The ultrastructural morphology of gynecologic neoplasms

Myxoid Leiomyosarcoma of the Uterus -A Case Report with Light Microscopic and Ultrastructural Appraisal

A case of an infiltrating myxopolypoid tumor of the uterus is presented. Histologically, the tumor revealed spindle-shaped cells with mitotic counts ranging between 1-4/hpf, myxoid stroma, and multinucleated giant cells mimicking syncitial giant cells of pregnancy trophoblast. Conventional light microscopic methods failed to establish the histogenesis of the tumor. At the ultrastructural level the tumor showed three main cellular components; myoblasts, myofibroblasts and collagen-producing fibroblasts. On the basis of light microscopic and electron microscopic findings, the tumor was labelled myxoid leiomyosarcoma. This variant of leiomyosarcoma is rare. This is the seventh case reported in the international literature.

Non-neoplastic granulosa cells within ovarian vascular channels: a rare potential diagnostic pitfall

AIMS

To describe six cases seen in consultation in which artefactual vascular involvement within the ovary by benign granulosa cells caused diagnostic confusion.

METHODS/RESULTS

In five cases, the initial favoured diagnoses of the submitting pathologists were metastatic carcinoma (three cases) and immature neural elements within a teratoma (two cases). In two cases, the ovary contained a benign cystic teratoma (one with struma ovarii), in two cases endometriosis, in one case follicular cysts, and in the other no pathological lesion was present. In all cases, several small ovarian vascular channels contained cohesive groups of cells with mildly atypical nuclei and cytoplasm, which varied from scant to abundant and eosinophilic. In four cases, mitotic figures were identified. The cells were morphologically consistent with benign granulosa cells and were associated in four cases with a nearby follicle lined by similar cells. There was no evidence of a mass lesion, grossly or histologically, to suggest a granulosa cell tumour. The nature of the cells was confirmed using immunohistochemistry for alpha inhibin and calretinin in one case.

CONCLUSIONS

This phenomenon is probably an artefact secondary to surgical trauma or sectioning within the laboratory; alternatively, it could be related to ovulation. It is important that this benign process is not misinterpreted as cancer, either primary or metastatic, which may prompt inappropriate treatment or investigations that are not needed.

Uterine tumor resembling ovarian sex-cord tumor: report of a case mimicking cervical adenocarcinoma

Uterine tumors resembling ovarian sex-cord tumors (UTROSCTs) are unusual neoplasms with histologic features that resemble those within ovarian Sertoli and granulosa cell tumors. We report the case of a 24-year-old woman with a UTROSCT presenting as a cervical mass, which on initial evaluation was thought to represent cervical adenocarcinoma. The patient's cervical biopsy specimen contained epithelioid cells arranged in tubules and anastomosing cords, without significant cellular atypia or mitotic activity. Because this morphology elicited a broad differential diagnosis, immunohistochemical studies were performed. The tumor was found to be diffusely positive for cytokeratin cocktail, calretinin, and desmin, focally positive for CK7 and SMA, and negative for EMA, CEA, inhibin, CD10, CK20, chromogranin, and synaptophysin. Ultrastructural examination revealed occasional gland-like lumens with cells joined by desmosomes and a continuous basal lamina. UTROSCTs have features that may cause them to be confused with more common tumors, especially in limited biopsy samples, and should be included in the differential diagnosis when a gland-forming neoplasm with an unusual appearance is identified in a cervical or endometrial biopsy specimen.

