Clear cell adenocarcinoma associated with clear cell adenofibromatous components: a subgroup of ovarian clear cell adenocarcinoma with distinct clinicopathologic characteristics

We occasionally encountered clear cell adenofibromatous (CCAF) components coexisting in the ovarian clear cell adenocarcinoma (CCA). To reveal the clinicopathologic significance of CCAF components in CCA, we classified 67 cases of surgically resected CCA into CCA with and without CCAF components [CCAF(+) and (-) groups], and compared clinicopathologic parameters, that is, patient age, clinical stage, the degree of optimal cytoreduction, patient outcome, histologic grade and Ki-67 labeling index of the CCA, and the presence of endometriosis, between these 2 groups. Fourteen cases (21%) and 53 cases were classified as CCAF(+) and CCAF(-) groups, respectively. Of these 14 CCAF(+) cases, the CCAF components with atypia were observed adjacent to the CCAF components without atypia in 10, and adjacent to the obvious CCAs in 13 cases. In comparison with the CCAF(-) group, the CCAF(+) group showed a higher frequency of histologically low-grade tumors [93% (13 of 14) vs. 43% (23 of 53), P=0.0027], a lower Ki-67 labeling index (mean 35.9% vs. 44.0%, P=0.0492), and better patient prognosis (5-year survival 78.8% vs. 49.3%, P=0.0277). Endometriosis was much less frequent in the CCAF(+) group than in the CCAF(-) group [14.7% (2 of 14) vs. 67.9% (36 of 53), P=0.00096]. Multivariate analysis identified only optimal cytoreduction as independent favorable prognostic factor. These results suggest that CCAF besides endometriosis is associated with the development of CCA, and that the CCAF(+) group may be a distinct subgroup of CCA with less aggressive biologic behavior.

Impact of induction chemotherapy and preoperative chemoradiotherapy on operative morbidity and mortality in patients with locoregional adenocarcinoma of the stomach or gastroesophageal junction

BACKGROUND

Significant tumor downstaging has been achieved in patients with localized gastric or gastroesophageal adenocarcinoma by induction chemotherapy and preoperative chemoradiotherapy (CTX-CTXRT). However, the influence of CTX-CTXRT on operative morbidity and mortality has not yet been clarified. The aim of the present study was to document the frequency and nature of morbidity and mortality after surgery combined with CTX-CTXRT, and identify factors predictive of postoperative complications in patients with localized gastric or gastroesophageal adenocarcinoma.

METHODS

A prospectively collected database on 71 consecutive patients who underwent CTX-CTXRT at M.D. Anderson Cancer Center between January 1997 and August 2004 was reviewed. Postoperative morbidity and mortality were investigated, and risk factors for overall complications were identified by multivariate logistic regression analysis.

RESULTS

Overall morbidity and mortality rates were 38.0% (27 patients) and 2.8% (2 patients), respectively. Age greater than 60 years [relative risk 11.3 (95% confidence interval 2.50-50.6)] and body mass index (BMI) of 26 kg/m(2) or above [relative risk 4.08 (95% confidence interval 1.08 to 15.4)] were significant risk factors for overall complications.

CONCLUSIONS

CTX-CTXRT can be performed safely with an acceptable operative morbidity and a low operative mortality rate in patients with gastric or gastroesophageal cancer, with careful consideration of added risk associated with age and obesity.

Prognostic relevance of soluble interleukin-2 receptors in patients with ovarian tumors

Soluble interleukin-2 receptors (sIL-2R) are measurable in the sera of patients with ovarian cancer and several other benign and malignant diseases. However, the function of these sIL-2R is still unclear. Since high levels of sIL-2R are thought to be an indicator of an activated immune system we investigated the correlation of sIL-2R concentration and prognosis of ovarian cancer patients. sIL-2R measurement was performed on the preoperative sera of 130 patients with benign, and 119 patients with malignant ovarian tumors. The IMMULITE sIL-2R assay by DPC Biermann, Bad Nauheim, Germany was used. In ovarian cancer patients sIL-2R concentrations were significantly higher than in those with benign tumors. By defining the 95th percentile of the sIL-2R concentration distribution in patients with benign diseases as the cut-off (1200 U/ml) 35% of the ovarian cancer patients had elevated concentrations. Concentrations of sIL-2R increased with FIGO stage. FIGO-III patients with highly elevated sIL-2R concentrations tended to have better prognosis than those with sIL-2R levels within normal range in contrast to FIGO IV patients. Since sIL-2R concentrations indicate an immunological activation in ovarian cancer patients our data give hints of the possible role of sIL-2R in the assessment of the risk of recurrence in ovarian cancer patients.

