2007 Winter Meeting - London - The Pathological Society of Great ...

P57Primary Fallopian Tube Carcinoma- A Case Report{P} L Radhakrishnan, AQ Ganjifrockwala, A Howat, W Salman,Z Twaij, H Stringfellow, A Al-DawoudDepartment of Histopathology, Burnley General Hospital,East LancashireHospitals NHS Trust. Royal Preston Hospital, Burnley and Preston,United KingdomBackground: Malignant neoplasms of the fallopian tube (FT) are the rarest ofthe gynaecological cancers (0.3-1.1%). While cancers metastatic to the FToccur frequently from ovarian, endometrial and other sources, primary cancersare a rarity.Case report: We report a case of a 56 year old woman who presented with CINIII and a past history of breast cancer. Imaging revealed an enlarged, solid andnodular left ovary. A total abdominal hysterectomy with bilateral salpingooophorectomyand omentectomy was performed.Macroscopically, there was presence of a mass occupying the middle portion ofthe FT and extending into the mesosalpinx. On sectioning a solid, creamcoloured tumour mass was seen measuring 6 x 4 x 2.5cms compressing theovary.Microscopically, the left FT showed extensive infiltration of the wall andmesosalpinx by a poorly differentiated adenocarcinoma showing areas of serousand clear cell differentiation. The tubal epithelium showed presence ofcarcinoma in situ which was in continuation with the invasive cancer. Thetumour adhered to the left ovary but showed no evidence of direct extension tothe ovary. The above features suggested a diagnosis of a primaryadenocarcinoma of the FT.Conclusion: Although Fallopian tubes are frequently involved in benigngynaecological conditions, primary malignant involvement is rare, and becauseof its rarity, lack of diagnostic accuracy, non presenting symptoms and physicalfindings, primary fallopian tube carcinoma is a diagnostic difficulty.P58Comparison Between Flow Cytometry and Trephine BoneMarrow Biopsy in the Detection of Lymphoid and Plasma CellInfiltrations{P} A Sandouka, E Raweily, L Jone, M SempleEpsom & St Helier University Hospitals NHS Trust, Surrey, UnitedKingdomObjective: To assess the diagnostic value of bone marrow trephine biopsies(BMB) and flow cytometry (FC) in the assessment of bone marrow infiltrationin plasma cell disorders (PCD) and other lymphoid disorders (LD).Methods: We have reviewed retrospectively 101 diagnostic and follow up bonemarrow specimens from a series of patients in whom BMB and FC data wereavailable. Of these, there were 30 specimens from patients with PCD and 71specimens from patients with other LD.Results: In PCD there was significant disagreement between the twoinvestigations in 63.3% of samples. In 13.3% of samples there was completeagreement. In 23.3% of specimens there was a non significant disagreement,these were almost all in the monoclonal gammopathy of uncertain significance(MGUS) category. This makes a total of 86.6% disagreement in the monoclonalplasma cell disorders category. In contrast, in other LD, complete agreementwas 90.1%, complete disagreement 2.8% and insignificant differences in 7.1%.Conclusions: BMB is the better method for the detection of infiltration in PCD.While a much less marked difference in sensitivities of BMB and FC to PCDhas been reported before, the cause of this marked difference in our figuresneed to be clarified.P59The utility of PWS44, an anti-CD33 antibody active inparaffin-embedded tissue, in routine haematopathologypractice{P} A D Ramsay, P Munson, I ProctorUniversity College London, London, United KingdomAntibody PWS44 (Novocastra, UK) recognises the CD33 transmembraneglycoprotein on cells of myeloid and monocytic cells lineage in paraffinembeddedtissues. Anti-CD33 is routinely used in flow cytometry but until nowhas not been available for histological use. We report on the utility of thisantibody in a specialist haematopathology unit.We applied PWS44 to 70 haematopathological specimens (54 bonemarrow biopsies, 13 lymph nodes and 3 other sites). There was strongmembrane staining on almost all myeloid and monocytic cells, from precursorforms through to mature cells. All 25 cases of acute myeloid leukaemia werepositive, as were myeloid cells in 5 cases of myelodysplastic syndrome, 3 casesof chronic myeloid leukaemia and one case of granulocytic sarcoma. 1 of 5cases of T-lymphoblastic lymphoma was positive as was one of 3 cases of B-lymphoblastic lymphoma. Three Burkitt lymphoma cases were negative. Reed-Sternberg cells in classical Hodgkin lymphoma were positive in 1 of 5 cases.Overall PWS44 was useful in the recognition of acute leukaemias derived frommyeloid or monocytic cells, especially where CD117 or myeloperoxidaseexpression was absent, but the extent of staining of normal marrow cells meantthat assessment of subtle infiltrates or dysplastic changes was difficult.P60Immunohistochemical staining of bone marrow for CD33 inpatients with acute myeloid leukaemia – a comparison withflow cytometry{P} I Proctor, P Munson, AD RamsayUniversity College London, London, United KingdomCD33 is a transmembrane glycoprotein expressed by cells of myeloid lineagebut not by pluripotent stem cells, B-cells or T-cells. Anti-CD33 monoclonalantibodies for flow cytometry have been available for some years and play animportant role in the diagnosis of acute myeloid leukaemia (AML) and inassessing CD33 status prior to treatment with Mylotarg. Until now no anti-CD33 monoclonal antibodies were available for use in paraffin embeddedtissue.We report on the efficacy of a new monoclonal antibody PWS44 (Novocastra,UK) which recognises CD33 expressed in paraffin embedded tissue. UsingPWS44 we examined CD33 expression in paraffin embedded bone marrowtrephine biopsies from 25 patients with AML and compared this to the CD33flow cytometry findings.PWS44 immunohistochemistry was positive in all cases of AML, although thestaining intensity was variable. In 3 patients reported as CD33 negative by flowcytometry, PWS44 staining was strongly positive.These results show that PWS44 is able to identify CD33+ve cells in AML inparaffin embedded tissue, and that cases reported as negative with flowcytometry may show CD33 expression in paraffin section. This is a potentiallysignificant observation considering the importance of assessing CD33 status inpatients prior to treatment with Mylotarg.42 Winter Meeting (191 st ) 3–5 January 2007 Scientific Programme