Is Endocervical Glandular Involvement Related to The Depth of Cone Biopsy?

Introduction. This study aimed to determine whether endocervical glandular involvement by squamous intraepithelial lesion would differ with respect to the depth of the excised specimen and analyze the related factors that may define endocervical glandular involvement among cases treated with cone biopsy. Methods. Between April 2016 and December 2018, women who underwent colposcopy and excisional procedures in the department of gynecologic oncology were retrospectively investigated. Patients with multiple specimens, or whose specimen depths were not measured, and a negative/unknown HPV status were excluded from the study. Also, patients with no dysplasia or microinvasive/invasive cancer in the final pathology report and those who had not undergone endocervical curettage during colposcopy were excluded. HPV genotypes, degree of dysplasia, surgical margin status, and specimen depth were documented from medical records. Further, the association of these factors with endocervical glandular involvement was evaluated. Results: A total of 321 patients who fulfilled the criteria were included in the study, with a mean age of 41.9 years. In total, 101 patients (31.5%) had endocervical glandular involvement. The mean excised specimen depth was 17.04 mm; 17.9 and 16.7 mm for the positive and negative glandular involvement groups, respectively (p = .13). The mean ages were 42.7 and 41.6 years for these groups, respectively (p = .32). There was no association between the HPV genotypes and glandular involvement. Conclusions: Endocervical glandular involvement is not associated with the depth of the excised specimen. A deeper cone biopsy may not necessarily enable a more effective treatment of the disease.

Clinical Significance of Endometrial Cells in Pap Smear of Women Aged 40 Years and Older.

OBJECTIVE: To investigate the histopathological follow-up results in women diagnosed with endometrial cells in the Papanicolaou (Pap) test. MATERIAL AND METHOD: Between January 2013 to December 2018, women with endometrial cells on the Pap test were searched from the hospital electronic database. The patients with endometrial cells on the Pap test who underwent further histopathological evaluation and who were followed-up for at least 1 year were enrolled in the study, while those who had a Pap test result other than endometrial cells, were lost during follow-up, or had missing data were excluded. RESULTS: Out of 91,142 Pap smears, 121 (0.1%) cytologically had endometrial cells, and of those 65 cases were eligible for final analysis. The mean age of patients with premalignant/malignant lesions (57.7 ± 2.9) was higher than those with benign lesions (50.1 ± 0.7), with 77% of them in the postmenopausal period. Gynecologic premalignant/malignant lesions were detected in 9 (17.7%) patients including 2 (3.1%) endometrial hyperplasias and 7 (10.8%) endometrial cancers. The menopausal status (p=0.010) and being 50 years and older (p=0.002) were significantly associated with pre-neoplastic or neoplastic changes in patients with endometrial cells. CONCLUSION: The presence of endometrial cells in Pap tests may be a harbinger of endometrial pathologies, especially at the age of 50 years and over. The menopausal status is another possible determinant in detecting endometrial carcinoma. Further investigation may be suggested in women aged ≥50 years and postmenopausal in the event of endometrial cell detection.

Tumor diameter as a predictor of lymph node involvement in endometrioid type endometrial adenocarcinomas.

AIM: To analyze the risk factors of lymph node involvement in pure endometrioid type endometrial cancer and assess factors that necessitate lymphadenectomy. METHODS: Patients who had been operated on due to endometrial cancer and whose final pathology was reported as pure endometrioid carcinoma between January 2014 and January 2020 were assessed. Hysterectomy, bilateral salpingo-oophorectomy, and systematic lymphadenectomy were performed in all patients. All specimens were reported by expert gynecopathologists. RESULTS: The lymph node positivity rate was 14.4%. When the study population was classified according to the Mayo risk criteria; lymph node involvement in the low-risk and high-risk groups was 9.1% and 14.8%, respectively and there was no statistically difference (p > 0.05). The median of tumor size and the rate of deep myometrial invasion, lymphovascular space invasion, adnexal involvement, FIGO grade 3 tumor were found significantly higher in the positive lymph node group in univariate analysis. In the receiver operating characteristic curve analysis, the cut-off value of the tumor diameter was determined as 47.5 mm (sensitivity 85%, specificity 62%). Every 10 mm increase in tumor diameter increased the risk of lymph node involvement 10 times. CONCLUSION: This study defined that the tumor diameter is an independent predictor for lymphatic dissemination. In the future, it could be shown that even with new modeling based on tumor diameter, lymphadenectomy or adjuvant radiotherapy requirements would be reevaluated.

