Schwannoma de nervio vago cervical / Schwannoma of the cervical vagus nerve

RESUMEN Los schwannomas del espacio parafaríngeo son tumores benignos de la vaina de los nervios pe riféricos y corresponden al 0,09% de todos los tumores de cabeza y cuello; es aún más inusual su localización en el nervio vago. El diagnóstico suele ser desafiante debido a las diversas patologías ubicadas en la región lateral del cuello. Habitualmente se presentan como masas cervicales laterales asintomáticas. Presentamos el caso de un paciente de 42 años que consulta asintomático. Se le realizó tomografía computarizada y angiografía de vasos del cuello. Se procedió a su resección completa, ob jetivándose parálisis de cuerda vocal derecha en el posoperatorio. La disfonía causada por la parálisis de cuerda vocal es una complicación frecuente; si se presenta, debe comenzarse con rehabilitación fonatoria temprana.

ABSTRACT Schwannomas of the parapharyngeal space are benign tumors that arise from the peripheral nerve sheaths and represent 0.09% of all head and neck tumors. Those originating from the vagus nerve are rarer. The diagnosis represents a challenge due to the different conditions encountered in the lateral neck. They usually present as asymptomatic lateral neck masses. An asymptomatic 42-year-old male patient sought medical advice. He underwent computed tomography scan and carotid angiography. The patient underwent complete resection and developed postoperative vocal cord paralysis. Dysphonia due to vocal cord paralysis is a common complication requiring immediate vocal cord rehabilitation.

The study on radical cure for once in perianal abscess in infants / 中国基层医药

Objective To research the efficacy and healing rate of radical cure surgery by one time in perianal abscess in infants.Methods 46 cases infant perianal abscess were cured by radical cure surgery for once and the healing rate was observed.Results All of 46 cases were healed.Conclusion The radical cure by one time was an effective procedure for perianal abscess in infants.

Clinical Analysis of Atypical Glandular Cells of Undetermined Significance (AGUS) on Pap Smear according to Menopausal Status / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical significance of AGUS including histologic results and diagnostic modalities according to menopausal status. METHODS: One hundred and four patients with AGUS were identified. Corresponding biopsies were available for 87 of these cases. The evaluation for histologic results and diagnostic modalities was made according to menopausal status. RESULTS: Among the 87 patients with AGUS, the number of premenopausal and menopausal patients were 46 (52.9%) and 41 (47.1%), respectively. Over all, 70 (80.5%) of 87 patients were found to have important histologic findings and of them, premenopausal and menopausal patients with invasive diseases were 19 (41.3%) and 31 (75.6%) respectively. There were significant differences in pathologic findings between premenopausal and menopausal patients indicating more invasive lesions in menopausal than premenopausal patients (p=0.002). For the evaluation of diagnostic modality, the second arm was significantly more needed for menopausal than premenopausal patients (p=0.018). CONCLUSION: AGUS on pap smear represents a cytologic diagnosis associated with high incidence of underlying preinvasive and invasive lesions, especially in postmenopausal patients. Thus aggressive work-up is recommended to rule out the potential pathologic conditions in endocervix, endometrium and rarely extrauterine lesions such as gastrointestinal, tubal, ovarian or breast in patients otherwise unexplained AGUS after careful first arm work-up.

Preoperative Pap Smears in Endometrial Carcinoma: The Clinicopathologic Relevance / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the correlation between preoperative Pap smears and known poor prognostic factors in patients with endometrial carcinoma. METHODS: Between January 1989 and June 2000, preoperative evaluation of Pap smears were done in 163 patients with endometrial carcinoma who underwent total abdominal hysterectomy with bilateral salpingo- oophorectomy, peritoneal cytology, and pelvic and/or para-aortic lymphadenectomy. All Pap smears and histologic sections were reviewed. Pathologic parameters of hysterectomy specimens were evaluated and correlated with the findings of Pap smears. Chi-square test was used for statistical analysis. p-values<0.05 were considered significant. RESULTS: The mean age of patients was 49 years with range between 24 and 75 years old. 72 patients (44.2%) had normal, 38 patients (23.3%) had atypical glandular cells of undetermined significance (AGUS), and 53 (32.5%) had adenocarcinoma on preoperative Pap smears. Statistically significant associations were found between Pap smears and age (p=.014), histologic grade (p=.000), cervical involvement (p=.015), depth of myometrial invasion (p=.000), lymph-vascular space invasion (p=.000), and surgical stage (p=.049). Patients with malignant cytology were more likely to have older age, poorly differentiated malignancies, deeper myometrial invasion, cervical metastases, lymphvascular invasion and higher surgical stage. However, histologic subtypes (p=.328), peritoneal cytology (p=.067), adnexal involvement (p=.602) and pelvic and/or para-aortic lymph node metastases (p=.266 and p=.220) were not statistically significant. CONCLUSION: This study revealed that preoperative abnormal Pap smears in patients with endometrial carcinoma were significantly associated with age, histologic grade, cervical involvement, depth of myometrial invasion, lymphvascular space invasion and surgical stage. Therefore, Pap smears could be an important part of the preoperative evaluation in patients with endometrial carcinoma.

