Distribution of cervical lesions in young and older women.

INTRODUCTION: Age range for cervical screening varies widely between countries. In addition, sexual behavior has changed, life expectancy is increasing, and new insights have been gained into the pathogenesis of HPV infection. Our aim is to evaluate the distribution of cervical lesions in young and older patients. METHODS: Review of all cervical smears diagnosed in a public institution (2010-2017) and a private institution (2016-2017) in Madrid, Spain. We have included all women aged younger than 30 and older than 65 years with atypical smears (n = 1573). RESULTS: Women younger than 30 years were diagnosed with ASCUS, ASC-H, LSIL, and HSIL in 47%, 5.3%, 45.17%, and 2.6% of atypical cases, respectively. Women older than 65 years were diagnosed with ASCUS, ASC-H, LSIL, HSIL, and SCC in 38%, 12.39%, 16.8%, 13.27%, and 19.5% of atypical cases, respectively. Medical records of patients from the public institution were reviewed. Of note, 76.3% of young women showed negative smears at follow-up and 14.1% showed high-grade dysplasia (HGD). Mean ages for low-grade and HGD were 24.7 and 25.7 years, respectively. HGD was found in 37.9% of women with histological examination (33.5%). As for older patients, 25% of them had no Pap smears performed before age 65, and in 60% of the previously screened women, the screening program had not been used adequately. Mean age of first smear was 69.5 years. Carcinoma was subsequently detected in 20.7% of patients. CONCLUSIONS: Current guidelines seem to be adequately preventing carcinoma in young women. However, screening adherence should be encouraged to detect important lesions in both age groups, especially among older women.

Displasia cemento-ósea del maxilar: problemas de diagnóstico diferencial a propósito de un caso / Differential diagnosis of cemento-osseous dysplasia of the maxilla. A case report

La displasia cemento-ósea es una lesión frecuente que afecta a los maxilares y no exige tratamiento intensivo. Su principal interés radica en el riesgo de confusión con entidades de comportamiento más agresivo, como los fibromas osificantes y cementificantes, que exigen tratamiento. No existen unos claros criterios de diagnóstico diferencial histopatológico entre ambas entidades. En este trabajo presentamos el caso de un niño de 13 años al que se realizó una biopsia de una lesión en el maxilar, sin diagnóstico clínico de sospecha. El estudio histológico revela un tejido fibroso poco celular en el seno del cual se observan trabéculas óseas sin ribete de osteoblastos y cúmulos de cemento. Nuestro diagnóstico final fue displasia cemento-ósea. Se muestran los principales rasgos de la lesión y se analizan los criterios que pueden ayudar al difícil diagnóstico diferencial de esta entidad

Cemento-osseous dysplasia is a benign lesion which affects the jaw bones. It is a frequent incidental finding but no aggressive therapy is necessary. However, it may be confused with more aggressive entities, such as ossifying and cementifying fibroma, which do require treatment. There are no clear-cut histopathological criteria to differentiate between these entities. We present a case of a 13-year old boy who underwent a biopsy of a clinically undiagnosed maxillary lesion. Histopathological analysis revealed moderately cellular fibrous tissue with bone trabeculae with no osteoblastic rimming and clusters of intensely basophilic material corresponding to cementum. The final diagnosis was cemento-osseus dysplasia. The main histopathological features important in the distinction of these entities are discussed

[Differential diagnosis of cemento-osseous dysplasia of the maxilla. A case report]. / Displasia cemento-ósea del maxilar: problemas de diagnóstico diferencial a propósito de un caso.

Cemento-osseous dysplasia is a benign lesion which affects the jaw bones. It is a frequent incidental finding but no aggressive therapy is necessary. However, it may be confused with more aggressive entities, such as ossifying and cementifying fibroma, which do require treatment. There are no clear-cut histopathological criteria to differentiate between these entities. We present a case of a 13-year old boy who underwent a biopsy of a clinically undiagnosed maxillary lesion. Histopathological analysis revealed moderately cellular fibrous tissue with bone trabeculae with no osteoblastic rimming and clusters of intensely basophilic material corresponding to cementum. The final diagnosis was cemento-osseus dysplasia. The main histopathological features important in the distinction of these entities are discussed.

Tumor miofibroblástico inflamatorio de mama: una entidad poco frecuente / Inflammatory myofibroblastic tumor of the breast: A rare entity

