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Hemangioma of the ovary: a clinicopathologic, immunohistochemical and cytogenetic analysis of 10 cases
S86
Pathology (2014), 46(S2)
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Background: Ectopic pregnancy is a major health problem among women of reproductive age and is a major gynaecological emergency that requires prompt diagnosis and treatment. It has been estimated that less than half of the affected women will conceive again, only a third can achieve a live birth and a risk of repeat ectopic pregnancy is 1 in 20 in subsequent pregnancies. On the global scene, a rising incidence has been observed in the last two decades and this has been attributed to an increase in the incidence of sexually transmitted diseases and the use of contraceptives. Aim: To determine the prevalence, mode of presentation and forms of ectopic pregnancy. Method: This is a four year retrospective study of ectopic pregnancy cases managed in the hospital between 1 January 2009 and 31 December 2012. Results: A total of 44 ectopic pregnancy cases were received during the four year period. The total gynaecological and pregnancy-related specimens were 1082 and 410, respectively. Ectopic pregnancy accounted for 4.1% of all the gynaecological and 10.7% of pregnancy-related specimens received in the laboratory. Age range was 16–40 years with a peak age distribution in the 3rd decade (61.4%). The most common site of involvement was the left fallopian tube (34.1%), an infrequent site was the ovary (4.6%) while in (31.8%) site was not specified. There was rupture in 56.8% of the cases while 43.2% were unruptured. The triad of amenorrhoea, abdominal pain and vaginal bleeding was the most common mode of presentation (52.3%). Conclusion: Ectopic pregnancy is still a major health problem among women of reproductive age group. The rate of tubal rupture associated with ectopic pregnancy can be reduced through creation of better awareness of this condition in this environment, as this will ensure early presentation and prompt intervention.
Gynecologic Pathology: Poster#148 EXPRESSION OF PROTEIN REGENERATING LIVER-3 (PRL-3) AND VEGF IN OVARIAN EPITHELIAL CANCER AND METASTATIC SITE Upik Anderiani Miskad1, Sharvianty Arifuddin2, Syahrul Rauf2 and Syarifuddin Wahid1 1Department of Pathology, and 2Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia Background: PRL-3 (phosphatase of regenerating liver-3) and VEGF have been reported to play a role in the growth and metastasize of some cancers, including ovarian cancer. Aims: To investigate the expression of PRL-3 and VEGF in ovarian epithelial cancer, metastatic tumor and correlate with the clinicopathologic parameters. Methods: Expressions of PRL-3 and VEGF in 40 ovarian epithelial cancer specimens and 25 omentum metastasis site were detected by immunohistochemistry. RT-PCR was also performed to detect PRL-3 mRNA from ascites. Results: PRL-3 mRNA expression was clearly detected in the ascites of ovarian cancer patient positive metastasis compare with ovarian cancer without metastasis. Among ovarian epithelial cancer, there were 7 (17.5%) endometrioid, 11 (27.5%) mucinous and 22 (55%) samples of serous tumor. The expression of PRL-3 and VEGF was significantly higher in the primary ovarian epithelial
cancer with omentum metastasis than primary tumor without metastasis ( p ¼ 0.031, p ¼ 0.036). There was no significant correlation between PRL-3, VEGF expression and histological type, histological grade, and stadium. Conclusions: These results strongly suggest that PRL-3 and VEGF may play a significant role in invasion and metastasis of ovarian epithelial cancer. PRL-3 might be a novel molecular marker for aggressive ovarian cancer and act as a poor prognostic factor.
