Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists

Endometrial intraepithelial neoplasia (EIN) applies specific diagnostic criteria to designate a monoclonal endometrial preinvasive glandular proliferation known from previous studies to confer a 45-fold increased risk for endometrial cancer. In this international study we estimate accuracy and precision of EIN diagnosis among 20 reviewing pathologists in different practice environments, and with differing levels of experience and training. Sixty-two endometrial biopsies diagnosed as benign, EIN, or adenocarcinoma by consensus of two expert subspecialty pathologists were used as a reference comparison to assess diagnostic accuracy of 20 reviewing pathologists. Interobserver reproducibility among the 20 reviewers provided a measure of diagnostic precision. Before evaluating cases, observers were self-trained by reviewing published textbook and/or online EIN diagnostic guidelines. Demographics of the reviewing pathologists, and their impressions regarding implementation of EIN terminology were recorded. Seventy-nine percent of the 20 reviewing pathologists' diagnoses were exactly concordant with the expert consensus (accuracy). The interobserver weighted kappa values of 3-class EIN scheme (benign, EIN, carcinoma) diagnoses between expert consensus and each of reviewing pathologists averaged 0.72 (reproducibility, or precision). Reviewing pathologists demonstrated one of three diagnostic styles, which varied in the repertoire of diagnoses commonly used, and their nonrandom response to potentially confounding diagnostic features such as endometrial polyp, altered differentiation, background hormonal effects, and technically poor preparations. EIN diagnostic strategies can be learned and implemented from standard teaching materials with a high degree of reproducibility, but is impacted by the personal diagnostic style of each pathologist in responding to potential diagnostic confounders

Mullerian adenosarcoma with sarcomatous overgrowth of the cervix - Unusual large polypoid mass

WOS: 000253451900006PubMed: 17578809Mullerian adenosarcoma ( MS) is a rare neoplasm of uterine cervix composed of benign epithelial and malignant stromal components. An aggressive variant of adenosarcoma, mullerian adenosarcoma with sarcomatous overgrowth (MASO) is extremely rare. The difference between MS and MASO is the pure high grade sarcoma features in MASO. In this report we present a MASO case, derived from uterine cervix of a 60 year-old-female patient presenting as a cervical polypoid mass, to our knowledge the second case of the English literature. In spite of sarcomatous overgrowth, high mitotic activity and huge tumor size of 12,5 cms, it displayed no myometrial invasion, vascular invasion and heterologous elements. The patient has been clinically free of disease for 14 months of follow up after total abdominal hysterectomy and bilateral salpingo-oopherectomy. The difficulties in diagnosis and treatment of this entity will be evaluated in this report

Mammary pseudoangiomatous stromal hyperplasia composed of predominantly giant cells: An unusual variant

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferative lesion of mammarian stroma that presents as a localized mass. We describe the clinical, radiologic, cytologic, and histopathologic features of a case of PASH with giant cells that presented as a rapidly growing localized mass in the breast in a 32-year-old woman. An unusual feature of our case was the presence of multinucleated giant cells lining pseudovascular spaces and dispersing in collagenous stroma. To the best of our knowledge, this is the second case in the English literature and PASH with predominance of multinucleated giant cells has never been described previously in a female patient

Sex Cord-Stromal Tumor with Annular Tubules of the Ovary

Sex cord-stromal tumors with annular tubules (SCTAT) of the ovary are rare. They have two clinical presentation forms: the syndromic form, which is associated with Peutz-Jeghers syndrome, and the non-syndromic form, which is frequently seen in the second or third decades. We describe a 13-year-old patient who underwent left oophorectomy. Macroscopically, the mass was 16x13x8 cm in diameter, encapsulated, and lobulated. It showed a yellow-to-orange solid cut surface with small cystic areas and hemorrhagic cleft-like spaces. Microscopically, the tumor had nodular areas that were separated with fibrous stroma. They were composed of tubules, which were lined by columnar shaped cells with eosinophilic cytoplasm, nuclear palisading, and central Periodic Acid Schiff (PAS)-positive eosinophilic hyaline bodies. Immunohistochemically, the tumor cells were strongly positive for inhibin. Finally, the tumor was diagnosed as non-syndromic ovarian SCTAT

