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Adenoid basal epitheliomas of the uterine cervix: a reevaluation of distinctive cervical basaloid lesions currently classified as adenoid basal carcinoma and adenoid basal hyperplasia.

A series of 12 adenoid basal carcinomas and three adenoid basal hyperplasias of the cervix were analyzed. The ages of the patients with adenoid basal carcinoma ranged from 30 to 91 years with a mean of 71 years. Pap smear results for 11 of 12 (92%) were abnormal. Almost all patients were asymptomatic. None had a gross cervical tumor. All tumors had typical histologic features of adenoid basal carcinoma, with various degrees of squamous differentiation. Depth of tumor invasion ranged from 2 mm to 10 mm (mean, 4.3 mm; median, 3.7 mm), exceeding 3 mm in six tumors (50%). Tumor volume was >500 mm3 in four tumors (33%). An associated neoplastic squamous lesion was present in 92% of patients, including high-grade cervical intraepithelial neoplasia in 10 cases and microinvasive squamous cell carcinoma in one. Treatment was predominantly surgical, usually after some form of cervical conization; conization alone was performed in three patients. Lymph nodes were removed in five patients; none of 104 nodes had metastases. No recurrence of tumor developed in any patient. Nine patients were alive without disease after 4 to 82 months (mean, 30 months), and three died without disease after 24, 63, and 87 months. The three patients with adenoid basal hyperplasia also were asymptomatic and did not have a gross cervical lesion. Pap smear results for two patients were abnormal. The adenoid basal hyperplasias were incidental, very superficial lesions that resembled small adenoid basal carcinomas. Generally, they were attached to the squamous or endocervical mucosal epithelium; all were less than 0.5 mm in depth. Treatment was hysterectomy in one patient and conization in two. Follow-up was short but uneventful. Our findings, together with those previously reported, indicate (1) adenoid basal carcinoma with typical histologic features is not a malignant neoplasm in that it typically presents in asymptomatic women, usually is discovered after an abnormal Pap smear result due to cervical intraepithelial neoplasia, does not produce a grossly visible lesion, has never metastasized to regional lymph nodes or elsewhere, and has never itself caused death; (2) rare, histologically atypical tumors with distinctly malignant features should not be regarded as adenoid basal carcinoma; and (3) adenoid basal hyperplasia probably is a small adenoid basal carcinoma. We propose the term "adenoid basal epithelioma" to replace adenoid basal carcinoma and adenoid basal hyperplasia, because it better describes the clinicopathologic features of these distinctive lesions and their excellent prognosis and may reduce the likelihood of unnecessarily aggressive treatment.

Adult↗

Primary adenoid cystic carcinoma of the skin. A clinical, histological, and immunocytochemical comparison with adenoid cystic carcinoma of salivary glands and adenoid basal cell carcinoma.

An adenoid cystic carcinoma of the skin was compared with three similar neoplasms of salivary glands and with an adenoid basal cell carcinoma, from unrelated cases. The histological and immunocytochemical details of these tumors were analyzed in an attempt to determine whether or not their differing clinical behaviors would be reflected in pathologic dissimilarities. Although the single adenoid cystic carcinoma of the skin did not recur or metastasize over a 10-year follow-up period, its morphologic and biochemical features were identical to those of biologically aggressive salivary gland tumors. All four adenoid cystic carcinomas contained carcinoembryonic antigen, epithelial membrane antigen, salivary-type amylase, and alpha-lactalbumin, and all bound peanut agglutinin. Three of four expressed positivity for S100 protein, and two contained low-molecular-weight cytokeratin. In contrast, none was immunoreactive for beta-2-microglobulin, and only one displayed blood group isoantigen positivity. The adenoid basal cell carcinoma was negative for all immunological determinants, but it bound peanut agglutinin. Although these results should be regarded as preliminary, it appears that adenoid cystic carcinoma is a pathologically distinct and uniform entity, whether it occurs in the skin or in salivary glands. However, the clinical behavior of this tumor cannot be predicted on the basis of immunohistochemical or morphological studies. Finally, adenoid basal cell carcinoma is histopathologically and immunocytochemically separable from cutaneous adenoid cystic carcinoma.

Aged↗

[A new outlook on adenoid hypertrophy: adenoids or adenoid disease?].

Hypertrophy of the pharyngeal tonsil affects functions of some organs and systems producing negative effects on physical and mental development of the child. The existing classification based of the tonsil size does not reflect the complexity of the pathological process. "Adenoid disease" is thought to be a more adequate term. A new classification of adenoid disease is proposed. Indications for conservative and surgical treatments can be well formulated with the new classification. The authors prefer adenotomy as, in their opinion, adenectomy is not safe for health.

