Retrospective analysis of 26 cases of pregnancy luteoma

BACKGROUND

Pregnancy luteoma is a rare hormone-dependent ovarian tumor-like lesion caused by increased androgenic activity during pregnancy.

OBJECTIVE

To explore the clinical history, ultrasound manifestations, and differential diagnosis of pregnancy luteoma.

METHOD

A retrospective analysis was conducted on 26 cases of pregnancy luteoma diagnosed by postoperative pathology, from 2009 to 2022. All cases were from two hospitals: Shanghai First Maternity and Infant Hospital and International Peace Maternity and Child Health Hospital. The clinical history data and ultrasound characteristics were analyzed and the relevant literature was reviewed.

RESULTS

Among the 26 cases, five of them had preoperative ultrasound images. Among these five cases, three patients showed hyperechoic masses with less internal uniformity, while two demonstrated loculated anechoic zones, with clear boundary and regular morphology. Color Doppler showed no obvious internal blood flow signals, or that blood flow signals were visible within the cyst wall and hyperechoic mass. Among the cases, 16 had multiple gestations, while two visited the clinic due to sudden abdominal pain and a huge ovarian mass was found by ultrasonography. The ovarian lump was detected during routine obstetric ultrasound in three cases. The remaining were ovarian cysts found incidentally during caesarean section. Four patients presented with hairy manifestations and one patient had a deepened voice.

CONCLUSION

There is no characteristic ultrasound of pregnancy luteoma, and its diagnosis is mainly based on clinical history data and laboratory tests.

Utility of p63 and PTEN Staining in Distinguishing Cervical Microglandular Hyperplasia from Endometrial Endometrioid Carcinoma with Microglandular/Mucinous Features

Aims

Distinction between well‐differentiated endometrial carcinoma (EMCA) with microglandular/mucinous features and benign endocervical microglandular hyperplasia (MGH) can be a diagnostic challenge, especially when tissue is limited. The immunostains used to distinguish endocervical and endometrial carcinoma are less useful when the differential diagnosis is MGH. Here, we investigate the utility of p63 and phosphatase and tensin homologue (PTEN) to aid accurate classification.

Methods and results

Cases obtained from our pathology archives included 25 EMCA with mucinous/microglandular features, 26 MGH and nine atypical microglandular proliferations. Cases were assessed for glandular architecture, presence of mucinous and/or eosinophilic luminal secretions, subnuclear vacuoles, foamy histiocytes, inflammation, squamous metaplasia, cytological atypia and mitotic activity. The presence and pattern of immunohistochemical staining for p63 and PTEN was recorded. Microglandular proliferations with cytological atypia, mitotic activity, foamy histiocytes and complex glandular architecture were more commonly seen in EMCA, while small glands, bland nuclei and subnuclear vacuoles were enriched in MGH. All MGH cases displayed p63‐positive subcolumnar reserve cells and retained PTEN expression. Four EMCA cases showed non‐specific focal p63 staining either at the surface of the tumour or in areas of squamous differentiation. p63 and PTEN immunostains accurately predicted the final diagnosis for 3 atypical microglandular proliferation cases with follow‐up.

Conclusions

While there are morphological characteristics that differentiate EMCA and MGH, there is frequent overlap between these entities. Nonetheless, the pattern and extent of p63 and PTEN can aid accurate classification. Consistent p63‐positive subcolumnar reserve cells were seen only in MGH.

Don't be STUMPed: description and management of uncommon pathologies encountered on specimens from benign gynecologic surgery

PURPOSE OF REVIEW

In this review, we aim to describe uncommon pathologies that gynecologic surgeons may reasonably encounter on surgical specimens following benign gynecologic surgery.

RECENT FINDINGS

Herein, we describe uncommon pathologic findings of the uterus (e.g. squamous morular metaplasia, fibroid variants, stromal tumor of uncertain malignant potential), peritoneum and adnexa (e.g. endosalpingiosis, serous tubal intraepithelial carcinoma), endometriosis (e.g. stromal endometriosis, atypical endometriosis), and findings of particular interest in postmenopausal women (e.g. ovarian cortical stromal hyperplasia, tubal metaplasia). The majority of pathologic findings presented in this article are inherently benign, although they can present diagnostic challenges. If properly classified, additional treatment and/or extended follow-up is often not required; exceptions are highlighted.

SUMMARY

The gynecologic surgeon may encounter uncommon pathologies during a career. Inherent diagnostic difficulties, as well as nonstandardized or outdated terminology, can introduce further uncertainty. Whenever such a situation arises, the surgeon and pathologist should discuss the diagnosis to ensure appropriate treatment options.

Colonic Endometriosis: A Study of Near Obstructing Sigmoid Endometrioma

A 41-year-old woman had a near-obstructing endometrioma involving the distal sigmoid colon treated with en bloc removal of the involved segment of colon and the adherent adnexa.

