On the basis of pathogenesis, two types of endometrial cancer can be recognized. Type 1 endometrial carcinomas are relatively indolent tumors that develop after prolonged estrogen stimulation, on a background of endometrial hyperplasia. Type 2 endometrial carcinomas are aggressive tumors that are not associated with hyperplasia or estrogen excess. The aim of this study is to evaluate the prognostic significance of tumor proliferative activity in early-stage endometrial cancer by using mitotic index and immunostaining, comparing Type 1 (endometrioid) and Type 2 (papillary serous carcinoma) tumors. The mitotic index, MIB-1, and p53 immunostaining in 39 tumors from patients with lowgrade Stage Ia or Ib endometrioid adenocarcinoma; as well as 23 tumors from patients with Stage I papillary serous carcinoma. In low-grade endometrioid adenocarcinoma, mitotic and MIB-1 indices were statistically significant independent prognostic indicators (P ‫؍‬ .004 and P ‫؍‬ .018, respectively), and both were strongly correlated with p53 expression (P ‫؍‬ .01 and P ‫؍‬ .006, respectively). The mean mitotic index was 5 mitoses/10 high-power fields, and mean MIB-1 index was 27.5%. There was no significant correlation between mitotic or MIB-1 indices and patient outcome or p53 expression in papillary serous carcinoma. The mean mitotic index was 31 mitoses/10 high-power fields, and mean MIB-1 index was 30.5% in these tumors. p53 expression and proliferative indices are strongly correlated in low-grade endometrioid adenocarcinoma. MIB-1 and mitotic indices are independent prognostic indicators in these tumors. Papillary serous carcinoma of endometrium is rapidly proliferative in tumors even at an early stage, and quantification of proliferative activity in these tumors does not allow prediction of patient outcome. KEY WORDS: Endometrial carcinoma, MIB-1, Mitotic index, p53, Papillary serous carcinoma, Proliferative activity. Mod Pathol 2002;15(4):365-371Endometrial cancer is the fourth most common malignancy in North American women. In the United States, there are 33,000 newly diagnosed cases and 4,000 deaths per year (1, 2). On the basis of the proposed dualistic model of endometrial carcinogenesis, there are two types of endometrial carcinoma that differ with regard to epidemiologic risk factors, histopathologic lesions, and molecular events (3). Type 1 endometrial carcinomas are relatively indolent tumors that develop after prolonged estrogenic stimulation. Low-grade endometrioid adenocarcinoma is the prototype of Type 1 endometrial carcinoma. Although most of these patients do well, recurrence and death due to disease can occur. Type 2 endometrial carcinomas are more aggressive tumors that are not associated with endometrial hyperplasia or estrogen excess. These tumors develop de novo in the atrophic endometrium of older postmenopausal women (4 -7). Papillary serous carcinoma of endometrium (PSCE) is the prototype of Type 2 endometrial carcinoma and is an uncommon aggressive variant of endometrial cancer. It accounts for 1-10% of cas...

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IntroductionMale breast cancer is rare, accounting for about 1% of total breast cancer cases. In contrast to gynecomastia, which has a painful, soft, movable mass concentric to the nipple, the traditional presentation is a painless, hard, eccentric retro-areolar mass. However, when cancer occurs concurrently with significant gynecomastia, the mammographic pattern simulates female-type breast cancer, whereby there is a variable location and pattern of cancer. This study addresses the clinical and radiologic implications of this combination of gynecomastia and co-existing breast cancer. This combined presentation has not been highlighted thus far. Materials and methodFollowing institutional approval, a retrospective study of male breast cancer was conducted over a 10-year period (2011-2021) in a single institution. Age, clinical presentation, risk factors, comorbidities, imaging results, and comprehensive pathology reports were all obtained from the picture archiving and communication system (PACS). Patients who did not have an initial imaging examination were eliminated from the study. ResultsThere were 18 cases in all that were investigated. Ten (56%) of the men exhibited a classic presentation appearance, whereas eight (44%) had gynecomastia. The mean age was 58 years. The female-type presentation included multicentric cancers away from the nipple, diffuse parenchymal involvement, leukemia/lymphoma, and positive axillary lymphadenopathy without intramammary lesion, some of which had delayed investigation due to clinical suspicion of gynecomastia or breast swelling. All of the radiologic diagnoses were accurate. The pathology report in all except two cases was hormone receptor-positive and human epidermal growth factor receptor 2 (HER2) negative. ConclusionFemale-type presentation of male breast cancer is highlighted to prevent false clinical impressions and delayed radiologic investigation and treatment. Mammography readily identifies such cancers and should be requested at the initial clinical presentation of males with significant gynecomastia or risk factor.