INTRODUCTION:A 51 year-old woman was diagnosed with endometrial cancer (EC) and underwent surgical staging. Pathological evaluation showed a 2 cm × 1 cm G2 endometrioid EC with a 30% myometrial deep invasion (FIGO Stage 1A). The patient was classified as low risk of recurrence, and no adjuvant treatment was offered. Six months after surgery, the patient developed an early vescico-vaginal recurrence, and chemotherapy treatment was started. Few months later, a subsequent involvement of vaginal wall, ileum, and omentum was detected, and the patient underwent second surgery.BACKGROUND:LH/hCG-receptor (LH/hCG-R) expression has been previously reported to be associated with an invasive phenotype in EC cells. Moreover, in a preclinical mouse model of EC behaves as a prometastatic molecular device.DISCUSSION:We analyzed the expression level of LH/hCG-R in cancer specimens collected during surgeries. Molecular and immunohistochemical analyses showed a strong expression of both mRNA and protein for LH/hCG-R in all specimens.CONCLUSION:LH/hCG-R expression may be assessed together with other clinicopathological parameters in order to better predict the risk of recurrence in low-risk EC patients. Further clinical trials are warranted in order to validate LH/hCG-R as biomarker in EC.

The goal of this study was to evaluate the characteristics and the prevalence of histopathologic and immunohistochemical changes in vulvar biopsies, in women with Primary Sjögren Syndrome (pSS) and non-Sjögren Sicca Syndrome (nS-SS). Twenty-one women with pSS and 11 with nS-SS (investigated by xerophtalmia and xerostomia tests, biopsy of minor salivary glands, gynecological history, and gynecologic symptoms score) underwent vulvar biopsies, evaluated for histopathologic and immunohistochemicalchanges, and compared with those obtained from 26 patients with lichen sclerosus. An inflammatory infiltrate was present in 31/32 biopsies (96.9%); biopsies from pSS patients showed a mild infiltrate in 10 cases and a moderate infiltrate in 11 cases; and patients with nS-SS had a mild infiltrate in 8 biopsies and moderate infiltrate in the other 2 biopsies. By immunohistochemistry, the infiltrate was composed predominantly of T lymphocytes (CD3), CD20 B cells were sparse and mean CD4:CD8 T-cell ratio was 1.5. No differences were observed between the grading of the inflammatory infiltrate in nS-SS and pSS; no correlation was shown between vulvar inflammatory infiltrate score (mild or moderate) and salivary glands inflammatory score. No differences were found in gynecologic symptoms, as well as in clinical and demographical characteristics between patients with mild and those with moderate vulvar inflammatory score. A higher prevalence of moderate inflammatory infiltrate was observed in biopsies from women with lichen sclerosus than in pSS and nS-SS patients (61.5% vs. 27.5%, P=0.02). Women with pSS and nS-SS show a high and similar prevalence of vulvar inflammatory infiltrate. A gynecologic evaluation is needed both in pSS and nS-SS to assess genital involvement and, eventually, to address a therapy targeted to genital symptoms.

Central Nervous System (CNS) embryonal tumors are malignant neoplasms that share the predilection for the pediatric age, the tendency to early disseminate throughout the CNS via the cerebro spinal fluid, the high mortality and the significant long-term morbidity for survivors. The pathological diagnose of these tumors on the basis of the morphological analysis may be sometimes difficult, and also not all of these tumors, with an equal stage and treatment, have the same behavior. The application of basic research findings to clinical oncology has led to new approaches to the diagnosis, prognosis, and treatment of these tumors. In this chapter we discuss the molecular biology of the CNS embryonal tumor with particular emphasis on that aspects having clinical impact.

