Sabato 27 ottobre 2012 - Pacini Editore

PoStER
bination chemotherapy the prognosis appears similar to that for
nodal lymphoma of comparable stage and histological type. We
report two cases of ovarian lymphomas in two woman of 57 and
79 year-old, which underwent bilateral hystero-annessiectomy
for leiomyomas and prolapse without clinically appearance of an
ovarian neoplasm.
Case reports. First case. A 57 year-old woman with a familiarity
for lymphomas underwent hystero-annessiectomy for uterine leyomiomas.
A pre-operative ultrasonography showed three uterine
leyomiomas but it didn’t report any ovarian alteration. Blood tests
were normal, and the patient was in good general health. On gross
examination uterus showed multiple leiomyomas, and the left
ovary was normal. The right ovary was 4 cm in major diameter
and showed greyish, fleshy lesion 1.2 cm in major diameter. The
specimen was fixed in formalin and embedden in paraffin. Thin
sections were cut and stained with Haemathoxylin/Eosin. Microscopically,
the tumor was composed of cellular elements of medium-large
size, monomorphic, with evident atypia, growing in a
storyform pattern. The neoplastic cells add abundant cytoplasm,
basophilic to the Giemsa stain and hyperchromatic nuclei with
evident nucleoli, rarely multiple. The lesion was not delimited by
a capsule but was well defined from the surrounding parenchyma.
There were also small foci of necrosis. We performed immunohistochemical
staining and found positivity for LCA and CD20
and negativity for CAM 5.2; CD10, CD3, CD5, CD23, CD34 and
MT1. More over the proliferative cell index has determined by
Ki67, was positive in the 60% of the neoplastic cells.
The final diagnosis was of primary ovarian lymphoma, large cell
B phenotype (WHO 2008). Although ovarian lymphoma traditionally
has been considered an aggressive tumor with a poor
prognosis the patient is still alive after chemotherapy.
Second case. A 79-years old woman underwent hystero-annessiectomy
for IV grade uterine prolapse.
The patient was in good health, except for thyroid goiter; blood
tests and pelvic imaging were normal. On gross examination
uterus showed an evident prolapse with ulceration of cervix mucosae,
left ovary was normal. The right ovary was 2 cm in major
diameter and was fully replaced by a whitish, nodular lesion
with a firm and rubbery consistency. The specimen was fixed in
formalin and embedden in paraffin. Thin sections were cut and
stained with Haemathoxylin/Eosin. Microscopically the neoplastic
population was constituted by small cells with irregular nuclei
(centrocytes) with only rare large cells (centroblasts: 1-2 HPF)
with one or more basophilic nucleoli and a moderate amount of
cytoplasm. Scattered follicular dendritic cells were intermingled
with neoplastic cells and showed large nuclei with delicate nuclear
membranes and prominent nucleoli, often binucleated. The
tumor cells were positive for CD20, CD10 and bcl-2 and negative
for CD3, CD5 and ciclyn D1. More over the proliferative cell
index has determined by Ki67, was positive in the about 30% of
the neoplastic cells.
The final diagnosis was of primary ovarian lymphoma, follicular
type, low grade (grade1) (WHO 2008). The neoplasm had an
indolent course and patient is still alive after chemoterapy.
Discussion. Primary ovarian lymphoma is an uncommon disease,
accounting for 0,5% non Hodgkin lymphomas and 1,5% of all
ovarian tumours. Most common symptoms are a vague sense
of heaviness or abdominal pain, a palpable mass and ascites.