Gynecologic Pathology: Poster#149 GESTATIONAL NON-TROPHOBLASTIC CANCERS Daksha Prabhat, Pradeep Vaideeswar, Rushabh Shah, Pragati Sathe, Lalita Patel and Naina Goel Department of Pathology, Seth GS Medical College, Mumbai, India Non-trophoblastic cancers complicating pregnancy are rare with an incidence of approximately 1 in 1000 pregnancies, common sites being female genital tract and breast. We report a series of seven pregnancy associated cancers in a six year period (2009–2014). The patients ranged in age from 22–38 years (mean age 27.7 years). An antemortem diagnosis was made in four patients, the gestational age ranging from 12 weeks to 28 weeks. They presented with mass lesions and site associated symptoms. These included dysgerminoma of the left ovary, serous papillary tumour of borderline malignancy involving the right ovary, angiosarcoma of the left breast and left frontal anaplastic oligodendroglioma. Surgical excision was performed in all four cases with two postoperative deaths. The remaining three cancers were encountered at autopsy, the gestational age ranging from 31–37 weeks. These patients presented with acute febrile illness, dysphagia with multiple subcutaneous nodules and generalized weakness which were due to pulmonary giant cell carcinoma, esophageal adenosquamous carcinoma and hematologic malignancy, respectively. Cancers associated with pregnancy tend to have aggressive course with poor prognosis.
Gynecologic Pathology: Poster#150 HEMANGIOMA OF THE OVARY: A CLINICOPATHOLOGIC, IMMUNOHISTOCHEMICAL AND CYTOGENETIC ANALYSIS OF 10 CASES John K. Schoolmeester1, Andrew L. Folpe1, Patricia T. Greipp1, Gary L. Keeney1 and Robert A. Soslow2 1Mayo Clinic, Rochester, MN, United States, and 2Memorial Sloan Kettering Cancer Center, New York, NY, United States Background: The morphologic features and natural history of ovarian hemangioma are not fully elucidated. A novel EWSR1NFATC1 fusion was recently reported in a hemangioma of bone.1 We characterized the clinicopathologic and cytogenetic features of the largest series of ovarian hemangiomas to date. Methods: Ten cases coded as hemangioma involving the ovary were studied. Clinical history was obtained for every case. Seven cases were immunohistochemically stained. FISH was performed on seven cases utilizing a laboratory developed break apart probe for EWSR1.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
IAP 2014 ABSTRACTS
Results: Patient age range was 48–87 years. Tumor size range was 0.4–5.0 cm. Seven cases were cavernous type and three were mixed cavernous and capillary types. Each expressed CD31, CD34, FLI-1, ERG but not D2–40. Follow up ranged from 1–139 months. All patients were disease free. All cases were negative for EWSR1 rearrangement; however, two cases demonstrated additional intact copies of EWSR1 indicating aneusomy 22 or a structural abnormality of chromosome 22. Conclusions: Ovarian hemangiomas are benign neoplasms that may achieve large size, clinically and radiologically mimicking malignancy. The histologic features of ovarian hemangiomas are similar to those of other sites. Although hemangiomas of the ovary do not appear to harbor EWSR1 rearrangements, a subset contain abnormalities of chromosome 22 Reference 1. Arbajian E, Magnusson L, Brosjo¨ O. A benign vascular tumor with a new fusion gene: EWSR1-NFATC1 in hemangioma of the bone. Am J Surg Pathol 2013; 37: 613–6.
Gynecologic Pathology: Poster#151 HISTOMORPHIC AND DEMOGRAPHIC PROFILE OF PATIENTS WITH OVARIAN NEOPLASMS AT A TERTIARY GOVERNMENT HOSPITAL IN MANILA Eric Manila Mirandilla and Sergio P. Paguio Ospital ng Maynila Medical Center, Manila, the Philippines Ovarian neoplasms have been an important health issue. Ovarian carcinoma is the ninth most common cancer in women and is the fifth ranked cause of cancer deaths among women. The objective of this study is to determine the histomorphic and demographic profile of patients with ovarian neoplasms at Ospital ng Maynila Medical Center from the years 2010–2012. This is an epidemiological descriptive study in which all the ovarian neoplasms, from the years 2010–2012 were included. There was a total of 141 cases of ovarian neoplasms: 117 were benign (83%), 22 were malignant (16%) and two were borderline (1%). The most common benign neoplasm was mature cystic teratoma with 70 cases (50%) out of 117. Among the malignant neoplasms, mucinous cystadenocarcinoma was the most common with 8 cases (36%) out of 22. Age distribution among the benign ovarian neoplasms fell on the 21–30 year age range. For the malignant neoplasms, the majority fell on the 41–50 year age range based on the 22 cases of ovarian malignancies. The mean age of diagnosis was 49 years old.
