The jet-wash-technique (author's transl)

For the early detection of the endometrial adenocarcinoma the Gravlee-Jet-wash-technique was used in 600 cases. The procedure is simple and requires only 2 to 3 minutes to the gynecologist. An anesthesia is not necessary. In women with stenosed os externum and in anxious patients we use an analgesia of the paracervix (PCB). The technique allows a cytologic and/or cytohistologic investigation. In 600 examined cases we found 37 endometrial adenocarcinomas. We obtained a 100 per cent accuracy in the detection of the 37 malignant lesions. Our experience up to now with the Jet-wash-technique should stimulate its wider use also for outpatients with a high risk for the endometrial adenocarcinoma.     

Endometrial biopsy

Endometrial biopsy is an important diagnostic tool for the evaluation of infertility and abnormal uterine bleeding. The documented safety and accuracy of the plastic endometrial sampling devices have made them popular for use in the office. The procedure requires limited equipment and supplies, and it is generally well tolerated without anesthesia. The pathology report can guide the treatment of benign lesions, including simple hyperplasia. The finding of cytologic atypia indicates a significant risk of progression to carcinoma, and hysterectomy should be considered. If symptoms persist despite a normal endometrial biopsy, further evaluation is recommended.     

Gynecologic effects of tamoxifen and the association with endometrial carcinoma

Tamoxifen has been used as an adjuvant therapy for breast cancer for nearly two decades. The benefits of adjuvant tamoxifen therapy in prolonging disease-free and overall survival have been shown in randomized clinical trials. Despite this, some developing evidence suggests that tamoxifen causes a 2- to 3-fold increase in endometrial cancer. This paper reviews the reports of endometrial carcinoma in tamoxifen-treated patients. Two hundred fifty cases of endometrial carcinoma are reported, but only one case is identified in a premenopausal woman. When documented, 77% (n=127) of the cases are good-grade (grade 1 or 2) and 80% (n=125) are stage-I disease. Since the distribution of good grade (79%) and stage I (74%) from the Surveillance, Epidemiology and End Results (SEER) data are comparable, concerns about more aggressive or late-stage disease appear to be unwarranted. The modest increase in the incidence of early-stage, good-grade endometrial carcinoma described during tamoxifen therapy suggests that it would be unreasonable to institute an aggressive detection strategy of endometrial biopsies. This approach would only lead to further detection bias and would not be cost-effective. Physicians should ensure that patients do not have pre-existing endometrial cancer prior to adjuvant tamoxifen therapy for breast cancer and, furthermore, they should educate patients about signs and symptoms of early endometrial carcinoma and when reported these should be followed up with a gynecologic examination.     

Early diagnosis of adenocarcinoma by endometrial cytologic samples

145 endometrial cytologic samples were taken by Endocyte and they were compared to histologic samples. The diagnostic concordance was 96.55%, proliferative endometrium, secretory endometrium, hyperplastic endometrium and carcinoma were screened and only 2.75% of cases were uncertain. Endometrial cytology is advantageous because Endocyte can be used in the out-clinic without risks for patients.     

Cytology of malignant endometrial tumors

Endometrial cytology is made by direct endometrial sampling. It allows the appreciation of the hormonal status and the diagnosis of inflammatory and/or tumoral pathology. Evidence has been presented that the rate of endometrial cancer is on the increase. Thus, detection and diagnosis have acquired a new significance, where endometrial cytology takes a particular place. Cytologic features of adenocarcinomas in their different kinds are presented. Furthermore, cytologic aspects of uterine sarcomas are outlined, including leiomyosarcomas whose diagnosis can be made by the mean of endometrial cytology.     

Calcium channel blocker decreases pentagastrin-stimulated alkaline-tide: a role for extracellular calcium in gastric acid secretion

The value of magnetic resonance imaging (MRI) in the diagnosis and staging of endometrial carcinoma was studied in 43 cases of clinically suspected endometrial carcinoma and 7 normal women. All of the 43 cases showed abnormal endometria measured by MRI, among which were pathologically proven 40 cases of endometrial carcinoma, 2 cases of endometrial polyps and 1 case of adenomyosis. This suggested that MRI showed a high susceptibility in the diagnosis of endometrial carcinoma, and a lack of specificity. MRI could predict myometrial invasion, its accuracy being verified by surgico-pathological findings in 11 of 13 cases. MRI staging was correct in 10 of the 13 primarily operated cases, and only half of the clinical staging was in conformity with surgical staging. The results suggest that MRI is useful in the staging of endometrial carcinoma and therefore is of value in the choice of treatment planning, although it is not yet an ideal diagnostic aid to detect small metastatic pelvic lesions.     

