Vlajkova tajna. Marija Magdalena. Nikola Tesla. Pas koji je voleo vozove. Subota ujutru. Tamo i natrag. Nije nego. Povratak otpisanih.
Kost od mamuta. Nacionalna klasa. Sedam plus sedam. Djetinjstvo mladosti. Ko to tamo peva.
Poseban tretman. Laf u srcu. Idemo dalje. Kante ili kese. Provincija u pozadini. Srebrena lisica. Ne znate vi Martina. Milan — Dar.
Iznenadna i prerana smrt pukovnika K. Sabirni centar. Balkan ekspres 2. Balkan ekspres 2 TV serija. Sile u vazduhu. Poslednji krug u Monci.
Osmi dan u nedelji. The Fall of Italy Sesta brzina Duvanski put TV Mini-Series Dorotej Visoki napon The Red Horse Erogena zona Nesto iz zivota TV Movie Snovi, zivot, smrt Filipa Filipovica Rad na odredjeno vreme Poseban tretman Pozorisna veza Tren TV Mini-Series Sedam plus sedam TV Series Partizanska eskadrila Usijanje The Pals Radio Vihor zove Andjeliju Anno domini TV Series Cardak ni na nebu ni na zemlji TV Series Noc od paucine TV Movie Moment Arrive Before Daybreak Tit for Tat Povratak otpisanih TV Series The Tiger Sekvence i konsekvence Short Lude godine Pas koji je voleo vozove Hajka Beasts Beloved Love Group Portrait with a Lady Idi tamo gde te ne poznaju TV Movie Morava 76 TV Mini-Series The Written Off Return The Peaks of Zelengore Beach Guard in Winter Sinovi TV Movie Zivot je lep TV Series Naivko Anno Domini Massacre at Noon Povest o dobrih ljudeh Potomak TV Short Rekvijem za teskasa TV Movie Crveni udar Hell River The Wind The Dervish and Death Valter brani Sarajevo TV Series Partizani TV Mini-Series Hotel za ptice TV Movie Sluga TV Short Mirko and Slavko Kamenolom TV Movie Bombasi Kolnati sme, Irina The Battle of Sutjeska Obraz uz obraz TV Series The Master and Margaret Traces of a Black Haired Girl I Bog stvori kafansku pevacicu Gradjani sela Luga TV Series Walter Defends Sarajevo Zvezde su oci ratnika Das falsche Gewicht TV Movie Breakfast with the Devil Moja luda glava The Bet Zarki Bloody Tale The Battle of Neretva Most Oseka It Rains in My Village Operacija Beograd Bekstva Do Not Mention the Cause of Death The Girl in the Park Brat doktora Homera Ima ljubavi, nema ljubavi Posalji coveka u pola dva The Birch Tree The Feast Noz I Even Met Happy Gypsies The Demolition Squad Anabelin san Short At one end of the spectrum of plasma cell dyscrasia is monoclonal gammopathy of undetermined significance, which is the most common and relatively indolent form of plasma cell dyscrasia; this contrasts with plasma cell myeloma, which is aggressive and requires treatment.
Plasma cell myelomas are more advanced neoplasms and classified as either asymptomatic smouldering myeloma or symptomatic myeloma.
When there are multiple bone lesions or the disease is systemic, the clinical term is multiple myeloma MM , as opposed to plasma cell myeloma plasmacytoma.
Benign plasma cells are typically negative for CD and CD Bataille et al. Conversely, a ratio of even 4 lambda-expressing cells to 1 kappa-positive one indicates the presence of a monoclonal lambda-positive plasma cell population.
Cytologic features of plasma cells in the bone marrow smears may vary from normal-appearing mature plasma cells to immature and anaplastic forms.
Multinucleated or multilobated plasma cells may be present. Cells with cherry-red, Some plasma cells may appear like grapes and demonstrate numerous, round, Ig-containing cytoplasmic structures Mott and Morula cells.
Blood smears may show rouleaux formation of the red blood cells or the presence of plasma cells in various proportions.
In some patients with multiple myeloma, the neoplastic cells are so immature or atypical that they are cytologically indistinguishable from large cell lymphoma or other anaplastic tumours, including carcinoma, melanoma and acute leukaemias.
Plasmablastic myeloma and large cell lymphoma with cells having the features of immunoblasts are particularly likely to be confused.