The meaning of high-risk HPV other than type 16/18 in women with negative cytology: Is it really safe to wait for 1 year?

BACKGROUND: Human papillomavirus (HPV) is a primary risk factor for cervical cancer. HPV 16 and 18 are the two most carcinogenic genotypes and have been reported in the majority of cervical cancer. High-risk HPVs (hrHPVs) other than HPV 16/18 cause approximately a quarter of cervical cancers. We aimed to present the colposcopy-guided biopsy results of non-16/18 hrHPV-infected women with negative cytology. METHODS: This is a retrospective cohort study conducted on 752 patients between the ages of 30-65 years with non-16/18 hrHPV and negative cytology undergoing colposcopy-guided biopsy at a tertiary gynecological cancer center between January-2016 and January-2019. RESULTS: The mean age of the women was 42.35±9.41 years. Cervical intraepithelial neoplasia (CIN) 2+ lesion was detected in 49 (6.5%) women with negative cytology. The rate of CIN 2+ lesions in women with abnormal cytology was 12.8%. Patients with abnormal cytology had about 2.1 and 2.4 times increased the odds of CIN 2+ lesion in cervical biopsy and endocervical curettage specimens, respectively. CIN 3+ lesion was detected in 20 (2.7%) women with negative cytology. One (0.1%) of the patients with HPV 39 and negative cytology had invasive cervical cancer. The two most common HPV subtypes were HPV 31 and HPV 51. CONCLUSIONS: The risk of cervical preinvasive lesions still can be detected and cannot be completely eliminated among hrHPV other than 16/18-infected women with negative cytology. Based on the results of this study, referral of non-16/18 hrHPV-infected women with negative cytology to colposcopy is supported as a credible and feasible strategy.

Factors Affecting the Histopathological Outcomes of Atypical Glandular Cells on Pap Test.

BACKGROUND: Glandular cell abnormalities may indicate the presence of pre-malignant or malignant lesions. AIM: This study aimed to investigate the relationship between atypical glandular cells (AGC) and patients' demographics, histopathological outcomes, Human Papillomavirus (HPV) test results. MATERIAL AND METHODS: Between January 2015 and December 2019, women with AGC on Pap tests were retrieved from the hospital electronic database. The patients with AGC on cervicovaginal smears who underwent further pathological, laboratory, and imaging diagnostic testing and who were followed up at least 1-year were included in the study, while those who had a history of cervical dysplasia or cancer, lost during follow-up, or had missing data were excluded. RESULTS: Of 85,692 Pap smears, 114 (0.13%) were diagnosed with AGC, of those 88 cases were eligible for final analysis. Gynecological malignancies were detected in 13 (14.8%) patients; including 6 (6.8%) endometrioid endometrial cancers, 3 (3.4%) non-endometrioid endometrial cancers, 2 (2.3%) cervical adenocarcinomas, 1 (1.1%) cervical squamous cell carcinoma, and 1 (1.1%) high-grade tubal serous cancer. Multivariate analysis revealed that presence of concomitant abnormal squamous lesion (P = 0.002), being 50 years and older (P = 0.028), HPV positivity (P < 0.001), and menopause (P = 0.023) were risk factors for significant pathology. CONCLUSION: The diagnosis of AGC may be related to the preneoplastic/neoplastic processes. A further comprehensive histopathological examination is required in women with AGC, aged 50 years and older, postmenopausal, HPV-positivity and concomitant squamous cell abnormality Clinicians should consider ovarian pathologies when there is no pathological finding on endometrial or cervical histopathological examination.

Is cervical cytology testing as a part of co-test unnecessary for HPV 16/18-infected women? A retrospective cohort study of 1647 women.

