Sabato 27 ottobre 2012 - Pacini Editore

384
Pure uterine lipoma: a case report
R. Giannatiempo1 , M. Postiglione1 , L. Nugnes1 , R. Franco2 ,
A. Russo1 , A. Nicastro1 , D. Oppressore1 1 UOS Anatomia ed Istologia Patologica /Ospedale Evangelico Fondazione
Betania, Napoli, Italia; 2 AF Anatomia Patologica/ INT Fondazione G. Pascale,
Napoli, Italia
Case presentation. A 68-year-old post-menopausal woman presented
with vaginal bleeding and intermittent abdominal pain of
three-four mounths duration.
Gynecological examination revealed no abnormalities of the vulva
or the cylindrical vaginal portion of the cervix. The uterine cavity
was slightly big in size. The adnexaes were non-palpable, there
was marked tenderness to palpation, but no evident pathological
change was detectable on clinical examination. Longitudinal, endovaginal
ultrasound image of the uterus demonstrated a well-delineated,
8-cm hyperechoic mass, with a semi-solid characteristic,
located intramurally in the posterior wall of the uterus. Endometrial
biopsy showed scanty material with no evidence of malignancy.
The patient underwent a total abdominal hysterectomy and bilateral
salpingo-oophorectomy
The hysterectomy specimen measured 11 × 6 × 5 cms, with
globular enlargement of the fundus. Both ovaries were atrophic.
Laparotomy revealed an enlarged uterus with a globular fundal
mass. The mass was soft-to-firm in consistency and the surface
was smooth and glistening with no adhesions. A 8 cm soft, yellow,
well-circumscribed, intramural mass was found within the
myometrium: there was a very large intramural uterine tumour
mass which measured 80 mm in greatest diameter and weighed
740 g. The tumour, which distorted the uterine cavity into an
enlarged slit, was rounded and well circumscribed but not encapsulated.
On cut surface the greater part of the tumour appeared,
homogenous yellow, lobulated and fatty, with displacement of
the endometrial cavity toward the lower pole. Also the cervix
appeared normal.
No areas of necrosis or hemorrhages were seen. A histopathological
examination showed a thin atrophic endometrium. The
intramural tumor was composed of only mature adipose tissue.
No smooth muscle cells or fibrous elements or lipoblasts were
seen within the tumor. A final diagnosis of primary pure uterine
lipoma was considered.
Clearance and persistence of human papillomavirus
infections in patients with lesions of the cervix
G. Giuffrè1 , R. Scarfì1 , A. Simone1 , P. Todaro1 , G. De Luca1 ,
M. Le Donne2 , P. A. Nicotina1 1 2 Departments of Human Pathology and Ginecology, Obstetrics and Reproductive
Medicine, University of Messina, A.O.U. “Policlinico G. Martino”,
Messina, Italy
Background. Human papillomavirus (HPV) infection is the
most common sexually transmitted agent and is a necessary
condition for the development of invasive cervical cancer that
represents the third most common malignancy of the female
genital tract. On the basis of their oncogenic potential, HPV
have been classified as high- or low-risk types. In particular,
18 types have been proposed with a probable or definite highoncogenic
role, while 12 low-risk HPV have been associated
with benign condylomatous lesions of the anogenital areas, as
well as low-grade squamous intraepithelial lesions of the cervix.
However, HPV has been detected also in cervical samples of 10-
40% of women who have no cytologic abnormalities. Between
March 2007 and March 2012, a total of 2.369 cervical samples
of 1.860 Italian women living in province of Messina were
consecutively tested for HPV from the Laboratory of Molecular
Biology Applied to Pathologic Anatomy of the Department of
Human Pathology of our University. In order to evaluate the
clearance or persistence of HPV in patients with cervical le-
CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012
sions, we have selected 318 patients who underwent several
times to HPV genotyping.
Patients and methods. At the first diagnosis, the mean age
of women was 33.3 + 9.4 (SD) years (range, 17-60 years). In
particular, 45 patients showed condylomatous cervical lesions,
while 273 showed squamous cell abnormalities (13 ASCUS, 221
LSIL, 39 HSIL). The women were followed-up for a mean period
of 24.6 + 13.9 (SD) months and clinico-pathological data were
collected at the time of HPV testing also by means of a written
questionnaire. Outcome was defined as clearance of infection, type
specific persistence, clearance associate with new HPV infection.
From each cervical sample the cells were collected by centrifugation
and total DNA was extracted with the QIAamp DNA mini
kit (Qiagen GmbH, Germany). HPV genotyping was performed
by nested PCR and a non-radioactive reverse line blot hybridization
assay with specific probes for the most frequent HPV types
(HPV-Type, AB Analytica, Padova, Italy). Hybridisation was
made by a BeeBlot Instrument and hybrids between biotinylated
PCR products and specific HPV probes were visualized on the
strip following the manufacturer’s instructions. In some of the
cases yielding unidentifiable by line blot genotyping, the corresponding
HPV DNA was sequenced.
Results. At the first diagnosis, single HPV infection was detected
in 171 cases (53.8 %), while multiple infection with different
HPV-types was found in 147 cases (46.2 %). A high-risk HPV infection
was detected in 265 patients (83.3 %); of these, 194 (61.0
%) showed only a single or multiple high-risk HPV infection,
while the coexistence with a low-risk HPV infection was documented
in 71 cases. A low-risk HPV infection was found in 124
(39.0 %) patients and 53 (16.7 %) of these showed only a single
or multiple low-risk HPV infection. In condylomatous lesions an
exclusive low-risk HPV infection was found in 34 (75.0 %) cases,
while a prevalence of high-risk HPV infection was encountered
in patients with cervical squamous cell abnormalities (69.2 %
ASCUS, 91.9 % LSIL, 100% HSIL). At the end of follow-up
period a complete clearance of infection was found in 130 (40.88
%) patients, while in 92 (28.93 %) a HPV type specific persistence
was encountered. In the remaining patients, 87 showed a
clearance associate with a concomitant new HPV infection, while
8 developed a new infection after a period of complete HPV absence.
A significant association was found between resolution of
lesions and viral clearance. Moreover, this latter finding was also
associated with initial single HPV infection.
Conclusions. HPV genotyping can provide useful indications in
the management of patients with squamous intraepithelial lesion
of cervix.
“Basaloid-adenoid cystic” carcinoma of the ovary:
variant of epithelial surface tumor or indipendent
neoplasia?
L. Marcolini, A. Pesci, P. Castelli, G. Zamboni
Ospedale Sacro Cuore Don Calabria di Negrar Dipartimento di Patologia,
Verona, Italy; Università di Verona Dipartimento di Patologia e Diagnostica,
Verona, Ital.
We report a new case of a primary ovarian adenoid-cystic like
carcinoma resembling salivary gland carcinoma (ACC) in a 53year-old
woman. The tumor showed a myoepithelial differentiation
and there was no evidence of an associated ovarian surface
epithelial-stromal neoplasia. The negativity for PAX 8 rises the
possibility to consider pure ovarian ACC as a monodermal teratoma
instead of a surface epithelial tumor.
Material and methods. A 53-year-old woman referred to the
Obstetric and Gynecology Department for the presence of leiomyomata
growing-up in the last 3-4 months. CT-scan revealed
the presence of a solid mass of the left ovary with a mean
diameter of 12 cm. A laparoscopic hysterectomy and bilateral
salpingo-oophorectomy was performed.