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ABSTRACT: Difference in prognosis between grade 3 endometrioid carcinoma (G3EC) of the endometrium and uterine serous carcinoma (USC) is controversial. In this study, we further evaluated the difference in prognosis, if any, between G3EC (n = 61) and USC (n = 47) on a total of 565 patients with endometrial cancer. In addition, meta-analysis was performed using data from seven previous publications (n = 8,637) and from the Asan Medical Center (n = 108). Regarding the cases from our institution, USC tended to occur in older patients (≥65 years) than G3EC (P = 0.011). Deep myometrial invasion (more than or equal to half) was more frequently identified in G3EC (36/61, 59.0 %) than in USC (17/47, 36.2 %) (P = 0.021). Between patients with early stage G3EC and USC (stages I and II), there were no significant differences in any clinicopathological parameter, but there was a significant difference in overall survival (P = 0.017) that was not found in advanced stage (P = 0.588). USC was an independent prognostic factor for poor overall survival (hazard ratio, 6.125; P = 0.030) in early stage patients. In the meta-analysis on 5-year survival in patients with early stage cancers, which also included our study results, a higher relative risk (1.92, 95 % CI 1.62-2.27) was demonstrated in USC than in G3EC (P < 0.001). In conclusion, our study reveals that USC is associated with a poorer prognosis compared with G3EC, only in patients with early stage carcinoma, suggesting that different treatment strategies should be considered according to the histologic type in order to improve treatment outcome.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 03/2013; 462(3):289-96. · 2.49 Impact Factor
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Won-Dong Kim,
Hyun-Sook Chi,
Kang-Hyeon Choe,
Yeon-Mok Oh,
Sang-Do Lee, Kyu-Rae Kim,
Kwang-Ha Yoo,
David A Ngan,
W Mark Elliott,
Don D Sin,
James C Hogg
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ABSTRACT: BACKGROUND AND OBJECTIVE: CD8(+) cell infiltration and apoptosis of airway epithelial cells is increased in COPD. CD8(+) T cells induce apoptosis by releasing granzymes, which can also cause extracellular matrix degradation and remodeling. Granzyme B levels and T cells expressing granzyme B are increased in BAL fluid of COPD patients, which suggests that granzyme B may contribute to the pathogenesis of COPD. This study provides quantitation of granzyme B positive cells in relation to CD8(+) cells in the small airway walls of emphysema. METHODS: Antibodies against CD8 and granzyme B were used to identify CD8(+) and granzyme B(+) cells. Volume fraction (Vv) of CD8(+) and granzyme B(+) cells were quantitated by the point counting method in the small airways of 13 nonsmoker control subjects and 46 emphysema patients (14 panlobular (PLE) and 32 centrilobular (CLE) emphysema lungs). Immunohistochemical detection of macrophage scavenger receptor was also performed in randomly selected cases. RESULTS: The volume fraction of CD8(+) and granzyme B(+) cells in CLE were greater than those in control and PLE (both p<0.001) subjects. The volume fraction of granzyme B(+) cells was greater than that of CD8(+) cells (p=0.006) and not all CD8(+) cells were positive for granzyme B in CLE subjects. Monocytes expressing both granzyme B and macrophage scavenger receptor and granulocytes expressing granzyme B were identified. CONCLUSIONS: Up-regulation of granzyme B in CD8(+) and non-CD8(+) cells is an early phenomenon of small airway wall remodeling in centrilobular emphysema and suggests its possible role in the pathogenesis of COPD.