BACKGROUND: We aimed to present the biopsy results of women with HPV 16/18 infection and investigate whether cytology is necessary as a part of routine cervical cancer screening in women with HPV 16/18. METHODS: This is a retrospective cohort study conducted on 1647 patients between the ages of 30 and 65 years with HPV 16/18 undergoing colposcopy-guided biopsy at a tertiary gynecological cancer center between January-2016 and January-2019. We compared the preinvasive lesion rates and the invasive cervical cancer rates of women with HPV 16/18 between the negative and the abnormal cytology group. RESULTS: Of the 1647 women, 1105 (67.1%) had negative cytology and 542 (32.9%) had abnormal cytology. Among women with initial negative cytology, cervical intraepithelial neoplasia (CIN) 2+ lesion was detected in 205 (18.6%) women. The rate of CIN 2+ lesion in women with abnormal cytology was 28%. There was a significant difference between negative and abnormal cytology group in terms of CIN 2+ lesion rates (P < .001). Among women with initial negative cytology, invasive cervical cancer was detected in 6 (0.5%) women. The rate of invasive cervical cancer in women with abnormal cytology was 8 (1.5%). There was no significant difference between negative and abnormal cytology group in terms of invasive cervical cancer rates (P = .082). CONCLUSIONS: The rate of cervical cancer among HPV 16/18-infected women with negative cytology is similar to women with abnormal cytology. Based on the results of this study, Pap testing could be unnecessary in HPV 16/18-infected women to diagnose invasive cervical cancer who will undergo colposcopy biopsy.

Expression of androgen, estrogen, and progesterone hormone receptors in the penile tissues of children with different types of hypospadias.

OBJECTIVE: Androgen (AR), Estrogen (ER) and Progesterone (PR) hormones play an important role in the prenatal and postnatal development of urogenital tract and especially the penis. The expressions of AR, ER and PR receptors in penile tissues in children with hypospadiases had also been shown previously. In this leading study, to demonstrate of the sex hormone receptor expression in cases with different types of hypospadias were aimed. METHODS: This study was designed in children operated due to hypospadiases without DSD. Biopsy samples of 3 mm's were obtained from three different sytes as the lateral parameatal tissue and the anterior corner of the prepuce, and inner layer of posterior prepuce. The presence of AR, ER and PR receptors was investigated immunehistochemically. RESULTS: Mean age was 5.4 years in 18 children with hypospadiases; in totally 33 specimens were taken in 5 subcoronal as 5 specimens, and 7 penile as 15 specimens, and 6 penoscrotal as 13 specimens. According to sytes of samples; 13 samples were from lateral para-meatal tissues, and 13 were from anterior corners of prepuces, and 7 were from inner layers of posterior prepuces. In regard to receptor expression; ER and AR receptors were positive in 29 (87.8%) and 12 (36.4%) respectively; PR receptors were negative. CONCLUSION: This study emphasized the dominant expression of estrogen receptors in penile tissues of children with hypospadias. Although there was not a manifest correlation of androgen receptors absence in regard to the severity of hypospadias patients, there was a marked estrogen receptors presence in penile tissues. These findings suggest that the disrupted androgen and estrogen receptor interaction and/or balance could play a role during the development of external genitalia in hypospadias patients. Progesterone receptor was not present and therefore the active role in the postnatal development of hypospadias is still debatable.

What does the Data of 354,725 Patients from Turkey Tell Us About Cervical Smear Epithelial Cell Abnormalities? - The Epithelial Cell Abnormality Rate is Increasing - Quality Control Studies and Corrective Activity are Musts.

OBJECTIVE: There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories. MATERIAL AND METHOD: In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire. RESULTS: The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells /Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers. CONCLUSION: There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.

Prenatal diagnosis and outcomes of fetal teratomas.

PURPOSE: Our aim was to evaluate the diagnostic performance of ultrasonography (US) in the prenatal identification of teratomas and the perinatal outcome of the fetuses with those teratomas. METHODS: In this retrospective case series study, we searched the archives using the keywords "fetal mass" or "fetal tumor" or "fetal teratoma" and "sacrococcygeal teratoma," diagnosed between 2009 and 2014, within the US database of our center. RESULTS: One hundred seven fetuses were prenatally diagnosed as having a cystic or solid mass, tumor, or teratoma. Nineteen of those cases were diagnosed prenatally as having fetal teratoma, but that diagnosis could not be verified in three cases. In one fetus, the prenatal diagnosis could not be confirmed. The sensitivity of US in identifying fetal teratoma was 100% and the false-positive rate, 3.3%. Six pregnancies complicated by a fetal teratoma were terminated. A normal karyotype was identified in all fetuses that underwent karyotyping. Among the nine women who continued their pregnancy, polyhydramnios was identified in four fetuses; although high-output heart failure was also identified in two of those fetuses during prenatal follow-up, none developed hydrops. On delivery, nine infants were born alive, but three (33.3%) of them died within the early neonatal period. CONCLUSIONS: US has very high sensitivity and low false-positive rates in identifying fetal teratoma prenatally. The risk of chromosomal abnormalities is very low in fetuses with teratoma, and their prognosis depends on the location and size of the tumor and any associated perinatal complications.

