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The reactivity of a new monoclonal antibody (MAb), MSN-1, raised against a human endometrial cancer cell line (SNG-II), was studied in a variety of endometrial, endocervical, and ovarian carcinomas as well as normal cycling endometrium. Moderate to strong reactivity (2-3+) was seen in six of nine normal secretory endometria (67%), one of 10 normal proliferative endometria (10%), 18 of 18 endometrial adenocarcinomas (100%), 10 of 11 endometrioid ovarian adenocarcinomas (91%), seven of nine clear cell ovarian adenocarcinomas (78%), one of 12 endometrial hyperplasias without atypia (9%), two of four endometrial hyperplasias with atypia (50%), zero of five endometrial serous adenocarcinomas, two of 17 serous ovarian adenocarcinomas (12%), zero of 10 intestinal-type mucinous ovarian adenocarcinomas, and zero of nine metastatic adenocarcinomas in ovary. Endocervical adenocarcinomas showed moderate to strong staining in 75% (six of eight). It is concluded that MSN-1 can be used to confirm endometrioid/clear cell differentiation in ovarian and endometrial tumors, cannot be used to discriminate endocervical from endometrial differentiation, cannot be used to discriminate atypical hyperplasia from carcinoma, and may be useful to distinguish between atypical (premalignant) endometrial hyperplasias and those without atypia.

We report on the pathologic findings in primary tumors and metastases in 203 cases of stage I and II endometrial carcinosarcoma (malignant mixed mesodermal tumor) subjected to hysterectomy and staging laparotomy. Metastases were studied in 40 of these cases, including 34 with positive findings in the pelvic and/or para-aortic lymph nodes. Features of the stromal component of the primary tumors, including grade, mitotic index, and the presence and types of heterologous elements, showed no relation to the presence of metastases at operation. High-grade, serous, and clear cell carcinomatous components, on the other hand, were associated with a higher frequency of metastases, as were deep myometrial invasion, lymphatic or vascular space invasion, and involvement of the isthmus or cervix. The current concepts of histogenesis and differentiation of these tumors are discussed, and the suggestion is made that they might represent metaplastic carcinomas.

The reactivities of new monoclonal antibody 1C5 and anti-carcinoembryonic antigen (CEA) were determined immunohistochemically in 4 adenocarcinomas in situ, 20 invasive adenocarcinomas of various types, and 6 adenosquamous carcinomas of the uterine cervix, as well as in 10 endometrial adenocarcinomas and 10 normal cervices. Among the invasive adenocarcinomas, 90% were positively stained by 1C5 and 55% stained for CEA. Three of four in-situ adenocarcinomas were positively stained by 1C5 and two of four were positively stained by anti-CEA. All adenosquamous carcinomas were stained by 1C5 and four of six stained for CEA. Invasive adenocarcinomas always stained more intensely with 1C5 than did noninvasive lesions in the same specimen. Poorly differentiated adenocarcinomas were stained as strongly with 1C5 as were well-differentiated tumors, but CEA was less effective in identifying poorly differentiated lesions. 1C5 was also more useful than CEA was in distinguishing glandular from squamous neoplastic differentiation, and also appears to be useful in distinguishing endocervical from endometrial differentiation.

Immunoperoxidase localization of carcinoembryonic antigen (CEA) was performed on tissue sections of microglandular hyperplasia and adenocarcinoma of endocervical origin to see if CEA would be a marker of malignancy in this context. Twenty (95%) of 21 of the benign lesions were negative and one was focally positive. Nine (64%) of 14 adenocarcinomas were widely positive, four were focally positive, and one was negative. These results suggest that extensive immunohistochemical positivity for CEA in endocervical glandular lesions is indicative of malignancy.

Cases of endometrial carcinoma (104) from the Cancer Registry of Miyagi Prefecture, Japan, during the period from 1966--1977 have been reviewed histologically. The most impressive differences between tumors in this low-risk population and those reported in American women are higher frequencies of the mixed adenosquamous histology, myometrial vascular invasion, and lymphoid infiltration within and around the tumors in the Japanese cases. The possible significance of these observations, both clinical and epidemiologic, is discussed in detail.