Respirology 02/2013; · 2.42 Impact Factor
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ABSTRACT: OBJECTIVE: To investigate potential therapeutic targets and prognostic markers for low-grade endometrial stromal sarcoma (LGESS). MATERIALS AND METHODS: Thirty-nine patients with LGESS were included in this study. Using tissue microarrays, the immunohistochemical expression levels of 5 therapeutic targets (epidermal growth factor receptor, human epidermal growth factor 2, vascular endothelial growth factor receptor, platelet-derived growth factor receptor [PDGFR], and c-kit) and 3 proteins involved in cell proliferation (p16, p53, and ki67) were investigated. The associations between these targets, markers, other clinicopathological factors, disease-free survival (DFS), and overall survival (OS) were analyzed. RESULTS: Epidermal growth factor receptor and human epidermal growth factor 2 were not expressed in these 39 patients. Vascular endothelial growth factor receptor, PDGFR, c-kit, p16, p53, and ki67 were expressed in 10 (25.6%), 28 (71.8%), 32 (82.1%), 18 (46.2%), 4 (10.3%), and 21 (53.8%) patients, respectively. The expression of each marker was not significantly associated with other clinicopathological factors. On multivariate analysis, p53 and ki67 were associated with significantly poorer DFS and OS. The 5-year DFS rates were 88%, 46%, and 0% for the p53(-)/ki67(-) group (n = 18), p53(-)/ki67(+) group (n = 17), and p53(+)/ki67(+) group (n = 4) (P = 0.002), respectively; the 5-year OS rates were 100%, 71%, and 0%, respectively (P < 0.001). The time to recurrence was longer (P = 0.123), and more patients had distant recurrence in the p53(+)/ki67(+) group (P = 0.063). CONCLUSIONS: In patients with LGESS, c-kit and PDGFR were expressed in higher portions of patients, suggesting that imatinib mesylate should be investigated as a potential targeting agent. Both p53 and ki67 demonstrated strong prognostic implications, suggesting that further evaluation using these markers is required.
International Journal of Gynecological Cancer 12/2012; · 1.65 Impact Factor
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Jeong-Yeol Park,
Dae-Yeon Kim,
Jong-Hyeok Kim,
Yong-Man Kim, Kyu-Rae Kim,
Young-Tak Kim,
Seok Ju Seong,
Tae-Jin Kim,
Jae Weon Kim,
Seok Mo Kim,
Duk-Soo Bae,
Joo-Hyun Nam
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ABSTRACT: OBJECTIVE: To analyse the long-term oncologic outcomes of a fertility-sparing management using oral progestin in young women with endometrial cancer. METHODS: We analysed 148 patients (age⩽40years) with stage IA, grade 1, endometrioid adenocarcinoma of the uterus who underwent fertility-sparing management using daily oral medroxyprogesterone acetate (MPA) or megestrol acetate (MA). RESULTS: 115 (77.7%) showed complete response (CR) to progestin treatment, and 35 (30.4%) of them experienced recurrence after median follow-up time of 66months. The 5-year recurrence-free survival was 68% (95% confidence interval [CI], 58.5-76.9%). However, 33 patients (22.3%) who failed to achieve CR underwent definitive surgical management, and no one had recurrence after median follow-up time of 41months. During progestin treatment and at the time of recurrence, no patient showed clinical progression of disease over stage IA. Body mass index (BMI) ⩾25kg/m(2) was the only significant factor associated with a failure to achieve CR (odds ratio [OR], 3.00; 95% CI, 1.35-6.66; P=0.007). Upon multivariate analysis, BMI⩾25kg/m(2) (OR, 2.14; 95% CI, 1.06-4.31; P=0.033) was significantly associated with a higher risk of recurrence and the use of MPA (compared to MA) (OR, 0.44; 95% CI, 0.22-0.88; P=0.021), maintenance treatment (OR, 0.22; 95% CI, 0.05-0.94; P=0.042) and pregnancy (OR, 0.25; 95% CI, 0.11-0.56; P=0.001) were significantly associated with a lower risk of recurrence. CONCLUSION: Fertility-sparing management was highly effective and safe. BMI<25kg/m(2), MPA (compared to MA), maintenance treatment and pregnancy were associated with higher possibility of long-term success.
