Citopatología de la glándula mamaria del varón / Cytopathology of the mammary gland in the male

La mama del varón presenta diferentes procesos, gran parte semejantes a los de la mama de la mujer, pero algunos tienen especiales características: 1) Lesiones inflamatorias: mastitis, absceso retroareolar. 2) Ginecomastia, agrandamiento benigno, no tumoral del tejido mamario del varón. a) Hiperplasia juvenil: presenta un cuadro histopatológico con proliferación irregular de los conductos. La PAAF muestra placas de hiperplasia epitelial y células mioepiteliales y apocrinas. b) Hipertrofia senil. Corresponde al patrón fibroso, con escasas placas ductales y fragmentos del estroma en los extendidos. 3) Fibroadenomas y papilomatosis, análogos a la mama femenina. 4) Hiperplasia ductal. Los extendidos presentan células ductales hiperplásicas, células espumosas y material proteináceo. 5) Carcinoma. Los tipos histológicos, tanto en el carcinoma in situ como en el infiltrante, son análogos a los de la mujer, siendo también la citopatología indistinguible por el sexo. 6) Tumores metastásicos. Indistinguibles del cáncer primario. 7) Tumores malignos no epiteliales. Los más comunes son los sarcomas del estroma y los linfomas. Presentamos los resultados de las publicaciones más importantes sobre la citopatología de la mama del varón: Hajdu, Silverman, Martin Bates, Bhagat y Kleine, Gupta, Sneige y Katz, Lilleng, Das y Joshi y Kapila. Nuestra contribución nos permite concluir presentando las aplicaciones de la Citopatología de la mama del varón: la punción-aspiración es un método sensitivo y específico para el diagnóstico del cáncer mamario y de la ginecomastia, evitando innecesaria cirugía en las lesiones benignas. Finalmente es un método estándar en varones con masas mamarias (AU)

Cervical cancer screening, screening errors and reporting.

Screening for cervical carcinoma by cervicovaginal cytology has led to a marked reduction in the incidence of and mortality from this tumor over the last 50 years in essentially all countries with a functioning screening program. It is the most successful cancer prevention program of all times. Consequently, approximately 80% of the current incidence of and mortality from this disease occurs in geographic areas of underserved and underscreened women. Essential components of a successful program are a high coverage rate of the female population, screening at regular intervals, well-trained clinical and laboratory staff, and an efficient follow-up and treatment system. Deficiencies in any of these areas may lead to a failing screening system. Thus, the most important reason for the remaining mortality from cervical carcinoma in developed countries is lack of complete coverage. It is questionable if new and more expensive technologies will be able to renmedy the remaining failures of the system if no improvement in the coverage rate is achieved. Screening errors do occur but represent only a small fraction of screening failures. Currently, there are a number of terminology systems around the world; thus, a unified terminology is currently not a realistic goal.

Terminology. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: Differences in type, structure, quality of health care systems and availability of resources influence reporting systems. In most countries, individual systems have a long history of usage that might preclude adoption of a uniform terminology worldwide. CONSENSUS POSITION: It is desirable but unrealistic at this time to aim for a unified terminology worldwide. It should be the stated objective of the International Academy of Cytology to serve as an umbrella organization for various terminologies and enhance mutual understanding and cooperation. Translation tables of equivalent terms have been created to allow increased communication. Consensus has been achieved in defining essential elements required of any terminology system: (1) the report must be text based: numerical Papanicolaou class designations alone are inadequate; (2) an assessment of the adequacy of the sample should be included; and (3) the diagnosis must address the primary purpose of cervical cytology: to indicate the presence or absence of epithelial abnormalities. Incorporating additional elements within a terminology system may be more or less appropriate, depending on the setting in which the system is used. ONGOING ISSUES: Despite the cited problems in adopting a uniform terminology worldwide, a single system would have many advantages in terms of communication and research and may be a long-term goal worth pursuing. Countries are invited to present their individual national terminology systems and participate in an ongoing dialogue, critically evaluating the advantages and disadvantages of all systems.

