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While histological diagnosis of Paget disease of vulva is mostly straightforward, identifying and confirming invasion can be challenging. Often invasion is accompanied by epidermal hyperplasia, marked inflammatory response and desmoplastic reaction. Diagnosis of invasion in Paget disease portends a poor outcome. We report findings from a recurrent primary vulvar Paget disease where overall histomorphology of possible invasive disease is unusual and raises a possibility of displacement of Paget cells in the dermis. We compare histology of the index case with known invasive vulvar Paget disease cases retrieved from our pathology archives. Unique histomorphology in the index case suggests a possibility of previous excision related dermal displacement of Paget cells. [ABSTRACT FROM AUTHOR]

Low-grade serous carcinoma of the ovary is an uncommon lesion, composing approximately 3% of ovarian neoplasms. It typically arises in association with a serous borderline tumor and is most often at an advanced stage upon diagnosis. Gene mutations in BRAF and KRAS are characteristic. Various histologic architectural patterns are known, such as papillary, micropapillary, inverted micropapillary, glandular and nested. We report a case of low-grade serous carcinoma arising years after a serous borderline tumor and contralateral teratoma; the low-grade serous carcinoma showed two patterns: micropapillary growth and a previously unreported form of solid pattern manifesting as large tumor islands without slit-like spaces. This unusual solid morphology raises the differential diagnosis of high-grade serous carcinoma, which would result in different clinical management. The presence of areas with classic micropapillary architecture, in addition to the absence of high-grade cytonuclear atypia and marked pleomorphism, support the diagnosis of low-grade serous carcinoma. Immunohistochemical stains for p53 and p16 failed to show abnormal patterns characteristic of high-grade serous carcinoma. The patient declined chemotherapy and is on letrozole; she has had recurrent right pleural effusions over six months of follow-up after surgery. [ABSTRACT FROM AUTHOR]

Mesonephric-like adenocarcinoma (MLA) of the endometrium shows a variety of morphologic appearances, including small glands, tubules with eosinophilic materials in the lumen, prominent papillary patterns, spindled cells, solid formations, and corded and hyalinized patterns. Unique morphology, characteristic immunohistochemical staining patterns, molecular alterations, and awareness of the pathologists make it possible to identify this tumor accurately. This report of two additional morphologic patterns, intestinal goblet cells mimicking intestinal-type mucinous carcinoma and squamous differentiation with spindle and epithelioid cells mimicking carcinosarcoma of the endometrium will expand the literature on MLA. [ABSTRACT FROM AUTHOR]

A 40-year-old woman underwent excision of a painless left vulvar mass. The specimen showed a well-circumscribed mass measuring 3.5 × 2.7 × 2.5 cm. Microscopic examination exhibited an encapsulated neoplasm with a solid and papillary growth pattern. The tumor cells were oval to columnar and showed moderate nuclear atypia. No capsular invasion was identified. Immunonegativity for calponin and p63 confirmed the absence of myoepithelial cells either within or at the periphery of the tumor. The tumor was immunopositive for gross cystic disease fluid protein 15, synaptophysin, and chromogranin. The histologic and immunohistochemical characteristics were consistent with an encapsulated solid papillary carcinoma with neuroendocrine differentiation. The patient has been free of disease for 4 years after surgery. This is the first report of a vulvar encapsulated solid papillary carcinoma with neuroendocrine differentiation. Correct diagnosis is imperative because of the distinct biologic behavior of the tumor. [ABSTRACT FROM PUBLISHER]

Most endometrial carcinomas contain only 1 Müllerian cell type although the presence of 2 or more cell types within 1 tumor, for example a predominantly low-grade endometrioid carcinoma with a minor component (arbitrarily defined as 30% or less) of high-grade serous and/or clear cell carcinoma, is not uncommon. The current study attempts to evaluate whether the presence of minor serous or clear cell components exerts an adverse effect on the prognosis in stage-I endometrial carcinomas of "mixed-type." The study cases include 22 cases of stage-I endometrioid carcinoma with a minor component of serous carcinoma and 14 cases of endometrioid carcinoma with a minor component of clear cell carcinoma. Minor components were arbitrarily defined as representing anywhere between 5% and 30% of the total tumor. The study cases were compared with 56 cases of histologically pure age-matched and stage-matched endometrioid carcinomas, 6 pure serous carcinomas, and 13 pure clear cell carcinomas. All study and control cases were fully staged. Treatment history and outcome status were obtained and follow-up ranged from 56 to 140 months. Our study suggests that the presence of minor components of serous and clear cell carcinoma, defined as between 5% and 30%, within a mixed-type endometrial carcinoma appears to adversely influence the long-term survival of stage-I tumors, although a larger study is needed to corroborate our findings. [ABSTRACT FROM AUTHOR]