References 1. Laudico AV, Mirasol-Lumague MR, Mapua CA, et al. Cancer incidence and survival in Metro Manila and Rizal Province, Philippines, 2010. Jpn J Clin Oncol 2010; 40: 603–12. 2. International Agency for Cancer Research (IARC). GLOBOCAN 2012: Estimated Cancer Incidence, Prevalence and Moratality Worldwide in 2012. Lyon, IARC, 2012.
Gynecologic Pathology: Poster#152 HYDATID CYST OF THE UTERUS (A CASE REPORT) Fatima Salih Ali1, Ahmed Mohamed Bahar2 and Abdulrahman El sheikh Mohamed3
S87
1Department of Histopathology, National Health Laboratory, Khartoum, Sudan, 2Department of Obstetrics and Gynecology, Fadail Hospital, Khartoum, Sudan, and 3Department of
Medicine, Royal Hospital, Khartoum, Sudan Echinococcosis or hydatid cyst disease is a common parasitic disease. Echinococcosis manifests as a cyst formation. It is caused by E. granulosis. We present a case report of a hydatid cyst of the uterus.The patient was a 35-year-old female, gravida 2. She presented with abdominal distension and lower abdominal pain for 6 months. Her bowel habits were normal and she had no gastrointestinal symptoms or urinary symptoms. Her periods were regular and heavy, but there was no dysmenorrhea. She had no past history of gastrointestinal disease or any disease of note. Laparotomy showed a cystic mass football size continuous with the uterus. Both tubes and ovaries were normal. The mass contained clear fluid and white membrane. The false capsule was removed and cavity curetted. No other cysts were detected in the abdomen. The abdomen was closed in layers. The histology showed a hydatid cyst composed of laminated acellular membrane and single layer of germinal epithelium with multiple broad capsules and scolices. The patient had an uneventful postoperative course and was referred to an internist for treatment of the hydatid disease. She was put on albendazole and praziquantel.
Gynecologic Pathology: Poster#153 IMMUNOPHENOTYPIC COMPARISON OF CK7 AND CK5 IN NORMAL AND NEOPLASTIC FALLOPIAN TUBE MUCOSA Suchanan Hanamornroongruang1, Brooke E. Howitt2, Gang Ning3, Christopher P. Crum2 and Wa Xian3 1Mahidol Hospital, Bangkok, Thailand, 2Brigham and Womens Hospital, Boston, MA, USA, and 3Jackson Laboratory for Genomic Medicine, Farmington, CT, USA In the lower genital tract, CK7 is most strongly expressed in the cervical squamocolumnar junction and surface endometrial lining suggesting a link to progenitor cells; CK5 is typically expressed in basal and reserve cells and related proliferations. Both are expressed in the mesothelium. We studied 38 benign and neoplastic tissue sections from 18 high grade serous carcinomas (HGSCs) and clonogenic cell cultures from adult and fetal fallopian tube. CK7þ cells in vitro behaved as progenitor cells, becoming CK7- upon ciliated or basal (CK5þ) differentiation. In normal tube, CK7þ was most intense in the apices and sides of the plicae and occasionally diffuse in atrophic epithelium. In intramucosal (STICs) and invasive HGSCs, CK7þ was typically non-uniform and strongest on the luminal borders, while CK5 staining was usually less intense albeit occasionally strong. These findings support a model where progenitor CK7þ cells give rise to CK5þ in both benign and malignant tubal epithelium. In this model, the apical localization of CK7þ suggests that progenitor-type cells in this setting might actually be luminal rather than basal. Given the unique location of CK7þ to CK5þ transitions in the fimbria, the possibility of a novel tumorigenic pathway near the Mullerian-mesothelial junction bears further study.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
