bluuebunny/crossref_metadata_2025_split huggingface dataset:
Histological heterogeneity of dysembryoplastic neuroepithelial tumour: identification and differential diagnosis in a series of 74 cases
Authors: Honavar  , Janota  , Polkey  
Published: March 2003

AimsIn a retrospective study of resected specimens from 416 patients being treated for long‐standing epilepsy, 74 cases of dysembryoplastic neuroepithelial tumour (DNT) were encountered that were all characteristically composed of small round oligodendroglia‐like cells (OLC), astrocytes and mature neurones in varying proportions. The architectural patterns, histological, immunohistochemical and ultrastructural features and results of cell proliferation studies and postoperative follow‐up are described to facilitate the identification of DNT and to differentiate it from other intrinsic neoplasms that commonly present with seizures.Methods and resultsThe tumours presented with early onset of seizures, at a median age of 7 years, without the signs of raised intracranial pressure. A majority of the lesions were located in the temporal lobe (n = 59), with fewer cases in the frontal (n = 8), parietal (n = 6) and occipital lobes (n = 1), and ranged in size from 10 to 70 mm; 33 were cystic. Histologically three types could be distinguished, multinodular, solitary nodular and diffuse. The first type (37.8%) had the features of a typical DNT with multinodular architecture and mixed cellular composition. The second type (33.8%) consisted of a solitary nodule, while the third (28.4%) was a diffuse tumour, both composed of a similar mixture of cells as the multinodular DNT. The lesions were seen in the neocortex and white matter and tumours in the temporal lobe often involved the amygdala and hippocampus. The presence of myxoid matrix, microcystic change, calcification and leptomeningeal involvement were common. Dysplastic neurones at the periphery of the tumour and abnormalities in cortical lamination in the adjacent neocortex were found in about one‐third of the resections. Rare mitotic figures were encountered in eight of the tumours and necrosis was found in two. Immunocytochemistry for glial fibrillary acidic protein (GFAP) and neuronal markers neuron‐specific enolase, synaptophysin and neurofilament (RT 97) assists in establishing the diagnosis, highlighting the astrocytic and neuronal components, and the OLC, by the absence of expression of GFAP. Electron microscopy showed that in some cases OLC show neuronal differentiation. Although the proliferating cell nuclear antigen labelling index varied between 0 and 45.5%, 20 of the 51 tumours stained failed to express the antigen, in keeping with the indolent nature of this neoplasm. The response to surgery was excellent; none of the tumours have recurred, and the control of seizures remained good.ConclusionsDespite some histological heterogeneity, the clinical and pathological features and indolent biological behaviour indicate that these tumours constitute a single distinct entity. The spectrum of morphological appearances of DNT is broader than has been previously reported, the recognition of which is needed to avoid unnecessary neoadjuvant therapy.
Endometrial apoptosis in patients with dysfunctional uterine bleeding
Authors: Stewart  , Campbell‐Brown  , Critchley  , Farquharson  
Published: March 2003

AimsTo assess glandular apoptosis in the zona functionalis of proliferative phase endometrium in normal individuals and in patients with dysfunctional uterine bleeding (DUB).Methods and resultsRoutinely processed, haematoxylin and eosin‐stained endometrial biopsies were assessed in 26 patients with symptomatic menstrual abnormality, mainly menorrhagia, and in 24 controls. All biopsies were in the proliferative phase and had been reported as within normal limits and consistent with the menstrual cycle dates provided. Apoptotic and mitotic figures were counted in a minimum of 100 transversely sectioned endometrial glands in all cases. In 16 biopsies (12 DUB and four controls) apoptosis was further assessed using the in situ terminal deoxynucleotidyl‐transferase‐mediated 2′‐deoxyuridine‐5′‐triphosphate (dUTP) nick‐end labelling (TUNEL) method. Apoptotic figures were identified in most control biopsies averaging 5.6/100 glands, and were significantly increased in biopsies from patients with DUB averaging 13.9/100 glands. There was no difference in mitotic figure counts. Apoptoses tended to be clustered within adjacent glands in both groups and individual glands exhibited both mitotic and apoptotic activity. Application of the TUNEL method gave broad agreement with morphological assessment although approximately 20–25% of typical apoptotic figures were not labelled.ConclusionsEndometrial glandular apoptosis is present in most normal proliferative phase biopsies and appears increased in some cases of DUB. The significance of this finding is not known but increased apoptosis may serve as a morphological marker of abnormal endometrial development in otherwise normal biopsy specimens.
Primary cardiac sarcomas: an immunohistochemical and grading study with long‐term follow‐up of 24 cases
Authors: Donsbeck  , Ranchere  , Coindre  , Le Gall  , Cordier  , Loire  
Published: March 2003