Cytogenetics and molecular genetics are not essential for diagnosis of PCM. Conventional cytogenetic analysis is frequently unsuccessful but it appears that the detection of deletions of 13q by metaphase analysis may have prognostic value, along with t 4;14 and deletion of TP53 by FISH Translocations involving chromosomes 4, 14, and 16 as well as del17p13 TP53 have been associated with a poor prognosis.
Different surface molecules could be targeted as individual therapies for either well-defined MM entities i.
CD27 expression is lost with myeloma progression. The presenting features of nonsecretory myeloma are similar to those in patients with a detectable M-protein, except for the absence of renal function impairment and hypercalcemia.
The response to therapy and survival of patients with nonsecretory myeloma are similar to those of patients with measurable M-protein.
It is a variant of multiple myeloma characterized by greater than or equal to 2 x circulating plasma cells in one litre of peripheral blood.
In primary PCL, the constellation of adverse biologic prognostic factors in patients with advanced aggressive myeloma is already present at diagnosis.
The plasma cells express cytoplasmic but not surface Ig light chain. Primary PCL has a more aggressive clinical presentation than MM, with a higher frequency of extramedullary involvement, anemia, thrombocytopenia, hypercalcemia, and renal failure.
Some patients with SBP present with a single painful bone lesion due to a monoclonal plasma cell infiltrate, and further studies show no evidence of myeloma elsewhere.
In other cases, SBP may be discovered during roentgenographic studies for another condition or the patient presents with a painless swelling of the sternum, rib, or other bone.
In true solitary or multifocal osseous plasmacytomas, trephine biopsy show no plasmacytosis and have no demonstrable clonal population of plasma cells.
The majority of the tumors do not produce detectable serum Because most PLNPs and other types of extramedullary plasmacytomas show mature plasma cell morphologic features relatively often and because reactive plasmacytoses form dense tumefactive plasma cell infiltrates simulating plasmacytoma in multiple body sites, as previously reported in the upper respiratory tract.
Diagnosis is dependent on demonstration of amyloid protein and exclusion of secondary non-immunoglobulin amyloidosis. The protein binds Congo Red dyes with apple-green birefringence when viewed under polarised light.
The light chain type in primary amyloidosis is usually lambda, presumably reflecting easier conversion of this protein, compared with kappa, into beta-pleated sheet structures.
Abnormal protein comprising heavy or light chains or both is deposited in tissues such as the heart and liver leading to organ dysfunction.
As with primary amyloidosis, the associated tumor burden is usually low. In light chain deposition disease, the light chain type is usually kappa and neoplastic cells, if identifiable, are usually plasma cells.
Heavy chain diseases mu and gamma usually affect older individuals and involve lymph nodes, marrow, spleen and peripheral blood, with varying lymphocytic, lymphoplasmacytoid and mature plasma cell morphology in cellular components.
Occasional examples appear to be variants of diffuse large B-cell lymphoma. Alpha chain disease differs in presenting typically with small intestine and mesenteric lymph node involvement causing malabsorption in younger individuals.
The small bowel in alpha chain disease has histological features resembling those seen in extranodal marginal zone B-cell lymphomas of MALT type.
The bone changes are characterized by osteosclerosis rather than lytic lesions. Lymph nodes may show Castleman disease.
In some patients this can be associated with peripheral neuropathy. Splenomegaly is frequent but not usually massive and lymphadenopathy, when present, is not usually prominent.
Trephine biopsy histology shows irregular nodular and paratrabecular infiltrates, with or without additional diffuse interstitial infiltration.
Intrasinusoidal infiltration is uncommon, in contrast with splenic marginal zone and mantle cell lymphomas.
Plasma cells may contain PAS-positive inclusions of immunoglobulin, which may appear in the cytoplasm Russell bodies or indenting the nucleus Dutcher bodies.
The proportions of lymphocytes, lymphoplasmacytoid cells and plasma cells vary widely. There may also be scattered larger blast cells but no true para-immunoblasts or proliferation centres.
Accompanying reactive mast cells are often abundant. Absence of neoplastic follicles, expanded marginal zones or infiltrates of monocytoid B cells is important in differentiating lymphoplasmacytic lymphoma from other types of small B-cell lymphoma.
