Immunohistochemical demonstration of myoepithelial cells in sweat gland carcinomas

Although myoepithelial cells are detectable in many benign sweat gland tumours, little is known about their role in sweat gland carcinomas. To specifically demonstrate myoepithelial cells, paraffin sections from 46 sweat gland carcinomas were stained, using a standard avidin-biotin-peroxidase complex method, with the monoclonal alpha-smooth muscle actin antibody 1A4. Myoepithelial cells were not found in adenoid cystic eccrine carcinoma (n = 2), malignant nodular hidradenoma (n = 2), porocarcinoma (n = 4), extramammary Paget's disease (n = 12), sclerosing sweat duct carcinoma (n = 4) or in adenosquamous-mucoepidermoid carcinoma (n = 1). In contrast, myoepithelial cells were demonstrated in two of eight apocrine adenocarcinomas, one of six mucinous eccrine carcinomas and two of seven eccrine adenocarcinomas. In all these tumours myoepithelial differentiation was found in peripheral cells of solid tumour islands, or in basal cells of tubular structures. However, in most areas of the tumours, myoepithelial layers were discontinuous. Cells in the centre of solid tumour nodules, and luminal cells of tubular structures, were negative for alpha-smooth muscle actin. In analogy to breast tumours, in which malignancy and invasiveness correlate with scattered or absent myoepithelial cells, we suggest that disrupted myoepithelial layers in sweat gland carcinomas may be interpreted as a loss of the invasion barrier.     

Unindicated preoperative testing: ASA physical status and financial implications

Adenoid basal carcinoma of the uterine cervix is rare and its cell origin is still obscure. We report a case of adenoid basal carcinoma of the uterine cervix discovered incidentally in a 69-year-old woman who had been hysterectomized due to endometrial adenocarcinoma of the uterine corpus. Histologically, small round-to-oval cancer cell nests with peripheral cell palisading were seen budding from the basal cell layer of the uterine cervix showing carcinoma in situ. Immunohistochemically, the basaloid cells of the adenoid basal carcinoma were positive for keratins 14, 17 and 19 and resembled reserve cells of the cervical epithelium. The results of this study clearly demonstrated that adenoid basal carcinoma shows a phenotype similar to reserve cells of the uterine cervix. A review of the literature indicated that this tumor has a favorable prognosis and should be clearly separated from adenoid cystic carcinoma, which has a much poorer outcome.     

Use of polymerase chain reaction with L1 consensus primer for detection of HPV16 and HPV18 in cervical cancer tissues

Biopsy materials of cervical carcinoma including 20 cervical adenocarcinomas and 20 squamous cell carcinomas were collected. A rapid method for determining HPV type was developed, based on DdeI restriction enzymes analysis within the L1 region of HPV, amplified by PCR using consensus primers. The results indicated that HPV type 16 was detected more often in squamous cell carcinomas than in adenocarcinomas (80% vs 15%, P < 0.001), conversely, HPV type 18 was detected significantly more often in adenocarcinoma tissues (45% vs 5%, P < 0.001). These differences may reflect the presence of different virus receptors in cancer cells with different morphologic potential, or, they may indicate that the specific HPV infection actually plays a direct role in the process of carcinogenesis.     

Adenoid basal carcinoma of the cervix uteri: a case report

We report a rare case of adenoid basal carcinoma of the uterine cervix, unexpectedly found in a uterus resected for the treatment of cervical intraepithelial neoplasia (CIN) 3. The patient was a 47-year-old Japanese female. She received a total abdominal hysterectomy under a diagnosis of CIN 3 of the cervix. Grossly, there were no significant findings in the surgical specimens. Microscopically, in seven of the 12 blocks of the cervix examined, scattered small nests of uniform small cells, which extended 4 mm below the epithelial surface, with dark nuclei and scant cytoplasm were observed. Peripheral palisading as well as the formation of gland-like or acinar structures were noted. The latter were positive for mucicarmine. Stromal reaction was not obvious. There were also foci of squamous differentiation in some portions of the small nests. Occasional mitoses as well as large atypical cells were also seen in this area. Immunohistochemically, the foci of squamous differentiation were positive for carcinoembryonic antigen. The epithelial surface in other portions showed CIN 3 with crypt extension. Distinction between adenoid basal carcinoma of the cervix and other diseases, such as adenoid cystic carcinoma and squamous cell carcinoma with basaloid features, is important for clinical management because the clinical behavior of adenoid basal carcinoma is less malignant.     

