Mark Heatley

• St. James University

AimsTo report a previously undescribed phenomenon of incidentally detected microscopic proliferations of sex cord cells, often mimicking adult granulosa cell tumour or sex cord tumour with annular tubules, in extraovarian locations. Methods and resultsThe six cases were in patients aged 23-58years. The proliferations were located in the fallopian t...

This systematic review assesses the accuracy of the frozen section classification of benign and borderline lesions or invasive carcinoma when compared with the final diagnosis on paraffin section. A Pubmed database search identified 18 retrospective cohort studies, published since 2005 that satisfied the criteria, on the critical appraisal sheet of...

A persistent problem in gynaecological differential diagnosis is the differentiation of primary ovarian mucinous carcinoma from metastatic disease either in the ovary or disseminated throughout the abdomen and pelvis from extragenital organs. Traditionally, there has been a tendency to vary treatment depending on a perception of origin in the ovary...

Subspecialisation in histopathology was anticipated to improve the quality of reporting, teaching and communication with the clinical team. Although there is little information available, there is a suggestion that subspecialised services are more expensive than services provided by general departments but are speedier, although even this improveme...

This audit was carried out to develop the criteria recommended in various guidelines to establish if a punch biopsy of the cervix is adequate, and to determine if these are met in sufficient proportions of patients. A total of 100 patients who had cervical punch biopsies followed by large loop excision of the transformation zone (LLETZ) specimens w...

To establish the prognosis associated with female adnexal tumour of probable wolffian origin (FATWO) and determine the frequency with which it behaves as a truly benign lesion. Medline and Embase electronic databases were interrogated to identify 31 papers describing 63 patients with FATWO with follow up. Fifty (79%, CI 67.4-87.3%) were alive and w...

A study to compare the immunohistochemical profile of the human rete ovarii, and epoophoron, with the Fallopian tube and ovarian surface epithelium was performed with 31 antibodies and antisera. A reaction was present in the epithelial cytoplasm of the rete ovarii and epoophoron of mesonephric origin, for vimentin, GFAP, cytokeratin markers, (AE1/A...

This study was carried out to establish whether the macroscopic/gross dimensions of a cone biopsy or large loop excision of the transformation zone specimen (LLETZ) were a reliable reflection of the microscopic measurements and whether any of these dimensions could be used to reliably predict whether the deep lateral stromal margin of the specimen...

The aim of this article is to provide as comprehensive a review as possible of the techniques in use in dissecting and sampling the major specimens encountered in gynaecological practice, whether these have originated from gynaecological oncologists or from gynaecologists who specialise in non-malignant conditions. A brief description of relevant h...

To compare the relative risk of antigen expression being detected immunohistochemically in ovarian and gastric carcinoma aggregated from studies performed for diagnostic purposes, with the relative risks of their expression in all patients in the English literature. Both types of series indicated that cytokeratin (CK) 7 expression was greater and t...

To establish whether a period of fixation in formalin before incision reduced distortion of intact uterine specimens. A record was kept of the period between placing the intact specimen in formalin and incising the uterine corpus for 98 hysterectomy specimens. After fixation and at the time of cut up, the size of any gap that developed in the anter...

The objective of this study was to assess the adequacy of network cancer guidelines paying particular attention to referral criteria, referral routes, tumor diagnosis, staging, and suggested management and care pathways for ovarian and endometrial cancer. Guidelines from 15 regions in England and Wales were analyzed quantitatively and qualitatively...

The objective of this study was to assess the adequacy of network cancer guidelines paying particular attention to referral criteria, referral routes, tumor diagnosis, staging, and suggested management and care pathways for ovarian and endometrial cancer. Guidelines from 15 regions in England and Wales were analyzed quantitatively and qualitatively...

Although described originally as the sine qua non for endometriosis, plasma cells have been identified in the endometrium in a variety of other situations. This study of patients who did and did not have plasma cells in their endometrium was carried out to establish the association between the clinical presentations and a variety of pathological ch...

The pathological characteristics included in the current FIGO criteria as being of prognostic significance in vulval carcinoma were compared for 62 women aged over and under 65 years. Older women were more likely to have high-grade carcinoma, large tumours and tumours of higher stage than the younger women, although all the cases had infiltrated mo...

To establish the validity of assuming that by examining midline blocks from the anterior and posterior lips of the cervix, a previously unsuspected cervical intraepithelial glandular neoplasia (CIGN) lesion would be identified. The distribution of CIGN in 30 cone biopsy specimens of cervix was examined. Nine low grade and 21 high grade cases were i...