The clinical significance of ASCUS and AGUS in Pap smear / 대한부인종양콜포스코피학회잡지

OBJECTIVE: This study was undertaken to evaluate the clinical significance of ASCUS and AGUS in routine Papanicolaou smears. METHOD: A review of retrospective medical records was conducted on 267 women whose Papanicolaou smears yielded diagnoses of either ASCUS or AGUS from March, 1998 to December, 2000 at Youngdong Severance Hospital. RESULT: The incidences of ASCUS and AGUS on PAP smears are 1.3%(258 cases) and 0.1%(23 cases). Of these, 89 cases with ASCUS and 9 cases with AGUS had subsequent cervical biopsies. The biopsy cases with ASCUS showed 68(74.4%) cervicitis, 2(2.2%) hyperkeratosis, 1(1.1%) condyloma, 9(9.9%) CIN 1, 5(5.5%) CIN 2, 1(1.1%) CIN 3, 2(2.2%) microinvasive squamous cell carcinoma and 1(1.1%) adenocarcinoma. Those with AGUS showed 6(6.6%) cervicitis, 1(1.1%) CIN 2, 1(1.1%) CIN 3, 1(1.1%) endometrial cancer. Women under 35 year-old(P=0.012) or who had coital history in younger periods(before 20 years old, P=0.014) had much higher frequency of high grade lesion. The overall incidence of HSIL was higher in the group with ASCUS favoring SIL than in the group with unqualified ASCUS. (P=0.042) The group with AGUS also had much higher frequency of high grade lesion than the group with ASCUS. (P=0.043) CONCLUSION: Immediate colposopic evaluation should be performed for AGUS and ASCUS favoring SIL. Regarding ASCUS, high risk patients who are under 35 years old or who have early coital history(< 20 yrears old) also should undergo colposcopic examination. With the exception of the aboves, we propose HPV screening and HPV DNA testing for intermediate screening test.

Atypical Glandular Cells of Undetermind Significances (AGUS) ; Histopathologic Results and the Significance of the HPV DNA Detection / 대한산부인과학회잡지

OBJECTIVES: AGUS often reflects an immediate cervical cancer precursor such as a HSIL mimicking an endocervical glandular lesion. In this study, we attempted to assess the clinical significance of a cytologic diagnosis of atypical glandular cells of undetermined significance (AGUS) and determine the usefulness of the human papillomavirus (HPV) DNA testing as the triage strategies in evaluating AGUS. METHODS: Between 1994 and 1998, 67,730 Papanicolaou smears were evaluated at Kangnam and Uijongbu St Mary's Hospital. There were 87 (0.13%) cases of AGUS smears during that time. Colposcopy was performed on all women, and HPV DNA testing was performed on 11 persons. RESULTS: Mean age of these patients was 45.8 years. Histologic diagnosis of AGUS were kolocytosis and CIN-I in 6 (6.9%), CIS in one, endometrial hyperplasia in 2 (2.3%), endometrial adenocarcinoma in 7 (8.0%), cervical adenocarcinoma in 14 (16.1%) and cervical squamous cell carcinoma in 2 (2.3%) cases. Endometriosis was 8.9% under 46 years old and none in over 46. CIN was 8.9% and 7.2%, respectively. Cervical adenocarcinoma was 6.7% under 46 and 19.1% over 46. Endometrial cancer was 4.4% and 11.9%, respectively. The risk of cervical cancer and endometrial cancer was high in the AGUS with

