Biomedical subjects

F A Tavassoli

Publications and source records attributed to F A Tavassoli.

At least 73 records · Page 4Linked to original sources

PubMed1997

Papillary squamotransitional cell carcinoma of the cervix: a report of 32 cases.

Papillary carcinomas of the uterine cervix with transitional or squamous differentiation are rare tumors that often resemble transitional cell carcinomas of the urinary tract. We reviewed 32 such cases of papillary cervical carcinoma and divided them into three groups: 1) predominantly (> 90%) squamous (nine cases), 2) mixed squamous and transitional (16 cases), and 3) predominantly transitional (seven cases). Overall, the patients ranged in age from 22 to 93 years (mean 50), and the most common clinical presentation was abnormal bleeding (15 patients) and an abnormal Papanicolaou smear (nine patients). The tumors ranged in size from 0.7 to 6.0 cm (mean 3.0). All cases demonstrated a papillary architecture with fibrovascular cores lined by a multilayered, atypical epithelium resembling a high-grade squamous intraepithelial lesion of the cervix. Underlying superficial to deep stromal invasion was seen in 18 of 20 cases (90%); in the remaining 12 cases, the specimen was too superficial to assess invasion. Eighteen (86%) of the 21 cases examined immunohistochemically demonstrated immunoreactivity for cytokeratin 7, whereas only two of the 21 (9.5%) showed positivity for cytokeratin 20. Of the 12 women for whom follow-up information was available, three were treated by simple hysterectomy, two underwent radical hysterectomy, one was treated with radiation alone, and one with combination chemotherapy and radiotherapy. Three patients died of disease (two in the squamous group and one transitional) within an average of 13 months after diagnosis. Local recurrence developed in two women, and one of these, a vaginal recurrence, occurred 12 years after the original diagnosis. Based on the above findings, we believe that these tumors are a clinicopathologically distinct, homogeneous group that display a morphologic spectrum. Nevertheless, because some tumors may show a purely squamous or purely transitional appearance, we propose retaining the above three separate designations for these tumors with the understanding that there is often a substantial degree of subjectivity in deciding whether a tumor is squamous or transitional. The most distinctive, objective, and easily recognizable feature of these tumors is their surface papillary architecture rather than their superficial resemblance to transitional cell carcinomas of the urinary tract, and we emphasize the need to distinguish these potentially aggressive malignant tumors from the far more common and benign papillary lesions of the cervix.

Adult↗

PubMed1997

Superficial angiomyxoma (cutaneous myxoma): a clinicopathologic study of 17 cases arising in the genital region.

Seventeen cases of superficial angiomyxoma (cutaneous myxoma) of the genital region are reported. Thirteen patients were female (age range: 15-33 years; mean: 21 years) and four were male (age range: 18-55 years; mean: 39 years). The sites of involvement in females were the labium majus or labium, not otherwise specified (n = 6), vulva (n = 4), groin (n = 2), and mons pubis (n = 1). All lesions in male patients involved the scrotum. The tumors were present from 2 months to 4 years before resection and ranged from 0.9 to 6 centimeters in maximal dimension; 10 tumors were 3 centimeters or less in size. The predominant reason for seeking medical attention was a slow growing painless mass. All lesions were locally excised. Follow-up was obtained for 9 patients with a mean and median follow-up interval of 135 and 95 months, respectively. A recurrence developed in three patients at 8 months, 7 years 11 months, and 20 years. No patient has been shown to have Carney's complex. The tumors were immunoreactive for vimentin (11/11), CD34 (11/11), muscle-specific actin (8/12), smooth muscle actin (9/11), S100 protein (5/13), and Factor XIIIa (5/9). No immunoreactivity was present for desmin (DE-R- 11), glial fibrillary acidic protein, estrogen receptor or progesterone receptor. Superficial angiomyxomas are probably derived from fibroblast-like cells capable of antigen modulation.

Adolescent↗

PubMed1997

Pure pleomorphic rhabdomyosarcomas of the uterus.