Angiocentric glioma is a rare slow growing tumor. It is associated to seizures and is mainly diagnosed in children and young adults. We describe the clinical, histo-pathological and molecular (IDH1, IDH2 and BRAFV600E mutational status) features in 3 children, 2 girls (2- and 11-years old) and 1 boy (10-years old). The tumors were located at the left temporo-parietalinsular, left parieto-occipital and left subcortical paramedian region respectively. All 3 patients were operated. Two patients are well at 2 and 16 months of follow-up while the third still suffers from seizures at 7 years of follow-up. Histologically, all tumors were composed of spindle-shaped cells showing a prominent tendency to align around the blood vessels and to grow in the subpia space creating palisade-like structures. In one case the tumoral cells were embedded in a mucoid matrix and some microcalcifications were observed. In all the cases the neoplastic cells diffusely immunostained for GFAP and S-100. Punctate dot-like intracytoplasmic staining for EMA was also observed. All tumors resulted in wild type for the mutations investigated. Owing to the rarity of angiocentric glioma, we believe that each new case should be recorded to produce a better clinical, pathological and molecular characterization of this lesion.

Glioneuronal tumors with neuropil-like islands are rare. The 1st reported cases were localized in the cerebral hemispheres of adults, showed homogeneous histopathologic features (infiltrating astrocytic growth and neuropil-like islands rimmed by neuronal cells), and had an unfavorable behavior. We report 3 pediatric cases (1 boy and 2 girls, ages 4, 6, and 8 years, respectively). The boy had a cerebral tumor, and the girls had a spinal tumor. The younger girl also had multiple posterior fossa lesions. The boy and older girl underwent a gross total resection. The younger girl underwent a subtotal resection of the spinal tumor; posterior fossa lesions were not surgically treated. The boy and younger girl are in complete remission at 33 and 24 months, respectively, after surgery and subsequent high-dose chemoradiotherapy. The older girl had a recurrence that was partially resected. Afterward, she started high-dose chemoradiotherapy and had an optimal radiologic response at 4 months follow up. Microscopically, the common denominator was the presence of synaptophysin-positive neuropil-like islands. One tumor showed ependymal features (pseudorosettes and punctate epithelial membrane antigen immunopositivity). Two tumors had 1p deletion. 19q deletion, MGMT gene promoter methylation, EGFR amplifications or polysomy, and EGFR, IDH1, IDH2, and TP53 genes mutation analyses yielded negative results. In conclusion, glioneuronal tumor with neuropil-like islands can affect children, arise in the spinal cord, and show ependymal features in its glial component. A high-dose chemoradiotherapy program is effective.

Herein, we describe an intracerebral primary low-grade myxofibrosarcoma occurring in a 9-year-old boy. The lesion measured 7 cm and occupied the left parieto-occipital region. A gross-total removal of the tumor was performed. Nine months later, radiologic follow-up revealed a local recurrence which was again surgically removed. The patient then underwent radiotherapy and chemotherapy. He was well and disease-free at 6 months follow-up. The tumor was composed of spindle, stellated, and multinucleated cells embedded in a myxoid background. Foci of increased cellularity, pleomorphism, and high mitotic rate were present. The tumor borders were sharply demarcated from the non-neoplastic nervous parenchyma. Immunohistochemical staining showed that the neoplastic cells were vimentine and CD34 positive. Fluorescence in-situ hybridization analyses did not show FUS and EWSR1 gene rearrangements. Primary intracranial myxofibrosarcomas are very rare (to the best of our knowledge, less than 10 published cases in the international literature). We believe each new case should be recorded to produce a better clinical, pathologic, molecular, prognostic, and therapeutic characterization of this lesion.

Herein, we describe an intracerebral primary low-grade myxofibrosarcoma occurring in a 9-year-old boy. The lesion measured 7 cm and occupied the left parieto-occipital region. A gross-total removal of the tumor was performed. Nine months later, radiologic follow-up revealed a local recurrence which was again surgically removed. The patient then underwent radiotherapy and chemotherapy. He was well and disease-free at 6 months follow-up. The tumor was composed of spindle, stellated, and multinucleated cells embedded in a myxoid background. Foci of increased cellularity, pleomorphism, and high mitotic rate were present. The tumor borders were sharply demarcated from the non-neoplastic nervous parenchyma. Immunohistochemical staining showed that the neoplastic cells were vimentine and CD34 positive. Fluorescence in-situ hybridization analyses did not show FUS and EWSR1 gene rearrangements. Primary intracranial myxofibrosarcomas are very rare (to the best of our knowledge, less than 10 published cases in the international literature). We believe each new case should be recorded to produce a better clinical, pathologic, molecular, prognostic, and therapeutic characterization of this lesion.