European journal of cancer (Oxford, England: 1990) 10/2012; · 4.12 Impact Factor
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ABSTRACT: Fibroepithelial stromal polyp (FSP) is a benign lesion that can occur at various sites, including the lower female genital tract. In rare cases, however, it may exhibit hypercellularity, bizarre cytomorphological features, and atypical mitoses resulting in an overdiagnosis as a malignant tumor despite its benign clinical course. Recently, we experienced one case of a 30-year-old pregnant woman with cellular pseudosarcomatous FSP that was initially diagnosed as a malignant fibrous histiocytoma at a primary clinic. In addition to describing the rare features of this case, we wish to increase awareness about this benign lesion which will be essential for avoiding unnecessary radical surgery or chemoradiation treatment.
Korean journal of pathology. 10/2012; 46(5):494-8.
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ABSTRACT: Mucinous adenocarcinoma is an uncommon type of endometrial adenocarcinoma for which precursor lesions have yet to be clarified. During a review of noncancerous endometrial lesions in postmenopausal women, we found that mucinous endometrial glands showed variable degrees of epithelial changes that ranged from the formation of simple tubular glands to the formation of complex glands with papillary tufts, and some of the glands with papillary tufts were architecturally similar to low-grade mucinous adenocarcinomas. Based on histological similarities, we have postulated that mucinous metaplasia could be a precursor lesion of mucinous adenocarcinoma. To explain the pathogenetic significance of endometrial mucinous metaplasia, we analyzed the immunohistochemical expression of ER, PR, MKI67, PTEN, β-catenin, P16(INK4A), TP53, and PAX2 in 21 endometrial mucinous metaplasias, screened for KRAS (n=16) and PTEN (n=14) mutations, and compared expression patterns between samples with simple mucinous glands, those with complex glands having intraglandular papillary tufts, and endometrioid adenocarcinomas. Compared with the surrounding flat mucinous epithelium and simple mucinous metaplasia, the intraglandular papillary tufts associated with papillary mucinous metaplasia were characterized by selectively decreased expression of PAX2 (P=0.029) and PR (P<0.001), and overexpression of P16(INK4A) (P=0.014). There were no significant differences in the levels of expression of ER, PTEN, β-catenin, TP53, and MKI67 between the two groups. In contrast with endometrioid adenocarcinomas, rates of MKI67 proliferation were very low in both groups. Mutations in KRAS were identified in 89% of cases with papillary mucinous metaplasia, in contrast to 14% in simple mucinous metaplasia (P=0.001). No PTEN mutations were observed in either of the two groups. In conclusions, immunohistochemical and molecular genetic profiling suggest that papillary mucinous metaplasia is a possible precancerous lesion in a subset of endometrial carcinomas.Modern Pathology advance online publication, 6 July 2012; doi:10.1038/modpathol.2012.113.
Modern Pathology 07/2012; · 4.79 Impact Factor
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Pathology International 05/2012; 62(5):363-5. · 1.62 Impact Factor
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ABSTRACT: Wilms' tumor is one of the most frequent malignant neoplasms in childhood. Advances in treatment modalities such as the combination of chemoradiation therapy with surgery have enhanced overall survival. However, recurrence of Wilms' tumor is still a problem. In this case, a 28-year-old female had experienced intermittent abdominal pain, and the computed tomography scan showed a huge pelvic mass. The patient had a history of radical nephrectomy for Wilms' tumor with concurrent chemotherapy at the age of three. The pelvic mass was resected in February 2010 and was confirmed to be a recurrent Wilms' tumor. The recurrent tumor showed a classic triphasic Wilms' tumor growth pattern with frequent mitoses and tumor necrosis. Our case is an extraordinary case of a long-delayed recurrent Wilms' tumor after 25 years, which is the longest disease-free interval ever reported. The possible effects of chemotherapy as well as some other mechanisms of this late relapse are discussed.
Korean journal of urology 04/2012; 53(4):288-92.
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ABSTRACT: To analyze the role of surgical staging and adjuvant chemotherapy in patients with adult type granulosa cell tumor (GCT) of the ovary.
Patients were divided into those with early-stage (stages I-II, n=93) and advanced-stage (stages III-IV, n=13) GCT and analyzed separately in this retrospective study.
