Watery diarrhoea: an unusual manifestation of breast cancer.

Analysis of an 83-year-old male presenting with diarrhoea showed secretory diarrhoea. serum levels of gastrin and pancreatic polypeptide were elevated. Somatostatin-receptor scintigraphy revealed a hot spot in the left thoracic wall and subsequently, breast adenocarcinoma with neuroendocrine differentiation was diagnosed. Postoperatively, the patient made an uneventful recovery. The relationship between the clinical picture, the results of pathological examination and hormonal analysis is discussed and put into perspective.

[Participation in the Dutch national screening programme for uterine cervic cancer higher after invitation by a general practitioner, especially in groups with a traditional low level of attendance]. / Opkomst bij bevolkingsonderzoek naar baarmoederhalskanker hoger na uitnodiging door de huisarts, in het bijzonder voor groepen met doorgaans lage participatiegraad.

OBJECTIVE: To gain insight into the differences in participation in the screening programme for uterine cervix cancer between women invited by a general practitioner (GP) and women invited by the local health authority (GGD). Specific attention was given to those groups whose participation is generally below average. DESIGN: Descriptive epidemiological study. METHOD: In the period 2000-2003, 237,719 women (30-60 years of age) were invited to participate in the national uterine cervix cancer screening programme in the Southwest of the Netherlands; 37.1% of the women were invited by the GP and 62.9% by the GGD. Data were obtained from the Cervix Information System of the GGDs. Differences in attendance between those invited by the GP and those invited by the GGD were tested by linear regression. Participation was defined as the number of women for whom the result of a cervical smear was known, divided by the number invited. RESULTS: Invitation by a GP led to a 7.9% (95% CI: 7.5-8.3) higher attendance rate than invitation by a GGD. This difference in attendance was higher for women born in Morocco, Turkey, Surinam and the Netherlands Antilles/Aruba (17.2%; 95% CI: 15.2-I9.2), young women (11.9%; 95% CI: 10.8-13.0), women with a low socio-economic status (11.6%; 95% CI: 10.4-12.7), and women who lived in highly urban areas (13.0%; 95% CI: 12.3-13.6). The differences were the greatest among non-western women who were also part of another low-attendance group: 19.0% (95% CI: 16.7-21.2) for women who lived in highly urban areas and 20.8% (95% CI: 16.8-24.9) for those in the youngest age group.

How to improve cytologic screening for endocervical adenocarcinoma?

AIM: A retrospective study was undertaken to investigate how to improve the diagnosis of endocervical adenocarcinoma in screening programs. MATERIAL AND METHODS: The study group consisted of 29 slides of women diagnosed with cancer but who had negative smears. The slides were subdivided in 12 smears taken less than one year before diagnosis by histology and 17 smears taken between one and 10 years prior to diagnosis. A hundred smears of healthy women were used for comparison. All smears were studied macroscopically after which both groups of smears were scanned by the Neural Network Scanner (NNS). Differences between groups were studied for statistical significance using Pearson's Chi-squared test. FINDINGS: The macroscopic parameter of these smears found to be present most frequently was a heavy admixture of blood. The presence of blood (lysed or not) in the smears was equally consistently highlighted by the NNS. Statistical significance of the association of this parameter, with the presence of cancer, was demonstrated. CONCLUSION: The awareness of blood as a background feature of adenocarcinoma of the cervix will help to select cases needing special attention. These difficult bloody smears, studied by light microscopy and by NNS images can also be selected for additional MiB-1 staining. With this approach, blood in smears, otherwise frequently leading to a compromise of classification, can become a blessing in disguise. The diagnosis of endocervical adenocarcinoma in screening smears will therefore be improved.

Splenectomy-induced long-term remission in a patient with multicentric Castleman's disease.

Castleman's disease (CD) is a rare lymphoproliferative disorder with a poorly understood pathogenesis. Multicentric CD can progress in different patterns, none of which can be cured with the current treatment options. We present a patient with multicentric CD in complete remission, eight years after a splenectomy without any other systemic treatment. We discuss the possible mechanism causing this long episode of complete remission in this patient.