Histologic changes in the female genital tract after prolonged androgen stimulation have been described in the past. However, these changes have not been systematically addressed in hysterectomy specimens from subjects undergoing surgical gender-reassignment, typically after treatment with exogenous androgens. The current study aims to provide practicing pathologists with a list of expected histologic features in hysterectomy specimens from female-male transgender individuals. Twenty-seven hysterectomy with bilateral salpingo-oophorectomy specimens were identified from our Laboratory Information System. Slides were retrieved and reviewed for features associated with androgen exposure. Clinical information for the 27 subjects (20–46 yr old, mean=29 yr) was obtained from the electronic medical records. Twenty-four subjects had received androgen 19 mo to 24 yr preoperatively. Focal decidua-like endometrial stromal change with glandular paucity was present in 16/27 (59%) uteri associated with predominantly inactive endometrial glands. Ectocervical or transformation zone transitional cell metaplasia was present in 17/27 (63%) subjects. Bilateral cystic follicles were present in all 23 subjects who underwent bilateral salpingo-oophorectomy and had preoperative androgen exposure. In these ovaries, follicular density appeared higher than that expected for age with counts ranging from 1.5 to 32.5 follicles/mm2 (average=10.7 follicles/mm2). Predominantly inactive, sparse endometrial glands with focal decidua-like stromal change, cervical transitional cell metaplasia, bilateral cystic follicles and higher follicular density are observed in the majority of specimens from female-male transgender individuals. These histologic changes correlate with prolonged preoperative androgen administration. The significance of these findings relies on recognizing the spectrum of androgen-related histologic alterations and not confusing transitional cell metaplasia with cervical dysplasia.

Context.— Transgender men and transmasculine persons experience a discordance between the female sex they were assigned at birth and their gender. They may choose to take hormone therapy and/or undergo surgery to masculinize the body. Understanding the common (and less common) histologic changes present in patients taking masculinizing hormones will empower pathologists to better serve this unique patient population. Objective.— To summarize histologic findings in surgical pathology specimens from persons taking masculinizing hormones as a part of gender transition. Data Sources.— A systematic review of the OVID Medline and PubMed databases was performed to identify all studies describing histologic findings in surgical pathology specimens from transgender men from January 1946 to January 2021. Conclusions.— Publication in this area has markedly increased in the last 2 decades. However, most of the studies identified were descriptive and case reports describing changes seen in specimens removed as a part of masculinizing surgical procedures. Benign histologic findings include stromal hyalinization and epithelial atrophy in the breast, polycystic ovarian syndrome–like changes in the ovary, and transitional cell metaplasia in the cervix. The most commonly reported neoplastic finding was adenocarcinoma of the breast, with rare cases of ovarian, endometrial, cervical, vaginal, pituitary, pancreatic, and cardiovascular neoplasia also reported. Ongoing research in this area is needed to better characterize the histologic findings in persons taking masculinizing hormones to provide a deeper understanding of the effect of these treatments on different tissues and facilitate better patient management.

In this retrospective study, we quantified the hematogone (normal B-lineage precursor) population by flow cytometric immunophenotyping in post-transplant bone marrow biopsy specimens from adult patients who received an autologous stem cell transplant for either plasma cell myeloma (n = 57) or diffuse large B-cell lymphoma (n = 73). The majority of patients (80%) had <5% marrow hematogones post-transplant. Extreme (>10%) hematogone percentages were quite rare, seen in only four patients, and were not associated with disease progression. There was a positive association between the post-transplant day and hematogone percentage within the first year after transplant, and a negative association thereafter. Plasma cell myeloma patients with ≥5% hematogones in any post-transplant flow cytometry study had a worse overall survival as did plasma cell myeloma patients with increased hematogones (as defined by percentile) at 100 days post-transplant. These findings require further study, ideally in a prospective study design.

Verificar os fatores associados ao indicativo da depressão de idosos institucionalizados. Estudo transversal, quantitativo, com 208 idosos de instituições de longa permanência. Avaliou-se os dados sociodemográficos, econômicos e clínicos, autopercepção de saúde, capacidade funcional, avaliação cognitiva e indicativo de depressão. A análise incluiu distribuições de frequências absolutas e relativas, o teste T, correlação de Pearson e regressão linear múltipla (p<0,05) por meio do SPSS. Prevaleceu o sexo masculino; cor branca; estudaram de um a cinco anos; solteiros; usam cinco medicamentos ou menos; possuem até quatro doenças; dependência total ou parcial para atividades de vida diária e elevado percentual de declínio cognitivo e indicativo de depressão. O indicativo de depressão associou-se a escolaridade e a deambulação. Deve-se propor ações que visem melhorar a saúde e a convivência social e familiar dos idosos com vistas a minimizar o indicativo de depressão. Descritores: Depressão, Idoso, Institucionalização, Enfermagem Geriátrica.   Indicative of depression in institutionalized elderly Abstract: To verify the factors associated with indicative of depression in institutionalized elderly people. Cross-sectional, quantitative study with 208 elderly people from long-term care facilities. Sociodemographic, economic and clinical data, self-perceived health, functional capacity, cognitive assessment and indicative of depression were evaluated. The analysis has included absolute and relative frequency distributions, the t test, Pearson correlation and multiple linear regression (p<0.05) using SPSS. Male gender has prevailed; White color; studied from one to five years; singles; use five medications or less; have up to four diseases; total or partial dependence on activities of daily living and a high percentage of cognitive decline and indicative of depression. The indicative of depression was associated with education and deambulation. Actions aimed at improving health, family and social life of the elderly people should be proposed in order to minimize the signs of depression. Descriptors: Depression, Aged, Institutionalization, Geriatric Nursing.   Indicativo de depresión en ancianos institucionalizados Resumen: Verificar los factores asociados a indicativos de depresión en ancianos institucionalizados. Estudio transversal, cuantitativo, con 208 ancianos de centros de cuidados de larga duración. Se evaluaron datos sociodemográficos, económicos y clínicos, salud autopercibida, capacidad funcional, valoración cognitiva e indicativos de depresión. El análisis ha incluido distribuciones de frecuencias absolutas y relativas, la prueba t, correlación de Pearson y regresión lineal múltiple (p <0,05) utilizando SPSS. Ha prevalecido el género masculino; El color blanco; estudió de uno a cinco años; individual; use cinco medicamentos o menos; tiene hasta cuatro enfermedades; dependencia total o parcial de las actividades de la vida diaria y un alto porcentaje de deterioro cognitivo e indicativo de depresión. El indicador de depresión se asoció con la educación y la deambulación. Se deben proponer acciones encaminadas a mejorar la salud, la vida familiar y social de las personas mayores con el fin de minimizar los signos de depresión. Descriptores: Depresión, Anciano, Institucionalización, Enfermería Geriátrica.

Tumor of the follicular infundibulum or infundibuloma is a relatively rare benign adnexal tumor usually solitary and located in the head, neck, and trunk. Here we present a 70-year-old woman with a tender vulvar lesion. Histopathologic exam shows a well-circumscribed lesion with a subepidermal horizontally oriented, plate-like proliferation of pale appearing squamous epithelial cells with numerous points of connections with the overlying epidermis and peripheral palisading. Overall these histopathologic features are consistent with the diagnosis of tumor of follicular infundibulum involving genital skin.