Radiotherapy of humero-scapular periarthritis using ultra-hard photons. Evaluation by MRI findings

OBJECTIVE: To determine the clinical implications of atypical glandular cells of uncertain significance (AGCUS) in cervical cytologic smears. STUDY DESIGN: Retrospective analysis. RESULTS: Eighty-eight of 32,181 (0.27%) cervical smears obtained during the study period contained AGCUS. Of the 47 women with AGCUS, 16 had intraepithelial or invasive neoplasms (34%; 95% confidence interval, 21-49%), including 9 low or high grade squamous intraepithelial lesions, 1 adenocarcinoma in situ of the cervix, 3 adenocarcinomas of the cervix, 2 adenocarcinomas of the endometrium and 1 adenoid basal cell carcinoma of the cervix. CONCLUSION: The high prevalence of cervical and endometrial neoplasia among women with the isolated finding of AGCUS on cervical cytologic smears warrants a thorough diagnostic evaluation.     

The piloting of a group for the fathers of children with Down syndrome

Inflammatory lesions and cysts are by far the most common causes of swelling or enlargement of Bartholin's glands, and carcinomas, though rare, are the most frequent solid lesions that arise at this site. There have been very few reports of benign solid lesions of Bartholin's gland, and, among these lesions, the distinction between adenoma (AD) and hyperplasia has not been well defined. All cases diagnosed as either Bartholin's gland adenoma or hyperplasia in the Armed Forces Institute of Pathology files were reviewed. Using specific criteria, 17 qualified as nodular hyperplasia (NH), 1 as AD, and 1 as adenomyoma (AM). Five NHs, the AD, and the AM were studied with immunohistochemical stains for estrogen receptor (ER), progesterone receptor (PR), MIB-1, and p53. The average age of the patients with NH was 35 years (range, 19 to 56). These lesions were solid or solid and cystic, had a mean maximal dimension of 2.3 cm, and were frequently thought to be Bartholin's cysts on clinical examination. Microscopically, the NHs had an irregular or lobulated contour and were composed of a proliferation of cytologically bland mucinous acini with maintenance of the normal duct-to-acinar relationship. Varying degrees of inflammation and squamous metaplasia of the ducts were common in NH. The patient with the AD was 45 years old and the patient with AM was 65. Both were well-circumscribed, solid lesions, 2.2 and 2.5 cm in maximal dimension, respectively, and composed of a haphazard proliferation of acini and tubules. A small adenoid cystic carcinoma (ACC) arose from the periphery of the AD. p53 positivity was evident in up to 40% of the ACC cells; the cells in the adjacent AD were negative for p53. Only occasional cells were MIB-1 positive (< 5%) in some cases, and ER and PR were absent in the epithelial elements in all 7 cases tested but were focally present in the stromal cells of 3 of the 5 NHs and the fibromuscular stroma of the AM. The patient with the AM and the one with the AD are alive without evidence of recurrent or metastatic disease after 4 months and 19.8 years, respectively. NH, AD, and AM of the Bartholin's gland, as defined in this study, are extremely rare lesions. NH occurs in younger patients and is often associated with inflammation or obstruction of Bartholin's duct.     

Controlling Hamiltonian chaos

A 50-year-old woman underwent excision of a vaginal cyst. Its distal end lay in the submucosal tissue of the posterior lateral aspect of the vulvar vestibule near the orifice of Bartholin's gland. The caudal wall of the cyst contained a papilloma with an epithelial lining which consisted of columnar and stratified polygonal cells resembling squamous and transitional epithelium. The histochemical attributes of the papillary epithelium were homologous to those of Bartholin's gland. Immunohistochemical studies supported glandular and squamous differentiation. Evolution from a dysontogenetic remnant of Müllerian origin cannot be excluded with certainty, but location and histopathology were consistent with origin from Bartholin's gland duct. The presence of mucin and the absence of a smooth muscle investment exclude derivation from Gartner's duct. Cysts of Bartholin's gland are common, but solid benign tumors are rare. We have been unable to find a report of a papilloma of either vulva or vagina with features similar to those in our patient.     