AimsPrimary cardiac sarcomas are rare and aggressive tumours. The aims of this study were to precisely classify cardiac sarcomas according to their pathology, and to determine their clinicopathological features and prognosis.Methods and resultsTwenty‐four primary cardiac sarcomas were studied. Clinical features and follow‐up of all patients were collected. Histological diagnoses were obtained by combining both morphological features as described in soft tissue counterparts and the immunoprofile of the tumours. The 24 cases were classified as undifferentiated sarcoma (nine cases), angiosarcoma (six cases all located in the right atrium), leiomyosarcoma (six cases), malignant fibrous histiocytoma (one pleomorphic and one giant cell type) and synovial sarcoma (one case). Patients included 14 men and 10 women, with a mean age of 46 years. Clinical manifestations were protean, often delaying the diagnosis. Dyspnoea resulting from obstruction of the cardiac chambers was the most common symptom. Echocardiography and magnetic resonance imaging were useful respectively to detect and to evaluate tumour extension. Complete macroscopic resection was possible in only 33% of patients. The most common cause of death was local recurrence of the tumours (50%), even in the cases of complete macroscopic resection. Whatever the treatment, the prognosis was poor with a mean survival of 16.5 months after diagnosis.ConclusionsAll types of sarcomas may be observed in the heart with a predominance of undifferentiated sarcomas. Histological grading, unlike histological type, seems to correlate with survival which remains extremely poor.
Adenocarcinomas of various sites may exhibit immunoreactivity with anti‐inhibin antibodies
Authors: McCluggage  , Maxwell  
Published: March 2003

AimsThe aim of this study was to investigate the immunohistochemical staining of adenocarcinomas arising primary at a variety of sites with antibodies against the α and β subunits of human inhibin. We wished to determine whether positivity in an adenocarcinoma is specific for an ovarian primary.Methods and resultsSeventy‐eight adenocarcinomas were stained with the commercially available monoclonal antibodies R1 and E4 which react against the α and βA subunits of human inhibin, respectively. In 20 adenocarcinomas, there was positivity with R1 and 46 cases were immunoreactive with E4. Positive staining was generally weak although there was strong reactivity with R1 in five cases and with E4 in two cases.ConclusionsPositive staining with antibodies against the α and β subunits of inhibin may be present in adenocarcinomas arising primary at a variety of sites. Caution should be exercised when using anti‐inhibin antibodies to distinguish between an ovarian carcinoma and a sex cord‐stromal tumour. These antibodies should always be used as part of a panel. Positivity with anti‐inhibin antibodies in an adenocarcinoma is not specific for an ovarian primary.
Cribriform adenocarcinoma of the tongue: a hitherto unrecognized type of adenocarcinoma characteristically occurring in the tongue
Authors: Michal  , Skálová  , Simpson  , Raslan  , Čuřík  , Leivo  , Mukenšnábl  
Published: March 2003

AimsWe report a review of our institutional and consultation files in order to select cases of hitherto unrecognized type of adenocarcinoma occurring in the tongue.Materials and resultsEight cases of a characteristic adenocarcinoma of the tongue resembled solid and follicular variants of the papillary carcinoma of the thyroid. All the tumours were unencapsulated and were divided by fibrous septa into lobules. Major parts of the lesions were composed of areas with solid and microcystic growth patterns. The most striking cytological feature was that the tumour nuclei were pale‐staining with a ‘ground glass’ quality, and they often appeared to overlap. Immunohistochemically, the tumours expressed cytokeratin and S100 protein and, focally, actin; thyroglobulin was negative. Ultrastructurally the cells had clefted nuclei, and the cytoplasm contained a few mitochondria, lysosomes and Golgi apparatus. Many tumour cells had combined features of both myoepithelial and secretory differentiation—well formed microvilli on their apical borders and bundles of microfilaments. At first presentation, all eight patients had metastases in the regional neck lymph nodes, but all are alive 2–6 years after the initial excision and irradiation.ConclusionWe describe a distinctive type of adenocarcinoma of the tongue, for which we propose the name cribriform adenocarcinoma of the tongue (CAT). CAT usually presents with metastases in the neck lymph nodes at the time of presentation. We hypothesize that the tumour might arise from the thyroglossal duct anlage.
Acinar morphology in colorectal cancer is associated with survival but is not an independent prognostic variable
Authors: Whittaker  , Carr  , Midwinter  , Badham  , Higgins  
Published: March 2003