Amniotic band syndrome is an uncommon congenital pathological condition that may lead to malformations and foetal-infant death. We report an autoptic case. The patient was a male preterm infant. At 14 weeks of gestation, a routine ultrasonography showed severe craniofacial anomalies and a close contiguity of the foetal head with the amnios. The neonate survived three days, after which an autopsy was carried out. The infant had a frontoparietal meningoencephalocele; a fibrous band was attached to the skin, close to the meningoencephalocele base. Cleft lip and palate, nose deformation and agenesis of the right eye were also present. At the opening of the cranial cavity, occipital hyperostosis was observed. The herniated brain showed anatomical abnormalities that made identification of normal structures difficult. Microscopically, the nervous parenchyma had architectural disorganization and immaturity, and the fibrous band consisted of amniotic membranes. As evident from this case report, amniotic band syndrome may cause severe malformations and foetal-infant death.

Lipoastrocytoma is an extremely rare tumor, with only six cases described. We report the case of an astrocytoma involving the upper part of the cerebellar‐pontine angle and the right portion of the clivus starting from the brainstem with a diffuse lipomatous component in a 39 year‐old man. The patient was admitted with headache of 1 year's duration and diplopia over the previous 3 months. MRI revealed a ponto‐cerebellar lesion that showed irregular enhancement after contrast administration. Subtotal excision of the tumor was accomplished. Adjuvant chemotherapy and radiation therapy were not administered. Histologically the tumor showed the classical histology of low‐grade astrocytoma and a portion of the lesion was composed of lipid‐laden cells. Immunohistochemistry for glial fibrillary acid and S‐100 proteins clearly demonstrated the glial nature of these cells. Ki‐67/Mib‐1 labeling index was low (2%). The patient remains in good neurological conditions after 10 months. Our case has a benign postoperative behavior, also after subtotal excision, with restrictions due to the short follow‐up. It is important to record each new case of this rare tumor to produce a better characterization of this lesion.

Gestational diabetes insipidus (GDI) refers to the state of excessive water intake and hypotonic polyuria. Those cases manifesting in pregnancy and referred to as GDI may persist thereafter or may be a transient latent form that resolves after delivery. Microscopic examination of affected subjects has not been previously reported. In the literature, there are various case reports and case series on diabetes insipidus in pregnancy. In this study, we present a case that had transient diabetes insipidus during pregnancy in which the placenta was examined.

Pilomyxoid astrocytoma is a recently described tumor. Its most typical morphological characteristics are an angiocentric astrocytic proliferation embedded in a myxoid background. The behavior seems to be unfavorable due to the reported high rate of local recurrence. The earlier studies indicated that pilomyxoid astrocytoma typically affects young children and arises in the hypothalamic/chiasmatic region. We report a case of a 14-year-old patient with a 6-year history of absence seizure. Magnetic resonance imaging showed a right occipital lesion of approximately 3 cm in diameter. The patient underwent the surgical procedure with gross total excision. Histologically, the tumor was mainly composed of a monomorphous population of bipolar elongated piloid cells radially arranged around thin-walled blood vessels in a prominent myxoid background. There were focal hemorrhagic foci but no bona fide evidence of tumor necrosis or mitoses. Rosenthal fibers and eosinophilic granular bodies were not observed. The postoperative course was uneventful. No adjuvant therapy was administered. The patient is alive and well at 18-month follow-up. The case presented provides evidence that pilomyxoid astrocytoma can occur at a later age and can arise in regions different from hypothalamic/chiasmatic.

Colon cancer is the most frequent neoplasia of the intestine. This pathology is the third highest cause of death from cancer with 430,000 deaths globally per year. Estrogen has also been implicated in the development and progression of colon cancer. Also sex-specific differences have been suggested to be involved in the process. Previous studies have shown the estrogen beta receptor to be the dominant receptor type in normal colonic tissue and its down-regulation along with the progression of colorectal cancer. The presence of estrogen receptors and products of estrogen-related genes in the colon suggests that estrogens have direct effects on the colonic tissue. However, the specific effect of estrogens on a normal colon and the role in the colon carcinogenesis are far from clear. The aim of this study is to analyze by real-time polymerase chain reaction, the relative quantitative expression of the estrogen receptors beta, beta1, beta2, and beta5 in colon adenocarcinomas and to compare this expression with the respective in normal tissues. Moreover, we evaluate a possible correlation between estrogen's receptor expressions and disease stages. Normal tissues show estrogen receptor beta expression greater than pathologic tissues and the estrogen receptor beta result as most expressed in the lower disease stages.

