1/18. Fine-needle aspiration cytology of primary granulosa cell tumor of the adrenal gland: a case report.Extraovarian granulosa cell tumors are extremely rare. We report on a primary granulosa cell tumor of the adrenal gland. A 69-yr-old African-American female presented with a 1-yr history of irregular uterine bleeding and a palpable right abdominal mass. CT scan showed a 9.0-cm suprarenal mass as well as an enlarged uterus. CT-guided fine-needle aspiration (FNA) cytology of the adrenal mass was interpreted as a malignant neoplasm. She underwent exploratory laparotomy, right nephrectomy, and hysterectomy with bilateral salpingo-oophorectomy. The gross, histologic, and immunohistochemical findings of the adrenal mass were characteristic of a granulosa cell tumor. The uterus contained multiple leiomyomas. The endometrium showed simple hyperplasia. Both fallopian tubes and ovaries showed no pathologic abnormality. There was no evidence of tumor elsewhere. Although rare, extraovarian granulosa cell tumor should be considered in the differential diagnosis of adrenal tumors in women showing the FNA features described herein, especially when there is evidence of excessive estrogen production. Diagn. Cytopathol. 2000;22:107-109.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/18. Mucinous endometrial adenocarcinoma simulating microglandular hyperplasia of the cervix.A case of endometrial adenocarcinoma simulating microglandular hyperplasia (MGH) of the cervix is presented. A postmenopausal 53-year-old woman, with no previous history of taking exogenous hormones, presented with vaginal bleeding. An endometrial biopsy exhibited a tumor composed predominantly of a microglandular proliferation of tightly packed glands with mild to moderate atypia and mitotic figures. The majority of the tumor cells contained intracytoplasmic mucin. There were numerous neutrophils within the microglandular lumens and in the stroma. The tumor was focally positive for carcinoembryonic antigen and vimentin. The MGH-like proliferation, focally, had a transition to a conventional mucinous adenocarcinoma. hysterectomy specimens showed a residual mucinous endometrial adenocarcinoma with no myometrial invasion, the uterine cervix was unremarkable. Four years following her hysterectomy the patient was well, with no evidence of disease. Pathologists need to be cautious about MGH-like changes in the endometrial biopsy of postmenopausal women and be aware of this type of endometrial cancer as it may be misdiagnosed.- - - - - - - - - - ranking = 1.6keywords = gland (Clic here for more details about this article) |
3/18. Long-term mifepristone (RU486) therapy resulting in massive benign endometrial hyperplasia.mifepristone (RU486) is a potent antiprogestagen, and at high doses it also acts as an antiglucocorticoid drug. mifepristone, administered as a single 600 mg dose, is commonly employed to induce medical abortion in conjunction with prostaglandins. The long-term safety profile of mifepristone, especially at high doses, is less well-established. Long-term mifepristone is considered efficacious in treating uterine myomas, endometriosis (25--100 mg/day), and possibly in inoperable meningiomas (200 mg/day), as well as inoperable Cushing's syndrome. Many animal studies document an antiproliferative effect (antioestrogenic), as do some reports in humans. However, there are also data to suggest that, as an antiprogestagen, mifepristone may promote an unopposed oestrogen milieu, and thus have a proliferative effect upon the endometrium. We hereby describe the first reported case of an adolescent female with Cushingoid features and morbid osteoporosis who was treated with mifepristone for its antiglucocorticoid effect (400 mg/day) in an attempt to prevent further bone loss. The patient's striae, weight gain, and buffalo hump markedly improved, and further bone loss was halted. However, with each of the two 6-month courses of mifepristone (9 months apart) she developed massive simple endometrial hyperplasia and a markedly enlarged uterus. This reversed to normal after cessation of mifepristone treatment. In conclusion, High doses of the antiprogestagen mifepristone over a prolonged period of time may promote an unopposed oestrogen milieu leading to endometrial hyperplasia. Therefore, interval pelvic imaging in women who receive long-term mifepristone may be prudent.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