The association of Ewing's sarcoma/peripheral neuroectodermal tumor and endometrioid type endometrial carcinoma has been reported relatively recently. We have recently identified Ewing's sarcoma/peripheral neuroectodermal tumor differentiation in uterine serous carcinomas and undertook this study to evaluate the frequency of both serous and endometrioid carcinomas expressing Ewing's sarcoma/peripheral neuroectodermal tumor differentiation. Seventy cases of uterine serous carcinoma were retrieved from the archival files and stained with antibodies to CD99. Positive and negative control slides were run with each staining batch. Perinuclear dot-like and/or membranous staining was regarded as positive. The frequency of Ewing's sarcoma/peripheral neuroectodermal tumor differentiation in 56 FIGO grade 3 endometrioid carcinomas was also determined and 7% uterine serous and 12.5% of FIGO grade 3 endometrioid endometrial carcinomas showed Ewing's sarcoma/peripheral neuroectodermal tumor differentiation. Given the worse prognosis associated with Ewing's sarcoma/peripheral neuroectodermal tumor differentiation, even in neoplasms already at high risk for recurrence and metastasis, a high index of suspicion for Ewing's sarcoma/peripheral neuroectodermal tumor should be maintained in high-grade uterine serous carcinomas. [ABSTRACT FROM AUTHOR]

Background: Published reports have demonstrated that introduction of the ThinPrep Imaging System (Imager) to the cytology screening services has increased the detection rate of high-grade squamous intraepithelial lesions (HSILs). In accordance with recent clinical treatment guidelines, patients with atypical squamous or glandular cells of undetermined signiicance (ASC-US or AGUS) are often tested for high-risk HPV infection using the Hybrid Capture HPV DNA test. We took the opportunity to investigate whether the Imager had resulted in any significant differences in our diagnostic categories, as well as whether the Imager increased the detection of high-risk HPV-DNA-positive (HRHPV+) ASC-US or AGUS. Materials and Methods: Cytology cases with the diagnosis of ASC-US and AGUS were retrieved from the archival iles of our institution during periods of 11 months prior to and 11 months after the introduction of the Imager. The total number of cases in each category was correlated with results of relex high-risk HPV DNA testing when the latter were available. All AGUS diagnoses were correlated with subsequent biopsy follow-up. Statistical analyses were performed using the chi-Square test with Yate's Correction and Fisher's Exact test. Results: A total of 108,371 and 104,555 of ThinPrep Pap Test (TPPT) cases were reviewed during 11 months pre- and post-imager introduction. The ASC-US rate was 5.4% in the pre-Imager and 5.3% in the post-Imager period. The HPV relex test was 38% and 34% positive respectively in the pre- and post-Imager period (P>0.124). Similarly, 0.14% and 0.12% AGUS were found in the pre- and post-Imager period. The positive HPV relex test was 14% versus 23% (P = 0.1690). The abnormal biopsy follow-up rate in the AGUS category was increased from 20.9% in the pre-Imager period to 31% in the post-Imager period (P = 0.1471). The ASCUS/SIL ratios were 1.9 and 1.6 respectively. Conclusions: The ASC-US and AGUS rates did not change statistically before and after the introduction of the Imager in our cytology laboratory. Although use of the Imager did not increase detection of HPV+ ASC-US, it did appear to increase the detection rate of HPV+ AGUS and subsequent abnormal biopsy follow-up rates in all categories. However, the increase in the detection rate did not reach the point of statistical significance [ABSTRACT FROM AUTHOR]

To study the expression of HER2 in high-grade FIGO3 endometrial endometroid carcinoma (EEC) and to correlate our findings with the clinicopathologic characteristics of this tumor. HER2 expression by immunohistochemistry (IHC) was performed on 10% formalin-fixed paraffin embedded tissue on cases diagnosed as FIGO3 EEC. HER2 expression was interpreted as negative (0), low (1+ and 2+) or positive (3+) using similar criteria as in the breast. HER2 amplification by Fluorescence in situ hybridization (FISH) was performed on cases interpreted as 2+ and 3+ by IHC. One hundred and forty-three FIGO3 EEC were identified. Of these, 70 (49%) cases were HER2 negative (IHC 0), and 73 (51%) cases expressed/amplified HER2 by IHC and/or FISH. Of the 73 cases expressing or amplifying HER2, 59 cases were IHC 1+, 12 cases were IHC 2+, and 2 cases were IHC 3+. FISH testing was performed in 12 cases. Only one of the two HER2 IHC 3+ cases showed HER2 gene amplification by FISH and the other 11 cases were not amplified. The 5-year overall survival (OS) rate for HER2 IHC 1+ cases was 92.20% (95% CI: 83.97–100.00), and the 5-year OS rate for HER2 IHC 2+/3+ cases was 89.50% (95% CI: 56.41–100.00). Our findings indicate that about one half of FIGO3 EEC variably expresses HER2 and with the emerging concept of "HER2 low", anti-HER2 agents may be explored as potential therapeutic options in these patients, for possible survival benefits. [Display omitted] • About 50% of FIGO3 endometrial endometrioid carcinomas (EEC) express the HER2 protein with varying intensities. • Amplification or overexpression of HER2 in FIGO3 EEC is very low. • The therapeutic implication of low-level expression of HER2 in FIGO3 EEC is largely unknown. • Anti-HER2 therapy might be explored as a treatment option in low-level HER2 expression in FIGO3 EEC with potential benefits. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the pathogenesis of low-grade and high-grade serous carcinoma.

