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S F Lax, K F Tamussino, P F Lang
Malignancies of the uterus metastasize by direct invasion of neighboring structures, lymphatically or hematogenously. Endometrial and cervical cancers lymphatically spread to the pelvic and para-aortic lymph nodes. For endometrial cancer the depth of myometrial invasion, lymphosvascular space involvement (LVSI) and a microcystic, elongated and fragmented (MELF) glandular invasion pattern are predictors for lymph node metastases. Metastases to the pelvic lymph nodes occur in approximately 10 % of endometrial cancer patients and in 30 % of these cases the para-aortic lymph nodes are also involved...
October 18, 2016: Der Pathologe
Amy S Joehlin-Price, Kelsey E McHugh, Julie A Stephens, Zaibo Li, Floor J Backes, David E Cohn, David W Cohen, Adrian A Suarez
MELF invasion has been associated with nonvaginal recurrences and lymph node (LN) metastases in multi-institutional case control studies but has not been well examined in large single-institution cohorts. Hysterectomy specimens with FIGO 1 endometrioid endometrial carcinoma and lymphadenectomies from 2007 to 2012 were identified. Electronic medical records and histologic slides were reviewed. Of 464 identified cases, 163 (35.1%) were noninvasive, 60 (12.9%) had MELF, 222 (47.8%) had a component of the infiltrative invasion pattern without MELF, 13 (2...
October 12, 2016: American Journal of Surgical Pathology
Marián Švajdler, Michael Michal, Pavol Dubinský, Peter Švajdler, Ondrej Ondič, Michal Michal
We describe a case of an unusual endometrial endometrioid carcinoma occurring in a 67-year-old woman. The tumor involved uterine corpus as well as lower uterine segment and presented as polypoid tumor protruding through the cervical orifice. Microscopically, the tumor was characterized by broad zones of cytologically bland fibromyxoid stroma resembling nodular fasciitis, showing vaguely nodular architecture. Neoplastic glands were characterized by interconnected elongated slit-like and large cystic profiles, mostly lined by flattened epithelium with variable squamous differentiation, whereas typical columnar endometrioid cells were only focally present...
November 2016: Advances in Anatomic Pathology
Felix Kommoss, Friedrich Kommoss, Friederike Grevenkamp, Anne-Kathrin Bunz, Florin-Andrei Taran, Falko Fend, Sara Y Brucker, Diethelm Wallwiener, Birgitt Schönfisch, Karen Greif, Sigurd Lax, Annette Staebler, Stefan Kommoss
PURPOSE: Low- and intermediate-risk endometrial carcinomas have an excellent prognosis. Nonetheless, a small subgroup of such patients will experience unexpected relapse. Recently L1CAM was suggested to be a strong prognosticator in endometrial carcinoma. The focus of our study was on low- and intermediate-risk disease, where no or only limited adjuvant treatment is recommended according to current guidelines. METHODS: Endometrial carcinomas of low, intermediate and high-intermediate risk according to published 2016 consensus guidelines were identified...
September 30, 2016: Journal of Cancer Research and Clinical Oncology
Shinichiro Tahara, Satoshi Nojima, Kenji Ohshima, Yumiko Hori, Masako Kurashige, Naoki Wada, Jun-Ichiro Ikeda, Eiichi Morii
Endometrioid carcinoma (EC) is one of the most common malignancies of the female genital system. Although the behavior of EC ranges from an excellent prognosis to aggressive disease with a poor outcome, the factors that determine its diversity have not been determined. Here, we show that S100A4, a calcium-binding protein of the EF-hand type, is correlated with the proliferation and invasion ability of EC. We demonstrated previously that EC cells with high aldehyde dehydrogenase (ALDH) activity were more tumorigenic than ALDH-lo cells...
September 2016: Cancer Science
Anais Malpica
This article reviews the salient features of variants of endometrioid carcinoma (ECa) that can pose a diagnostic challenge and/or are associated with unique clinicopathological findings. Variants with distinct architectural and cytologic features include the following: (1) ECa with a villoglandular pattern (tumor with finger-like papillae lined by bland cells with a tendency for vascular/lymphatic invasion and lymph node metastasis once this pattern is seen within the myoinvasive component); (2) papillary ECa of intermediate grade (grade 2) (tumor that can be mistaken for serous carcinoma, as it contains papillae showing slightly irregular contours, moderately atypical cells, and it is associated with vascular/lymphatic invasion/lymph node metastasis, but with common association with mucinous metaplasia, MELF (microcystic, elongated, and fragmented) pattern of invasion, and wild p53 expression); (3) ECa with non-villous papillae (tumor containing pseudopapillae within glands with bland-appearing cytology commonly associated with abortive squamous differentiation and otherwise not different from usual ECa); (4) ECa with microglandular-like pattern (tumor that mimics microglandular hyperplasia of the cervix, often lacking the typical appearance of microglandular hyperplasia and showing Ki-67 index >10%, strong CD10 expression, and negative PAX-2, p63, and CD34); and (5) ECa with sex cord-like formations and hyalinization (tumor with interconnected cords and nests of bland epithelioid and spindled cells that merge with a typical component of low-grade ECa, usually associated with squamous differentiation and hyalinization)...