Endometrioma Causing Near-Complete Obstruction of the Sigmoid Colon

Endometriosis is characterized by extra-uterine endometrial gland and stroma implantation. Intestinal endometriosis is believed to affect about one-third of patients with endometriosis⁴; 72-95% of patients experience recto-sigmoid involvement.^2,3 Occasionally, endometriotic lesions precipitate mass effect or infiltrate the bowel wall, mimicking a neoplasm. In the index case, we evaluated a G0P0 41-year-old perimenopausal female with near obstructing sigmoid endometrioma, clinically presented, investigated, and managed in the lines of sigmoid colon carcinoma. Computed Tomography revealed marked distention of the distal descending and proximal sigmoid colon to the level of a [possible] intraluminal mass. CA-125 was 247.4. Transvaginal ultrasound revealed a heterogeneous irregularity adjacent the left adnexa. Flexible sigmoidoscopy to 12-15 cm was unable to pass liquid or visualize the lumen secondary to extrinsic colonic obstruction. She underwent exploratory laparotomy with sigmoidectomy, oversew of rectal stump, and descending colostomy. Left fallopian tube and ovary were adherent to sigmoid mass, therefore, removed en-bloc. Histopathological report revealed extensive endometriosis involving the muscularis propria and serosal surface of colon and ovary, with fibrinous serosal adhesions of the sigmoid colon. While inconsistent clinical presentation, similar radiographic features, and colonoscopy with other inflammatory or malignant lesions of the bowel makes the preoperative diagnosis challenging, colonic endometriosis is to always be considered as one of the differential diagnoses in reproductive age women with patterned, cyclic gastrointestinal symptoms, and intestinal masses of uncertain etiology or diagnosis.

Endocervical microglandular hyperplasia: Colposcopic aspects, physiopathology and differential diagnosis

Endocervical microglandular hyperplasia (MGH) is a reactive type of glandular lesion that may be confused with endocervical adenocarcinoma from the macroscopic and the colposcopic findings, as well as from a histological. Differential diagnosis is very important. Here, we report a case of a 21 years-old women with a challenging differential diagnosis in the colposcopy and a MGH as histological finding.

Clear cell lesions in pathology: Histomorphologic approach to diagnosis

There has been remarkable progress in the field of surgical pathology; however, histomorphology has remained the most important and essential tool of the surgical pathologist in everyday practice till now. It is surprising that the hematoxylin-eosin (H and E) stain, introduced more than a century ago, has still remained the gold standard stain for histological examination and diagnosis of human diseases. Besides different findings or clues observed in histopathology sections like inclusions, granules, grooving, globules, halo, or clearing, which would enable the pathologist to provide a precise and accurate diagnosis; observation of clear cells is one of the important findings and clue for reporting. It may also sometimes lead to difficulties and delays in establishing the diagnosis. It can be focal or extensive and primary or rarely it may be secondary. Clear cell changes may be observed in many non-neoplastic, benign, or malignant tumors of diverse origin. Clear cell tumors contain a preponderance of clear cells. It can be seen in almost all the organs of human body and can be classified according to location or biological behavior. Commonly seen clear-cell tumors are usually malignant and common organs involved are female genital tract, urogenital tract, head and neck areas, central nervous system, skin, and rarely in bone and soft tissues. For approach to clear cell lesions, one has to decide if the change is artifactual, a mimic of clear cell tumors, or a clear cell tumor in reality. Once the mimics and artifactual/degenerative changes have been ruled out, a tumor either primarily of clear cell origin or showing secondary change has to be decided. The tumor next is to be diagnosed as benign/malignant and epithelial/mesenchymal based on morphology.

In Thyroidectomized Thyroid Cancer Patients, False-Positive I-131 Whole Body Scans Are Often Caused by Inflammation Rather Than Thyroid Cancer

Objective. To show that I-131 false-positive results on whole-body scans (WBSs) after thyroidectomy for thyroid cancer may be a result of inflammation unassociated with the cancer. Methods. We performed a retrospective image analysis of our database of thyroid cancer patients who underwent WBS from January 2008 to January 2012 to identify and stratify false positives. Results. A total of 564 patients underwent WBS during the study period; 96 patients were referred for 99 I-131 single-photon emission computed tomography (SPECT/CT) scans to better interpret cryptic findings. Among them, 73 scans were shown to be falsely positive; 40/73 or 54.7% of false-positive findings were a result of inflammation. Of the findings, 17 were in the head, 1 in the neck, 4 in the chest, 3 in the abdomen, and 14 in the pelvis; 1 had a knee abscess. Conclusions. In our series, inflammation caused the majority of false-positive WBSs. I-131 SPECT/CT is powerful in the differentiation of inflammation from thyroid cancer. By excluding metastatic disease, one can properly prognosticate outcome and avoid unnecessary, potentially harmful treatment of patients with thyroid cancer.

[Diagnosis and differential diagnosis of cervical adenocarcinoma]

This overview summarizes pathogenetic and practical aspects of (sub-)classification of cervical glandular (pre-)neoplasias and, inter alia, calls into question the usefulness of grading. In the context of the differential diagnosis of benign "imitations", the phenotypic variability of glandular precancerous lesions and carcinomas is described as well as the use of special tests to distinguish them. With regard to carcinomas, the differential diagnosis of well-differentiated neoplasias is addressed including "minimal deviation" adenocarcinoma (MDA, malignant adenoma), carcinomas with endometrioid or villoglandular morphology, and mesonephric hyper- and neoplasias. Furthermore, knowledge of HPV-negative glandular (pre-)neoplasias is covered including "gastric-type" adenocarcinomas and diagnostic algorithms for discriminating between primary and secondary cervical adenocarcinomas. Finally, comments are offered on the difficulties in recognizing early invasive adenocarcinomas, especially also the pitfalls inherent in determining the depth of invasion.