Cases with little evidence of plasma cell differentiation may be confused with other small B-cell lymphomas; immunophenotyping can exclude chronic lymphocytic leukaemia, mantle cell lymphoma and follicular lymphoma, but not splenic or extranodal marginal zone lymphomas.
Tumors with plasmablastic morphology typically occur in patients with an abnormal immune state HIV positive, posttransplantation, or the elderly.
These tumors often arise in the oral cavity or other mucosal sites of the head and neck, or body cavity PEL , or in association with multicentric Castleman disease.
PBL with plasmacytic differentiation and DLBCL with secretory differentiation immunoblasts and plasmacytoid cells are distinguished by the presence of centroblasts in the latter.
Non HIV patients with plasmablastic lymphoma may present with nodal, soft tissue or bone marrow disease.
However, many questions still remain. Klein U, Dalla-Favera R. Germinal centres: role in B-cell physiology and malignancy.
Nat Rev Immunol. Transcription factor IRF4 controls plasma cell differentiation and class-switch recombination. Nat Immunol.
Nat Genet. Haematologica ; Intrinsic constraint on plasmablast growth and extrinsic limits of plasma cell survival. J Exp Med.
Calame K. Immunology: end game for B cells. Nature ; B lymphocytes express and lose syndecan at specific stages of differentiation. Cell Reg.
Hargreaves, D. A coordinated change in chemokine responsiveness guides plasma cell movements. Klein U, Pasqualucci L. B-cell receptor signaling derailed in lymphomas.
Immunol Cell Biol. Application of immunohistochemistry in the diagnosis of non-Hodgkin and Hodgkin lymphoma. Systemic polyclonal immunoblastic proliferations.
Polyclonal plasma cell proliferation with marked hypergammaglobulinemia and multiple autoantibodies. Ann Clin Lab Sci.
Infections and reactive changes. Bone marrow plasmacytosis in idiopathic plasmacytic lymphadenopathy with polyclonal hyperimmunoglobulinemia: a report of four cases.
Pathol Res Pract. Dham A, Peterson BA. Castleman disease. WHO classification of tumours of haematopoietic and lymphoid tissues.
International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International MyelomaWorking Group.
Br J Haemotol. Joseph Melton LJ. Cell surface markers in multiplemyeloma. Am J Pathol. Blood ; a Abstract. Neural cell adhesion molecule expression in plasma cells in bone marrow biopsies and aspirates allows discrimination between multiple myeloma, monoclonal gammopathy of uncertain significance and polyclonal plasmacytosis.
Histopathology ; 44 4 : The phenotype of normal, reactive and malignant plasma cells. Stewart AK, Fonseca R.
Prognostic and therapeutic significance of myeloma genetics and gene expression profiling. Primary lymph node plasmacytomas Plasmacytic lymphomas.
Blood ; Tryptase-positive mast cells accompany lymphocytic as well as lymphoplasmacytic lymphoma infiltrates in bone marrow trephine biopsies.
Histopathology ; Clin Lymphoma ; 5: Teruya-Feldstein J. Diffuse large B-cell lymphomas with plasmablastic differentiation.
Curr Oncol Rep. Plasmablastic lymphomas of the oral cavity: a new entity associated with the human immunodeficiency virus infection.
Diffuse large B-cell lymphomas with plasmablastic differentiation represent a heterogeneous group of disease entities. Plasmablastic lymphomas and plasmablastic plasma cell myelomas have nearly identical immunophenotypic profiles.
Mod Pathol. Infektivne bolesti vulve se mogu preneti direktnim kontaktom. Extramamarna Pagetova bolest je retka. Dermatologic diseases of vulvar skin and mucosa can be divided in two groups.
The first includes dermatoses similar extravulvar sites,and second includes dermatoses affected predominantly vulvar region.
Specific dermatoses of vulva are contact dermatitis, seborrhoic dermatitis, lichen planus, lichen sclerosus. Infectios deseases of vulva can be transmited by direct contact.
Recognition of typical microscopic findings can helped for dignosis of scabies,herpes virus,molluscum contagiosum diseases of vulva.
Human papilloma viruses HPV are epithelitrophic viruses and cause premalgnant and malignant transformation of epithelial cells.
Invasive squamous carcinoma is the most common carcinoma of vulva. Prognostic factors like stage, extracapsular nodal spread,infiltrative margins, vascular invasion, degree of differentiation, status of adjacent skin, stromal response, p53 overexpression are necessary for report.
