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PubMed2006

Uterine adenomyoma: a clinicopathologic review of 26 cases and a review of the literature.

The aim of this study is to highlight the importance of diagnosing uterine adenomyoma and help in differentiating it from other sinister lesions. Adenomyoma of the uterus is a circumscribed nodular aggregate of benign endometrial glands surrounded by endometrial stroma with leiomyomatous smooth muscle bordering the endometrial stromal component. It may be located within the myometrium, or it may involve or originate in the endometrium and grow as a polyp. A retrospective analysis of 26 consecutive cases of uterine adenomyomas diagnosed in the Department of Pathology, Government Medical College, Chandigarh from January 1994 to December 2004 was done, and their clinical and histological features were analyzed. The criterion used for case identification was a circumscribed mass composed of benign endometrial glands with a stromal component consisting of endometrial type stroma surrounded by leiomyomatous smooth muscle. Mitotic figures were counted within 50 high-power fields (hpf) and recorded as the highest number per 10 hpf. The age of the patients ranged from 22 to 60 years (mean age, 41 years). The most common presenting symptom was abnormal vaginal bleeding (n = 15). Thirteen patients underwent panhysterectomy; 7, total hysterectomy; 1, subtotal hysterectomy; 4, polypectomy or tumor removal; and 1, curettage. Of the 26 cases of adenomyoma, 24 were in the corpus, 1 was in the cervix, and 1 was in the broad ligament. An associated leiomyoma was noted in 12 cases (46.9%). The adenomyomas were firm in consistency and, on cut section, showed a gray-white surface. Five tumors showed cystic spaces filled with dark brown material. On microscopic examination, the tumors were well demarcated from the surrounding structures. The endometrial glands were mostly tubular and showed relatively regular spacing from each other without any back-to-back arrangement. The glands were lined by benign proliferative pseudostratified columnar epithelium. An occasional typical mitotic figure was noted in these glands in a few cases. The glands were surrounded by endometrial stroma which was compact and spindly. This stroma was, in turn, bordered by leiomyomatous smooth muscle. Thick-walled blood vessels were commonly observed. One to two typical mitotic figures per 10 hpf were noted in the endometrial stroma in few cases; however, no mitosis was noted in the myometrial component. Associated adenomyosis was also noted in 8 cases (30.8%). Adenomyomas have to be distinguished from a number of other lesions, for example, adenomyosis, leiomyoma with entrapped glands, atypical polypoid adenomyoma, endometrial polyps, adenofibroma, and adenosarcoma. This study highlights the importance of correctly identifying this fairly common entity and helps to distinguish adenomyoma from other similar appearing benign and malignant lesions.

Adenomyoma↗

PubMed1984

Nephroblastoma with fibroadenomatous-like structures.

Review of the histological sections of the tumours of 889 patients from the files of the SIOP Nephroblastoma trials and studies has revealed 23 cases with a distinctive growth pattern. Due to the similarity of the histological structures with the architecture of adenofibroma (fibroadenoma) of the ovary we have called this type: nephroblastoma with fibroadenomatous-like structures (NFS). We have studied the clinical and histopathological factors and correlated them with recurrence-free survival and actuarial survival and compared them with the whole series of SIOP Nephroblastomas. This subtype appears to be a distinctive clinicopathological entity with favourable prognosis.

Child↗

PubMed1995

Müllerian adenosarcoma of the cervix: differential diagnosis, histogenesis and review of the literature.

A new case is reported of müllerian adenosarcoma, presenting as a 'benign cervical polyp' protruding through the vulva of a 44 year-old woman admitted with abnormal vaginal bleeding. This report emphasizes the importance of a careful examination of the stroma and special features of the entrapped glands in order to contribute to an earlier and proper diagnosis. The literature is reviewed and the probable histogenesis of this tumor and differential diagnosis with embryonal rhabdomysarcoma (sarcoma botryoides), adenofibroma, malignant mesodermal tumor and carcinosarcoma is discussed.

