Role of Papinicolaou Smears in the Diagnosis of Premalignant and Malignant Lesions of the Cervix.

Cervical carcinoma is an important cause of morbidity and mortality among women worldwide and has been considered as one of the preventable cancers. Aim: To determine the prevalance of various lesions on cervical cytology and to study the clinicopathologic correlation of conventional Papanicoloau smears for the diagnosis of squamous intraepithelial lesion and invasive carcinoma using the Bethsda system for reporting cervical cytology. Material and method: The study included a retrospective reviewing of conventional cervical smears reported in the Department of pathology, Government medical College, Miraj over a period of six months from January 2012 to June 2012. Results: Epithelial cell abnormalities were found in 3% cases. Atypical squamous cells of undetermined significance (ASCUS) and atypical squamous cell- cannot exclude HSIL(ASC-H) was seen in 3(0.91%) cases each. Squamous intra-epithelial lesion was seen in 6(1.83%), out of which 2(0.61%) had low grade squamous intra-epithelial lesion(LSIL) exhibiting koilocytic atypia and 4(1.22%) had high grade squamous intra-epithelial lesion(HSIL). Invasive squamous cell carcinoma was seen in 4(1.22%) cases. The mean age of patients with LSIL was 43.4 years, and that with HSIL and invasive carcinoma was 53 years and 54 years, respectively. Conclusion: Cervical screening using Pap smear helps to detect premalignant and malignant cervical lesions at an early stage.

Histopathological Study of Ovarian Tumors.

The ovarian tumors show wide variation in the clinical and morphological features. The incidence also varies in different parts of the world. This is a histopathological study of 100 ovarian tumors over a period of 5 years in our institute. The ovarian tumors were classified according to WHO Classification. The aim of this work was to study the incidence and gross and microscopic features of different benign and malignant ovarian tumors. Benign tumors were more common than malignant tumors. Among benign tumors serous cystadenoma (41.89%) was the most common followed by mucinous cystadenoma (29.72%) and mature cystic teratoma (16.21%). Among malignant ovarian tumors, the most common type was serous cystadenocarcinoma (38.46%) followed by dysgerminoma (11.53%) and clear cell carcinoma (11.53%). Majority of the ovarian tumors were surface epithelial tumors (77%) followed by germ cell tumors (16%) and sex cord stromal tumors (6%).

Cytological Study of Effusions.

Background: Effusion fluid analysis plays an important role in clinical medicine. Clinicians rely on the reports of effusion fluids and use them as complement to their clinical assessment for the diagnosis and management. Aim: To study the incidence of neoplastic and non neoplastic effusions. Objectives: i) To study the gross and microscopic features of effusions; ii) To study the pattern of effusions in various neoplastic and non neoplastic conditions. Material and Method: 550 specimens of pleural, peritoneal and pericardial fluid were studied. Fluid samples were centrifuged for five minutes at 2000 rpm and smears prepared from deposit were stained by Haematoxylin and Eosin (H and E), Giemsa and Papanicolaou stains (Pap). Result: Out of 550, 315 were pleural effusions, 234 peritoneal and one was pericardial. Out of total 315 cases of pleural effusions, 297 were non neoplastic and 18 were neoplastic effusion. Out of total 234 peritoneal effusions 214 were non neoplastic and 20 neoplatic. Commonest malignancy in pleural and peritoneal fluid was adenocarcinoma. Conclusion: Pleural effusion was the commonest fluid in this study. Exudates were predominant in pleural effusion and transudates were predominant in peritoneal effusion. Common causes of exudates in pleural effusion were tuberculosis (TB), pneumonia and malignancy. Common causes of transudates in peritoneal effusion were liver cirrhosis and congestive cardiac failure (CCF). Adenocarcinoma was the commonest malignancy in both pleural and peritoneal effusion (30 cases).

Interobserver reproducibility of Gleason grading of prostatic adenocarcinoma among general pathologists.

Context: Gleason grade is the most widely used grading system for prostatic carcinoma and is recommended by World Health Organization. It is essential that there should be good interobserver reproducibility of this grading system as it has important implications in patient management. Aim: To assess interobserver reproducibility of Gleason grading of prostatic adenocarcinoma. Design: A total of 20 cases of prostatic adenocarcinoma were scored using Gleason grade by 21 general pathologists. The scores were then compared using κ-coefficient and consensus score. Results: For Gleason score groups (2-4, 5-6, 7 and 8-10) overall agreement with consensus score was 68%. Exact agreement for Gleason scores with consensus score was 43.3% and 92.3% within ±1 of the consensus score. κ coefficient for primary grade ranged from -0.32 to 0.92 with 60% of the readings in fair to moderate agreement range; and for secondary grade κ ranged from -0.30 to 0.62 with 78% of the readings in slight to fair agreement range. Kappa for Gleason scores ranged from -0.13 to 0.55 with 80% of the readings in slight to fair agreement range; and for Gleason score groups κ ranged from -0.11 to 0.82 with 68.5% of the readings in fair to moderate agreement range. Conclusions: In our study interobserver reproducibility of Gleason scores among general pathologists was at lower level and it highlights the need to improve the observer reproducibility by continuous educational sessions and taking second opinion in cases where grade could significantly influence management.

Superficial extension of squamous cell carcinoma in situ of cervix involving endometrium, bilateral fallopian tubes and ovaries: a case report.

Although squamous cell carcinoma of the cervix is the commonest gynaecological malignancy in India, squamous cell carcinoma of the endometrium is rare. Direct extension from the cervical growth can involve the uterine corpus but superficial spread without invasion of the underlying myometrium is uncommon. We report a case of squamous cell carcinoma in-situ of the cervix with superficial extension to the endometrium and both fallopian tubes with simultaneous involvement of both the ovaries.

Stromal luteoma: report of a rare case.

Steroid cell tumours (SCTs) account for less than 0.1% of all ovarian tumours. Three major categories ofSCTs include (1) stromal luteoma, (2) steroid cell tumour not otherwise specified and (3) Leydig cell tumours that do not have another component. Stromal luteomas constitute 20% of SCTs. They usually occur in postmenopausal women and about 60% present with estrogenic manifestations. We report a case of stromal luteoma in an elderly lady who presented with postmenopausal bleeding secondary to endometrial hyperplasia. An interesting finding in our case was the presence of many eosinophilic hyaline globules scattered throughout the tumour, the significance of which remains to be determined.