Pathology (2014), 46(S2)
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Background: Ectopic pregnancy is a major health problem among women of reproductive age and is a major gynaecological emergency that requires prompt diagnosis and treatment. It has been estimated that less than half of the affected women will conceive again, only a third can achieve a live birth and a risk of repeat ectopic pregnancy is 1 in 20 in subsequent pregnancies. On the global scene, a rising incidence has been observed in the last two decades and this has been attributed to an increase in the incidence of sexually transmitted diseases and the use of contraceptives. Aim: To determine the prevalence, mode of presentation and forms of ectopic pregnancy. Method: This is a four year retrospective study of ectopic pregnancy cases managed in the hospital between 1 January 2009 and 31 December 2012. Results: A total of 44 ectopic pregnancy cases were received during the four year period. The total gynaecological and pregnancy-related specimens were 1082 and 410, respectively. Ectopic pregnancy accounted for 4.1% of all the gynaecological and 10.7% of pregnancy-related specimens received in the laboratory. Age range was 16–40 years with a peak age distribution in the 3rd decade (61.4%). The most common site of involvement was the left fallopian tube (34.1%), an infrequent site was the ovary (4.6%) while in (31.8%) site was not specified. There was rupture in 56.8% of the cases while 43.2% were unruptured. The triad of amenorrhoea, abdominal pain and vaginal bleeding was the most common mode of presentation (52.3%). Conclusion: Ectopic pregnancy is still a major health problem among women of reproductive age group. The rate of tubal rupture associated with ectopic pregnancy can be reduced through creation of better awareness of this condition in this environment, as this will ensure early presentation and prompt intervention.
Gynecologic Pathology: Poster#148 EXPRESSION OF PROTEIN REGENERATING LIVER-3 (PRL-3) AND VEGF IN OVARIAN EPITHELIAL CANCER AND METASTATIC SITE Upik Anderiani Miskad1, Sharvianty Arifuddin2, Syahrul Rauf2 and Syarifuddin Wahid1 1Department of Pathology, and 2Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia Background: PRL-3 (phosphatase of regenerating liver-3) and VEGF have been reported to play a role in the growth and metastasize of some cancers, including ovarian cancer. Aims: To investigate the expression of PRL-3 and VEGF in ovarian epithelial cancer, metastatic tumor and correlate with the clinicopathologic parameters. Methods: Expressions of PRL-3 and VEGF in 40 ovarian epithelial cancer specimens and 25 omentum metastasis site were detected by immunohistochemistry. RT-PCR was also performed to detect PRL-3 mRNA from ascites. Results: PRL-3 mRNA expression was clearly detected in the ascites of ovarian cancer patient positive metastasis compare with ovarian cancer without metastasis. Among ovarian epithelial cancer, there were 7 (17.5%) endometrioid, 11 (27.5%) mucinous and 22 (55%) samples of serous tumor. The expression of PRL-3 and VEGF was significantly higher in the primary ovarian epithelial
cancer with omentum metastasis than primary tumor without metastasis ( p ¼ 0.031, p ¼ 0.036). There was no significant correlation between PRL-3, VEGF expression and histological type, histological grade, and stadium. Conclusions: These results strongly suggest that PRL-3 and VEGF may play a significant role in invasion and metastasis of ovarian epithelial cancer. PRL-3 might be a novel molecular marker for aggressive ovarian cancer and act as a poor prognostic factor.