We present five cases in which ovarian neoplasms (three clear cell carcinomas, two endometrioid carcinomas) were associated--and in four cases contiguous--with atypical glandular epithelial changes in endometriosis. This association has not been reported previously in the ovary, but four cases of extragonadal malignant tumors have been noted to occur with or after atypical endometriosis. We propose that a diagnosis of atypical endometriosis be followed by careful long-term observation of the patient to detect possible subsequent development of neoplasia.

Parathyroid exploration involves identification of all accessible parathyroid glands and the distinguishing of normal and pathologic parathyroid glands. Close collaboration of the surgeon and the surgical pathologist is characterized by courtesy and efficiency with special techniques by each that facilitate accuracy and speed, particularly at the conclusion of the surgical exploration when the biopsy specimens have been passed to the pathologist on a "parathyroid map" and the patient remains anesthetized. Parathyroid imprint by touch preparation technique allowed cytologic examination in less than 1 minute per specimen, with ready identification of the presence or absence of parathyroid tissue. Pathologic diagnoses were also possible on abnormal parathyroid glands when the parathyroid imprint was used as a screening procedure to select specimens for frozen section. Accuracy and speed were excellent as used in this series of parathyroid surgical pathology consultations. Intraoperative imprint confirmation of parathyroid tissue is suggested as an improvement in pathologic consultation during parathyroid exploration.

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.

Primary oncocytic carcinoma of the breast was diagnosed in a 76-year-old man. The histologic and electron microscopic features are characteristic of oncocytic neoplasms that occur at other sites, such as salivary glands and endocrine organs. The pathologic features and the presence of estrogen receptors biochemically are distinct from apocrine carcinoma. The patient is alive 7 years after modified radical mastectomy without additional chemotherapy or radiotherapy.

Members of the Editorial Board who have been active in the study of female genital HPV-related lesions have responded to a series of questions related to the histopathologic diagnosis of such lesions in the uterine cervix, the performance of auxiliary studies, therapeutic choices, and the correlation of cytologic and tissue diagnoses.

We report a population-based histopathologic review of primary ovarian neoplasms. No significant changes in incidence were encountered between the 1969 and 1979 review periods. The most frequent single tumor was benign cystic teratoma (26.5%), while the coelomic-derived "epithelial" tumors constituted the most frequent group (57.6% of all tumors and 93.8% of all malignant tumors). The high frequency of borderline tumors reported by others in nonpopulation-based material is confirmed, and the usual disseminated state of invasive carcinomas at the time of diagnosis is noted. Other data concerning incidence and bilaterality rates, patient ages, multiple primary malignancies, and problems in differential diagnosis and tumor grading are discussed.

The clinical and pathologic features of 23 cases of hepatocellular carcinoma occurring in patients younger than age 35 years (mean age, 17.4 years) were analyzed. Ten of these (43%) were the fibrolamellar oncocytic variant (FLO), characterized by large polygonal neoplastic hepatocytes and lamellar bundles of collagen. The remainder (non-FLO) showed the usual wide range of gross and histologic patterns typical of hepatocellular carcinoma in older age groups. Overall, hepatocellular carcinoma was more common in females than in males. The FLO variant was characterized by a longer duration of symptoms prior to diagnosis, increased frequency of resectability of the tumor, and infrequency of mitoses. Of particular importance is the fact that 5 of 10 patients with the FLO variant are alive and clinically free of disease 1 1/2 to 8 years postoperatively, while none of the 13 patients with non-FLO hepatocellular carcinoma is alive and free of disease. There was no significant difference between the two groups in mean age at diagnosis, presence of single versus multiple hepatic tumors, vascular invasion, or tumor necrosis. Although cirrhosis was present in three non-FLO patients and none of the FLO patients, the difference was not statistically significant. The prognosis of hepatocellular carcinoma in young patients does not appear to differ from that in older patients, with the exception of the fibrolamellar oncocytic variant, a variant which is common in younger patients.

