Papanicolaou smear sensitivity for the detection of adenocarcinoma of the cervix: a study of 49 cases.

BACKGROUND: Papanicolaou smear sensitivity for cervical adenocarcinoma (CVCA) is not well established. Also uncertain are the relative contributions to falsely negative diagnoses of sampling, screening, and interpretive errors. METHODS: Papanicolaou smears were identified from all patients at our institutions with biopsy-proven cervical adenocarcinoma from 1988-1998. All available negative and unsatisfactory smears were reviewed. RESULTS: Of 49 patients with CVCA, 66 smears initially diagnosed as negative and 4 smears initially diagnosed as unsatisfactory from 30 patients were identified. Thirty-two negative smears and 4 unsatisfactory smears from 19 patients were available for review. The retrospective diagnoses in the cases initially called negative were: unsatisfactory in 2, negative in 15, and atypical glandular cells consistent with either adenocarcinoma in situ (AIS) or CVCA in 15. Three of four smears initially called unsatisfactory had neoplastic glandular cells identified retrospectively. The 18 falsely negative or falsely unsatisfactory smears were from 13 patients obtained up to 5 years before biopsy diagnosis. These smears contained neoplastic cells likely to have been mistaken for lower segment endometrial cells (LUS) or endocervical cells with tubal metaplasia (TM) in 11, reactive endocervical cells in 6, and both in 1. In 16 of the 18 smears, the abnormal cells were abundant, although preservation was suboptimal in 6. CONCLUSIONS: Sensitivity of a single Papanicolaou smear for CVCA was between 45% and 76% depending on the classification of negative slides that were not available for review, comparable to previously reported sensitivity for AIS. The diagnostic false-negative or false-unsatisfactory rate in reviewed smears was 50% (18 of 36). Diminished sensitivity is due to the under recognition of glandular neoplasia resembling LUS, TM, or reactive endocervical cells. Cancer (Cancer Cytopathol)

Endocervical sampling: a comparison of endocervical brush, endocervical curette, and combined brush with curette techniques.

OBJECTIVE: This study was conducted to compare the collection of endocervical specimens by endocervical brush, curette, and a combined curette and brush technique. METHODS: Women underwent colposcopy with endocervical curettage using one of 3 collection methods. RESULTS: The endocervical brush produced equivalent amounts of tissue and endocervical cells compared to the curette alone or combined techniques. More squamous and glandular atypia and SIL/AIS were found when a brush was used, but a statistically significant difference was not noted. The brush alone produced a significantly greater percentage of samples that were insufficient for diagnosis and more specimens without stromal components. The brush with the curette as a combined technique provided no improvement in amounts of tissue, endocervical cells/clusters, or amount of stroma retrieved. CONCLUSION: Each technique has advantages and disadvantages in terms of what types of components are collected and what diagnosis may be determined from the sample taken.

Scrape cytology for intraoperative evaluation of lymph nodes in gynecologic cancer.

OBJECTIVE: To compare scrape cytology with frozen section in accuracy and time required for preparation and interpretation and assess accuracy and surgical effect of scrape cytology as the only method of intraoperative evaluation of lymph nodes from women with gynecologic cancers. METHODS: Between February 1998 and March 1999, 242 lymph nodes removed from 60 women with gynecologic cancers were submitted for scrape cytology alone (34 women, 177 lymph nodes) or with frozen section (26 women, 65 lymph nodes). Results of scrape cytology and time required for preparation and interpretation were compared with those from frozen section. Accuracy and proportion of incorrect surgical decisions based on combined evaluation by scrape cytology and frozen section were compared with those from scrape cytology alone. For statistical analysis, we used Student t test, chi2, and Cohen's kappa statistics. Two-tailed P < .05 was considered significant. RESULTS: There was excellent agreement between scrape cytology and frozen section (kappa = .78 with 95% confidence interval .495, 1.065). Scrape cytology had a higher accuracy than frozen section and required significantly less time (95.8% versus 87.5% and 14 +/- 3.2 versus 25 +/- 5.1 minutes, P < .005). The accuracy and proportion of incorrect surgical decisions based on combined evaluation were similar to those based on cytology alone (91.7% for both and 7.7% versus 8.8%, respectively). CONCLUSION: Scrape cytology is as accurate and faster than frozen section in intraoperative evaluation of lymph nodes from women with gynecologic cancers. Adding frozen section to scrape cytology did not seem to improve accuracy or reduce incorrect surgical decisions.

Primary vaginal squamous cell carcinoma presenting as a cystic pelvic mass.

A 57-year-old woman presented with urinary retention, diarrhea, rectal bleeding, a cystic pelvic mass with thick irregular borders posterior to the vagina displacing the cervix and the bladder, and an intact vaginal mucosa. The patient underwent exploratory laparotomy on the assumption that she had an ovarian neoplasm. The mass originated from the posterior vaginal wall and was consistent with primary squamous cell carcinoma. The patient was treated with surgical cytoreduction followed by external radiation therapy and weekly cisplatin with good response. One year following treatment the patient remains without evidence of disease. Primary vaginal squamous cell carcinoma arising from the posterior vaginal wall can present as a cystic pelvic mass resembling an ovarian neoplasm. Cytoreductive surgery followed by chemoradiation might be of value in some patients with primary vaginal carcinoma.

Desmoplastic small round cell tumour of unknown primary origin with lymph node and lung metastases: histological, cytological, ultrastructural, cytogenetic and molecular findings.

Desmoplastic small round cell tumour (DSRCT) is an extremely aggressive neoplasm belonging to the family of "small round blue cell tumours", which includes primitive neuroectodermal tumour (PNET), Wilms' tumour and Ewing's sarcoma. DSRCT is considered to be a neoplasm derived from a primitive cell. It is immunohistochemically reactive with epithelial, neuronal and mesenchymal cell markers, demonstrating divergent differentiation along three cell lines. Originally thought to arise from serosal surfaces, the tumour has recently been reported in the central nervous system and ovary. The tumour in this case is a neoplasm that meets the histological, immunohistochemical, cytological and cytogenetic criteria of DSRCT; it is not associated with serosal membranes, and it has supraclavicular and axillary lymph node deposits and multiple pulmonary and brain metastases. Tumour cells from our case show cytogenetic similarities with Ewing's sarcoma and PNET. Electron microscopic findings suggest similarities between DSRCT and Wilms' tumour. Cloning and sequencing of PCR products showed in-frame fusion of EWS exon 7 to WT1 exon 8.