Prognostic value of the diagnostic criteria distinguishing endometrial stromal sarcoma, low grade from undifferentiated endometrial sarcoma, 2 entities within the invasive endometrial stromal neoplasia family

The World Health Organization (WHO 2003) recognizes 3 endometrial stromal neoplasms: noninvasive endometrial stromal nodule and the 2 invasive neoplasms, endometrial stromal sarcoma (ESS), low grade and undifferentiated endometrial sarcoma (UES). It is important to note that the WHO 2003 does not define moderate atypia (an important differentiating diagnostic criterion for ESS, low grade and UES), nor does it discuss its significance. Moreover, studies on reproducibility and additional prognostic value of other diagnostic features in large are lacking. Using strict definitions, we analyzed the agreement between routine and expert-review necrosis and nuclear atypia in 91 invasive endometrial stromal neoplasias (IESN). The overall 5-year and 10-year recurrence-free survival rate estimates of the 91 IESN patients were 82% and 75%, respectively. Necrosis was well reproducible, and nuclear atypia was reasonably well reproducible. The 10-year recurrence-free survival rates for necrosis absent/inconspicuous versus prominent were 89% and 45% (P<0.001) and those for review-confirmed none/mild, moderate, severe atypia were 90%, 30%, and <20% (P<0.00001). Therefore, cases with moderate/severe atypia should be grouped together. Nuclear atypia and necrosis had independent prognostic values (Cox regression). Once these features were taken into account, no other feature had an independent additional prognostic value, including mitotic count. Using "none/mild atypia, necrosis absent/inconspicuous" as ESS, low grade versus "moderate/severe atypia present or necrosis present" as UES resulted in 68 ESS, low grade and 23 UES cases with disease-specific overall mortality-free survival of 99% versus 48% (P<0.00001, hazard ratio=45.4). When strictly defined microscopic criteria are used, the WHO 2003 diagnoses of ESS, low grade and UES are well reproducible and prognostically strong. © 2012 International Society of Gynecological Pathologists.

Psychological and Interpersonal Implications of Believing that Everything is One: Identity, Personality, Values, and Worldviews

For thousands of years, people from a variety of philosophical, religious, spiritual, and scientific perspectives have believed in the fundamental unity of all that exists, and this belief appears to be increasingly prevalent in Western cultures. The present research was the first investigation of the psychological and interpersonal implications of believing in oneness. Self-report measures were developed to assess three distinct variants of the belief in oneness – belief in the fundamental oneness of everything, of all living things, and of humanity – and studies examined how believing in oneness is associated with people’s self-views, attitudes, personality, emotions, and behavior. Using both correlational and experimental approaches, the findings supported the hypothesis that believing in oneness is associated with feeling greater connection and concern for people, nonhuman animals, and the environment, and in being particularly concerned for people and things beyond one’s immediate circle of friends and family. The belief is also associated with experiences in which everything is perceived to be one, and with certain spiritual and esoteric beliefs. Although the three variations of belief in oneness were highly correlated and related to other constructs similarly, they showed evidence of explaining unique variance in conceptually relevant variables. Belief in the oneness of humanity, but not belief in the oneness of living things, uniquely explained variance in prosociality, empathic concern, and compassion for others. In contrast, belief in the oneness of living things, but not belief in oneness of humanity, uniquely explained variance in beliefs and concerns regarding the well-being of nonhuman animals and the environment. The belief in oneness is a meaningful existential belief that is endorsed to varying degrees by a nontrivial portion of the population and that has numerous implications for people’s personal well-being and interactions with people, animals, and the natural world.