Sabato 27 ottobre 2012 - Pacini Editore

PoStER
21 to 55 years in age, the largest measuring 23.0 cm. The lesion
was described as a well-circumscribed nodule, polypoid in 8 of
10 cases, often showing gross mucinous cysts. A single layer of
endocervical mucosa lined the cysts, although in this series, there
was focal tubal-type epithelium in six cases, and one showed focal
endometrial glands surrounded by endometrial stroma. The
glands were arranged in a lobular fashion, with large irregular
glands showing papillary infolding surrounded by smaller simpler
glands.
The rarity of endocervical adenomyoma makes its recognition
important. Familiarity with the gross and microscopic characteristics
of both lesions should facilitate correct diagnosis and
therapy 9 . The risk of recurrence is considerable with hysteroscopic
polypectomy. Although our findings indicate that cervical
adenomyoma may recur if only locally excised, no evidence of
malignant behaviour was present.
references
1 Kisu I, Banno K, Yanokura M, et al. Atypical Polypoid Adenomyoma
(APAM) of the Uterine: Relationship with Endometrial Cancer. Journal
of Cancer Therapy 2011;2:458-62.
2 Mazur MT. Atypical Polypoid Adenomyoma of the Endometrium.
American Journal of Surgical Pathology 1981;5:473-82.
3 Gilks CB, Young RH, Clement PB, et al. Benign endocervical adenomyomas
and adenoma malignum. Mod Pathol 1996;9:220-4.
4 Young RH, Clement PB, Scully RE. Premalignant and malignant lesions
of the uterine cervix. In: Clement PB, Young RH, eds. Tumors
and Tumor Like Lesions of the Uterine Corpus and Cervix. New York:
Churchill Livingstone 1993, p. 85.
5 Young RH, Clement PB. Endocervicosis involving the uterine cervix:
a report of four cases of a benign process that may be confused with
deeply invasive endocervical adenocarcinoma. Int J Gynecol Pathol
2000;19:322-8.
6 Nucci MR, Clement PB, Young RH. Lobular endocervical glandular
neoplasia not otherwise specified: a clinic pathologic analysis
of thirteen cases of a distinctive pseudoneoplastic lesion and
comparison with fourteen cases of adenoma malignum. Am J
SurgPathol1999;23:886-91.
7 Mikami Y, Maehata K, Fujiwara K et al. Endocervical adenomvoma:
A case report with histochemical and immunohistochemical studies.
APMIS 2001;109:546-50.
8 Ota S, Ushijima K, Nishio S, et al. Polypoid endocervical adenomyoma:
A case report with clinicopathologic analyses. J Obstet Gynaecol
Res 2007;33:363-7.
9 Uppal S, Heller DS, Cracchiolo B. Adenomyoma of the Cervix: Report
of a Case and Review of the Literature. Departments of Pathology
& Laboratory Medicine and Obstetrics, Gynecology, & Women’s
Health, UMDNJ-New Jersey Medical School, Newark.
Ovarian fibromatous tumours of uncertain
biological potential: study of three cases
M.G. Zorzi, T. Pusiol, D. Morichetti
Dirigente Medico, U.O. Anatomia e Istologia Patologica, Ospedale di Rovereto,
Rovereto (TN)
Introduction. About 10% of fibromatous tumours (FTs) exhibit
increased cellularity, mitotic activity, and less frequently nuclear
atypia. It is then difficult to classify a case within the group of
FTs when one or several of these features exist. We report three
cases of primary ovarian FTs with an average mitotic count of 4
or more per 10 high-power fields (HPFs) in the absence of nuclear
atypia and necrosis.
Materials and methods. The clinical, histological features, treatment,
and follow-up of three ovarian FTs with increased mitotic
activity were studied.
Results. Case 1. A 44-year-old woman presented at our hospital
with lower abdominal pain of 3 months duration. A total hysterectomy
with salpingo-oophorectomy was performed. A large
amount of ascitic fluid was detected, however, no tumor cells
were observed on cytology. There was no rupture of the capsule
of the tumours. The left ovary was 18×17×10 cm and weighed
391
760g. A cross-section of the tumor revealed multiple lobules of
various sizes. Uterus and right ovary appeared unremarkable.
Microscopically, the tumour was densely cellular and involved
the entire ovary diffusely, with no remaining normal stroma. It
was composed of spindle-shaped cells arranged in intersecting
fascicles; the nuclei of the tumor cells were hyperchromatic and
atypical. Mitotic activity was increased up to 17 mitoses/10 HPFs
(Fig. 1). The tumor cells were strongly positive for vimentin, and
negative for smooth muscle actin (SMA), S-100, desmin, h-caldesmon,
CD10, HMB45, muscle-specific actin, estrogen receptor
(ER), and progesterone receptor (PR). The Ki-67 proliferation
index was low (< 1%). No significant atypia or necrosis could be
observed. The right ovary and uterus were normal. The patient
has been free from disease, without evidence of recurrence, 10
years after the initial diagnosis.
Case 2. A 67 year-old woman looked for assistance to the
gynaecological consultation due to recent pelvic pain. A total
hysterectomy with bilateral adnexectomy and an omentectomy
were performed. No rupture of the capsule occurred on either
ovary. The right and the left ovaries measured 4×2.5×2 cm and
3x2.5x2.5 cm. respectively. The external surface of both ovaries
Fig. 1. Case 1: the tumour was composed of spindle-shaped cell
arranged in intersecting fascicles. Mitotic activity was increased up to
17 mitoses/10 high-power fields (arrows) (H&E 100x).
Fig. 2. Case 2: the tumour of right ovary was composed by cellular proliferation
of uniform spindle cells arranged in sheets and intersecting
fascicles. in some areas, thick hyaline fibrous plaques could be observed.
the nuclei were bland with pointed ends and indistinct nucleoli.
the mitotic count varied from 4 to 6 per 10 high-power fields (arrows).
No significant atypia or necrosis could be observed (h&E 100x).