Sabato 27 ottobre 2012 - Pacini Editore

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was smooth. Both ovaries were involved enterely by white solid,
firm, yellow, grey tissue. Histologically, booth ovarian tumor
were composed of uniform spindle cells arranged in sheets and
intersecting fascicles. The stroma showed loose areas as well as
more fibrous areas containing intercellular collagen. In some areas,
thick hyaline fibrous plaques could be observed. The nuclei
were bland and slim with pointed ends and indistinct nucleoli.
The neoplastic cells were positive for vimentin. S100, desmin,
h-caldesmon, C10, HMB45, muscle-specific actin, estrogen, progesterone
receptors, CD31, and c-KIT were negative. The mitotic
count varied from 4 to 6 per 10 HPF (Fig. 2). The Ki-67 proliferation
index was low (< 1%). No significant atypia or necrosis
could be observed. Eighteen months after the surgery, no sign of
new recurrence was noted.
Discussion. The histologic criteria of ovarian FTs are controversial.
In 1981, Prat and Scully 1 proposed histologic criteria for the
distinction of cellular fibromas (CFs) from fibrosarcomas (Fs).
These authors found that mitotic activity was the most important
factor in diagnosing the sarcomas, and that nuclear grading
with cellular pleomorphism was not so much reliable. CFs were
characterized by densely cellular proliferations of fibroblasts
with mild to moderate nuclear atypia, a mitotic count of 3 or
fewer mitotic figures (MFs) per 10 HPFs, and a low malignant
potential 1 . In contrast, Fs usually exhibited moderate to severe
nuclear atypia, mitotic counts of 4 or more MFs/10 HPFs, and a
clinically malignant course in most cases 1 . After the first study
published by Prat and Scully 1 a number of ovarian Fs with a benign
clinical course have been reported in the literature in which
the diagnosis was based on a mitotic count of 4 or more mitotic
figures/10HPFs 2 . The Atlas of Tumor Pathology, published by
Armed Forces Institute of Pathology and the World Health Organization
Classification of Tumours are the textbooks of choice
consultation for pathologists in the diagnosis of tumour. Scully
et al. 3 believe that pure Fs are among the most common forms
of ovarian sarcoma. Microscopic examination shows a densely
cellular neoplasm with moderate to severe nuclear atypia and an
average mitotic count of 4 or more per 10 HPFs. Abnormal mitotic
figures and areas of necrosis and hemorrhage are common 3 .
In the Chapter “Sex cord-stromal tumours” of the World Health
Organization Classification of the Breast and Female Genital
Organs, Tavassoli et al. 4 considered ovary F as a rare fibroblastic
tumour that typically has 4 or more mitotic figures per 10 high
power fields as well as significant nuclear atypia. Irving et al. 5
believe that cellular FT with bland nuclear feaures and mitotic
count of ≥ 4 MFs/10 HPFs should be considered a mitotically active
cellular fibroma of the ovary (MACF) rather than an ovarian
F. The latter term should be reserved for fibroblastic tumors that
exhibit a combination of moderate to severe atypia and a usually
high mitotic rate.
Conclusions. Our cases may be classified as Fs according to Prat
and Scully 1 histological criteria of and as MACFs of the ovary
according to Irving et al. 5 criteria. Because of the controversial
diagnostic criteria, we prefer the terminology ovarian fibromatous
tumours of uncertain biological potential when an average
mitotic count of 4 or more per 10HPFs are found and nuclear
atypia and necrosis are absent. This term reflect the controversial
prognosis of these tumors. The management of choice of these
lesions consist of exclusive strict radiological follow-up, in order
to monitoring recurrences or metastases.
references
1 Prat J, Scully RE. Cellular fibromas and fibrosarcomas of the ovary:
a comparative clinicopathologic analysis of seventeen cases. Cancer
1981;47:2663-70.
