OBJECTIVE:It was our aim to assess the usefulness of cytohistology in cervical thin layer brush samples with problems in the differential diagnosis of endometrial cells.STUDY DESIGN:This study reveals the cytological, cytohistological and immunohistochemistry findings of 8 cases suspicious of adenocarcinoma in situ (AIS)/adenocarcinoma (AC) in cervical liquid-based cytology (LBC) preparations that turned out to be normal endometrial cells.RESULTS:All 8 cervical LBCs featured endometrial and atypical endocervical-like columnar cells with frequent ragged 'feathered' edge appearance and rosette formations. Overlapping atypical glandular cell groups were present on 2 ThinPrep slides as well. In cytohistology of 7 cases, the recognition of endometrial stroma with endometrial glands easily allowed the diagnosis of normal endometrium. In 1 case with very small loose tissue fragments without glands, the diagnosis could be established by positivity for CD10 marker (endometrial stroma) and without proliferative activity in the Ki-67 immunostaining.CONCLUSION:In cervical LBC preparations, nuclear hyperchromasia, pleomorphism and nucleoli in normal endometrial cells are more obvious than in conventional smears, and their arrangement is sometimes suggestive of AIS or AC. In the 8 cases presented, we could avoid a false-positive diagnosis of AIS or AC through cytohistology/immunohistochemistry, and in consequence, unnecessary colposcopical/histological examination.

E. K. J. Risse, J. P. Holierhoek, E. M. Meijer‐Marres, E. Ouwerkerk‐Noordam and M. E. Boon

The records of 28 patients who underwent free jejunal graft reconstruction after resection for cancer involving the pharynx were analysed. Seven patients had a T3 carcinoma, 15 patients T4 and six patients recurrence after laryngectomy. Ten patients had received radiotherapy in the past. Post-operatively, 15 patients (54%) had complications and two patients (7%) died. No significant difference was observed in the complication rate between the group that received radiotherapy in the past and those who did not. Nineteen patients received post-operative radiotherapy. Nine patients had no radiotherapy on the basis of complete resection or because of serious complications. For the whole group the 2-year recurrence free period and survival were 42% and 51% respectively. The post-operative radiotherapy group had a significantly better survival (73%) and recurrence free period (63%) than the group without post-operative radiotherapy (0%). Thus, post-operative radiotherapy seems indicated irrespective of resection margins.

The prevalence of human papillomavirus (HPV) genotypes in relation to age was investigated by the polymerase chain reaction (PCR) method in cytologically normal smears from 4 different groups of women. Group A consisted of young women from a district population, aged 15-34 years, using oral contraceptives and visiting general practitioners for a check-up (n = 156); group B were asymptomatic women, aged 35-55, in a district population participating in a triennial screening program for cervical cancer (n = 1555); group C and D consisted of women, seen at the gynecological outpatient department for a wide spectrum of gynecological complaints or for control of their hormonal contraception, aged 15-34 years (n = 2320), and aged 35-55 years (n = 1826) respectively. An HPV (all types) prevalence of 14.1%, 4.1%, 13.9% and 6.6% and an HPV 16/18 prevalence of 3.8%, 0.9%, 3.3% and 1.5% were found in groups A, B, C and D respectively. Statistically significant differences (p value < 0.001) in HPV prevalence were found between women aged 15-34 years and women aged 35-55 years in the district population and in the hospital population. No statistically significant differences in HPV 16/18 were observed after age-matching between women in corresponding age-classes of both populations. In a 5-year interval analysis a strong age-dependent relationship was demonstrated, with a maximum between 20 and 24 years. After the age of 35 a constant level of 1-2% HPV 16/18 was observed. These results indicate that genital HPV infections are age-dependent and suggest that HPV infections at young age can be transient. The implications of these findings in the context of cervical cancer screening are discussed.

A study was set up to investigate correlations between different light microscopic grades and morphometric features in cytological breast cancer specimens and to evaluate the discriminative power of morphometry for the three grades. 76 slides (smears and imprints) were graded independently in two different laboratories, and the 54 unequivocally graded slides were used as a training set for computing classification rules. In all slides, 100 nuclei and their nucleoli were measured on a graphic tablet at a final magnification of 2800x. A total of 43 morphometric features was evaluated. Univariate analysis showed significantly different values for most of the morphometric features for the three grades. Discriminant analysis revealed that a combination of the mean nuclear area and the number of mitoses per slide provided optimal discrimination between grades one and two (87.5% correct classification). One more feature (mean nuclear shape factor) was needed to obtain optimal discrimination between grades two and three (83.3% correct classifications). 16 of the 22 (72.7%) equivocally graded slides could be classified with high probability using these classification rules. We conclude that morphometry has discriminative power for the three grades in cytologic breast cancer specimens and may therefore be a useful instrument for classification of difficult cases.

In patients with a malignant lung process (146 patients with primary lung cancer and 21 patients with a metastatic lung malignancy), the quality and the percentage of true-positive diagnoses of sputum produced directly after bronchoscopy were evaluated. The quality of prebronchoscopic and postbronchoscopic sputum samples differed significantly, the former being of better quality for cytologic diagnosis. When calculated for the whole group, the quality of postbronchoscopy sputum was not related to any specific anamnestic or clinical patient data. Overall, there was no statistically significant difference between the percentages of true-positive diagnoses in prebronchoscopic and postbronchoscopic sputum specimens. However, the percentage of true-positive diagnoses was significantly higher in postbronchoscopic sputum in comparison with the results of sputum cytology prior to bronchoscopy when the results were calculated separately for patients with low forced expiratory volume values (less than 50% of the vital capacity) or for patients without a history of previous sputum production. In patients who produced bloody sputum, the percentage of true-positive diagnoses in prebronchoscopic sputum was significantly higher than in postbronchoscopic sputum.

In patients with a malignant lung process (146 patients with primary lung cancer and 21 patients with a metastatic lung malignancy), the quality and the percentage of true-positive diagnoses of sputum produced directly after bronchoscopy were evaluated. The quality of prebronchoscopic and postbronchoscopic sputum samples differed significantly, the former being of better quality for cytologic diagnosis. When calculated for the whole group, the quality of postbronchoscopy sputum was not related to any specific anamnestic or clinical patient data. Overall, there was no statistically significant difference between the percentages of true-positive diagnoses in prebronchoscopic and postbronchoscopic sputum specimens. However, the percentage of true-positive diagnoses was significantly higher in postbronchoscopic sputum in comparison with the results of sputum cytology prior to bronchoscopy when the results were calculated separately for patients with low forced expiratory volume values (less than 50% of the vital capacity) or for patients without a history of previous sputum production. In patients who produced bloody sputum, the percentage of true-positive diagnoses in prebronchoscopic sputum was significantly higher than in postbronchoscopic sputum.