Costs of prophylactic resection.
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Genetic Predisposition to Disease↗
Biomedical subjects
Terence J Colgan
Publications and source records attributed to Terence J Colgan.
Pathologic features of uteri and leiomyomas following uterine artery embolization for leiomyomas.
The objectives of this study were to identify the presence/absence and location of any embolic material and to describe the morphologic appearance of the leiomyoma and adjacent tissues of cases undergoing surgical intervention following uterine artery embolization (UAE) for leiomyomas. A total of 555 women underwent UAE using polyvinyl alcohol particles (PVA) in a multicenter clinical trial. The histopathologic slides from 17 of 18 women who subsequently underwent myomectomy or hysterectomy in the follow-up period (median 8.2 months) were reviewed without knowledge of the indication for surgery or time elapsed since UAE. The presence/absence and distribution of PVA emboli, associated inflammatory response, and necrosis were noted. Necrosis of leiomyoma(s) was classified as hyaline-type, coagulative tumor cell necrosis, and/or acute suppurative necrosis. In all cases PVA emboli were identified within smooth muscle tumors of the uterine body, its periphery, cervix, uterine body, myometrium, and/or the adnexa. A florid foreign body giant cell type of chronic inflammatory reaction was seen within 1 week of UAE and persisted with visible PVA for up to 14 months post-UAE. Typically, post-UAE leiomyomas showed hyaline-type, but rarely coagulative tumor cell necrosis and acute suppurative necrosis could be seen as well. Five of eight cases coming to surgery for complications showed necrotizing endomyometritis with tissue infarction. PVA particles are recognizable in post-UAE specimens. Leiomyoma necrosis is typically of the hyaline type; coagulative tumor cell necrosis was rarely seen. In some cases with complications, uterine and/or cervical necrosis occurred. The applicability of these findings for UAE patients who have been successfully treated and not resected is uncertain.
Adolescent↗
Challenges in the early diagnosis and staging of Fallopian-tube carcinomas associated with BRCA mutations.
The histopathologic diagnosis of fallopian-tube carcinoma has been traditionally made at an advanced stage. More recently, predictive genetic BRCA testing is leading to the recognition in prophylactic oophorectomy specimens of clinically occult tubal carcinomas that are frequently in situ or small early-stage invasive carcinomas. These early lesions present a challenge in diagnosis and staging because the available criteria for the histopathologic diagnosis and staging of tubal carcinoma were derived from the clinicopathologic experience derived from the usual high-stage tubal carcinomas. The detection of early-stage tubal carcinomas requires that all tubal tissue be submitted for histologic examination. The diagnostic criteria for tubal in situ carcinoma have been defined, although the natural history of this lesion is unclear. Similarly defined criteria for a diagnosis of tubal dysplasia are lacking. Any early, invasive tubal carcinoma should be staged using a refined staging system suitable for early stage and fimbrial carcinomas. The adoption of these methods should increase our knowledge of early-stage tubal carcinoma and may add to our understanding of the development of ovarian-epithelial neoplasia.
Carcinoma↗
Management of women with cervical cytologic results interpreted as low-grade squamous intraepithelial lesion: the foundation of the ASCCP guidelines.
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Journal Article↗
Women harboring BRCA1/2 germline mutations are at risk for breast and female adnexal carcinoma.
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Breast Neoplasms↗
Interinstitutional pathology consultations. A reassessment.
We retrospectively determined the clinical impact of 1,000 randomly selected interinstitutional pathology consultations (IPCs). An IPC included all specimens from the patient. IPCs were classified as concordant or discordant with the original diagnosis. Discordant IPCs were classified as having a clinical impact or no impact. Discordant IPCs owing to interpretation differences were subclassified further. The IPCs included 1,522 specimens (1,204 histology, 318 cytology); 923 (92.3%) were concordant, 9 (0.9%) indeterminate, and 68 (6.8%) discordant (clinical impact, 37; no impact, 31). Reasons for discordant IPCs were interpretation differences, 45; additional sectioning, 7; ancillary testing, 1; clerical error, 5; or a combination, 10. Reasons for 26 discordant IPCs with clinical impact owing to interpretation differences were overdiagnosis, 11; tumor subtype change, 4; stage change, 4; underdiagnosis, 3; resection margin status change, 2; undergrading, 1; and understaging with resection margin status change, 1. IPC may identify diagnostic discrepancies that impact management for some patients. The prevalence of a clinical impact of IPC on management varies according to body site. Mandatory IPC does ensure identification of clinically significant diagnostic discrepancies; targeted IPC by body site or specimen type may represent an alternative strategy after further data accumulation. Discordant IPCs may be due to factors other than interpretation difference.