The EXIT for Prenatally Diagnosed Cervical Cystic Teratoma: A Case Report.

The Ex-utero intrapartum treatment (EXIT) is a procedure performed during caesarean section while on fetal-placental circulation. We present a prenatally diagnosed cervical cystic mass causing tracheal compression which was managed successfully with the EXIT procedure.

Pure gonadal dysgenesis (Swyer syndrome) due to microdeletion in the SRY gene: a case report.

46,XY complete gonadal dysgenesis (Swyer syndrome) is a rare cause of disorder of sexual development. This syndrome is caused by a defect in the determination of sex during embryogenesis and is characterised with female external genitalia, normal or rudimentary uterus, and streak gonads, despite the presence of the 46,XY karyotype. Most of the studied cases presented with leak of secondary sex characteristics and primary amenorrhea during adolescence. Laboratory findings reveal hypergonadotropic hypogonadism. Herein we present the case of a female with a 46,XY karyotype who was admitted with delayed puberty and detected to have a microdeletion in the SRY gene and diagnosed to have Swyer syndrome. We highlight the importance of karyotype analysis in patients with delayed puberty and primary amenorrhea. Once the diagnosis of 46,XY complete gonadal dysgenesis is established, early laparoscopic removal of the dysgenetic gonads is crucial to prevent the development of gonadal malignancy.

Testicular cavernous hemangioma presenting as an ipsilateral lesion in a child with multicystic dysplastic kidney.

Childhood malignant testicle tumors are very rare. In the literature to date, it has been reported that there are only 24 cavernous hemangioma cases existing in English literature. In this study, we discuss a testicular mass case which was diagnosed as cavernous hemangioma. The patient, who followed for left multicystic dysplastic kidney since his birth, was admitted to our clinic with complaints of left testicular mass and pain at 1-year of age. Histopathological investigation revealed cavernous hemagioma. Even if it has its characteristic ultrasonographic findings, radiology is too far beyond to eliminate the malignancy, final diagnosis can only be made after orchiectomy.

Clinico-pathological significance of extra-nodal spread in special types of breast cancer.

OBJECTIVE: To investigate the significance of extra-nodal spread in special histological sub-types of breast cancer and the relationship of such spread with prognostic parameters. METHODS: A total of 303 breast cancer cases were classified according to tumor type, and each tumor group was subdivided according to age, tumor diameter, lymph node metastasis, extra-nodal spread, vein invasion in the adjacent soft tissue, distant metastasis, and immunohistochemical characteristics [estrogen receptor (ER), progesterone receptor (PR) existence, p53, c-erbB-2, and proliferative rate (Ki-67)]. The 122 cases with extra-nodal spread were clinically followed up. RESULTS: An extra-nodal spread was observed in 40% (122 cases) of the 303 breast cancer cases. The spread most frequently presented in micro papillary carcinoma histological sub-type (40 cases, 75%), but least frequently presents in mucinous carcinoma (2 cases, 8%). Patients with extra-nodal spread had a high average number of metastatic lymph nodes (8.3) and a high distant metastasis rate (38 cases, 31%) compared with patients without extra-nodal spread. CONCLUSION: The existence of extra-nodal spread in the examined breast cancer sub-types has predictive value in forecasting the number of metastatic lymph nodes and the disease prognosis.

Is cervical punch biopsy enough for the management of low-grade cervical intraepithelial neoplasia?