Adenosarcoma↗

PubMed2006

My approach to the interpretation of endometrial biopsies and curettings.

A major proportion of the workload in many histopathology laboratories is accounted for by endometrial biopsies, either curettage specimens or outpatient biopsy specimens. The increasing use of pipelle and other methods of biopsy not necessitating general anaesthesia has resulted in greater numbers of specimens with scant tissue, resulting in problems in assessing adequacy and in interpreting artefactual changes, some of which appear more common with outpatient biopsies. In this review, the criteria for adequacy and common artefacts in endometrial biopsies, as well as the interpretation of endometrial biopsies in general, are discussed, concentrating on areas that cause problems for pathologists. An adequate clinical history, including knowledge of the age, menstrual history and menopausal status, and information on the use of exogenous hormones and tamoxifen, is necessary for the pathologist to critically evaluate endometrial biopsies. Topics such as endometritis, endometrial polyps, changes that are induced by hormones and tamoxifen within the endometrium, endometrial metaplasias and hyperplasias, atypical polypoid adenomyoma, adenofibroma, adenosarcoma, histological types of endometrial carcinoma and grading of endometrial carcinomas are discussed with regard to endometrial biopsy specimens rather than hysterectomy specimens. The value of ancillary techniques, especially immunohistochemistry, is discussed where appropriate.

Algorithms↗

PubMed1996

Focal calcifications in otherwise ultrasonographically normal ovaries.

PURPOSE: To analyze the natural history, clinical importance, and need for follow-up in patients with discrete calcifications in otherwise ultrasonographically (US) normal ovaries. MATERIALS AND METHODS: US scans obtained in 28 women with ovarian calcifications but without masses or other structural abnormalities were retrospectively reviewed. Follow-up findings were available in 15 women (mean age, 38.0 years; range, 26-72 years). RESULTS: Two of the 15 women had trilateral calcifications. Thus, 17 ovaries had focal calcifications. Histopathologic confirmation was obtained in 10 cases; follow-up US findings, five cases; and follow-up laparoscopic findings, two cases. In 13 (76%) of the 17 ovaries, calcifications were not clinically important. In four (24%) of the 17, the calcification was the initial or only manifestation of a neoplasm. Lesions were benign in all four of these ovaries: There was one dermoid, one mucinous cystadenoma, and two adenofibromas. CONCLUSION: Until more data are available, findings of calcifications in ovaries with otherwise normal US findings warrant some form of follow-up.

Adult↗

PubMed2006

An immunohistochemical study of morules in endometrioid lesions of the female genital tract: CD10 is a characteristic marker of morular metaplasia.

PURPOSE: To analyze immunohistochemically morules in endometrioid lesions to show that CD10 is a sensitive marker for morular metaplasia. EXPERIMENTAL DESIGN: Immunohistochemical analysis of 53 instances of morular metaplasia comprising 1 cyclic endometrium and 52 endometrioid lesions associated with focal glandular complexity corresponding to 9 polyps, 4 atypical polypoid adenomyomas, 24 complex endometrial hyperplasias (18 with and 6 without atypia), 12 grade 1 endometrioid adenocarcinomas in early clinical stages of both uterus and ovary, and three ovarian adenofibromas. Immunohistochemistry in paraffin sections was done for CD10, beta-catenin, estrogen and progesterone receptors, and cytokeratins 5-6, 7, 8, 13, 18, 19, 20, and 34beta-E12. RESULTS: Morules were negative for estrogen and progesterone receptors and had beta-catenin-positive nuclei. Cytokeratins 8, 18, 19 were positive; cytokeratins 7 and 20 were negative; and cytokeratins 5-6, 13, and 34beta-E12 were weakly positive. All cases revealed strongly positive membranous CD10 staining in morules, which was absent in glands. CD10 positivity allowed easy identification of morules at low power in various types of surgical specimens and in curettings. CD10 also highlighted early morular metaplasia in glandular epithelium. In cases associated with squamous, keratinizing metaplasia, CD10 discriminated between both types of metaplasia. CONCLUSIONS: CD10 staining represents a useful marker of morules in endometrioid neoplasms of the female genital tract, permitting identification of lesions usually associated with an attenuated malignancy. Considering the immunohistochemical and genetic similarities of morules in tumors of different organs, it is likely that this marker may be also useful to diagnose morular metaplasia in similar neoplasms of extragenital locations.

