progression or recurrence, 36 (73%) had low-grade serous carcinoma, and 13 (27%) had serous ovarian tumors of low malignant potential. Forty-five patients received nonsurgical therapy and had an evaluable response. There were six (13%) patients with a complete response and six (13%) patients with a partial response. The median time to first progression or recurrence was 5.6 years. Median survival from diagnosis of first recurrence was 7.7 years. Median survival from initial diagnosis was 21 years. Nineteen (36%) patients are dead of tumor. Patients who recurred with low-grade serous carcinoma were more likely to die of tumor than those with serous ovarian tumors of low malignant potential (47% versus 0%, P =.045). Optimal cytoreduction was associated with improved survival (P =.007). CONCLUSION: Patients with progressive or recurrent serous ovarian tumors of low malignant potential have a long interval from diagnosis to progression and from progression to death, resulting in extended overall survival. Recurrence as low-grade serous carcinoma and failure to achieve optimal secondary cytoreduction were adverse prognostic factors. There were few responses to nonsurgical therapy.

Adult↗

PubMed2002

Elevated luteinizing hormone in serum, breast cancer tissue, and normal breast tissue from breast cancer patients.

PURPOSE: Hormones are known to be important in breast cancer, but studies have focused on steroid hormones and their cognate receptors. We report here an analysis of luteinizing hormone (LH) concentration in serum and breast tissue samples. MATERIALS AND METHODS: We studied serum and breast tissue samples from 353 women, 231 with breast cancer and 122 controls. Four breast tissue sites were sampled in every case. Tumor samples were also available from 48 patients and serum from 101 subjects. LH was measured by enzyme-linked immunosorbent assay. RESULTS: LH concentration in breast tissue was significantly higher in samples from patients with breast cancer than in samples from control subjects. In breast cancer patients, there was a decreasing gradiant from the cancer to the normal breast tissue, near and far from the tumor. Serum LH levels could not distinguish between breast cancer and control cases in most cases; but tissue LH could. CONCLUSIONS: LH concentrations were higher in breast tumors than in normal tissue near to or far from the tumor in women with breast cancer, and these concentrations were higher in women with breast cancer than in control cases. The different LH concentrations in breast tissue might be used to detect small or hidden carcinomas. In addition, the identification of luteinizing hormone in breast tissue offers a different explanation for the mechanism of action of LHRH agonists and might identify patients that respond to this treatment.

Adult↗

PubMed2002

Micropapillary and cribriform patterns in ovarian serous tumors of low malignant potential: a study of 99 advanced stage cases.

Recently some investigators have proposed abandoning the term ovarian serous tumor of low malignant potential (SLMP) and dividing the tumors in this category into two new groups, micropapillary serous carcinoma and atypical proliferative serous tumor, based on the presence or absence of marked epithelial proliferation with a micropapillary or cribriform pattern (MP/CP). We reviewed 99 cases of advanced stage SLMP (FIGO stages II and III) to determine whether the presence or absence of MP/CP predicts the clinical course, thus justifying the proposed change in terminology. Eighteen cases of MP/CP and 81 cases of typical SLMP were identified. The patients with MP/CP ranged from 23 to 59 years of age at the time of diagnosis (median 35 years), whereas those with typical SLMP were 17 to 67 years old (median 38 years). Bilateral ovarian involvement by SLMP was more frequent in the MP/CP cases, 13 of 18 (72%), as compared with the cases with typical SLMP, 46 of 81 (57%). There was a trend toward a greater frequency of invasive implants in MP/CP cases, 3 of 18 (17%) MP/CP versus 5 of 81 (6%) typical. The mean follow-up period was 125 months for MP/CP patients and 132 months for the typical group. Differences in the frequency of recurrence and the progression-free survival between the groups were found to be significant. Fourteen (78%) of the MP/CP patients experienced either progression or recurrence of disease, whereas 25 (31%) of the typical SLMP patients had a recurrence (p = 0.001). The progression-free survival ranged from 3 to 208 months for MP/CP patients versus 15 to 233 months for typical SLMP patients (p <0.0001). The majority of the recurrences in both groups were low-grade serous carcinoma, 11 of 14 (79%) patients with progression/recurrence in the MP/CP group and 17 of 25 (68%) patients with recurrence in the typical group. The overall survival of the patients in the two groups, however, was not significantly different. Five (28%) MP/CP patients and 12 (15%) patients with typical SLMP died of disease (p = 0.11). All 17 of these patients developed serous carcinoma and died secondary to tumor progression. Four of eight (50%) patients with invasive implants and 13 of 91 (14%) patients with noninvasive implants died of disease. Our findings of more frequent bilateral ovarian involvement, more frequent recurrence with a shorter progression-free interval, and the trend toward a more frequent association with invasive implants support the contention that MP/CP SLMP are a distinct subgroup of serous tumors. However, the overall survival of patients with MP/CP SLMP is similar to that of patients with typical SLMP and justifies the retention of tumors with MP/CP within the LMP category. Additionally, our long-term follow-up of patients with typical SLMP indicates that a number of these tumors do not follow a benign course and supports their continued designation as borderline neoplasms.

Adolescent↗

PubMed2002

Vaginal melanoma: a clinicopathologic and immunohistochemical study of 26 cases.