Presents a letter to the editor regarding a case of simplex type vulvar intraepithelial neoplasia.

During breast cancer staging, histological evaluation of axillary sentinel lymph nodes (SLN) is usually straightforward. However, the exact characterization of a small epithelial deposit in an SLN can be challenging, especially during the frozen section examination. We report the first case of endosalpingiosis involving bilateral axillary lymph nodes. We review published literature on axillary endosalpingiosis and discuss the differential diagnosis of small epithelial deposits in an axillary SLN. Pathologists should consider benign epithelial rests and displaced epithelium as differential diagnoses for the microscopic epithelial nodal deposit, especially during the frozen section examination. [ABSTRACT FROM AUTHOR]

The lobular carcinoma in situ (LCIS) subtypes include classic (CLCIS), pleomorphic (PLCIS), and florid LCIS (FLCIS). The CLCIS is considered a breast cancer risk factor, but clinical significance and natural history of other LCIS subtypes are unclear. The outcome data on PLCIS and FLCIS is limited. The aim of current study is to compare excision and follow‐up findings of CLCIS and nonclassic LCIS (NCLCIS). The breast needle biopsies (NBs) with LCIS during 01/2007‐12/2017 were identified. The imaging, clinical findings, and outcome were compared between CLCIS and NCLCIS. A total of 36 NBs from 32 patients with NCLCIS (14 PLCIS & 22 FLCIS) and 73 NBs from 68 patients with CLCIS were identified. The NCLCIS patients were older (57 vs 52 years; P =.02) and presented more often with calcifications (78% vs 44%; P =.01). Seven (19%) PLCIS were initially diagnosed as ductal carcinoma in situ (DCIS). The microscopic invasion was frequent with NCLCIS (25%). No invasion was identified in NBs with CLCIS. A separate concurrent NBs with a carcinoma (29% vs 6%; P =.018) or ductal atypia (12% vs 3%; P =.1) was more frequent with CLCIS. The upgrade rate (invasion or DCIS) was higher with NCLCIS (25% vs 4%). Four NCLCIS developed ipsilateral recurrences: 2 NCLCIS, 1 IDC, and 1 ILC (50; 10‐96 months). No breast event was reported in 24 pure CLCIS (60; 8‐144 months). Invasive carcinoma with NCLCIS, unlike CLCIS, is always lobular type. Recurrences following NCLCIS are ipsilateral lobular tumors. NCLCIS subtypes are nonobligate precursors to invasive lobular carcinoma. [ABSTRACT FROM AUTHOR]

Background: The incidence of abnormal cervical smears in the United Arab Emirates (UAE) is 3.6%. Data regarding specific high-risk HPV (hrHPV) genotypes are insufficient. Identification of hrHPV subtypes is essential to allow formulating effective vaccination strategies. Methods: A total of 75 archival cervical cone biopsies with HSIL or higher lesions (2012–2016) were retrieved from a tertiary hospital, including HSIL (n = 70), adenocarcinoma in-situ (n = 1) and squamous cell carcinoma (n = 4). Five tissue sections (10-μ-thick each) were cut and DNA extracted using the QIAamp DNA FFPE Tissue Kit. GenomeMeTM's GeneNavTM HPV One qPCR Kit was used for specific detection of HPV 16 and 18; and non-16/18 samples were typed by GenomeMeTM's GeneNavTM HPV Genotyping qPCR Kit. Results: Median age was 34 years (range 19–58) with 70% UAE Nationals. hrHPV detected were 16, 18, 31, 33, 35, 39, 45, 51, 52, 58, 59, 66 & 68. hrHPV testing was negative in 12% of cases. Most common types were HPV 16 (49%), HPV 31 (20%) and HPV 18 (6.6%). hrHPV 16 and/or 18 represented 56% and rare subtypes 32%. Co-infection was present in 16%. Eight cases had two-viral subtype infections and 4 cases had 3 subtype infections. Multi-viral HPV infection was limited to hrHPV 16, 18, 31 & 33 subtypes. Conclusions: Infection by non HPV 16/18 is fairly common. A higher than expected incidence of rare subtype (20% hrHPV31) and multi-viral hrHPV (16%) were detected. This finding stresses the importance of this pilot study as currently only quadravalent vaccine is offered to control the HPV infection in the UAE population. [ABSTRACT FROM AUTHOR]

