Screening for endometrial cancer in asymptomatic postmenopausal women with conventional and colour Doppler sonography.

OBJECTIVE: To evaluate endometrial thickness and uterine arterial flow measurement as predictors of endometrial cancer. DESIGN: Prospective study among a cohort of women invited to age-adjusted, population-based breast cancer screening by mammography. SETTING: City of Turku, Finland. POPULATION: 1074 postmenopausal women aged 57-61 years (mean 59 years). METHODS: Conventional and colour Doppler sonography. Endometrial biopsy was taken when the endometrial thickness (double layer) was > or = 4.0 mm, if the uterine artery pulsatility index was < or = 1.0 or if there was a fluid accumulation in the endometrial cavity. MAIN OUTCOME MEASURES: Detection of endometrial cancer in endometrial biopsy. Record linkage with the files of the Finnish Cancer Registry three and a half years after the first ultrasound examination. Major statistical results are based on the analysis of variance and logistic regression models. RESULTS: An endometrial biopsy was taken from 291 women (27%). One woman had endometrial tuberculosis, three an endometrial polyp, 16 endometrial hyperplasia, three endometrial carcinoma (Stage Ib), and one had cervical carcinoma (Stage Ib). One woman was diagnosed as having endometrial cancer Stage Ib two and a half years after screening; she had refused further examination after a positive screen. A second endometrial cancer (Stage Ib) was diagnosed three years after a negative screening result. CONCLUSION: Transvaginal sonography is confirmed to have a very high sensitivity for the detection of early endometrial carcinoma, but the specificity remains low. If endometrial cancer is to be detected at an early stage, further examinations should be carried out when the endometrial thickness is > or = 4.0 mm, especially when the woman has risk factors such as obesity, late menopause or current use of hormonal replacement therapy. Doppler sonography does not improve the detection of premalignant and malignant endometrial lesions compared with normal ultrasound.

Endometrial fluid accumulation in asymptomatic postmenopausal women.

Postmenopausal endometrial fluid accumulation was considered in the past to be related to cancer of the genital organs. Our purpose was to evaluate its prevalence, and its association with cervical stricture, use of hormone replacement therapy and endometrial pathology. A group of 1074 asymptomatic postmenopausal women aged 57-61 (mean 59) years was examined by transvaginal sonography with color Doppler imaging. Women who had an endometrial fluid accumulation underwent endometrial biopsy. Statistical analysis was mainly based on analysis of variance. Endometrial fluid accumulation was found in 134 women (12%). Women using only estrogen as hormone replacement therapy had a relative risk of 3.5 of endometrial fluid accumulation. In 12 women (9%), a cervical stricture precluded endometrial sampling. Six abnormal histopathological samples were found (5%): two endometrial polyps, one cystic hyperplasia, two adenomatous hyperplasias but only one adenocarcinoma. One further patient with endometrial cancer was registered by the Finnish Cancer Registry 2.5 years later in a woman who had refused endometrial sampling. Endometrial fluid accumulation is quite a common finding on transvaginal sonography among asymptomatic postmenopausal women and the process may be multifactorial. Cervical stricture is not the most important etiological factor. The use of estrogen replacement therapy increases the risk of endometrial fluid accumulation; however, it is rarely a sign of malignancy.

A longitudinal study of screening for endometrial cancer by endometrial biopsy in diabetic females.

Diabetics are at high risk of developing endometrial cancer; the relative risk of endometrial cancer in diabetics is fourfold in comparison to non-diabetic controls. The purpose of this longitudinal study was to evaluate the effectiveness of screening asymptomatic diabetic females in terms of the premalignant and malignant endometrial findings, and to try to determine the optimal screening interval. In 1980-1981, a group of 462 diabetic females was identified and registered. One half of them (237) was invited to be screened. Endometrial samples were taken by using Vabra aspiration. The results of this first randomized screening in 1980-1981 have been published elsewhere. At that time 124 females participated. The remaining 225 females acted as an unscreened control group. Eight years later (1988-1989), both groups were invited to be screened. The Pistolet aspiration method was used. At this stage, group 1 (screened in 1980-1981) consisted of 78 females, and group 2 (not screened in 1980-1981) consisted of 148 females. In 85% (193/226) of the females, the uterine cavity was reached with the Pistolet instrument; 96% of the females found the pain acceptable. In the group screened twice (group 1), no pathologic lesions of the endometrium were found in the second screening. In the group screened for the first time (group 2), one female had endometrial adenocarcinoma (0.8%), one had complex hyperplasia without atypia (0.8%) and four had endometrial polyps (3.3%). In 165 cases of 193, both a cytologic and a histologic specimen were available. In 130 cases (79%) the cytology was of class I, including the one endometrial adenocarcinoma. In three cases (2%) it was of class II and in one case (1%) of class III. Endometrial biopsy by Pistolet aspiration was a method highly acceptable by the patients for examining the endometrium. However, cytologic examination was not able to show the existing endometrial adenocarcinoma. One endometrial sampling of asymptomatic diabetic females during early menopause could detect the bulk of the occult, slowly progressing lesions of the endometrium. Such screeening might be most efficient in terms of cost-benefit ratio.