High tumor grade, capillary lymphatics invasion, biger tumor size and depth invasion deserve imunohistochemical analysis lymph nodes for metastatic cells of carcinoma.
Extramammary Pagets desease is rare neoplasm. Paget desease can be primary cutaneus vulvar disease,or associated with noncutaneous carcinoma gastrointenstinal origin or bladder carcinoma.
Immunohistochemical analysis is very helpful to determine primary origin. The first includes dermatoses similar extravulvar sites,and second includes dermatoses affected predominantly vulvar region1.
Specific dermatoses of vulva Contact dermatitis Agents like hygienic, synthetic materials may cause inflammatory response of the squamous epithelium.
Histologic features are not specific and include intracellular and intercellular edema of squamous epithelim, with edema of dermis and dillatation of blood vessels.
Inflammatory infiltrtation consist lymphocytes and histiocytes, and eosinophiles may be or not prominent.
Figure 1. Dermal inflammatory infiltration Figure 2. Fungal organisms on surface vulvar skin HEx40 PASx40 Seborrhoic dermatitis Vulvar erruptions of in obese woman with, frictin cause, exematous apperance can have nonspecific histologic changes.
Microscopic features may be akantosis, spongiosis and parakeratosis, with elongation of rete pegs of epidermis. Mild chronic dermal inflammation persist, and finding fungal and other infectious agents are according for the diagnosis sebborhoic dermatitis2.
Psoriasis Vulvar psoriasis may be part of generalize disease or affect vulvar region. Erruptions have sharp dermacated areas with red surface covered with white plaques.
The clinical course can be persistent with progress in chronic and generalized disease, or have remission. Histologic findings are hypekeratosis, parakeratosis,uniform elongation of rete pegs, lack of granular layer, thinning of stratum malpighii.
Munro microabscesses are accumulation neutrofils in the epidermis. Dermal capillares are dilated, and dermis is with edema,with minimal inflammatory cells1.
It can be localized or generalized and can spontanous regress with exacerbations. Histologic features this interface dermatitis are akantosis, parakeratosis, hypekeratosis and hypergranulosis with elongation of rete pegs.
Band-like lymphocytic infiltration next the epidermis is typically present and infiltrate extend in epidermis bassal cells..
Liquefaction degeneration of basal epithelial cells is present. Cytoid bodies present degenerated keratinocytes and dysceratotic cells, and they are localized in the epidermis or superficial dermis.
Lichen sclerosus et atrophicus Lichen sclerosus affected predominantly postmenopausal women, but and young womens may be affected. Desease can affect any or all areas of vulva, and may extend perianal skin, or extragenital sites neck, extremimites.
Microscopic features can vary related to stage of desease. In the advanced the epithelium is atrophic, hyperkeratotic in some cases, with flattened rete pegs.
In basal layers of epidermis are present edema and hydropic degeneration what sometimes separate basal cells from the basment membrane in some cases.
Infiltration of lymphocytes in the basal and parabasal layers are visibly. Homogenisation, edema, collagenisation of the dermis are in association with mild chronic inflammation3,4.
Infectious disease of vulva- selected topics Scabies Infestation of scabies is related with sexual contact. Pruritic disease cause excoriation, secondary infection.
Microscopic features are epidermal irregular acantosis, focal spongiosis, psoriasiform epidermal hyperplasia with exoskeleton on the lower stratum corneum, dermal inflammation with perivascular infiltrate of lymphocites and variable numbers of eosinophils5.
Figure 3. Exosceleton of scabies on the surfaceof Figure 4. Vulvar herpes simplex PASx40 vulvar skin HEx10 Herpesvirus infection Herpes simplex virus hominis type 2 can be transmited by direct contact.
Fever, inguinal lymphadenopathy, dysuria, urinary retention and vesicles, pustules and painful ulcers are typical clinical findings.
Microscopic Imunohistohemistry for HSV is helpful for diagnosis of viral presence6. Molluscum contagiosum Poxyviral disease transmited with direct contact.
Vulvar an perianal pruritic papules with central umbilication or punctum are present, and can be single or multiple.
Microscopic findings are acantosis, spongiosis, ballonooning degeneration of epithelial cells which contain intracytoplasmatic eosinophilic inclusion bodies Henderson-Paterson which push the nucleus on the periphery of cells.