Adult↗

PubMed2003

Review of metanephric adenoma of the kidney with focus on clinical and pathobiological aspects.

The concept of metanephric adenoma has become established in recent years. Metanephric adenoma is a rare neoplasm. Macroscopically, the cut surface of the tumor displays a tan to gray or yellow color, and tumors generally form well-circumscribed masses. Histologically, tumors are composed of small epithelial cells that form small acini. Glomeruloid bodies, which are composed of lobulated papillary projections, are occasionally seen. Although there have been few studies using chromosomal analysis, two recent studies have shown partial monosomy or LOH of 2p. On the other hand, the concept of metanephric tumors has recently become broadened. These tumors include metanephric adenomas, adenofibromas and stromal tumors, and they compose a continuous histological spectrum. Therefore, further studies on various aspects are needed to identify the gene responsible for the occurrence of metanephric tumors and, furthermore, to clarify the association among the three types of metanephric tumors.

Adenoma↗

PubMed2003

Secondary tumors in mammary adenolipomas: a report of 2 unusual cases.

Two unusual examples of secondary tumors arising in adenolipomas were diagnosed in a 16-year-old girl and a 27-year-old woman, each of whom presented with asymmetric enlargement of the right breast. In both instances, a significant secondary lesion was associated with the adenolipoma. In the first case, a cyst appeared to have arisen in a fibroadenoma within the adenolipoma, which had apparently undergone infarction during a recent pregnancy and postpartum period. There was micropapillary duct epithelial hyperplasia of the cyst lining epithelium. In the second case, an adenofibroma with atypical lobular hyperplasia was present within the adenolipoma.

Adenoma↗

PubMed1999

Tamoxifen and the endometrium: review of 102 cases and comparison with HRT-related and non-HRT-related endometrial pathology.

Tamoxifen, a synthetic anti-estrogen that paradoxically acts as a partial estrogen agonist on the endometrium, is associated with an increased frequency of proliferative endometrial lesions, including hyperplasias, neoplasms, and polyps. Tamoxifen-related polyps are characteristically multiple and fibrotic. A variety of metaplasias and periglandular stromal condensation may be seen. Relatively few articles have focused on the descriptive morphology of the full range of tamoxifen-associated lesions. The present study further defines the histologic features in both endometrial polyps and nonpolyp endometrium. One hundred and two specimens (including 50 polyps) were reviewed using hormone replacement therapy-related endometrial specimens and conventional polyps as the control groups. The most characteristic findings of tamoxifen-associated lesions included polarized glands along the long axis of polyps (40%), a cambium layer (72%), frequent and diverse metaplasias, staghorn glands (36%), myxoid degeneration (12%), and small glands (36%). Similar morphologic features were identified in the hormone replacement therapy and control groups but to a variable, lesser extent. Overall, the tamoxifen group consisted of 18 cases of hyperplasia (11 complex, 7 simple) and one case each of adenofibroma, adenosarcoma, endometrial stromal sarcoma, and leiomyosarcoma. Although none of the features is diagnostic, the presence of diverse metaplasias, polarized glands, staghorn glands, and a cambium layer strongly suggest tamoxifen exposure especially if a number of these features are present concurrently within the same material.

Adult↗

PubMed1978

[Mesenchyme-associated antigen: a new immunochemical marker of human tumors].