Serous surface papillary carcinoma of the ovary metastatic to a cervical polyp. A case report.

BACKGROUND: Malignancies in cervical polyps are rare. In the literature, malignant transformation to adenocarcinoma and squamous cell carcinoma has been described, but metastasis from ovarian tumors has not been reported before. CASE: An asymptomatic female had a serous surface papillary carcinoma of the ovary, metastatic to a cervical polyp and first noticed on a routine vaginal/cervical/endocervical smear. CONCLUSION: The most common sources of adenocarcinoma cells in a cervical/vaginal smear are the endocervix and endometrium, but, as in our case, the tumor may well be metastatic disease, originating in the ovary or even in extragenital sites, such as gastrointestinal tract, breast and lung. The possibility of dual primaries, involving, for instance, both ovary and endocervix, should be considered.

Hemangiopericytoma in a male breast. Report of a case with cytologic, histologic and immunochemical studies.

A hemangiopericytoma in a male breast was studied by fine needle aspiration (FNA) biopsy. The FNA smears contained tissue clumps showing knob-like formations of atypical cells, spindle-shaped cells and fragments of capillaries lined by normal endothelial cells. Immunocytochemical study showed a positive reaction for vimentin, but a negative reaction for desmin and keratin. Staining for Factor VIII was positive only in the capillaries and endothelial cells. The cytodiagnosis was "mesenchymal tumor." Histopathologic study of the mastectomy specimen made the final diagnosis of hemangiopericytoma. While FNA cytology and immunocytochemistry cannot make a definitive diagnosis of this rare vascular tumor, they can be decisive in planning the surgical treatment, as in the present case.

Computerized recording and reporting system for cytology and colposcopy.

The computerized system for recording and reporting cytologic and colposcopic data at the Madrid Provincial Hospital is discussed. Cytodiagnostic codes based on standard international nomenclature, and yet open to constant updating, were created for the anatomic sites from which samples are currently examined (vagina and cervix, endometrium, vulva and breast), with areas allocated for expansion to other sites. A similar novel code was devised for colposcopic data. Specific forms were developed for each anatomic site; the cervicovaginal and endometrial forms are used for both cytology and colposcopy. The system has provided the laboratory with automation of its managerial, clerical and administrative tasks, including (1) record keeping, (2) reporting, (3) statistics, (4) correlation of clinical, cytologic, colposcopic and histopathologic data, (5) patient follow-up, (6) technical support in research programs and (7) quality control. Use of the system led to an improvement in the efficiency of the laboratory and resulted in reports of better quality. The program has been of help in our research and has not increased the total cost of cytologic studies.

The cytologic diagnosis of breast lesions.

In view of the increasing number of patients presenting with breast lesions, cytology was used as a first step diagnostic procedure. This is the first study of its kind in Spain. Material was obtained from 660 patients, either from spontaneous nipple secretion or by fine needle aspiration. Cytologic criteria for recognition of the different cell types in the smears are discussed. The accuracy of the method was high (2.6% false negatives; 4.1% false positives). The cytologic technique for diagnosing breast lesions is simple, rapid and economic as well as harmless and painless. It therefore fulfills all requirements for an early diagnostic procedure.

Endometrial and endocervical brushing techniques with a Medhosa cannula.

A new technique for obtaining endometrial material using the Medhosa Cannula is described. This method is also useful to obtain samples from the endocervix. The Medhosa Cannula is made of flexible plastic. It is 30 cm long and has thin fins on its distal end which, guided by an introduction cone, permit endometrial and endocervical brushing. Six hundred cases are reported. Concomitant histopathological studies were performed in 40 per cent of the patients. There were two false negative cytologic reports (0.88%) and one false positive (6.66%). This is a simple, rapid, innocuous and economical technique, thus fulfilling the prerequisites for routine cytodiagnostic methods. Adequate material was always obtained.