Intraperitoneal free cancer cells in non-gynaecological adenocarcinomas: a reproducibility study.

OBJECTIVE: In recent years, therapeutic approaches including cytoreductive surgery followed by intraperitoneal chemotherapy have proven effective in peritoneal carcinomatosis of colorectal origin. If cytology is to be used to include patients in aggressive treatment regimens, it is necessary to evaluate its performance, particularly in terms of specificity. The aim of this study was to assess interobserver agreement for the detection of intraperitoneal free cancer cells (IFCCs) in patients with non-gynaecological adenocarcinomas. METHODS: Over a 5-year period, 1223 patients were recruited in 19 French surgery departments. Peritoneal samples were examined in 14 dispersed pathology laboratories. Giemsa-stained slides were sent to a control reader blind to the previous diagnosis. Discordant cases, concordant positive results and a random selection of negative concordant cases were reviewed by a panel of seven cytopathologists. The 'final diagnosis' was that of the consensus meetings but took into account locally-processed slides. RESULTS: Gathering dubious cases with negative results, a 95.6% concordance was achieved between local readers and the control reader. IFCCs were ascertained by the panel in 85 cases (7.0%). Eight of 873 colorectal cancers cases viewed locally were falsely positive (0.9%). Radiotherapy and neoadjuvant therapy had no impact on the false-positive rate as assessed by final validation by the panel (P > 0.05). Samples initially considered as dubious were reclassified as negative by the panel in 24 of 25 cases (96.0%). CONCLUSIONS: The panel consensus allowed reclassification of most dubious/equivocal peritoneal cytology cases, whereas clearcut distinction between benign and malignant cases was correctly achieved in almost all cases.

Value of ultrasound-guided fine-needle aspiration in the management of ovarian and paraovarian cysts.

This study was designed to assess if cytology was accurate for an appropriate diagnosis of ovarian and paraovarian cysts, and if the ultrasound-cytology-estradiol (UCE) triad was sufficient to discriminate functional vs. nonfunctional cysts, the latter requiring surgical resection. One hundred twenty-two ultrasound-diagnosed adnexal cysts were punctured and surgically removed, and then subjected to cytologic and histologic examinations; 90 of these fluids were assayed for estradiol. Histologically, 30 cysts were functional and 92 were nonfunctional. A correct discrimination between functional and nonfunctional origin was obtained in 54.9% of cases with cytology, in 94.4% with estradiol assay, in 50.8% with ultrasonography, and in 97.8% with these three examinations combined (UCE triad). Among the 34 patients with no criteria of neoplastic origin (age >40, ultrasonographic findings), the UCE triad diagnosed six functional cysts. Therefore, 17.6% (6/34) of these young women could have avoided unnecessary surgery. Diagn. Cytopathol. 2000;22:70-80.

[Askin's tumor in a 67 year-old man with cancer of the prostate. X-ray computed tomographic aspects]. / Tumeur d'Askin chez un homme de 67 ans, présentant un cancer de la prostate. Aspects tomodensitométriques.

A case of Askin tumor has been diagnosed by thin needle punction, in a sixty seven years old man who had a prostatic cancer with bone metastasis. The TDM aspect is described and compared to the aspects already related in literature.

[The Stein-Leventhal syndrome. Clinical, biological and anatomic study of 6 cases in adolescent girls (author's transl)]. / Etude clinique, biologique, anatomique de 6 syndromes de Stein Leventhal de l'adolescente.

Clinical, biological and anatomic studies were performed in 6 adolescent girls with the Stein-Leventhal syndrome. The rare occurrence of this syndrome in pediatrics is emphasized. The main clinical signs consist of obesity, hirsutism and menstrual irregularities. Basic LH and plasma testosterone are useful diagnostic means, as well as -- in children -- the suppression-stimulation and LH-RH tests. However, coelioscopy is necessary to allow a correct diagnosis. Histological examination might not be absolutely necessary since a large biopsy could be responsible for untimely ovulation. Estrogens and anti-androgens are the only logical treatment at the time of puberty.

[Mammary Paget's disease: an ultrastructural study (author's transl)]. / Maladie de Paget du mamelon. Etude ultrastructurale.

A case of mammary Paget's disease has been studied under electron microscopy. It seems that Paget's cells are coming from the basal layer which is not affected by the malignant proliferation. Paget's cells show some characters of keratinocytes such as rudimentary desmosomes and tonofilaments. But the tumoral tissue is very loose. The Paget's cells are not keratinised; they present numerous vesicles as malignant cells of apocrin mammary carcinoma. There are numerous histogenetic theories of Paget's disease. One of them sounds very interesting: it consists in looking for associations between microscopic mammary Paget's disease and mammary apocrin carcinoma.