Fine needle aspiration cytology and immunocytochemistry of metastatic melanoma.

The cytological and immunological findings of 81 metastatic melanomas are described. Fine needle aspiration was performed from secondary deposits in lymph nodes (38), subcutaneous and soft tissue (36), abdomen (5), lung (1) from 67 patients with histologically verified malignant melanoma. One patient had disease which had spread into the cerebrospinal fluid. Cytomorphologically the cases were classified as classical (47%), carcinoma-like (22%), spindle cell type (14%), lymphoma like (6%), undifferentiated (6%), myxoid type (3%), and clear cell type (2%). All cases were immunologically characterized using antibodies to S-100, vimentin and cytokeratin. All cases were S-100 positive and the majority (96%) reacted with antibodies to vimentin. A weak heterogenous reactivity to cytokeratin antibody was detected in only eight cases. The HMB45 antibody was applied to 20 cases and 16 (80%) of these tumours were positive. In summary, we found that an immunological characterization was necessary to conclusively diagnose over 50% of metastatic melanomas which presented with an equivocal cytological picture.

Fine needle aspiration cytology and immunocytochemistry of large cell lymphomas expressing the Ki-1 antigen.

Cytomorphology and immunocytochemistry were used to diagnose two cases of large cell anaplastic lymphomas that expressed the Ki-1 antigen. Smears stained with the May-Grünwald-Giemsa stain showed a cytomorphologic spectrum that varied from immunoblastlike cells to large tumor cells with pleomorphic nuclei. The tumor cells had a distinct basophilic cytoplasm, which often contained vacuoles. Giant cells with wreathlike multilobulated bizarre nuclei were also observed. Immunocytochemistry on a cytocentrifuged specimen showed that the tumor cells were of a T-helper phenotype; all strongly expressed the Ki-1 antigen and receptors for HLA-DR and IL-2.

Behavior of mild cervical dysplasia during long-term follow-up.

Five hundred and fifty-five women with cervical cytologically diagnosed mild cervical dysplasia were followed by cytology without major treatment. Biopsies were performed in 14% resulting in no significant influence on the outcome of the studied material. Regression to normal occurred in 62% (follow-up 39 months), progression to severe dysplasia/carcinoma in situ/invasive carcinoma in 16% (invasive carcinoma: two patients), and persistence of dysplasia in 22%. Life table analysis calculated the risk of progression of mild dysplasia to be 250 to 800/100,000 women/year. A comparison with the incidence of carcinoma in situ, four of 100,000 women/year, illustrates the yearly risk for a woman with mild dysplasia as 560 times greater than for a woman without cervical dysplasia to develop severe dysplasia/carcinoma in situ/invasive carcinoma.

Diaphanography in benign breast disorders. Correlation with clinical examination, mammography, cytology and histology.

Histologically classified benign breast disorder was present in 163 breast of 158 symptomatic women. The results of diaphanography (DPG) were correlated with those obtained by clinical examination (CE), mammography (M) and cytology (C). A tumour was palpable in 108 cases (66.3%). A false positive diagnosis, i.e. possibly malignant, probably malignant or malignant was made in 15 cases (9.2%) with DPG, and in 33 cases (20.2%) with M. Use of both M and DPG reduced the number of false positives to 1.8 per cent. In 8 cases (4.9%) false positive diagnosis was made with C. During a mean observation time of 58.5 months (range 44-72 months, one case of breast carcinoma was diagnosed.

Diaphanography in breast carcinoma. Correlation with clinical examination, mammography, cytology and histology.

Histologically classified carcinoma was present in 110 breasts of 108 symptomatic women. The results of diaphanography (DPG) were correlated with those obtained by clinical examination (CE), mammography (M) and cytology (C). A tumour was palpable in 87 cases (79.1%). A false negative diagnosis was made in 17 cases (15.5%) using DPG, in 13 cases (11.8%) using M and in 15 cases (13.6%) using C, but in 12 of the latter cases (10.9%) the specimen was not representative. The validity of the findings using DPG and M was also analysed. The calculations were based on the results obtained from the present investigation and from a study of diaphanography in 163 cases of benign breast disorders. For DPG the sensitivity was 85 per cent, the specificity 91 per cent, the positive predictive value 86 per cent and the negative predictive value 90 per cent. For M the sensitivity was 86 per cent, the specificity 80 per cent, the positive predictive value 75 per cent and the negative predictive value 91 per cent. The specificity for diaphanography was significantly different from mammography (p less than 0.05). The use of both M and DPG reduced the number of false negatives from 11.8 per cent to 5.5 per cent. In conclusion, DPG has been demonstrated to be a useful adjunct to CE and M.

Cytomorphologic and cytochemical analysis in the differential diagnosis of cervical epithelial lesions.