Twenty cases of immature teratoma of the ovary with a neural component are analyzed. A plea is made for use of the nomenclature adopted from the new World Health Organization classification of ovarian tumors, the past confusion over terminology and histogenesis of this rare tumor is discussed. All the primary tumors in the present series contained at least some immature tissues (predominantly of neural origin) and were thus graded from 1 to 3 according to the criteria of Thurlbeck and Scully. No grade 0 tumors ("benign solid teratomas") were identified. We believe that thorough sectioning almost always insures the identification of immature elements. The prognosis was closely related to the histologic grade, but correlated poorly withthe clinical stage, the latter being influenced by the common finding (25 per cent of the cases in this series) of peritoneal implants composed exclusively of mature glial tissue, which is associated with a benign clinical evolution. This phenomenon of maturation or differentiation appears to be the rule rather than the exception in this tumor, since implants are usually of better or equal differentiation when compared with their primary tumors and older patients tend to have lower grade tumors than younger patients. Since the majority of patients with this tumor are young, primary surgical therapy should be conservative, unilateral salpingooophorectomy often being sufficient. Spontaneous or operative rupture of the tumor capsule carries an increased risk of subsequent dissemination. We have noted impressive clinical responses in patients with disseminated tumors of a high histologic grade after treatment with triple chemotherapy (vincristine, actinomycin D, and cyclophosphamide) but do not recommend adjuvant therapy in patients with only grade 0 implants.

The stroma and stromal reaction in normal breast, benign, and malignant breast tissue was studied by electron microscopy. Elastosis is the main stromal response in infiltrating duct and lobular carcinomas. Medullary carcinoma elicits no significant elastosis but intraductal carcinoma has significant local elastosis. Benign conditions such as fibroadenoma and sclerosing adenosis produced no significant elastosis. The high number of elastic fibers and the high microfibril:elastin ratio indicate that most of the elastic fibers are recently secreted, probably by fibroblasts and myofibroblasts. The factors stimulating the increased production of elastic fibers and the prognostic significance of elastosis remain unclear.

The autopsy plays an important role in neoplastic disease. Over one third of all adult autopsies disclose cancer, and clinical diagnostic errors are disclosed in approximately 40% of these. There is no evidence that diagnostic accuracy has improved in recent years. In addition to monitoring diagnostic accuracy--particularly with reference to new technologies--the autopsy is also important in detecting both new types of cancer and new causative agents and patterns of incidence and behavior in "old" types of cancer. It also plays a major role in characterizing the toxic effects of new therapeutic regimens and in establishing true causes of death (including accurate primary cancer sites) for setting local, national, and international research and health care priorities.

Levonorgestrel-releasing intrauterine devices (IUD) were inserted in 92 women. Endometrial biopsies were taken between 3 months and 7 years after these insertions. Intrauterine release of levonorgestrel resulted in endometrial glandular atrophy and decidualized stroma. Inflammation and necrosis were also seen as local signs of IUD use. The biopsies were similar regardless of the duration of IUD use. Endometrial morphology returned to normal in biopsy specimens taken 1-3 months after IUD removal.

The first 21 cases recorded in the Registry for Endometrial Carcinoma in Young Women Taking Oral Contraceptive Agents are reported. We have found no other such cases in the literature, and indeed several authors have stated that these agents, because of their predominantly progestional action, would be expected to be protective against this disease. In 8 of the 21 patients, factors were present which militated against a close relation between oral contraceptives and carcinoma, and 5 of these 8 patients had taken only or predominantly combined agents. On the other hand, 11 of the remaining 13 patients took sequential agents, a ratio directly opposite that of the usage of combined and sequential agents in the American population. The possible reasons for the excess of sequential agents, chiefly Oracon, are discussed, and directions for future study are suggested.