Intracystic papillary carcinoma of the breast: case report

İstanbul Bilim Üniversitesi, Tıp Fakültesi.İntrakistik papiller karsinom memenin nadir görülen bir tümörüdür ve duktal karsinomdan daha iyi prognozludur. Elli yaşında kadın hasta sol memesinde kitle fark etmesi üzerine doktora başvurdu. Ultrasonografide 2,5 cm çaplı, düzgün kenarlı, solid yapı içeren kistik kitle tespit edildi. Kist içindeki 1,3 cm'lik solid yapıdan ince iğne aspirasyon biyopsisi yapıldı; atipi gösteren prolifere papiller yapılar izlendi. Hastaya segmenter mastektomi uygulandı. Frozen incelemede papiller karsinom tespit edildi, invazyon şüphesi bildirilmesi üzerine sentinel lenf nodu biyopsisi yapıldı. Postoperatif histopatolojik değerlendirmede intrakistik papiller karsinom tanısı kesinleşti. Postmenapozal kadınlarda görülen kistik lezyonların değerlendirilmesinde ve ayırıcı tanıda intrakistik papiller karsinom hatırlanmalıdır. Bu lezyonların tedavisinde segmenter mastektomi önerilmektedir. Sentinel lenf nodu biyopsisi ve adjuvan tedavi konusunda ise konsensus bulunmamaktadır.Intracystic papillary carcinoma which has a better prognosis than ductal carcinoma is a rare tumor of breast. A 50-year-old female was admitted to hospital with palpable mass on her left breast, which was mainly a cystic lesion including a solid component, with regular margin, and 2.5 cm in dimension on ultrasound examination. Fine needle aspiration biopsy of the solid component of 1.3 cm inside the cyst showed proliferative papillary structures with atypia. The patient underwent segmental mastectomy. Papillary carcinoma was detected on frozen section examination and sentinel lymph node biopsy was applied due to the doubt of invasive carcinoma. Intracystic papillary carcinoma was ascertained on postopertive histopathological examination. Intracystic papillary carcinoma should be recalled in the evaluation and diff erantial diagnosis of cystic lesions detected on postmenopausal women. Segmental mastectomy is suggested in the treatment of intracystic papillary carcinoma. However, there is no consensus as to performing sentinel node biopsy and adjuvant therapy

C-Erb-b2 Oncogene Expression in Intraductal Proliferative Lesions of the Breast

The ductal intraepithelial neoplasia (DIN) classification which proposes new approaches to the diagnosis, terminology and differential diagnosis of intraductal proliferative lesions of the breast was applied to a series of female patients comprising C-erbB2 oncogene expression which may serve as an adjunct to the morphology by immunohistochemistry. The study was performed using the data of 94 patients. There was no difficulty encountered in the diagnosis of intraductal hyperplasia (IDH). In patients with Atypical Ductal Hyperplasia (AIDH), the diagnosis could be made by using the 2-mm rule of the DIN classification in patients who exhibited cytologic and structural characteristics of Ductal Carcinoma in Situ (DCIS) alone or in conjunction with classical IDH patterns. However, in lesions that mimicked classical IDH patterns despite displaying cytological features of in situ carcinomas, the experience and view point of the pathologist played a more prominent role. When the DIN classification criteria were applied to grade DCIS lesions, although the system was found to be practical, it did not provide adequate differentiation in intermediate grade (grade II-DIN 2) patients and further improvement was considered desirable. Fourty-five cases (47.8%) IDH, 19 (20.2%) AIDH, and 30 (31.9%) were DCIS. There were statistically significant differences in the levels of c-erbB2 oncogene expression between IDH, AIDH and DCIS lesions (p<0.001). In DCISs, grade, cell size, pleomorphic nuclear atypia showed statistically significant associations with c-erbB2 oncogene expression. These results suggest that c-erbB2 oncogene expression is a valuable marker in the differential diagnosis and prognostic evaluation of patients with intraductal proliferative lesions. (C) 2012 Association of Basic Medical Sciences of FBIH. All rights reserve