Characteristic findings of cervical Papanicolaou tests from transgender patients on androgen therapy: Challenges in detecting dysplasia.

INTRODUCTION: The characteristic features of Papanicolaou (Pap) tests collected from female-to-male (FTM) transgender patients on androgen therapy have not been well defined in the literature. FTM transgender patients require cervical cancer screening with the same recommended frequency as cis-gender females. Dysplasia remains challenging to differentiate from atrophy. Without pertinent history, the atrophic findings in younger transgender patients can be misinterpreted as high-grade dysplasia. METHODS: A review of all cervical Pap tests of transgender patients receiving androgen therapy (2010-2017) was performed. Bethesda diagnosis, cytomorphological features, HPV testing and cervical biopsy results were reviewed. RESULTS: Eleven transgender patients receiving androgen therapy were identified with 23 cervical Pap tests, 11 HPV tests and five cervical biopsies performed. A review of the Pap tests demonstrated: 57% negative for intraepithelial lesion; 13% unsatisfactory; 13% atypical squamous cells of undetermined significance; 13% atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion; and 4% high-grade squamous intraepithelial lesion. The rates of abnormal tests were higher than our age-matched cis-gender atrophic cohort rates of unsatisfactory (0.5%), atypical squamous cells of undetermined significance (7%), atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (0%) and high-grade squamous intraepithelial lesion (0.5%). The cytological findings from liquid-based preparations included dispersed and clustered parabasal-type cells, scattered degenerated cells, smooth evenly dispersed chromatin, and occasional mild nuclear enlargement and irregularity. Dysplastic cells had larger nuclei, hyperchromatic clumped chromatin, and more irregular nuclear contours. CONCLUSIONS: The evaluation of dysplasia can be challenging on Pap tests from transgender patients on androgen therapy. The cohort evaluated had higher rates of unsatisfactory and abnormal Pap tests. Pathologists should be familiar with the distinctive cytomorphological changes in the Pap tests from patients on androgen therapy to evaluate them appropriately.

Association of HLA-DQA1*0501 with Graves' disease in English Caucasian men and women.

OBJECTIVE: A recent report has demonstrated a stronger association between the HLA-DQA1*0501 allele and Graves' disease in Caucasian men than in women. Our aim was to confirm this association in a larger series of male Caucasian patients. DESIGN: Polymerase chain reaction/sequence specific oligonucleotide probing (PCR/SSOP). PATIENTS: Fifty men and 70 women with Graves' disease were studied as well as a control group consisting of 57 healthy, unrelated men and women. METHODS: Genomic DNA was derived from venous blood samples. Appropriately primed DNA was amplified by PCR and the products were subjected to SSOP. The presence of the allele was demonstrated by enhanced chemiluminescence. RESULTS: A significant association between HLA-DQA1*0501 and Graves' disease was demonstrated among both the men and women as well as in the combined disease cohort, with HLA-DQA1*0501 conferring a greater relative risk than HLA-DR3 in all three groups. This association persisted when the results from the DR3-negative Graves' patients were analysed in isolation. HLA-DQA1*0501 was heterogeneously distributed between the sexes with significantly more female Graves' patients carrying this allele. CONCLUSIONS: There is a significant association between HLA-DQA1*0501 and Graves' disease which may be unrelated to the inheritance of this allele on an extended haplotype with HLA-DR3. In contrast to a recent report, HLA-DQA1*0501 was significantly more prevalent among women with Graves' disease than men.