Humans↗
Precision in gynecologic cytologic interpretation: a study from the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.
CONTEXT: Numerous studies address the accuracy or positive predictive value of cytologic interpretations for defined histopathologic entities. The reproducibility (precision) of cytologic interpretation is less well defined. OBJECTIVE: To establish and compare the reproducibility (precision) of cytologic interpretation in gynecologic cytopathology, as reflected in the educational program of the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology (PAP). METHODS: The pathologists' interpretations for both validated (25 745 responses) and educational conventional (14 353 responses) slides in the PAP program for 2001 were analyzed. The frequency of exact matches between the reference and pathologists' interpretation for each of the cytologic interpretative categories was identified, and the cumulative distributions of exact match rates were derived. chi2 Tests by reference interpretations were used for cytodiagnostic categories, least and most reproducible groupings, and high-grade (HSIL) versus low-grade (LSIL) squamous intraepithelial lesions. RESULTS: Pathologists' interpretations of negative, Candida, Trichomonas, herpes, and LSIL were characterized by a high degree of exact matching, while interpretations of repair, HSIL, adenocarcinoma, and squamous cell carcinomas were characterized by a lesser degree of exact matching (reproducibility). Pathologists' cytologic interpretations of HSIL were significantly less reproducible than those of LSIL. CONCLUSION: The cytologic interpretations of the most significant categories (HSIL, squamous cell carcinoma, and adenocarcinoma) are less precise than those of specific infection (Candida, Trichomonas, and yeast), negative, and LSIL categories. Cytologic interpretations of LSIL are made with greater precision than those of HSIL and may represent a more appropriate endpoint to measure the precision performance of gynecologic cytology laboratories.
Adenocarcinoma↗
Screening for cervical disease in mature women: strategies for improvement.
BACKGROUND: Cervical carcinoma remains a significant health risk for the older woman. In the current study the yield of screening of mature women in an established, opportunistic screening program was examined. Strategies for improving screening in this age group were identified through examination of recent Pap test history of women with high grade squamous intra-epithelial lesions (HSIL). METHODS: From the population based registry of the Ontario Cervical Screening Program, the Pap test cytodiagnoses for almost 700,000 women screened during the first six months of 2000 were classified by age quintile. Screening yields for younger women (< 50 years of age) and mature women (>/= 50 years of age) were compared using the detection ratio (abnormalities per 1000 women tested). Any pap test results during the three years preceding a diagnosis of HSIL in mature women were identified (excluding any Pap test in the six months immediately prior to the HSIL cytodiagnosis) and classified into one of three categories: no prior test known, prior negative Pap test known, and prior abnormal Pap test known. RESULTS: Twenty four percent of all Pap tests in the six month period were from mature women. Approximately 11% of all cytodiagnoses of HSIL and carcinoma (HSIL+), and 13% of all low grade squamous intra-epithelial lesions (LSIL), HSIL, carcinoma, and atypical glandular cells of uncertain significance (AGUS); [LSIL+ and AGUS] cytodiagnoses, were from mature women. The yield of Pap testing in mature women (1.7 HSIL+ per 1000 women tested) was slightly more than 40% of that for younger women (4.2 HSIL+ per 1000 women tested). Mature women with HSIL were more likely to have had a history of no prior screening (61.1%) than younger women (49.5%). The majority (62.9%) of mature women with HSIL and a prior known Pap test had a prior registered abnormal Pap test. CONCLUSIONS: Pap testing of mature women yields a significant number of abnormalities, but is less efficient than Pap testing of younger women. Screening yield could be increased by recruiting mature women who are currently inadequately screened and by revising guidelines for cessation of screening. Proper followup of mature women with Pap test abnormalities would improve clinical outcome but could adversely affect the yield of Pap testing, since current inappropriate repeat testing of women would decrease.
Adolescent↗
Peritoneal lavage cytology: an assessment of its value during prophylactic oophorectomy.
