1/35. An unusual cervical carcinoma showing exception to epitheliotropism of human papillomavirus.Human papillomaviruses (HPV) infect epithelial tissues but have not been previously detected within mesenchymal cells. During a systematic investigation of FIGO stage Ib cervical cancers with colorimetric in situ hybridization, we detected HPV 16 dna within the stromal compartment of an unusual undifferentiated carcinoma. The mesenchymal nature of the HPV-containing cells was confirmed by immunohistochemistry and electron microscopy. No viral particles were identified. Sequencing the majority of the HPV 16 genome identified few changes from the revised reference clone; all previously reported in other HPV 16 variants. These viral changes are unlikely to explain the exceptional mesenchymal localization of the HPV 16 dna in this case.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/35. Exfoliative cytology of lymphoepitheliomalike carcinoma of the uterine cervix. A report of two cases.BACKGROUND: Lymphoepitheliomalike carcinomas (LECs) are morphologically similar to undifferentiated nasopharyngeal carcinoma but occur at sites other than the nasopharynx. They rarely occur in the uterine cervix. Sixty-five cases of LEC of the cervix have been published to date, and the pitfalls of histopathologic interpretation have been discussed. This undifferentiated carcinoma with a prominent lymphocytic infiltrate represents a challenge for the pathologist examining a scant cervical biopsy or Pap smear. Distinguishing LEC as a separate entity is important. Despite the fact that the epithelial component is poorly differentiated, this neoplasm is associated with a lower frequency of lymph node metastases, is potentially radiosensitive and has a better prognosis. Although mentioned in passing in several papers, the exfoliative cytology of this cervical neoplasm has not been adequately discussed. We report the cytologic features of LEC in cervical smears obtained from two patients. CASES: The first patient presented with menometrorrhagia and postcoital bleeding. The cervical smear taken at the time of presentation was reported as unsatisfactory for evaluation. ASCUS was diagnosed on a vaginal smear obtained one year earlier. The second patient presented with a complaint of postcoital bleeding. A cervical smear and the cervical biopsy taken at the time of presentation were reported as ASCUS and high grade dysplasia versus carcinoma, respectively. A retrospective review of the cervical smears revealed rare malignant cells occurring singly or in small groups. The tumor cells had a high nuclear/cytoplasmic ratio, irregular nuclear membrane and hyperchromatic nuclei with coarse chromatin and were obscured by heavy inflammation and blood. The background resembled that of a menstrual smear. CONCLUSION: The diagnosis of LEC of the cervix is often made on a loop electrical excision procedure or on a hysterectomy specimen. The presence of heavy inflammation and blood, which can obscure the malignant nature of the cells, presents the cytopathologist with a challenging diagnosis of LEC in cervical smears. In view of the prognostic implications, it is desirable for the pathologist to classify LEC as a distinct entity.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/35. Coexistence of metastatic neuroendocrine carcinoma of the uterine cervix with human immunodeficiency virus infection.women now constitute 28% of new cases of human immunodeficiency virus (hiv) infection. Cervical cancer in hiv-infected women has a high recurrence and death rate, as well as decreased intervals to recurrence and death. Neuroendocrine carcinomas of the cervix are characterized by a high frequency of early nodal and distant metastases. We present the first report of a neuroendocrine carcinoma of the cervix in an hiv-positive patient. A 28 year old with a 9-year history of hiv succumbed to metastatic neuroendocrine carcinoma of the cervix 5 months after diagnosis. Given the aggressive nature of the cell type, an extended metastatic workup should be considered prior to surgery. The immune suppression present in hiv-positive patients with neuroendocrine cervical carcinoma may make such a workup particularly crucial, such that surgery is offered only to those who can be expected to benefit.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/35. Inverted transitional cell papilloma of the uterine cervix.A rare case of inverted transitional cell papilloma of the uterine cervix in a 54-year-old woman is described. A polypoid nodule 8 mm in diameter showed histologic features similar to those of urinary tract inverted papilloma. It contained inverted anastomosing epithelial nests divided by scarce fibrovascular septa. The epithelial nests with peripheral palisading had uniform and oval nuclei with longitudinal grooves and swirling orientation. Significant atypia and mitotic activity were absent. Inside the nests there were foci of intraepithelial glandular metaplasia resembling glandular cystitis of the urinary bladder. MIB-1 index was 6%, and the distribution of MIB-1-positive nuclei was similar to that of immature metaplasia. A recurrence-free follow-up period of 16 months along with a low level of proliferation assessed by histology and immunohistochemistry suggests a benign nature of the lesion. A review of published transitional cell (urothelial) lesions of the female genital tract is added.