January 2016: Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc
William Selove, Leslie S Bradford, Yuxin Liu
Intraoperative frozen section (IFS) on endometrial cancer is an invaluable skill for pathologists-in-training to master. Within limited time constraints, pathologists are expected to determine tumor type, grade, and depth of myometrial invasion. During their training, pathology residents gradually gain experience in handling the majority of cases. However, significant errors can still be seen among senior level trainees. We aimed to improve training effectiveness by evaluating our trainees' performance, identifying common errors, and recommending focused curriculum...
September 2016: International Journal of Gynecological Pathology
Andres A Roma, Lisa A Rybicki, Denise Barbuto, Elizabeth Euscher, Bojana Djordjevic, Elizabeth Frauenhoffer, Insun Kim, Sung Ran Hong, Delia Montiel, Rouba Ali-Fehmi, Anais Malpica, Elvio G Silva
Prognosis of endometrial adenocarcinoma is favorable; however, the risk of recurrence ranges from 7% to 13%. Recurrence has been related to age, tumor type, International Federation of Gynecology and Obstetrics grade, depth of invasion, and lymphovascular invasion (LVI); however, morphologic features that would predict the site of recurrence have not been established. In this multi-institutional study, we reviewed 589 patients with International Federation of Gynecology and Obstetrics grades 1 or 2 endometrial adenocarcinoma, endometrioid type...
October 2015: Human Pathology
Yifei Huang, Chunfang Jin, Yun Xiang, Lei Wang, Zimeng Wang, Wei Wang, Yujuan He
OBJECTIVE: To develop a mouse model for acute otitis media (AOM) via transbullar injection method and evaluate its feasibility and practicability. METHODS: The middle ears (ME) of C57BL/6 mice were inoculated via transbullar injection method with 5 µl streptococcus pneumoniae ( 19F suspension (1×10(7) CFU/ml), and the control group was inoculated equivalent phosphate buffered solution (PBS). Behavior changes were observed daily following inoculation. The ME tissues for histological examination and the middle ear lavage fluid (MELF) for total cells quantification, S...
April 2015: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
Anders W Bjerring, Marius E Lier, Siri Malene Rød, Pia Fiskaa Vestby, Klaus Melf, Birger H Endreseth, Øyvind Salvesen, Johan von Schreeb, Arne Wibe, Thaim Buim Kamara, Håkon Angell Bolkan
BACKGROUND: The traditional tools to assess surgical capacity in low-income countries require significant amounts of time and resources, and have thus not been utilized systematically in this context. Proxy indicators have been suggested as a simpler tool to estimate surgical volume. The aim of this study was to assess caesarean section and inguinal hernia repair as proxy indicators of the total number of surgeries performed per capita in a given region of sub-Saharan Africa. METHODS: Surgical data was compiled from 58 health institutions (96...
May 2015: Surgery
Silvina Limandri, Pablo de Vera, Raul C Fadanelli, Luiz C C M Nagamine, Alexandre Mello, Rafael Garcia-Molina, Moni Behar, Isabel Abril
Ion-beam cancer therapy is a promising technique to treat deep-seated tumors; however, for an accurate treatment planning, the energy deposition by the ions must be well known both in soft and hard human tissues. Although the energy loss of ions in water and other organic and biological materials is fairly well known, scarce information is available for the hard tissues (i.e., bone), for which the current stopping power information relies on the application of simple additivity rules to atomic data. Especially, more knowledge is needed for the main constituent of human bone, calcium hydroxyapatite (HAp), which constitutes 58% of its mass composition...
February 2014: Physical Review. E, Statistical, Nonlinear, and Soft Matter Physics
M Dogan Altunpulluk, G Kir, C S Topal, H Cetiner, A Gocmen
The purpose of this study was to investigate the frequency of microcystic, elongated and fragmented (MELF) pattern of invasion in endometrioid endometrial adenocarcinomas (EA) and its association with prognostic factors. Stained tissue sections from 121 cases of EA (total hysterectomy and pelvic, with or without para-aortic, lymphadenectomy specimens) were reviewed to identify cases showing MELF-type invasion. The prognostic factors of low tumour grade, deep myometrial invasion (MI), cervical stromal involvement, lymphovascular space invasion (LVSI), lymph node (LN) metastasis and advanced clinical stage were more frequently observed in MELF-positive cases (p < 0...
May 2015: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Richard J Zaino
Although most of Dr Scully's research addressed diseases of the ovary, about 10% of his published manuscripts focused on endometrial lesions, most often consisting of observations about unusual types or deceptive patterns of endometrial carcinoma that had not previously been described, or lesions for which the behavior had been unknown. He characterized and clarified the entity of clear cell carcinoma of the endometrium, and wrote about endometrial carcinomas with argyrophil, oxyphil, and giant cells, and those simulating microglandular hyperplasia of the cervix, as well as uterine papillary serous, squamous cell, and small cell carcinoma,...