OBJECTIVE: This study aimed to analyze the correlation between the histopathologic results of excisional procedure and cervical punch biopsy and to investigate the accuracy rates of colposcopic punch biopsy and cervical cytology to detect cervical intraepithelial neoplasia (CIN) grade 2 and/or more severe lesions (CIN 2+). MATERIALS AND METHODS: Two hundred six patients who underwent excisional procedure in the gynecologic oncology clinic of the Zeynep Kamil Women and Children Diseases Education and Research Hospital between 2004 and 2011 were enrolled in a retrospective study. RESULTS: The correlation between the pathologic findings gained by excisional procedure and punch biopsy was weak ( p = .0001, κ = 0.03). The overall concordance rate between the pathologic findings of cervical biopsy and excisional procedure was 57.29%. The rates of detecting more severe lesions by excisional procedure when compared to biopsies (biopsy underestimation) were 71.42%, 22.91%, 37.03%, and 12.72% for biopsy results with negative, CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. Similarly, the rates of less severe lesions diagnosed by excisional procedure when compared to biopsies (biopsy overestimation) were 29.16%, 40.74%, and 15.45% for biopsy results with CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. The rate of CIN 2+ lesions after excisional procedure in cases with previous biopsy results with either negative or CIN 1 was 27.27%. CONCLUSIONS: Our results suggested that colposcopy-directed biopsy was neither a good diagnostic nor a reliable management method. We think that the indications of conization should be enlarged to avoid overlooking high-grade lesions.

A case report: angiomatoid fibrous histiocytoma in a 6-year-old male and review of the literature.

Angiomatoid Fibrous Histiocytoma (AFH) is a distinctive tumor in children, adolescent and young adults which is slow growing with metastatic potential. The histogenesis of AFH is uncertain. Here, we present a case of AFH of 6-year-old on the trunk. In addition, the differential diagnosis for this lesion is also discussed.

Significance of foamy histiocytes in cervical smears from postmenopausal women.

OBJECTIVE: To determine the significance of the presence of foamy histiocytes (FH) in postmenopausal cervicovaginal smears for the detection of endometrial carcinomas (EC). STUDY DESIGN: Endometrial sampling was performed over 6 months in 53 of 102 cases that presented with postmenopausal FH, benign endometrial cells (BEC), FH with BEC (FH + BEC), and atypical endometrial cells (AEC), resulting in a total of 41,150 cervicovaginal smears. The control group consisted of 58 cases with a cytologic diagnosis of a normal smear (NS). RESULTS: There were 0 (0%), 1 (4.54%), 2 (13.33%), 2 (33.33%), and 5 (50.00%) cases of EC diagnosed on histopathologic evaluation in patients with NS (n = 58), BEC (n = 22), FH (n = 15), FH + BEC (n = 6), and AEC (n = 10), respectively. The sensitivities and specificities of the cytologic diagnoses of FH, FH + BEC, and AEC for the detection of EC were 81.7 and 100%, 93.6 and 100%, and 92.1 and 100%, respectively. CONCLUSION: The cytologic diagnoses of FH and FH + BEC had reasonably high sensitivities and specificities for the diagnosis of EC by cervicovaginal smear. Additional studies are needed.

Sclerosing stromal tumour in young women: clinicopathologic and immunohistochemical spectrum.

AIM: Sclerosing stromal tumor is a benign tumor of ovary. We aimed to review the clinical findings and immunohistochemical results of SSTs through the 7 diagnosed cases in our hospital. MATERIAL AND METHODS: As immunohistochemical, blocks were applied with estrogen receptor , progesterone receptor, inhibin, calretinin, melan-A, CD10, smooth muscle actin, desmine, vimentin, CD34, S-100, C-kit, cytokeratin , cytokeratin7. RESULTS: Macroscopically, while 5 tumors had solid appearance, 2 tumors were composed of solid and cystic areas. All the tumors were in shape of ovarian masses with good limits. Microscopically, two types of cells were observed as fusiform fibroblast-like cells and theca-like cells with vacuolised cytoplasm. Immunohistochemical results: vimentin, smooth muscle actin, desmine, progesterone receptor, calretinin, inhibin were positive in all the cases; S-100, cytokeratin, cytokeratin7, estrogen receptor were negative in all the cases; CD-10 was positive in 2 cases; C-kit was positive in 5 cases; melan-A was positive in 4 cases. CONCLUSIONS: The significance of these tumors is that it is necessary to distinguish the histopathology in the frozen section in order to protect the other adnexa because of the characteristics to be observed at early ages (2(nd) and 3(rd) decades). Our findings support the conclusion that sclerosing stromal tumors are benign-character tumors that stem from over stroma and are hormonally active tumors because of the detected clinical and immunohistochemical results, although no hormonal effect that could be supported with laboratory tests was observed.

Is the low-grade squamous intraepithelial lesion/atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion category associated with cervical intraepithelial neoplasia 2?