Of the 93 patients with early-stage GCT, 30 were completely staged and 25 underwent lymph node dissection. After surgery, 17 patients received adjuvant chemotherapy with bleomycin/etoposide/cisplatin (BEP). None had lymph node metastasis. Completely staged patients had no recurrence or deaths. However, recurrences were observed in 9 of 63 patients (14.3%) who did not undergo complete staging, with four (6.3%) dying due to disease. The 5-year disease-free survival (DFS) rates of groups with and without complete staging were 100% and 84%, respectively (P=0.037). Adjuvant chemotherapy was not significantly associated with DFS (P=0.193). All patients with advanced-stage GCT underwent optimal cytoreduction and received adjuvant chemotherapy with BEP. None of the 6 patients who completed 6 cycles of BEP had recurrence, whereas 5 of the 7 patients (71.4%) who received fewer than 6 cycles of BEP had recurrences and 3 (42.9%) died due to disease. The 5-year DFS rates of these two groups were 100% and 50%, respectively (P=0.022), with cycles of chemotherapy being the only significant factor for DFS in patients with advanced-stage GCT.
Complete surgical staging is recommended, but lymph node removal is not recommended for early-stage GCT. Optimal debulking followed by six cycles of BEP chemotherapy is recommended for advanced-stage GCT.
Gynecologic Oncology 12/2011; 125(1):80-6. · 3.89 Impact Factor
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ABSTRACT: Histological assessment of parametrial invasion in uterine cervical cancer is often subjective due to the parametrium being a loosely defined structure without apparent definitive landmarks. This study defines a precise and consistent histological landmark for the parametrium.
Based on study of cervico-parametrial junctions in 22 type III radical hysterectomy specimens from FIGO stage IB/IIA patients, three candidate histological landmarks were tested for ease in determination and reliability in 66 hysterectomy specimens with FIGO stage IIB tumors. The candidate landmarks were abrupt narrowing point of vascular branches, adipose/loose connective tissue of parametrium, and presence of a distinct smooth muscle layer in the outermost cervical wall.
All uteri had a distinct smooth muscle layer in outermost cervical wall. The layer was compact, circumferential, and continuous with the corpus above and vagina below. It clearly distinguished parametrium from cervical wall, especially when the Masson trichrome stain was used which differentiated fibrous tissue from smooth muscle. Smooth muscle bundles are also present in the parametrium, but course perpendicularly or diagonally to the cervical wall, clearly distinguishable from the circular smooth muscle in the outer wall. With clear histological criteria, concordance rates among three pathologists rose from 55% to 98%.
Clear histological criteria together with the use of Masson trichrome stains to distinguish smooth muscle from fibrous tissue improved concordance rates in identifying parametrial invasion by tumor to near 100%.
Gynecologic Oncology 11/2011; 124(3):502-7. · 3.89 Impact Factor
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ABSTRACT: To evaluate the clinical and prognostic impact of micropapillary pattern in patients with serous borderline ovarian tumors (SBOT).
We retrospectively assessed 130 consecutive patients with typical (n=97, 74.6%) or micropapillary (n=33, 25.4%) SBOT. Clinicopathologic factors and outcomes were compared between these two groups.
There were no significant between-group differences in age, menopausal status, parity, body mass index, cancer antigen 125 concentration, tumor size, tumor rupture, positive cytology, ovarian surface involvement, retrieved lymph nodes, use of laparoscopy, fertility-sparing and ovary-sparing procedures, complete staging and restaging, and adjuvant chemotherapy. However, the incidences of advanced stage (II-III) tumors (10.3% vs 36.4%, P=0.001), microinvasion (2.1% vs 15.2%, P=0.012), peritoneal implants (8.3% vs 33.4%, P<0.001), and lymph node involvement (0% vs 21.2%, P<0.001) were significantly higher in patients with micropapillary than with typical SBOT. Five patients with typical (5.2%) and three with micropapillary (9.1%) SBOT had recurrent disease (P=0.418), and one patient (3%) in micropapillary SBOT group died due to the disease (P=0.254). The 5-year disease-free survival (DFS) rates for patients with typical and micropapillary SBOT were 96% and 86%, respectively (P=0.148). All three patients with micropapillary SBOT who had recurrence had peritoneal implants (one noninvasive and two invasive). Multivariate analysis showed that peritoneal implant was the only significant factor related to DFS (P=0.002).