4/18. Two kinds of endometrial neoplasia arising from different origins in the uterine corpus: comparison of p53 expression and sex steroid receptor status.This study presents a case of endometrial clear cell adenocarcinoma complicated by complex atypical glandular hyperplasia surrounded by adenomyosis in the uterine myometrium. The former was immuno-negative for estrogen receptor (ER) and positive for p53, whereas both of the latter were immuno-positive for ER and negative for p53. Therefore, there were two kinds of neoplasia arising from different origins in the uterine corpus.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
5/18. endometrial hyperplasia with berrylike squamous metaplasia and pilomatrixomalike shadow cells. Report of an intriguing cytohistologic case.BACKGROUND: The usefulness of endometrial cytology as a diagnostic method in asymptomatic women, especially in postmenopause, in the interpretation of composite pictures characterized by borderline features between atypical hyperplasia and well-differentiated adenocarcinoma, especially if associated metaplastic features are present, is somewhat controversial. CASE: An asymptomatic, 50-year-old, postmenopausal woman underwent a Pap smear and endometrial cytology for routine screening, disclosing three-dimensional, sometimes pseudopapillary groupings of hyperplastic endometrial glandular cells with focal atypia in direct continuity with large, squamoid cells of the keratinizing type and shadow cells. Histologic examination of endometrial tissue was advised, and two subsequent endometrial biopsies and hysteroscopic ablation were performed. The borderline character of the lesion (complex atypical hyperplasia vs. well-differentiated adenocarcinoma) with concomitant squamous metaplasia and pilomatrixomalike shadow cells prevented diagnostic agreement between several pathologists. CONCLUSION: Diagnostic cytology with direct endometrial sampling represents a valuable diagnostic screening tool for the differential diagnosis between normal and pathologic endometrium, a mucosal picture that deserves a subsequent (histologic) diagnostic procedure. In a few cases, as in the one presented above, even histologic examination, especially of so-called borderline lesions, reveals squamous or other types of metaplasia that can lead to interobserver discrepancies.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
6/18. Microglandular adenocarcinoma of the uterus mimicking microglandular cervical hyperplasia.We present a rare case of microglandular carcinoma of the uterus occurring in 76-year-old woman. The tumor tissue in the curettage specimen showed strong similarity with microglandular hyperplasia of the cervix. Microglandular aggregates of glands with only mild nuclear atypia but without any structures of conventional endometrioid carcinoma were seen. Therefore, a microglandular hyperplasia of the cervix was seriously considered. The following features were helpful in the differential diagnosis: numerous neutrophils and "dirty" amount within glandular lumens; very scarce (but nevertheless present) mitoses; isolated single glands with more endometrioid than endocervical appearance; and strong expression of vimentin, which is unusual for microglandular hyperplasia of the cervix. In the resectate, a conventional well-differentiated endometrioid adenocarcinoma with microinvasion of the myometrium (under 1 mm of depth) was found. Microglandular differentiation has been, however, present in plaque-like proliferation replacing the endometrium and on the surface of conventional adenocarcinoma. Eleven months after the hysterectomy, the patient has no signs of recurrence or metastasis. Our case shows the difficulties in the diagnosis of this lesion and confirms a low aggressiveness that was observed in all 10 cases described to date.- - - - - - - - - - ranking = 3.4keywords = gland (Clic here for more details about this article) |
7/18. Malignant transformation of atypical endometrial hyperplasia after progesterone therapy showing germ-cell tumor-like differentiation.A 31-year-old woman was treated for atypical endometrial hyperplasia (AEH) with high-dose medroxyprogesterone acetate (MPA) therapy to preserve fertility. The AEH was found by repeated cytologic and histologic examinations to have completely disappeared with the therapy, but 3 years after her last follow up she required emergency surgery to treat severe genital bleeding. The hysterectomied uterus consisted mostly of poorly differentiated adenocarcinoma, G3 endometrioid type. Minor AEH was present in the exophytic area, in which some glands were cystically dilated. Part of the AEH had transformed into other histologic features with germ-cell-like