OBJECTIVE: A number of cervical smears may exhibit unequivocal low-grade squamous intraepithelial lesions (LSIL) in association with atypical cells cytomorphologically suspicious, but not sufficient to be interpreted as high-grade squamous intraepithelial lesions (HSIL). These lesions are presently called LSIL, atypical squamous cells cannot exclude HSIL (LSIL/ASC-H). Previous studies have shown that LSIL/ASC-H and ASC-H are both equivocal for HSIL and have a high risk of underlying HSIL. However, in researching the literature only two studies were found which rendered the results as cervical intraepithelial neoplasia (CIN) 2 and CIN3 separately. The purpose of this study was to compare the distribution of biopsy results for CIN2 and CIN3 in patients with ASC-H, HSIL, and LSIL/ASC-H. STUDY DESIGN: Between January 2005 and December 2011, cervicovaginal smears (98,594) with a diagnosis of ASC-H, LSIL, LSIL/ASC-H, or HSIL were re-evaluated to determine the prevalence of future lesion development. RESULTS: A total of 252 patients who had histologic follow-up within a year were selected. Among these, LSIL/ASC-H (31.7%) had the highest prevalence of CIN2 between LSIL (9.3%), ASC-H (10%), and HSIL (16%). All differences were statistically significant. CONCLUSION: Because of the high predictive value of CIN2, LSIL/ASC-H may have further importance, especially in women of different age groups.

Clinical significance of benign endometrial cells found in papanicolaou tests of Turkish women aged 40 years and older.

BACKGROUND: Spontaneously exfoliated benign-appearing endometrial cells (BEC) on a Papanicolaou smear might indicate endometrial pathology in postmenopausal women, necessitating further investigation. A cut-off age of 40 years was included in the Bethesda System 2001 based on studies of clinical significance of endometrial cells in Pap smears in Western countries. AIMS: The purpose of this study was to determine the significance of age subgroup for women with a cytological diagnosis of BEC, regardless of menopausal status, in a retrospective cohort of Turkish women. MATERIALS AND METHODS: Between October 2006 and November 2011, 41 patients with a BEC diagnosis and 64 patients with a cytological diagnosis of normal smear (NS) were enrolled; regardless of menopausal status, these women were 40 years and older and for whom follow-up endometrial biopsies had been performed. RESULTS: On subsequent histopathologic evaluation, no malignant lesion was detected in women aged 40-50 years compared to three endometrioid-type adenocarcinomas in women older than 50 years with cytological diagnosis of BEC. There was a significant difference between women older than 50 years with cytologic diagnosis of BEC and NS in relation to premalignant lesions on histopathologic evaluation; however, this was not the case for women aged 40-50 years. CONCLUSIONS: According to our study, reporting BEC for women aged between 40 and 50 years has minor clinical significance but is significant for women older than 50 years, regardless of menopausal status. Larger sample size would be appropriate to confirm the results of the current study.

LSIL/ASC-H (LSIL-H) in cervicovaginal smear: histopathological outcomes and clinical significance.

OBJECTIVE: Conventional Pap smears exhibiting unequivocal features of 'low grade squamous intraepithelial lesion' (LSIL) are occasionally mixed with some cells suspicious for, but not diagnostic of 'high grade squamous intraepithelial lesion' (HSIL) on daily routine. The 2001 Bethesda System does not address the significance of such cytological entities. We have referred to these changes in our laboratory as'LSIL, atypical squamous cells cannot exclude HSIL' (LSIL/ASC-H). In this study, we aimed to compare the cytology and biopsy results of LSIL/ ASC-H to LSIL, ASC-H and HSIL. MATERIAL AND METHOD: Out of 37884 cases which were evaluated between 2005-2009 in our laboratory, cases interpreted as LSIL, LSIL/ ASC-H, HSIL and ASC-H were reevaluated and 153 cases for which biopsy materials were available were selected. RESULTS: The rate of histological CIN2 or worse associated with LSIL/ ASC-H (45%) was between the rates of LSIL (10%) and HSIL (65%), but not significantly different from ASC-H (50%). However, LSIL/ ASC-H was more frequently associated with a definitive histological diagnosis of any CIN2 than ASC-H (30% vs. 8%). CONCLUSION: Based on our results, we recommend LSIL/ASC-H to be added to Bethesda System, and Pap test cases of LSIL/ASC-H may need to be clinically followed-up in a manner similar to ASC-H, i.e., with colposcopy for all patients.