Differential transforming growth factor-beta secretion in adenocarcinoma and squamous cell carcinoma of the uterine cervix

Tumor cells from eight freshly isolated cervical cancers (i.e., four adenocarcinomas and four squamous carcinomas) were analyzed for their production of the immune-inhibitory cytokine transforming growth factor-beta (TGF-beta) in vitro. All fresh adenocarcinomas secreted significant levels of TGF-beta (mean 397, range between 207 and 782 pg/ml/10(5) cells/48 hr). In contrast, no detectable TGF-beta was present in the supernatants from the four fresh squamous carcinoma cultures (P < 0.001). These data suggest that major differences in the secretion of the immunoinhibitory cytokine TGF-beta exist between squamous cell carcinomas and adenocarcinomas of the uterine cervix. Furthermore, these findings suggest that at least some of the differences in the natural biologic behavior, as well as in the response to radiation treatment, between these two histologic types of cervical cancer could be related to differences in secretion of this immune-inhibitory cytokine.     

Incidence, survival and mortality in cervical cancer in Norway, 1956-1990

Long-term trends in incidence, survival and mortality were examined in women with squamous cell carcinoma and adenocarcinoma of the uterine cervix, diagnosed in Norway in the 35-year period 1956-1990. During the 1970s the number of cervical smears increased substantially in Norway, although no organised screening programme was introduced. Special attention was paid to the time period 1971-1990 to evaluate the effect of the extensive spontaneous screening. In addition, the prognostic importance of clinical stage and age was explored. In the squamous cell carcinoma patients the incidence rate peaked in the time period 1971-1975, since when there has been a decrease. In the adenocarcinoma patients the incidence rate rose through the years 1976-1990. Also, the proportion of adenocarcinomas increased in this time period. The mortality rates in both histological types declined modestly through the years 1966-1990. A more favourable stage distribution was noted among the squamous cell carcinomas (P = 0.00), but not among the adenocarcinomas, when comparing the two diagnostic periods 1971-1975 and 1981-1985. The multivariate analysis (GLIM) revealed that stage was the most important prognostic factor in both histological types (P = 0.00). In the squamous cell carcinoma patients the relative rate increased (P = 0.04) in the last period. There was a tendency towards a poorer prognosis in younger women in this group, but age did not prove to be an important prognostic factor (P = 0.08).     

Papillary squamous cell carcinoma of the uterine cervix: report of a case with HPV 16 DNA and brief review

Papillary squamous cell carcinoma (PSCC) of the uterine cervix is a rare variant of squamous cell carcinoma (SCC). It is characterized by a papillary architecture and markedly atypical epithelium. Invasion and metastasis have been reported. We report a case of PSCC in a 72-year-old woman who subsequently tested positive for HPV 16. To our knowledge, this is the first report of HPV typing in a case of PSCC. Our finding of a high-risk HPV type in PSCC may help explain why PSCC has been reported to have a clinical course similar to that of nonpapillary SCC.     

Determination of DNA content in salivary gland tumors

BACKGROUND: DNA content determination is a useful tool in the characterization of different malignant tumors. AIM: To measure DNA content in cells of salivary gland tumors as adjunct to histological diagnosis, correlating morphologic and biological features of these tumors. MATERIAL AND METHODS: From the archives of the Pathology service of a general hospital, 21 salivary gland tumors, 15 pleomorphic adenomas, 3 mucoepidermoid carcinomas and 3 cystic adenoid carcinomas were selected. DNA content was determined in the histological samples using a flow cytometric DNA analysis. RESULTS: All pleomorphic adenomas had a normal or diploid DNA content. Fifty percent of malignant tumors had an aneuploid DNA content (1 mucoepidermoid carcinoma and 2 cystic adenoid carcinomas). CONCLUSIONS: DNA determination may help in the histological diagnosis of salivary gland tumors. The presence of aneuploidy suggests malignity.     

Antibody-targeted radio-chemotherapy of human primary liver cancer with radio-iodinated AFP monoclonal antibodies conjugated with mitomycin C: a preliminary clinical observation

Our study was carried out on 70 patients with invasive squamous carcinoma of the uterine cervix (CC) or invasive adenocarcinoma of the uterine cervix at all stages, admitted to the University Department of Gynecology and/or to the Institute of Oncology in Ljubljana. The patients were not selected by age. A questionnaire on known risk factors in CC was filled in for each of the 70 patients, and two tumor smears were taken for the determination of human papilloma viruses (HPV) 16 and 18 by means of in situ hybridization and polymerase chain reaction (PCR). Each patient also had the serum level of vitamin A determined. The results of our study revealed a correlation between HPV 16 or 18 infection (60:40) and CC. When analysing some already known risk factors, no statistically significant difference could be established for any of the factors studied, except for the age at first birth.     