Because micropapillary SBOT was significantly associated with peritoneal implants, especially invasive implants, and lymph node involvement, complete staging procedures, including lymph node dissection, are recommended. However, micropapillary SBOT itself was not significantly associated with DFS. Peritoneal implant was the only factor independently associated with tumor recurrence.
Gynecologic Oncology 09/2011; 123(3):511-6. · 3.89 Impact Factor
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Pathology International 07/2011; 61(7):445-8. · 1.62 Impact Factor
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ABSTRACT: The purpose of this study was to assess clinical outcomes with respect to the extent of stromal invasion in patients with stage I ovarian mucinous adenocarcinoma (MAC) of the intestinal type.
We retrospectively reviewed the medical records and pathologic slides of 113 patients with stage I ovarian MACs who were treated at the Asan Medical Center from January 1994 to July 2009. According to the recent histopathologic criteria, MACs were classified into 3 groups: intraepithelial carcinoma without invasion (IEC), intraepithelial carcinoma with microinvasion (IECMI), and mucinous adenocarcinoma with extensive invasion (MACEI). Stromal invasion was confined to the tumors showing severe cytologic atypia in the invasive foci. Therefore, cases showing mucin granulomas composed only of macrophages without malignant cells were excluded from the definition of invasion.
Of the 113 patients, 54 (47.8%) had IEC, 15 (13.3%) had IECMI, and 44 (38.9%) had MACEI. There were no differences among groups in age, menopausal status, CA-125 level, surgical procedures, stage, capsular and lymphovascular space invasion. The 5-year disease-free-survival rates in the IEC, IECMI, and MACEI groups were 97.7%, 77.3%, and 79.9%, respectively (IEC vs IECMI, P=0.004; IEC vs MACEI, P=0.012; IECMI vs MACEI, P=0.555). Prognosis was significantly poorer for patients with IECMI than for those with IEC, but not different between patients with IECMI and MACEI.
Stromal microinvasion in ovarian MAC is a significant prognostic factor. Therefore, diligent search for "stromal microinvasion" with adequate sampling of tumor tissue are important at the time of histopathologic diagnosis, and patients with IECMI should no longer be treated identically to those with IEC.
Annals of Surgical Oncology 05/2011; 18(12):3462-8. · 4.17 Impact Factor
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ABSTRACT: Primary extragonadal germ cell tumors are rare and mostly occur in young men with predominance of nonseminomatous histology. We report an undescribed case of primary retroperitoneal dysgerminoma presenting as an adrenal tumor in a 17-year-old girl. Surgery was performed on a 10 × 9.5 cm sized adrenal gland tumor and the resected tumor showed unequivocal histological features of dysgerminoma. The diagnosis was confirmed by the tumor's germ cell immunophenotype. Postoperative ultrasonography, CT and PET over a 6-month period revealed no evidence of ovarian lesion. The patient is stable, but with a suspicious residual tumor after adjuvant chemotherapy.
Pathology International 04/2011; 61(4):248-51. · 1.62 Impact Factor
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ABSTRACT: Terahertz (THz) spectroscopic imaging technique was applied to classify the tumor region in the rabbit liver with VX2 hepatocellular carcinoma. Within the measurement range of 0.1–2 THz, the average reflectance values for all tumor samples were more than 4% higher than those for healthy cells, and the terahertz measurements correlated well with histological analysis results. This study on paraffin-embedded tissues showed the alteration of cell density and protein content in tumors, excluding the effect of water.