AimsMicroacinar morphology has been reported as a stage‐independent prognostic variable for colorectal cancer. We have undertaken a retrospective analysis to test this observation in patients with colonic as well as rectal adenocarcinoma, and to assess interobserver agreement for identifying microacinar morphology.Methods and resultsOne hundred and eighty patients with colorectal cancer, 144 colonic and 36 rectal, were assigned to either macroacinar (144) or microacinar (36) groups. There was excellent correlation between two observers examining the colorectal cancers independently (kappa statistic, κ = 0.87). Patients with microacinar tumours had a significantly reduced median survival compared with macroacinar lesions (46 and 87 months, respectively, P = 0.022) and this morphology was significantly associated with higher Dukes' stage (P = 0.007). Microacinar morphology lacked statistical significance when examined in a multivariate analysis with other prognostic variables, both when colonic and rectal tumours were examined either separately or as a combined colorectal group, but small numbers of rectal tumours in this study make it difficult to draw useful conclusions about microacinar morphology in rectal adenocarcinoma.ConclusionsMicroacinar morphology was strongly associated with poor prognosis when examined in isolation but was not found to be an independent factor when examined with other prognostic variables.
Giant lamellar bodies as a feature of pulmonary low‐grade MALT lymphomas
Authors: Perry  , Florio  , Dewar  , Nicholson  
Published: March 2003

AimsGiant lamellar bodies (GLBs) are rare pulmonary inclusions, most frequently described in sclerosing haemangiomas. Following a recent report of their presence in a case of pulmonary lymphoma of MALT origin, our aims were to determine their frequency in pulmonary lymphoproliferative disorders, examine their structure and investigate their aetiology further.Methods and resultsWe reviewed a series of 29 pulmonary lymphomas (23 low‐grade, six high‐grade) and 18 cases of reactive pulmonary lymphoid hyperplasia. Five of 23 (22%) low‐grade lymphomas contained GLBs, 4/4 of which stained for surfactant apoprotein A but not for surfactant apoprotein B. No GLBs were seen in 18 cases of reactive pulmonary lymphoid hyperplasia or six high‐grade primary pulmonary lymphomas. Ultrastructural examination revealed concentrically arranged extracellular material forming roughly spherical structures up to 25 μm in diameter. The GLBs were often surrounded by foamy cells and cholesterol clefts, supporting an origin, at least in part, from products of cell breakdown and surfactant degradation.ConclusionThese findings support the idea that the presence of lamellar bodies is in part due to stasis of products arising from degradation of surfactant, in association with certain types of chronic pulmonary pathology. Given their absence in reactive pulmonary lymphoid hyperplasia, the presence of GLBs as an epiphenomenon in a pulmonary lymphoid infiltrate should warrant careful investigation with regard to the diagnosis of low‐grade MALT lymphoma.
Gangliocytic paraganglioma of the appendix
Authors: Van Eeden  , Offerhaus  , Peterse  , Dingemans  , G Blaauwgeers  
Published: March 2003

AimsA case of gangliocytic paraganglioma is reported in the appendix which, to the best of our knowledge, is the first case at this particular site to be described in modern literature.Methods and resultsA 47‐year‐old man with signs and symptoms of acute appendicitis underwent appendectomy. In the resected specimen a tumour with a diameter of 9 mm was found, which microscopically consisted of three different cell types: (a) epithelioid cells lying in a trabecular pattern and in formations reminiscent of ‘Zellballen’ as seen in paragangliomas (b) spindle cells and (c) ganglion‐like cells. A diagnosis of ‘gangliocytic paraganglioma’ was made and confirmed by immunohistochemical and ultrastructural examination.ConclusionGangliocytic paragangliomas are rare tumours of uncertain histogenesis. More than 40 years ago a tumour in the appendix with features similar to our case was described by Masson as ‘neuro‐carcinoïde’. Concerning its origin, Masson, as well as other authors describing gangliocytic paragangliomas decades later, referred to the endodermal–neuroecto dermal complexes found by Van Campenhout. It is felt that the current finding of a gangliocytic paraganglioma in the appendix supports the hypothesis that gangliocytic paragangliomas arise from these embryonal structures.
The World Health Organization classification of neoplastic diseases of the haematopoietic and lymphoid tissues: report of the Clinical Advisory Committee Meeting, Airlie House, Virginia, November 1997
Authors: Harris  , Jaffe  , Diebold  , Flandrin  , Muller‐Hermelink  , Vardiman  , Lister  , Bloomfield  
Published: March 2003

