Background This study examined the accuracy and pitfalls associated with frozen section diagnosis of primary ovarian tumors and ovarian metastases based on the 2014 World Health Organization classification (WHO) criteria and proposed improvements from a pathologist’s perspective. Methods We microscopically reviewed 871 cases of primary ovarian tumor (N = 802) and ovarian metastasis (N = 69) and compared the results of frozen sections with the final diagnosis. Malignant potential concordance (benign, borderline, or malignant) and specific discordant diagnosis rates were analyzed. Finally, we conducted a unique literature review of specific diagnostic errors in the frozen section diagnosis of primary ovarian tumors. Results Of 802 primary ovarian tumors, 50 (6.2%) cases showed discordant diagnoses in which mucinous carcinoma (40.5%), low-grade serous carcinoma (LGSC; 31.3%), and mucinous borderline tumor (18.4%) were frequently misinterpreted. Of 69 ovarian metastases, all 4 cases of low-grade appendiceal mucinous neoplasm (LAMN) were misdiagnosed as primary ovarian mucinous tumor. A literature review revealed that mucinous/serous borderline tumor or carcinoma accounted for approximately 70% of 217 reported discordant diagnoses. Conclusion In the present study, the concordance rate of malignant potential of the tumor was comparable to that previously reported. Even in the 2014 WHO classification, primary ovarian mucinous borderline tumor/carcinoma and LGSC still comprised the majority of discordant cases. Grossing methods that reduce sampling error are required. LAMN was frequently misinterpreted as a benign or borderline ovarian mucinous tumor. To prevent this error, a differential algorithm integrating clinical information and gross findings should be developed.
Abdominal aortic aneurysm (AAA) is a vascular disease that results in the gradual dilation of the abdominal aorta and has a high rupture-related mortality rate. However, the mechanism of AAA rupture remains unknown. In our previous study, we established a novel AAA animal model (hypoperfusion-induced AAA rat model) with spontaneous AAA rupture. Using the hypoperfusion-induced AAA rat model, we demonstrated that the abnormal appearance of adipocytes in the vascular wall is associated with AAA rupture. However, pathological analysis of the rupture area has not been performed because it is particularly difficult to identify the rupture point. In this study, we succeeded in obtaining samples from the rupture point and performed a histological analysis of the ruptured area in the vascular wall in the hypoperfusion-induced AAA rat model. Adipocytes were observed along the AAA-ruptured area of the vascular wall. In the areas around the adipocytes, macrophage infiltration and protein levels of matrix metalloproteinases 2 and 9 were significantly increased and collagen-positive areas were significantly decreased, as compared with areas without adipocytes. The AAA diameter was correlated with the number of adipocytes in the vascular wall of the hypoperfusion-induced AAA rat model. On the other hand, serum triglyceride levels and serum total cholesterol levels were not correlated with the number of adipocytes in the vascular wall. These results suggest that local adipocyte accumulation in the vascular wall, not serum lipids, has an important role in AAA rupture.
The pathophysiology underlying abdominal aortic aneurysms (AAAs) remains unknown. In this study, we applied imaging mass spectrometry (IMS) to analyze the pathophysiology of the aneurysmal wall. Comparisons were performed between the tissue samples from the neck and the sac of the AAA, at a single time point, in 30 patients who underwent elective surgery of their AAAs. The localization of each lipid molecule in the aortic wall was assessed by IMS. Histopathological examination and IMS revealed a characteristic distribution of triglycerides (TGs) specifically in the aneurismal adventitia of the sac. This characteristic TG distribution was derived from an ectopic appearance of adipocytes in the adventitia. Furthermore, ectopic adipocyte accumulation in the aortic wall leads to the loss of the collagen fiber network subsequent to the wall rupture. The underlying mechanism of adipocyte accumulation involves the presence of adipose-derived stem cells (ADSCs) in the aneurismal adventitia and the expression of peroxisome proliferator-activated receptor gamma 2, a master regulator of adipocyte differentiation by some ADSCs. This study reveals new, previously overlooked aspects of AAA pathology.
An operated case of para-aortic lymph node recurrence after surgery for a cancer of the transverse colon is reported. A 64-year-old woman underwent an operation for cancer of the transverse colon on September 26, 1995. Six months after the operation, increases in serum CEA and CA19-9 level were found and further exermination revealed para-aortic lymph node swelling from the level of the It. renal vein to the bifurcation of the aorta. Para-aortic lymph node metastasis of the colonic cancer was suspected. There was no evidense of another metastasis in Ga scintigraphy. We judged that the patient was a candidate for operation and performed para-aortic lymphadenectomy. The patient has no sign of recurrence at present, 16 months after the operation. No case of para-aortic lymphadenectomy after operation for the colonic cancer has been reported to this time in Japan. It is suggested that this operation is beneficial for proloning the survival time in case of no evidence of another metastasis.
Introduction: Power morcellator is useful as a surgical instrument for shredding a specimen during laparoscopic surgery; however, because this technology requires a widened porthole in the abdominal wall, we consider that it has scope for improvement in terms of esthetic outcome and perspective on pain. In addition, at the time of transvaginal removal of the shredded specimen, we often cannot have enough space to perform the removal because the vaginal cavity is narrow and deep; alternatively, it may be difficult to perform owing to the extremely large specimen present. We report here a case of transvaginal in- bag morcellation.
Objective: Previously, we analyzed human varicose veins (VV) using imaging mass spectrometry (IMS) and detected the abnormal accumulation of lipid molecules in the walls of VV, possibly due to insufficient lipid drainage by the lymphatic vessels. In this study, we created an animal model of lymphatic insufficiency to investigate the effects of insufficient lymph drainage on vein walls.
Summary Three cases of bovine γδ T‐cell lymphoma without skin involvement are described. Case 1 was a 17‐month‐old Holstein heifer with generalized lymphadenopathy. Case 2 was a 4‐year‐old Holstein cow that had multiple tumour masses in the uterine body and horns. Case 3, a 23‐month‐old Holstein bull was presented with generalized tremor, nystagmus and hyperesthaesia, and there were several tumour masses in the meninges. Cases 1 and 2 had epitheliotropic neoplastic infiltrates in the tonsillar epithelium and endometrial glands, respectively. Immunohistochemistry showed CD3+, WC1+, CD79a− lymphoma cells in all cases, and perforin was positive in two cases. Electron‐dense granules were present in many neoplastic cells of all cases. These findings supported the cytotoxic γδ T‐cell origin of the present lymphomas. Bovine γδ T‐cell lymphoma may originate in a wide variety of anatomical sites and may be classified into several histological subtypes.
