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Objective: Difficulties in detecting cervical adenocarcinoma early are well known. We report a detailed pathology review of cervical adenocarcinoma subtypes, comparing growth patterns and appearance of non-neoplastic epithelium to inform possible clues for disease progression and early detection., Methods: This analysis includes 154 women aged 18-69 years and diagnosed with incident in situ or invasive adenocarcinoma (AC), adenosquamous (AS), or other rare cervical glandular tumors from 1992-1996 in six U.S. medical centers. A pathology review panel evaluated histological features from original diagnostic slides., Results: Higher tumor grade (P < 0.001) and vascular invasion (P = 0.002) were more common in AS compared to AC. Adenocarcinoma in situ (AIS) was also more common among AC than AS (P = 0.002). Among AC with cervical intraepithelial carcinoma (CIN), AIS and cribriform patterns were more common than AC without CIN (P = 0.01). Further, non-endometrioid AC had higher tumor grade (P = 0.01) and stromal responses (P = 0.02) than endometrioid AC. Finally, although microglandular hyperplasia is historically thought to be related to oral contraceptive (OC) use, our data do not support this notion., Conclusion(s): AS appears to be either diagnosed later or histologically more aggressive than AC, and among AC subtypes, there are distinct histologic characteristics. Further research is needed to identify precursor lesions for early detection of AC and particularly for AS where AIS may not be a common precursor.

We present a case of a 62-year-old G0P0 Caucasian woman who developed endometrial adenocarcinoma, FIGO grade 2, endometrioid type, after receiving tamoxifen for 2 years following a diagnosis of invasive carcinoma and ductal carcinoma in situ of the breast. An incidental finding in the hysterectomy specimen was numerous endometriotic foci involving the submucosa, subserosa, and serosa of the cervix; lower uterine segment serosa; and bilateral ovaries. Polypoid structures, similar to the endometrial polyps occurring in tamoxifen-treated patients, were observed to arise from endometriotic foci in the serosa of the cervix and bilateral ovaries. We have found only one similar report in the literature. Since these structures do not fit the definition of "polyp," we suggest "basaloma" as an alternative. We also review all cases of tamoxifen-associated endometriosis reported in the world literature and cases of polypoid endometriosis occurring in non-tamoxifen-treated patients. Of 12 reported cases of tamoxifen-associated endometriosis, 4 occurred in premenopausal women, 1 in a perimenopausal women, and 7 in postmenopausal women, of whom none had a known history of endometriosis. The endometriotic foci gave rise to a spectrum of lesions which included epithelial metaplasias, simple and complex hyperplasias, polypoid lesions, and 2 cases of endometrioid carcinomas., (Copyright 1999 Academic Press.)

Objective: Because there is no universally accepted grading system for ovarian epithelial carcinoma, we attempted to compare the prognostic utility of the individual components used in some systems--both architectural and cytologic features, as well as mitotic activity and histologic tumor type--to determine which of these components fit best with survival., Methods: We studied 461 patients with invasive ovarian carcinoma who had uniform treatment, complete clinical data including staging and follow-up, and slides available for review. Each tumor was assigned a histologic subtype, architectural grade (based on whether the predominant pattern was glandular, papillary or solid), nuclear grade, mitotic count, and FIGO grade (based on the system for endometrial carcinoma). These features were compared with each other and with tumor stage and survival., Results: The architectural grade, nuclear grade, and mitotic count were independent variables both in stage I/II and stage III/IV disease. Each of them correlated with survival for most combinations of histologic type and stage. By multivariate analysis, in stage I/II cancer, nuclear grade and architectural grade were significantly correlated with survival, mitotic count showed only a trend, and FIGO grade did not correlate. In stage III/IV disease, nuclear grade, architectural grade 3, and mitotic count were significant, and FIGO grade was not., Conclusion: The new architectural grading system proposed worked better than the FIGO system in this study. Furthermore, it could be applied to all histologic subtypes of carcinoma. The nuclear grade and mitotic count were also independent of each other, correlated with survival, and could be utilized for all histologic types. These data support the development of a grading system which combines these architectural, nuclear, and mitotic features and can be applied regardless of the histologic type of carcinoma, modeled after the Nottingham system for grading of breast carcinoma.

Mutations involving the K-ras proto-oncogene are believed to play an important role in the mechanism of tumorigenesis for many human cancers and occur in 10-30% of endometrial carcinomas. In the present study 221 cases of endometrioid endometrial carcinoma obtained from Japanese patients with average follow-up of 41 months were examined for point mutations in codon 12 of K-ras through use of the polymerase chain reaction. In 103 cases lymph node dissection had been performed. K-ras mutations were significantly associated with the presence of lymph node metastases (P < 0.04). Since endometrial carcinoma in premenopausal women generally behaves less aggressively than tumors of similar histologic grade arising in postmenopausal patients, we evaluated the effect of K-ras mutation on outcome in patients stratified into three different age categories (<53 years, premenopausal; 54-59 years, perimenopausal; >60 years, postmenopausal). In the postmenopausal age group (>60 years), the presence of K-ras mutations was statistically significantly associated with patients who died or experienced recurrence (41.2% vs 13.0%; P < 0.03). This was related to a dramatic (greater than eightfold; P = 0.011) increase in the likelihood of adverse outcome between the premenopausal and postmenopausal states for patients whose tumors contained mutant K-ras. These findings point to a possible role for K-ras activation in the mechanism(s) responsible for more aggressive clinical behavior of endometrioid endometrial cancer that is observed in postmenopausal patients.

A case of bilateral tubal carcinoma occurring 22 years after tubal sterilization is presented. We believe that this is the first case report of bilateral tubal carcinoma that has arisen in ligated fallopian tubes. The possibility that tubal occlusion is one of the causative factors of tubal carcinoma is discussed.

Mature cystic teratomas of the ovary frequently contain intestinal-type tissues, but these rarely organize into complete intestinal walls, including all layers, and even more rarely develop secondary neoplasms. The present report documents two mature teratomas with formation of complete segments of intestinal wall, one also containing a benign mucinous cystadenoma of the appendiceal type and the other an intestinal-type adenocarcinoma infiltrating into the neoplastic bowel wall but not the surrounding ovarian parenchyma. The latter patient is alive and well 5 years after surgery. These cases expand the repertoire of secondary neoplasms, benign and malignant, developing in mature cystic teratomas.

The first case of ovarian sclerosing stromal tumor associated with endometrial adenocarcinoma in a 44-year-old woman is presented. By ultrastructural study, typical steroid-secreting type theca cells and various transitional tumor cells from fibroblast-like cells to theca-like cells were observed in the ovarian tumor. The clinical history of the patient and the ultrastructural study of this tumor suggested hormonal activity, but no apparent evidence of active hormone secretion was detected by plasma analysis for steroid hormones.