Ciliated bodies in gynecologic cytopathology: parasite or cellular debris?

Ciliated bodies, similar to the ones described originally by Gaudefroy and Coliche, were discovered in fluid from an ovarian cyst and fluid in the Douglas pouch. These were reproduced experimentally by mucosal scraping of Fallopian tubes. In fact, they were of cellular origin from desquamation of the ciliated apical portion of columnar cells.

[Prostatic carcinoma: cytopuncture. Technic, cytological aspects, diagnostic value]. / Carcinomes prostatiques: cytoponction. Technique, aspects cytologiques, intérêt diagnostique.

Transrectal fine needle aspiration of the prostate is an excellent method of diagnostic approach. The simplicity of its application and its reliability in the positive cases make it particularly valuable. Therefore, this method should be used more currently as diagnostic tool in prostatic carcinoma.

[Is the Tru-Cut needle more efficient than the fine needle in the diagnosis of hepatic lesions? Comparative study of 45 echography-guided punctures]. / L'aiguille Tru-Cut est-elle plus efficace que l'aiguille fine dans le diagnostic des lésions hépatiques? Etude comparative de 45 ponctions guidées par l'échographie.

A comparison of diagnostic efficiency of fine needle biopsy (22 G) versus coarse needle biopsy (Tru-Cut 14 G) was performed on ultrasound-guided liver biopsies in 45 patients. Diagnosis was established through clinical, paraclinical and pathologic features. For each patient pathologic examination of both fine needle biopsy (cytology and histology) and coarse needle biopsy (histology) were performed by a pathologist unaware of any clinical data. Of 36 malignant tumors, diagnosis of malignancy was made in 83 percent of the cases by fine needle biopsy and in 81 percent of the cases by Tru-Cut biopsy, and distinction between primary and secondary cancer, in 83 and 86 percent of cases respectively. Specificity was 100 percent with both techniques. Of 9 benign lesions, the 6 focalized fatty infiltrations were diagnosed by both fine and coarse needle biopsies. As fine needle biopsy is less invasive than coarse needle biopsy and gave equally satisfying results, we suggest that it should be used preferentially in the diagnosis of focalized liver lesions.

[Liquid phase cytology in the primary screening for cervical cancer: a multicenter study]. / Cytologie en phase liquide dans le cadre du dépistage primaire du cancer du col utérin: une étude multicentrique.

The aim of this six-centre, split-sample study was to compare ThinPrep fluid-based cytology to the conventional Papanicolaou smear. Six Cytopathology laboratories and 35 Gynaecologists participated. 5428 patients met the inclusion criteria. Each cervical sample was used first to prepare a conventional Pap smear, then the sampling device was rinsed into a PreservCyt vial, and a ThinPrep slide was made. Screening of slide pairs was blinded. On initial screening, 29% more ASCUS and 39% more low-grade squamous intraepithelial lesions (LSIL) and more severe lesions (LSIL+) were detected on the ThinPrep slides than on the conventional smears (p = 0.001). Independent and consensus review confirmed 145 LSIL + diagnoses; of these, 18% more had been detected initially on the ThinPrep slides than on the conventional smears (p = 0.041). The ThinPrep Pap Test is more accurate than the conventional Pap Test and has the potential to optimize the effectiveness of primary cervical cancer screening.

[Guidelines for the evaluation of internal quality control of smears for screening of uterine cancer in France in the structures of Pathologic Anatomy and Cytology. French Association for Quality Assurance in Pathologic Anatomy and Cytology (AFAQAP)--Commission for cervical smears]. / Recommandations pour l'évaluation de qualité interne des frottis de dépistage du cancer du col utérin en France dans les structures d'Anatomie et Cytologie Pathologiques. Association Française pour l'Assurance de Qualité en Anatomie et Cytologie Pathologiques (AFAQAP)-Commission Frottis du col utérin.

A national organized mass-screening effective programme is the only way to reduce the risk of cervical cancer, if properly organized and correlated with a system of Quality Assurance. Since 1900, an Association for Quality Assurance was created by the French pathologists, named "AFAQAP". These pathologists thus demonstrated their interest in this kind of action that should be effective if women and clinicians are also implied. The pathologists have concluded the first part of their programme with these French guidelines for internal quality control of pap smears.

[Systematic cytological examination of discharges from the breast in young women. The value of screening for cancer of the breast and for borderline states (author's transl)]. / L'examen cytologique systématique de l'écoulement du sein chez la femme jeune. Intérêt dans le dépistage du cancer du sein et des états frontières.