The importance of histologic type on breast cancer survival

Breast cancer is a morphologically and genetically heterogeneous disease. The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute provides the large number of cases necessary to study individual histologic types of female invasive breast cancer that for practical reasons are otherwise unattainable. Attention was specifically focused on 4082 cases of mucinous adenocarcinoma and 139,154 cases of infiltrating duct carcinoma identified for the years 1973-1990. Life table analyses were conducted to compare survival by histologic type using death due to breast cancer as the outcome; Cox proportional hazards analysis was used to adjust for important covariates. Findings were that women diagnosed with mucinous adenocarcinoma have a rate of mortality due to breast cancer that is 0.38 that of the rate of women diagnosed with infiltrating duct carcinoma (95% confidence interval 0.34-0.42). We conclude that histologic type is important to consider in the prognosis and treatment of women diagnosed with breast cancer.

Carcinoma arising within fibroadenomas of the breast. A clinicopathologic study of 105 patients

The authors report the clinicopathologic features of 105 carcinomas arising within fibroadenomas (FAs) of the breast. The mean age of the patients was 44 years. The presentation and gross characteristics of these tumors rarely differed from those of uncomplicated FAs. Carcinoma in situ (CIS) was the predominant type of malignancy (95%) found to arise in FAs, and lobular and ductal types occurred with equal frequency. Nine of ten FAs harboring an invasive carcinoma also contained CIS supporting the origin of the infiltrative component in the FAs. CIS within FAs was associated with in situ malignancy in surrounding breast tissue in 21% of cases. Age, fibroadenoma size, and type and extent of CIS were similar in patients with disease limited to the FA and in those with associated malignant disease in the remainder of the breast. Axillary nodal metastases were not detected. Sixty-three patients were observed for a mean period of 8.4 years. Only one of 26 patients with CIS within an FA who was treated conservatively developed an ipsilateral carcinoma. None of the 26 developed contralateral carcinoma; however, 3 of 23 with similar lesions, who were treated by mastectomy, did so. The contralateral carcinomas were invasive in two patients, one of whom died with distant metastases. Seven patients with FAs harboring lobular CIS underwent bilateral mastectomy. Their postoperative course was uneventful. None of seven patients with invasive carcinoma arising in an FA, two of whom were treated conservatively, succumbed to disease. However, one developed contralateral carcinoma. The authors recommend breast-conserving therapy for CIS arising in an FA.

Occurrence of breast carcinoma within a fibroadenoma. A review

Sixty-two cases of carcinoma within a breast fibroadenoma are adequately documented in the literature, including the present case. All are found in women. The mean age of occurrence is 42.4 years. This corresponds to the peak age of lobular in situ breast cancer but is much higher than the peak age for breast fibroadenomas. Sixty-five percent of patients harboring cancer within a fibroadenoma have lobular in situ malignant neoplasms. In 42% of the cases the surrounding breast tissue is also involved by cancer, a fact that dictates generous surgical margination of all fibroadenomas excised, especially in older women. The data indicate that the presence of the fibroadenoma is a parameter independent of the development of cancer in either the ipsilateral or contralateral breast and does not influence the clinical course of the malignant neoplasm, other than that it contributes to its earlier detection. Treatment should follow the general principles of therapy for the in situ or infiltrative breast cancers.

Unusual cystadenofibromas: endometrioid, mucinous, and clear cell types

Cystadenofibromas are benign ovarian neoplasms containing both epithelial and stromal components. The epithelial component is usually of simple serous type resembling fallopian tube epithelium. Occasionally, tumors with unusual epithelial pattenrs are encountered. In this study, 16 cystadenofibromas with unusual epithelium are described. Twelve are examples of an endometrioid type, 3 of a clear cell (mesonephroid) type, and 1 of a mucinous-type epithelium. The stromal component in all tumors is identical to that of ordinary cystadenofibromas. One of the patients with a tumor containing endometrioid epithelium developed recurrence in the vagina after surgical removal of the ovarian tumor. The rest of the clinical features of these tumors are similar to those of ordinary cystadenofibromas with the exception that the median age is 10--20 years greater in the unusual-epithelium group.

Cystadenofibromas of the ovary with epithelial atypia

Epithelial atypia is rarely encountered in ovarian cystadenofibromas. Ten examples are reported with cytological features identical to serous tumors with low malignant potential. In two neoplasms the epithelium resembled an atypical endometrial hyperplasia, and one of these had squamous metaplasia. These two neoplasms probably qualify as endometrioid tumors of low malignant potential. None of the 10 patients had recurrence following excision of their neoplasm, and no similar patients have been encountered with neoplasms in more advanced stages. Even though aggressive behavior has not yet been established, the histologic features suggest a low degree of malignant potential and long-term follow-up of patients is warranted. Cystadenofibromas iwth epithelial atypia probably have less malignant potential than serous tumors of low malignant potential possessing the same epithelial characteristics because cystadenofibromas with atypia have less epithelial surface area and the epithelium is enveloped by connective tissue more than it is in serous tumors of low malignant potential.