Primary adenocarcinoma of the cervix and endocervix is an unusual lesion. It is cytologically evasive, diagnostically challenging, histologically variable, and therapeutically perplexing. During the period 1954 through 1971, 53 cases were diagnosed at the Medical College of Virginia, representing 3% of all invasive cervical carcinomas. Clinical material, therapy, and five-year survival statistics have been complied for each histologic type of adenocarcinoma. The average age of the patients was 53.8 years, and the most frequent complaint was abnormal uterine bleeding. Histologically, the majority had adenocarcinomas of the endocervical type. Others, in order of descending frequency, had endometrioid, clear cell, colloid, and adenoid cystic carcinomas. Patients treated for endometrioid carcinomas had the best five-year survival rates. Standardization of the diagnostic process and the use of modern radiation therapy have significantly improved survival. All patients having radiation plus operation or operation alone lived five years or more.

Forty-four squamous cell carcinomas (SCC) of the skin and lip were observed in 9 of 464 renal homograft recipients. Clinically and histologically the SCC's fell into two groups. Two patients with widespread warts, suggestive of epidermodysplasia verruciformis, showed multiple SCC's predominantly on the upper extremities which were associated with minimal solar elastosis of the adjacent dermis. The other seven patients did not have widespread warts; their SCC's occurred predominantly on the head and neck and were associated with prominent solar elastosis of the adjacent dermis. The degree of solar elastosis was particularly striking in view of the young age of this group (mean age: 37 years). Inflammatory cellular response to the transplant SCC's was significantly diminished in comparison with a group of control SCC's from non-immunosuppressed patients. In both transplant groups sunlight appears to be an important etiologic factor; in the first group viruses may also be important.

Endosalpingiosis in female peritoneal washings can be a source of false-positive diagnoses, especially in patients with known ovarian carcinoma. In this article we report the features of endosalpingiosis in the peritoneal washings of four patients, three of whom were initially reported as "suspicious for malignancy." Two of the patients had ovarian serous tumor of borderline malignancy; however, the tumors were confined to the ovaries with no evidence of disseminated peritoneal malignancy. All four patients had histologic evidence of pelvic endosalpingiosis. It is important to recognize this entity cytologically to avoid a misdiagnosis of recurrent or disseminated malignancy.

Limited subtotal thyroidectomy was performed in 42 of 43 patients with Graves' disease. Twenty of 23 patients (87%) who were followed up for an average of 54 months after operation remained euthyroid. Only one patient (4.3%) had recurrent thyrotoxicosis. There were no deaths and no permanent complications. A coexisting, invasive papillary cancer necessitated total thyroidectomy in one patient, and occult papillary cancers were discovered histologically in three others. This study supports the thesis that postoperative thyroid function depends on the volume of remaining thyroid tissue. While preserving thyroid function, limited subtotal thyroidectomy lowers postoperative complications and induces no increase in recurrent thyrotoxicosis.

Aromatase, 17 alpha-hydroxylase, and cholesterol side-chain cleavage P-450 cytochromes (P-450AROM, P-450(17 alpha,) and P-450SCC, respectively) were immunohistochemically localized in nine granulosa cell tumors, 15 thecomas, ten Sertoli-Leydig cell tumors, two steroid cell tumors, five fibromas, and five sclerosing stromal tumors. In the thecomas, P-450SCC and P-450(17 alpha) were positive in luteinized theca cells and in cells with vacuolated cytoplasm, while P-450AROM was not observed. In the steroid cell tumors, all the P-450 cytochromes were intensely stained. P-450SCC and P-450(17 alpha) were present in cells with vacuolated cytoplasm in two cases of sclerosing stromal tumor. P-450AROM was weakly demonstrated in one of the granulosa cell tumors. P-450(17 alpha,) P-450SCC, and P-450AROM were all faintly stained in the Sertoli-Leydig cell tumors. No P-450 cytochrome immunoreactivity was observed in any fibroma.