There is an increasing tendency to eradicate all cytologically diagnosed cervical epithelial lesions. A considerable number of the milder atypias are, however, known to originate from benign reactive cell populations. In nine women with initial mild or moderate dysplasia who had been followed by cytologic controls for 5 to 15 years, DNA analysis was retrospectively performed in characteristic smears from the follow-up. Progression to carcinoma in situ in six patients was invariably accompanied by a sequence of increasing DNA pattern deviations. In three patients with cervicitis as the final diagnosis, DNA patterns were constantly within normal limits. Although DNA analysis cannot conclusively determine whether a cell population is truly neoplastic, the method can establish the DNA pattern in a cell population as within normal limits or as clearly deviating from normal. A combination of cytomorphologic and cytophotometric diagnostic methods is suggested as a means to improve the differential diagnosis in cervical lesions between cell populations representing true dysplasias, i.e., premalignant lesions, and those resulting from reactive lesions and thus to avoid unnecessary overtreatment of nonneoplastic cervical abnormalities.

Behavior of moderate cervical dysplasia during long-term follow-up.

Eight hundred ninety-four women with cytologically diagnosed moderate cervical dysplasia were followed by cytology without major treatment. The results were regression in 54% (follow-up 78 months), progression in 30%, and persistence in 16%. Biopsies were performed in 54%. Results in patients without biopsies were regression in 50%, progression in 35%, and persistence in 15%, implying a statistically significant difference between biopsied and nonbiopsied lesions. Fewer lesions progressed in patients age 51 or older than in younger patients, the progression time also being significantly longer. The cytology periodically returned to normal for more than 12 months in 3.8% of patients with persisting moderate dysplasia. Life table analysis indicated the risk of progression of moderate dysplasia to be 5 to 9/100 women/year. A comparison with the incidence of carcinoma in situ, 4/100,000 women/year, illustrates the yearly progression risk for a cervix with moderate dysplasia as 2000 times greater than for a woman without cervical dysplasia.

Surgical treatment of post abortum endometriosis of the bladder and postoperative bladder function.

During the years 1953-1967, 17 women with endometriosis of the urinary bladder were treated with extirpation of the endometrial tissue, including partial or total resection of the trigone. In all cases the endometriosis had followed vaginal hysterotomy for legal abortion. Urethrocystoscopy was performed and the residual urine and bladder capacity were measured in all the patients one month and one year after the bladder operation. At follow-up in 1978 only 4 of the 17 women were available for urodynamic studies. Combined urethrocystometry, recording of the urethral pressure profile and measurement of the maximal urethral pressure in supine and standing positions were performed in these four patients, using the technique of Ulmsten et al. In all cases in the series, including those with trigone extirpation, all the tested parameters were normal. The writers therefore conclude that even total trigone resection can be done without disturbance to the bladder function.

Retrospective DNA analyses in cervical dysplasia as related to neoplastic progression or regression.

Intracellular DNA distribution was measured in cells from two groups of patients with moderate cervical dysplasia. One group consisted of patients who subsequently developed carcinoma in situ; the other consisted of patients whose lesions regressed to normality. Papanicolaou-stained slides were examined cytologically, and dysplastic cells were located. The slides were then destained and restained by means of the Feulgen DNA staining method, after which they were analyzed in a microspectrophotometer. The DNA distribution pattern of both groups was different from that of normal cells and exhibited the same characteristics observed earlier in premalignant cervical cellular atypias. There was no significant difference between the two groups. The results indicate that quantitative DNA determinations in cytomorphologically equivalent dysplastic cervical cells do not offer additional means of predicting the outcome of the lesions.

Follow-up studies in dysplasia and cancer in situ of the cervix uteri.

In order to study when recurrences appear following conization for dysplasia or cancer in situ of the cervix uteri, a series of 477 patients has been investigated. They all underwent conization at Sabbatsberg 1965-1970. Among the 181 cases of dysplasia two developed recurrences one respectively three years after treatment. In the series of 296 patients with cancer in situ thirteen recurrences appeared. Eight of them were detected within the first three years. The other five were spread out during the next four years. About 50% of all patients had been followed-up for five years or more (Table I). The conclusion is reached that a yearly follow-up is necessary for at least ten years. As it is impossible to take care of such an accumulating number of examinations at the Swedish departments of obstetrics and gynecology without extra personnel, the following proposal is made. During the first three years after treatment the examinations are performed at the department where the conization has been performed. After that period the follow-up is limited to vaginal smears taken once every year in connection with the general gynecologic health control.

The unique cytologic picture of oat cell carcinoma in effusions.

Characteristic and unique patterns of the tumor cell population in pleural effusions in oat cell carcinoma have been described in detail. This pattern is constituted by rows of tumor cells or cell layers forming "vertebrae like" figures and "onion like" formations. A distinct pattern of this kind was only found in oat cell carcinoma. A distinct "oat cell carcinoma pattern" was also found in one quarter of the patients in a series of oat cell cancer with cytologic analysis of sputum. This fact may be of importance for the accurate typing of small cell undifferentiated cancer in sputum and bronchial secretions. Identical formations were also found in a histologic series of oat cell cancer. The study indicates that in small cell carcinoma of the lung it is possible by cytologic analysis of positive effusions not only to make a diagnosis of carcinoma, but also to confirm the histologic type and, thus, the origin of the tumor.