Mass screening for endometrial cancer directed in risk groups of patients with diabetes and patients with hypertension.

BACKGROUND: The interest in mass screening programs for the early detection of endometrial cancer (EC) has grown with the rising incidence of this disease. Preliminary programs directed at asymptomatic women with only one risk factor, i.e. age, have not been cost-effective. METHODS: In the current study, 597 asymptomatic women from 45-69 years of age with diabetes and/or hypertension were screened by Vabra (Berkeley Medevices Inc., Berkeley, CA) aspiration. RESULTS: Among the women with diabetes, 6.3% preinvasive lesions of the endometrium were found. This is significantly more than the rate among women with hypertension, which was 1.3% (P < 0.01). CONCLUSIONS: Regular mass screening programs for the early detection of EC should be directed at asymptomatic diabetic women 45 years of age or older. This study does not indicate that similar screenings would be effective for women with hypertension.

Aggressiveness of breast cancers found with and without screening.

OBJECTIVE: To examine how breast cancers found by mammographic screening differ from those found outside screening. DESIGN: Comparative cohort study. SETTING: Turku, southwestern Finland. PATIENTS: 126 women aged 40-74 years with breast cancer detected during the first round of mammographic screening in 1987-90 and 125 women within the same age range with breast cancer detected outside screening during the same period. MAIN OUTCOME MEASURES: Primary tumour size, axillary nodal status, histological features, oestrogen and progesterone receptor concentrations, ploidy, and S phase fraction. RESULTS: Compared with the controls women with cancers detected by screening had a smaller primary tumour (57 (46%) screened v 11 (10%) controls had tumours less than or equal to 11 mm in diameter, p less than 0.0001), and less often had axillary nodal metastases (104 (83%) screened v 71 (57%) controls node negative, p less than 0.0001). After adjustment for the smaller size of the primary tumour compared with control cancers, those cancers detected by screening were less likely to have axillary nodal metastases (odds ratio 0.44, 95% confidence interval 0.23 to 0.84), poor histological differentiation (0.20, 0.08 to 0.49), high mitotic counts (0.38, 0.15 to 0.97), tumour necrosis (0.45, 0.22 to 0.93) or to be of the ductal histological type (0.46, 0.22 to 0.95). They had low oestrogen receptor (0.29, 0.12 to 0.70) and progesterone receptor (0.35, 0.17 to 0.92) concentrations less often and had smaller S phase fractions (0.72, 0.55 to 0.96) than control cancers. CONCLUSIONS: Even after adjustment for the smaller size of screen detected breast cancers, their histological and cytometric features suggest low malignant potential. They may also be less likely to metastasise to axillary lymph nodes than cancers found outside screening.

Preoperative tissue characterization with chemical shift imaging: a case report of an epidermal cyst.

We introduce here a case of an epidermal cyst, which was preoperatively examined with chemical shift MR imaging at 0.1-T magnetic field. The case shows that fat/water separation method can be successfully used in tissue characterization.

Cytolysis and karyopyknosis in postmenopausal vaginal smears as markers of endometrial cancer, diabetes and obesity. Studies based on a ten-year follow-up.

The vaginal cytology of 507 postmenopausal women was followed prospectively for ten years. Of the subjects, the 207 with cytolytic or karyopyknotic vaginal smears constituted the study group and the 300 with atrophic smears (indicating an absence of estrogenic activity) constituted the control group at the beginning of the follow-up. A woman whose initial smear was cytolytic usually had a cytolytic smear ten years later, which implies that high postmenopausal estrogenic activity is constitutional. Both at the beginning of the study and ten years later, the mean body weights were higher in the study group than in the control group. The mean karyopyknotic index and the prevalence of cytolytic smears were significantly higher among women with impaired glucose tolerance than among subjects with a normal glucose tolerance test. During the follow-up period, 3.6% of the women in the study group and 0.7% of the women in the control group developed endometrial cancer (P less than .02). The incidence of 3.6% of endometrial cancer is significantly higher than the corresponding age-specific incidence (P less than .001). We conclude that obese and/or diabetic postmenopausal women with cytolytic or markedly karyopyknotic vaginal smears exhibit a high intrinsic estrogen activity and may thus be at risk for endometrial cancer.

Aspiration biopsy cytology of renal oncocytoma.

