Screening history in women with cervical cancer in a Danish population-based screening program.

OBJECTIVE: The aim of this study was to explore the screening histories of all cervical cancers in a Danish screening population. The intention was to decide suboptimal sides of the screening program and to evaluate the significance of routine screening in the development of cervical cancer. METHODS: The study describes the results of a quality control audit, performed on all new cervical cancer cases diagnosed in the years 2008-2009 at two major Danish screening-centers. All relevant cytological and histological cervical samples were reviewed. RESULTS: 202.534 cytological samples were evaluated in the study period, while 112 women were diagnosed with cervical cancer. The histological diagnoses comprised: 62 (55.4%) squamous cell carcinomas, 20 (17.9%) microinvasive squamous cell carcinomas, 25 (22.3%) adenocarcinomas and 5 cancers of different histology. The mean age of study subjects was 46.6 years. 51 (45.5%) women had deficient screening histories, while 45 (40.2%) women had followed the screening recommendations and had normal cervical samples in review. 11 (9.8%) women were diagnosed with false negative cytology, 2 women had false negative histological tests, while pathological review was not feasible for 3 subjects. CONCLUSIONS: More than 45% of the cervical cancer cases in our study were due to deficient cervical screening, stressing the importance of increasing the screening-uptake and coverage. 40% interval cancers emphasize the relevance of further cervical testing of women with relevant symptoms, despite of prior normal cervical samples. Finally, 9.8% false negative cytological samples are consistent with previous reports, but still a part of the screening program that should be improved.

Partial necrosis of cervix uteri as a complication to HELLP-syndrome.

BACKGROUND: The HELLP-syndrome is a rare complication to pregnancy and a potential fatal condition. CASE: We report such a case in a 32-year-old para 2, gravida 1 woman with no known risk factors. A lower transverse uterotomy was performed at 29 weeks and 6 days' gestation based on an indication of HELLP-syndrome. Uncharacteristically lower back pain developed on the second day postoperatively and a gynaecological examination was performed. A partial necrotic cervix uteri was found with many trombosed vessels and necrotic tissue. CONCLUSION: Partial necrosis of cervix uteri can be seen as a complication to the HELLP-syndrome.

[Testicular microlithiasis--are biopsy and follow-up necessary?]. / Testikulaer mikrolithiasis--er biopsi og opfølgning nødvendig?

INTRODUCTION: Improvement in the technology of ultrasound has made it possible to visualise small calcifications in the testes, known in the literature as testicular microlithiasis (TM). TM is described in otherwise healthy men, but is also found related to cancer and CIS. Here we will discuss the evaluation and follow up of patients with diagnosed TM. MATERIAL AND METHODS: The study comprises 14 patients in whom TM was diagnosed sonographically in the period from December 1997 to May 2000. RESULTS: Ultrasound indicated cancer in two patients. Pathology showed germ cell cancer in both. In 12 patients, ultrasound showed only TM, no suspicion of cancer. Biopsies taken in eight of these patients were all benign. DISCUSSION: The prevalence of TM is still unknown, as is its aetiology. TM is somehow correlated to testicular cancer, as microliths are found much more often in testes with cancer than in those without malignancy. However, in the vast majority of patients, evidence of cancer or CIS cannot be found. Development of cancer in patients formerly diagnosed with TM is rarely described. In the case of TM and no sonographic signs of cancer, we therefore believe biopsies can be limited to patients at increased risk of testicular cancer, for instance those with retained or small atrophic testes, and also possibly to patients known to have developed TM between repeated ultrasound examinations. If a biopsy shows no signs of malignancy or CIS, we see no need for follow up. If biopsy is not indicated, we recommend a clinical check up, followed by further investigations if these are indicated.