OBJECTIVE: Prophylactic oophorectomy (PO) is an accepted treatment strategy for women who are at high risk for the development of ovarian carcinoma, particularly women who are BRCA mutation-positive. This study sought to assess the utility of peritoneal lavage cytology at the time of PO in detecting occult malignancy in this group of patients. METHODS: Thirty-five high-risk women, who were not suspected of having any malignancy or ovarian mass, underwent peritoneal lavage at the time of PO. Thirty-one of the thirty-five women had undergone BRCA mutation analysis (BRCA1+, 18; BRCA2+, 10; BRCA-, 3). Intensive histopathologic examination was used in all 35 cases to identify occult carcinoma. Lavage specimens were reviewed for the presence of malignant cells and endosalpingiosis. The cytologic review was conducted without knowledge of either the histopathologic or BRCA results. RESULTS: In 32 of the 35 lavage specimens no malignancy was detected. In the remaining three cases malignant cells were detected; in two of these cases histopathologic examination confirmed an ovarian/tubal occult carcinoma. Two of these women were BRCA1 mutation positive. Endosalpingiosis was detected in the peritoneal lavage specimens of 7 of the 32 cases showing no evidence of malignancy. All of these 7 women were BRCA mutation positive or unknown. CONCLUSION: Peritoneal lavage cytology can detect occult carcinoma at the time of PO and should be performed at PO. The significance of occult carcinoma detected by either histopathologic or cytopathologic examination is uncertain. Whether the prevalence of endosalpingiosis detectable by lavage cytology is increased in BRCA mutation-positive patients requires further study.
Ascitic Fluid↗
Laparoscopic ultrasound-guided radiofrequency ablation of uterine fibroids.
Four patients with symptomatic uterine fibroids measuring less than 6 cm underwent laparoscopic ultrasound-guided radiofrequency ablation (RFA) using multiprobe-array electrodes. Follow-up of the treated fibroids was performed with gadolinium-enhanced magnetic resonance imaging (MRI) and patients' symptoms were assessed by telephone interviews. The procedure was initially technically successful in 3 of the 4 patients and MRI studies at 1 month demonstrated complete fibroid ablation. Symptom improvement, including a decrease in menstrual bleeding and pain, was achieved in 2 patients at 3 months. At 7 months, 1 of these 2 patients experienced symptom worsening which correlated with recurrent fibroid on MRI. The third, initially technically successfully treated patient did not experience any symptom relief after the procedure and was ultimately diagnosed with adenomyosis. Our preliminary results suggest that RFA is a technically feasible treatment for symptomatic uterine fibroids in appropriately selected patients.
Adult↗
Search for cancer markers from endometrial tissues using differentially labeled tags iTRAQ and cICAT with multidimensional liquid chromatography and tandem mass spectrometry.
A total of nine potential markers for endometrial cancer (EmCa) have been discovered and identified from endometrial tissue homogenates using a combination of differentially labeled tags, iTRAQ and cICAT, with multidimensional liquid chromatography and tandem mass spectrometry. The tissues were snap frozen in liquid nitrogen within 15-20 min after devitalization. Samples for proteomic analysis were treated with protease inhibitors before processing. Marker proteins that were overexpressed in EmCa are chaperonin 10, pyruvate kinase M1 or M2 isozyme, calgizzarin, heterogeneous nuclear ribonucleoprotein D0, macrophage migratory inhibitory factor, and polymeric immunoglobulin receptor precursor; those that were underexpressed are alpha-1-antitrypsin precursor, creatine kinase B, and transgelin. The chaperonin 10 result confirms our earlier observation of overexpression in EmCa tissues using surface-enhanced laser desorption/ionization mass spectrometry, verified by Western analysis and immunohistochemistry [Yang, E. C. C. et al. J. Proteome Res. 2004, 3, 636-643]. Pyruvate kinase was observed to be overexpressed using both iTRAQ and cICAT labeling. All nine markers have been found to be associated with various forms of cancer. A panel of these plus other markers may confer sufficient selectivity for diagnosing and screening of EmCa. The use of cICAT led to identification of a higher proportion of lower-abundance signaling proteins; conversely, iTRAQ resulted in a higher percentage of the more abundant ribosomal proteins and transcription factors.
Chromatography, Liquid↗
Protein expression profiling of endometrial malignancies reveals a new tumor marker: chaperonin 10.
Endometrial carcinoma is a common malignancy in women, being exceeded in incidence only by that of breast, lung, and colorectal cancers. At present, no serum tumor markers are available for the monitoring of endometrial carcinoma patients, and patients with recurrent disease are detected only following the development of symptoms or abnormalities in imaging assessments. Similarly, no screening tools are available for endometrial carcinoma. Protein profiling by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS) has proven to be a sensitive and fast method of analysis for small proteins or peptides to yield specific biomarkers. In this study, a variety of normal and malignant endometrial tissue samples were fractionated and analyzed by SELDI-TOF MS (SELDI is a version of MALDI utilizing protein "chips"). A number of proteins displayed differential expression in malignant endometrial tissues. One of the prominent proteins fractionated by weak cation exchange chromatography and displaying enhanced expression in these malignant tissues was identified as chaperonin 10. The increased expression of chaperonin 10 in malignant endometrial tissues was further confirmed by parallel Western blot and immunohistochemistry analyses.
Biomarkers, Tumor↗