The fine needle aspiration biopsy findings in four cases of renal oncocytomas were reviewed. The cytologic smears contained many large, well-demarcated, eosinophilic cells with prominent nucleoli. Some of the cells were binucleated. The findings in these cases indicate that renal oncocytoma may be suggested preoperatively on the bases of renal angiography and aspiration biopsy cytology. The differential diagnosis between renal adenocarcinoma and carcinomas with oncocytic differentiation is discussed.

Transabdominal and lumbar nephrectomy for renal adenocarcinoma.

The results of 178 transabdominal and 79 lumbal nephrectomies were compared, based on a consecutive series of patients with renal adenocarcinoma. The corrected 5-year survival rate for patients without distant metastases was 64% for transabdominal and 57% for lumbar nephrectomy. This difference is not statistically significant. The transabdominal approach made possible a more extensive operation in patients with tumours extending to neighbouring organs, but none has survived as long as three years. Duration of surgery, need for blood transfusion and duration of postoperative hospital care were similar. Splenic injury occurred in 9.6% of the patients with transabdominal nephrectomy, but this did not result in additional morbidity or mortality. There were a few other sporadic complications.

Reliability of aspiration biopsy cytology in the grading of renal adenocarcinoma.

Needle aspiration biopsy and histologic samples were taken from three corresponding regions of the surgical specimens immediately after nephrectomy from 150 renal parenchymal tumours. At review 144 of these were diagnosed as adenocarcinomas and 6 as oncocytomas. The adenocarcinomas were classified into three grades according to the degree of differentiation: High, moderate, poor. The grade, as evaluated on cytologic grounds, was in agreement with the histologic grade in 75.9% of the cases and in disagreement by one grade in 24.1%. The cytologic assessment was undergraded in 19.1% and overgraded in 5.0%. The 5-year survival rate for patients with histologically highly differentiated carcinomas was 82.7%, for moderately differentiated 48.7% and for poorly differentiated 28.1%. For corresponding cytologic groups the survival rates were 72.7%, 49.9% and 22.2%. The grade was variable in the same tumour in 24.2% of the cases. The assessment demands several samples, from which the least differentiated is significant. The prognostic significance of needle aspiration biopsy is reliable when cytologic differentiation is poor, but declines as the differentiation improves.

Monoclonal IgG immunoglobulinemia with subsequent myeloma in psoriatic arthritis.

A 42-year-old man had suffered from skin psoriasis for 27 years, psoriasis arthritis for 6 years and corneal crystalline deposits for 1 year, when an IgG-kappa monoclonal immunoglobulin was detected in his serum electrophoretic pattern. All the diagnostic studies for multiple myeloma were negative. However, 16 months later he developed this disease.

Atypical necrobiosis lipoidica of the face.

A 36-year-old healthy man with atypical necrobiosis lipoidica of the face is described. The lesions were annular with a raised erythematous palpable border. The centres were slightly depigmented and atrophic, without telangiectasia or hair loss. Histopathological changes revealed prominent giant cells in small groups without clear granuloma formation. They were located at all levels of the drmis between the collagen bundles.

Seminal vesicle epithelium in fine-needle aspiration biopsies of the prostate as a pitfall in the cytologic diagnosis of carcinoma.

The morphologic features of seminal vesicle epithelial cells were studied in a material of ca 3,300 fine-needle aspiration biopsies of the prostate. Seminal vesicle material was considered to be found in 50 cases. The most usual and distinctive features in seminal vesicle epithelial cells were yellowish-brown cytoplasmic pigment granules and large hyperchromatic polyploid nuclei. Intranuclear cytoplasmic inclusions, nuclear folding and prominent nucleoli were observed in approximately one third of the cases. Seminal vesicle secretion and stromal cells were seen in most cases, spermatozoa less frequently. The recognition of seminal vesicle epithelial cells in fine-needle aspiration biopsies of the prostate is considered to be important in the avoidance of cytodiagnostic errors.

Significance of histopathological findings in Dupuytren's contracture.

Clinical and histopathological data were compared in a series of 59 patients with Dupuytren's contracture (DC) from the years 1946-1971 in order to clarify whether histopathological findings were in accordance with the clinical development of the disease. All well known histopathological features were inspected. The most valuable prognostic sign seemed to be the appearance of several active nodules, indicating rather rapid development of DC, with a high frequency of postoperative recurrence in these patients. Lack of active nodules did not exclude this possibility but made it less likely. Other occasional findings typical of DC such as the number of mitoses, microhaemorrhages, perivascular lymphocytic infiltrations and hypertrophied corpuscles of Vater-Paccini seemed to be of minor prognostic value. Mucopolysaccharides from DC tissue showed metachromasia with toluidine blue did not stain with HID-AB (high iron diamine-alcian blue) as HID positive in specimens preserved embedded in paraffin blocks for several years.