Adenoidectomy↗

Bacteriology of tonsil and adenoid and sampling techniques of adenoidal bacteriology.

The value of pernasal swabs and direct adenoid swabs in chronic adenoid and adenotonsillar disease was assessed in 175 patients. Prior to adenoidectomy (53 patients) or adenotonsillectomy (122 patients), pernasal and direct adenoid swabs were taken. Adenoid currettings and tonsil tissue were cultured. Haemophilus influenzae was the bacterium most frequently isolated from adenoid currettings and from the centre (core) of the resected tonsil. There was a close relationship between the bacteriology of the pernasal swab and the adenoid tissue and tonsil core in 72 and 71% of patients, respectively. There was an identical profile of pathogens in 52 and 49%, respectively. We suggest that in children with adenoiditis or adenotonsillitis and hypertrophy of the adenoid, a pernasal swab should be used in preference to a throat swab in selecting appropriate antimicrobial therapy. Penicillin and ampicillin are not appropriate blind therapy in chronic adenoid and adenotonsillar infections because of the prevalence of beta-lactamase-producing aerobes (40%) in adenoid and tonsil core in these conditions.

Adenoidectomy↗

Cervical adenoid basal tumors comprised of adenoid basal epithelioma associated with various types of invasive carcinoma: clinicopathologic features, human papillomavirus DNA detection, and P16 expression.

Adenoid basal tumors are uncommon cervical lesions that some pathologists consider invasive carcinomas but others consider "epitheliomas" due to their low-grade histological appearance and rarely documented malignant behavior. We report the clinicopathologic features of 10 tumors comprised of both typical low-grade adenoid basal tumors (epitheliomas) intimately associated with invasive carcinomas having infiltrative growth, increased cytological atypia and mitotic activity, and various types of differentiation, including adenoid basal/squamous, pure squamous, adenoid cystic, and small cell neuroendocrine. Tumors were evaluated for the presence of human papillomavirus (HPV) DNA and immunohistochemical p16 expression. The patients in the study group ranged in age from 45 to 81 years (mean, 65 years). Most of the patients presented with abnormal cervicovaginal smears. The initial diagnosis was made on specimens obtained by cervical biopsy, laser electrocautery excision procedure (LEEP), or cone biopsy in 8 patients. Two 2 patients were incidentally diagnosed in hysterectomy specimens. All 10 patients had squamous intraepithelial lesions (9 high-grade, 1 low-grade). In all cases diagnosed in LEEP or cone biopsy specimens, the invasive carcinoma component was present in the excisional specimen and extended to the margins. Seven patients diagnosed on excisional or biopsy specimens who underwent hysterectomy had residual tumor in the cervix, ranging from microscopic foci to deeply invasive. No lymph node metastases were identified in 4 patients who were staged. Seven patients with follow-up were alive without evidence of disease after follow-up intervals of 8 to 84 months (mean, 45 months; median, 29 months). One patient with a component of small cell carcinoma died of other causes without evidence of disease at 18 months. HPV 16 DNA was detected in both the adenoid basal epithelioma and invasive carcinoma components in 9 tumors by in situ hybridization, and HPV 33 was detected by polymerase chain reaction in 1 tumor. All tumors expressed p16 diffusely. Adenoid basal tumors are high-risk HPV-related tumors that can be comprised of both a low-grade adenoid basal tumor, which can be designated as epithelioma, and invasive carcinomas of various types. The invasive component is usually evident in the excisional biopsy specimen, allowing for recognition of a tumor that needs further management.

Aged↗

The clinical significance of adenoid-choanae area ratio in children with adenoid hypertrophy.

OBJECTIVE: We designed a method to compare the adenoid-choanae area ratio (A/C ratio) measured in children with symptoms of adenoid hypertrophy with those from children without any symptoms related to adenoid hypertrophy. METHODS: A prospective analysis of A/C ratio of 42 patients undergoing adenoidectomy and tonsillectomy from January 2000 to September 2003 in a medical center was compared with 28 patients receiving treatment other than the above-mentioned procedures in the same period. We used 0 degrees telescope to take pictures of the nasopharynx under general anesthesia preoperatively. The pictures were transformed digitally. The A/C ratio was calculated by the program we developed after these pictures were processed by the Photoshop 6.0 (Adobe, USA) software. RESULTS: The A/C ratio in adenoid hypertrophy group (0.863+/-0.0983) is significantly higher (p<0.001) than that of control group (0.445+/-0.1431). Mouth breathing, nasal obstruction and snoring were found to be more severe in children with high A/C ratio (p<0.001). CONCLUSIONS: The A/C ratio provided the two-dimensional information of the nasopharyngeal airway. The A/C area ratio is significantly higher in the group of symptomatic adenoid hypertrophy when compared with symptomatic-free group. For practical purposes, the adenoid with an A/C ratio more than 2/3 is considered a pathological enlargement.