The authors have used the cytological investigation of the liquid discharge from the breast to search systematically for cancerous states and, more usually, for borderline conditions in the breast. Using a simple technique it has been possible to obtain some discharge from the breast more or less easily. In 15 per 1000 cases cytological abnormalities have been found, which means that there were 39 pathological discharges in the 2490 women who were examined over five years. 27 of these were benign lesions and 12 of them were suspect. Of these latter three borderline conditions were found and one invasive cancer was found. All four were asymptomatic. It is therefore worth while examining discharges from the breast in screening for borderline conditions in young women.

A model for quality assessment in cervical cytology used as a screening test.

Although many reliability studies on cervical cytology have been carried out, measurements of sensitivity and specificity have rarely been made since biopsies are not often performed on patients with a negative smear result. This screening assessment was performed over 3 years, using a database of 230,167 smears from 177,051 women. It would seem that cervical cytology has a high specificity (over 99%) but a relatively low sensitivity (61%). Values for sensitivity (exceeding 95%) and specificity (exceeding 99%) for invasive carcinoma should be regarded as reasonably accurate as all incident cases of symptomatic cervical carcinoma are recorded in the Burgundy register. The sensitivity (57%) for pre-invasive lesions is underestimated while their prevalence is overestimated: the lack of organized screening leads to the loss of prevalent cases. The predictive value of a positive smear is 76% for moderate-severe dysplasia, 85% for in situ carcinoma and over 95% for invasive carcinoma.

[Fibroadenoma and phyllode tumors. Cytopathological aspect]. / Fibro-adénomes et tumeurs phyllodes. Approche cytopathologique.

Fibro-adenomas and phyllode tumors of the breast are a classical cause of errors in cyto-diagnosis. On the basis of six personal cases, the authors show that the cytological diagnosis of fibro-adenoma is possible and that there are certain minimal factors which favourise the presence of a phyllode tumour. They emphasize the differential characteristics between fibro-adenomas and carcinomas on the one hand, and between fibro-adenomas and mastitis on the other hand.

[New trends in the cytodiagnosis of bronchial carcinoma (author's transl)]. / Nouvelles orientations du cytodiagnostic des cancers bronchiques.

Cytological examination of the sputum is nowadays mainly used for mass surveys among high-risk populations and in suspicious cases with normal X-ray films. In all other cases, bronchial brushing and percutaneous puncture-biopsy of the lung are preferred, being much more reliable. Several new bronchial cytology techniques have recently been developed but are not yet widely used. Their respective indications are governed by the facilities available and by the volume, site and characteristic features of the tumour.

[Multiple paragangliomas of the neck localized in the thyroid region. Papillary thyroid cancer associated with parathyroid adenoma]. / Paragangliomes multiples du cou avec localisation thyroïdienne. Cancer papillaire thyroïdien et adénome parathyroïdien associés.

A 58 years-old woman has had a goiter for many years. She was treated by neck irradiation for "lymphadenopathy" 20 years-ago. She is now operated on for bilateral carotid body paragangliomas and a similar tumor of the thyroid gland near the midline. She also presents a papillary carcinoma of the left thyroid lobe with lymph node metastasis and a chief-cell parathyroid adenoma. The diagnosis of thyroid paraganglioma is discussed. Then the authors raise the hypothesis of radiation-induced papillary carcinoma. They try to set a link between thyroid tumors and parathyroid adenoma.

[Bilateral breast localization of Kahler's disease: cytological and histological aspects]. / Localisation mammaire bilatérale d'une maladie de Kahler: aspects cytologiques et histologiques.

Breast localisation of multiple myeloma is quite unfrequent. In one case of a 69 years old man, the diagnosis was suspected by a cytological aspiration biopsy of the lesion, and later confirmed by histological and biological investigations. The analysis of the literature has enabled the authors to gather 7 other cases and to describe the characters of this peculiar tumoral localisation. The breast involvement is mostly observed in women. The average is 38 years old. Only 2 cases deal with men, both treated with estrogens. The lesion is usually bilateral and nearly always associated with other visceral and bone localisations. It is not modified by chemiotherapy and appears shortly before death.

[9 years of systematic cytologic examinations of expressed galactophorous discharge. Detection of cancerous and precancerous conditions]. / Neuf ans d'examens cytologiques systématiques d'écoulements galactophoriques provoqués. Dépistage des états précancéreux et cancéreux.

Nine years of experience performing cytologic examinations on expressed breast discharge has enabled the identification of precancerous and cancerous conditions of the breast. Three thousand women were monitored. The only abnormal findings were cytologic (clinical and radiological examinations were normal). One case of atypical hyperplasia, 3 cases of cancer in situ, and 2 invasive cancers were identified upon histologic examination. Three women were lost to follow-up and subsequently developed invasive cancer.

Quality assessment of cervical screening: a population-based case-control study in the C te-D'Or region, France.