Edema and perivascular inflammation with endothelial vascular proliferation are present in the derm. Recognition of typical microscopic findings can be helped with electron mycroscopy of the virus, but wery rare analisis7.
Figure 5. Molluscum contagiosum of vulvar skin HEx40 Human papilloma viruses HPV Human papilloma viruses HPV are epithelitrophic viruses and cause premalgnant and malignant transformation of epithelial cells8.
One-half of womens have other deaseases of genital tract cause HPV. Like other sexually trasmited deseases, direct contact is way for infection.
HPV type 6,11,16,18,33 are most commonly in vulva8,9. In the geometric style HPV started with disorders in the lowest third of epithelium where HPV include in cell nuclei, and transform and deregulate cell cycle and inhibition of apopthosis.
Condyloma are verrucous, papilary lesions of skin or mucous membrane. This benign neoplasms may be solitary, but may involve cervix, vagina, urethra, peranal skin and anal canal, predominantly in immunosuppresed patients.
Central fibrovascular cores covered with squamous epithelium with acantosis, hyperkeratosis, parakeratosis with or without koilocytic atypia in epithelium are microscopic features.
Hyperplasia an enlarging of the parabasal cells,with accentation of itracellular bridges and granular layer may be also present.
Abnormal mitosis are absent. Viral cytopathic changes are associated with HPV 6 and 11, but lack of koilocytic atypia does not exclude diagnosis of condyloma,an HPV infection8.
Vulvar intraepithelial neoplasia VIN are precancerous changes of the squamous type. Risk factors are cigarete smokong, immunodeficiency.
Microscoping features of VIN are high nucleo-cytoplasmatic ratio, lack of cytoplasmatic maturation of basal and parabasal layers with crowding and cellular disarray,hyperchromasia and nuclear pleomorphism, mitotic figures, parakeratosis, hyperkeratosis,individual-cell keratinisation.
Koilocytosis and binucleated and multinucleated cells are present too. Skin appendages are involved often. Figure 6. Lesion is predimninatly solitary without assotiation with cervical desease, and HPV infection.
The keratinocytes of differetiated VIN are large and pleomorphic, with eosinophilic cytoplasm in the basal and parabasal keratinocytes in the base of rete ridges.
Prominent nucleoli in the enlarged nuclei are present predominantly in basal and parabasal keratinocytes. Elongation and anastomosis of rete pegs, and keratin pearl within rete may be present.
Parakeratosis is often present Vulvar malignant epithelial tumors - selected topics Vulvar squamous cell carcinoma Invasive squamous carcinoma is the most common carcinoma of vulva.
Carcinomas associated with HPV infection affected younger patients in risk groups of smokers, immunosupresion9, Morphologic subtypes of invasive squamous cell carcinoma include keratinizing, nonkeratinizing, basaloid, warty, spindled, verrucous.
Prognostic factors like stage, extracapsular nodal spread,infiltrative margins, vascular invasion, degree of differentiation, status of adjacent skin, stromal response, p53 overexpression are necessary for report14,15, Figure 8.
Immunoreactivity CD1a in squamous Figure 9. Metastatic cells of squamous cell carcinoma cell carcinoma of vulva x5 in lymph node HEx10 High tumor grade, capillary lymphatics invasion, biger tumor size and depth invasion deserve imunohistochemical analysis lymph nodes for metastatic cells of carcinoma.
Figure Pancitokeratin immunoreaktivity of Figure Desease can be focal or extensive. Microscopic features are typical with intraepidermal proliferation of large, atypical gladular-type cells, with granular or vacuolated cytoplasm and round nuclei with prominent nucleoli.
Mitotic figures are present, but not very frequent. Survivin immunoreactivity in cells of vulvar Paget desease x5 Literature 1.
Actas Dermosifiliogr. Mil Med ; 12 Ann Dermatol. Sander BB, Damsgaard K. Lichen sclerosus--a neglected disease. Ugeskr Laeger.
Rev Med Suisse. Int J Gynaecol Obstet. J Low Genit Tract Dis. Morphology and molecular pathology. Gynecol Oncol. Int J Gynecol Pathol.
Petignat P, Achtari C. Ann Surg Oncol. Surgical management of invasive carcinoma of the vulva. A retrospective analysis and review. Eur J Gynaecol Oncol.
Vulval cancer: what is an adequate surgical margin? Brustmann H. J Dermatol. J Cutan Pathol.
