醫學五 楊世慧 詹舜文 屠冠翔 pathology

2007/11/26 Breast Partial mastectomy Invasive ductal carcinoma, Grade 3 , pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR: 50% strongly postive

2010-7-20 Endometrium curettage 左：Viable polypoid fragments、Small inactive glands 右：Polypoid surface、Hypercellular Stromal spindle cells

Prominent Necrosis and hemorrhage

左：Hypercellular stroma beneath surface epithelium 右：cleft-like Benign Inactive endometrial glands with periglandular stromal cuffing

Edematous/myxoid areas Fascicular pattern, low grade nuclei

Relatively lower grade, spindled cells higher cellularity, rounder epithelioid, pleomorphic cells with numerous mitosis

CD10 CD10 positive in stromal component, negative in glands

2010/07/20 Uterus, endometrium, curettage -----malignant Tumor, favor adenosarcoma with sarcomatous overgrowth

Adenosarcoma Microscopic findings Benign epithelial component: Resembles inactive or proliferative endometrial epithelium Malignant mesenchymal component: Low-grade sarcoma Resembles ESS, fibrosarcoma Periglandular cuffs: hypercellularity May contain heterologous elements

Immunohistochemistry Epithelial component Keratin (+), ER (+), PR (+) Mesenchymal component Cytoplasmic CD 10 (+) Nuclear ER (+), PR (+), WT-1 (+) Smooth muscle actin sometimes (+), desmin (+)

Differential Diagnosis Adenofibromas Benign epithelial and stromal components paucicellular stroma , no periglandular cuffing, no stromal atypia Benign endometrial polyp inactive glands, No periglandular cuffing , no stromal mitoses Atypical polypoid adenomyoma Atypical epithelial component and benign stromal component cellular smooth muscle ,glandular component with squamous morules

Malignant mixed mullerian tumor (MMMTs) Malignant epithelial and stromal components carcinomatous glandular component Endometrial stromal sarcomas Malignant stromal component only no glandular component

Sarcomatous overgrowth Uncommon variant a benign glandular component sarcomatous portion constituting more than 25% of the tumor Higher grade and higher mitotic rate High recurrence and mortality, comparable to carcinosarcoma

2010/08/06 Uterus, Endometrium, total Hysterectomy Bilateral salpingooophorectomy Pelvic lymph node dissection Partial omentectomy

Gross Features Endometrial polypoid tumor occupying the endometrial cavity and measuring 7.5 x 5 x 4.2 cm. Foci of necrosis and hemorrhage present. No definite myometrial invasion grossly Ovaries: no tumor Omentum: 4.1 x 2.8 x 0.4 cm, no tumor

Noncancer areas: Benign endometrial polyps Irregularly distributed proliferative glands with cystic dilatation Fibrotic stroma Aggregates of thick walled blood vessels

Sarcomatous overgrowth Stromal overgrowth with myometrial invasion

High grade stromal overgrowth with numerous mitosis

Diagnosis Uterine adenosarcoma with sarcomatous overgrowth Myometrial invasion less than 25% of myometrial wall thickness All else negative

2011 / 02/ 18 Intra-abdomen tumor resection with right hemicolectomy 28cm colon and 56cm ileum 19.2 x 14.7 x 10 cm mass adhered to bowel serosa Hemorrhage and necrosis

左：Hyper nodules separated by fibrotic hypocellular tissue 右：Hypercellular ----high grade atypia, frequent mitosis

Omentectomy Gross: Multiple nodules measuring up to 1.5 x 1.5 x 1.0 cm 左：Many nodules of Tumor metastasis Gross: Multiple nodules measuring up to 1.5 x 1.5 x 1.0 cm

Reference [1] Piura B, Rabinovich A, Meirrovitz M, Yanai I. Müllerian adenosarcoma of the uterus: case report and review of literature. Eur J Gynecol Oncol. 2000;21:387–390. [2] American Cancer Society, Inc [3] Atlas of Gynecologic Surgical Pathology [4] Blaustein’s pathology of the female genital tract , fourth edition