A 44-year-old woman was found to have a sessile lesion replacing most of her endometrium and endocervical mucosa, consisting of an intimate admixture of endometrial glands, endometrial stroma, and smooth muscle. On the basis of a previous curettage, it was concluded that the lesion had been present for at least seven years. The lesion is considered to be related to the pedunculated adenomyomatous polyp. The possibilities that it may represent adenomyosis, neoplasm, or hamartoma are discussed, and the latter is considered to be the most likely possibility. The presence of smooth muscle distinguishes the present case from the recently described and probably closely related entities of papillary adenofibroma, benign müllerian tumor, and müllerian adenosarcoma.

Seventy-six patients with malignant germ cell tumors of the ovary received vincristine, dactinomycin, and cyclophosphamide (VAC) postoperatively. Fifty-four were treated after removal of all gross disease. The majority of these remain disease-free. Indeed, only 15 (28%) have failed, including 11 of 24 with pure endodermal sinus tumor, 3 of 11 (27%) with mixed germ cell tumor containing endodermal sinus elements, and only 1 of 20 with immature teratoma grade 2 or 3, a patient seen initially with recurrent disease. Postoperative VAC therapy, however, did not appear to be effective in patients with unresectable or incompletely resected germ cell tumors of the ovary. Fifteen of 22 patients (68%) with incompletely resected germ cell tumors failed VAC therapy, including 4 of 7 with pure endodermal sinus tumor, 5 of 5 with mixed germ cell tumors containing endodermal sinus elements, 2 of 2 with embryonal carcinoma, and 4 of 8 with immature teratoma. In failing, patients' median time to progression was 8 months. Dose-limiting toxicity was seen in 30% of the entire group. Combined cisplatin, vinblastine and bleomycin therapy now is being tested in this group of tumors.

Nineteen cases of ovarian hyperthecosis found in the Surgical Pathology Department files of the George Washington University Medical Center between 1976 and 1988 were reviewed. In all of these cases the ovaries were removed as part of a procedure for another clinical diagnosis. None of the cases was associated with clinical virilization, but the endometrium was abnormal in 15 of the 17 cases in which it was available for examination, ranging from simple hyperplasia to well differentiated adenocarcinoma. Immunohistochemical analysis of the ovarian lesion for cytochromes P-450 17 alpha and P-450AROM, which catalyze androgen and estrogen synthesis, respectively, was performed in nine cases in which adequate tissue was available. P-450 17 alpha was localized in luteinized stromal cells in six of these cases--the endometrium of four of which was carcinomatous--while P-450AROM was not present in any case. These results confirm androgen production by the luteinized stromal cells in hyperthecosis, and suggests that estrogenic effects in these cases are mediated through peripheral aromatization of these androgens.

A case report with ultrastructural analysis of an apocrine carcinoma of the breast is presented. The key finding with electron microscopy is numerous large mitochondria with abundant incomplete cristae. The ultrastructure of this tumor is compared to the ultrastructure of apocrine cells in the skin, oncocytes, and apocrine metaplastic cells of the breast. The apocrine carcinoma cells have some of the features of typical metaplastic breast epithelium and some features of oncocytes. Their exact origin remains open to speculation.

Five cases of epidermoid cysts of the ovary are added to the two-reported in the literature. This rare lesion was uniformly an incidental finding in the study of hysterectomy specimens. Its main interest is in its histogenesis, which is suggested to involve metaplasia of the coelomic surface epithelium of the ovary. Ultrastructural evidence is one case strongly favors this possibility, thus adding another line of differentiation to those already established for the multipotent coelomic epithelium. However, some cases may be teratoid in origin, as has been suggested for the analogous lesion in the testis.

A retrospective double-blind examination of the cytologic smears and frozen section tissue slides from 140 lesions of the breast was performed in order to assess the diagnostic accuracy of each method. The cases with diagnostic errors were reevaluated to define the pitfalls encountered in the intraoperative diagnosis of breast lesions by both methods. Results with the cytologic technics are more variable than with frozen sections, but when read by experienced observers the smears are as accurate as frozen sections and have the additional advantages of rapidity, sparing of tissue for other studies, better correlation with fine-needle aspiration cytologic results, and more complete sampling of large or multiple specimens. The authors recommend that intraoperative cytologic examination be employed routinely in breast diagnosis, initially always in conjunction with frozen section examination but eventually in many cases as an alternative technic.