U tipu I postoji PTEN mutacija, a u tipu II prekomerna ekspresija p53, pa se ova dva biomarkera koriste u njihovoj diferencijalnoj dijagnozi.
WHO je definisala trostepeni sistem u odredjivanju gradusa endometrioidnih adenokarcinoma u kome skvamozna komponenta tumora nema uticaja.
U grupi mezenhimalnih tumora izdvojen je nediferentovani sarkom, koji se svojom morfologijom i imunohistohemijski razlikuje od leiomiosarkoma i endometrijalnog stromalnog sarkoma.
Abstract The latest version of uterine tumors classification was done in Endometrioid adenocarcinoma has a higher frequency and belongs to Type I.
Serous and clear-cell adenocarcinoma, are forming Type II and by definition, they are high grade cancers with poor prognosis and no clearly defined precursors and predisposing risk factors.
These two biomarkers are used in their differential diagnosis. WHO has defined a three-step system in determining the grade of endometrioid adenocarcinoma in which squamous component has no significance.
There are other, two-step, grading systems which are not generally accepted. In the group of mesenchyme tumors, undifferentiated sarcoma was separated, due to different morphology and immunohistochemical profile compared to leiomyoma and endometrial stromal sarcoma.
Common believe is that these tumors have epithelial origin and therefore sarcoma component showed positivity on epithelial and mesenchymal markers too.
Large number of new antibodies was discovered which in the diagnosis and differential diagnosis of uterine tumors are only meaningful when used in correlation with the clinical picture and morphological data endometrial carcinoma vs.
Endometrioidni adenokarcinom Serozni adenokarcinom Slika 1. Za razliku od ostalih karcinoma, endometrioidni su izrazito vimentin pozitivni.
Po definiciji, oba tipa tumora pripadaju karcinomima visokog stepena maligniteta i ne gradiraju se. Endometrijalni stromalni sarkom ESS Ukoliko predominiraju pozitivnost na Inhibin!
Kriterijumi za dijagnozu leiomiosarkoma WHO Literatura 1. Bull Cancer. Silvereberg SG.. Tumors of the uterine corpus:epithelialtumours and related conditions.
Tumors of the breast and female genital tract. Lyon: WHO; ; Am J SurgPathol ; Lax SF. Endometrial stromal nodules and endometrial stromal tumors with limited infiltration:aclinicopathologicstady of 50 cases.
Am J surgPathol ; The pathology of the uterine smooth muscle tumors and mixed endometrial stromal-smooth muscle tumors: a selective review with emphasis on recent advances.
Int J GynecolPathol ; Mesenchymal tumorous and related lesions. Epitheloid smooth muscle tumors of uterus.
Mod Pathol ; 14 1 A. RaniKanthan and Jenna-Lynn Senger. ObstetGynecol Int. Adenofibroma and adenosarcoma oh the uterus: a clinicopathologic study of 35 cases.
Cancer ; Many of these deal with the molecular basis of common and rare gynaecological tumours but there are also many that deal with morphology, terminology and new perspectives.
This talk will focus on a few chosen entities and concepts that have been recently introduced and have reached everyday practice but which can cause problems or diagnostic difficulties and can require alteration in protocols.
The areas to be covered are: The concept of endometrial intraepithelial neoplasia EIN The concepts of endometrial intraepithelial carcinoma EIC and minimal serous carcinoma Undifferentiated endometrial carcinoma Inherited endometrial tumour syndromes The relevance of tubal carcinoma in situ and the preceding dysplastic lesion in the pathogenesis of pelvic serous carcinoma The concept of differentiated VIN and its association with squamous carcinoma Microinvasion in borderline serous ovarian tumours The implications of the FIGO staging system for endometrial and vulval malignancies and uterine sarcomas Endometrial intraepithelial neoplasia EIN The WHO and ISGP review of endometrial hyperplasia has retained the following classification.
Mitoses and apoptotic bodies are frequently found. Because of the common problem of reproducibility in identifying genuine cytological atypia, an alternative classification, the endometrial intraepithelial neoplasia EIN system has been proposed and is being increasingly used.
In this system, there is a spectrum from benign hyperplasias through EIN to adenocarcinoma. The EIN approach is supported by morphometric, molecular and genetic data.
There is a concept of latency with PTEN mutation. Some latent glands may involute and others may progress to EIN.