Expression of cytokeratin 20 in mucinous bronchioloalveolar carcinoma

Mucinous bronchioloalveolar carcinomas (BACs) can closely mimic metastatic adenocarcinoma to the lung both clinically and morphologically. Several studies have demonstrated that the differential expression of cytokeratin 7 (CK7) and cytokeratin 20 (CK20) is a valuable diagnostic tool in differentiating primary pulmonary adenocarcinomas (PPAs) (usually CK7 positive/CK20 negative) from metastatic colonic adenocarcinoma (usually CK7 negative/CK20 positive). The present study is designed to correlate the histologic subtypes of PPA with expression of 7 and 20. A total of 113 cases of bonafide PPA were selected and classified according to the 1999 World Health Organization criteria as adenocarcinoma, NOS (n = 80), nonmucinous BAC (n = 14), and mucinous BAC (n = 19). Representive sections of all the tumors were immunohistochemically analyzed for CK7 and CK20 expression. To evaluate the diagnostic utility of CK7 and CK20 expression, 6 cases of colonic adenocarcinoma metastatic to the lung were tested with the same antibodies and compared with mucinous BAC. Results were expressed in a semiquantitative fashion based on the percentage of positive tumor cells: <10%, focal; 10% to 25%, 1+; 26% to 75%, 2+; > or =76%, 3+. All 113 PPAs exhibited strong, diffuse CK7 expression. With respect to CK20 expression, 17 of the 19 cases (89.4%) of mucinous BAC showed moderate to strong expression of this protein, whereas only 10 cases of conventional adenocarcinomas and 4 cases of nonmucinous BAC exhibited expression. All 6 examples of metastatic colonic adenocarcinomas were negative for CK7 and strongly positive for CK20. In summary, mucinous BAC is distinct from other PPAs by virtue of its CK20 expression. Although the CK7/CK20 immunoprofile is a valuable diagnostic marker for differentiating primary lung adenocarcinoma from metastatic colonic adenocarcinoma, caution should be exercised when dealing with mucinous BAC.

The role of electron microscopy in gynecological pathology

Electron microscopy, as a diagnostic method, has been available to pathologists for about half a century. Its use in studying normal and abnormal gynecological tissues has been applied during the second half of that period, and many works on specific female genital topics have been published. Several of those subjects are worthy of citing in a review of the present type. Clear cell carcinoma has been revealed to be a mullerian, rather than a wolffian, derivative. Small cell carcinoma of the ovary with hypercalcemia is comprised of cells shown ultrastructurally to be epithelial, but unlike surface epithelial cells, germ cells, sex-cord cells, or neuroendocrine cells. Further electron microscopic studies provided evidence that these small cell tumors are not adult diffuse granulosa cell tumors, endometrioid stromal tumors, primitive neuroectodermal tumors, or numerous other primary and metastatic small cell tumors. Electron microscopy has also been useful in determining that not all signet-ring cell tumors of the ovary are stromal, and that there are multiple types of signet-ring (vacuolated) cells in ovarian tumors. Smooth muscle tumors are well known to have multiple light microscopic phenotypes, and electron microscopy has proven to be diagnostic in many of these cases, especially in epithelioid smooth muscle tumors. A number of other gynecological neoplasms that have been better defined by electron microscopic studies are described. Embryology and histogenesis are other areas of study in which electron microscopy has been a major contributor of new information at the subcellular level. Electron microscopy, solely or in harmony with clinical information, light microscopy, and immunohistochemistry, has been and is a valuable tool for the pathologist in the study of histogenesis and accurate diagnosis of gynecological lesions.

As You Like It, Part 2: A critique and historical review of the electron microscopy literature

As You Like It, Part 2, is a continuation of the lecture given at UltraPath VIII in 1996. It is meant to be a critical historical review of some topics of interest to electron microscopists that will show what went wrong and perhaps also why. Topics are presented under the following headings : (1) Amianthoid Fibers and Giant Collagen Fibrils, (2) Ribosome-Lamella Complex, (3) Globular Filamentous Bodies, and (4) Siderosomes, Hemosiderin vs. Ferritin.

Confronting cisternae and ciliated cells in malignant pleural mesothelioma: an ultrastructural study

The incidence of malignant mesothelioma of the pleura has recently increased in Japan, and ultrastructural and immunohistochemical studies can help in the histopathologic diagnosis. Confronting cisternae consist of dense laminae between the cisternae of rough endoplasmic reticula. Cylindric confronting cisternae have recently been found in patients with acquired immunodeficiency syndrome. The pathologic significance of this unusual structure is still obscure, but it has been proposed that trapped ribosomes on the confronting unit membranes of rough endoplasmic reticula produce the dense laminae. In this study, prominent confronting cisternae were found in more than half the tumor cells, and accumulation of an electrondense fine granular substance surrounded by Golgi vesicles (so-called vesicular rosettes) were noted and found to be continuous with the dense laminae. The nature and origin of the vesicular rosettes are important with regard to the formation and significance of confronting cisternae. Oligocilia have been found in various metaplastic and neoplastic cells and are thought to be nonspecific. There has been only one report of ciliated cells and confronting cisternae in a malignant peritoneal mesothelioma, however, indicating that these unusual cytoplasmic structures might be related to some epithelial-type mesotheliomas.