An antiserum raised in Rabbits against brain glycoprotein precipitated an identical antigen in faetal dermis and intestine extracts, and also in non nervous tumors (breast adenocarcinomas and adenofibromas, ovarian cystadenoma, gastric and colonic adenocarcinomas, hepatomas, malignant melanomas, rhabdomvosarcoma, fibrosarcomas). By the indirect immunofluorescence technique, this antigen was always found associated with the mesenchymal proliferation, either malignant (fibrosarcoma) or reactive (fibrous stroma reaction of carcinomas).

Animals↗

PubMed2001

[Mammaglobin mRNA measurement in the detection of micrometastasis in peripheral blood of breast cancer patients].

OBJECTIVE: To investigate mammanglobin (hMAM) mRNA as a marker for the detection of carcinoma cells by reverse transcriptase chain reaction (RT-PCR) in the peripheral blood of breast cancer patients. METHODS: Blood samples from 63 breast cancer patients obtained at various stages of their disease, blood samples from 8 breast hyperplasia, 5 breast adenofibroma, 25 other cancers (stomach, colon, esophagus, lung, ovary) and 31 healthy volunteers were screened for hMAM mRNA by a nested RT-PCR combined with fluorescence quantitative PCR (FQ-PCR) assay. RESULTS: Among 63 breast carcinoma patients, 19(30.2%) were RT-PCR positive for hMAM mRNA which was elevated with the tumor stage. None of the other cancer patients or those suffering from benign breast diseases were positive but only 1 of the 31 healthy volunteers gave detectable hMAM mRNA findings. hMAM mRNA was not detectable in the peripheral blood after operation in 6(32%) of 19 patients whose pre-operative test had been positive even though the hMAM mRNA expression increased with tumor stage. These results did not correlate with patients' stage, estrogen or pregnant receptor status. CONCLUSION: hMAM transcripts are detectable in the peripheral blood of some breast cancer patients. hMAM may be a novel candidate and a clinically useful breast tumor marker, especially in detecting micrometastasis.

Breast Neoplasms↗

PubMed2001

[Breast diseases in young women of Niger: results of a campaign for self examination awareness in a nursing school].

In order to favour the early diagnosis of breast cancer, the authors used an original method consisting in teaching nurses about breast tumors and cancer, and especially about self-examination of the breasts. Subsequently, 73 patients aged under 24 years were admitted to our survey: 90 per cent had an understanding of risk factors and 97 per cent were practicing self-examination. In 21 cases, consultation was carried out for mastalgia and in 12 cases for esthetic and/or banal inflammatory lesions: 40 patients presented a lump in the breast. Sonography turned out to be a better method of examination than mammography in those young women presenting breast lesions. Following surgery, histological examination found that in the majority of cases the tumour was benign (fibrocyst or adenofibromas). We were surprised by medullary carcinoma in one case.

Adolescent↗

PubMed2003

[Benign ovarian tumor with ascites and high serum levels of CA125: report of 3 cases].

OBJECTIVE: To describe the clinical characteristics of benign ovarian tumor/mass which manifest as pelvic mass, ascites and high serum levels of CA(125). METHOD: Clinical data of 3 cases of such disease in Peking Union Medical College Hospital were analyzed and relevant literatures were reviewed. RESULTS: The patients all were misdiagnosed as ovarian carcinoma, and operations designed for malignant ovarian tumor were performed on all of them. There was no definite proof of malignant tumor, such as positive findings of pathology and/or cytology, in any patients before operation. Among these diseases, pelvic tuberculosis, ovarian endometrioid cyst and ovarian fibroma are the three most common ones, others are: fibrothecoma, thecoma, struma ovarii, adenofibroma, benign Brenner tumor, mature theratoma, ovarian edema and fibromatosis. CONCLUSIONS: Pelvic mass, ascites and high serum level of CA(125) can't always result of a diagnosis of ovarian carcinoma. Positive findings of pathology and/or cytology is the only definite proof of a diagnosis of ovarian malignant tumor. On the susceptible case, laparoscopy is a useful and reliable method.