The article focuses on study that determines the possible prognostic significance of the lymphocytic infiltration (LI) and subgroups of lymphocytes (CD3 and CD20) presence in the primary tumors of colon cancer. Topics discussed immunohistochemical phenotyping of the lymphocytes; patients operated for colorectal carcinoma; absence of correlation between any clinicopathological pattern; and prognosis that show influence of lymphocytes

The article presents a case study related to a 54-year-old woman with bilateral pelvic masses. She had undergone a total abdominal hysterectomy for fibroids several years earlier. Exploratory laparotomy and possible staging were planned. Intraoperative consultation was obtained, and a right-sided adnexal mass, and a leftsided adnexal mass were found. Both the tumors had similar gross appearance and microscopic features. Pathologic diagnosis was well-differentiated papillary serous carcinoma arising in serous adenofibroma of borderline malignancy. Such carcinomas are believed to have an indolent clinical course.

Immunohistochemistry confirmed the biphasic cellular nature of the tumor, not only in the excised lesion but also in the previous core needle biopsy. In the excised lesion, the inner cells of the tubules were positive for cytokeratin (AE1/AE3), carcinoembryonic antigen (CEA), and epithelial membrane antigen, but were negative for smooth muscle markers including smooth muscle actin and calponin, consistent with a ductal epithelial origin. The outer cells of the tubules and the cells in the solid nests were strongly positive for smooth muscle actin and calponin, weakly positive for AE1/AE3, but negative for CEA and epithelial membrane antigen, consistent with a myoepithelial origin.

Interpretation of this finding can be confusing resulting in significant interobserver variability even among gynecologic pathologists.[1] It is critical to distinguish bona fide clear cell carcinoma from other endometrial lesions as management is significantly different. The papillae were lined by a single layer of eosinophilic and clear cuboidal cells with hyperchromatic nuclei, focal hyalinization, and neutrophilic infiltration (Figure 2A). The tumor was positive for Napsin A (Figure 3B), consistent with endometrial clear cell carcinoma. [Extracted from the article]

Context.--: Human papillomavirus (HPV) in the postmenopausal age group is complex, with infected patients in this age group at increased risk of progressing to invasive disease and showing decreased clearance of the virus. Additionally, atrophic changes of the cervix can make histologic distinction of high-grade squamous intraepithelial lesions (HSILs) difficult. Objective.--: To determine morphologic and ancillary testing characteristics of atrophy and HSIL in postmenopausal patients. Design.--: Files of patients at least 65 years of age were examined, with 81 patients (109 cases [53 benign, 56 HSIL]) included in the study. Results of morphology, immunostaining (p16 and Ki-67), and HPV RNA in situ hybridization (ISH) were noted on all cases with available material. Results.--: Atrophy was present in 96 of 109 cases (88%) overall. Coarse nuclear chromatin was noted in none of the benign cases, in 19 of 30 HSIL biopsies (63%), and in 24 of 26 HSIL excisions (92%). All benign cases were negative for p16 and ISH. In the HSIL cases, 45 of 53 (89%) were positive for p16, and of cases with sufficient tissue for ISH, 44 of 45 (98%) were positive. Of the ISH/p16 discordant cases (n = 7), most were p16 negative/ISH positive (6 of 7; 86%), whereas 1 of 7 (14%) was p16 positive and ISH negative. A majority of HSIL cases showed near-full-thickness elevation of Ki-67 (45 of 54; 83%), whereas mitotic figures were less elevated. Conclusions.--: In postmenopausal patients with HSIL, mitotic activity is not reliably elevated, but Ki-67 is consistently high. ISH is a more direct method of HPV detection and should be considered in cases where morphology and immunolabeling show discordance. [ABSTRACT FROM AUTHOR]

(A) Alternating mucinous and ciliated epithelia, mucinous epithelia with cilia, acidic, blue mucin, and neutral mucin (hematoxylin and eosin [H&E] 40×); (B) Predominantly low columnar mucinous epithelia (H&E 40×); (C) Exceedingly tall columnar mucinous epithelia (H&E 40×); (D) Bird's eye view of the seromucinous cystadenoma (H&E 4×). Microscopic examination revealed a cystadenoma lined by 2 types of epithelia: tubal-type ciliated epithelium alternating with endocervical-type mucinous epithelium. Seromucinous tumors, introduced in the 2014 World Health Organization classification as one of the categories of ovarian epithelial tumors, are defined as neoplasms with 2 or more Müllerian epithelial cell types.[1] Benign tumors of this category are rare and may represent fewer than 1% of benign epithelial neoplasms of the ovary.[1],[2] We report a case of a 55-year-old female who presented with back pain and was found to have a complex cystic lesion of the left adnexa by computed tomography examination. [Extracted from the article]

