Priscilla D. Taft

Glassy cell carcinoma of the cervix

A clinicopathologic analysis of 13 cases of glassy cell carcinoma of the uterine cervix is presented. The glassy cell carcinoma is considered to be a poorly differentiated mixed adenosquamous carcinoma. Its histologic appearance is distinctive, being characterized by cells with a moderate amount of cytoplasm having a ground glass or finely granular appearance, a distinct cell wall that stains with eosin and PAS, and enlarged nuclei with prominent nucleoli. In the present study this tumor was associated with extrapelvic spread in 6/13 cases at diagnosis. Results were poor with either surgery and/or radiotherapy. Only four of 13 patients survived 5 years. The glassy cell carcinoma appears to be a distinct clinicopathologic entity which warrants a place in the classification of carcinoma of the cervix.

Dysplasia and cytologic findings in 4,589 young women enrolled in diethylstilbestrol-adenosis (DESAD) project.

Abstract This report presents the cytologic findings and the rates of dysplasia for 4,589 young women enrolled in the National Cooperative Diethylstilbestrol-Adenosis (DESAD) Project. Mucinous columnar cells and/or metaplastic squamous cells with or without mucinous droplets were encountered in 22% of vaginal scrape smears from all diethylstilbestrol (DES)-exposed participants identified by review of prenatal records and in 43% of women in whom vaginal epithelial changes (VEC) were observed by colposcopy or by iodine staining. The frequency of cellular findings in the vaginal scrape smears was closely related to the timing of the administration of the DES to the mother. With increasing age of the daughters, the overall frequencies of both the mucinous and metaplastic cells decreased; relative to each other, an increasing proportion was metaplastic squamous cells. These data suggest that, as the women grow older, vaginal adenosis regresses by the process of squamous metaplasia. Endometrial type cells were found in 2% of vaginal scrape smears. Their cyclical occurrence during the menstrual cycle and lack of correlation with the presence of VEC indicated an origin from the uterine corpus rather than the tuboendometrial type of adenosis. Squamous cell dysplasia of the vagina and cervix was detected by biopsy or scrape smear specimens in 1.8% of DES-exposed women in the record review group. The rate in unexposed women was twice as high. In general, the rates of dysplasia were higher in the cervix than vagina, and the more severe degrees of dysplasia were encountered only in those women who were referred to the DESAD Project or who themselves requested entry. Four patients who were referred or who themselves requested entry were found to have clear cell adenocarcinoma of the vagina. The vaginal smear provided the first clue to the presence of an abnormality in three of them.

Squamous cell dysplasia and carcinoma in situ of the cervix and vagina after prenatal exposure to diethylstilbestrol.

Squamous cell abnormalities of the vagina and cervix were evaluated in 1424 women exposed to diethylstilbestrol (DES) in utero. The prevalence of dysplasia was 2.1% and the incidence 0.85/100 person-years of followup. The dysplastic epithelial changes were almost always mild in women with no prior history of dysplasia and was slightly more frequent in the cervix than the vagina. Severe dysplasia and carcinoma in situ (CIS) were encountered only in those subjects specifically referred because of those abnormalities. The most common problem in the diagnosis of these squamous cell changes was the misinterpretation of mature and immature metaplastic cells for dysplastic squamous cells. Discordance between biopsy and cytology was common-place in the detection and followup of dysplasia, especially when it was mild. There were no instances in the study where cytology and biopsy samples from the vagina were both abnormal concurrently. Colposcopically directed biopsies did not increase the frequency of confirmation of cytologic findings. These data suggest that both cytology and biopsy of abnormal segments of the vagina and cervix remain an integral part of the examination of the DES-exposed female during long-term follow-up studies.

Correlation of ascitic fluid cytology with histologic findings before and after treatment of ovarian cancer.

One hundred thirteen specimens of ascitic fluid from 97 patients with primary, persistent, or recurrent ovarian cancer were examined cytologically. Advanced stage of disease, involvement of the ovarian surface, a moderate or large volume of fluid, and nonbloody serous ascites were factors that correlated with a high rate of positive findings in ascites in these patients. Other factors influencing the positive rate appeared to be the invasive as opposed to borderline malignant histology of the tumor. Involved external surface and volume of ascites were influencing factors only in advanced cases. Therefore, the most important factor influencing the positive rate of ascites cytology was the proportion of cases in advanced stages to total cases.