Journal of Applied Physics 04/2011; · 2.17 Impact Factor
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ABSTRACT: Clinicopathological aspects of the endocervical-like mucinous borderline tumour of the ovary (EMBT), including higher frequencies of bilaterality, endometriosis and hormone receptor reactivity, and often admixtures of various Müllerian-type epithelia, closely resembles endometrioid tumour more than mucinous borderline tumour of the intestinal type (IMBT). Thus, the aims of this study were to determine whether EMBT is really a subtype of mucinous borderline tumours, as shown in the current classification system, and to determine the best classification for EMBT.
The clinicopathological and immunohistochemical features of 17 EMBTs were analysed, including oestrogen receptor (ER), progesterone receptor (PR), PTEN, cytokeratins (CK) 7 and 20, and β-catenin. Additionally, mutational analyses of the KRAS (exon 1) and PTEN genes (all nine exons) were performed in all cases, and the results were compared with literature findings for IMBT and endometrioid tumours. Twelve patients (71%) were confirmed histologically to have endometriosis in one or both ovaries. In seven cases, gradual transitions from endometriotic foci to the EMBT were identified. Immunohistochemically, all cases were reactive for ER and PR, with no nuclear expression of β-catenin. CK7 positivity was strong in all patients, whereas there was no reactivity for CK20. PTEN reactivity was diffuse in the nuclei of epithelial and underlying stromal cells. Sixty-nine per cent showed KRAS mutations in exon 1 and codon 12, but no PTEN mutation was identified in any of the nine exons.
Our study suggests that EMBT has features of both mucinous and endometrioid tumours and is an additional tumour type arising in endometriosis. While clinicopathological features of EMBTs are closer to endometrioid tumours, they still have molecular characteristics closer to IMBTs.
Histopathology 10/2010; 57(4):587-96. · 3.08 Impact Factor
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ABSTRACT: Carcinomas of müllerian origin involving colorectum in women with no concurrent or history of gynecologic malignancies are diagnostically challenging, and its histogenetic origin is uncertain. We reviewed 13 cases of carcinoma of müllerian origin with clinical presentation mimicking primary colorectal carcinoma. The patients' average age was 63.9 years. All except 2 patients presented with mass lesions in rectosigmoid colon or rectovaginal septum. The major presenting symptoms were rectal bleeding (4/13), rectosigmoid mass (6/13), vaginal mass (1/13), and abdominal pain or constipation (2/13). The average size of tumor was 4.2 cm (range, 2.4-15.0 cm). Among the 10 patients who underwent preoperative biopsy, 5 were diagnosed to have moderately and poorly differentiated colorectal carcinoma. All tumors were surgically resected with final diagnoses of moderately differentiated endometrioid carcinoma in 6 cases, mixed serous and endometrioid carcinoma in 4 cases, malignant mixed müllerian tumor in 2 cases, and undifferentiated carcinoma in 1 case. In 9 of 13 cases, foci of endometriosis were identified adjacent to or within the tumor. One case had endosalpingiosis. Immunohistochemical stains showed, after positive results, the following: cytokeratin 7 (CK7; 13/13), estrogen receptor (13/13), progesterone receptor (10/13), cytokeratin 20 (CK20; 0/13), and CDX-2 (0/13). In conclusion, carcinoma of müllerian origin often presents as bulky mass in rectosigmoid or rectovaginal septum clinically mimicking primary colorectal cancer. Endometriosis might be an important etiologic factor. Familiarities of this unusual clinicopathologic entity, careful morphologic evaluation, and immunohistochemical stain with a panel of markers (CK7, CK20, estrogen receptor, progesterone receptor, CDX-2) will be helpful for the correct diagnosis.
Annals of diagnostic pathology 10/2010; 15(1):12-8.
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ABSTRACT: This study was a matched case-control study to analyze the clinical and pathological characteristics and the prognosis of patients with small cell neuroendocrine carcinoma in the uterine cervix.