Adenoids↗

Inter-observer variability in the clinical and radiological assessment of adenoid size, and the correlation with adenoid volume.

Forty-six children were independently assessed with respect to size of adenoids and other clinical features by 3 observers of differing experience. Similar assessment was made of adenoid area and post-nasal-space airway from lateral cephalometric X-rays. The inter-observer agreement for these findings has been calculated. Absolute agreement between observers for the assessments is poor and in some instances this is related to clinical experience. In relative terms the agreement is more satisfactory. A nasal obstruction score due to adenoid enlargement has been derived from assessment of mouth breathing and speech hyponasality and this is shown to correlate with the nasopharyngeal radiology score derived from visual assessment of the radiological adenoid area and post-nasal-space airway. The radiology score correlates well with measurements of the nasopharyngeal area made by planimetry. Both the radiology score and the nasal obstruction score correlate with the volume of adenoid tissue removed at adenoidectomy. This study provides the basis for a scoring system for the clinical and radiological assessment of adenoids in order to detect preoperatively those children most likely to benefit from adenoidectomy.

Adenoids↗

Adenoid cystic and adenoid basal carcinomas of the cervix.

Adenoid basal and adenoid cystic carcinomas of the cervix are uncommon and differ from each other in their histology, treatment, and prognosis. Whereas adenoid basal carcinoma is a slow-growing, locally invasive lesion amenable to simply hysterectomy, adenoid cystic carcinoma is an aggressive tumor associated with regional lymph node involvement and late pulmonary metastases. This study, based on the evaluation of nine cases of adenoid cystic and five cases of adenoid basal carcinoma of the cervix, reviews the literature and formulates a program for the management of these rare lesions.

Adult↗

Nasal obstruction. Adenoiditis vs adenoid hypertrophy.

The terms "adenoiditis" and "adenoid hyperplasia" are often used interchangeably to describe posterior nasal obstruction in children, tending to obscure indications for adenoidectomy. To more clearly define the role of the adenoid bed in nasal obstruction and its relationship to aural disease, we examined tissue obtained at adenoidectomy from 22 children via the quantitative bacteriological technique. In three patients, adenoidectomy was performed for nasal obstruction alone, in nine patients for serous otitis media and nasal obstruction, and in ten patients for nasal obstruction with serous otitis media and recurrent bacterial otitis. Using the criteria that 10(5) bacteria per gram of tissue indicates infection, 90% of the patients in the last group had infected adenoids vs 8% of the patients in the first two groups. Quantitative immunoglobulin levels, WBC counts, or preoperative antibiotic therapy was not helpful in determining which patients had infected adenoids. Pressure-equalizing tubes were placed when appropriate. A follow-up of nine to 22 months is included.

Adenoidectomy↗

Adenoid cystic-like tumor of the prostate gland. A report of two cases and review of the literature on "adenoid cystic carcinoma" of the prostate.

Two prostatic neoplasms that closely resemble adenoid cystic carcinoma of the salivary glands, but in the authors' opinion merit separate designation, are reported. Most of the well-documented examples of prostatic lesions interpreted as "adenoid cystic carcinoma" appear to have been similar to the cases reported herein. The lesions in this report, which the authors have designated as adenoid cystic-like tumors, occurred in men of 60 and 68 years of age who presented with urinary tract obstruction and had transurethral resection of the prostate. Both neoplasms were associated with a minor component of prostatic adenocarcinoma of the usual acinar type. Each adenoid cystic-like tumor had areas that closely resembled basal cell hyperplasia of the prostate, and one had conspicuous foci of squamous differentiation. One patient had a radical prostatectomy and is well six years after operation. The other patient was treated with transurethral resection and irradiation and is well eight months after operation. The prognosis associated with this neoplasm appears to be excellent on the basis of the limited experience to date.

Aged↗

Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio.