Coagulation factor XIII in scleroderma

BACKGROUND: In contrast to most major salivary gland malignancies, mucoepidermoid carcinoma has been rarely documented and tentatively accepted as carcinoma ex pleomorphic adenoma. The authors present the cytologic and clinical findings for six examples of these rare tumors. METHODS: The six examples were identified during an extensive review of the authors' salivary gland files, and all were high grade mucoepidermoid carcinomas on histologic evaluation. RESULTS: Overall, mucoepidermoid carcinomas cytologically presented as non-specific high grade malignancies and consisted of highly malignant cells, in clusters or isolated, that were rarely associated with intracellular and extracellular mucin. In only two cases, a background of cellular and stromal elements consistent with pleomorphic adenoma was identified. CONCLUSIONS: Although it is nearly impossible cytologically to distinguish these lesions from other high grade primary or metastatic carcinomas (such as poorly differentiated squamous cell carcinomas, adenosquamous carcinomas, and salivary duct carcinomas), this limitation is not dramatic, as a cytologic diagnosis of high grade malignancy per se allows for proper preoperative patient management.     

Diagnostic cytology for detection of early cancer

Cytologic methods for detection of early cancers of the uterine cervix, lung and various other organs are discussed. The scraping smear method using a spatula is more effective than the cotton swab or vaginal pool smear method for detection of preinvasive intraepithelial lesions, such as, carcinoma in situ and dysplasias of various degrees of the uterine cervix. The use of sputum specimens pooled for three to five days is recommended for cytologic examination in population screening of lung cancer. Good cytopreparatory techniques, suitable screening and cytodiagnostic classifications of malignancy are also described and emphasized, especially, the importance of properly fixed cytologic material for correct cytopathological diagnosis.     

Accidental detection of nonmetastatic ovarian adenocarcinoma in tissue samples recovered during dilatation and curettage

We report two patients with ovarian cancer who were diagnosed with primary endometrial cancer when detached fragments of adenocarcinoma were identified in their dilatation and curettage specimens. Retrospectively, a fragment of fallopian tube and ovarian stroma were identified in the specimens. These findings served to alert the pathologist to the possibility that extrauterine sampling had occurred as a result of perforation of uterine wall during dilatation and curettage. Previous studies have focused on the cytologic detection of extrauterine cancer or on cases where metastasis to the endometrium has led to a misdiagnosis of primary endometrial cancer.     

Serum ceruloplasmin as a diagnostic marker of cancer

Immunohistochemical staining of MMP-9 and the type-IV collagen was performed on paraffin sections of endometrial carcinoma. Immunostaining in 129 cases of endometrial cancer detected MMP-9 in 19.0% of the cases. MMP-9 positive was shown in 30% of the cases with vessel invasion, and in 12.7% of the cases without vessel invasion (p < 0.05). MMP-9 showed positive in many cases with poor differentiation and lymph node metastasis, but still failed to achieve statistical significance. MMP-9 staining did not correlate with disease outcomes. We can not clarify that MMP-9 is associated with tumor-cell invasion and metastasis. Type-IV collagen deposition at the tumor-stromal border was studied in 58 cases of endometrial carcinoma in which disruptions were seen in varying degrees. The type-IV collagen in the primary lesion decreased as the differentiation decreased. Even in the lymph node metastasis lesions, the type-IV collagen was stained and was almost in agreement with the primary lesions. In the primary lesions, there was no relationship between MMP-9 staining and the type-IV collagen. It was suggested that the type-IV collagen observed in endometrial carcinoma was more concerned with the differentiation of the tumor than with the degradation by MMP-9.     

