[Severe gastric dysplasia with intramucosal carcinoma in a 16-year-old male]. / Displasia gástrica severa con carcinoma intramucoso en un hombre de 16 años.

Gastric dysplasia is a rare adult condition affecting a small area near polyps, ulcers or is an inflammatory process. Adenocarcinoma develops in severe gastric dysplasia, and this process may take 1 year. Mild and moderate dysplasias regress and only a small proportion progresses to severe dysplasia. We report a severe dysplasia in a 16-year-old male with no clinical history of gastric disease with acute and severe upper gastrointestinal bleeding that lowered hemoglobin levels to 2.8 g/dL. Bleeding persisted and subtotal gastrectomy was performed on an emergency basis. At gross examination, bleeding and congestion were found with superficial ulcers. Microscopically, severe dysplasia was observed with intramucosal areas of carcinoma limited to foveolar mucosa. The ulcers were congested and there was no inflammation, no polyps or other alterations in the mucosal layer. Ki-67 and P53 markers were positive, p16 with sporadic positivity. The purpose here is to report an exceptional case because of the young age and extensive and severe dysplasia with areas of intramucosal carcinoma and no previous clinical history. No similar cases of severe dysplasia with carcinoma in situ are reported in the literature.

Improving cytologic samples from the uterine cervix: a simple visual instruction.

OBJECTIVE: To improve the quality of smears from uterine cervix. MATERIALS AND METHODS: Fifteen photographs of different types of cervixes (nulliparous, multiparous, ectopia, and others) were shown to a group of physicians and technicians who send samples to our laboratory. We had previously evaluated accuracy of sampling the transformation zone and compared results of the test group with our previous evaluation using Student's t test. RESULTS: The rate of transformation zone sampling increased from 45% to 77% (p = 0.0001) after physicians and technicians saw the photographs and received instructions. CONCLUSIONS: This method is simple and very effective for the improving sampling of the uterine cervix by clinicians and other health providers.

[Vaginal cytology: the importance of the transformation zone and how to obtain an adequate sample]. / Citología vaginal: la importancia de la zona de transformación y cómo obtener una muestra adecuada.

Cytology smear is the test most frequently used to detect cancer of the uterine cervix. Much is written concerning it in its three phases, analytical, post-analytical, and preanalytical; the later implies sampling and preservation and is the purpose of this review. According to the national literature, result of the sampling is deficient in 64% of cases. Many instruments have been developed to take good samples, and statistically there is no difference between these in terms of achieving the goal of taking a good sample; despite this in Mexico bad samples persist. In this paper it is analyzed the source of these errors that are principally from ignoring the anatomy of the cervix, the handling and fixation of the sample, among others, and some observations are made that are not described in other articles in the same field. Some of the most popular instruments available in Mexico to take samples are the endocervical brush, spatula, and brush (Pappette) here described; their advantages and disadvantages are included, according to the type of cervix in which is going to be used, stressing some details concerning the transformation zone and how to select the best instrument. The results improved with these observations from 45 to 77% in taking good samples.

Citología vaginal: la importancia de la zona de transformación y cómo obtener una muestra adecuada / Vaginal cytology: the importance of the transformation zone and how to obtain an adequate sample

Cytology smear is the test most frequently used to detect cancer of the uterine cervix. Much is written concerning it in its three phases, analytical, post-analytical, and preanalytical; the later implies sampling and preservation and is the purpose of this review. According to the national literature, result of the sampling is deficient in 64 of cases. Many instruments have been developed to take good samples, and statistically there is no difference between these in terms of achieving the goal of taking a good sample; despite this in Mexico bad samples persist. In this paper it is analyzed the source of these errors that are principally from ignoring the anatomy of the cervix, the handling and fixation of the sample, among others, and some observations are made that are not described in other articles in the same field. Some of the most popular instruments available in Mexico to take samples are the endocervical brush, spatula, and brush (Pappette) here described; their advantages and disadvantages are included, according to the type of cervix in which is going to be used, stressing some details concerning the transformation zone and how to select the best instrument. The results improved with these observations from 45 to 77 in taking good samples.