High-resolution electron microscopy of interlysosomal junctions

Five different malignant tumors and two nasal polyps were examined by electron microscopy for diagnosis purposes. In all cases occasional large cells containing lysosomes interconnected by characteristic junctions were observed. The interlysosomal junctions appeared organized in zig-zag and ladder like configurations. The ultrastructural and morphometric analyses of these junctions postulated that the two configurations represented the same structure viewed in two different sectioning planes. High-resolution electron microscopic evidence suggests that the interlysosomal junction is organized as a 35-40 A thick pleated ribbon extending between a 200-A wide interlysosomal space, in close contact with the adjoining lysosomal membranes, without apparent integration into the membrane.

Ultrastructural observations on human sublingual gland

That part of the human sublingual gland that corresponds in morphology to the conventional description of this organ presented in most histology texts (probably the major sublingual gland, in contradistinction to the aggregated small glands that compose the minor sublingual glands) was studied by electron microscopy. The gland is mixed, with slightly more mucous elements than seromucous ones. The mucous cells are arranged in tubules that usually are capped by seromucous demilunes. Seromucous cells also form occasional acini or may be scattered in the walls of the mucous tubules. The appearance of the mucous cells varies with the stage of the secretory cycle that they may be in. Their secretory droplets increase in number and progressively compress cytoplasmic organelles. Filamentous bodies also may be present. Based on secretory-granule substructure, four different kinds of seromucous cells can be recognized; these may be a morphological expression of asynchronous synthesis of different secretory proteins. The duct system is an abbreviated one compared to the other major salivary glands. The first duct segments, into which the mucous tubules drain, are similar to intercalated ducts. Larger ducts contain mitochondria-rich cells but lack the basal striations that characterize striated ducts. The paucity of typical striated ducts may be correlated with the elaboration of sodium-rich saliva by the human sublingual gland.

Cellular junctions in a spectrum of human malignant tumors

Cellular junctions in tumors are often considered a hallmark of epithelial differentiation. However, junctions are also seen in tumors having a different differentiation. This observation prompted us to study cellular junctions in malignant nonepithelial tumors. We found a variety of cellular junctions in such tumors, although the majority were poorly formed. This observation is of importance for diagnostic purposes. We have also tried to clarify the nomenclature of cellular junctions as applied in tumor diagnosis by proposing a systematic categorization of terms in everyday use by pathologists and by referring more extensively to the term paired subplasmalemmal densities (PSD) for non-well-formed junctions.

Small cell undifferentiated carcinoma of the uterine cervix: histology, ultrastructure, and immunohistochemistry of two cases

Two clinical stage IB small cell undifferentiated carcinomas (SCUC) of the cervix were studied by light and electron microscopy and immunohistochemistry. Both cases occurred in women aged less than 31 years. Despite radical hysterectomy and external pelvic radiotherapy, both patients died of recurrent disease within 14 months after initial therapy. The tumors consisted of sheets of closely packed, uniform small, round to oval cells with hyperchromatic nuclei and scant indistinct cytoplasm. One case was associated with cervical squamous cell carcinoma. The neoplastic cells had few organelles and desmosome-like junctions and lacked mucinous or neurosecretory granules or tonofilaments. Immunohistochemistry failed to reveal S-100, CEA, neuropeptides or neuron-specific enolase. SCUC probably arises either from basal cells of the cervical squamous epithelium, or gland cells of the endocervical epithelium, or still from subcolumnar endocervical reserve cells. Based on ultrastructure and immunohistochemistry, SCUC seems to represent the undifferentiated variant of small cell neuroendocrine tumors of the cervix.