In order to ascertain the reproducibility of the mitosis count in histologic tumor diagnosis, a reference set of 10 microscopic slides from smooth muscle tumors of the uterus was shown to six different pathologists, who were asked to record the number of mitotic figures per 10 high power fields in the most active region of each slide. The results, when tubulated, revealed considerable observer variation in this supposedly objective and quantitative diagnostic criterion. The diagnosis of benignity or malignancy, based on this criterion alone, were unamimous in only four of the 10 cases, whereas the diagnoses based on a constellation of histologic criteria were unanimous in all cases and correlated well with the subsequent clinical evolution of those cases with follow-up data. Possible reasons for the lack of reproducibility of the mitosis count are discussed. We conclude that a qualitative estimation of mitotic activity is helpful as one of the diagnostic and prognostic criteria in the assessment of uterine and other smooth muscle tumors, but that it cannot be used as the sole criterion for distinguishing benign from malignant tumors.

Immunohistochemical localization of cholesterol side-chain-cleavage, 17 alpha-hydroxylase and aromtase cytochromes P-450 was performed in 35 morphologically normal human premenopausal ovaries by using specific antibodies against the enzymes. In well-developed ovarian follicles in the late stages of follicular growth, immunoreactivity of P-450AROM was only seen in granulosa cells while P-450(17 alpha) and P-450SCC activity was confined to theca interna cells, confirming that follicular oestrogen is produced in granulosa cells by the aromatization of androgens derived from the theca interna cells. In the corpus luteum, this functional differentiation is maintained, since immunoreactivity of P-450AROM was exclusively present in luteinized granulosa cells while that of P-450(17 alpha) was present in luteinized theca calls. Immunoreactivity of P-450SCC was present in both types of cells in the corpus luteum.

Five cases of the type of mammary carcinoma that has been designated "signet-ring cell carcinoma" are presented. This tumor is characterized by the presence of numerous cells containing intracellular mucin, without large amounts of extracellular mucin as is seen in colloid (gelatinous, mucinous) carcinoma of the breast. Although such cells may be seen in many mammary carcinomas, they are never as frequent as in the variant described. Ultrastructurally, the most characteristic finding is the presence of numerous intracellular lumina containing material which appears to represent the mucin identified with the light microscope. This finding differs from that in colloid carcinoma, in which the scantier intracellular mucin occurs in the form of intracytoplasmic membrane-bound vesicles. The five tumors in the present series were all associated with either in situ lobular carcinoma or a "sinus catarrh"-like pattern of nodal metastases, or both. On the basis of these light and electron microscopic data, the signet-ring cell carcinoma is suggested as a variant of infiltrating lobular carcinoma, clinically and pathologically distinct from colloid carcinoma.

Immunohistochemical analysis of cytochromes P-450 aromatase and P-450 17 alpha-hydroxylase, which catalyze the production of estrogens and androgens, respectively, was performed for 23 cases of ovarian Brenner tumor. Immunoreactivity for P-450 aromatase was observed in the epithelial cells of the tumor distinctly in two cases and faintly in four cases, while immunoreactivity for P-450 17 alpha-hydroxylase was seen in two cases. No immunoreactivity was observed in the stromal cells of the tumors, nor were luteinized cells observed in the cases examined. No correlation was observed between the immunoreactivity of cytochromes P-450 in the epithelial cells of the tumor and endometrial abnormalities. These findings, together with a review of the literature, suggest that the usual Brenner tumor is not associated with specific steroidogenesis. Rare massive Brenner tumors may, however, be capable of androgenic or estrogenic activity.