Gynecologic Pathology: Poster#149 GESTATIONAL NON-TROPHOBLASTIC CANCERS Daksha Prabhat, Pradeep Vaideeswar, Rushabh Shah, Pragati Sathe, Lalita Patel and Naina Goel Department of Pathology, Seth GS Medical College, Mumbai, India Non-trophoblastic cancers complicating pregnancy are rare with an incidence of approximately 1 in 1000 pregnancies, common sites being female genital tract and breast. We report a series of seven pregnancy associated cancers in a six year period (2009–2014). The patients ranged in age from 22–38 years (mean age 27.7 years). An antemortem diagnosis was made in four patients, the gestational age ranging from 12 weeks to 28 weeks. They presented with mass lesions and site associated symptoms. These included dysgerminoma of the left ovary, serous papillary tumour of borderline malignancy involving the right ovary, angiosarcoma of the left breast and left frontal anaplastic oligodendroglioma. Surgical excision was performed in all four cases with two postoperative deaths. The remaining three cancers were encountered at autopsy, the gestational age ranging from 31–37 weeks. These patients presented with acute febrile illness, dysphagia with multiple subcutaneous nodules and generalized weakness which were due to pulmonary giant cell carcinoma, esophageal adenosquamous carcinoma and hematologic malignancy, respectively. Cancers associated with pregnancy tend to have aggressive course with poor prognosis.
Gynecologic Pathology: Poster#150 HEMANGIOMA OF THE OVARY: A CLINICOPATHOLOGIC, IMMUNOHISTOCHEMICAL AND CYTOGENETIC ANALYSIS OF 10 CASES John K. Schoolmeester1, Andrew L. Folpe1, Patricia T. Greipp1, Gary L. Keeney1 and Robert A. Soslow2 1Mayo Clinic, Rochester, MN, United States, and 2Memorial Sloan Kettering Cancer Center, New York, NY, United States Background: The morphologic features and natural history of ovarian hemangioma are not fully elucidated. A novel EWSR1NFATC1 fusion was recently reported in a hemangioma of bone.1 We characterized the clinicopathologic and cytogenetic features of the largest series of ovarian hemangiomas to date. Methods: Ten cases coded as hemangioma involving the ovary were studied. Clinical history was obtained for every case. Seven cases were immunohistochemically stained. FISH was performed on seven cases utilizing a laboratory developed break apart probe for EWSR1.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
IAP 2014 ABSTRACTS
Results: Patient age range was 48–87 years. Tumor size range was 0.4–5.0 cm. Seven cases were cavernous type and three were mixed cavernous and capillary types. Each expressed CD31, CD34, FLI-1, ERG but not D2–40. Follow up ranged from 1–139 months. All patients were disease free. All cases were negative for EWSR1 rearrangement; however, two cases demonstrated additional intact copies of EWSR1 indicating aneusomy 22 or a structural abnormality of chromosome 22. Conclusions: Ovarian hemangiomas are benign neoplasms that may achieve large size, clinically and radiologically mimicking malignancy. The histologic features of ovarian hemangiomas are similar to those of other sites. Although hemangiomas of the ovary do not appear to harbor EWSR1 rearrangements, a subset contain abnormalities of chromosome 22 Reference 1. Arbajian E, Magnusson L, Brosjo¨ O. A benign vascular tumor with a new fusion gene: EWSR1-NFATC1 in hemangioma of the bone. Am J Surg Pathol 2013; 37: 613–6.
Gynecologic Pathology: Poster#151 HISTOMORPHIC AND DEMOGRAPHIC PROFILE OF PATIENTS WITH OVARIAN NEOPLASMS AT A TERTIARY GOVERNMENT HOSPITAL IN MANILA Eric Manila Mirandilla and Sergio P. Paguio Ospital ng Maynila Medical Center, Manila, the Philippines Ovarian neoplasms have been an important health issue. Ovarian carcinoma is the ninth most common cancer in women and is the fifth ranked cause of cancer deaths among women. The objective of this study is to determine the histomorphic and demographic profile of patients with ovarian neoplasms at Ospital ng Maynila Medical Center from the years 2010–2012. This is an epidemiological descriptive study in which all the ovarian neoplasms, from the years 2010–2012 were included. There was a total of 141 cases of ovarian neoplasms: 117 were benign (83%), 22 were malignant (16%) and two were borderline (1%). The most common benign neoplasm was mature cystic teratoma with 70 cases (50%) out of 117. Among the malignant neoplasms, mucinous cystadenocarcinoma was the most common with 8 cases (36%) out of 22. Age distribution among the benign ovarian neoplasms fell on the 21–30 year age range. For the malignant neoplasms, the majority fell on the 41–50 year age range based on the 22 cases of ovarian malignancies. The mean age of diagnosis was 49 years old.