Progesterone secreting Sertoli cell tumor of the ovary

A 33-year-old woman presenting with secondary amenorrhea and galactorrhea was found to have a Sertoli cell tumor of the ovary. The neoplasm also had a sex cord tumor with annular tubules (SCTAT) component. Further investigations revealed that in many respects the patient was endocrinologically pregnant. She had markedly elevated serum estrogen and progesterone levels and the endometrium demonstrated pronounced decidualization, but there was no evidence of actual pregnancy. Estrogen and progesterone were demonstrated by immunohistochemistry to be present in both the Sertoli cell and SCTAT portions of the tumor.

Juvenile granulosa cell tumor of the infant testis: case report with ultrastructural observations

This report describes the light-microscopic and ultrastructural features of a juvenile granulosa cell tumor of infant testis. Microscopic examination revealed a macrofollicular patterns simulating the preovulatory Graafian follicle and the juvenile granulosa cell tumor of the ovary. Ultrastructure confirmed three cell types: granulosa, theca interna, and externa, with occasional luteinized cells lacking crystalloids of Reinke. Charcot-Bottcher crystalloids were not detected, though rare cells contained a complex arrangement of filaments. An ultrastructural comparison was carried out with infant testes (2 cases), preovulatory Graafian follicle (1 case), juvenile granulosa cell tumor of ovary, adult granulosa cell tumor of ovary, and adult Sertoli cell tumor of testis and ovary. Ultrastructural similarities were noted between the present case and primitive Sertoli cells, preovulatory granulosa cells, and juvenile granulosa cell tumor of ovary. This may reflect the common histogenesis of Sertoli/granulosa cells from the common specialized gonadal stroma.

Coexpression of intermediate filaments in human epithelial neoplasms

A wide variety of human neoplasms were examined by immunocytochemical and ultrastructural techniques. In most, one intermediate filament (IF) type was expressed reflecting the tissue of origin. However, multiple classes of intermediate filaments were regularly found in a subgroup of these tumors. We chose to subdivide them into those with a complex or mixed growth pattern, and those which showed a more "monomorphic" histologic growth pattern. This latter group is the subject of this paper. Regular coexpression of cytokeratin and vimentin was observed in tumors of endometrial, thyroid, ovarian and renal origin, and coexpression of cytokeratin and neurofilament was observed in a subgroup of neuroendocrine tumors. Immunocytochemical/ultrastructural correlation demonstrated few, if any, observable intermediate filaments in tumors expressing only low molecular weight cytokeratin, whereas vimentin and neural filament characteristically were randomly dispersed or formed whorled bundles of cytoplasmic filaments. The potential diagnostic usefulness of these observations in surgical pathology is discussed.

Ultrastructural and immunohistochemical studies of bronchiolo-alveolar carcinoma

A detailed ultrastructural study was made of seven cases of bronchiolo-alveolar carcinoma, and the findings were correlated with histochemical and immunohistochemical data. By electron microscopic examination all seven tumors displayed glandular differentiation, manifested by the presence of microvilli and intercellular junctions, with or without mucin production. Variable proportions of tumor cells retained ultrastructural characteristics of alveolar type II cells and Clara cells. In addition, some tumor cells revealed desmosomes and tonofilaments consistent with squamous differentiation. Immunohistochemical evaluation was carried out using a peroxidase-antiperoxidase technique and specific antibodies against surfactant high molecular weight glycoproteins, keratin proteins, IgA + secretory piece, carcinoembryonic antigen (CEA), human chorionic gonadotropin (HCG), and alpha-fetoprotein (AFP). Four tumors with type II cell-like differentiation stained with anti-surfactant glycoprotein sera. All seven tumors stained focally with anti-keratin and IgA + anti-secretory piece antibodies, and diffusely with CEA. These tumors failed to stain with antisera against HCG and AFP. It is concluded that bronciolo-alveolar carcinomas are primarily composed of cells with alveolar and bronchiolar cell differentiation. Adequate criteria were established for ultrastructural identification of tumor cells with differentiation to type II alveolar cell or Clara cell. Moreover, the findings of this study indicate that the surfactant glycoprotein marker, when present in a given tumor either diffusely or focally, is diagnostic of bronchiolo-alveolar carcinoma.