The relation of adenomyosis uteri to coexistent endometrial carcinoma and endometrial hyperplasia

The relation of adenomyosis uteri to endometrial carcinoma and endometrial hyperplasia has been the subject of only a few studies. These investigations have resulted in opposing conclusions on the association between the conditions. In this study of a 10-year period, all cases were retrieved from the surgical pathology laboratory files of adenomyosis uteri with either simultaneous endometrial carcinoma or endometrial hyperplasia. A control population was selected from patients who underwent hysterectomy for mechanical problems related to the uterus. Adenomyosis was found in association with endometrial carcinoma in 19.4% of 175 cases and in association with endometrial hyperplasia in 20.5% of 254 cases. The control series of 203 patients had a 16.7% incidence of adenomyosis. Statistical analysis showed no association between these conditions.     

Radiotherapy of humero-scapular periarthritis using ultra-hard photons. Evaluation by MRI findings

OBJECTIVE: To determine the clinical implications of atypical glandular cells of uncertain significance (AGCUS) in cervical cytologic smears. STUDY DESIGN: Retrospective analysis. RESULTS: Eighty-eight of 32,181 (0.27%) cervical smears obtained during the study period contained AGCUS. Of the 47 women with AGCUS, 16 had intraepithelial or invasive neoplasms (34%; 95% confidence interval, 21-49%), including 9 low or high grade squamous intraepithelial lesions, 1 adenocarcinoma in situ of the cervix, 3 adenocarcinomas of the cervix, 2 adenocarcinomas of the endometrium and 1 adenoid basal cell carcinoma of the cervix. CONCLUSION: The high prevalence of cervical and endometrial neoplasia among women with the isolated finding of AGCUS on cervical cytologic smears warrants a thorough diagnostic evaluation.     

Detection of heterozygosity loss in microdissected fine needle aspiration specimens of breast carcinoma

OBJECTIVE: To use the polymerase chain reaction (PCR) to detect loss of heterozygosity (LOH) in microdissected cells form cytologic smears obtained by fine needle aspiration (FNA) from 20 cases of invasive breast carcinoma. STUDY DESIGN: In each case, histologic sections of the primary tumor were also available. Tumor and nontumor cells were dissected from both the cytologic smear and tissue section in all cases except in three smears that showed only tumor cells. RESULTS: LOH was identified in 10 of 19 informative cases using two polymorphic DNA markers at chromosome 11q13 (INT-2, PYGM). The same results were obtained in both the cytologic and histologic specimens, including three cases that had hypocellular cytologic smears. CONCLUSION: FNA of breast lesions provides adequate samples for direct microdissection of the cytologic smear to detect LOH using PCR amplification.     

Cytopathology of retrograde renal pelvis brush specimens: an analysis of 40 cases with emphasis on collecting duct carcinoma and low-intermediate grade transitional cell carcinoma

We report our experience with 40 retrograde renal brush samples of pelvic-calyceal lesions with confirmatory tissue studies. On-site cytopathologic evaluation was performed in 38 of these specimens. The final histologic diagnoses included 24 cases of transitional cell carcinoma (TCC), 17 of which were low-intermediate grade tumors. All 24 cases were diagnosed cytologically as TCC (22), or as suspicious for TCC (2). Three cases classified as collecting duct carcinomas were resected; the cytologic specimens in 2 of these cases were interpreted as TCC, and one as reactive change. There were three renal cell carcinomas (RCC); cytologically, one was considered a papillary neoplasm, one suspicious for malignancy, and one as reactive. Two cases of atypical renal cysts were reported as suspicious for malignancy in both cytologic and histologic material. There was one case of metastatic colon carcinoma identified in the brush specimen. Finally, tissue studies in the remaining 7 cases showed reactive/inflammatory changes; however, four of the corresponding pelvic brush specimens were considered abnormal. A review of the above cases is reported with the objective of presenting the cytologic features seen in collecting duct carcinoma, low-intermediate grade TCC, and diagnostically difficult cases with cyto/histomorphologic discrepancies. The contribution of on-site assessment to diagnostic accuracy is also discussed.     

