Prenatal ultrasound diagnosis of an intracranial teratoma influencing management: case report and review of the literature.

Of seventeen cases of prenatally diagnosed intracranial teratomas, fourteen babies were delivered through a cesarean section. All children died before or shortly after delivery. In this report another case is presented of ultrasound diagnosis of an intracranial teratoma. The teratoma filled the whole fetal cranium, and eroded through the skull base into the left maxillary region. In full agreement with the wishes of the parents, conservative management resulted in the spontaneous vaginal delivery of a fetus that died during labor as a result of brain compression and acidosis during the second stage. In contrast with other cases in the literature, no encephalocentesis was performed. In order to minimize maternal morbidity, it is advised to induce or accept labor as soon as the diagnosis is clear and to pursue a vaginal delivery.

Adenocarcinoma in situ of the cervix: an underdiagnosed lesion.

Although invasive adenocarcinoma of the cervix constitutes 5--15% of all cervical cancers, the in situ counterpart is underrepresented in the published series of percursor lesions of cervical cancer. Moreover, no cases are known to have been published in which in situ adenocarcinoma preceded invasive cancer. Partly, this can be explained by the fact that in situ adenocarcinoma is an underdiagnosed lesion. In a series of 52 cases of adenocarcinoma of the uterine cervix, 18 "negative" endocervical biopsies, taken 3--7 years prior to the clinical presentation of cancer, were available for study. In five of these cases, areas of adenocarcinoma in situ were found. The quantitative parameters of these "missed" adenocarcinomas in situ and adenocarcinomas in situ adjacent to invasive cancer were the same. The in situ lesions differed significantly from benign endocervical epithelium. This study strongly suggests that these lesions may progress to invasive cancer. With the acquired information on the quantitative features of adenocarcinoma in situ cells, the most significant criteria for routine diagnostic practice can be identified.

The identification of atypical reserve cells in smears of patients with premalignant and malignant changes in the squamous and glandular epithelium of the uterine cervix.

Atypical reserve cells can be recognized in cervical smears by their characteristic exfoliation pattern and the fragility of their cytoplasm. The frequency of cases with such cells in 30,000 cervical smears is given, as well as that in 440 cases of dysplasia, epidermoid carcinoma in situ and invasive carcinoma. The presence of atypical reserve cells was found to increase in frequency with the increasing severity of the lesions. The bipotential character of these cells is discussed in relation to the possible progression to carcinoma in situ of the adenomatous type in two of the 42 cases of pure atypical reserve cell hyperplasia, and the presence of these cells in the majority of the 43 cases of adenocarcinoma of the uterine cervix in the present series.