The so-called "corkscrew"-shaped I Helicobacter heilmannii i , usually found in cats, pigs, and other primates, is a large (0.5 µm × 5-10 µm), strongly urease-positive, gram-negative rod accounting for 0.2% to 4% of human gastritis cases; hence, it is a candidate for zoonotic infection, along with I Campylobacter i , I Salmonella i , I Yersinia i , I Listeria i , among others.[1][2] [3] It causes a relatively milder form of gastritis clinically and histologically confined to the gastric antrum (Figure 1a and b). Like I H. pylori i , the organism stains with both polyclonal and monoclonal I H. pylori i immunohistochemical stains (Figure 1e). [Extracted from the article]

Combined blue nevus and benign nevus cells were identified in the same sentinel lymph node. Blue nevus alone was also present in an additional sentinel lymph node in the same axilla in a patient who underwent needle localization, wide local excision, and sentinel lymph node biopsy for her pT1cN1mi(sn)M(na) invasive duct carcinoma of the breast. Of the 4 sentinel lymph nodes, 1 showed micrometastasis and 2 other lymph nodes showed blue nevus involving the capsule and trabeculae of the nodes. The patient had no significant previous clinical history of any skin tumors and had a negative clinical examination for malignant melanoma or pigmented skin lesions after the diagnosis of nodal blue nevus. To our knowledge, this is the first case report of combined blue nevi involving multiple sentinel lymph nodes in the same axilla. An equally interesting finding is the presence of benign nonpigmented nevus cells in continuation with the blue nevus in the same node. [ABSTRACT FROM AUTHOR]

A 45 year old woman underwent Laparoscopy-assisted total hysterectomy with staging procedure following a diagnosis of endometrial endometrioid adenocarcinoma on her endometrial biopsy. The hysterectomy specimen showed a FIGO I stage 1a, endometrioid carcinoma. A separate polypoid lesion in the endometrium, distinct from the carcinoma, was also identified. Microscopicopically the polypoid lesion was "nodular histiocytic hyperplasia". The H&E, immunohistochemical staining findings and the differential diagnoses are discussed in this report. Although description of similar lesions is available in the literature, the current lesion is unique as it is identified in a hysterectomy specimen in its entirety and its association with an endometrial endometrioid carcinoma. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1060511915121922 [ABSTRACT FROM AUTHOR]

A 73-year-old woman was found to have a 1.7 cm axillary mass, for which a core needle biopsy was performed. The specimen revealed fragmented squamous epithelium surrounded by lymphoid tissue consistent with a squamous inclusion cyst in a lymph node, but a metastatic squamous cell carcinoma could not be excluded. Within one month, the lesion enlarged to 5 cm and was excised. Touch preparation cytology during intraoperative consultation displayed numerous single and sheets of atypical epithelioid cells with enlarged nuclei and occasional mitoses, suggesting a carcinoma. However, multinucleated giant cells and neutrophils in the background indicated reactive changes. We interpreted the touch preparation as atypical and recommended conservative surgical management. Permanent sections revealed a ruptured squamous inclusion cyst in a lymph node with extensive reactive changes. Retrospectively, the atypical epithelioid cells on touch preparation corresponded to reactive histiocytes. This is the first case report of a rapidly enlarging ruptured squamous inclusion cyst in an axillary lymph node following core needle biopsy. Our case demonstrates the diagnostic challenges related to a ruptured squamous inclusion cyst and serves to inform the readers to consider this lesion in the differential diagnosis for similar situations. [ABSTRACT FROM AUTHOR]

Endometrial intraepithelial neoplasia[1] and endometrial intraepithelial carcinoma (EIC)[2] are 2 known precursors of endometrioid and serous type endometrial carcinomas, respectively. Graph: Figure 1. 1a: Low magnification view of endometrial polyp with Clear cell carcinoma in-situ (CCEIC) (HEx2x); 1b. [Extracted from the article]

The article present a case study of a 63-year-old woman with abdominal discomfort and was found to have a large pelvic mass on imaging. It mentions Hysterectomy with bilateral salpingo-oophorectomy revealed a 13×10×5 cm intact right solid adnexal mass with attached dilated fallopian tube; and also mentions Gross inspection revealed a yellowish-white solid firm multilobulated mass with shiny outer surface.

The article presents a case study of a 57-year-old female presented with 2 left vulvar masses. It discusses the histological examinations revealed the Verrucous carcinoma (VC) as a histologic subtype of squamous cell carcinoma characterized by highly differentiated squamous cells with a bulbous invasive pattern of the underlying stroma often associated and confused with giant condyloma of Buschke-Löwenstein.

The article offers information on the challenges in the diagnosis of the fibroepithelial lesions of breast. Topics discussed include information on the breast lesions with epithelial and spindle cell components including the fibroadenoma, phyllodes tumor and the nodular pseudoangiomatous stromal hyperplasia (NPASH); discussions on the uniform stromal cellularity and minimal epithelial proliferation in NPASH.