References 1. Laudico AV, Mirasol-Lumague MR, Mapua CA, et al. Cancer incidence and survival in Metro Manila and Rizal Province, Philippines, 2010. Jpn J Clin Oncol 2010; 40: 603–12. 2. International Agency for Cancer Research (IARC). GLOBOCAN 2012: Estimated Cancer Incidence, Prevalence and Moratality Worldwide in 2012. Lyon, IARC, 2012.
Gynecologic Pathology: Poster#152 HYDATID CYST OF THE UTERUS (A CASE REPORT) Fatima Salih Ali1, Ahmed Mohamed Bahar2 and Abdulrahman El sheikh Mohamed3
S87
1Department of Histopathology, National Health Laboratory, Khartoum, Sudan, 2Department of Obstetrics and Gynecology, Fadail Hospital, Khartoum, Sudan, and 3Department of
Medicine, Royal Hospital, Khartoum, Sudan Echinococcosis or hydatid cyst disease is a common parasitic disease. Echinococcosis manifests as a cyst formation. It is caused by E. granulosis. We present a case report of a hydatid cyst of the uterus.The patient was a 35-year-old female, gravida 2. She presented with abdominal distension and lower abdominal pain for 6 months. Her bowel habits were normal and she had no gastrointestinal symptoms or urinary symptoms. Her periods were regular and heavy, but there was no dysmenorrhea. She had no past history of gastrointestinal disease or any disease of note. Laparotomy showed a cystic mass football size continuous with the uterus. Both tubes and ovaries were normal. The mass contained clear fluid and white membrane. The false capsule was removed and cavity curetted. No other cysts were detected in the abdomen. The abdomen was closed in layers. The histology showed a hydatid cyst composed of laminated acellular membrane and single layer of germinal epithelium with multiple broad capsules and scolices. The patient had an uneventful postoperative course and was referred to an internist for treatment of the hydatid disease. She was put on albendazole and praziquantel.
Gynecologic Pathology: Poster#153 IMMUNOPHENOTYPIC COMPARISON OF CK7 AND CK5 IN NORMAL AND NEOPLASTIC FALLOPIAN TUBE MUCOSA Suchanan Hanamornroongruang1, Brooke E. Howitt2, Gang Ning3, Christopher P. Crum2 and Wa Xian3 1Mahidol Hospital, Bangkok, Thailand, 2Brigham and Womens Hospital, Boston, MA, USA, and 3Jackson Laboratory for Genomic Medicine, Farmington, CT, USA In the lower genital tract, CK7 is most strongly expressed in the cervical squamocolumnar junction and surface endometrial lining suggesting a link to progenitor cells; CK5 is typically expressed in basal and reserve cells and related proliferations. Both are expressed in the mesothelium. We studied 38 benign and neoplastic tissue sections from 18 high grade serous carcinomas (HGSCs) and clonogenic cell cultures from adult and fetal fallopian tube. CK7þ cells in vitro behaved as progenitor cells, becoming CK7- upon ciliated or basal (CK5þ) differentiation. In normal tube, CK7þ was most intense in the apices and sides of the plicae and occasionally diffuse in atrophic epithelium. In intramucosal (STICs) and invasive HGSCs, CK7þ was typically non-uniform and strongest on the luminal borders, while CK5 staining was usually less intense albeit occasionally strong. These findings support a model where progenitor CK7þ cells give rise to CK5þ in both benign and malignant tubal epithelium. In this model, the apical localization of CK7þ suggests that progenitor-type cells in this setting might actually be luminal rather than basal. Given the unique location of CK7þ to CK5þ transitions in the fimbria, the possibility of a novel tumorigenic pathway near the Mullerian-mesothelial junction bears further study.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.