The significance of atypical squamous cells of undetermined significance in Barbados - Poster abstract

OBJECTIVE: To evaluate the significance of a Papanicolaou (Pap) cervico-vaginal smear diagnosis of atypical squamous cells of undertermined significance (ASCUS) using cytohistologic correlation and to determine the ASCUS squamous intraepithelial lesions (SIL) ratios of five cytopathology laboratories. DESIGN AND METHODS: A combined retrospective and prospective study was undertaken to evalute the histologic diagnoses of the biopsies from patients who attended the colposcopy clinic at the Queen Elizabeth Hospital with the Pap smear cytologic diagnosis of ASCUS during the period, January 1 - April 15, 1998. The laboratory from which the Pap reports were issued was recorded. RESULTS: During this three and a half month period three hundred and sixty-four (364) patients with abnormal smears diagnosed at five different cytology laboratories were investigated. One hundred and fifty (42.1 percent) patients has a Pap smear diagnosis of ASCUS, followed by 161 (46.5 percent) SIL, 130 (35.8 percent) wit low grade intraepithelial lesions (LSIL) and 31 (10.7 percent) high grade intraepithelial lesions (HSIL). Three cases with ASCUS were subsequently excluded from the study because of insufficient data. The histologic diagnosis of the remaining 147 biopsies from patients with the Pap smear diagnosis of ASCUS were LSIL 49 (33.6 percent), HSIL 9 (6.2 percent), atypia/metaplasia 66 (45.2 percent) and inflammation/normal 23 (15.1 percent). The overall ASCUS/SIL ratio was 0.90 and the individual laboratory ratios ranged from 0.25 to 1.70 with a mean of 0.84 ñ 0.63. CONCLUSION: The histologic diagnosis of a cervical cytologic smear assessed as ASCUS may vary from normal to HSIL. Just under 40 percent are likely to be SIL with LSIL predominant. The ASCUS/SIL ratios of Barbadian cytopathology laboratories are less than the ASCUS/SIL ratio (2.0-3.0) suggested by the 1992 NCI Workshop at Bethesda. Hence a diagnosis of ASCUS in Barbados requires careful follow-up.(AU)

Disseminated histoplasmosis detected by lingual and tonsillar erosions in an immunocompetent patient

BACKGROUND: Histioplasmosis is a usually asymptomatic fungal infection. In the immunocompetent patient, it leads to chronic disseminated infection. Mucosal involvement is common and can provide the diagnosis. CASE REPORT: A metropolitan Frenchman with a history of alcoholism and smoking and living in Guyana consulted for lingual and tonsil erosion. Squamous cell carcinoma was suspected but not confirmed at pathology. The patient had bi-apical infiltration on the chest x-ray and was treated empirically for tuberculosis. The diagnosis of histoplasmosis was reached when rare Histoplasma capsulatum were evidenced from a buccal swab. Itraconazole led to cure in 6 months. DISCUSSION: This case illustrates the importance of mucosal signs in the diagnosis of disseminated histoplasmosis in immunocompetent subjects. Histoplasmosis is rarely the cause of active infection in immunocompetent subjects. In these patients, the fungal infection generally progresses to chronic dissemination. Mucosal signs are frequent in this from but are rare in the case of cutaneous histoplasmosis. Itraconazole (200 mg/d) is indicated for 6 months. (AU)

Detection of oncogenic HPV DNA by a consensus polymerase chain reaction method in genital carcinomas in twenty women in Barbados

Paraffinized tissue from Barbadian women with histologically proven gential carcinoma was subjected to a consensus polymerase chain reaction method. Nineteen patients had cervical and one, vaginal carcinoma. The histological types were 17 squamous cell carcinoma, 2 adenocarcinoma and 1 adenosquamous carcinoma. HPVDNA was detected in 18/20 (90 percent). HPVDNA type 16 in 13 (65 percent), type 33 and type 45 in 1 (5 percent) each and 3 (15 percent) could not be typed. HPVDNA, type 16, was detected in one (50 percent) of the two cases of adenocarcinoma and 12/17 (71 percent) cases of squamous cell carcinoma. DNAHPV, type 33, and type 45 were each detected in 1/17 (6 percent) cases of squamous cell carcinoma. No HPVDNA, type 18, was detected (AU)

Radical vulvectomy: a 21 year review

The factors surrounding patients subjected to radical vulvectomy were examined. Most patients were over the age of 40 years. The standard butterfly incision was used in all but 2 cases. The histology in all cases was invasive squamous cell carcinoma. The main complications were primary haemorrhage, urinary tract infection and wound dehiscence. The mean hospital stay was 50 days and the mortality rate was 4 percent. (AU)

Adenosquamous carcinoma of the stomach with a note of pathogenesis

A case of the rare adenosquamous carcinoma of the stomach is presented. This unusual type of stomach tumor is the first such case to be reported in Jamaica and in the Commonwealth Caribbean. We provide evidence in support of the metaplastic derivation of the squamous component from an existing adenocarcinoma. (AU)

Pseudosarcoma (spindle cell variant of squamous cell carcinoma) of the larynx

Pseudosarcoma of the larynx is reported in a 50-year-old man. With the use of special stains and light microscopy, the tumour was identified as a spindle cell variant of squamous cell carcinoma. The histogenesis of the tumour is discussed (AU)

Antibodies to herpes simplex virus (types 1 and 2) in Jamaican patients with cervical dysplasia and neoplasia

