Gladwyn Leiman

Pregnancy following conization of the cervix: Complications related to cone size

A retrospective study of 88 pregnancies occurring in 77 patients after cervical conization was undertaken to compare pregnancy outcome with cone size. Cone specimens were divided into two groups. Those measuring less than 2 cm in height or less than 4 cc in volume were considered to be small cones and those greater than 2 cm in height or 4 cc in volume were regarded as large cones. The over-all normal term vaginal delivery rate was 46.6%, and was found to be inversely proportional to the size of the cone. The incidence of both spontaneous midtrimester abortion and prematurity increased in direct proportion to cone size. Cervical stenosis necessitating cesarean section was, however, noted to be a complication associated with small rather than large cones. It was concluded from this study that all postcone pregnancies should be regarded as high risk, preterm complications being particularly related to large cones.

Depo-medroxyprogesterone acetate as a contraceptive agent: Its effect on weight and blood pressure

Abstract Clinical experiences with DMPA as a contraceptive agent are presented, with particular reference to weight changes and alterations in blood pressure. Variations in weight in 816 women are analyzed, with special attention being directed to the more excessive gains which occurred. Significant alterations in blood pressure were found in 24 per cent of 1,050 women studied, a prominent feature being relatively rapid rises in diastolic levels. Possible theories for these findings with a pure progesterone preparation are suggested.

Cervical endometriosis: Facilitated diagnosis by fine needle aspiration cytologic testing

Regarded as infrequent, endometriosis of the cervix probably occurs more commonly than is generally realized. The lesions apparent rarity may be ascribed to limited awareness of the clinical appearance, combined with technical difficulty in obtaining suitable biopsy material for confirmation. A consequence of previous cervical trauma, endometriosis of the cervix can be expected to increase in incidence with more widespread use of invasive cervical procedures. Clinical recognition and tissue confirmation thus become essential. This paper refocuses attention on cervical endometriosis by documenting the clinical, colposcopic, and histopathologic findings in 16 cases seen at a single colposcopy clinic over a 6-month period. Diagnosis in these patients was facilitated and improved by fine needle aspiration cytologic testing. This technique, not previously used for documentation of endometriosis in this location, is outlined in detail, together with a full description and illustration of the cytologic features.

Malignant transformation in a schwannoma

The two most common benign neoplasms of peripheral nerve sheath are neurofibromas and schwannomas (neurilemmomas). Malignant change is well known to occur in neurofibromas, in the setting of type 1 neurofibromatosis. In this context, up to 5% of neurofibromas undergo malignant transformation, this being a complex multistep process involving the NF-1 gene, and the p53 gene. Malignant transformation of schwannomas, in contrast, is an exceedingly rare occurrence, with no hereditary predisposition. It has been stated that malignant change is so rare, that for practical purposes it may be disregarded. In a recent review of 32 previously reported cases, 25 were found to be unacceptable examples; hence there are, to our knowledge, only nine acceptable examples of malignant transformation in benign schwannomas. We present a case of sarcomatous change within a benign schwannoma probably representing the earliest example yet reported.

Cytopathology of follicular dendritic cell tumors

Follicular dendritic cell tumors are rarely described entities, arising from antigen‐presenting immune accessory cells, found within B‐lymphocyte follicles in nodal and extranodal sites. We report two cases, one associated with Castlemans disease, in whom fine‐needle aspiration biopsy was performed followed by surgical biopsy. The diagnosis was confirmed using immunoreactivity with CD21 and CD35 antibodies and by ultrastructural demonstration of interdigitating cell processes with desmosomes.

