Manual Liquid-Based Cytology: A Clinical Pilot Study of the VitroPrep™ Cytology Processing Kit.

OBJECTIVE: It was the aim of this study to assess the utility of the manual liquid-based cytology (LBC) product VitroPrep™ Cytology Processing Kit (ChemQ Bioscience LLC, Research Triangle Park, N.C., USA). STUDY DESIGN: This is a descriptive pilot study. Women underwent cervical sampling processed by the ThinPrep™ automated LBC system followed by cervical sampling for the VitroPrep manual system. The following criteria were assessed on a scale of 1-5 (1 = unsatisfactory, 2 = borderline, 3 = acceptable, 4 = good, 5 = excellent): monolayer cell adhesion, overall cellularity, background clarity, preservation of cellular morphology, red cell lysis, and elimination of mucus/debris. Cytological diagnosis was compared to results from ThinPrep samples. In addition, VitroPrep samples were taken prior to conization procedures and compared to pathology results. Descriptive statistics were performed. RESULTS: Forty-two of 47 women who underwent dual cytologic sampling had satisfactory samples. All scores were 3-5, with >90% graded 4-5. The VitroPrep diagnosis correlated with the ThinPrep diagnosis in 90% (38/42) of cases. All specimens obtained from 15 women prior to conization were satisfactory and correlated abnormal cytologic findings with cervical intraepithelial neoplasia 1-3 pathology. CONCLUSIONS: The VitroPrep Cytology Processing Kit was able to provide adequate specimens for evaluation and diagnosis. This low-cost processing kit may provide a useful alternative in settings where automated LBC systems may not be feasible.

Bilateral syringomatous adenomas of the nipple: Case report with immunohistochemical characterization of a rare tumor mimicking malignancy.

OBJECTIVES: Syringomatous adenoma of the nipple (SAN) is a rare benign infiltrative neoplasm that may be confused with low-grade breast carcinomas. We report the case of 71-year-old woman with a fungating left breast mass and subareolar calcifications in the contralateral breast. METHODS: Histomorphologic features were evaluated with standard H&E-stained sections. Both lesions were also evaluated by immunohistochemistry for further characterization. A literature review was performed to place the current case in context relative to previous observations. RESULTS: Both lesions were infiltrating syringomatous adenomas, confirmed by detailed immunohistochemical analyses, which also provided new evidence for the putative sweat duct origin for these tumors. The debated presence of myoepithelial cells in these lesions was newly and convincingly supported in this study by strong diffuse immunostaining of the outer cell layer of the tubules for smooth muscle myosin, cytokeratin 34ßE12, cytokeratin 5/6, and p63. Previous reports describing similar detailed immunophenotypical characterization of these uncommon tumors are lacking. CONCLUSIONS: To our knowledge, this case represents only the second reported patient with bilateral SAN and the first such case to be reported in the pathology literature.

Topical 5-fluorouracil for treatment of cervical intraepithelial neoplasia 2: a randomized controlled trial.

OBJECTIVE: The objective of the study was to evaluate the efficacy of intravaginal application of 5% 5-fluorouracil (5-FU) for the treatment of cervical intraepithelial neoplasia (CIN) 2 in women. STUDY DESIGN: Women aged 18-29 years with CIN 2 were recruited for this randomized controlled trial of observation vs treatment with intravaginal 5-FU. Women in the observation group returned in 6 months for a Papanicolaou smear, colposcopy, and a human papillomavirus (HPV) deoxyribonucleic acid test. Women in the 5-FU group were treated with intravaginal 5-FU once every 2 weeks for a total of 16 weeks and were similarly evaluated at 6 months. All women who had a baseline visit were included in the intention-to-treat analysis. Values of P < .05 were considered statistically significant. RESULTS: Between August 2010 and June 2013, 60 women were randomized and had a baseline visit for intervention (n = 31) vs observation (n = 29). Of women who had cervical biopsy results at 6 months, regression of disease was demonstrated in 93% of women in the 5-FU group (26 of 28) and 56% of women in the observation group (15 of 27). Under the intention-to-treat analysis, a relative risk for cervical disease regression of 1.62 (95% confidence interval [CI], 1.10-2.56) was found between the 5-FU and observation arms (P = .01). When the cervical biopsy, Papanicolaou smear, and HPV results were combined for the 6 month follow-up visit, 50% of the 5-FU group (14 of 28) had a documented normal biopsy, normal Papanicolaou smear, and negative HPV test compared with 22% in the observation group (6 of 27) (relative risk, 2.25; 95% confidence interval, 1.05-5.09; P < .05). There were no moderate or severe side effects in the intervention group. CONCLUSION: Topical 5-FU appears to be an effective medical therapy for CIN 2 in young women. 5-FU is readily available and may be considered as an off-label treatment option for young women with CIN 2 who are interested in the treatment of disease but want to avoid excisional procedures.

Outcomes after management of young women with cervical intraepithelial neoplasia 2 with a 6-month observation protocol.

OBJECTIVE: Recommendations regarding treatment of cervical intraepithelial neoplasia (CIN) 2 in women have evolved over the years: young women with CIN 2 may be offered observation with Pap smears and colposcopy every 6 months instead of immediate excision or ablation of disease. The purpose of this study was to observe patient follow-up during the initiation of this management protocol for young women with CIN 2. MATERIALS AND METHODS: This was a retrospective review of clinical outcomes of women younger than 30 years with CIN 2 on index biopsy and planned follow-up at UNC between July 2009 and August 2010. A chart review for clinical variables, follow-up visits, and progression of disease was conducted. Primary analysis determined the rate of follow-up and pathology at 6 months. Secondary analysis investigated risk factors for incomplete follow-up. RESULTS: Seventy women met inclusion criteria; 46 were managed with observation. Twenty-eight (60.8%; 28/46) women completed a follow-up visit. Demographic and clinical variables did not reach statistical significance in predicting the likelihood of completion of a follow-up visit, although there was a trend toward greater follow-up in employed patients (odds ratio = 5.25, 95% confidence interval = 0.84-34.78). Approximately half (52.4%; 11/21) of women with a completed cervical biopsy demonstrated regression of disease during the study period. CONCLUSIONS: On the basis of these data, follow-up in this population was unpredictable based on basic demographic or clinical factors that we often use to judge likelihood of compliance with medical recommendations. The percentage of patients with regression at follow-up was as expected from the natural history of CIN 2.

Clear cell chondrosarcoma: Cytologic findings in six cases.

Clear cell chondrosarcoma (CCCS) is a rare variant of chondrosarcoma characterized, in most instances, by indolent behavior and a long interval to progression of disease. CCCS commonly occurs in adult individuals and has a proclivity for the epiphysis of long bones, although it has been reported in other sites. This lesion is difficult to diagnose preoperatively. Factors contributing to difficulty in recognizing this lesion include its relative scarcity as well as its tendency to be confused with other lesions on imaging studies. In the following, we report six cases of CCCS initially diagnosed by fine needle aspiration and/or touch preparations of needle biopsy samples. The cytologic features identified include large, plasmacytoid cells with foamy cytoplasm as well as extracellular chondroid type matrix material. Definitive diagnosis was made in each case by recognizing the "clear cell" nature of the tumor on cell block material.