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Slide Seminar
Pathology of the cervix

September 4th, 14.00-16.00 Auditorium VII
Chairpersons: Ben Davidson (Norway) and Maria Raspollini (Italy)
Case 1
Presented by: Ben Davidson, Oslo, Norway

A 62-year old female with post-menopausal bleeding and palpable tumor in the uterine cervix.
Slide 1HE x5HE x10HE x10bHE x10c
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Case 2
Presented by: Ben Davidson, Oslo, Norway

A 40-years old woman with tumor in the lower abdomen.
Slide 1Slide 2HE x10 cervixHE x20 cervixHE x10 abdomenHE x20 abdomen
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Case 3
Presented by: Sigurd Lax, Graz, Austria

A 37 year old female with inconspicuous history presented with abnormal Pap smear (Pap III/ ASCUS). Colposcopy revealed a large ectopy of the endocervix, harboring adenocarcinoma in situ (AIS) on cervical biopsy. Cold knife cone biopsy was performed. The seminar slide represents one section of the cone specimen.
Slide 1Slide 1_1xSlide 2_1xSlide 3_2xSlide 4_2xSlide 5_2xSlide 6_10x
Slide 7_10xSlide 8_10xSlide 9_10xSlide 10_20x
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Case 4
Presented by: Cristina Riva and Laura Cimetti, Varese, Italy

A 70 ys old Caucasian female presented with uterine prolapse and urinary incontinence. Her past history included two pregnancies with vaginal deliveries and menopause at 52 ys. She never had hormone therapy. Pap smear was not performed.

The patient underwent vaginal simple hysterectomy and cystopexy.

Gross appearance of the uterus was consistent with cervical prolapse and endometrial atrophy; no significant macroscopic abnormalities were observed.

Histology revealed in the cervical stroma an organoid proliferation of rounded nests of uniform basaloid cells with scanty cytoplasm, peripheral palisading and rare mitotic figures; only focal glandular alcianophilic or squamous differentiation in the central areas of the nests was found. The lesion measured approximately 9x7 mm. Multiple foci of high-grade CIN were observed in the superficial squamous epithelium. The nests of basaloid cells showed intense and diffuse cytoplasmatic p16 immunoreactivity along with strong low molecular weight cytokeratin (8-18) positivity. There was focal and weak positivity for cytokeratin 7, EMA and CD-117, whereas CEA and p53 resulted negative. Proliferative index (Ki-67) was 10 % . In Situ Hybridization for high risk HPV showed positivity in both basaloid nests and CIN.

The patient is alive without evidence of disease after a follow-up period of 5 years.
Slide 1Snapshot 1 (H&E x40)Snapshot 2 (H&E x40)Snapshot 3 (H&E x200)Snapshot 4 (H&E x400)Snapshot 5 (H&E x400)Snapshot 6 (CK8-18 x40)
Snapshot 7 (p16 x40)Snapshot 8 (HPV x400)Snapshot 9 (MIB1 x200)
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Case 5
Presented by: Bernard Czernobilsky MD, Nes-Ziona, Israel

A 32 year old woman, gravida 2, para 2 presented with a 3 months history of vaginal bleeding.

Physical examination showed an enlarged, bulky cervix with erosions and ectropion.

A PAP smear revealed many large malignant epithelial cells, which could not be further identified.

Subsequently, cervical biopsies were taken from different sites and all of them showed, on H&E stain, an undifferentiated, diffusely infiltrating tumor, composed of large cells with vesicular and some hyperchromatic nuclei with prominent nucleoli. Mitotic activity was brisk and necrotic areas were present. The tumor cells were arranged in cord-like and solid patterns.

The tumor cells stained for pan cytokeratin as well as for neuroendocrine markers such as chromogranin, synaptophysin, NSE and CD56. Some of the tumor cells were positive for TTF1. The diagnosis of large cell neuroendocrine carcinoma (LCNEC) was reached.

Computed tomography scan of the pelvis, abdomen and chest showed no evidence of metastases.

The patient underwent a radical hysterectomy with pelvic and para-aortic lymphadenopathy. The specimen showed diffuse involvement of the cervix by LCNEC. There was no evidence of a tumor in the uterus, nor in the other tissues removed, including lymph nodes.

Following the operation, the patient was treated with cisplatin and etoposide. Radiation therapy was administered to the pelvis.

Within the next 4 months metastatic tumor appeared within the abdominal cavity, liver and lung.

She expired 7 months after the diagnosis was established.
Slide 1Slide1-HESlide2-HESlide3-HESlide4-CKSlide5-synaptophysinSlide6-Chromogranin
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Case 6
Presented by: Evanthia Kostopoulou, Larissa, Greece

A 46-year-old woman, gravida 3, para 2, presented with profuse watery vaginal discharge, which had lasted for several months. On gynecological examination her cervix was mildly enlarged and a significant amount of watery mucus was discharged. Transvaginal ultrasonography showed cervical cysts measuring up to 2.3 cm in maximum diameter. The patient had no other significant physical findings or previous history, and her family history was unremarkable. Her pap smear showed inflammatory changes.

Although the possibility of a florid pseudoneoplastic glandular lesion was considered, her symptoms, in conjunction with the above findings, led to a decision for exploratory laparotomy, which resulted in total hysterectomy with bilateral salpingo-oophorectomy.

Eleven-month follow-up was uneventful.
Fig.1. HE x40Fig.2. HE x40Fig.3. HE x100Fig.4. HE x100Fig.5. HE x100Fig.6. HE x40Fig.7. AB/PAS
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