Cytological evaluation of endometrial hyperplasia in relation to histological pictures.

The Authors analyse possible parameters of cytological evaluation which can be used for the grading of endometrial hyperplasias and the diagnostic differentiation between atypical hyperplasia and adenocarcinoma. They consider 77 women who underwent endometrial cytology by aspiration just before diagnostic examination of the uterine cavity. Results show that in atrophic endometrium desquamation in clusters of less than 100 cells prevails whereas proliferative and secretory endometrium presents mainly clusters of 100-500 regularly stratified cells. Hyperplasia show progressive increase in isolated cells; "branched" glands appear rarely in hyperplasia with minimal atypia while prevailing in hyperplasia with severe atypia and adenocarcinoma. Simple layers prevail in atrophic endometrium, stratified regular layers prevail in proliferative and secretory endometrium; three-dimensional clusters appear in hyperplasia with minimal atypia and become significant with severe atypia. Adenocarcinoma is characterized by haematic and necrotic background, high percentage of isolated cells and prevalence of clusters of less than 100 cells, mainly three-dimensional. In addition it shows a significant incidence of papillary and rosette-like arrangements and abnormal cytoplasmic vacuolization.

Colposcopic pictures in cervical intraepithelial neoplasia grade III.

This study concerns 414 women affected by cervical intraepithelial neoplasia grade III. In each case we have considered and compared the colposcopic examination and the cyto-histologic type of lesion. Ectopy and/or typical transformation prevail in atypical metaplasia. Leukoplakia has its highest incidence in severe dysplasia, is prominent in severe dysplasia and carcinoma in situ unless these two lesions are combined atypical metaplasia. The mosaic prevails in atypical metaplasia, but appears in a prominent form in carcinoma in situ only, whereas the punctation prevails in carcinoma in situ. When the suspect white areas appear in association their incidence in the various CIN III lesions they do not vary. The red suspect areas are rather infrequent, while the atypical transformation is absent in atypical metaplasia, fairly frequent in carcinoma in situ and prevails significantly in microinvasive carcinoma.

Post treatment behaviour of cervical intraepithelial neoplasia - grade III.

The behaviour in time of cervical intraepithelial neoplasia grade III has been evaluated in 141 patients treated for CIN III. It was observed that surgery ensures the higher healing-rate, whether hysterectomy or conization are performed, while diathermocoagulation seems unsatisfactory. Colposcopy, colpocytology and sight biopsies of the cervical canal, portio and vagina, which provide a precise lesion-map, are then essential investigations to make the subsequent treatment a truly radical one. A very close monitoring of patients, treated for CIN III, seems required in the first year after surgery, when we observed the highest rate of persistence and recurrences, while, subsequently, their incidence decreases as time passes by.

Incidence of single or associated "CIN III" lesions according to age.

The incidence of single or associated CIN III lesions has been evaluated in 520 patients. 48.92 +/- 13.89 years is the mean age of incidence. Atypical metaplasia has the lowest mean age and is the only CIN III lesion to affect patients under 20 and never to be found--individually--after the age of 50. Severe dysplasia reaches its maximum incidence in the fourth decade. Carcinoma in situ has the highest mean age, reaching its maximum incidence in the fifth decade. But when it is associated with atypical metaplasia, the age shifts to the fourth decade. Apparently, these results confirm the role of "precursor" of atypical metaplasia. Severe dysplasia and carcinoma in situ are later stages of the cervical carcinogenesis. Furthermore, the high rate of associated lesions provides further evidence of their similarity and "common origin", with important prognostic and therapeutical implications.

Lymphoplasmacyte infiltrate in cervical intraepithelial neoplasia grade III.

The behaviour of the lymphoplasmacyte reaction, regarded as an immune defence reaction of the organism, has been evaluated in 167 patients affected by cervical intraepithelial neoplasia or by microcarcinoma. It was observed that in surely in situ forms (atypical metaplasia, severe dysplasia and carcinoma in situ) there is a clear prevalence of cases with a minimal or absent reaction, while in the potentially invasive carcinoma and in the microcarcinoma there is a predominance of cases with a marked reaction, as if the first biological modifications that lead to invasion were accompanied by a massive activation of the immune defence mechanisms. We finally noticed that no relation exists between the appearance of CIN-lesion recurrences and the intensity of the stromal reaction. This further confirms the hypothesis that in the first steps of the carcinogenic process exogenous causes are mainly involved.