Surface characteristics of adenocarcinoma of the uterine cervix

The purpose of this study was to analyze the development and classification of cervical adenocarcinoma as seen by scanning electron microscopy (SEM) and correlate the result to morphological alterations in cervical squamous cell carcinoma and endometrial adenocarcinoma. The results showed the endocervical area to be covered by a single layer of columnar cells, some with cilia, containing numerous folds and clefts, but no real glandular structures. The surface of malignant tumors consisted of pavelike arrangements of grooves and clefts covered with blunt microvillous processes, shorter and less delicate than those found on normal columnar cells. The surface microridges of squamous cells were replaced by irregular projections in squamous malignancy and endometrial adenocarcinoma showed a more undulating endometrial appearance.

Juvenile granulosa cell tumor associated with rapid distant metastases

We have encountered a case of juvenile granulosa cell tumor, first described by SCULLY as a specific form of granulosa cell tumor, in a 23-year-old, nulliparous female associated with some unusual clinicopathological features. The tumor showed a diffuse or macrofollicular pattern with eosinophilic or clear, often vacuolated cytoplasm containing abundant lipid. Ultrastructures revealed features very similar to those of previously reported juvenile granulosa cell tumor. Intracytoplasmic filaments were observed, but smooth surfaced endoplasmic reticulums were not evident. The patient succumbed unexpectedly rapidly due to recurrence and distant metastasis, in spite of anti-cancer therapy. It is also interesting that surprisingly high levels of estrogens as well as testosterone in both urine and serum was recorded before surgery and after the development of recurrence.

The effect of oral estriol succinate therapy on the endometrial morphology in postmenopausal women: the significance of fractionation of the dose

Postmenopausal women were given estriol succinate orally in a daily dose of 4 mg X 2 for 14 days or 4 mg X 2, 8 mg X 1 and 2 mg in the morning + 2 mg at noon + 4 mg in the evening for 4 wk. Each group consisted of 4 women. The effect of the estrogen treatment was estimated by the endometrial curettage samples taken both before and after the hormone treatment. The curettage samples were studied by both light and electron microscopy. The results showed that a treatment period of 4 wk was necessary to obtain any effect. When 8 mg of estriol succinate was given in a single dose only a slight effect was obtained on the endometrium but when the same dose was divided in 2 daily 4 mg parts, the endometrium showed clearly proliferative changes. Thus estriol is able to produce the same endometrial effect as estradiol. Ultrastructurally the hormone treatment caused an increase in the cytoplasm of the endometrial epithelial cells. Also, whorls of cytoplasmic microfilaments often appeared near the nucleus of the cells.

Ovarian Sertoli-Leydig cell tumor with rhabdomyosarcoma: an ultrastructural study

The clinical and light and electron microscopic findings of a moderately differentiated, virilizing, Sertoli-Leydig cell tumor (SLT) with pleomorphic rhabdomyosarcoma of the ovary are presented. The tumor recapitulates the primitive embryonal testis and rhabdomyogenesis, respectively. The natural history, including pathogenesis, of this peculiar and rare tumor is discussed in the light of the pertinent literature on SLT and ovarian rhabdomyosarcoma. It seems that when rhabdomyosarcoma is a significant or predominant component of SLT, as occurred in this case, the prognosis is poor and is that of rhabdomyosarcoma in general.

Ultrastructural diagnosis of pleural tumors

The significant association of two kind of mesothelial cells, differentiated and fibroblastoid, caracterises the ultrastructure of malignant pleural mesotheliomas. The differentiated mesothelial cancer cells (MCC's), whether they are observed in fluids or in biopsies, are not caracteristic enough to assert the diagnosis of mesothelioma. They can easily be mistaken for metastatic cells. Therefore, the diagnosis of mesothelioma relies on the identification of fibroblastoid MCC's, whether they are in association with the preceeding form in epithelial-like tumors, or the main component in sarcomatous-like tumors. Since the absence of fibroblastoid MCC's would eliminate the diagnosis of mesothelioma, patient and careful search for these cells must be done in all pleural tumors with a unique differentiation (epithelial-like or sarcomatouslike). This justifies the need for electron microscopy in the diagnosis of these pleural tumors: for this reason, pleural biopsies should routinely be embedded for possible future ultrastructural examination.