Five cases of so-called "adenoma malignum" of the cervix are presented. This term has been used to describe an extremely well-differentiated adenocarcinoma characterized histologically be distorted and architecturally irregular endocervical glands which penetrate deeply into the wall of the cervix, but without more than minimal and focal evidence of gland cell stratification, anaplasia, or mitotic activity. Despite this innocuour histologic appearance, these tumors have classically been thought to be clinically highly malignant, with an almost invariably rapid lethal outcome. This discrepancy between the histology and behavior has been presented as justification for the otherwise paradoxical name, "adenoma malignum". In the present series, all patients were treated with modern radiotherapeutic techniques, and four of the five are long-term survivors. Of the patients in the literature who died after rapid dissemination, none received treatment with acceptable radiotherapeutic techniques. Thus, we believe that with proper therapy this tumor is no more malignant than one would expect for a highly differentiated adenocarcinoma, and we suggest that the name, "adenoma malignum," be replaced by "minimal deviation adenocarcinoma of the cervix."

Five cases of the recently characterized cystic mesothelioma of the peritoneum are presented. The patients, all women, ranged in age from 23-50, and were seen with large, solitary or multiple, multicystic masses involving the abdominal and pelvic peritoneum. Histologically, they consisted of interconnecting cystic cavities lined by a single layer of flattened to cuboidal cells with variable nuclear atypia. These cells in one case showed ultrastructural features consistent with mesothelial origin. In follow-up periods ranging from 1-13 years, two patients have had recurrence of disease, but all patients are still alive. When these cases are combined with the ten previously reported, the recurrence rate in patients followed for two years or more is 50% (four of eight). This lesion may represent a clinically "borderline" variant between the better known benign (adenomatoid tumor) and malignant mesotheliomas of the peritoneum.

Electron microscopic studies were conducted on 11 cases of cystosarcoma phyllodes (6 benign, 3 malignant, 2 recurrent), 1 stromal sarcoma, and 15 cases of fibroadenomas. Particular emphasis was placed on examination of the epithelial-stromal junction. The epithelial cells were basically similar in all cases. The basal lamina of fibroadenomas tended to be reduplicated, whereas in cystosarcoma phyllodes the basal lamina was less reduplicated and even focally absent. A continuous layer of delimiting fibroblasts was not present in either type of tumor. Stromal cells were generally fibroblasts, with 2 of 15 being fibroadenomas and 2 of 11 cystosarcoma phyllodes showing myofibroblastic differentiation. The stromal sarcoma also showed smooth muscle differentiation. The authors conclude that the epithelial-stromal junction is abnormal in both fibroadenomas and cystosarcomas, but the abnormality is different in these two tumors. Increasing prominence of stromal cell junctions and of lysosomes also correlated with the diagnosis of cystosarcoma, particularly the malignant variant.

The clinical and pathologic features of 18 cases of endocervical adenocarcinoma (in situ and invasive) and adenosquamous carcinoma in women less than 50 years of age were reviewed. The findings were compared with those from an equal number of cases of cervical squamous carcinoma (in situ and invasive), obtained by matching for age and year of diagnosis. A positive history of oral contraceptive use was found in five cases (28%) in the study group and in seven (39%) of the squamous carcinoma control patients. Microglandular hyperplasia was present in five cases of adenocarcinoma and one case of squamous carcinoma. Neither of these differences is statistically significant. Additionally, in only one case was there a transition from microglandular hyperplasia to adenocarcinoma--in a patient who was not on oral contraceptives but who received medroxyprogesterone acetate for vaginal bleeding. These findings fail to support the hypothesis that use of oral contraceptives or presence of microglandular hyperplasia is causally related to the development of endocervical carcinoma.

Published criteria for classifying endometrial hyperplasias and their differential diagnosis from well-differentiated endometrioid-type adenocarcinoma are reviewed, and the author's own interpretations and recommendations are presented. Also discussed are the subjects of misdiagnosis of hyperplasia and carcinoma, premalignant significance of hyperplasia, and prognostic significance of hyperplasia in patients with carcinoma patients.