Cytological features that are different from those of background glands. Exclusion of potential mimics such as disordered proliferation, polyps and adenocarcinomas.
Most complex atypical hyperplasias could be reclassified as EIN. Many studies have shown an increased risk of associated Features which help to identify adenocarcinoma are: prominent nuclear pleomorphism a confluent, fused glandular pattern a cribriform architecture of glands a confluent papillary pattern desmoplastic stroma replacement of stroma by squamous epithelium The confluent or papillary pattern or squamous epithelial predominance has to occupy at least half of a low-power field.
EIC and minimal serous carcinoma Endometrial intraepithelial carcinoma EIC or serous EIC is the precursor lesion of serous endometrial adenocarcinoma and occurs typically in post-menopausal women on a background of atrophy.
It comprises highly pleomorphic cells on the surface and in glands without invasion but with frequent mitoses and prominent nucleoli in atypical nuclei.
Mib 1 Ki67 staining shows a high proliferation index and there is strong p53 staining indicating p53 gene mutation.
Rarely, there may be microinvasion associated with EIC. It is well known that EICs can be associated with a high incidence of extrauterine metastatic disease despite lack of invasion in the uterus.
These lesions are WT1 and ER negative. They usually occur in young pre-menopausal patients and are more common than colorectal cancers in female patients with this syndrome.
In a significant number of cases of endometrial serous carcinoma, including EIC, there is co-existent STIC with similar p53 signatures.
STIC or tubal invasive serous carcinoma may also be the origin of some endometrial serous carcinomas which have the reversed immunoprofile of WT1 positivity and p53 negativity.
The STIC is also thought to be the origin of many peritoneal and ovarian serous carcinomas particularly in cases of high grade serous histology.
Associated with high risk HPV 16,18 3. Multifocal 4. Young women 6. Lower risk for SCC 7. Rare mucinous differentiation 1. Difficult to diagnose in isolation i.
Hyperplastic epithelium with basal atypia 3. Arises in vulval dystrophy e. Older women 5. Associated with keratinising SCC 8. Basaloid variant recognised Recently, there has been a proposal to reclassify VIN.
Assessment of cervical involvement by the endometrial malignancy has become easier. In vulval cancer, there is more detailed analysis of lymph node involvement required with the introduction of substages in stage 3.
One now needs to asses how many lymph nodes are involved and what the size of the metastasis is. For the first time there are now FIGO stages available for the uterine sarcomas rendering it easier to assign the appropriate stages based on size, etc.
Pathological features of endometrial carcinoma associated with HNPCC: A comparison with sporadic endometrial carcinoma.
Cancer ; 1 : Endometrial cancer and Lynch Syndrome: Clinical and pathologic considerations cancer control, ; 16 1 : IARC Press; A multicentric European study testing the reproducibility of the WHO classification of endometrial hyperplasia with a proposal of a simplified working classification for biopsy and curettage specimens.
Am J Surg Path ; Mutter GL. Diagnosis of premalignant endometrial disease. J Clin Path, ; Endometrial intraepithelial neoplasia is associated with polyps and frequently has metaplastic change.
Histopathology, ; Occurrence of endometrial glandular dysplasia precedes uterine papillary serous carcinoma. Int J Gynaecol Pathol ; Endometrial hyperplasia and carcinoma in endometrial polyps: Clinicopathologic and follow-up findings.
Hui P et al. Minimal uterine serous carcinoma: a clinicopathological study of 40 cases. Mod Pathol ; Reproducibility of biopsy diagnosis of endometrial hyperplasia: Evidence supporting a simplified classification.
Mutter, MD. WT1, p53 and ER receptor expression in uterine serous carcinoma. Histopathol ; Minimal uterine serous carcinoma: current concepts in diagnosis and prognosis.
Pathology ; Am J Surg Pathol ; Patterns of stromal invasion in ovarian serous tumours of low malignant potential borderline tumours : a reevaluation of the concept of stromal micro-invasion.
Incidental carcinomas in prophylactic specimens in BRCA1 and BRCA2 germi-line mutation carriers, with emphasis on fallopian tube lesions: report of 6 cases and review of the literature.
Tubal and ovarian pathways to pelvic epithelial cancer: a pathological perspective. Zagreb, Croatia Introduction There is no doubt that obstetrics carries high medical liability risk.