differentiation, demonstrated by immunohistochemical positive reaction of placental alkaline phosphatase, alpha-fetoprotein, and human chorionic gonadotrophin. Recurrent AEH had undergone malignant transformation, resulting in the development of well- and poorly differentiated adenocarcinoma and tumor exhibiting germ-cell-like differentiation. The patient died of a massive tumor extension 7 months after surgery. The AEH before MPA therapy and the recurrent tumors had genetically different characteristics based on evidence of a loss of heterozygosity, detected at D8S1132 (chromosomal locus, 8q22.1) in the latter but not in the former, by analysis of genetic alterations using microsatellite markers.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
8/18. A case of microglandular adenocarcinoma of the endometrium.BACKGROUND: Microglandular adenocarcinoma is a rare type of endometrium carcinoma and had some potential diagnostic problems with difficulties in discriminating from some malign and benign lesions of cervix. CASE REPORT: A 70-year-old woman misdiagnosed as cervical adenocarcinoma was referred to our clinic, and the lesion was ultimately evaluated as microglandular adenocarcinoma in repeat of endometrial curettage specimen. Postoperatively, histopathologic examination of specimen revealed grade 1 microglandular adenocarcinoma. To our best knowledge, this is the twelfth case of uterine carcinoma simulating microglandular hyperplasia in the literature. CONCLUSION: Because microglandular adenocarcinoma can be confused with benign lesions like microglandular hyperplasia and malignant lesions of cervix, we aim to discuss the clinical, demographic and immunohistochemical characteristics of the patients with microglandular adenocarcinoma useful in differential diagnosis.- - - - - - - - - - ranking = 2.2keywords = gland (Clic here for more details about this article) |
9/18. Endometrial mucinous microglandular adenocarcinoma: morphologic, immunohistochemical features, and emphasis in the human papillomavirus status.We report two cases of endometrial microglandular adenocarcinoma, a rare neoplasm, which, in its morphologic features, mimics cervical microglandular hyperplasia and mucinous proliferations of endometrium. The criteria for a correct pathological diagnosis, such as clinical, morphologic, and immunohistochemical data, are emphasized. For the first time, we probed to establish whether endometrial mucinous microglandular adenocarcinoma could be correlated to human papilloma virus (HPV) infection by using polymerase chain reaction amplification (PCR) of tumoral dna. Similar to previous studies reported in the literature, the present lesions, occurring in postmenopausal women, immunohistochemically showed positivity for B72.3, Ca 125, CEA, vimentin, estrogen and progesterone receptors, and negativity for p53. Molecular study by PCR amplification of tumor dna showed no signal for HPV dna in any of these cases; thus, this variant of endometrial carcinoma is not caused by the HPV infection, but probably by other pathogenetic mechanisms, such as an accumulation of the mutations, which arrive in old age or as the consequence of a peculiar hormonal situation.- - - - - - - - - - ranking = 1.4keywords = gland (Clic here for more details about this article) |
10/18. Clinical effects of danazol on endometrial hyperplasia in menopausal and postmenopausal women.Much evidence has been suggested that cystic, adenomatous, and atypical hyperplasia as well as adenocarcinoma in situ of the endometrium may ultimately progress to invasive cancer. Consequently, these lesions should be considered to be precursors of endometrial cancer. Twelve postmenopausal and three perimenopausal women with vaginal bleeding due to endometrial hyperplasia received 400 mg/d of danazol orally for 3 months. After 15 to 30 days of continuous danazol therapy, the endometrial glands ceased to grow and became smaller and rounder. The lumina of glands were narrow and contained no secretion. The nucleic mitosis of the glands disappeared. All women showed regression of hyperplastic endometrium within 2 to 3 months of initial treatment. In the 15 cases treated, endometrial hyperplasia could be controlled successfully with danazol without further recurrence and/or progression of the disease. In summary, danazol should be an effective and safe alternative therapy to progesterone for the treatment of endometrial hyperplasia.- - - - - - - - - - ranking = 0.6keywords = gland (Clic here for more details about this article) |
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