Thirty-two patients were treated for small cell neuroendocrine carcinoma of the cervix (SCNEC) at Asan Medical Center between January 1996 and June 2008. For a 1-to-2 matched case-control study, 64 patients with squamous cell carcinoma of the cervix (SCC) whose clinical stage and age are consistent with the SCNEC group were selected. Medical records were retrospectively reviewed to analyze and compare the clinical and pathological outcomes.
In the SCNEC group, the median age was 45 years, and early stage (stage IIA or below) was 75.0%. The postoperative adjuvant therapy was given more frequently in the SCNEC group. The recurrence rate was 59.4%, and lung, bone, and liver were common sites in the SCNEC group. Parametrial involvement and lymphovascular space invasion were risk factors in the SCNEC group, whereas lymph node metastasis is the risk factor in the SCC group. The progression-free survival and overall survival were significantly shorter in the SCNEC group than in the SCC group (16.9 and 30.6 months vs 47.7 and 49.1 months, P < 0.05). Interestingly, survival outcomes in the early stage of SCNEC were remarkably worse than those of SCC and almost identical to those of the advanced stage of SCNEC.
We confirmed the unfavorable prognosis related to hematogenous metastasis in SCNEC. The treatment modality of early-stage SCNEC, which is radical hysterectomy followed by adjuvant therapy, needs to be reevaluated.
International Journal of Gynecological Cancer 04/2010; 20(3):411-6. · 1.65 Impact Factor
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ABSTRACT: Teratoid Wilms' tumor is an unusual morphological entity characterized by a classic triphasic malignancy with predominantly heterologous tissue. The authors describe two cases of teratoid Wilms' tumor with an extrarenal site: one in a 13-year-old girl with vaginal spotting (patient 1) and another in a 1-day-old girl with a sacrococcygeal mass (patient 2). The tumors were located in the vagina and coccyx, respectively. Under the initial clinical diagnosis of sarcoma botryoides in patient 1 and teratoma in patient 2, the masses were removed. Microscopically, both tumors were composed of typical triphasic Wilms' tumor tissue with primitive cartilage and skeletal muscle, and squamous and columnar mucinous epithelia. The patient with sacrococcygeal mass (patient 2) had an elevated serum AFP level. The patients were given chemotherapy and have now remained disease free for 7 years 1 month, and 2 years 5 months after surgery, respectively. Familiarity with this rare variant of Wilms' tumor might be important in arriving at a correct diagnosis.
Pathology International 01/2010; 60(1):35-41. · 1.62 Impact Factor
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ABSTRACT: This study evaluated the reliability of magnetic resonance imaging (MRI) in assessing the absence of myometrial invasion in endometrial carcinoma patients, to identify candidates for conservative hormonal treatment.
A total of 301 endometrial carcinoma patients who showed Stage I findings on preoperative MRI, and had received staging operations were reviewed retrospectively. We compared MRI findings of myometrial invasion with myometrial invasion levels reported by pathologists when surgical specimens were examined.
A descriptive study.
Tertiary care gynecologic oncology clinic, Seoul, Korea.
A total of 301 endometrial carcinoma patients who showed Stage I findings on preoperative MRI, and had received staging operations.
We compared MRI findings of myometrial invasion with myometrial invasion levels reported by pathologists when surgical specimens were examined.
Of 301 patients, 17 showed higher stages (FIGO Stages IIA through IIIC) on the final pathology of surgical specimen. Among the 284 patients with Stage I on histology reports, 124 showed no myometrial invasion on preoperative MRI (FIGO Stage IA). The negative predictive value (probability of absence of myometrial invasion) was 49.2%. MRI showed an accuracy of 59.2%, a sensitivity of 68.8%, a specificity of 74.4%, and an 86.9% positive predictive value, for myometrial invasion.
MRI had a rather weak predictive value when used to assess absence of myometrial invasion. This should be borne in mind when choosing patients for conservative treatment of endometrial carcinoma.
Acta Obstetricia Et Gynecologica Scandinavica 08/2009; 88(9):990-3. · 1.77 Impact Factor