Fox et al proposed three criteria for diagnosing primary ovarian
lymphoma. At the time of diagnosis, only the ovary must
be involved by lymphoma; peripheral blood and bone marrow
must be negative for lymphomatous cells and several months
must be elapsed between the appereance of the ovarian lesion
and further lymphoid masses at sites different from ovary. Treatment
of primary ovarian lymphoma includes surgery followed by
chemotherapy. The prognosis of primary ovarian lymphoma is
poor, with survival reported which varies from 0 to 36% with an
average survival time less than 3 years, similar to that for nodal
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lymphoma of comparable stage and histologic type. Our two
cases are peculiar because they were detected as incidental findings
during the work-up of other gynecologic disease, moreover
they were unilateral without clinical symptoms referred to ovarian
and peritoneal localization. In conclusion, we must to keep in
mind that gynaecological lymphoproliferative disorders are rare
but they exist and so we must suspect it. Moreover the distinction
between primary and secondary lymphomas has a clinical, therapeutic
and prognostic significance.
references
1 Scully RE. Tumors of the ovary and mal developed gonads. In: Atlas
of tumor pathology. 2nd series. Washington (DL): Armed Forces Institute
of Pathology 1979, fascicle 16, pp. 117-27.
2 Vang R, et al. Ovarian non-Hodgkin lymphoma: a clinicopathologic
study of eight primary cases. Modern Pathol 2001;14:1093-9.
3 Neuhauser TS, et al. Follicle center lymphoma involving the female
genital tract: a morphologic and molecular genetic study of three
cases. Am Diagn Pathol 2000;4:293-9.
4 Lagoo AS, et al. Lymphoma of the female genital tract: current status.
Int J of Gynecol Pathol 2006;25:1-21.
5 Ozsan N, et al. Clinicopathologic and genetic characterization of follicular
lymphomas presenting in the ovary reveals 2 distinct subgroups.
Am J Surg Pathol 35:1691-9.
6 Barzilay J, et al. Malignant lymphoma of the ovary: report of a case
and review of the literature. Obstet Gynecol 1984;64:93S.
Polypoid endocervical adenomyoma: case report
R. Ponte1 , L. Abete1 , T. Celiento1 , P. Ceriolo1 , E. Pacella1 ,
P. Calamaro1 , S. Bruno1 , P. Sala2 , E. Fulcheri1 1 University of Genoa, IRCCS San martino, IST, U.O. Anatomia Patologica
DISC; 2 IRCCS San martino, IST, U.O. Ginecologia e Ostetricia
Introduction. Endocervical adenomyoma is a rare neoplastic
condition of the uterine cervix, one of a group of endocervical
benign lesions that may histologically be confused with an aggressive
cervical carcinoma, adenoma malignum. It represents
the benign counterpart of atypical polypoid adenomyoma of the
uterine body which mainly consists of endometrial glands (which
are atypical and present squamous morules) and smooth muscle
cells 1 2 . The designation endocervical adenomyoma has been
used for biphasic tumors composed of irregularly shaped endocervical
glands with bundles of smooth muscle cells 3 . A gross
well-circumscribed appearance and intermingling of bundles of
smooth muscle fibres and benign-looking glands are indicative of
the diagnosis. There have been only a limited number of reported
cases and therefore it is important be aware of this entity to avoid
any diagnostic mistakes, especially in consideration of the differential
with malignancy 4 .
Materials and methods. We report a case of adenomyoma of
endocervical type arising in a 47-year-old female, gravida 3, para
2, Italian woman. The patient was in good health without any notable
family history. She had a history of relapsing menometrorrhagia
and 7 years previously she had had a fibrous peduncolated
formation in expulsion from the endocervical canal removed.
Simple ablation without revision of the base plant had been
performed. Histological examination of the lesion showed this to
be an endocervical adenomyoma. After six years of good health,
the symptoms recurred in 2011. The transvaginal ultrasound
(Figg. 1,2) visualized a single large mass involving deeply the
cervical wall and slightly protruding on the mucosal surface. In
consideration of the age of the patient conservative surgical treatment
by hysteroscopy was decided. This approach permitted the
removal of the polypoid component only while, in consideration
of the lesions persistence within the cervix wall, hysterectomy
was subsequently performed.
Results. Gross description identified a polypoid tumor which
measured 3x2x1,5 after hysteroscopic polypectomy. The infiltrating
lesion was well-circumscribed and measured 3x2,5 cm in size