Pure rhabdomyosarcoma arising in the uterus is a rare tumor currently classified by the World Health Organization (WHO) as a uterine sarcoma. The records of eight women with uterine rhabdomyosarcomas were retrieved from the files of the Armed Forces Institute of Pathology (AFIP). The eight women presented with vaginal bleeding, abdominal enlargement, or acute abdomen. The mean age of the patients was 64.6 years (range 35-87). Macroscopically, 4 tumors were polypoid endometrial masses, 2 were intramyometrial, 1 was located in the cervix, and 1 was a 15-cm mass involving the endometrium and myometrium with direct extension into the small intestine. Microscopically, the tumors consisted of a variable proportion of large rhabdomyoblasts admixed with smaller round, polygonal, and spindle-shaped cells. No epithelial elements were identified on light microscopy. Tissue from the extrauterine and metastatic lesions was available for review in four cases and also showed pure rhabdomyosarcoma. Immunohistochemical assessment of seven tumors supported the sarcomatous nature of the neoplastic cells. Six patients died of disease within 15 months of initial diagnosis and 1 patient died of a pulmonary embolus. The patient whose 15-cm tumor had extended into the small intestine survived 6 years; she died of a presumed pancreatic carcinoma. Presenting mainly in elderly women, uterine pleomorphic rhabdomyosarcomas are rare, highly malignant tumors with frequent extrauterine spread at presentation. Patients rarely survive beyond 15 months.

Actins↗

PubMed1997

Identical clonality of both components of mammary carcinosarcoma with differential loss of heterozygosity.

The histogenesis of carcinosarcomas is controversial, specifically with respect to clonality and cell of origin. To answer these questions, tumor cells from both epithelial and spindle-cell components were microdissected from three cases each of mammary carcinosarcoma and its postulated precursor, carcinoma with spindle-cell metaplasia. Clonality was assessed using the principle of X chromosome inactivation. Loss of heterozygosity (LOH) was evaluated at seven chromosomal loci to assess shared and distinctive genetic alterations for the two components in each tumor. All of the six cases demonstrated identical clonality of the carcinomatous and spindle-cell components, identical to a focus of ductal carcinoma in situ present in one case. LOH for NM23 was detected in both components in one carcinosarcoma, whereas LOH for INT-2 was detected in both components in one metaplastic carcinoma. Differential LOH for D11S904 was present in only the mesenchymal components of these two cases. We conclude that the two components of carcinosarcoma and its precursor are clonal and that the sarcomatous and spindle-cell components arise from mutation of the carcinoma. Presence of differential LOH at D11S904 in only the spindle-cell components suggests that this mutation might be critical to the development of this second phenotype.

Breast Neoplasms↗

PubMed1997

The influence of endogenous and exogenous reproductive hormones on the mammary glands with emphasis on experimental studies in rhesus monkeys.

Endogenous and exogenous reproductive hormones have long been recognized as a risk factor for breast carcinoma. These hormones are thought to exert their influence by altering the kinetics of cell proliferation, differentiation or atrophy resulting in an increased population of susceptible cells. Prolonged exposure to endogenous hormones (predominantly estrogens and progestins) resulting from either early menarche, late menopause, and absent or reduced ovarian cyclic functions due to parity are associated with an increased risk. Oophorectomy, in contrast, provides a protection inversely related to age at ablation. The influence of exogenous hormones (birth control pills, hormone replacement therapy, etc.) on mammary carcinogenesis remains a controversial issue. The various viewpoints will be discussed. Among rhesus monkeys in captivity, experimental exposure to a variety of synthetic oral contraceptive steroids has resulted in a variety of proliferative changes including atypical hyperplasia and carcinoma in the mammary duct system. A much higher proportion of severe atypias and carcinoma was observed among those receiving progestational hormones in pure form or in combination with estrogens. Pure estrogenic compounds did not cause as severe a proliferation or atypia in as high a proportion as observed when progestational hormones were used in pure or combined form. In view of this finding it is important to use caution when considering addition of progestins to hormone replacement therapy in an effort to prevent endometrial carcinomas. This is particularly important if the patient has other risk factors for breast carcinoma.