Antibody activity to Herpes simplex virus (HSV) types 1 and 2 was measured in sera from women with cervical dysplasia (19 cases), squamous-cell carcinoma, stages 0-4 (54 cases), other genital tumours (15 cases) and matched controls (60 cases) by the indirect immunofluorescent (IFA) test. The frequency of HSV-2 antibody activity was significantly greater in women with cervical cancer than in those with other genital tumours and in matched controls (p<0.05). No significant difference was observed for the HSV-2 antibody activity between women with cervical dysplasia and matched controls. The mean antibody titres to HSV-1 and HSV-2 were significantly higher in cancer cases than the respective titres in control groups (p<0.05). The cervical cancer cases were also analysed according to their clinical stage (Stages 0-4), and there was no significant variation either in frequency of antibody activity, or mean HSV-2 antibody titres. These preliminary findings suggest that there may be an association between HSV-2 and squamous cell carcinoma of uterine cervix in Jamaican women but further studies are required for meaningful conclusions to be drawn (AU)

Vulvar carcinoma in premenopausal Jamaican women

Between the years 1958 and 1973, 119 patients with primary invasive cancer of the vulva were treated at the University Hospital of the West Indies, Jamaica. Seventy-seven (64.7 percent) were premenopausal women. Because the pattern of the disease differed from that in late middle and older aged Jamaican women, the results of the disease are presented. The analysis stresses that vulvar carcinoma before menopause in our community is rare in the absence of various sexually transmitted granulomatous diseases of the vulva (AU)

Epidemiology of cancer of the uterine cervix in Jamaica

The aetiology of carcinoma of the cervix uteri has been investigated in a retrospective interview study of patients with histologically diagnosed lesions, and suitably selected controls. Both groups were comprised of predominantly Negroes of low socio-economic status. There was significant association with early age at first coitus, early and multiple pregnancies, and promiscuity. The factors of male circumcision and sexual hygiene could not be evaluated because of unreliable information. Environmental influences seem to be largely responsible for the high incidence of the condition in Jamaica. It is hoped that, with the detection of further cases, it would be possible to compare the epidemiology in various ethnic groups and in different social classes (AU)

Aspects of lung cancer in Jamaica

The incidence of lung cancer in the approximately one- half million population living in the parish of Kingston and St. Andrew of Jamaica- a tropical developing country- has been investigated for the years 1958-1970 inclusive. When compared- on an age standardized basis- with figures published fr om other areas, Jamaica's figures appear to be substantially above those from Africa, but much lower than those from Britain and the United States (table 12). The incidence appears to be rising both in males and females (fig.1, table 12). Clinical and pathologic data on 105 cases of lung cancer were obtained through the postmortem and surgical pathology services of the University Hospital of the West Indies, a 500-bed general hospital. The three main histologic types were equally represented at postmortem, but the squamous carcinoma type was more frequently seen in the surgical pathology material. The patients had an inadequate follow-up and were small in number, the data, therefore, did not allow an evaluation of the use of the W.H.O. histologic classification as to its prognostic significance. The duration of symptoms from onset to death or operation was gene rally less than 6 months (AU)

Carcinoma of the pharynx in a 10-year-old Jamaican boy

A case of hypopharyngeal carcinoma developing in a ten-year-old Jamaican boy is presented. This is the youngest case of hypopharyngeal carcinoma by many years to be reported as far as can be determined from the available literature. The possible aetiological factors responsible for a cancer developing in one so young and the failure to find involvement of the regional lymphatic system with tumour cells is discussed. The relationship of cancer developing in the unaffected twin of a pair of mono- or dizygotic twins is also examined (AU)

An island-wide screening program for cervical neoplasia in Barbados

In an attempt to develop a cervical cancer screening program applicable to nonindustrialized nations, an island wide project was undertaken in Barbados, West Indies, utilizing paramedical personnel and existing health facilities. Among the first 5,000 women screened, 0.5 percent were found to have invasive carcinoma, 0.8 percent carcinoma in situ, and 4.2 percent dysplasia. The results of this project suggest that directing a screening program at those women who are undergoing a reproductive event is an efficient, effective, and relatively inexpensive method of detecting cervical neoplasia. (AU)

Cancer of the bladder in Jamaica

The pattern of carcinoma of the bladder in Jamaica is presented. The high incidence squamous carcinoma in both sexes is discussed together with possible etiological factors. The incidence of urethral stricture in association with carcinoma is given (Summary)

Carcinoma of the urinary bladder in Jamaica

Seven cases of benign papilloma and 25 cases of carcinoma of the urinary bladder seen in the University College Hospital of the West Indies between 1953 and 1960 are reviewed. Benign papilloma of the urinary bladder is relatively uncommon in Jamaica. A high incidence of squamous cell carcinoma situated away from the base of the bladder, and often associated with stricture of the urethra is noted. Early diagnosis of these lesions should be possible with consequent improvement in the length of survival after radical surgery. The use of a rectal bladder (with a perineal colostomy) is suggested as a substitute for the excised bladder. In hospital practice, this operation has certain advantages over either the use of the intact rectum as a receptacle for the urine or of an isolated ileal loop as a urinary conduit

Squamous cell carcinoma arising in discoid lupus erythematosus

A case of "carcinoma erythematosum" is reported. One would expect this complication of lupus erythematosus to be more common in Jamaica. The literature is reviewed (Summary)