IntroductionSince 1995, the European Association of Pathologists (EAHP) and the Society for Hematopathology (SH) have been developing a new World Health Organization (WHO) classification of haematological malignancies. The classification includes lymphoid, myeloid, histiocytic and mast cell neoplasms.DesignThe WHO project involves 10 committees of pathologists, who have developed lists and definitions of disease entities. A Clinical Advisory Committee (CAC) of international haematologists and oncologists was formed to ensure that the classification will be useful to clinicians. A meeting was held in November 1997 to discuss clinical issues related to the classification.ResultsThe WHO has adopted the ‘Revised European–American Classification of Lymphoid Neoplasms’ (REAL), published in 1994 by the International Lymphoma Study Group (ILSG), as the classification of lymphoid neoplasms. This approach to classification is based on the principle that a classification is a list of ‘real’ disease entities, which are defined by a combination of morphology, immunophenotype, genetic features and clinical features. The relative importance of each of these features varies among diseases, and there is no one ‘gold standard’. The WHO classification has applied the principles of the REAL classification to myeloid and histiocytic neoplasms. The classification of myeloid neoplasms recognizes distinct entities defined by a combination of morphology and cytogenetic abnormalities. The CAC meeting, which was organized around a series of clinical questions, was able to reach a consensus on most of the questions posed. The questions and the consensus are discussed in detail below. Among other things, the CAC concluded that clinical groupings of lymphoid neoplasms was neither necessary nor desirable. Patient treatment is determined by the specific type of lymphoma, with the addition of grade within the tumour type, if applicable, and clinical prognostic factors such as the international prognostic index (IPI).ConclusionThe experience of developing the WHO classification has produced a new and exciting degree of cooperation and communication between oncologists and pathologists from around the world, which should facilitate progress in the understanding and treatment of haematological malignancies.
Combined dermatofibroma: co‐existence of two or more variant patterns in a single lesion
Authors: Zelger B G , Sidoroff A , Zelger B 
Published: March 2003

Aims: Based on a series of 25 cases, we define and characterize combined dermatofibroma, a tumour comprising two or more variant patterns of dermatofibroma in a single lesion.Method and resultsDermatofibroma may present with a wide variety of architectural, cellular or stromal peculiarities. Architectural peculiarities include deep penetration, atrophy, collarette formation, fascicular to plexiform architecture, massive haemorrhage, prominent haemangiopericytoma‐like vascularity and palisading; cellular peculiarities the presence of epithelioid cells, clear cells, granular cells, prominent myofibroblastic differentiation and atypical giant cells (‘monster cells’); or stromal peculiarities such as prominent sclerosis, mucin, haemosiderin and cholesterotic deposits. In combined dermatofibromas two or more of these features are seen in complex or inhomogenous combination such as the silhouette of a deep penetrating dermatofibroma with an ‘ordinary’ storiform pattern in the upper and granular cell differentiation in the lower part of the lesion; or a dermatofibroma with ordinary features in the upper, prominent sclerosis in the middle and clear cells in the lower portion of the lesion; or the characteristic epidermal collarette and cells of epithelial cell histiocytoma with a plexiform (‘neurothekeoma‐like’) architecture surrounded by a myxoid stroma with spindle‐shaped to stellate cells. Clinically, these lesions preferentially occur on the lower extremities of young to middle‐aged females, frequently with the diagnosis of a fibrohistiocytic lesion. Apart from one recurrence follow‐up was uneventful in all other cases. Immunohistochemically, lesions are consistently positive with KiM1p, variably positive for factor XIIIa, smooth muscle specific actin and with KP1 (CD68), NK1C3 and E9.ConclusionRecognition of combined dermatofibroma allows the histopathologist to apply a confident benign label to unusual lesions which might otherwise elude diagnosis, or tempt description of ‘new’ entities and to avoid a misdiagnosis of malignancy.
Poor agreement in recognition of abnormal mitoses: requirement for standardized and robust definitions
Authors: Barry M , Sinha S K , Leader M B , Kay E W 
Published: March 2003