Animals↗

PubMed1996

Genetic analysis of synchronous mucinous tumors of the ovary and appendix.

The coexistence of mucinous ovarian and appendiceal tumors in association with pseudomyxoma peritonei (PP) is well established. However, it has not been determined whether they represent independent or metastatic neoplasms. The authors analyzed microsatellites on chromosome 17q 21.3-22 (nm23), 3p 25-26 (von Hippel Lindau disease [VHL] gene), and 5q 21-22 (D5S346 locus) in 12 synchronous ovarian and appendiceal mucinous lesions. Loss of heterozygosity (LOH) at the nm23 locus has been shown previously in ovarian carcinomas, and genetic alterations at both the 3p and 5q loci have been reported in colorectal carcinomas. The ovarian lesions consisted of nine mucinous tumors of low malignant potential and three invasive adenocarcinomas, and the appendiceal lesions consisted of eight carcinomas without invasion, two invasive carcinomas, and two mucosal hyperplasias. DNA was extracted from microdissected cells obtained from formalin-fixed, paraffin-embedded tissue sections and amplified by polymerase chain reaction. In three specimens, genetic alterations occurred at 17q 21.3-22 in only the ovarian tumors. One of these cases showed LOH on chromosome 5q 21-22 in only the appendiceal tumor. In three other specimens, LOH at the same locus was found in both tumors. Six specimens did not show LOH at any locus. These results suggest that a subset of synchronous mucinos ovarian and appendiceal lesions showing different LOH patterns in both sites most likely represent patients with two separate primary lesions. Another group of specimens with the same allelic loss in both tumors most likely represent patients with a single primary and metastatic spread. Thus, genetic analysis of these lesions may be useful in investigating the origin of histologically similar synchronous tumors.

Adenocarcinoma, Mucinous↗

PubMed1996

Primary diffuse large B-cell lymphoma of the breast. A clinicopathologic study of 31 cases.

Primary non-Hodgkin's lymphoma of the breast is a rare neoplasm for which survival data vary among the reported studies. Thirty-one cases of diffuse large B-cell lymphoma of the breast, which had been seen in consultation from 1973 to 1985 at our institution, were reviewed. This represents the largest number of lymphomas of this histologic subtype reported to date in the English literature. Histologic examination and immunophenotypic analysis were performed and the results were correlated with clinicopathologic data. The patient population consisted of 29 females and 2 males with a mean patient age of 58.2 years. At the time of diagnosis, 26 patients had unilateral involvement (16 left, 10 right), and 5 had bilateral disease. Mean tumor size was 3.8 cm. Histologically, all cases showed a diffuse large B-cell lymphoma as classified by the Revised European-American Classification of Lymphoid Neoplasms (R.E.A.L Classification). Immunophenotypic studies on paraffin sections confirmed a B-cell lineage in every case. The majority of patients received chemotherapy and/or radiation therapy. The median survival was 36 months, confirming that this neoplasm has a poor prognosis.

Adult↗

PubMed1996

The pathology of vulvar neoplasia.

Current literature on the pathology of vulvar disease continues to focus on vulvar intraepithelial neoplasia, the role of human papillomavirus in vulvar neoplasia, and Paget's disease of the vulva. Of particular concern is an increasing incidence of vulvar intraepithelial neoplasia noted over the past several decades, specifically among younger women. Human papillomavirus has emerged as a major factor in this trend. Furthermore, a more aggressive course may ensue in these young women, requiring diligent follow-up.

Carcinoma in Situ↗

PubMed1995

Mesonephric hyperplasia of the uterine cervix: a clinicopathologic study of 51 cases.