We investigated the presence of polymorphonuclear leukocytes (PMNs) in normal endometrium. Hematoxylin and eosin stained slides of 100 endometrial curettage and biopsy specimens were reviewed for dating and presence of PMNs. Polymorphonuclear leukocytes were quantitated by chloroacetate esterase (CAE) stains. Polymorphonuclear leukocytes were present in large numbers in areas of tissue degradation (day 28 and menstrual phase endometrium) and were found only in small numbers in intact tissue throughout the cycle. The CAE and H&E stains showed minimal difference in ability to detect PMNs. Polymorphonuclear leukocytes could be easily discriminated from endometrial granulocytes, which did not stain with CAE.

Three cases of papillary serous carcinoma of the endometrium ( PSCE ) have been studied by transmission electron microscopy, and the ultrastructural findings compared with those in classical "endometrioid" carcinoma of the endometrium ( CECE ) and papillary serous carcinoma of the ovary ( PSCO ). PSCE possesses many ultrastructural features in common with both CECE and PSCO , as well as with clear cell carcinoma of the endometrium, emphasizing the close relationship existing among these different tumors of Müllerian origin. The only useful ultrastructural distinguishing features between serous and endometrioid carcinomas of similar histologic grade are more numerous secretory granules in the former and prominent paranuclear microfilaments and tonofilaments in the latter. Despite its lack of ultrastructural distinctiveness, the clinical behavior of PSCE justifies its consideration as a unique clinicopathologic entity.

The clinical records and pathologic specimens from 150 patients with endometrial carcinoma were reviewed to test the hypothesis that constitutionally predisposed patients with evidence of endogenous hyperestrinism (i.e., obesity, hypertension, diabetes, nulliparity, leiomyomata, adenomyosis) have a more benign form of carcinoma than do patients who do not fit this profile. Our results do not support this hypothesis, but do reveal certain other prognostic indicators, in addition to factors relating to the tumor itself, including stage, grade, histologic type, and extent of invasion. These indicators include: (a) age and menopausal status--women over 50 years of age, and more impressively, postmenopausal women of any age, have less favorable histology, staging, and survival; (b) race--black women have higher-grade tumors, higher-stage tumors, and poorer survival rates than white women; (c) hyperplasia--when hyperplasia is found in the biopsy, curettage, or hysterectomy specimen, the accompanying carcinoma is of a much more favorable type and extent, and survival rates are significantly better. The reasons for these correlations are not fully understood, and possible explanations are discussed. There may be two distinct patterns of endometrial carcinoma: a prognostically favorable one arising on a background of hyperplasia predominantly in premenopausal women, and a prognostically unfavorable one, occurring principally in postmenopausal women without hyperplasia. Empirically, we advise pathologists to comment on the presence or absence of hyperplasia in any specimen in which endometrial carcinoma is diagnosed.

The lectin binding properties of ten cases each of adenomatoid nodule, follicular adenoma, and papillary carcinoma and five cases of microinvasive follicular carcinoma were examined histochemically and compared with adjacent normal thyroid tissue. Wheat germ agglutinin, concanavalin A, Ulex europaeus agglutinin I, peanut agglutinin, soybean agglutinin, Dolichos biflorus agglutinin, Ricinus communis agglutinin, and Helix pomatia agglutinin were employed. All the lectins but Ulex europaeus agglutinin I, peanut agglutinin, and Helix pomatia agglutinin were bound to thyroid parenchymal cells, colloid and stromal cells, but none uniquely to thyroid parenchymal cells. Helix pomatia agglutinin binding was present in stromal cells but not in parenchymal cells. Ulex europaeus agglutinin I binding to parenchymal cells was weakly positive only in five cases of papillary carcinoma. The binding in adenomatoid and neoplastic cells and their colloid was stronger than in adjacent normal thyroid tissue in all cases examined. Wheat germ agglutinin and concanavalin A binding was most intense among the lectins examined. In papillary carcinoma, lectin binding was observed mostly in the apical cytoplasm of carcinoma cells, whereas a diffuse surface binding pattern was predominant in follicular adenoma and carcinoma, adenomatoid nodules and normal thyroid gland. No consistent differences in lectin binding were found between follicular adenoma and carcinoma, or between adenomatoid nodules and follicular neoplasia.