Denominado también seudotumor inflamatorio, el tumor miofibroblástico inflamatorio se considera actualmente una auténtica neoplasia de bajo grado. Aunque su localización más frecuente es el pulmón, se ha descrito en muchas otras, incluida la mama, cuya afectación fue descrita por vez primera por Pettinato et al. en 1998. Presentamos el caso de una mujer de 52 años perimenopáusica que consultó por notar masa de crecimiento lento en la mama derecha. La lesión era bien delimitada en la mamografía, con un aspecto hipoecogénico en la ecografía. Se realizó una biopsia con aguja gruesa y el diagnóstico fue miofibroma con recomendación de exéresis. Tras la resección se observó una lesión fusocelular con llamativa presencia de elementos inflamatorios, cuya morfología y estudio inmunohistoquímico era compatible con tumor miofibroblástico inflamatorio. Tras ampliar los márgenes de resección y con un estudio de extensión negativo (PET-TC), la paciente está siendo seguida en consulta sin signos sugestivos de recidiva tras 8 meses. El tumor miofibroblástico inflamatorio de mama es muy poco frecuente, con menos de 30 casos a nivel mundial. Plantea un extenso diagnóstico diferencial con lesiones benignas y malignas y en ocasiones puede coexistir o anteceder a carcinomas en la mama adyacente. Su comportamiento es de bajo potencial maligno, aunque hay algunos casos que se han comportado de forma agresiva con recidiva precoz y metástasis sistémicas. El tratamiento es quirúrgico y no está indicado tratamiento sistémico, pero sí control clínico a medio plazo. No es posible definir con claridad los factores que determinan el comportamiento biológico de esta lesión, dada su rareza

Also known as inflammatory pseudotumor, inflammatory myofibroblastic tumor is now considered a true low-grade neoplasm. Although the lung is the most common site, it has been described in many other locations, including the breast; the first report of breast involvement was by Pettinato et al. in 1988. We report the case of a 52-year-old perimenopausal woman presenting with a slow-growing mass in her right breast. Mammography revealed a well demarcated lesion which was hypoechoic on ultrasound. A needle biopsy was performed yielding an initial diagnosis of myofibroma and the mass was resected. Histopathology of the 5-cm tumor revealed a fusocellular proliferation with a striking presence of inflammatory cells, morphologically and immunohistochemically concordant with inflammatory myofibroblastic tumor. The patient underwent further surgery to ensure free margins and after a negative extension study (PET-CT) is receiving no further therapy. To date, she has shown no signs of recurrence 8 months postoperatively. Inflammatory myofibroblastic tumor of the breast is very infrequent, with less than 30 reported cases. Differential diagnosis with both benign and malignant entities is extensive and it may precede or coexist with carcinoma of the adjacent breast. Although it is considered a low-malignant potential lesion, there are well documented cases of recurrence and even metastasis. Surgical resection with wide margins is the primary treatment and no systemic therapy is indicated; however, clinical follow-up is mandatory as there are no well-established criteria as yet to predict the biological behavior of this tumor

[Inflammatory myofibroblastic tumor of the breast: A rare entity]. / Tumor miofibroblástico inflamatorio de mama: una entidad poco frecuente.

Also known as inflammatory pseudotumor, inflammatory myofibroblastic tumor is now considered a true low-grade neoplasm. Although the lung is the most common site, it has been described in many other locations, including the breast; the first report of breast involvement was by Pettinato et al. in 1988. We report the case of a 52-year-old perimenopausal woman presenting with a slow-growing mass in her right breast. Mammography revealed a well demarcated lesion which was hypoechoic on ultrasound. A needle biopsy was performed yielding an initial diagnosis of myofibroma and the mass was resected. Histopathology of the 5-cm tumor revealed a fusocellular proliferation with a striking presence of inflammatory cells, morphologically and immunohistochemically concordant with inflammatory myofibroblastic tumor. The patient underwent further surgery to ensure free margins and after a negative extension study (PET-CT) is receiving no further therapy. To date, she has shown no signs of recurrence 8 months postoperatively. Inflammatory myofibroblastic tumor of the breast is very infrequent, with less than 30 reported cases. Differential diagnosis with both benign and malignant entities is extensive and it may precede or coexist with carcinoma of the adjacent breast. Although it is considered a low-malignant potential lesion, there are well documented cases of recurrence and even metastasis. Surgical resection with wide margins is the primary treatment and no systemic therapy is indicated; however, clinical follow-up is mandatory as there are no well-established criteria as yet to predict the biological behavior of this tumor.

Terminology for vulvar cytology based on the Bethesda System.

OBJECTIVE: To present a new terminology for vulvar cytology based on the Bethesda System. STUDY DESIGN: Material for cytologic diagnosis was collected by scraping vulvar lesions with a scalpel blade. RESULTS: This terminology was presented for the first time at an International Academy of Cytology conference in Kamuela, Hawaii, in 1997. It is based on the Bethesda System (1994) and WHO system. We recommend the following elements for a vulvar cytologic report: adequacy of specimen, general categorization and descriptive diagnosis. The terminology of vulvar lesions includes benign cellular changes (vulvitis and reactive changes) and epithelial cell abnormalities. If epithelial cell abmormalities are found, the following diagnoses are made: atypical squamous cells of undetermined significance, LSIL, HSIL and vulvar tumors. The most common epithelial tumors are papillary hydradenoma, squamous cell carcinoma and Paget's disease. Five hundred and sixty-three patients with vulvar cytology were examined in our department over 11 years, including 132 with normal vulvas, 220 with vulvitis, 145 with VSIL and 56 with squamous cell carcinoma. Histologic examination of 147 patients (26.11%) showed a sensitivity of 97.70% for benignity and 98.21% for malignancy and 98.87% and 94.82% for specificity, respectively. CONCLUSION: Vulvar cytodiagnosis with the new terminology allows both reporting on the type of vulvar lesions and cancer detection.