Adenoidal-nasopharyngeal ratios (AN ratios) obtained by simple linear measurements from lateral skull radiographs are described. The AN ratio reliably expresses adenoidal size and patency of the nasopharyngeal airway. The validity of the ratio as an indicator of adenoidal size was determined by evaluation of measurements of radiographs of 1,398 infants and children and comparison with a subjective visual assessment made by experienced observers in 92 patients. An AN ratio greater than 0.80 was present in 34 of 36 patients (94%) subjectively judged to have enlarged adenoids.

Adenoids↗

Aerobic and anaerobic bacteriology of adenoids in children: a comparison between patients with chronic adenotonsillitis and adenoid hypertrophy.

Adenoids were obtained from 18 children with chronic adenotonsillitis (Group A) and from 12 others with adenoid hypertrophy (Group B). Patients' ages ranged from 20 months to 15 years (mean 6 years); 18 were males and 12 females. The adenoids were sectioned in half after heat searing of the surface, and the core material was cultured for aerobic and anaerobic microorganisms. Mixed aerobic and anaerobic flora were obtained from all patients, yielding an average of 7.8 isolates (4.6 anaerobes and 3.2 aerobes) per specimen. There were 97 anaerobes isolated. The predominant isolates in both groups were: Bacteroides sp. (including B. melaninogenicus and B. oralis), Fusobacterium sp., gram-positive anaerobic cocci, and Veillonella sp. There were 138 aerobic isolates. The predominant isolates in both groups were: alpha and gamma hemolytic streptococci, beta hemolytic streptococci (Group A, B, C, and F), S. aureus, S. pneumoniae, and Hemophilus sp. Hemophilus influenzae type B, and S. aureus were more frequently isolated in Group A. B. fragilis was only recovered in Group A. Beta lactamase production was noted in 27 isolates obtained from 18 patients. Fifteen of these patients belonged to Group A (83% of Group A), while 3 were members of Group B (25% of Group B). These bacteria were all isolates of S. aureus (11) and B. fragilis (2), 8 of 22 B. melaninogenicus group, 4 of 11 B. oralis, and two of 8 H. influenza type B. Our findings indicate the polymicrobial nature of deep adenoid flora and demonstrate the presence of many beta lactamase-producing organisms in children with recurrent adenotonsillitis.

Adenoids↗

[Adenoid basal carcinoma and adenoid cystic carcinoma of the uterine cervix].

Adenoid basal carcinoma and adenoid cystic carcinoma are rare primary cervical neoplasms occurring in postmenopausal women. They are generally regarded as distinct entities on the basis of their distinctive morphology and a different biological behaviour. Although the separation of these two entities is still mandatory, some rare complex cases may show overlapping pathological features and are difficult to classify. We report a case of composite cervical tumor with both types of carcinoma, an in situ epidermoid carcinoma and a hitherto undescribed clear cell component, each with a different morphology and immunophenotype. The adenoid basal component is mainly immunoreactive for cytokeratin KL1. The adenoid cystic component is strongly stained for smooth muscle actin and is associated with a hyaline stroma immunostained for collagen IV.

Adenocarcinoma, Clear Cell↗

[Ultrastructure of adenoid-cystic carcinoma as a sign of malignity (comparison of ultramicroscopical investigations concerning adenoid-cystic carcinoma and adeno-carcinoma of salivary glands) (author's transl)].

The ultrastructure of Adenoid-cystic carcinoma of salivary glands analysed by 7 cases is compared with ultrastructure of Adenocarcinoma. Both carcinomas have corresponding secretory cells. The dysregulation of secret production is typical in Adenoid-cystic carcinoma and Adenocarcinoma and based on defective differentiation and missing innervation of carcinoma cells. The diversity of tumour-cells, increased by nesecretory cells, based on large cytogenetic prospection of acinary and ductulary epithelium of salivary glands. Based on the ultramicroscopical correspondence of secretory cell-types in both carcinomas the malignity of the Adenoid-cystic carcinoma is founded.

Adenocarcinoma↗

Basal cell hyperplasia, adenoid basal cell tumor, and adenoid cystic carcinoma of the prostate gland: an immunohistochemical study.