To establish the value of vimentin expression in predicting survival in patients with breast cancer. Five-year follow-up data were obtained for 68 patients with ductal carcinoma (NOS) of the breast in whom vimentin expression had been studied in fresh frozen and formalin-fixed, paraffin-embedded tissue. The predictive value on survival of tumour si...

How should we grade CIN? The grading of cervical intraepithelial neoplasia (CIN) is problematic. CIN represents a morphological continuum, but biopsies displaying this lesion are classified into two (e.g. Bethesda) or three grade categories, sometimes with poor reproducibility. There are also difficulties in reliably distinguishing low-grade CIN fr...

The frequency with which residual carcinoma was encountered in 33 simple hysterectomy and 52 radical hysterectomy specimens from women who had squamous cell carcinoma (67), adenocarcinoma (8), adenosquamous carcinoma (3) and other tumours (7) of the cervix was studied. Predicted pathological stage was IaI (32 cases), IaII (10), Ib (16) and IIa tumo...

The case of a 34-year-old woman who had a radical hysterectomy for stage 1 b squamous cell carcinoma of the cervix and in whom an epithelial polyp was identified in the left fallopian tube is presented. The case is unusual in that the polyp developed in the absence of any evidence of tubal damage as demonstrated by a history of endometriosis or tub...

The prevalence of chlamydial DNA determined by PCR and in-situ hybridisation (ISH) in fresh tissue specimens (endometrium, fallopian tube and ovary) was investigated in 33 women presenting with ectopic pregnancy (EP), 14 women with tubal factor infertility (TFI) and 50 control patients from the UK and the West Indies. In the UK EP group, chlamydial...

To establish the value of examining additional histological levels in cone biopsy and large loop excision of the transformation zone (LLETZ) specimens of cervix. Three deeper levels were examined from 200 consecutive cone biopsy and LLETZ specimens reported by a single pathologist. Examination of the first deeper level resulted in cervical intraepi...

The term epithelial changes of uncertain significance (ECUS) describes a minor degree of nuclear pleomorphism limited to the basal layers of cervical epithelium in the absence of severe inflammation with associated normal mitoses, koilocytosis, or koilocytosis associated features. This study aimed to investigate the long term prognosis of this lesi...

A 73 year old woman presented with a right sided adnexal cystic mass. At laparotomy, this proved to be a benign serous ovarian cyst and an aggregation of thin walled subserosal and soft tissue cysts and spongy nodules up to 16 mm in diameter involving the side wall of the uterus and adjacent parametrium. These were removed by total abdominal hyster...

Renal clear cell carcinoma rarely metastasizes to the ovary potentially mimicking a primary ovarian clear cell carcinoma. The immunocytochemical profiles of the two tumors were compared. Control groups of ovarian endometrioid and serous adenocarcinomas were also examined using the same antibody panel. Paraffin sections were studied with the immunoc...

To investigate the necessity of examining the entire cervix in hysterectomy specimens from women with a previous history of cervical intraepithelial neoplasia (CIN) or dyskaryosis. The overall frequency with which squamous CIN was encountered in hysterectomy specimens of women with a previous diagnosis of squamous CIN or dyskaryosis was calculated...

I should again like to congratulate Dr Al-Nafussi and her colleagues for providing us with an interesting and stimulating paper1 and to take the opportunity to add some comments of my own. Following earlier correspondence in the journal,2,3 I have sought to develop a system of standardised phrases that are used in reporting the features listed in t...

We compared the immunohistochemical profiles of the rete ovarii and endometriosis in order to identify a panel which distinguishes between these structures. The immune profiles of the epoophoron, Fallopian tube and ovarian surface epithelium were also studied. Twenty-four women with no evidence of endometriosis and seven who had endometriosis in th...

Systematic reviews and meta-analyses are techniques of data retrieval and analysis which complement traditional narrative reviews. They are widely used in clinical medicine and are finding an increasing role in anatomical pathology. Performing high quality systematic review and meta-analysis requires the accumulation of large numbers of cases from...

A study to compare the immunohistochemical profile of the human rete ovarii, and epoophoron, with the Fallopian tube and ovarian surface epithelium was performed with 31 antibodies and antisera. A reaction was present in the epithelial cytoplasm of the rete ovarii and epoophoron of mesonephric origin, for vimentin, GFAP, cytokeratin markers, (AE1/A...