Basal cell adenocarcinoma of the parotid gland: a rare tumor entity. Case report and review of the literature

Basal cell adenocarcinoma is a rare entity that was first defined as a malignant salivary gland tumor in 1991. We present another case report and discuss pathology, pathogenesis, differential diagnosis, therapy and prognosis on the basis of currently available literature. Although histomorphologic features of the tumors are similar to basal cell adenomas, proof of an infiltrative and destructive growth is essential for diagnosis. Adenoid cystic carcinoma and basaloid squamous carcinoma must also be considered in any differential diagnosis. Tumor development within a pre-existing basal cell adenoma and de novo development are discussed. Most of the tumors appear to be benign clinically. Facial pain is rare and facial nerve palsy was noted in only one case. Metastases have occurred in less than 10% of patients, with only one involving the lung. Due to their biologic behavior and prognosis, basal cell adenocarcinomas should be classified as low-grade carcinomas. The therapy of choice is parotidectomy with preservation of the facial nerve. Neck dissection has to be added in cases with cervical metastases. Radiation is advisable in patients with recurrent disease. Since there is a nearly 30% local recurrence rate, intensive follow-up is necessary.     

Diagnosis and prognosis of salivary gland tumors. An interpretation of new revised WHO classification

An exact morphological classification of salivary gland tumours is necessary for international comparison of clinical tumour studies. The basis is formed by the TNM system for determining tumour stage ("staging") and the WHO classification as the underlying principle of identifying the pathohistological tumour state and cellular tumour differentiation ("grading"). The second, revised edition of the WHO classification of salivary gland tumours differs from the first in that the exact definition of a considerably greater number of tumour entities is given and in the consideration of additional factors concerning prognosis and therapy. In the present interpretation of salivary gland tumours, not only are solitary tumour entities defined, but new findings are also considered concerning immunohistochemical tumour markers, proliferation markers (Ki-67 resp. MIB 1, AgNORs, PC-NA), oncogenes and cell receptors as well as cytogenetic alterations as prognostic factors. In particular the new tumour entities of adenomas (myoepithelial adenoma, basal cell adenoma, canalicular adenoma) and carcinomas (acinic cell carcinoma, mucoepidermoid carcinoma, polymorphous low-grade adenocarcinoma, salivary duct carcinoma, myoepithelial carcinoma) are characterized. In addition, the tumour-like lesions and differential diagnostic aspects are mentioned and a general review about new prognostic factors is presented.     

Fine needle aspiration of basal cell adenocarcinoma of the parotid gland. Report of a case with assessment of DNA ploidy in aspirates and tissue sections by image analysis

BACKGROUND: Basal cell adenocarcinoma of the parotid gland is a low grade malignant neoplasm. It has cytologic features of basal cell adenoma and a histologically infiltrative growth pattern of malignant tumors with perineural and vascular invasion. CASE: Fine needle aspiration biopsy findings of basal cell adenocarcinoma of the parotid gland in a 77-year-old male were supplemented by DNA ploidy analysis. CONCLUSION: No single cytologic feature was found to unequivocally distinguish this lesion from basal cell adenoma and/or solid variant of adenoid cystic carcinoma. Therefore, for diagnostic purposes, we grouped all three lesions under the term basal cell tumor. Evaluation of DNA content of tumor cells revealed diploid histograms in both cytologic material and paraffin-embedded tissue. Infiltrative tumor nests, the histologic basis for differentiating basal cell adenocarcinoma from adenoma, showed the same diploid pattern. Though DNA quantitation may not discriminate basal cell adenoma from basal cell adenocarcinoma, it may prove useful in separating them from adenoid cystic carcinoma, which is considered to be a tumor with high malignant potential.     

Genomic imprinting in the brain

Biopsies of cervix uteri from 166 patients with benign and malignant lesions (12 normal, 48 inflammatory lesion, 6 adenocarcinoma, 2 adenosquamous carcinoma and 98 from squamous cell carcinomas) were studied histochemically. The stains used were PAS with/without diastase, AB/PAS (pH 2.5) and OR/AB. In inflammatory lesions neutral mucin was predominent which was replaced by sialomucin and sulphomucin in endocervical polyps. In malignant lesions sulphomucin was predominent. Seventeen percent cases of squamous cell carcinomas needed reclassification after mucin staining. Of the fourteen large cell non-keratinizing squamous cell carcinomas, 12 were reclassified as squamous cell carcinoma with mucin secretion and 2 as adenosquamous carcinoma. One case of small cell non-keratinizing squamous cell carcinoma was reclassified as moderately differentiated adenocarcinoma. None of the keratinizing carcinomas had evidence of mucin secretion. Mucin histochemistry should be done routinely on non-keratinizing squamous cell carcinomas to pick up more cases of carcinoma with evidence of mucin secretion which can be missed on routine haematoxylin and eosin stains. Such carcinomas are known to pursue a more aggressive clinical course and have a poorer prognosis than non-mucin secreting type of squamous cell carcinoma.     