Lesions derived from remnants of the mesonephric (Wolffian) duct frequently occur in the wall of the uterine cervix and often cause diagnostic problems. Fifty-one cervical mesonephric lesions were studied. There were 40 lobular mesonephric hyperplasias and 11 diffuse mesonephric hyperplasias. Lobular hyperplasia was characterized by a distinctive clustering of mesonephric tubules, while diffuse hyperplasia was nonclustered. Fifteen patients with hyperplasia followed for a mean of 6.3 years were alive and well at last contact. In addition to morphologic differences between lobular and diffuse hyperplasia, there were statistically significant differences in patient age (means of 35 and 46 years, respectively) and lesion size (means of 11.8 and 15.7 mm, respectively), and less pronounced differences in proximity to surface epithelium and age-size correlations. Evidence suggests that the two types of mesonephric hyperplasias may be distinct entities. The morphologic appearances of the diffuse hyperplasias are emphasized to prevent their misinterpretation as variants of minimal deviation adenocarcinoma.

Adult↗

PubMed1995

Pseudoinvasion in intraductal carcinoma.

Fine-needle aspiration, stereotactic biopsies, and guide wire localization have introduced an element of pre-excision trauma to mammary lesions. Dislodgement of tumor cells may result in diagnostic difficulties and misinterpretation of a tissue artifact as an invasive carcinoma. Eight breast biopsy specimens with intraductal carcinoma (ranging from cribriform to comedo types) displayed changes suggestive of an invasive carcinoma. Three of the patients had a prior history of needle aspiration; the remaining five women had undergone needle localization to guide the biopsy. In all cases, two or more dislodged tumor cell clusters were found in the stroma or adipose tissue either immediately adjacent to a disrupted duct with intraductal carcinoma or in the nearby stroma. Those cases with prior needle aspiration were associated with significant hemorrhage and reactive changes with small, rounded clusters of tumor cells within pools of blood. The needle localization specimens had minimal tissue reaction with larger fragments of detached cell clusters. Breast trauma by a puncturing instrument (needle or guide wire) can disrupt mammary ducts with intraductal carcinoma and dislodge the proliferating cells into the surrounding stroma. The dislodged cells simulate invasion. To minimize damage to the architectural integrity of the lesion under investigation, limits should be imposed on the number of needle passes.

Adult↗

PubMed1995

Coexistence of nipple duct adenoma and breast carcinoma: a clinicopathologic study of five cases and review of the literature.

The simultaneous occurrence of nipple duct adenoma (NDA) and carcinoma in the same breast is rare and generally considered an incidental finding. Five examples of such concurrent lesions are reported. The patients ranged in age from 48 to 70 y, and they all presented with a palpable mass that was subareolar in three and in the lower inner quadrant in two women. The presence of distorted nipple with discharge in two patients and nipple erosion in another had raised the possibility of Paget's disease clinically. Microscopically, an infiltrating duct carcinoma was present in four women and an intraductal carcinoma in the fifth--all along with a NDA. Two of the invasive carcinomas were adjacent to the NDA and immediately beneath the surface epithelium of the nipple; the NDA in one of these had atypical intraductal hyperplasia. Three women had mastectomy and axillary node dissection, two had excisional biopsy only. Follow-up was available in four women and ranged from 1.5 to 8 y. One of these women developed metastasis and died 8 y postdiagnosis; the remaining three are alive and well. In at least three cases, the invasive carcinoma was not suspected clinically, and the initial procedure was done because of symptomatology secondary to the NDA.

Adenoma↗

PubMed1995

Pathology of advanced primary breast carcinoma.

For a majority of women with breast carcinoma, the clinical course of the disease is determined by tumor size and axillary node metastases. Tumor type and grade are also important prognostic factors. Estrogen and progesterone receptor statuses are good predictors of the likelihood of response to hormone therapy and survival. Patients with high S-phase fraction are at increased risk for early relapse. As far as other markers are concerned, sufficient information is not available currently to make definitive decisions regarding inclusion of their assessment in the routine evaluation of breast carcinomas.

Breast↗

PubMed1994

Intraductal apocrine carcinoma: a clinicopathologic study of 37 cases.

