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Manini C.,Science Anatomia Patologica | Magistris A.,Science Ginecologia e Ostetricia | Puopolo M.,Science Ginecologia e Ostetricia | Montironi P.L.,Science Ginecologia e Ostetricia
Pathologica | Year: 2010

Three cases of cystic struma ovarii in women aged 16, 20 and 40 are described. All patients had an asymptomatic ovarian mass at ultrasound scan. The tumours, all of which were unilateral and confined to the ovary, ranged from 7 to 10 cm in the greatest dimension. Two lesions were unilocular, the third multilocular, and all were filled with green fluid. Microscopic examination showed cysts with fibrous wall lined by non-specific-appearing epithelial cells. In the wall of the cysts, there was a small number of thyroid follicles. In one case, an association with a cystic mature teratoma was seen. The paucity of thyroid follicles and the non-specific appearance of the epithelial cells required a careful sampling and immunohistochemical staining for thyroglobulin to establish an exact diagnosis. The postoperative period was uneventful and thyroid function remained normal. In conclusion, cystic struma is probably often underdiagnosed and should be considered when evaluating cystic ovarian tumours whose features are not obviously those of another tumour type. A careful search for thyroid follicles should be undertaken. In problematic cases immunohistochemical staining for thyroglobulin may be required.

Manini C.,Science Anatomia Patologica | Montironi P.L.,Science Ginecologia e Ostetricia | Magistris A.,Science Ginecologia e Ostetricia | Stramignoni D.,Science Anatomia Patologica
Pathologica | Year: 2010

Introduction. The efficacy of direct endometrial sampling by brushing in the collection of adequate and representative material is evaluated. Methods. From January 1 2008 to October 31 2009, 195 women (age 29-82, mean 56, 113 postmenopausal), underwent endometrial brushing with Endoflower®. All samplings were performed in an outpatient setting. 137 patients had abnormal uterine bleeding (70 postmenopausal), 25 had asymptomatic endometrial thickening (> 4 mm), 6 had atypical endometrial cells on pap-smear, 9 patients needed preoperative controls for uterine prolapse, 11 were treated with tamoxifen and 7 had other problems. The samples were fixed in a solution containing alcohol, water, EDTA and KCO3, and centrifuged. The supernatant was filtered and the pellet embedded in paraffin. Results. All patients reported that the technique was painless. Three cases suffered from shock. In 29 cases (15%), the sampling procedure was difficult due to cervical stenosis. A cellular sample large enough to prepare a cell-block was obtained in all cases. In 27 cases (14%), the sample was non-diagnostic. Cases were categorized as non-pathologic (negative) or pathologic (atypical and carcinoma). The correlation between cyto-histology on samples obtained with brushing and histology on biopsy or surgical specimen was possible in 46 cases (24%), with a diagnostic concordance of 93%. The rate of inadequate biopsies was 27% (8/30). 13 of 15 malignant neoplasias (2 carcinosarcomas, 13 endometrioid adenocarcinomas) were correctly diagnosed in samples collected with Endoflower®. The sensitivity was 87% and specificity was 96%, with a positive predictive value of 92% and a negative predictive value of 90%. Conclusions. Endometrial direct sampling with the Endoflower® device in an outpatient setting is well tolerated and well accepted by the gynaecologist. This sampling procedure allows preparation of cell-blocks. Endometrial cyto-histology is less expensive and invasive than other procedures and it could therefore be used in association with transvaginal sonography, even in institutions where liquid-based cytology is not in use.

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