Urinary cytology in female genital cancer

Abstract Stimulated by a report that 89 per cent of patients with cancer of the uterine cervix showed malignant cells in the urine sediment, the present study was undertaken to evaluate urinary cytology as a means of early cancer detection. In 350 patients both vaginal smears and urinary sediments were examined; of 69 cases of genital cancer, 67 revealed significant findings on vaginal smear as compared to 29 in urine specimens. The urine cytology was of little diagnostic value in noninvasive cervical carcinomas—only one case was reported positive and one as doubtful from the 13 cases in this class. Eighteen of 38 invasive cervical carcinomas revealed malignant cells in the urine specimens. For other tumors also the urine cytology was found to be of limited value. The procedure may be of use as a supplement to and not as a substitute for more direct cytologic examination.

Dysplasia and cytologic findings in 4,589 young women enrolled in diethylstilbestrol-adenosis (DESAD) project

This report presents the cytologic findings and the rates of dysplasia for 4,589 young women enrolled in the National Cooperative Diethylstilbestrol-Adenosis (DESAD) Project. Mucinous columnar cells and/or metaplastic squamous cells with or without mucinous droplets were encountered in 22% of vaginal scrape smears from all diethylstilbestrol (DES)-exposed participants identified by review of prenatal records and in 43% of women in whom vaginal epithelial changes (VEC) were observed by colposcopy or by iodine staining. The frequency of cellular findings in the vaginal scrape smears was closely related to the timing of the administration of the DES to the mother. With increasing age of the daughters, the overall frequencies of both the mucinous and metaplastic cells decreased; relative to each other, an increasing proportion was metaplastic squamous cells. These data suggest that, as the women grow older, vaginal adenosis regresses by the process of squamous metaplasia. Endometrial type cells were found in 2% of vaginal scrape smears. Their cyclical occurrence during the menstrual cycle and lack of correlation with the presence of VEC indicated an origin from the uterine corpus rather than the tuboendometrial type of adenosis. Squamous cell dysplasia of the vagina and cervix was detected by biopsy or scrape smear specimens in 1.8% of DES-exposed women in the record review group. The rate of unexposed women was twice as high. In general, the rates of dysplasia were higher in the cervix than vagina, and the more severe degrees of dysplasia were encountered only in those women who were referred to the DESAD Project or who themselves requested entry. Four patients who were referred or who themselves requested entry were found to have clear cell adenocarcinoma of the vagina. The vaginal smear provided the first clue to the presence of an abnormality in three of them.

Nuclear chromatin determination in amniotic fluid cells for prenatal sex prediction in the macaque

Amniotic fluid cells obtained after the ninetieth day of gestation in the macaque were analyzed for nuclear chromatin. The technique proved reliable for the prediction of fetal sex.

CYTOLOGY OF CLEAR-CELL ADENOCARCINOMA OF GENITAL TRACT IN YOUNG FEMALES: REVIEW OF 95 CASES FROM THE REGISTRY

The role of cytology in detection of clear-cell adenocarcinoma (CCA) was determined by analysis of cytologic studies of 95 patients registered with the disease. Morphology of CCA was also delineated. Positive or suspicious smears from 11 patients taken before the tumor was detected clinically provided the 1st suggestion of malignancy. 5 of these patients were asymptomatic and had had smears as part of a routine examination. 49/65 smears obtained after the tumor had been detected clinically or by biopsy were positive. Once the primary tumor had been treated vaginal smears were made as part of routine follow-up; in 5 instances the cytologic findings provided the 1st clue that the tumor had persisted or recurred. Morphologic characterization showed that tumor cells occurred singly and in clumps and in general resembled endocervical cells (29 figures included). The nuclei were usually large and contained a prominent nucleolus. Bare nuclei were frequent. Variations included occasional slight nuclear atypicality and rare bizarre nuclei. Cytoplasm was usually delicate. Cytologic diagnosis was difficult because of the following occurrences: 1) absence of tumor cells; 2) presence of numerous inflammatory cells; and 3) the high degree of differentiation of the tumor cells in some cases. Vaginal cytology however in young girls with abnormal bleeding or a history of stilbestrol exposure in utero may provide the 1st indication of the presence of CCA.