The article presents a case study of 40-year-old woman with a history of abnormal uterine bleeding and trapped endometrial stromal cells created an appearance of small oval nuclei. Her immunohistochemical staining for CD10 displayed diffuse cytoplasmic staining in the endometrial stroma and mucin and glycogen stains were negative. It mentions endometrium pneumatosis (EP) has been proposed to be associated with possible infection and mucosal disruption.

: BackgroundNeoadjuvant chemotherapy may decrease tumor volume to allow breast conservation surgery. Its effect on estrogen and progesterone receptor (ER/PR) expression and hormone receptor (HR) status is controversial.: MethodsFrom February 2001 to July 2002, 56 breast cancer patients treated with neoadjuvant chemotherapy and 56 non-neoadjuvant therapy (control) patients with adequate tissue samples were identified. Quantitative ER/PR expression was analyzed in preneoadjuvant or preoperative core biopsies and final surgical specimens. Changes between the two groups were compared to determine if alterations were due to neoadjuvant chemotherapy or tissue sampling.: ResultsThe ER/PR expression changed in 34 (61%) neoadjuvant chemotherapy patients and 27 (48%) control patients. These expression changes resulted in HR status (positive/negative) alterations in 3 patients (5%) in both groups. Age, histology, chemotherapy regimen, and neoadjuvant response did not predict change.: ConclusionsHormone receptor status changed in 5% of neoadjuvant chemotherapy and control groups due to tissue sampling. As these changes may impact treatment, HR expression reanalysis in final surgical specimens is recommended. [Copyright &y& Elsevier]

Gastric-type adenocarcinomas of the uterine cervix have been described within the literature in detail; however, the description of gastric-type endometrial adenocarcinomas is a recent development, with only two cases originating from Japan in the world literature to date. According to these prior reports, the recognition of this pattern of differentiation is critical, as it is often associated with deep myoinvasion, positive regional lymph nodes, and poor outcome despite appropriate adjuvant treatment. We present two cases of endometrial adenocarcinoma with gastric-type differentiation in patients from the United States with superficial myoinvasion and positive patient outcomes. Gastric-type differentiation in endometrial adenocarcinomas is rare and likely underrecognized. Continued reporting of these cases is necessary to further understand the natural history and clinical implications of this entity. [ABSTRACT FROM AUTHOR]

Objectives The entity of ‘surface epithelial changes’ (SECs) was first described in 1995 [1]. Morphologically, SECs usually arise from malignant glands at the superficial aspect of well differentiated (WD) endometrioid carcinomas (ECs) and impart the appearance of a ‘maturational’ phenomenon at the surface of the cancer. Exhibiting a paradoxically bland histologic appearance, SECs typically show morphologic features that mimic benign entities, particularly endocervical microglandular hyperplasia (MGH). SECs have been associated with approximately half of WD endometrioid carcinomas many of which showed focal mucinous differentiation. Despite their morphologically benign histology, some have questioned whether the presence of SECs represents a ‘marker’ for an underlying malignancy, especially in postmenopausal women with endocervical or MGH-type SECs in their endometrial sampling. Since the biologic nature of SECs is unknown, we aimed to study the prevalence of KRAS gene mutations in SECs and the underlying WD endometrioid adenocarcinomas (EC) from which they directly arise. Methods 24 cases with biopsy proven SECs and ECs in their subsequent hysterectomy were retrieved. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissue. PCR amplification for KRAS codons 12 and 13 was performed, followed by sequencing using capillary electrophoresis. Results KRAS codons 12 and 13 mutations were detected in 19 of 24 (79%) SECs, and 19 of 24 (79%) ECs. All SECs had the same KRAS mutation as the underlying EC. Conclusions Our results suggest that SECs are of neoplastic origin and that KRAS mutations play an important role in the tumorigenesis of ECs and SECs. [ABSTRACT FROM AUTHOR]

The article discusses the characteristic inside-out pattern in invasive micropapillary carcinoma (IMPC) of the breast. It mentions that IMPC of the breast is a distinct histological variant of ductal carcinoma. It outlines the advantage of p120 immunohistochemical staining over epithelial membrane antigen (EMA) immunohistochemical staining which is the purely membranous expression that offers a cleaner background than EMA.