The finding of abnormal mitoses is a helpful feature in differentiating between benign and malignant neoplasia and has prognostic significance for some tumours. As the use of a histopathological variable is limited by the reproducibility of its recognition, we tested the interobserver agreement in the classification of abnormal mitoses among histopathologists.Ten practising histopathologists were shown 30 potential mitotic figures and were asked to classify these as ‘normal mitoses’, ‘abnormal mitoses’ or ‘not mitoses’ according to the criteria each pathologist used in their routine practice. The results were analysed using kappa statistics. Overall agreement was only fair with a combined kappa of 0.31 and there was unanimous categorization of only four of 30 test items, none of which was called abnormal. The poorest result was obtained for the category ‘abnormal mitosis’ with only slight agreement (kappa 0.19). Agreement for the other categories varied from moderate (kappa = 0.45) for ‘not a mitosis’ to fair (kappa = 0.26) for ‘normal mitosis’. Comparison of the results for observer pairs showed that for 12 out of the 45 possible pairings, there was no more agreement than might be expected by chance alone.Agreement is poor among practising histopathologists in the recognition of abnormal mitoses. A standardized and robust definition is needed if diagnostic and prognostic significance is accorded to the finding of an abnormal mitosis in the context of neoplasia.
Angiogenesis is redundant for tumour growth in lymph node metastases
Authors: Naresh K N , Nerurkar A Y , Borges A M 
Published: March 2003

Angiogenesis is redundant for tumour growth in lymph node metastases Aims: Angiogenesis is essential for the growth of solid tumours. As the role of angiogenesis is unclear in the pathogenesis of primary lymph node (LN) tumours, we wondered whether neoangiogenesis was important in supporting and promoting the growth of tumours in LNs. Methods and results: We investigated 16 cases of squamous carcinoma involving oral cavity (n=9) and larynx/pyriform fossa (n=7), all of whom had lymph node metastases. Sections of the primary tumour, uninvolved mucosa, metastatic LN and nonmetastatic LN were double‐immunostained with factor VIII‐related antigen and MIB‐1. Proliferating blood vessels, i.e. neoangiogenesis, was identified by coexpression of factor VIII‐related antigen‐stained blood vessels and MIB‐1 staining of the endothelial cell nuclei. Counts were performed in an area of 4 mm2. Primary tumours (127–188.7), uninvolved mucosa (54–84.5) and metastatic LNs (123.5–167) had significantly lower vessel counts than nonmetastatic LNs (194–253.9) (P=0.003; P < 0.001; P < 0.001, respectively). With regard to neoangiogenesis, primary tumours (1.7–5) had significantly higher counts than uninvolved mucosa (0–0.4), nonmetastatic LNs (0–0.4) and metastatic LNs (0.9–2.4) (P < 0.001; P < 0.001; P=0.047, respectively). Conclusions: Our data suggest that because of the rich native vascularity of lymph nodes, neoangiogenesis is redundant for the growth of metastatic tumour.
p27 immunostaining is related to prognosis in malignant mesothelioma
Authors: Beer T W , Shepherd P , Pullinger N C 
Published: March 2003

p27 immunostaining is related to prognosis in malignant mesothelioma Aims: To evaluate the prognostic value of the proliferation‐associated antigen p27 in malignant mesothelioma. Methods and results: Sections from 36 patients with malignant mesothelioma were immunohistochemically stained for the p27 antigen. The results were quantified by recording the proportion of positively stained nuclei and these data were tested for association with patient survival. p27 expression was also compared with tumour type, MIB‐1 expression, apoptotic and mitotic indices. Patients with pleural malignant mesothelioma showing low p27 expression (< 53% of cells positive) survived for significantly shorter periods of time than those with high p27 expression (≥ 53% of cells positive) (P=0.04). The 50% survival time of subjects with low p27 was 4–6 months whereas for those with high p27 expression it was 10–11 months. There was no significant association between p27 expression and MIB‐1, apoptotic or mitotic indices. Conclusions: Low p27 expression in pleural malignant mesothelioma is associated with a significantly worse prognosis. p27 appears to be an independent prognostic variable which may be of value in counselling patients with malignant mesothelioma.