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/35. Surgical resection of solitary brain metastasis from cervical cancer.This is the first report of a patient with cervical cancer who underwent surgical resection of a solitary brain metastasis eight years following diagnosis. This case is unique because of the indolent nature of the tumor and because the patient had resection of metastatic lung nodules three years earlier. In this particular case, the patient's survival was not prolonged, so craniotomy and resection cannot be recommended in this disease, even when there has been a prolonged disease progression-free interval. Palliative management should include steroids and radiation therapy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/35. Large cell neuroendocrine carcinoma of the uterine cervix: a clinicopathological study of six cases.Six cases of cervical large cell neuroendocrine carcinomas (LCNEC) were found among 972 patients (0.6%) with invasive cervical carcinoma. The patients, who were from 27 to 51 (mean 38) years of age, presented with vaginal bleeding or an abnormal Papanicolaou smear. Five tumors were stage Ib and one was IIa. All patients underwent radical hysterectomy and received adjuvant chemotherapy and pelvic radiotherapy. Four patients died of tumor 6 to 19 months (mean 14 months) postoperatively. On histologic examination, the tumor cells were arranged in an organoid growth pattern and were larger than those of typical small cell carcinoma. Glandular differentiation was present in one case. Mitotic figures ranged from 15 to 45 (mean 29) per 10 high-power fields. Prominent vascular invasion and necrosis was seen in all of the tumors. Each tumor was immunoreactive for chromogranin a and/or synaptophysin. The results of this study confirm the aggressive nature of cervical LCNECs. The recognition of LCNECs is necessary to establish the most effective treatment for these aggressive tumors.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/35. Neuroendocrine carcinoma of the uterus.Neuroendocrine carcinomas of the cervix and endometrium were reviewed. They have been variously designated as carcinoid, argyrophil cell carcinoma, apudoma, small cell carcinoma, oat cell carcinoma, endocrine carcinoma, and neuroendocrine carcinoma, the last-mentioned term being preferred in this chapter. Adenocarcinomas with neuroendocrine cells are occasionally encountered in the cervix and endometrium. It is generally questioned whether they should be included in the spectrum of neuroendocrine carcinomas, although differential diagnosis between some such tumors of the gastrointestinal tract and neuroendocrine carcinoma is reported to be difficult. Since the majority of neuroendocrine carcinomas of the cervix are highly aggressive, it is important to establish the neuroendocrine nature in the cervical carcinomas. In addition to the characteristic histologic features and argyrophil stainability, immunohistochemical demonstration of several neuroendocrine markers may be helpful in diagnosing neuroendocrine carcinoma of the cervix. Ultrastructural demonstration of neurosecretory granules is almost decisive in establishing the tumor's neuroendocrine nature, but it is not applicable in all cases. Neuroendocrine carcinomas of the cervix have been treated by surgery, radiation therapy, and chemotherapy, but optimal treatment methods have not yet been established because of the rarity of the tumor. Finally, we have described a typical neuroendocrine carcinoma of the cervix and reported some data regarding its experimental study.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
8/35. Squamous cell carcinoma in situ involving mesonephric remnants of the uterine cervix.Squamous cell carcinoma in situ (CIS) involving mesonephric remnants of the uterine cervix is a very rare lesion, the existence of which is still controversial. A second case of this lesion is reported. It was found in a cone biopsy specimen from an 40-year-old patient. Besides, in surface epithelium and within cervical glands, a structure of CIS was seen in conjunction with mesonephric tubules in deeper cervical stroma. The mesonephric nature of these tubules and of tubule-appearing epithelium within islands of CIS was supported by immunohistochemical positivity for CD10 and vimentin. The lesion strongly simulated invasive carcinomas, such as adenosquamous carcinoma and adenoid basal carcinoma (epithelioma) of the cervix.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/35. Ovarian mucinous cystadenocarcinoma with mural nodule of anaplastic carcinoma and synchronous cervical squamous carcinoma.Solid mural nodule within a mucinous cystic ovarian tumor occurs more often than generally presumed. One especially interesting case involving coincidental cervical carcinoma is presented. A 38-year-old woman underwent exploratory laparotomy for a right ovarian tumor. After ovarian malignancy had been diagnosed from frozen section, the bilateral salpingo-oophorectomy and hysterectomy was performed. The tumor had a unilocular cystic cavity and a mural nodule. The nodule showed undifferentiated carcinomatous features. The immunohistochemical examination revealed atypical cells in the nodule which were positive for cytokeratin, CEA, and vimentine, establishing its anaplastic nature. A synchronous cervical invasive squamous carcinoma was documented. The patient was treated with chemotherapy and radiotherapy. Currently, at 15 postoperative months, she is well and free of disease. The occurrence of ovarian mucinous cystadenocarcinoma with mural nodule of anaplastic carcinoma and cervical squamous cell carcinoma is evidently very uncommon, because we have not found a similar case in the literature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/35. Pelvic sidewall adenocarcinoma after definitive therapy for cervical adenocarcinoma in situ.BACKGROUND: Traditionally, hysterectomy is considered definitive therapy for cervical adenocarcinoma in situ (AIS) in women beyond childbearing. CASE: A 45-year-old gravida 2, para 2 patient presented with cervical dysplasia and on pathology review of the large loop excision procedure cervical adenocarcinoma in situ was diagnosed. She underwent extrafascial hysterectomy and bilateral salpingo-oophorectomy. Final pathology revealed adenocarcinoma in situ with negative margins. Twenty-eight months later, she presented with right lower extremity deep venous thrombosis. A computed tomography (CT) scan of the abdomen and pelvis showed a pelvic sidewall mass. A CT-guided biopsy of the mass was consistent with invasive adenocarcinoma of the endocervical type. She underwent combination therapy with weekly cisplatin and extended field radiation therapy. CONCLUSION: This case depicts another example of the unpredictable nature of cervical AIS. Despite undergoing definitive surgery, a residual focus of disease may remain leading to invasive adenocarcinoma. Close follow-up is required of all patients diagnosed with AIS because the disease is poorly understood.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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