Dennis M. O'Connor

Mitotically active leiomyomas of the uterus

Seventy-three smooth-muscle tumors of the uterus, with five to nine mitotic figures per 10 high-power fields but lacking cytologic atypia, were studied. Pathologic features assessed included necrosis, hemorrhage, vascular intrusion, abnormal mitoses, and the number of mitotic figures. Vascular ingrowth by the tumor was present in 11 neoplasms. Follow-up ranged from 23 months to 15 years, with all patients alive and well at last contact. In 14 patients, myomectomy was the only treatment. Thirteen of these patients demonstrated no subsequent residual or recurrent tumor. One woman developed a persistent or recurrent mitotically active leiomyoma 8 years after myomectomy. We conclude that mitotically active smooth-muscle tumors of the uterus, having five to nine mitoses per 10 high-power fields and no cellular atypia, have a metastatic rate too low to be regarded as sarcomas. Hysterectomy need not automatically follow myomectomy if follow-up is done.

Discrepancy in the interpretation of cervical histology by gynecologic pathologists.

OBJECTIVE To determine if subspecialty review of cervical histology improves diagnostic consensus of cervical intra‐epithelial neoplasia (CIN). METHODS After routine histologic assessment within the hospital pathology department, 119 colposcopic cervical biopsies were interpreted by two subspecialty‐trained gynecologic pathologists (GYN I and GYN II) blinded to each others interpretations and to the interpretations of the hospital general pathologists (GEN). Biopsies were classified as normal (including cervicitis), low grade (LG, including CIN I and human papillomavirus changes), and high grade (HG, including CIN II/III). The interobserver agreement rates between GEN and GYN I, between GEN and GYN II, and between GYN I and GYN II were described using the κ statistic. The proportions of biopsies assigned to each biopsy class were compared using McNemar test. RESULTS Interobserver agreement rates between GEN and GYN I were moderate for normal (κ = 0.53) and LG (κ = 0.46) and excellent for HG (κ = 0.76). There were no significant differences in the classifications between GEN and GYN I. Interobserver agreement rates between GEN and GYN II were moderate for normal (κ = 0.50) and LG (κ = 0.44) and excellent for HG (κ = 0.84). Also, GYN II was significantly more likely to classify biopsies as normal (P < .001) and less likely to classify biopsies as LG (P < .001). The interobserver agreement rates between GYN I and GYN II were moderate for normal (κ = 0.61) and LG (κ = 0.41) and excellent for HG (κ = 0.84). Also, GYN II was significantly more likely to classify biopsies as normal (P < .001) and less likely to classify biopsies as LG (P = .01). CONCLUSION Interobserver agreement between two gynecologic pathologists was no better than that observed between general and gynecologic pathologists. Subspecialty review of cervical histology does not enhance diagnostic consensus of CIN.

Metastatic placental site trophoblastic tumor

A patient with metastatic placental site trophoblastic tumor is presented. Her treatment included several aggressive chemotherapeutic regimens. In this patient, the clinical course and assays of beta-hCG (beta fragment of human chorionic gonadotropin) correlated with her response to these treatments.

A brief history of lower genital tract screening.

Abstract: The history of lower genital tract screening covers discoveries that occurred in the middle of the last century and involves methodologies (cytologic and noncytologic techniques) that, for decades, were independently used by different global regions. At present, cytologic testing has become an initial screening test, and noncytologic testing (colposcopy and iodine application) has evolved into the secondary diagnostic test for selected individuals. In the future, tests that are less subjective and more specific may enhance or eventually replace these methodologies, whereas prevention may become as important as screening.

Hyperspectral diagnostic imaging of the cervix: initial observations

The current standard approach to screening and diagnosing cervical intraepithelial neoplasia (CIN) includes Pap smear triage followed by colposcopy. While it is effective, colposcopy is subjective, includes painful procedures such as biopsies and endocervical curettage, requires specialized training and involves a waiting period of several days for histopathologic reports. We are developing an alternate method of detecting and localizing cervical pre-cancerous lesions, known as hyperspectral diagnostic imaging (HSDI), in which the surface of the cervix is scanned with ultraviolet and white light. Fluorescent and reflected light patterns generated by the cervical tissue are collected and analyzed by the spectrometer to determine features which discriminate among the various stages of CIN. The HSDI approach is objective, painless, requires minimal training and provides immediate results.

Measurement of endocervical canal extension of the transformation zone on fresh hysterectomy specimens.

Objective. Determine the extent of endocervical canal extension of the transformation zone on fresh hysterectomy specimens. Materials and Methods. After removal for standard gynecologic indications, 201 uteri were evaluated in the pathology accessioning area of a community hospital before formalin fixation. Uteri were opened in standard fashion. The length of the endocervical canal and the distance from the external cervical os to the most cranial extension of the squamocolumnar junction (SCJ) into the canal were measured grossly to the nearest millimeter. Patient age, menopausal status, and indication for surgery were extracted from the pathology consultation sheet. Results. The upper limit of the SCJ was located within the canal in 188 of 201 cases (93.5%), including 152 of 162 premenopausal cases (93.8%), 25 of 27 postmenopausal cases (92.6%), and 11 of 12 cases of unknown postmenopausal status (91.7%). The mean distance of SCJ extension was 3.8 mm (SD, 2.5 mm), with a trend toward a shorter distance in the postmenopausal women. The SCJ distance was ≥10 mm in 5 of 188 women (2.7%), all of whom were premenopausal, and ≥5 mm in 41 of 188 women (21.8%). Among women with SCJ extension into the canal, the mean canal length was 33.2 mm (SD, 5.4 mm) for the premenopausal women and 28.3 mm (SD, 5.6 mm) for the postmenopausal women (p < .001). Conclusions. Postmenopausal status and advancing age were not associated with an increased depth of the SCJ into the endocervical canal. The high rates of unsatisfactory colposcopy reported for postmenopausal women are more likely the result of anatomic changes precluding visualization of the canal rather than the skill of the colposcopist. A device designed to detect cervical intraepithelial neoplasia within the cervical canal should be capable of evaluating to a depth exceeding 5 mm.