ASCUS, AGUS and Benign Endometrial Cells in Cervicovaginal Smears: Histologic Correlations and Clinical Significance / 대한부인종양콜포스코피학회잡지

OBJECTIVE: The purpose of this study is to evaluate the histologic correlations and the clinical significance among patients with atypical squamous cells of undetermined significance (ASCUS), atypical glandular cells of undetermined significance(AGUS) and benign endometrial cells identified on cervical Pap smear screening. MATERIALS & METHODS: The computerized files of the Department of Pathology at Samsung Cheil Hospital were searched from 1991 to 1997 to evaluate the annual statistics of cytologic diagnoses including normal/benign, ASCUS, AGUS, low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion(HSIL) and cancer classified by the Bethesda System(TBS). Cytohistologic correlations on follow-up were separately analysed in ASCUS(190 cases), AGUS(268 cases) and benign endometrial cells(169 cases), respectively. Additionally, post-menopausal squamous atypia(83 cases) were also included in this study. TBS terminology was used in both cytologic and histologic diagnoses. RESULTS: During 7-year period (1991-1997), 447,049 cervicovaginal smears were evaluated. The median rate of abnormal cytology was 4.4%, with 2.1% of ASCUS, 2.06% of squamous intraepithelial lesion(SIL), and 0.08% of AGUS. The median ratio of ASCUS versus SIL was 1.24. Specimen adequacy was evaluated on 47,525 cases, of which categories of "satisfactory for evaluation but limited by" and "unsatisfactory for evaluation" were 28.3% and 0.03%, res-pectively. Follow-up of 190 patients with ASCUS cytology showed 30%(57 cases) with SIL on biopsy; 18%(35cases) with LSIL, 11%(21cases) with HSIL, and 1%(1case) with microinvasive squamous cell carcinoma. On histologic examination, 77%(37/48cases) with ASCUS favoring SIL revealed SIL in contrast to 14%(20/142cases) with ASCUS favoring reactive change, which is statistically significant.(Chi-Square test, P<0.0001). Of 83 cases of post-menopausal squamous atypia(PSA), smears with LSIL showed 34.9%(15/43cases) with LSIL on biopsy. 268 patients with AGUS smears had 25%(67cases) with clinically significant cervical or endometrial lesions on histologic examinations. Among 17.9%(48cases) with cervical lesions, squamous abnormalities were 10.5%(28cases); including 1.5%(4cases) with LSIL and 9.0%(24cases) with HSIL. Glandular lesions in cervix were 7.5%(20cases); 3.0%(8cases) of glandular atypia or dysplasia, 1.9%(5cases of adenocarcinoma in situ, 1.1%(3cases) of microinvasive adenocarcinoma and 1.5%(4cases) of adenocarcinoma. Of 7.1%(19cases) of endometrial lesions, 2.2%(6cases) was endometrial hy-perplasia, 4.1%(11cases) endometrial carcinoma, 0.4%(1case) MMMT and 0.4%(1case) metastatic adenocarcinoma from stomach were verified. The pathologies of 169 cases with benign endometrial cells shed in cervicovaginal smears were confirmed to be endometrial polyp(8.3%), endometrial hyperplasia(4.1%) and endometrial carcinoma(5.9%). CONCLUSION: The results of this study indicates that clinicians should communicate with pathologists for proper management of abnormal cytology. Further evaluation and decision of management should be made based on input from pathologists as well as on clinical setting and professional guidelines.

Clinical Evaluation of Follow-Up Methods and Results of Atypical Glandular Cells of Undetermined Significance (AGUS) on Cervicovaginal Pap Smears / 대한부인종양콜포스코피학회잡지

