[Atypical glandular cells (AGC) on Papanicolaou smears--the great challenge of cervix screening programs]. / Kóros mirigyhámsejtek cervixkenetekben--a méhnyakszurés nagy kihívása.

UNLABELLED: The "grey zone" diagnostic category for glandular cells in the Bethesda System 2001 (TBS 2001) has undergone significant modification since its last version in 1991. PATIENTS: The aim of the study was to follow up patients with "atypical glandular cells of undetermined significance" (AGUS)/ "atypical glandular cells" (AGC), and adenocarcinoma cytological interpretation, based on a three-year material between 2000-2002 at the Department of Cytopathology of National Institute of Oncology, Hungary. The smears were reviewed and interpreted according to TBS 2001. Histological slides were reviewed and cytohistologic correlations were investigated. RESULTS: Out of 36193 conventional Papanicolaou smears, there were 276 AGC-NOS (AGUS, favour reactive in TBS1991) and 7 AGC-favour neoplastic (AGUS, favour neoplastic in TBS 1991) (altogether 0.78%) and 35 (0.1%) adenocarcinoma interpretations. Histology was available in 136 (AGC-NOS: 106, AGC-favour neoplastic: 7 and adenocarcinoma: 23) cases. Among the followed 106 patients with AGC-NOS, there were 24 cases with concurrent "grey zone" squamous, ASC-US, interpretation. Clinically significant lesions were found in 5/7 (71%) of cases of the AGC-favour neoplastic group, and in 27/106 (25%) of the all AGC-NOS group, the difference is statistically significant. This ratio is 16/82 (20%) in the AGC-NOS only cases, while 11/24 (46%), in the AGC-NOS with concurrent ASC-US cases, the difference is statistically significant. The high-grade lesions were mostly squamous. CONCLUSION: The results suggest that AGC-NOS with concurrent ASC-US interpretation represent a group of potential patients with statistically significant higher risk of clinically significant (among them high-grade) lesions.

[The role of fine needle aspiration biopsy in the diagnosis of melanoma]. / Aspirációs cytologia szerepe a melanoma diagnosztikájában.

The role of fine needle aspiration biopsy (FNAB) is discussed in the follow up of patients with the diagnosis of malignant melanoma. The review is based on literary data and the author's own material. The primary role of FNAB is to confirm metastatic or recurrent melanoma lesions. US or CT guided FNAB is valuable in the diagnosis of visceral metastases. FNAB has limited role in the diagnosis of primary melanomas except in cases with unusual clinical presentation (e.g. oral mucosa). In spite of the well-known cytology the diagnosis can be difficult due to the inherent histological variation of malignant melanomas, especially in cases with unusual localisation and amelanotic tumor presentation when immunocytochemistry is needed. The known clinical history of melanoma is very helpful.

[Angiosarcomas of the chest wall and breast after radiotherapy: The questions of radiogenic origin, diagnosis and treatment] / Mellkasfali és emlô angiosarcoma sugárkezelés után: a radiogén eredet, a diagnózis és a kezelés kérdései.

PURPOSE: To present medical history of secondary chest wall and breast angiosarcomas (AS) developed after radiotherapy, and to discuss the questions of radiogenic origin, diagnosis and treatment by the review of the literature. METHODS: Report of two cases and MEDLINE search for relevant publications. RESULTS: Secondary AS occured in a previously irradiated field after a long (6 and 8 years) latency period in both cases. Detailed histopathological and immunohistochemical examinations from the biopsy and/or surgical specimens confirmed the diagnosis as AS. The first patient with moderately differentiated AS was treated successfully with radical surgery. The second patient with irresecable AS died of rapid local progression within 4 months. The incidence of chest wall and breast AS is increased after irradiation, however, controversial data exist in the literature. The incidence of chest wall and breast AS after radiotherapy was found to be 0.39% in our patient population, which means an estimated odds ratio of 2.4 for secondary AS. Stewart-Treves syndrome is not of radiogenic origin, since postoperative lymphoedema has been considered as primary etiological factor. CONCLUSIONS: Patients treated with surgery and/or radiotherapy for primary breast cancer are at higher risk for developing secondary AS, compared to the healthy population. An etiological relationship between radiotherapy and subsequent AS of chest wall and breast is likely, but still controversial. Initial radical surgery is the only effective treatment for achieving long term survival. Further adjuvant radiotherapy is no longer feasible, due to the previous irradiation. Chemotherapy has only palliative effect. These very rare cases deserve special attention due to the atypical clinical appearance, difficulties of differential diagnosis and poor prognosis.