Basal cell hyperplasia (BCH) is an uncommon proliferative lesion of the prostate gland. We studied ten cases of BCH, one case of an unusual adenoid basal cell tumor (ABT), and one case of a prostatic adenoid cystic carcinoma (ACC), using a panel of antibodies to define the histogenesis of these lesions. Monoclonal antibodies (MoAb) directed against a cytokeratin, which selectively stains basal cells (34 beta E12), and against muscle-specific actin, which stains myoepithelial cells (HHF35), were used. In addition, antibodies directed against prostatic acid phosphatase (PAP), prostate-specific antigen (PSA), S-100 protein, and vimentin were used. In the normal prostate, epithelial cells reacted positively with 34 beta E12, PAP, and PSA, and negatively with the actin, S-100 protein, and vimentin antibodies. In BCH, positive staining was seen for 34 beta E12, PSA, and PAP, with no reactivity for actin, S-100 protein, and vimentin. In ABT and ACC, positive reactivity was demonstrated for all antibodies except actin and vimentin. These findings indicate that the basaloid cells of BCH, ABT, and ACC are derived from basal cells of the normal prostate gland and suggest a continuum among the three lesions. The presence of S-100 protein in ABT and ACC may be related to the lack of this antigen's specificity for myoepithelial cells. The absence of reactivity with the HHF35 MoAb supports our belief that the S-100 positivity does not necessarily indicate myoepithelial cell differentiation.

Acid Phosphatase↗

"Adenoid cystic" carcinoma and adenoid basal carcinoma of the uterine cervix. A study of 28 cases.

Adenoid cystic carcinoma (ACC) and adenoid basal carcinoma (ABC) of the uterine cervix are rare tumors that have often been regarded as a single entity. We studied 28 cases of these neoplasms, with 14 cases in each category. Most patients were over 60 years of age, and there was a high proportion of black women. The majority of the women with ACC presented with postmenopausal bleeding and had an obvious mass on pelvic examination. Despite the tumors' architectural similarity to ACC of the salivary gland, microscopic examination of the cervical carcinomas showed necrosis, a high mitotic rate, and greater nuclear pleomorphism. In all but one of the cases, the tumor cells were negative for S-100 protein on immunoperoxidase staining--a finding that provides evidence against a myoepithelial component. However, S-100-positive dendritic cells were present in the stroma of the tumors and among the neoplastic cells. The patients with ABC were usually asymptomatic, without a gross abnormality of the cervix. Microscopic examination disclosed small nests of basaloid cells, almost always beneath, and often arising from, in situ or small invasive squamous cell carcinomas. In contrast to ABC, ACC was often complicated by local recurrence or distant metastasis. We conclude that ACC of the uterine cervix differs from ACC of salivary gland origin and is also distinct clinically and pathologically from cervical ABC.

Aged↗

Adenoid cystic and adenoid basal carcinoma of the uterine cervix: comparative morphologic, mucin, and immunohistochemical profile of two rare neoplasms of putative 'reserve cell' origin.

Adenoid cystic carcinomas (ACCs) and adenoid basal carcinomas (ABCs) are rare neoplasms of the uterine cervix that are currently regarded as distinct clinicopathologic entities. Accurate distinction between ABCs and ACCs is of clinical importance because of differences in their biological behavior. This study compares the morphologic, mucin, and immunohistochemical profiles of 18 cervical ACCs, 8 ABCs, and 1 combined ABC-ACC. Serial sections from the 27 cases were stained with hematoxylin and eosin, periodic acid-Schiff-diastase, mucicarmine, and alcian blue and subjected to a panel of immunoperoxidase markers, namely, MNF116, CAM 5.2, CK7, CK20, epithelial membrane antigen, carcinoembryonic antigen (CEA), S-100, HHF 35, laminin, and type IV collagen. One ACC was also examined ultrastructurally. Almost all patients were postmenopausal black women. The distinction between ABC and ACC was best made morphologically. Divergent epithelial differentiation was seen in 18 cases (11 ACCs, 6 ABCs, and 1 ABC-ACC). Six cases with intact surface epithelium showed a high grade squamous intraepithelial lesion. There was no significant difference in mucin staining. Both tumor types had a similar immunohistochemical profile, apart from type IV collagen and laminin staining, which occurred exclusively in relation to the extracellular basement membranelike material in the ACC. Eleven ACCs and three ABCs were S-100-positive, including the respective ACC and ABC components of the combined ABC-ACC. Eight of the S-100-positive neoplasms with ACC morphology also stained with HHF 35, suggesting myoepithelial differentiation. The latter was confirmed in one ACC examined ultrastructurally. The similar clinical profiles, apart from the different biological behavior, capacity for divergent differentiation, and the occurrence of ABC areas in some ACCs and vice versa suggest that these tumors may share a common histogenesis, forming part of a morphologic and biologic spectrum of basaloid cervical neoplasms of putative "reserve cell" origin. Circumstantial evidence suggests that ABC may be a precursor of cervical ACC.

Adult↗