Adenocarcinoma of the Fallopian tube. An ultrastructural study

A case of fallopian tube adenocarcinoma was studied by light and transmission electron microscopy. The neoplastic cells contained abundant mitochondria, moderate to large amounts of rough endoplasmic reticulum (RER) arranged in parallel arrays and often containing amorphous material, annulate lamellae, possible secretory vesicles, and glycogen. The presence of stacked RER and annulate lamellae together is unusual in papillary serous cystadenocarcinoma of the ovary, and has not been described in Fallopian tube adenocarcinoma. Golgi complexes were are. Small acini with projecting microvilli as well as junctional complexes were present, but cilia were not found. The electron microscopic findings suggest secretory activity, and are remarkably similar to those found in papillary serous cystadenocarcinomas of the ovary. The findings also support the hypothesis that ovarian serous tumors and adenocarcinomas of the Fallopian tube are derived from coelomic epithelium.

Intramural papilloma of the vagina: evidence of Müllerian histogenesis

A papillary tumor occurred in the posterior-superior vaginal wall of a 5-year-old girl who was free of recurrence one year following surgical excision. The light microscopic features included papillae lined by eosinophilic cells with uniform, bland nuclei, solid areas of identical cells, and scattered glandular lumina which contained mucopolysaccharides. Foci of eosinophilic hyaline globules were another distinctive feature. Electron microscopy of the tumor demonstrated features associated with müllerian neoplasms including projecting microvilli, whorls of perinuclear cytoplasmic microfilaments, conspicuous lysosomes, squamous metaplasia, complex cytoplasmic interdigitations, and pseudoinclusions of "cytoplasmic" collagen. Previously described "mesonephric papillomas" of the vagina and cervix are compared with the tumor of the authors' patient. The previously described tumors share some histologic and clinical features, although they were superficial rather than intramural proliferations. The authors conclude that the ultrastructure, location, and documented presence of müllerian structures in the vagina favor a müllerian origin for this vaginal tumor. A number of other vaginal tumors that occur in children and young women show different light microscopic features.

Granulosa theca cell tumors in premenarchal girls: a clinical and pathologic study of ten cases

Granulosa theca cell tumor (GTCT) in the premenarche accounted for 7% of all ovarian tumors treated at the Children's Hospital Medical Center from 1928 through 1979. The average age of the ten girls at the time of diagnosis was 5 years (range 11 months-121/2 years) with precocious "pseudopuberty" and an abdominal mass being the most common presentation. GTCTs were solitary (five right, five left) with an average diameter of 12.1 cm. Histologic examination showed a predominantly diffuse or solid pattern with prominent luteinization; Call-Exner bodies and folded ("coffee-bean") nuclei were inconspicuous. Ultrastructural examination of one GTCT confirmed the presence of both granulosa and theca components with the latter showing extensive luteinization; estradiol, testosterone and prolactin were demonstrated in the same tumor using immunologic techniques. The average follow-up time was 21 years with nine of the ten patients being followed for more than ten years. Salpingo-oophorectomy resulted in cures despite the occurrence of tumor spillage in two patients. The prognosis for GTCTs in the premenarche appears more favorable than for those occurring in adulthood, but further study is needed to completely define their full biologic potential; the significance of subsequent breast cancer in two long-term survivors merits further investigation as well.

Adenocarcinoma of the cervix. I. Clinical evaluation and pathologic features

A series of 137 patients with primary adenocarcinoma of the cervix is presented with emphasis on clinical and histologic features. Adenocarcinoma has several distinct histologic patterns that may occur in a pure form but often occur (44%) in combinations of two or more patterns. Mixtures of adenocarcinoma and squamous cell carcinoma occur in one third of the patients and squamous intraepithelial neoplasia occurs in one tenth. Transmission electron microscopy is helpful in classifying poorly differentiated tumors. Preliminary recurrence/survival data suggest that the identification of patterns and subpatterns has no prognostic significance, nor is there evidence that adenocarcinoma (or adenosquamous carcinoma) metastasizes earlier, metastasizes more frequently, or is more radioresistant. For most patients, treatment may be the same as that for squamous cell carcinoma but a few selected patients with bulky central lesions may benefit from combined therapy consisting of whole-pelvis irradiation and conservative hysterectomy.