Clear cell carcinomas (CCC) of themullerian systemare considered high grade tumors, but morphologically, the cells of CCC show both low and high grade features. The aims of the current study were to categorize CCC into low and high nuclear grade types, correlate their association with endometriosis, and then observe possible variations in pathogenesis based on their expression of p53 and Ki-67. We studied 41 pure mullerian CCCs and designated each as either a high (HNG) or low (LNG) nuclear grade tumor. Morphologically, 17 (41%) CCCs were LNG and 24 (59%) were HNG. Nine (38%) HNG and 2 (12%) LNG tumors showed positive immunostaining with p53. Endometriosis was associated with 8 (47%) LNG tumors and 8 (33%) HNG CCCs. Of the 11 cases with p53 alteration, 4 (1 LNG and 3 HNG) were associated with endometriosis. Conclusions: HNG CCCs, irrespective of their association with endometriosis, have alterations of p53. In general, LNG ovarian and endometrial CCCs, irrespective of their association with endometriosis/adenomyosis, are less likely to show p53 alteration. It appears that mullerian CCCs may have variable pathogenesis depending on their nuclear grade and association with endometriosis. A larger study is needed to validate these findings. [ABSTRACT FROM AUTHOR]

Clear cell carcinomas (CCC) of themullerian systemare considered high grade tumors, but morphologically, the cells of CCC show both low and high grade features. The aims of the current study were to categorize CCC into low and high nuclear grade types, correlate their association with endometriosis, and then observe possible variations in pathogenesis based on their expression of p53 and Ki-67. We studied 41 pure mullerian CCCs and designated each as either a high (HNG) or low (LNG) nuclear grade tumor. Morphologically, 17 (41%) CCCs were LNG and 24 (59%) were HNG. Nine (38%) HNG and 2 (12%) LNG tumors showed positive immunostaining with p53. Endometriosis was associated with 8 (47%) LNG tumors and 8 (33%) HNG CCCs. Of the 11 cases with p53 alteration, 4 (1 LNG and 3 HNG) were associated with endometriosis. Conclusions: HNG CCCs, irrespective of their association with endometriosis, have alterations of p53. In general, LNG ovarian and endometrial CCCs, irrespective of their association with endometriosis/adenomyosis, are less likely to show p53 alteration. It appears that mullerian CCCs may have variable pathogenesis depending on their nuclear grade and association with endometriosis. A larger study is needed to validate these findings. [ABSTRACT FROM AUTHOR]

We encountered two cases of endometrioid carcinoma of uterus with extensive surface epithelial changes (SECs) mimicking serous borderline tumor (SBT) of the ovary. The first case was a well-differentiated endometrioid carcinoma arising in a background of complex atypical hyperplasia. The second case was moderately-differentiated endometrioid carcinoma with squamous and mucinous differentiation. The SECs comprised of thin microapapillae without hierarchal branching, lined by cuboidal cells with eosinophilic cytoplasm and mild to moderate nuclear atypia. These areas were reminiscent of SBTs of ovary, micropapillary type. This report expands the existing spectrum of SECs. Serous borderline tumor of ovary like surface epithelial changes could be misleading if present in an endometrial biopsy or curettings. Therefore, knowledge of this morphologic variation is important. [ABSTRACT FROM AUTHOR]

Background: Selenium has been shown to inhibit cancer development and growth through the mediation of selenium-binding proteins. Decreased expression of selenium-binding protein 1 has been reported in cancers of the prostate, stomach, colon, and lungs. No information, however, is available concerning the roles of selenium-binding protein 1 in uterine leiomyoma. Methods: Using Western Blot analysis and immunohistochemistry, we examined the expression of selenium-binding protein 1 in uterine leiomyoma and normal myometrium in 20 patients who had undergone hysterectomy for uterine leiomyoma. Results and Discussion: The patient age ranged from 34 to 58 years with a mean of 44.3 years. Proliferative endometrium was seen in 8 patients, secretory endometrium in 7 patients, and atrophic endometrium in 5 patients. Two patients showed solitary leiomyoma, and eighteen patients revealed 2 to 5 tumors. Tumor size ranged from 1 to 15.5 cm with a mean of 4.3 cm. Both Western Blot analysis and immunohistochemistry showed a significant lower level of selenium-binding protein 1 in leiomyoma than in normal myometrium. Larger tumors had a tendency to show a lower level of selenium-binding protein 1 than smaller ones, but the difference did not reach a statistical significance. The expression of selenium-binding protein 1 was the same among patients with proliferative, secretory, and atrophic endometrium in either leiomyoma or normal myometrium. Also, we did not find a difference of selenium-binding protein 1 level between patients younger than 45 years and older patients in either leiomyoma or normal myometrium. Conclusions: Decreased expression of selenium-binding protein 1 in uterine leiomyoma may indicate a role of the protein in tumorigenesis. Our findings may provide a basis for future studies concerning the molecular mechanisms of selenium-binding protein 1 in tumorigenesis as well as the possible use of selenium in prevention and treatment of uterine leiomyoma. [ABSTRACT FROM AUTHOR]

