G. P. Vooijs

Monotypic plasma cells in labial salivary glands of patients with Sjögren's syndrome: prognosticator for systemic lymphoproliferative disease.

AIMS: To determine the prevalence of plasma cell monotypia in labial salivary gland tissue of patients with and without Sjögrens syndrome, and to evaluate its relation to the development of systemic monoclonal lymphoproliferative disorders. METHODS: A quantitative immunohistological study was performed on labial salivary gland tissue of 45 patients with Sjögrens syndrome, 18 with rheumatoid arthritis without Sjögrens syndrome, and 80 healthy controls. In none of the patients with Sjögrens syndrome was there evidence of systemic monoclonal lymphoproliferative disease at the time of biopsy. RESULTS: Monotypic plasma cell populations, defined by a kappa:lambda ratio of > or = 3, were only observed in older patients (above 43 years) with Sjögrens syndrome. In almost all these patients monotypic plasma cell populations were present in multiple labial salivary gland tissues and the IgM/kappa monotypia was observed most frequently. The prevalence of monotypic plasma cell populations in the group with Sjögrens syndrome was 22% (10/45) and there was no significant predilection for primary Sjögrens syndrome. Of special clinical interest was the observation that progression to systemic monoclonal lymphoproliferative disease had occurred exclusively in this subgroup of patients with Sjögrens syndrome, with a prevalence of 30% (3/10). CONCLUSION: Quantitative immunohistological examination of labial salivary gland tissues provides pathologists with a simple method to select those patients with Sjögrens syndrome who have an increased relative risk at the time of biopsy to develop benign or malignant lymphoproliferative disorders.

Clear cell adenocarcinoma of the vagina and cervix. A report of the central netherlands registry with emphasis on early detection and prognosis

The Central Netherlands Registry (CNR) of women with vaginal or cervical clear cell adenocarcinoma (CCAC) was established in 1985. An overview is presented of clinical and pathologic data of 55 patients who were registered at the CNR until July 1, 1988. All Netherlands Departments of Pathology (NDP) maintain a patient registry and 95% of the Institutes are connected with a Central Archive via a computer network. The histologic slides and clinical status were reviewed at the CNR. Twenty‐five tumors were classified as vaginal carcinoma and 30 as cervical carcinoma. The mean age of the patients was 22 years. Fifty‐five percent of patients (63% of patients with known maternal history) were exposed to diethylstilbestrol (DES) in utero. The majority of cases was initially diagnosed after 1980. Cytologic examination before the initial histologic diagnosis indicated that cervical tumors were detected in 80% of cases, but vaginal tumors were detected only in 33% of cases. It was concluded that an examination of DES‐exposed women should consist of colposcopic inspection of the cervix and vagina, cytologic examination of the cervix and four quadrants of the vagina, and careful palpation of the cervix and the entire vaginal wall. The most important prognostic parameter for patients with CCAC was stage and grade of nuclear atypia. The results of a statistical analysis showed that these features were the most effective to distinguish between nonsurvivors and patients surviving more than 5 years.

Quantitative immunohistologic study of lip biopsies evaluation of diagnostic and prognostic value in Sjögren's syndrome

In a group of 45 patients with Sjögrens syndrome (SS) and 80 controls the high specificity (95%) and sensitivity (100%) of a recently proposed bivariate quantitative immunohistologic (QIH) criterion for SS, based on percentages of IgA and IgG-containing plasma cells in labial salivary gland (LSG) tissue, was confirmed. The best univariate QIH criterion for discrimination between LSG biopsies of SS patients and controls appeared to be based on the percentage of IgA containing plasma cells, and had a specificity of 99% and a sensitivity of 96%. A criterion based only on the percentages of IgM-containing plasma cells, proposed in another recent study, resulted in a high number (31%) of false negatives. Interobserver reproducibility of QIH diagnoses was excellent. Moreover it was demonstrated that accuracy, precision and the interobserver reproducibility of plasma cell counting depends on the choice of tissue fixation and immunohistologic staining procedure. The combination of formol sublimate fixation and peroxidase anti-peroxidase procedure appeared to be the best combination for QIH examination. Furthermore, in 2 SS patients systemic monoclonal IgM/kappa gammopathy was preceded by high predominance of IgM and kappa containing plasma cells in the plasma cellular infiltrate of the LSG tissue.

Monoclonal Antibodies in Diagnostic Cytopathology

Especially in cytopathologic diagnosis, immunohistochemistry may be a particularly strong tool because fine-needle aspiration biopsy smears, sputum smears, or cytologic preparations from body cavity effusions are often partially or entirely devoid of any morphologic information. Since the diagnosis of pathologic changes by cytologic examination of exfoliated or aspirated cellular material is becoming an increasingly important part of diagnostic pathology, considerable effort has been put into the development of immunohistochemical methods for use in cytology during the past few years [3, 10].

Histomorphometric study of the lower urogenital tract in pre- and post-menopausal women : Cytometry 1990 11/6 (700–707)

In this study 22 histomorphometric parameters were used to quantify the histologic changes in the vagina, trigone of the bladder, and the proximal and distal urethra of 37 women aged between 18 and 82 years. The results of this quantitative study revealed a hormonally induced, age-independent atrophy of smooth muscle in the lamina propria of the mucosa and the longitudinal part of the muscular layer in the aforementioned anatomical sites in post-menopausal women. In the lamina propria of the mucosa of the lower urogenital tract in post-menopausal women hormonally induced quantitative changes of blood vessels were not observed. Senile atrophy of smooth muscles was only observed in the deeper part of the muscular layer of the vagina and the trigone of the urinary bladder and was less prominent than the hormonally induced smooth muscle atrophy.

Abstract sectionHistomorphometric study of the lower urogenital tract in pre- and post-menopausal women : Cytometry 1990 11/6 (700–707)

In this study 22 histomorphometric parameters were used to quantify the histologic changes in the vagina, trigone of the bladder, and the proximal and distal urethra of 37 women aged between 18 and 82 years. The results of this quantitative study revealed a hormonally induced, age-independent atrophy of smooth muscle in the lamina propria of the mucosa and the longitudinal part of the muscular layer in the aforementioned anatomical sites in post-menopausal women. In the lamina propria of the mucosa of the lower urogenital tract in post-menopausal women hormonally induced quantitative changes of blood vessels were not observed. Senile atrophy of smooth muscles was only observed in the deeper part of the muscular layer of the vagina and the trigone of the urinary bladder and was less prominent than the hormonally induced smooth muscle atrophy.

Histomorphometric study of the lower urogenital tract in pre- and post-menopausal women

In this study 22 histomorphometric parameters were used to quantify the histologic changes in the vagina, trigone of the bladder, and the proximal and distal urethra of 37 women aged between 18 and 82 years. The results of this quantitative study revealed a hormonally induced, age-independent atrophy of smooth muscle in the lamina propria of the mucosa and the longitudinal part of the muscular layer in the aforementioned anatomical sites in post-menopausal women. In the lamina propria of the mucosa of the lower urogenital tract in post-menopausal women hormonally induced quantitative changes of blood vessels were not observed. Senile atrophy of smooth muscles was only observed in the deeper part of the muscular layer of the vagina and the trigone of the urinary bladder and was less prominent than the hormonally induced smooth muscle atrophy.

Application of Monoclonal Antibodies in Cytopathology.

The diagnosis of pathologic changes by cytologic examination of exfoliated or aspirated cellular material is becoming an increasingly important part of diagnostic pathology.