Adolescent obesity increases significantly in second and third generation U.S. immigrants: the National Longitudinal Study of Adolescent Health

PURPOSE: Our aim was to determine the precision of MR imaging evaluation of perineural spread of head and neck tumors. METHODS: Nineteen patients had complete extirpation of head and neck tumors (10 squamous cell carcinomas, four adenoid cystic carcinomas, one poorly differentiated carcinoma, one salivary duct carcinoma, one mucoepidermoid carcinoma, one chordoma, and one meningioma) with histologic confirmation of perineural spread. Findings at presurgical contrast-enhanced MR imaging were compared with findings at pathologic examination. RESULTS: The sensitivity of MR imaging for detection of perineural spread was 95%; however, the sensitivity for mapping the entire extent of perineural spread fell to 63%. CONCLUSION: MR imaging may fail to depict microscopic foci of perineural tumor infiltration, leading to underestimation of the extent of perineural spread. Nevertheless, with careful analysis of foraminal architecture and MR enhancement patterns, one can reliably identify the presence if not the extent of perineural spread.     

Small-cell neuroendocrine carcinoma of the uterine cervix associated with micro-invasive squamous cell carcinoma and adenocarcinoma in situ

A case of small-cell neuroendocrine carcinoma of the uterine cervix associated with squamous cell carcinoma and adenocarcinoma in situ is reported. The tumor consisted mainly of uniform small cells with a population of intermediate cells that resembled carcinoid tumor cells. Foci of micro-invasive squamous cell carcinoma and adenocarcinoma in situ were recognized separately, adjacent to the main tumor. Both Grimelius stain and immunostaining of serotonin were positive for small-cell and intermediate-cell carcinoma. Neurosecretory granules were demonstrated by electron microscopy. Microacini with positive mucin staining and microvilli-like structures suggested glandular or exocrine differentiation of the tumor. Three distinctive types of differentiation, neuroendocrine, exocrine and squamous characteristics, were expressed in the tumor.     

Expression of keratin 13, 14 and 19 in oral squamous cell carcinomas from Sudanese snuff dippers: lack of association with human papillomavirus infection

In stratified squamous epithelia, altered expression of keratins (Ks) is one possible marker of malignant potential. In the epithelium of the uterine cervix, presence of human papillomaviruses (HPVs) is increasingly regarded as a marker of risk for cervical cancer. However, a similar role in oral cancer and precancer remains controversial. To address these questions, formalin-fixed, paraffin-embedded oral carcinomas from Sudanese snuff dippers (n=14) and oral carcinomas from Sudanese (n=14), Swedish (n=19) and Norwegian (n=41) non-snuff dippers were examined by immunohistochemistry for expression of K types 13, 14 and 19 using monoclonal antibodies. HPV infection was searched for in all the carcinomas by in situ hybridization (ISH) using the cocktail HPV OmniProbe and the ViraType probe. Carcinomas from Sudanese (snuff dippers/non-snuff dippers) were also examined for HPV infection by polymerase chain reaction (PCR) using the general HPV primers GP5+/GP6+. For the oral carcinomas from snuff dippers, moderate to intense expression of K13 (71%; 10/14), K14 (86%; 12/14) and K19 (93%; 13/14) was found. For the oral carcinomas from non-snuff dippers, weak to moderate expression of K13 (64%; 47/74), K14 (43%; 32/74) and K19 (45%; 33/74) was found. HPV DNA was not detected in any of the carcinomas from three countries when examined by ISH. The Sudanese (from snuff dippers/non-snuff dippers) oral carcinomas were also negative for HPV DNA with the PCR. The present study shows that (i) there is a high level of expression of K13, K14 and K19 in oral carcinomas from snuff dippers compared to those from non-snuff dippers, (ii) this high level of expression may arise from dysregulation of keratinocyte proliferation and maturation caused by damaging effects of snuff, (iii) the HPV genome is not found in Sudanese (snuff dippers/non-snuff dippers), Swedish or Norwegian oral carcinomas, and (iv) this may suggest that these viruses do not play a prominent role in the aetiology of oral carcinomas from these countries.