Stromal invasion is identified with difficulty in routine hematoxylin-eosin-stained sections of core needle biopsy specimens from mammary intracystic papillary carcinomas. The goal of this study was to determine if nuclear grade, mitotic activity, and immunohistochemical stains for p53 and cyclin D1 would assist in differentiating intracystic papillary carcinomas without stromal invasion (ICPC) from tumors with stromal invasion (ICPC-INVA). Eight cases of ICPC and 12 cases of ICPC-INVA were reviewed. Hematoxylin-eosin slides were examined to determine the histologic features. Immunohistochemistry was performed using monoclonal antibodies to human p53 and cyclin D1. Fisher's exact test was used to compare the nuclear grade, mitotic activity, and immunoreactivity between ICPC and ICPC-INVA. High nuclear grade was more often associated with ICPC-INVA than with ICPC, although the difference was not statistically significant (p = 0.069). Frequent mitotic activity was associated with ICPC-INVA more than with ICPC (p = 0.0198). All cases of ICPC were negative for either p53 or cyclin D1, whereas 7 of 12 cases (58.3%) of ICPC-INVA were positive for either cyclin D1 alone (3 cases), p53 alone (3 cases), or both cyclin D1 and p53 (1 case) (p = 0.0147). Identical nuclear grade, mitotic activity, and immunostaining patterns were seen in the intracystic and the invasive components, and in the core biopsy and the excision of the same tumor. When any one of the positive indicators (high nuclear grade, frequent mitotic activity, or positive immunostains for cyclin D1 and/or p53) was present, the positive predictive value for stromal invasion was 91.7%. When none of the positive indicators was present, the negative predictive value was 87.5%. [ABSTRACT FROM AUTHOR]

The article presents a study conducted on the Squamous differentiation (SQD) which involves breast carcinoma with the following of neo‐adjuvant chemotherapy (NACT) and adjuvant radiation therapy (RT). It reports on the effect of the therapy and tumor heterogeneity of SOD. A case of invasive ductal carcinoma (IDC) was analysed which identified SQD following NACT and pathological and clinical features.

The article discusses a case study of a 74-year-old postmenopausal woman who was diagnosed with cystic hypersecretory hyperplasia (CHH). Particular focus is given on the diagnosis of the disease and microscopic examination of the patient with subareolar palpable breast mass. It also presents several images which show CHH of breast.

Liesagang-like rings (LR) are periodic structures with equally spaced radial striations formed by a process that involves diffusion, nucleation, flocculation or precipitation, and supersaturation. Being more common in vitro, on rare occasions also reported in vivo in association with inflammatory or cystic lesions and confused with parasites or calcification on needle aspirates. The current paper documents that LRs may be seen in noncystic and noninflammatory changes of the breast. [ABSTRACT FROM AUTHOR]

Introduction: The nature of inverted follicular keratoses (IFKs) is disputed, with some suggesting that they represent a variant of verruca or seborrheic keratosis. While both verruca and genital seborrheic keratoses have been associated with human papillomavirus (HPV), no HPV association has been reported in extragenital IFKs. Furthermore, vulvar IFKs have not been separately examined for HPV. We aimed to detect and compare the type-distribution of high-risk HPVs (hrHPVs) in vulvar and extragenital IFKs using a PCR-based detection method. Methods: Vulvar and extragenital IFKs from 2014 to 2016 from patients without prior history of HPV-associated lesions were identified and reviewed. Cases with greater than 90% lesional tissue were selected for DNA extraction and assessed for adequate DNA yield. Each case was assayed using the GeneNav HPV One kit (GenomeMe, Richmond, BC, Canada) for HPV16 and HPV18 with nonspecific detection of other hrHPVs. Cases demonstrating other hrHPV types were genotyped using the GeneNav HPV genotyping kit. Immunohistochemical staining for p16 and Ki67 was also performed. Results: Twenty-six cases including four vulvar IFKs (4/26, 15.4%) meeting study criteria were identified. There were no appreciable morphologic differences between the vulvar and extragenital lesions. All four vulvar IFK cases (4/4, 100%) were positive for HPV16. Two of these were concurrently positive for HPV18 (2/4, 50%). Other hrHPV subtypes were not detected. HPV was not detected in any of the 22 extragenital IFKs. Immunohistochemical staining for p16 in all of the hrHPV-positive cases revealed strong diffuse staining with a high Ki-67 proliferation index. In contrast, the HPV-negative extragenital cases showed only patchy p16 and low K-67 expression. Conclusion: Although morphologically similar to extragenital non-HPV related lesions, vulvar IFKs appear to harbor hrHPVs, including HPV16, and should be considered as a previously unreported morphologic variant of high-grade vulvar intraepithelial lesion. [ABSTRACT FROM AUTHOR]

The article focuses on a study conducted by the authors on presence of cell polarity reversal in low-grade serous carcinomas (LGSCs) and micropapillary serous borderline tumours (M-SBTs) with application of immunohistochemical markers. Topics discussed include micropapillary growth patterns of LGSCs and M-SBTs, usage of epithelial cadherin (E-cadherin) for identifying cell polarity reversal and circumferential staining of boderline tumors.