Marina Suheko Oyafuso

Adenocarcinoma in females detected in serous effusions : Cytomorphologic aspects and immunocytochemical reactivity to cytokeratins 7 and 20

OBJECTIVE To investigate the usefulness of assessing the immunoreactivity of cytokeratins 7 (CK7) and 20 (CK20) as well as several cytomorphologic parameters in effusions with metastatic adenocarcinomas in the search for the primary site of the tumor. STUDY DESIGN From the files of the Pathology Department, A. C. Camargo Hospital, we studied cytologic smears from 73 metastatic adenocarcinomas originally from the breast, 63 from the ovary, 40 from the lung and 32 from the stomach, looking for morphologic parameters that could have discriminant potential in suggesting the primary site in a routine situation, including intranuclear inclusions, prominent nucleoli, mitosis, signet-ring cells, psammoma bodies, nuclear crease, binucleation and multinucleation, papillary features, acinar profile (including ball cells) and single cells. Immunoreactions were performed with monoclonal antibodies to CK7 (OV-TL 12/30) and CK20 (Ks 20.8) and included morphologic analysis. Both analyses were studied in a blind fashion regarding the primary site of the tumors. RESULTS Positivity ratios for breast, ovary, stomach and lung cases were 67.6%, 63.5%, 29.7% and 45.5%, respectively, for CK7 and 17.2%, 15.8%, 13.5% and 32.2%, respectively, for CK20. Discriminant analysis of morphologic and immunocytochemical parameters had an error rate of 42.9% in recognizing the primary site and a Wilks lambda of .7290. CONCLUSION The more efficient parameter with discriminant function was the papillary appearance showed by CK7, which should be used in further studies with a similar scope. The set of parameters used in this study were insufficient to discriminate the primary site of female adenocarcinomas in effusions with significant accuracy.

Cytomorphologic evidence of human papillomavirus infection in smears from the irradiated uterine cervix

OBJECTIVE To report the cytomorphologic evidence of human papillomavirus (HPV) infection in cervical smears from women treated with radiotherapy for carcinoma of the uterine cervix. STUDY DESIGN From January 1986 to December 1993, 32 cervical cytologic smears (CCSs) from women who had received radiotherapy (Rtx) for squamous cell cervical carcinoma at A.C. Camargo Cancer Hospital were selected for study due to the presence of signs of HPV infection. Review of the files of these patients showed 22 additional samples, which we included in this study. The avidinbiotin-immunoperoxidase technique was performed on previously stained slides using polyclonal rabbit antibovine papillomavirus type 1 to confirm the HPV infection. RESULTS Positive reactions were found in 18 cases (27 samples), mainly in cells with classic koilocytotic features, but also in epithelial cells that lacked cytopathic effects. Only one case, a biopsy from a verrucous lesion observed after Rtx, was found to be positive for HPV 6/11 DNA by in situ hybridization. CONCLUSION Cytologic and immunohistochemical positivity for HPV, as well as the reaction with a HPV 6/11 DNA probe, strongly suggested that HPV infection was acquired or expressed after radiotherapy. Further studies are needed to assess the mechanisms responsible for such an association.