A previous study1 that compared different methods of orienting cervical biopsies has been extended to determine the optimal method of mounting the sections, cut from these biopsies, on the slide to ensure that they are clearly visible for histological examination under the coverslip. In this department six levels have traditionally been cut from e...

To determine the proportion of women with abnormalities in cervical smears corresponding to borderline nuclear change, as defined by national guidelines, which return to normal or persist as cytological or histological abnormalities. 313 women with borderline nuclear change diagnosed by a single pathologist using the national criteria were followed...

Full textFull text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (203K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. 789 Selected References These references are in PubMed. This may not be the complete lis...

Although several genetic abnormalities are known to occur in endometrial cancer, including tp53 gene mutation, the pathogenesis of this common malignancy remains poorly defined. We investigated the relationship between overexpression of p53 protein, p21 protein expression and apoptosis in endometrial carcinoma. Sixteen cases of endometrial carcinom...

Significant epithelial proliferation is identified more frequently in the fallopian tube in patients with ovarian tumours than in control patients. More extensive sampling of the fallopian tube is also associated with a more frequent identification of epithelial proliferation. We compared cellular proliferation at either end of the fallopian tube a...

To examine proliferative activity using the Ki-67 protein, oestrogen receptor protein, and progesterone receptor protein expression in the rete ovarii, and to make comparisons with their expression in endometriosis. Immunohistochemistry was used to study the rete ovarii in 24 cases and endometriosis in seven cases, using antibodies to Ki-67 protein...

To compare methods of orienting cervical punch biopsies, since well oriented biopsies are needed to optimise the diagnosis and grading of cervical intraepithelial neoplasia. The orientation, the presence and preservation of the squamocolumnar junction, and the presence or absence of the surface layers of the squamous epithelium were compared in 345...

Meta-analysis, though increasingly popular in clinical medicine, has not found acceptance in anatomic pathology. This paper argues that, in combination with a systematic review of the literature, meta-analysis may be usefully applied to pathological research and two examples drawn from gynaecological pathology (the value of nuclear DNA quantitation...

To investigate the mutational status of the p53 gene (Tp53) in endometrial carcinomas expressing p53 protein by direct gene sequencing. Eighteen cases of endometrial carcinoma, selected on the basis of p53 protein expression as detected immunohistochemically by the monoclonal antibody DO7, were microdissected in the p53 positive areas. DNA was extr...

In order to determine whether a single representative section taken from routine specimens of products of conception would contain sufficient material to trigger a more comprehensive search for the features of a hydatidiform mole, cases of gestational trophoblastic disease submitted over a five year period were reviewed. Partial hydatidiform moles...

In this prospective study, we examined the possible diagnostic value of the measurement of two endometrial proteins, placental protein-14 (PP14) and CA-125, in the evaluation of pre- and post-menopausal bleeding. Concentrations of these two proteins were measured in plasma and uterine flushings obtained from 139 pre- and post-menopausal women with...

HEATLEY M. K. AND BURY J. P. (1998) Cytopathology 9 , 93–99 The correlation between the grade of dyskaryosis on cervical smear, grade of cervical intraepithelial neoplasia (CIN) on punch biopsy and the final histological diagnosis on cone biopsies of the cervix This study was carried out to assess how reliably a punch biopsy of the cervix predicts...

Heatley MK, Corke K. Integrin expression in cervical carcinoma. Int J Gynecol Cancer 1998; 8: 203–206. Integrin expression was studied in a series of 36 cervical carcinomas using antibodies to integrins αvβ5, α3, β1 and β4. Integrins αvβ5, α3 and β1 were localized to the cell membrane in well differentiated (0/13, 2/4 and 4/14 cases) and moderately...

Markers of cellular proliferation have been widely applied in cervical disease and include techniques which are applicable to routinely processed tissue including standard hematoxylin and eosin sections, and sections labelled with antibodies to Ki-67 and PCNA proteins. Flow cytometry and in vivo techniques including labelling with Bromodeoxyuridine...

Heatley MK, Cork K. Involucrin and cytokeratin intermediate filament protein expression in cervical carcinoma. Int J Gynecol Cancer 1998;8: 37-40. The expression of involucrin and cytokeratin (CK) 10/13, both markers of terminal squamous differentiation, CK14 and simple CK expression was studied in forty invasive cervical carcinomas. An intense rea...

A study was carried out to determine the apoptotic index (AI) in cases of endometrial adenocarcinoma that are usually associated with a poor prognosis, and to identify if the AI in these cases differs from the Al’s in grade I and II endometrial adenocarcinoma. The apoptotic index (defined as the percentage of morphologically identified apoptotic ce...