Malignant melanomas of the vagina are rare tumors. In this study we present the clinicopathologic features and immunohistochemical analysis of 26 such cases seen in our institution over a period of 30 years. The patients' age ranged from 38 to 90 years (mean 60 years); three patients were premenopausal. Ethnicity was known in 24 patients: 20 white, 2 hispanic, 1 black, and 1 Asian. The most common presenting symptom was vaginal bleeding, followed by vaginal mass. Grossly, the tumor was polypoid-nodular in the majority of cases. The neoplastic cells were epithelioid in 15 cases and spindled in three cases; eight cases had both cell types. Vascular-lymphatic invasion was seen in six cases and perineural invasion was seen in four cases. S-100 was strongly and diffusely positive in 25 of 26 cases (96%). HMB-45 was strongly positive in 16 (62%), 3 (11%) were focally positive, 1 case showed a rare positive cell, and 6 (23%) were negative. With MART-1, 20 cases (77%) were strongly positive, 1 (4%) showed a rare weakly positive cell, and 5 (19%) were negative. Twenty-one cases (81%) expressed tyrosinase and 20 (77%) expressed microphthalmia transcription factor. Twenty cases were Chung's level IV, 3 were level III, and 2 were level II. The patients were treated as follows: anterior exenteration with or without lymph node dissection and with or without radiotherapy (RT) or chemotherapy (CT) (7 cases), wide local excision with or without lymph node dissection and RT/CT (10 cases), hysterectomy with vaginectomy with or without RT/CT (3 cases), vaginectomy with RT (1 case), RT (1 case), and RT and CT (1 case). One patient had palliative RT for the brain metastasis only. Follow-up was available in 23 patients ranging from 3 to 276 months (median 18 months). Local recurrence after primary treatment was seen in six patients and distant metastases in 11 patients. Fifteen patients died of the disease (3-83 months), 4 have no evidence of disease (5-24 months), and 4 are alive with disease (6-276 months). This study confirms the poor prognosis of patients with vaginal melanoma. S-100 remains the most sensitive marker for these tumors. HMB-45 is negative in 23% cases of vaginal melanoma. Tyrosinase and MART-1 are useful markers when S-100 is negative or only focally positive.

Adult↗

PubMed2002

Peritoneal lesions in guinea pigs treated with hormones.

Foci of peritoneal fibrosis frequently occur with ovarian neoplasms, especially those of epithelial type, usually in association with foci of metastatic tumor or implants. However, in the absence of the latter, the presence of fibrosis cannot be clearly explained. To find an explanation for this phenomenon, we investigated the development of hormone-dependent peritoneal changes in guinea pigs. Of the 59 guinea pigs studied, 49 received one of the following hormones or hormone analogs: estradiol, diethylstilbestrol (DES), testosterone, estrone, Megace, human chorionic gonadotropin, Norethin, clomiphene, luteinizing hormone, dienestrol, hexestrol, and tamoxifen, over a period ranging from 3 to 9 months. Ten guinea pigs received sterile water (control cases). Multiple peritoneal fibrous plaques 1 to 7 mm in greatest dimension were found in 5 of 7 guinea pigs that received estradiol, 6 of 8 treated with DES, and 2 of 2 that received hexestrol and estrone. The largest lesions (fibrous polyps up to 1.2 cm in greatest dimension) were seen in those that received estrone; however, this hormone was poorly tolerated, as two of the animals that received it died after 1 and 2 months, respectively. Because DES was the best-tolerated hormone, we administered it to five additional guinea pigs for 12 months. All five developed fibrous plaques; three of them also developed peritoneal fibroleiomyomas. We conclude that estrogens can induce the development of fibrous plaques in the peritoneum and when they are administered for a long period of time they also induce the development of smooth muscle nodules. This finding is relevant to understanding the pathogenesis of both fibrous lesions associated with ovarian tumors and peritoneal leiomyomatosis.

Animals↗

PubMed2002

The association of benign and malignant ovarian adenofibromas with breast cancer and thyroid disorders.

An unexpected association with breast cancer and thyroid disorders was found during a review of 91 cases of benign and malignant ovarian adenofibromas. Sixty-three tumors were benign, 11 had areas of borderline neoplasms, and 17 had a component of carcinoma. Such tumors were divided into glandular/cystic (61 cases) and papillary (30 cases) according to their gross and microscopic appearance. Among the 61 patients with glandular/cystic adenofibromas, 13 (21%) had breast cancer and 19 (31%) also had thyroid disorders. Among the 30 patients with papillary adenofibromas there were no cases of breast cancer and only 2 patients had thyroid disorders. The average age of the patients with ovarian adenofibroma and breast cancer or thyroid disorders was higher (66 years) than that of patients without breast cancer or thyroid disorders (55 years). More patients with breast cancer and thyroid disorders had bilateral adenofibromas than patients without breast cancer or thyroid disorders. We also reviewed the medical records of 100 patients with ovarian cancer without adenofibroma component, 100 patients with breast cancer, and 100 patients with ovarian and breast cancer. Six percent of patients with ovarian cancer had breast cancer and 16% of each one of these groups had thyroid disorders. This unexpected association found between glandular/cystic adenofibromas, breast cancer, and thyroid disorders might be explained by defects common to these organs. Disorders of some of these organs have been linked by common genetic changes and it is known that these organs are under the influence of similar hormones. Mutations of PTEN have been found in breast and thyroid cancer. The thyroid and ovaries are controlled by glycoprotein hormones of the pituitary gland, which have common alpha subunits.

Adenofibroma↗