Juvenile granulosa cell tumor: a clinicopathologic study of three cases with ultrastructural observations

We have encountered three cases of a recently recognized form of granulosa cell tumor referred to by Scully as the juvenile type, and we have made ultrastructural observations on one case. This variant is encountered almost exclusively in the first two decades, and is characterized at the optical microscopic level by a macrofollicular or a diffuse, sometime disorderly pattern of growth, often with extensive luteinization and hyperchromatic nuclei. One of our patients developed precocious pseudopuberty. Our ultrastructural observations in this case supported the concept that this tumor is a granulosa cell tumor, and the tumor showed some similarities to previously reported granulosa cell tumors. A spectrum of cells was observed ranging from well differentiated granulosa cells to stromal cells with many intermediate forms present. The stromal cells varied from being fibroblast-like to theca-like. Both granulosa and stromal cells sometimes contained abundant lipid. Evidence of luteinization, i.e. abundant smooth endoplasmic reticulum and tubular mitochondrial cristae, was not noted in either the granulosa or stromal cells. Focal areas of smooth endoplasmic reticulum were found, however, in teh cytoplasm of cells intermediate between granulosa and stromal types. These cells may represent the source of steroid hormone secretion.

Ultrastructural effects of estrogen replacement on postmenopausal endometrium

Endometrial adenocarcinoma occurs almost exclusively in postmenopausal women, and excessive or unopposed estrogen stimulation is suspect as a causative factor in its pathogenesis. Furthermore, the incidence of endometrial adenocarcinoma has increased in women undergoing estrogen replacement therapy. In the present study, the cellular response of premenopausal and postmenopausal endometrium to estrogenic stimulation was compared with endometrial adenocarcinoma by the electron microscope. Tissues were obtained at hysterectomy, endometrial biopsy, or endometrial curettage and were processed routinely for light and electron microscopy. Ultrastructurally the endometrium from postmenopausal patients undergoing estrogen replacement therapy was similar to normal cyclic endometrium in the late proliferative phase. At least three features of the estrogen-treated postmenopausal tissue resembled those observed in adenocarcinoma of the endometrium: accumulation of lipid droplets, irregular nuclei, and perinuclear whorls of microfibrils.

Significance of squamous components in endometrioid carcinoma of the ovary

Forty-nine cases of ovarian endometrioid carcinoma with squamous foci were reviewed. Of particular interest was the biologic behavior of the neoplasms in relation to the appearance of the epithelium. As previously noted for the analogous uterine endometrial tumors, the ovarian adenosquamous lesions occurred later in life, were more advanced, were associated with less differentiated adenocarcinomatous components, and had a poorer prognosis. The five-year survival rate for patients with adenosquamous endometrioid ovarian carcinoma was 21% in comparison with the 90% survival found in patients with ovarian endometrioid adenocanthoma.

Comparison of cancer cell surfaces of the lower reproductive tract by scanning electron microscopy

The squamous cells of the cervix simulate those of the vagina and vulva both histologically and by scanning electron microscopy. However, in areas of the cervix undergoing active metaplasia, there are cells which share some of the characteristics demonstrated by scanning electron microscopy of both squamous and columnar epithelium. In these cells there is a wide range of characteristics of each cell type, suggesting a possible gradual transition from columnar to squamous epithelium. Furthermore, the cells of severe dysplasia and of intraepithelial and invasive squamous cancers of the cervix, though histologically similar to those of vaginal and vulvar cancers, are distinctly different when examined by scanning electron microscopy. These findings suggest that both metaplastic and neoplastic squamous cells are derived from the same progenitor columnar cells of the cervix, by orderly transition in the former and by atypical transformation in the latter. Second, the distinctiveness from the vaginal and vulvar cells indicates different embryonic stem cell lines.