Endometrial carcinoma: intraoperative evaluation of myometrial invasion. A prospective study

AIM

The authors investigated the diagnostic value of intraoperative assessment of myometrial invasion in endometrial cancer patients. Following hysterectomy, the uterus was sectioned and macroscopically examined in order to assess the depth of myoinvasion, which was classified as <50% and >50%. In patients with macroscopic depth of invasion>30% and <50%, a frozen section of this area was carried out. The results of intraoperative evaluation were compared with the results of postoperative pathological examination. The agreement between methods was developed as generalized Kappa type statistic. Sensitivity, specificity, positive and negative predictive values for intraoperative only macro and macro/micro evaluation were calculated.

METHODS

Seventy eight consecutive patients (median age 64 years, range 43-92; median Body Mass Index [BMI] 30.5, range 21.9-46.7) who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (THBSO) were included in the study. Following intraoperative macroscopic evaluation, frozen section was carried out in 15 (19%) patients. The median time to obtain the results was 16 min for macroscopic evaluation, and 29 min for the macro/micro assessment.

RESULTS

Macroscopic only assessment correctly identified depth of myoinvasion in 91% of patients, while, when the frozen section was carried out, myoinvasion was correctly identified in 95% of patients. For macroscopic only and macro-micro assessment sensitivity and specificity were 76% and 98%, 86% and 98%, respectively.

CONCLUSION

These data suggest that the frozen section may improve, the diagnostic value of macroscopic only intraoperative assessment of myometrial invasion in selected patients.

[Pharyngeal and laryngeal hamartoma: case report]

In this report a case of laryngeal hamartoma is presented. Macroscopically this lesion is quite similar to a tumor but is actually a malformation derived from an error in the development of a healthy organ. Histologically, the hamartoma is composed of a proportionally abnormal mixture of tissues as compared to what is normally present in its anatomic site. The lesion is extremely rare and usually appears in the head and neck district, spleen, pancreas, lung and liver. The diagnosis is essentially based on histological examination. The treatment of choice consists of surgery and periodic follow-up. Differential diagnosis must consider other rare neoplasms such as rhabdomyoma and teratoma.

Malignant peripheral neuroectodermal tumor (MPNET) of the kidney

BACKGROUND

Malignant peripheral neuroectodermal tumors (MPNETs) are primitive neuroblastic tumors that arise, unlike neuroblastomas, outside the autonomic nervous system. A renal origin has been described in very few cases.

CASE REPORT

We report the case of a young male patient with a large MPNET of the right kidney, studied with ultrasound and computed tomography before surgical resection. The main radiologic features, the microscopic appearance and the typical immunohistochemical findings, are described and discussed.

[Histological and immunohistochemical studies in cases of malignant mesenchymal neoplasms of the oromaxillofacial area]

The authors present an immunohistochemical study of 11 cases of maxillo-facial primitive sarcomas. Specimens from demoliti maxillary resections were prepared and stained with alpha-1-antichymotrypsin, lysozyme and CD68. Alpha-1-antichymotrypsin confirmed in this study its lack of specificity as a tumor marker being relevated both in fibroblasts and in osteoblasts and even in chondrosarcomatous tissue. The results of lysozyme and CD68 stainings were interesting especially in malignant fibrous histiocytoma (MFH), fibrosarcoma and osteosarcoma. The authors showed, once more, that while in osteosarcoma the markers were noted in osteoclasts or pre-osteoclasts alone and not in the neoplastic stroma; all fibroblastic elements were marked in MFH. Immunohistochemical research of histiocyte-macrophage lineage confirmed its utility in osteosarcoma versus MFH differential diagnosis. In fibrosarcoma, furthermore, the authors obtained a positive staining of CD68 and lysozyme in fibroblastic elements morphologically similar to the other neoplastic cells. This datum induced the authors to formulate the interesting hypothesis that MFH and fibrosarcoma represent the opposite ends of a wide spectrum of differentiation of a single neoplasm of fibrohistiocytic origin.

[Osteomas and exostoses of the facial structures: a morphological study and the etiopathogenetic considerations]

The differential diagnosis of the osteocondensing lesions (osteomata and exostoses) is till today a topical issue for the experts. In order to test the reliability of the etiopathogenetic theories advanced up to now, the authors carried out a research on samples of tissue coming from surgical interventions for osteomata and exostoses of the maxillofacial region resortied with optical and polarized-light microscopes (OM-PLM). This research meant to analyze the morphological and structural characteristics of newly formed tissues; a considerable attention has been devoted to the difference between primary and secondary bone and to the quality of cementing lines. Thanks to the data resulted from this study, the authors advanced interesting theories about these pathologies either from an etiological and nosological point of view.