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Author: search.filters.author.Kubelka-Sabit, KaterinaSubject: search.filters.subject.histology

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    Ovarian cellular fibromas: A cliniopathological and immunohistochemical analysis of 10 cases.
    (Springer, 2007-08)
    ;
    Prodanova, Irina
    ;
    Kubelka-Sabit, Katerina
    ;
    Zografski, George
    BACKGROUND: Traditionally, cellular fibroblastic tumors of the ovary were classified as either cellular fibroma (CF) or fibrosarcoma. A recent study suggests that cellular fibromatous neoplasms with bland cytology and elevated mitotic counts are associated with favourable prognosis and should be diagnosed as "mitotically active cellular fibroma" (MACF) rather than fibrosarcoma. In addition to clinicopathological features, immunohistochemistry may aid in further differentiating between CF and MACF, but its role has not been analyzed so far. METHOD: We retrospectively analyzed the clinicopathological and immunohistochemical features of 10 cases of ovarian cellular fibroblastic tumors diagnosed either as CF or fibrosarcoma in the last seven years. Patient records and archival pathology specimens were reviewed and immunohistochemistry was performed using pan-cytokeratin, EMA, vimentin, inhibin-alpha, calretinin, CD10, CD99, alpha-smooth muscle actin (SMA), desmin, S-100, c-kit, estrogen (ER), progesterone receptor (PR), p53, bcl-2, and MIB-1 antibody. RESULTS: Utilizing criteria proposed by Irving et al. the tumors were reclassified as CF (0-3 MFs/10 HPFs, n=5) and MACF (>4 MFs/10 HPFs, n=5). The mean age of patients with CF and MACF was 44 and 36 years, respectively. All tumors were unilateral, and the mean tumor size of CFs was 6.0 cm and 13.3 cm for MACFs. The majority of the tumors were solid; four of them had a cystic component, while ovarian surface rupture was present in one CF and one MACF. All tumors consisted of cellular, intersecting bundles of spindle cells showing slight or moderate pleomorphism. The mean highest mitotic count was 2.3 MFs/10 HPFs for CF, and 7.6 MFs/10 HPFs for MACFs. Follow-up of 4 to 79 months (mean 38 months) was available in 9 patients and was uneventful in all cases. One patient with MACF died 15 days following the operation as a result of the intercurrent disease. Immunohistochemical analyses showed that spindle cells in majority of the tumors were immunoreactive for vimentin, alpha-SMA, inhibin-alpha, calretinin, PR, and bcl-2. All tumors were negative for pan-cytokeratin, EMA, CD10, CD99, c-kit, ER, and p53, while one CF was positive for S-100, and one MACF showed positivity for desmin. In addition, the MIB-1 labeling index (LI) in MACFs was higher (mean 14.4%, range 10-25%), than that in CF (mean 5.6%, range 3-10%). CONCLUSION: Our results confirm the immunophenotypic similarity between ovarian fibromas and cellular fibromatous neoplasms, and suggest that the use of MIB-1 LI may help in differentiating between CF and MAFC.
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    Atypical polypoid adenomyoma of the uterus. A report of eleven cases.
    (Springer, 2008-05)
    Kubelka-Sabit, Katerina
    ;
    Prodanova, Irina
    ;
    Zografski, George
    ;
    Background: Atypical polypoid adenomyoma (APA) is a rare uterine polypoid tumor occurring in women in their reproductive age. Method: Eleven cases of atypical polypoid adenomyoma have been diagnosed at our department in the last five years (2003–2007). The mean age of the patients was 37 (range 26–46 years). The most common clinical diagnosis was abnormal uterine bleeding, leiomyoma or endometrial polyp. In one patient the clinical diagnosis was endometrial hyperplasia, while two were examined for primary sterility. In one case the diagnosis was established in a curettage material from a spontaneous abortion. Apart from the conventional hematoxylin and eosin, additional histochemical and immunohistochemical stainings were also performed. Results: Macroscopically, white-gray polypoid fragments measuring 0.5–2 cm were found in the curettage materials. Histologically, the APAs were composed of atypical endometrial glands surrounded by smooth muscle stroma. Squamous morules were a common finding. In three cases, the APA was accompanied by foci of invasive endometrial adenocarcinoma. The immunohistochemical stains confirmed the smooth muscle nature of the stroma (alpha-smooth muscle actin, desmin and caldesmon positive). The morules were positive for CD10 marker, whereas Ki-67 proliferative index was low (5–15%), except in the foci of invasive adenocarcinoma. All tumors were hormone responsive. One of the patients was surgically treated for advanced endometrial adenocarcinoma in FIGO IIIC stage. Complete regression of the disease after tumor extirpation and consecutive high-dosage progesterone therapy was achieved in four of the patients, in one the disease persisted after two years due to suboptimal therapy, whereas five were lost to follow up (four of which diagnosed in the last 10 months). Conclusion: APA is considered to be a benign form of mixed epithelial and mesenchymal uterine tumors. This tumor can be associated with sterility and rarely with endometrial carcinoma, therefore recognition and correct diagnosis of this entity is important.