PURPOSE:To determine whether infliximab may be used safely as an intraocular drug, the ocular safety of intravitreal infliximab in rabbits was studied by clinical examination, electroretinography (ERG), and histology in rabbits.METHODS:Twelve New Zealand albino rabbits were selected for this study. Different infliximab doses, namely 1.0 mg, 1.7 mg, and 3.3 mg in 0.1 mL, were injected intravitreally into one eye each of three rabbits. As a control, the vehicle solution was injected into the fellow eye of each animal. Eye clinical examination and ERG recordings were made before and 2, 6, and 12 weeks after injection. Eventually, the rabbits were humanely killed, and the retinas were examined by light microscopy. In addition, the elimination half-life of the drug in the vitreous was assessed.RESULTS:Slit lamp biomicroscopy, indirect funduscopy, and ERG evidenced no significant differences between control and infliximab-injected eyes in this rabbit model, at any of the tested doses. Histologic examination revealed no retinal abnormality in the rabbits injected with 1 mg and 1.7 mg intravitreal infliximab. In two of three eyes injected with 3.3 mg infliximab, significant edema of the nerve fibers was detected compared with the control group. The half-life of the drug was estimated to be 8.5 days.CONCLUSIONS:These results indicate that infliximab may be a safe intravitreal drug in the rabbit model at a dose of up to 1.7 mg. If proven safe and efficacious in further studies, intravitreal injection of infliximab could be considered an alternative to systemic administration in selected patients.

Kahraman, S. 212 Kamei, T. 24 Kanayama, S. 133 Karger, T. IV Karlikaya, G. 212 Karša, M. 222 Kavanagh, J.J. 35 Kawaguchi, R. 133 Kaya, M. 217 Kikuchi, A. 73, 116 Kim, D.Y. 62 Kim, H.S. 62 Kim, J.C. 62 Kim, J.W. 41 Kim, S.K. 41 Kim, S.W. 123 Kim, Y.-H. 62 Kitanaka, T. 133 Kliucinskas, M. 32 Kobayashi, H. 133 Kollender, Y. 89 Kostirova, M. 47 Kozuma, S. 116 Kriplani, A. 84 Ku, J.H. 62, 123 Kulaš, T. 222 Kumbak, B. 212

Diagnostic CytopathologyVolume 36, Issue 2 p. 113-114 Images in Cytology Gestational choriocarcinoma: Morphological features in a liquid-based endometrial cytological sample Francesca Garbini M.D., Corresponding Author Francesca Garbini M.D. [email protected] Department of Human Pathology and Oncology, University of Florence, Florence, ItalyDepartment of Human Pathology and Oncology, University of Florence, Viale G.B. Morgagni, 85, Florence 50134, ItalySearch for more papers by this authorAnna Maria Buccoliero M.D., Anna Maria Buccoliero M.D. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this authorFrancesca Castiglione M.D., Francesca Castiglione M.D. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this authorChiara Francesca Gheri M.D., Chiara Francesca Gheri M.D. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this authorDaniela Moncini M.D., Daniela Moncini M.D. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this authorDuccio Rossi Degl'Innocenti B.Sc., Duccio Rossi Degl'Innocenti B.Sc. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this authorAlfredo Barbetti B.Sc., Alfredo Barbetti B.Sc. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this authorAlessandro Villanucci M.D., Alessandro Villanucci M.D. Department of Gynecology, Perinatology, and Human Reproduction, University of Florence, Florence, ItalySearch for more papers by this authorGian Luigi Taddei M.D., Gian Luigi Taddei M.D. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this author Francesca Garbini M.D., Corresponding Author Francesca Garbini M.D. [email protected] Department of Human Pathology and Oncology, University of Florence, Florence, ItalyDepartment of Human Pathology and Oncology, University of Florence, Viale G.B. Morgagni, 85, Florence 50134, ItalySearch for more papers by this authorAnna Maria Buccoliero M.D., Anna Maria Buccoliero M.D. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this authorFrancesca Castiglione M.D., Francesca Castiglione M.D. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this authorChiara Francesca Gheri M.D., Chiara Francesca Gheri M.D. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this authorDaniela Moncini M.D., Daniela Moncini M.D. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this authorDuccio Rossi Degl'Innocenti B.Sc., Duccio Rossi Degl'Innocenti B.Sc. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this authorAlfredo Barbetti B.Sc., Alfredo Barbetti B.Sc. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this authorAlessandro Villanucci M.D., Alessandro Villanucci M.D. Department of Gynecology, Perinatology, and Human Reproduction, University of Florence, Florence, ItalySearch for more papers by this authorGian Luigi Taddei M.D., Gian Luigi Taddei M.D. Department of Human Pathology and Oncology, University of Florence, Florence, ItalySearch for more papers by this author First published: 07 January 2008 https://doi.org/10.1002/dc.20720Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Muggia FM,Eifel PJ,Burke TW. Gestational trophoblastic diseases. Philadelphia: Lippincott-Raven; 1997. 1427 p. 2 Fox H,Buckley CH. The female genital tract and ovaries. New York: Oxford University Press; 1992. 1565 p. 3 Tavassoli A,Peter Devilee. Tumours of the breast and female genital organs. WHO: World Health Organization classification of tumors. Lyon, France: IARC Press; 2003. 186 p. Citing Literature Volume36, Issue2February 2008Pages 113-114 ReferencesRelatedInformation