2 Gultekin M, Dursun P, Ozyuncu O, et al. Primary ovarian fibrosarcoma:
a case report and review of the literature. Int J Gynecol Cancer
2005;15:1142-7.
3 Scully RE, Young RH, Clement PB. Tumors of the Ovary, Maldeveloped
Gonads, Fallopian Tube, and Broad Ligament. Published by the
CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012
Armed Forces Institute of Pathology, Washington, D.C. 3rd series.
Fascicle 23, p. 197.
4 Tavassoli FA, Mooney E, Gersell DJ, et al. “Sex cord-stromal tumours”
of the World Health Organization Classification of the Breast
and Female Genital Organs. Edited by Fattaneh A. Tavassoli & Peter
Devilee. Lyon: IARCPress 2003, p. 151.
5 Irving JA, Alkushi A, Young RH, et al. Cellular fibromas of the ovary:
a study of 75 cases including 40 mitotically active tumors emphasizing
their distinction from fibrosarcoma. Am J Surg Pathol 2006;30:929-38.
InTErESSE GEnErALE
P16 and CK20, immunocytochemical double
staining in urinary cytology: method optimization
R. Rapezzi, B. Selmi, G. Ferro, P. Crucitti, S. Negri, A. Bondi
U.O. Anatomia, Istologia Patologica e citodiagnostica, Ospedale Maggiore,
Azienda USL di Bologna
Background. Every year more than 7000 patients attend to Anatomic
Pathology Unit (UO) of Maggiore Hospital in Bologna to
perform an urine cytological test.
Since 2009 access to this service has been progressively increased
by introducing a new procedure for sample collection by addiction
of alcohol based fixative capable of retaining cellular elements
well preserved and stable for 7 days at least.
The urinary cytology test has an important role in the follow up of
patients treated for urothelial cancer, with a high specificity (95-
100%) but low sensitivity (38-60%) due to difficulty to correctly
distinguish between florid benign lesions from well-differentiated
carcinomas. Therefore immunocytochemical investigations may
be useful in the follow-up of cystectomized patient or evaluation
of hyperplastic lesions.
Loss of heterozygosity at chromosome 9, where houses the
regulation of p16 synthesis, is an aberration found in urothelial
cell carcinoma of all stage and grade as well as in dysplastic
urothelium, possibly representing an early event in urinary bladder
carcinogenesis.. The expression of P16 protein represents an
indirect estimate of the most common genetic alteration found in
bladder cancer and an indication of its ability to replicate. P16 INK4a
is not found in non-neoplastic urothelium, while is expressed in
50% of urothelial carcinoma, increasing to 80% in high-grade
carcinomas.
CK20 is a high molecular weight cytokeratin little or not expressed
in normal urothelium, while it is clearly present in transitional
carcinomas.
Materials and methods. In our laboratory, samples are obtained
by simultaneous and complete filtration of 3 samples by a filtration
system with a vacuum pump of about 25 mmHg average
pressure and a polycarbonate membranes of ø 5 microns pore. For
each patient a single glass is set up, stained with Papanicolaou,
and produces a single diagnosis. The same analyzed material is
then used for immunocytochemical investigations.
P16 analysis was performed by a CINtec antibody into the Ventana
BenchMark XT. Initially the detection system used was
Phosphatase Red Detection Kit, where positivity is shown by
nucleus / cytoplasm red staining.
CK20 analysis was performed by an antibody anti-CK20 also into
the Ventana BenchMark XT. Initially the detection system used
was UltraView Universal DAB Detection Kit and positivity was
detectable as a brown cytoplasmic staining.
However CK20 positivity, revealed by DAB, completely masked
P16 positivity revealed by Red.
Having a single slide, we developed a double immunocytochemical
staining: P16 has been detected in brown with diaminobenzidine
(DAB) increasing incubation times and with
an amplification system and CK20 was detected in Red, after
appropriate reduction of time and incubation temperature of
primary antibody.