Purpose:To analyze immunohistochemically morules in endometrioid lesions to show that CD10 is a sensitive marker for morular metaplasia. Experimental Design: Immunohistochemical analysis of 53 instances of morular metaplasia comprising 1 cyclic endometrium and 52 endometrioid lesions associated with focal glandular complexity corresponding to 9 polyps, 4 atypical polypoid adenomyomas, 24 complex endometrial hyperplasias (18 with and 6 without atypia), 12 grade 1 endometrioid adenocarcinomas in early clinical stages of both uterus and ovary, and three ovarian adenofibromas. Immunohistochemistry in paraffin sections was done for CD10, h-catenin, estrogen and progesterone receptors, and cytokeratins 5-6, 7, 8, 13, 18, 19, 20, and 34h-E12. Results: Morules were negative for estrogen and progesterone receptors and had h-cateninp ositive nuclei. Cytokeratins 8, 18, 19 were positive; cytokeratins 7 and 20 were negative; and cytokeratins 5-6, 13, and 34h-E12 were weakly positive. All cases revealed strongly positive membranous CD10 staining in morules, which was absent in glands. CD10 positivity allowed easy identification of morules at low power in various types of surgical specimens and in curettings. CD10 also highlighted early morular metaplasia in glandular epithelium. In cases associated with squamous, keratinizing metaplasia, CD10 discriminated between both types of metaplasia. Conclusions: CD10 staining represents a useful marker of morules in endometrioid neoplasms of the female genital tract, permitting identification of lesions usually associated with an attenuated malignancy. Considering the immunohistochemical and genetic similarities of morules in tumors of different organs, it is likely that this marker may be also useful to diagnose morular metaplasia in similar neoplasms of extragenital locations.Morules (1) are nodular structures found in endometrial-type glands formed by a peculiar metaplastic non-keratinizing squamoid epithelium (2). Morphologically similar structures have also been described in neoplastic lesions in other anatomic sites, such as thyroid (3), lung (4, 5), stomach (6), pancreas (7), and colon (8).In both eutopic and ectopic endometrioid tissues, morules are almost invariably associated with the glandular architectural complexity of premalignant and low-grade glandular malignant lesions but are absent in high-grade ones. Thus, it can be said that the presence of morules in the endometrium relates well with an attenuated malignancy.This study deals with the immunohistochemical findings in a series of 53 cases of morular metaplasia from both uterus and ovary, showing for the first time that CD10 staining is a marker of morules, allowing its easy identification in various endometrioid lesions. Materials and MethodsA total of 53 cases of endometrioid morular metaplasia were collected from the files of the

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We report a case of a 9-cm mixed epithelial and stromal tumour of the kidney in an obese 70-year-old woman with diabetes. The ovarian-type stroma had a spindle cell component that was positive for progesterone receptors and had the hitherto unreported presence of abundant foci of luteinised stromal cells with characteristic immunohistochemical positivity to a-inhibin, calretinin, aromatase and gonadotropin-releasing hormone (GnRH) receptors. We conclude that the stromal component is identical to ovarian cortical stroma. We believe that ovarian-type stroma occurs in extragenital tumours as a result of an epithelial-stromal interaction in an environment of hormonal hyperstimulation.

We present, for the first time, two yolk sac tumors (YST) in women 37 and 18 years of age, one with a typical parietovisceral pattern and the other with a glandular pattern, which were associated with extensive areas of mucinous carcinoid (MC). The tumor in the first case had numerous nodules of tubulopapillary YST that merged with well-differentiated MC. This patient responded well to chemotherapy. The tumor in the second case consisted of an AFP-positive glandular YST, with a glandulopapillary pattern closely resembling fetal lung type adenocarcinoma, coexisting with an AFP-negative, cytokeratin 20-positive, atypical MC; transitional areas between the two components were also seen. In the material from the recurrences and metastases; however, no YST was present, the atypical MC having become the predominant component including areas that had become carcinomatous. There was a poor response to various chemotherapeutic regimens. AFP levels became negative during the course of disease paralleling the disappearance of the YST component and the overgrowth of an increasingly anaplastic MC. The patient died 1 year after diagnosis. We think that, in these cases, MC represented an unusual form of endodermal differentiation of the YST. It is important to differentiate the yolk sac and carcinoid components due to their different responses to chemotherapy and to evaluate the possibility of mucinous carcinoid developing into a highly aggressive carcinoma.