OBJECTIVE: To evaluate the efficacy of the follow up methods and results of AGUS detected on cervicovaginal Pap smears. METHODS: From May 1991 to December 1996, we have performed 407,451 cervicovaginal Pap smears, of which 326 patients were identified as AGUS. Out of them, 268 patients were followed by repeated Pap smears, colposcopy, cone biopsy or endometrial curettage. RESULTS: The incidence of AGUS on Pap smears is approximately 0.08%. The mean patient age was 43 years (range 22~79 years). The most common complaint was abnormal vaginal bleeding. The gross findings of the cervix were normal or mild erosion. The past histories of patients that could effect the AGUS results on Pap smears were as follows: 30 had cone biopsy, 21 had Pap smear on pregnancy or within 8 weeks after delivery, 3 had hormone replacement therapy, 2 had intrauterine device for contraception, and 5 were in the process of a follow up after a treatment of cervical cancer. The benign lesions detected during follow up periods were 6 microglandular hyperplasia of the cervix, 5 atypical squamous metaplasia of the cervix, 2 cervical endometriosis, 2 tubal metaplasia, 10 cervical myoma, 11 cervical polyp, 9 endometrial polyp, 3 uterine myoma, 1 pelvic endometriosis, 1 ovarian endometriosis, and 4 uterine adenomyosis. The premalignant or malignant lesions of the cervix were 4 low grade squamous intraepithelial lesion, 24 high grade squamous intraepithelial lesion, 8 glandular atypia/dysplasia, 5 adenocarcinoma in situ, 3 microinvasive denocarcinoma, and 4 invasive adenocarcinoma. The neoplastic lesions of the uterus were 6 endometrial hyperplasia, 11 endometrial adenocarcinoma, 1 malignant mixed M?lerian tumor, and 1 metastatic endometrial adenocarcinoma. Sixty seven (25%) among 268 patients followed up were identified to have clinically significant lesions of the cervix or uterus. The detection rates of abnormal lesions were 3.1% with repeated Pap smears (3/98), 28.4% with colposcopy-directed biopsy (31/109), 63.6% with cone biopsy (35/55), and 29.7% with endometrial curettage (19/64). CONCLUSION: AGUS on Pap smears showed various benign and malignant lesions of the cervix or uterus. The clinicians must communicate with the pathologists regarding the clinical informations of the patient as well as the origin of atypical glandular cells in Pap smears. We recommend that the patients with AGUS on Pap smear should undergo immediate intensive diagnostic studies, including colposcopy with endocervical curettage or cone biopsy in order to detect the lesion of the cervix and endometrial curettage in order to detect the endometrial lesions.

Management of ASCUS , AGUS and LSIL / 대한산부인과학회잡지

The diagnoses of ASCUS, AGUS and LSIL were introduced in 1988 by The Bethesda System(TBS) for reporting cervical/vaginal cytologies. However the outcomes and the appropriate managements of patients with these diagnoses are not well established. We reviewed all Papnicolaou smears which totaled 10,630 cases performed in the department of Obstetrics and Gynecology, University of Ulsan, Asan Medical Center from January 1995 through December 1995. The results were as follows. 1. Of the 10,630 specimens accessed during one-year period, 611(5.7%) were diagnosed as SCUS, 13(0.12%) as AGUS and 117(1.1%) as LSIL. 2. Of these, 92 cases with ASCUS and 66 with LSIL and subsequent cervical biopsies. The biopsy cases with ASCUS showed 49(53.3%) cervicitis, 13(14.1%) condyloma, 7(7.6%) CIN I, 3(3.3%) CIN II, 10(10.9%) CIN III and 3(3.3%) invasive carcinoma. Those with LSIL showed 21(31.8%) cervicitis, 5(7.6%) condyloma, 18(27.3%) CIN I, 6(9.1%) CIN II, 11(16.7%) CIN III and 3(4.5%) invasive carcinoma. 3. The repeated cytologic examination of 415 cases with ASCUS after 3~6 months revealed WNL(within normal limit) in 277(66.7%), BCC( benign cellular change) in 13(3.1 %) ASCUS again in 97(23.4%), AGUS in 2(0.1%), LSIL in 21(5.1%) and HSIL in 7(1.7 %). 4. The presence of high-risk or intermediate-risk HPV DNA was confirmed with Hybrid capture system(HCS) in 31.6%(6/19) of patients without evidence of CIN, 50%(4/8) of those with CIN I, 100%(5/5) of those with CIN II, 81.5%(22/27) of those with CIN III and 100%(6/6) of those with invasive squamous cell carcinoma. According to our result and thorough review of the recent articles, the management of ASCUS, AGUS and LSIL is reevaluated and the management guideline of our own is presented.