The clinical and pathologic features of 37 examples of intraductal apocrine carcinoma are reported along with criteria for distinguishing apocrine intraductal carcinoma (AIDCA) from apocrine hyperplasia. A majority of AIDCAs (32 cases) displayed both cytological atypia and intraluminal necrosis. Five AIDCAs lacked intraluminal necrosis but had at least subtle atypia with either epithelial bridging or a solid, mosaic-like growth pattern involving one or more ducts exceeding 2 mm in maximum cross-sectional diameter. Twenty-nine patients had mastectomy. Eight women had excisional biopsy or quadrantectomy only; two of these developed recurrences 2 and 4.5 yr following their biopsies. The original AIDCA in both patients was of the comedo type and neither woman had received any further treatment following biopsy. Both women were alive 4 and 6 yr after their respective mastectomies. The follow-up for the entire group ranged from 2.5 to 20 yr with a mean of 11.4 yr. One of the eight women died from breast cancer 4 yr after the diagnosis of her AIDCA; she had had mastectomy for a node-negative infiltrating nonapocrine carcinoma in the contralateral breast 4 yr before her AIDCA, however, and probably died from progression of the invasive carcinoma of the contralateral breast. In the absence of necrosis and significant atypia, a diagnosis of AIDCA should be made cautiously.

Adult↗

PubMed1994

Epithelioid stromal cells in lymphocytic mastitis--a source of confusion with invasive carcinoma.

Fourteen examples of lymphocytic mastitis (LM) with epithelioid stromal cells characterized by formation of a palpable, hard breast mass composed of a predominantly lobulocentric lymphocytic infiltrate, stromal fibrosis, and an unusual stromal infiltrate of epithelioid cells are presented. The epithelioid cells were so prominent and abundant that the possibility of an infiltrating carcinoma was raised in three cases, and a fourth case was misinterpreted as a granular cell tumor. Interestingly, eight of the 12 women and the only male patient had long standing, insulin dependent diabetes mellitus (IDDM), whereas two had IDDM and hypothyroidism, one had hypothyroidism alone, and one had systemic lupus erythematosus. Contrary to the conclusions in a recent report, our findings indicate that these mammary changes are not exclusive to patients with IDDM, and may also occur in nondiabetic patients particularly those with autoimmune disorders. The morphologic features of the epithelioid stromal cells which have been mistaken for infiltrating carcinoma are emphasized; immunohistochemical and ultrastructural findings favoring their myofibroblastic nature are presented.

Actins↗

PubMed1993

Association of mucinous tumors of the ovary and appendix. A clinicopathologic study of 25 cases.

Twenty-five patients with mucinous tumors of the ovary and appendix were studied. The average age of the patients was 52 years, and the ovarian and appendiceal tumors were discovered synchronously in all but two cases. The majority had either a pelvic mass or abdominal or pelvic pain. A high frequency of bilateral ovarian tumors (11/25), and right-sided predominance for the unilateral ovarian tumors (nine right, five left) were found. Four patients had ovarian mucinous carcinomas, 10 had mucinous tumors of low malignant potential, 10 had mucinous cystadenomas, and one had a mucinous cyst. Pseudomyxoma ovarii was present in 22 cases. Twenty-two of 24 appendices were grossly abnormal. There were six appendiceal mucinous adenocarcinomas, 10 mucinous tumors of uncertain malignant potential, seven mucinous cystadenomas, one hyperplastic polyp, and one mucocele. Twelve patients had ovarian and appendiceal tumors of similar malignant potential, nine had appendiceal tumors with more aggressive morphologic features than the corresponding ovarian tumor, and four had ovarian tumors with more aggressive morphologic features than the appendiceal tumor. Eighteen patients had peritoneal involvement by mucinous epithelium admixed with mucus (nine localized, nine diffuse). Immunoperoxidase reactions for four epithelial antigens in 15 cases showed complete concordance between ovarian and appendiceal lesions in only five cases and were not helpful in determining the site of origin of the peritoneal tumor. Our findings suggest an independent origin of the ovarian and appendiceal tumors in most cases and do not favor an origin in a single site. Furthermore, it is proposed that the peritoneal lesions may arise de novo as part of a multifocal neoplastic process.