Basal cell adenocarcinoma of the salivary gland. Diagnosis by fine-needle aspiration cytology

Basal cell adenocarcinoma of salivary gland is a relatively recently described neoplasm. Histopathologic features of these tumors have been published in the literature mainly in the form of case reports. This paper elaborates and describes the diagnostic fine-needle aspiration cytomorphology of two cases of basal cell adenocarcinoma of parotid gland, which, to the author's knowledge, has not been previously reported in the English literature. Fine-needle aspiration specimens in both cases contained cohesive, focally papillary, and filiform groups of neoplastic cells, which were highly reminiscent of basal cell adenoma on low power examination. Higher power, however, revealed significant cytologic atypia and mitotic activity. Differential diagnoses included basal cell adenoma, epithelial rich pleomorphic adenoma, myoepithelial lesions, small cell undifferentiated carcinoma, and metastatic carcinoma among others.     

Usefulness of transvaginal ultrasound and hysteroscopy in diagnosing endometrial hyperplasia and endometrial carcinoma

Modern methods enabling evaluation of endometrium in all phases of the menstrual cycle were presented. Transvaginal ultrasound does not give characteristic pictures. The most frequently observed sonographic features in endometrial hyperplasia and endometrial carcinoma were compared. Most frequently, in 29% we observed the thickening of the endometrium. The enlargement of the uterine body was detected in 27%. The dominant feature in endometrial carcinoma was distortion or lack of medium-focus echo-90%. Different echogenicity was observed in 69% of all cases. Application of hysteroscopy enables us to visualize changed endometrium and also to sample focal lesions for histopathological examination. Endometrial carcinoma was detected in all analyzed cases with application of hysteroscopy and ultrasound. Pathological endometrial hyperplasia was diagnosed by ultrasound only in 44% and with application of hysteroscopy in 84% of all material.     

Diagnostic conization of the uterine cervix. II. Comparison of histological diagnoses with cytological and colposcopic tentative diagnoses

This report presents colposcopic and cytologic misinterpretations in cases with a cervical intraepithelial neoplasia or early invasive carcinoma and benign cervical lesions and the accuracy of these two methods of screening for cervical cancer. The accuracy of the cytology and of the colposcopic impression in predicting the degree of cervical intraepithelial neoplasia and early invasive carcinoma was over 93 per cent. In patients showing benign cervical lesions the cytology is more accurate in predicting the correct histologic change with 94,2 per cent than the colposcopic impression with 63,1 per cent. The suspicious smears (Papanicolaou III) are discussed.     

p53 protein expression in benign and malignant breast lesions

OBJECTIVE: To investigate p53 protein expression in imprints from benign and ductal breast carcinoma cases in relation to the histologic grade of malignancy and clinical stage. STUDY DESIGN: The study group consisted of 60 cases of primary ductal breast carcinomas and 20 benign lesions. For the demonstration of p53 protein expression, an immunocytochemical avidin-extravidin complex technique was applied. Monoclonal antibody p53 was used as the primary antibody, diaminobenzidine as the chromogen and hematoxylin as the counterstain. RESULTS: Forty-five percent of breast cancer cases showed positive expression of p53. A statistically significant difference in p53 protein expression was observed between grade 1, 2 and 3 carcinomas and stage I, II and III cases. All benign lesions were negative for p53 protein expression. CONCLUSION: Immunocytochemical p53 protein expression in cytologic material is a simple method that can be applied in routine cytologic laboratories for the identification of genetic alterations in primary ductal breast cancer.     

Should children ever donate kidneys? Views of U.S. transplant centers

The retinoblastoma (RB) gene was the first defined tumor suppressor gene. While originally described in retinoblastoma, more recently alterations in RB have been described in a number of other human neoplasms and there has been a suggestion that alteration of RB may play a significant role in the development of endometrial carcinoma. We examined RB protein expression by immunohistochemistry in a series of cases including normal endometrium, endometrial hyperplasia, and endometrial carcinoma. A relatively homogeneous pattern of staining was observed in proliferative endometrium, while weak or absent reactivity was noted in secretory endometrium. A heterogeneous pattern of reactivity was observed in 10/10 cases of hyperplasia, 66/70 cases of endometrial adenocarcinoma, and 7/7 cases of uterine carcinosarcoma. An altered pattern of reactivity was observed in the remaining 4/70 cases of adenocarcinoma. All of the cases with altered reactivity were high grade neoplasms. We conclude that alteration of RB protein expression is uncommon in endometrial adenocarcinoma and when it does occur, it may represent a late event in carcinogenesis.