Glassy cell carcinoma of the uterine cervix.

Eighteen cases of glassy cell carcinoma of the uterine cervix are presented. Glassy cell carcinoma is an uncommon, aggressive type of adenosquamous carcinoma of the uterine cervix, which is considered to originate from the subcylindrical reserve cells of the cervix. The patients with this tumor are younger than those with other types of invasive carcinoma of the uterine cervix, and all but three in this study were 34 years or younger. The tumors were frequently large, endophytic and growing rapidly. Metastases were found on presentation in two cases. The larger tumors did not respond well to treatment. Seven of the patients died within 20 month of diagnosis. Histologically glassy cell carcinoma is composed of nests of large cells with ground glass cytoplasm and large vesicular nuclei with prominent nucleoli. There is marked cellular and nuclear pleomorphism and tumor giant cells are frequently seen. Mitotic activity is brisk. Infiltration by eosinophils and plasma cells with admixture of lymphocytes is a characteristic feature. Focal squamous or glandular differentiation may be seen. Ultrastructural studies showed a wide spectrum of appearances. These findings lend further support to the view that glassy cell carcinoma is a distinctive type of poorly differentiated adenosquamous carcinoma of the uterine cervix.

DNA ploidy profiles as prognostic indicators in CIN lesions.

The prognostic significance of DNA ploidy measurements in cervical tissues was examined. Microphotometric measurements of 302 Feulgen-stained tissue sections (91 normal squamous epithelia, 14 condylomata, 29 cervical intraepithelial neoplasia (CIN) I, 78 CIN II, and 90 CIN III) were performed with a personal computer (PC)-based video microphotometry system. Analysis of these data shows that the DNA profile provides significant prognostic information: CINs with a polyploid DNA profile are more likely to return to normal than are those exhibiting an aneuploid pattern. Of 211 abnormal cases, 38% had polyploid DNA profiles and 62% were aneuploid. Eight-six percent of the cases that regressed were polyploid and 14% were aneuploid. Of the 130 aneuploid DNA cases, 95% remained static or progressed and only 5% regressed. Of these nonregressing aneuploid lesions, 90 remained static and 34 progressed, whereas within the nonregressing polyploid group 37 remained static and only 6 progressed. This result holds across diagnostic categories. Several other ploidy-related descriptors also showed prognostic significance (including mean ploidy, the 5N exceeding rate and 2N deviation index, and discriminant functions derived from order statistic analysis of the cumulative DNA histograms), but not to the degree or with the consistency of expression as the DNA profile categorization. These results indicate that important information about the prognosis of CIN lesions may be obtained by the DNA profile on Feulgen-stained tissue specimens. The data were acquired by a cytophotometry system of relatively modest cost consisting of readily available hardware components.

Primary mucinous carcinoid tumor of the ovary.

A case of primary mucinous carcinoid tumor of the ovary occurring in a 37-year-old woman is described. The tumor, which replaced the left ovary, was accompanied by metastases in the contralateral ovary and para-aortic lymph nodes. Careful investigations excluded metastatic origin of the tumor. The tumor was solid, but contained an epidermoid cyst. There were no other teratomatous elements. The patient was treated with combination chemotherapy. A second-look operation 9 months following diagnosis revealed extensive microscopic involvement of the peritoneal cavity. The patient's condition deteriorated and she died 1 year after diagnosis. Detailed autopsy revealed peritoneal, pleural, lymphatic, and bone marrow carcinomatosis, but no evidence of a primary tumor elsewhere. Microscopic, ultrastructural, and immunocytochemical findings are described. It is considered that primary mucinous carcinoid tumor of the ovary represents a specific histopathologic entity. Unlike other types of primary ovarian carcinoid tumors, it behaves as an aggressive malignant neoplasm.

Alveolar macrophages in perinatal infants.

The presence of alveolar macrophages in the neonatal lung at the time of autopsy is correlated with the presence of pulmonary lesions and with the duration of postnatal life. Alveolar macrophages were noted at 20 weeks of gestation in infants with congenital pneumonia, but were not present in most full-term infants who were stillborn. They were found in nearly all infants who survived for 48 hours irrespective of pulmonary lesions or gestational age.

Limitations of qualitative serum beta-HCG assays in the diagnosis of ectopic pregnancy.

Seventy-four patients had ectopic pregnancies proven by surgery. Three of them had a serum beta-HCG test for pregnancy that was reported as negative (less than 25-35 mIU/ml). We sought a threshold for positive in the serum beta-HCG test that would maximize its usefulness in diagnosing ectopic pregnancy. Sera from 52 of the patients were available for reanalysis. Quantitative values of beta-HCG were determined. Lowering the threshold for positive from 25-35 to 10 mIU/ml might increase the test's sensitivity without sacrificing specificity but would still not ensure detection of all ectopic pregnancies. Of 445 cases of ectopic pregnancy described in the literature, 6 had serum beta-HCG values reported as negative. In the published reports and in our own cases, clinical histories and histologies indicated that a nonviable ectopic pregnancy can be expected to have an associated serum concentration of beta-HCG that may be below the sensitivity of detection even with current, commercially available quantitative tests.

A quality-control procedure on cervical lesions for the comparison of cytology and histology.

A new method for the quality control of cytologic and histologic diagnoses of cervical lesions is based on the automated high-resolution scanning, image processing and computer analysis of cytometric data by the TICAS system. It determines and then compares optical-density-based ploidy patterns of cells in cytologic smears and the corresponding histologic sections, with the results available both as computer-graphic displays and printouts. Examples of the former appear for an "agreement case," in which the cytologic and histologic patterns corresponded, and a noncorrespondence (nonrepresentative) case, in which the tissue sample had been nonrepresentative of the lesion sampled by cytology. Computergraphic examples concern one case of condyloma and one of tissue repair, in both of which both the cytologic and histologic diagnoses had been overcalled. A further example shows the method's use in monitoring response to therapy. The DNA ploidy patterns on which this method is based can give diagnostic and prognostic clues when morphology alone may be equivocal or insufficient. The utility of ploidy pattern determinations of material from other body sites is also well established. With the use of microprocessors, the system described could be made inexpensive and operationally simple for the routine quality control of many cytopathologic studies as well as for the clinical follow-up of patients.