The MonoPrep Pap test for the detection of cervical cancer and its precursors. Part I: results of a multicenter clinical trial.

The MonoPrep Pap Test (MPPT; MonoGen, Lincolnshire, IL) is a novel, liquid-based specimen collection and processing technology for cytologic and molecular testing. Its usefulness in the detection of cervical cancer and its precursors was evaluated in a multicenter, masked, adjudicated, split-sample study of 10,739 samples. After preparation of a conventional smear, the residuum on the collection device was rinsed into a collection vial from which an MPPT slide was prepared. Accuracy was assessed by masked reference interpretation by an independent pathologist. Slides prepared by MPPT, compared with smears, yielded statistically significant increases in relative sensitivity for atypical squamous cells of undetermined significance and worse, atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion/atypical glandular cells and worse, and low-grade squamous intraepithelial lesion and worse. There was no significant difference in relative specificity. MPPT provided a 58% reduction in unsatisfactory slides. There was no significant difference in the presentation of endocervical/transformation zone component or the detection of benign conditions. The MPPT is a promising new liquid-based technology for cervical cancer screening.

Myoepithelial neoplasia of the submandibular gland: case report and therapeutic considerations.

Tumors of the submandibular gland typically arise from the seromucinous acini, which make up the majority of the gland. The most common benign tumor of this structure is the pleomorphic adenoma, whereas the most common malignancy of the submandibular gland is adenoid cystic carcinoma. We describe an unusual case of a neoplastic process of the myoepithelial cells of the submandibular gland in a middle-aged woman. This rare tumor is most commonly diagnosed in the parotid gland and in the minor salivary glands of the hard palate; a review of the literature uncovered only 5 previous reports of myoepithelioma of the submandibular gland. Distinguishing myoepithelioma from benign pleomorphic adenoma and malignant myoepithelial carcinomas can be challenging. Immunohistochemical staining can help to distinguish between the benign neoplasms, but histologic features remain the "gold standard" for diagnosing the malignant tumors. Increasing use of immunohistochemistry panels to assess parotid neoplasms also suggests that myoepithelioma may be underrecognized.

Primary lymphoma of the larynx: new diagnostic and therapeutic approaches.

Tumors primary in the larynx, when not of squamous cell origin, require special diagnostic and therapeutic attention. An unexpected case of non-Hodgkin's lymphoma localized in the larynx in a patient with a brief history of dysphagia and hoarseness is discussed. This supraglottic tumor was extensively characterized at our institution for morphologic features by microlaryngoscopy, histology, immunocytochemical profiles with flow cytometry, chromosomal aberrations using banded karyotyping and extent of disease via PET-CT imaging. Our detailed analysis distinguished this neoplasm as a new-onset diffuse large B cell laryngeal lymphoma rather than a mucosa-associated lymphoid tissue lymphoma. A rational diagnostic approach guided the combination chemotherapy/immunotherapy treatment strategy instead of traditional localized radiation therapy. These findings highlight the importance of a thorough phenotypic and cytogenetic characterization of head and neck neoplasms, which has implications for downstream diagnostic considerations, interventional strategies and the available therapeutic options. The presence of nonsquamous laryngeal tumors reinforces the dictum to obtain a reliable tissue diagnosis before initiating definitive therapy.