Adult↗

PubMed1992

[Infrared light scanning in differentiating benign and malignant breast diseases].

One hundred and fifty patients with various breast diseases were studied using infrared light scanning. The results were compared with those of X-ray mammography and BUS. In 42 cases of breast cancer, 97% were correctly diagnosed using infrared light scanning. The method was significantly superior to X-ray (60%) and BUS (83%). To detect benign diseases, including adenofibromas (30 cases) and hyperplasias (21 cases), infrared light scanning was useful in this series in contrast to X-ray and BUS.

Adenocarcinoma↗

PubMed1991

[Value of mammography in the diagnosis of breast masses in adolescents].

Breast masses in teenagers are uncommon; in most cases, the palpation of a mass by the patient herself leads to physical and radiological examination. According to the age of the patient, radiographic exams should be limited, and mammography in particular, should not necessarily be performed. Ultrasonography using a high frequency transducer is very useful when associated with physical examination, and gives an accurate diagnosis in most cases. A large isolated mass detected in a healthy young girl is usually benign (adenofibroma). Multiple small masses suggest a malignancy (metastases or hemopathy), especially if the subject has been previously treated for such a disease. Primary breast carcinoma is exceptional.

Adolescent↗

PubMed1977

Adenomyoma: a precursor of extrauterine Müllerian adenosarcoma?

One patient had an extrauterine pelvic Müllerian adenosarcoma that recurred on multiple occasions and was originally diagnosed as a benign lesion. Caution is needed in the initial interpretatrion of such lesions as "adenofibromas." We have compared this lesion with a benign adenomyoma of the uterus from a second patient and suggest that such benign neoplasms serve as precursors for Müllerian adenosarcoma in some cases. Light and electron microscopic observations in the first case as well as data from the literature support this hypothesis.

Adult↗

PubMed1991

[What is mastopathy at risk? Epidemiologic and clinical basis].

One out of 11 women is destined to develop breast cancer. All women should be "under observation". Does a "normal" breast really exist? A discharge from a single orifice could suggest a papillomatosis, a real borderline lesion, the adenofibroma practically never degenerates, the essential problem is that of the fibrocystic disease, (or mastosis) which was the object of a recent detailed analysis (W. Dupont and D. Page), pre-menstrual mastodynia does not seem to be a risk factor. On the other hand, certain dystrophic lesions constitute a high risk, such as atypical epithelial hyperplasia, especially if it is associated with a direct family history of breast cancer. Recent studies on mammary cysts insist on their hormone and electrolyte content, the presence of EGF, as well as that of certain proteins (GCDFP 15). They also insist on the local tissue enzymatic activities, the importance of myoepithelial cells and of fibroblasts. On a practical level, the attention is drawn on: cysts whose diameter exceeds 5 mm, certain histological lesions found during the biopsies. The value of mammography and thermography in the assessment of the high risk is discussed. Finally, the present well-established notions are recalled: the family history, late pregnancies, the diet, the weight, certain pathological associations, the endogenous hormonal balance bearing on E2/P and the blood prolactin level, the exogenous hormone intake.

Breast Neoplasms↗

PubMed1990

[A case of an unusual mixed müllerian tumor in the lower uterine segment].

A unique case of a mixed müllerian tumor in a 33-year-old woman is presented. On gross examination of the hysterectomized specimen, well-circumscribed nodules, the largest measuring 3 cm in diameter, were found in the lower uterine segment. Microscopic examination revealed that the lesion was composed of a malignant glandular epithelium and a spindle cell stroma containing a smooth muscle. The atypical gland had deeply infiltrated into the normal myometrium and showed a squamous differentiation. This tumor should be differentiated from a benign mixed müllerian tumor, including an atypical polypoid adenomyoma, an adenofibroma, and an adenomyoma.

Adult↗