Adenocarcinoma↗

PubMed1993

Spindle cell epithelioma, the so-called mixed tumor of the vagina. A clinicopathologic, immunohistochemical, and ultrastructural analysis of 28 cases.

A total of 28 examples of vaginal mixed tumors, a circumscribed tumor composed predominantly of spindle cells, but often admixed with minor glandular, and focal areas of squamous differentiation along with localized hyaline globules, were evaluated. In addition to the clinicopathologic correlation with light microscopy, 10 cases were analyzed immunohistochemically by a panel of antibodies for keratin, smooth muscle actin, S-100 protein, and glial fibrillary acidic protein; five cases were also evaluated for estrogen and progesterone receptors. Ultrastructural analysis was performed on two tumors. The results indicate an epithelial differentiation in the predominating spindle cells based upon an intense immunoreaction with cytokeratin in nine of 10 cases and the presence of tonofilaments and desmosomes at the ultrastructural level. Contrary to mixed tumors of salivary gland and breast origin, no evidence of a myoepithelial differentiation was identified in these tumors. The name vaginal spindle cell epithelioma is proposed for these neoplasms as being more descriptive of the true nature of these tumors.

Adult↗

PubMed1993

Proliferative and histologically malignant struma ovarii: a clinicopathologic study of 54 cases.

We reviewed 54 cases of struma ovarii with histologic features diverging from the normal pattern of benign thyroid tissue. These 54 lesions were divided into proliferative struma (41 cases) and malignant struma (13 cases). The patients diagnosed with proliferative struma ovarii ranged in age from 18 to 84 years (average, 44 years). The most common clinical findings among the proliferative struma patients were a mass (58%) and acute abdominal pain (12%). Preoperative evidence of hyperthyroidism was noted in three of the patients with proliferative struma, whereas one additional patient presented with ascites and hydrothorax ("pseudo-Meigs' syndrome"). Proliferative struma differed from the usual struma ovarii in that they comprised areas of densely packed follicles or papillary formations that raised the possibility of malignancy. However, none of the lesions that we have designated as proliferative struma ovarii showed histologic evidence of overlapping "ground glass" nuclei, vascular space invasion, or mitotic activity that would have supported an unequivocal diagnosis of malignancy. None developed metastases or recurrent disease. The 14 malignant struma ovarii manifested the classical features of thyroid carcinoma (including the presence of overlapping "ground glass" nuclei lining papillary formations and vascular space invasion). Patients with malignant struma ovarii ranged in age from 30 to 77 years (average, 50 years). Their clinical presentations included a mass (78%) and acute abdominal pain (22%). One patient had clinical and laboratory evidence of hyperthyroidism. On follow-up, one patient had persistent disease with peritoneal involvement, but distant metastases did not develop in any of these patients. A diagnosis of malignant struma ovarii should be reserved for lesions that exhibit the full range of changes seen in thyroid carcinoma arising in the cervical thyroid. By requiring that these rigid criteria be adhered to, the diagnosis of malignant struma ovarii will probably become less frequent as the more commonly encountered proliferative struma ovarii are recognized.

Abdominal Pain↗

PubMed1993

Invasive micropapillary carcinoma of the breast.

Nine examples of a rare variant of invasive breast carcinoma characterized by the formation of micropapillae within clear spaces separated by a fibrocollagenous or delicate fibrovascular stroma are presented. Designated as invasive micropapillary carcinoma, the unusual morphology of this tumor requires its distinction from metastatic ovarian serous papillary carcinoma and extensive vascular/lymphatic invasion by either a primary or metastatic breast carcinoma. The micropapillary pattern is retained in metastatic foci and areas of recurrence. This pattern also occurs admixed with regular infiltrating duct carcinoma either in the primary mammary tumor or when it recurs.

Adult↗