Aims: The aim of this study was to evaluate the utility of liquid-based cytology for endometrial surveillance in patients receiving tamoxifen. Methods: One hundred and sixty-eight women scheduled for hysteroscopy were enrolled in the study. The women sequentially underwent hysteroscopy, endometrial cytology and biopsy. Results: Endometrial biopsy only was inadequate in 112 (67%) patients, both endometrial biopsy and cytology were inadequate in 19 (11%) patients, endometrial cytology only was inadequate in 4 (2%) patients, and both endometrial biopsy and cytology were adequate in 33 (20%) patients. Overall, endometrial biopsy was inadequate in 131 (78%) patients and endometrial cytology in 23 (14%) patients. Endometrial cytology provided sufficient material for diagnosis more often than endometrial biopsy (p < 0.05). In the series of 33 patients (20%) in whom both endometrial cytology and biopsy were adequate, there was a 100% correlation between the endometrial cytology and biopsy results. Conclusions: For the first time, this study shows the diagnostic efficacy of liquid-based endometrial cytology in the follow-up of women receiving tamoxifen. It could be applied solely or in conjunction with ultrasonography.

We present the case of a Middle Eastern child, diagnosed and treated at 8 months of age for a hepatic neuroblastoma. After surgical removal of a 7 cm mass of the left liver lobe at our institution when the child was 15 months of age, the tumor was reclassified as a teratoid hepatoblastoma. The tumor was composed of fetal and embryonal hepatic tissue, undifferentiated tissue, and a teratoid background of loose mesenchymal tissue containing osteoid, squamous, and mucinous epithelium. We speculate on the histogenesis of teratoid hepatoblastoma and discuss its association with chemotherapy.

Ependymomas are the third most common brain tumor in children. The post surgical management is controversial. There are no convincing data on an effective role for chemotherapy. O(6)-Methylguanine-DNA-Methyltransferase (MGMT) is a DNA repair protein considered to be a chemosensitivity predictor. Hypermethylation of the MGMT gene promoter is an important cause of MGMT inactivation. We evaluated the MGMT gene promoter methylation and the immunohistochemical MGMT protein expression in 12 recurrent anaplastic ependymomas affecting children. Our purpose was to investigate the molecular rationale of the administration of alkylating agents to children affected by recurrent anaplastic ependymomas. All ependymomas lacked MGMT promoter hypermethylation and 9 (75%) showed high MGMT protein expression (>50% tumoral cells). Differences between different recurrences in the same patient were not observed. These results may indicate MGMT as a factor of chemoresistance to alkylating drugs in anaplastic ependymomas and support the uncertainties regarding the actual benefit of chemotherapy for patients with anaplastic ependymomas.