Decidua associated with products of conception from intra-uterine and extra-uterine gestations and decidualized tissue from the appendix, cervix and Fallopian tube were studied using a panel of antibodies and antisera. Immunolocalization of vimentin and desmin intermediate filament proteins and of alpha-1-antitrypsin and alpha-1-antichymotrypsin wa...

The aim of this study was to determine if the apoptotic index can be readily determined for endometrial carcinoma in hysterectomy specimens and to establish if any association exists between the apoptotic index and tumour grade and stage. The apoptotic index, defined as the percentage of morphologically identified apoptotic cells and apoptotic bodi...

The value of dipping cervical cone biopsy specimens in iodine (the Schiller test) as a method of deciding which areas should be selected for histological examination was assessed. Schiller positive and negative areas were recorded in macroscopic specimen images from fifty specimens of cervix. The results were compared with the histological presence...

To determine whether sampling the anterior and posterior cervical lips in hysterectomy specimens provides the best opportunity for detecting unsuspected cervical intraepithelial neoplasia (CIN). The frequency with which CIN was identified at a range of positions on the anterior and posterior lips and left and right lateral aspects of the cervix was...

In 1986, Jass and colleagues claimed to have improved on Dukes' classification of prognosis for carcinoma of the colon and rectum. To have clinical relevance, such results should be reproducible and confirmed by other institutions. Retrospective clinicopathologic study of 312 carcinomas of the colon and rectum to determine whether or not Jass' clas...

A series of clinicopathological variables was assessed on 312 patients undergoing surgical resection for primary colorectal cancer. Although the presence of venous invasion was related to mortality (P = 0.02), classifying invasion into involvement of thick-walled or thin-walled veins did not produce a variable of prognostic value. Intestinal obstru...

DNA analysis was assessed by densitometry for 281 cases of colorectal adenocarcinoma. Detection of aneuploidy in a single case rose from 65% if one, to 92.5% when three or more sections, were analysed. Although aneuploid tumours had significantly larger nuclear areas than near diploid tumours (p = 0.009), densitometric measurements showed no associ...

Flow cytometry was performed upon 312 patients with adenocarcinoma of the colon and rectum, satisfactory results being obtained with 275 (108 diploid, 130 aneuploid and 37 tetraploid). The proportion of nondiploid instances increased from 28 percent if one, to 80 percent when six specimens were assessed per patient. Reproducibility of the technique...

Thirteen nuclear and cellular morphometric variables were measured in 312 cases of colorectal adenocarcinoma. All variables, except nuclear shape factors, differed significantly (P < 0.001) between normal colorectal and tumor tissue. In adenocarcinomas, epithelial nuclei in well-differentiated mucosa tended to be elliptic, while those in poorly dif...

The severity of disease in a series of patients in whom acute pancreatitis was diagnosed at autopsy was assessed by the retrospective application of a standard prognostic index modified for post-mortem use. The results were compared with cases dying of acute pancreatitis which was recognized during life and appropriately treated. No difference in d...

Six prognostic indices, which were developed to assess inpatients with acute pancreatitis, were evaluated for possible retrospective application. When applied to a series of 14 cases in whom pancreatitis was first diagnosed at necropsy, the index devised by Jacobs et al was found to be the most useful, because in nine of these cases eight or more o...

Of eighty-three tumours of ependymal origin diagnosed in the twenty years 1969-1988 in Northern Ireland, fifteen were located within the spine. Two were in children, 13 in young adults with a mean age of 33 years. 70% presented with back pain and 60% had weakness of the lower limbs. Survival was found to correlate well with histological grading (WH...

The mean blood alcohol concentration (BAC) in 175 fatal cases of acute alcohol intoxication was found to be 355 mg/100 ml. This figure is less than that quoted in many standard textbooks on forensic medicine. The BAC in fatal cases of acute alcohol intoxication complicated by aspiration was lower than in those cases where there was no evidence of a...

Acute pancreatitis is a commonly encountered acute inflammatory condition which involves the pancreas. It has been suggested that the distribution of necrosis and inflammation seen histologically depends on whether the pancreatitis occurs as a result of ductal obstruction or following an interruption in the supply of blood to the pancreas. A histol...

Twenty-eight cases of solitary cutaneous leiomyomata were encountered in a ten-year period. They occurred in nine males and nineteen females, the mean age at presentation being 53 years. The lesions occurred most commonly on the lower limbs and 36% were painful. Solitary cutaneous leiomyomata were found to differ from the better known syndrome of m...