Objectives To evaluate the performance of a two‐step strategy compared with the International Ovarian Tumor Analysis (IOTA) ‐ Assessment of Different NEoplasias in the adneXa (ADNEX) model for preoperative classification of adnexal masses. Methods An ambispective diagnostic accuracy study based on ultrasound data collected at one university hospital between 2012 and 2018. Two ultrasonographers classified the adnexal masses using IOTA Simple Rules (first step). Not classifiable masses were evaluated using the IOTA ADNEX model (second step). Also, all masses were classified using the IOTA ADNEX model. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR−), and receiver operating characteristic (ROC) curve were estimated. A P value of <.05 was used to determine statistical significance. Results The study included 548 patients and 606 masses. Patients' median age was 41 years with an interquartile range between 32 and 51 years. In the first step, 89 (14%) masses were not classifiable. In the second step, 55 (61.8%) masses were classified as malignant. Furthermore, for the totality of 606 masses, the IOTA ADNEX model estimated the probability that 126 (20.8%) masses were malignant. The two‐step strategy had a sensitivity, specificity, PPV, NPV, LR+, LR−, and ROC curve of 86.8%, 91.01%, 51.9%, 98.4%, 9.7, 0.1, and 0.889, respectively; compared to IOTA ADNEX model that had values of 91.8%, 87.16%, 44.4%, 99%, 7.1, 0.09, and 0.895, respectively. Conclusion The two‐step strategy shows a similar diagnostic performance when compared to the IOTA ADNEX model. The IOTA ADNEX model involves only one step and can be more practical, and thus would be recommended to use.

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Objectives: Ovarian cancer mortality remains high mainly due to late diagnosis. Since 1999, we have performed colour Doppler transvaginal (CDTV) ultrasound to screen for ovarian cancer. The purpose of this paper is to assess the efficiency of CDTV ultrasound to detect ovarian cancer in early stages. Methods: Screening by CDTV ultrasound was annually performed in asymptomatic women with no family history of ovarian cancer. Women with abnormal screenings had repeat tests after four to six weeks. If the finding remitted, CDTV ultrasound follow-up was performed at one year. If the abnormality persisted, the study was completed with tumour markers, CT scan, and laparoscopy. Results: A total of 606,770 CDTV ultrasound screenings performed in 153.403 women were reviewed. Malignant tumours were diagnosed and histologically confirmed in 107 patients. Borderline lesions were detected in 46 of them (44,2%). The mean age of the patients was 47 years (±±12). 76 (73%) of these tumours were in stage I (including two cases of Fallopian tube carcinoma); seven were in stage II; 21 were in stage III; and three lesions detected were metastases. 61 percent of the patients had normal levels of CA 125, measured after the lesions were detected by CDTV ultrasound study. Conclusions: Although consensus about the benefits of transvaginal ultrasound as a screening procedure is not unanimous, our data suggest that tumours in patients screened with CDTV ultrasound are detected at earlier stages. Additional randomised studies are needed to support these findings. OC03.04 An external validation of the O-RADS risk stratification to differentiate between benign and malignant adnexal masses

for a lipoma, or a cyst of the Bartholin gland. The treatment is conservative surgery. When there are forms of passage between angiomyofibroblastoma and aggressive angiomyxoma, the lesion should be treated as an aggressive angiomyxoma because of the risk of an anarchic local recurrence. If the transformation is rather malignant, the behaviour is rather oncological and multidisciplinary. VP05.27 Ovarian endometriosis detection by ultrasound