In many countries, gynecologists-obstetricians who attend childbirths and perform complex obstetric procedures are faced with increasing malpractice insurance premiums and litigation risk.
The American College of Obstetricians and Gynecologists ACOG publishes its Survey of Professional Liability since , with the objective to analyze the effect that malpractice litigation has had on the practice of obstetrics and gynecology in the United States1.
According to the ACOG survey, The average number of claims per obstetrician was 2. In all the Surveys, neurological impair is the leading cause of the reasons for liability claim, with the cerebral palsy being the most serious damage.
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Stara koka, dobra juha. Pre istine. U raskoraku. Gorski car. Kod Londona. Sezona poljubaca. Ljubitelj golubova. Ima ljubavi, nema ljubavi.
Pucanj u glavu. Prirodna granica. Engleski onakav kakav se govori. Uloga moje porodice u svjetskoj revoluciji.
Operacija 30 slova. Dom i lepota. Bez naziva. Uniforme TV serija. Obraz uz obraz. Majstor i Margarita. Bombardovanje Nju Hejvna.
Pjegava djevojka. Beograd ili tramvaj a na prednja vrata. Pred zoru. Zimovanje u Jakobsfeldu. Borisko i Natalija. Grlom u jagode.
Vlajkova tajna. Marija Magdalena. Obecana zemlja Zikina dinastija Sest dana juna Debeli i mrsavi Holding the Air Life Is Beautiful Brisani prostor TV Series I to ce proci Cao inspektore U zatvoru Groznica ljubavi Nema problema Pozoriste u kuci TV Series Balkan ekspres TV Series Mala pljacka vlaka The End of War Balkan Spy Opasni trag Sta je s tobom, Nina In the Jaws of Life Cudo nevidjeno Maturanti Pazi sta radis Pejzazi u magli Crveniot konj TV Series Secerna vodica Idi mi, dodji mi Timocka buna Veliki transport Igmanski mars Jos ovaj put Halo taxi Stepenice za nebo Ucitelj TV Series Kakav deda takav unuk Balkan ekspres Moj tata na odredjeno vreme Nedeljni rucak Venerijanska raja TV Short Progon Idemo dalje Price iz radionice TV Series Laf u srcu Lov u mutnom Sok od sljiva The Promising Boy The Fall of Italy Sesta brzina Duvanski put TV Mini-Series Dorotej Visoki napon The Red Horse Erogena zona Nesto iz zivota TV Movie Snovi, zivot, smrt Filipa Filipovica Rad na odredjeno vreme Poseban tretman Pozorisna veza Tren TV Mini-Series Sedam plus sedam TV Series Partizanska eskadrila Usijanje The Pals Radio Vihor zove Andjeliju Anno domini TV Series Cardak ni na nebu ni na zemlji TV Series Noc od paucine TV Movie Moment Arrive Before Daybreak Tit for Tat Povratak otpisanih TV Series The Tiger Sekvence i konsekvence Short Lude godine Pas koji je voleo vozove Hajka Beasts Beloved Love Group Portrait with a Lady Idi tamo gde te ne poznaju TV Movie Morava 76 TV Mini-Series The Written Off Return The Peaks of Zelengore Beach Guard in Winter Sinovi TV Movie Zivot je lep TV Series Naivko Anno Domini Massacre at Noon Povest o dobrih ljudeh Potomak TV Short Rekvijem za teskasa TV Movie Crveni udar Hell River The Wind The Dervish and Death Valter brani Sarajevo TV Series Partizani TV Mini-Series Hotel za ptice TV Movie Sluga TV Short Mirko and Slavko Kamenolom TV Movie Bombasi Kolnati sme, Irina The Battle of Sutjeska Obraz uz obraz TV Series The Master and Margaret Traces of a Black Haired Girl I Bog stvori kafansku pevacicu Gradjani sela Luga TV Series Walter Defends Sarajevo Zvezde su oci ratnika Das falsche Gewicht TV Movie Breakfast with the Devil Moja luda glava The Bet Zarki Bloody Tale The Battle of Neretva Most Oseka It Rains in My Village Operacija Beograd Bekstva Do Not Mention the Cause of Death The Girl in the Park Brat doktora Homera Ima ljubavi, nema ljubavi Posalji coveka u pola dva The Birch Tree The Feast Noz I Even Met Happy Gypsies The Demolition Squad Anabelin san Short