Our objectives were to evaluate the effectiveness of cervical cancer screening outside organized programs in the prevention of cervical carcinoma in situ (CIS) and to enhance the way in which case control studies avoid some common biases. In our case-control study, we assessed all incident, histologically verified cases of CIS registered from 1987 to 1997 in the population-based cancer registry of C te-d'Or, France (N = 104) and 208 controls randomly selected from the screened population and matched for age, date of last screening, residence, and pathology laboratory results. We considered as appropriate for controls screened women who had had at least one Papanicolaou smear in the 3 years preceding the diagnosis or similar period. Screening for controls was higher (67.8%) than for cases (41.4%; P < .001), with a relative protection against CIS of 3.09 (95% confidence interval, 1.83-5.22) and a prevented fraction in the screened population of 45% to 50%. These findings suggest a protective advantage for CIS even in the absence of organized screening. The methodologic approach has advantages as compared to previous types of case-control studies. Although further refinements still are warranted, learning about the protective effect of screening for CIS provides information that may be useful in assessing the impact of a screening policy on women actually at risk of invasive cervical cancer.

[The "white" cervix: a new anatomo-clinical entity?]. / Le col "blanc": nouvelle entité anatomoclinique?

The authors describe a very particular histologic pattern of the cervical epithelium. Many types of histologic lesions are involved and are almost always found in association one with another. This particular histologic pattern is characterized principally by well-differentiated epithelium, immature, with early necrosis of the superficial layers, associated with metaplastic endocervicitis. In addition to this particular association, there is a remarkable finding: this histologic pattern was found consistently in fifteen cases selected uniquely from their appearance at colposcopy. Could this be a new anatomic-histologic entity?

Liquid-based cytology for primary cervical cancer screening: a multi-centre study.

The aim of this six-centre, split-sample study was to compare ThinPrep fluid-based cytology to the conventional Papanicolaou smear. Six cytopathology laboratories and 35 gynaecologists participated. 5428 patients met the inclusion criteria (age > 18 years old, intact cervix, informed consent). Each cervical sample was used first to prepare a conventional Pap smear, then the sampling device was rinsed into a PreservCyt vial, and a ThinPrep slide was made. Screening of slide pairs was blinded (n = 5428). All non-negative concordant cases (n = 101), all non-concordant cases (n = 206), and a 5% random sample of concordant negative cases (n = 272) underwent review by one independent pathologist then by the panel of 6 investigators. Initial (blinded) screening results for ThinPrep and conventional smears were correlated. Initial diagnoses were correlated with consensus cytological diagnoses. Differences in disease detection were evaluated using McNemar's test. On initial screening, 29% more ASCUS cases and 39% more low-grade squamous intraepithelial lesions (LSIL) and more severe lesions (LSIL+) were detected on the ThinPrep slides than on the conventional smears (P = 0.001), including 50% more LSIL and 18% more high-grade SIL (HSIL). The ASCUS:SIL ratio was lower for the ThinPrep method (115:132 = 0.87:1) than for the conventional smear method (89:94 = 0.95:1). The same trend was observed for the ASCUS/AGUS:LSIL ratio. Independent and consensus review confirmed 145 LSIL+ diagnoses; of these, 18% more had been detected initially on the ThinPrep slides than on the conventional smears (P = 0.041). The ThinPrep Pap Test is more accurate than the conventional Pap test and has the potential to optimize the effectiveness of primary cervical cancer screening.

[Mucinous adenocarcinomas of the scalp. Anatomo-clinical, histochemical and ultrastructural study of a case and a review of the literature]. / L'adénocarcinome mucineux du cuir chevelu. Etude anatomo-clinique, histochimique et ultra-structurale d'un cas et revue de la littérature.

The third recurrence of a primary mucinous adenocarcinoma of the right parietal scalp was studied by histochemistry and electron microscopy. Histochemically the mucin produced by this neoplasm was of the sialomucine type. Electron microscopy revealed a high differentiated tumour whose cells looked like eccrine mucinous ones. The natural history of this carcinoma is similar to that of 33 ones already published. The tumours, round and elevated, grow in 75 p. 100 of the cases in patients over 50 years of age. They are located on the face or the scalp and more rarely on the trunk. Such tumours are frequently misdiagnosed as carcinomas. But the knowledge of thier morphological and histochemical features should lead to the right diagnosis all the more since the various biological and radiological investigations do not discover other primary neoplasm. Besides if these neoplasms are not metastases they are quite different from the other sweat gland carcinomas. They have a better prognosis than these tumours. However they give local recurrences, lymph node or subcutaneous metastases and a fatal issue in 6 p. 100 of the cases.