July 2014: International Journal of Gynecological Pathology
Johann D Hertel, Phyllis C Huettner, John D Pfeifer
The microcystic elongated and fragmented (MELF) pattern of myoinvasion is a feature of some well-differentiated endometrial endometrioid adenocarcinomas that has been associated with poor prognosis. The myoinvasion in MELF-pattern tumors can be subtle and lead to underestimation of the depth of myometrial invasion resulting in tumor understaging; the presence of lymphvascular space invasion (LVSI) and lymph node metastasis in MELF-pattern tumors can also be subtle and lead to tumor understaging. To investigate the association of MELF-pattern invasion and lymph node metastasis, we reviewed a series of well-differentiated endometrioid adenocarcinomas and correlated the presence of MELF-pattern myoinvasion and LVSI with lymph node metastasis...
March 2014: International Journal of Gynecological Pathology
Guo Min Liu, Ya Jun Wang, Dong Sheng Wang, Qin-Yi Liu
BACKGROUND: This study aims to compare the perioperative parameters and clinical results between microendoscopy laminoforaminotomy (MELF) and cervical arthroplasty (CA) in the treatment of one-level cervical spondylotic radiculopathy in a retrospective study. METHODS: From 2003 to 2007, a total of 97 patients with one-level cervical spondylotic radiculopathy were treated. Forty-five patients underwent CA. Fifty-two patients underwent MELF. Patient demographics and operative data were collected with a minimum 2-year follow-up...
2013: Journal of Orthopaedic Surgery and Research
Guangming Han, Diana Lim, Mario M Leitao, Nadeem R Abu-Rustum, Robert A Soslow
AIMS: Lymph node involvement affects prognosis/treatment in endometrial carcinoma patients. We assessed various histological features associated with nodal metastasis in patients with grade I, stage I endometrial endometrioid carcinoma (EEC). METHODS AND RESULTS: Eighteen stage I EECs with occult positive lymph nodes and 36 controls were assessed for depth of myoinvasion; microcystic, elongated and fragmented (MELF) pattern of myometrial invasion; lymphovascular invasion (LVI); and epithelial metaplasia...
February 2014: Histopathology
Elizabeth Euscher, Patricia Fox, Roland Bassett, Hayma Al-Ghawi, Rouba Ali-Fehmi, Denise Barbuto, Bojana Djordjevic, Elizabeth Frauenhoffer, Insun Kim, Sun Rang Hong, Delia Montiel, Elizabeth Moschiano, Andres Roma, Elvio Silva, Anais Malpica
The purpose of this study was to examine predictors of lymph node (LN) metastases or extrauterine disease (ED) in low-grade (FIGO grade 1 or 2) endometrioid carcinoma (LGEC) in a multi-institutional setting. For LGEC with and without LN metastasis or ED, each of the 9 participating institutions evaluated patients' age, tumor size, myometrial invasion (MI), FIGO grade, % solid component, the presence or absence of papillary architecture, microcystic, elongated, and fragmented glands (MELF), single-cell/cell-cluster invasion (SCI), lymphovascular invasion (LVI), lower uterine segment (LUS) and cervical stromal (CX) involvement, and numbers of pelvic and para-aortic LNs sampled...
November 2013: American Journal of Surgical Pathology
Charles M Quick, Taymaa May, Neil S Horowitz, Marisa R Nucci
Patients with low-stage, low-grade endometrial adenocarcinomas have a favorable prognosis; however, a subset has a risk of recurrence and death. We were interested in evaluating patterns of myometrial invasion and correlating them with clinical outcome to potentially identify patients at increased risk. A total of 324 cases of low-stage Grade 1 endometrial adenocarcinoma were reviewed to identify those with myoinvasion. The myoinvasive cases were classified on the basis of the pattern of invasion: infiltrating glands, microcystic elongated and fragmented (MELF; a distinctive histologic variant of the infiltrative gland pattern), broad front, adenomyosis like, and adenoma malignum...
July 2012: International Journal of Gynecological Pathology
Colin J R Stewart, Maxine L Crook, Joanne Lacey, Kathryn Louwen
The low-molecular-weight cytokeratin (CK) protein CK19 has been shown to have diagnostic use and prognostic significance in some types of human malignancy, but little is known of its distribution in normal endometrial mucosa or in endometrial endometrioid adenocarcinoma. However, we had observed that CK19 appeared to selectively label invasive tumor areas showing microcystic, elongated, and fragmented ("MELF") changes. Therefore, CK19 expression was assessed in 15 hysterectomy specimens showing normal proliferative, secretory, or atrophic endometrial appearances, and in 26 endometrioid adenocarcinoma cases with areas of MELF-type invasion...
September 2011: International Journal of Gynecological Pathology
Colin J R Stewart, Maxine L Crook, Lorella Manso
AIMS: The actin-binding protein fascin appears to potentiate the migratory capacity of both normal and neoplastic cells. It has been suggested that microcystic, elongated and fragmented (MELF) glands might represent areas of active invasion within uterine low-grade endometrioid adenocarcinomas. Therefore, fascin immunoreactivity was investigated in a series of endometrial carcinomas specifically comparing expression in conventional tumour areas, foci of MELF-type invasion and in stromal elements...
July 2011: Histopathology
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