Pemphigus vulgaris of the uterine cervix revisited : Case report and review of the literature

Pemphigus vulgaris is an autoimmune disease characterized by acantholytic blisters and erosions involving the oral mucosa, skin, and less frequently other mucosal surfaces. Although the cytology of scrapings from the cutaneous and oral lesions has been well‐documented, there are relatively few reports in the literature of the cytologic appearance of pemphigus on cervicovaginal smears. This report documents a case of pemphigus involving the cervix, in which the diagnosis was not known at the time of the cervical smear and biopsy. The cytologic features of this case and those in the literature are described in detail, highlighting the necessity of awareness of the disease and its presentation on cervicovaginal smears, in preventing an overdiagnosis of neoplasia. Diagn. Cytopathol. 2000;22:304–307.

An interinstitutional review of the value of FNAB in pediatric oncology in resource‐limited countries

Fine‐needle aspiration biopsy (FNAB) has been widely accepted as a reliable diagnostic modality in the general pediatric population, but its role in pediatric oncology still remains elusive. With new treatment protocols subscribing to preoperative chemotherapy, the need for a quick, minimally invasive, and accurate diagnostic procedure has arisen. This study assesses the feasibility of FNAB in childhood malignancies to render a specific diagnosis on which treatment can be initiated. An 11‐year retrospective study was done on FNABs in patients 19 years and under referred for clinically malignant mass lesions. Cases were confirmed with histology, immunocytochemistry, flow cytometry, or clinical follow‐up. Of the 357 patients referred for FNABs, 36 patients were lost to follow‐up and 31 FNABS were inadequate. A total of 290 cases were included in the study, of which 68 (23%) cases were benign and 222 (77%) were malignant. The most frequently occurring tumors were nephroblastoma (68), non‐Hodgkins lymphoma (39), rhabdomyosarcoma (22), Hodgkins lymphoma (22), and neuroblastoma (22). The sensitivity of the procedure for neoplasia was 96.6%, the specificity 97.0%, positive predictive value 99.0%, and negative predictive value 90.1%, with a diagnostic accuracy of 96.7%. The ability of FNAB to enable a specific diagnosis to be made, that is correct and accurate subtyping of the tumor on which chemotherapy or radiotherapy could be commenced was 75.7%. This study shows that FNAB can be used with confidence to confirm malignancy in children. With clinicoradiological correlation and the aid of ancillary techniques, FNAB allows a rapid and accurate preoperative diagnosis for definitive therapy commencement in most cases. Diagn. Cytopathol. 2012.

The cytomorphology of papillary serous carcinoma of the endometrium in cervical smears

An investigation into the determination of cytomorphologic criteria that may distinguish papillary serous carcinoma of the endometrium (PSC) from typical endometrioid carcinoma (TEC) in cervical smears was undertaken. Preoperative identification of this poor prognostic variant of endometrial carcinoma may influence the surgical management of these cases and the choice of adjuvant therapy.

Natural killer cell lymphoma in cytology : Breaking all the rules : A case report

A testicular mass aspirate was received from a 22‐yr‐old patient with known non‐Hodgkins lymphoma. The cells were large and pleomorphic, occurring in syncytial fragments and demonstrating abundant cytoplasm. No lymphoglandular bodies were seen. As characteristic lymphoma criteria were not present, a cytodiagnosis of germ‐cell tumor was suggested, and testicular biopsy advised. The final histopathology report, however, was of a CD 56‐positive (large‐cell) T‐natural killer cell lymphoma, of which this appears to be the first example described and illustrated cytologically. Diagn. Cytopathol. 1998;19:9–11.

Fine Needle Cytodiagnosis of Renal Tuberculosis

A total of 8 patients in whom renal tuberculosis was suspected on clinical or radiological grounds but in whom confirmation could not be achieved by urine culture underwent renal fine needle aspiration. Immediate cytodiagnosis was accomplished in 7 of 8 patients by the finding of Langhans giant histiocytes, epithelioid histiocytes and necrotic debris. Later confirmation was obtained in all 8 cases by radiometric culture of aspiration material or saline rinses of the fine needles. This experience introduces fine needle aspiration cytology as a diagnostic modality in renal tuberculosis.