Do women >or=50 years of age need as much screening as women <50 years after they have had negative screening results?

To assess the adequacy of a routine screening to identify cervical intraepithelial neoplasia 2 or worse (CIN2+) in women over 50 years of age, a retrospective cohort was set in six Italian organised population-based screening programmes. In all, 287 330 women (1 714 550 person-years of observation, 1110 cases) screened at age 25-64, with at least two cytological screening tests, the first negative, were followed from their first negative smear until a biopsy proven CIN2+ lesion or their last negative smear. For women aged 25-49 and 50-64 years, crude and age-standardised detection rate (DR), cumulative risk (CR), adjusted hazard risk for number of previous negative screens, probability of false-positive CIN2+ after two or more smear tests were calculated. Detection rate is significantly lower over 50 years of age. Multivariable analysis shows a significant protective effect from four screening episodes (DR=0.70, 95% CI: 0.51-0.97); the effect of age >or=50 is 0.29 (95% CI: 0.24-0.35). The CR of CIN2+ is at least eightfold higher in women <50 (CR=2.06, 95% CI: 1.88-2.23) after one previous negative test than in women >or=50 years with four screens (CR=0.23, 95% CI: 0.00-0.46). Over 50 years of age, after four tests at least three false-positive cases are diagnosed for every true positive. Benefits arising from cytological screening is uncertain in well-screened older women.

[Diagnosis and prognosis of malignant mesothelioma. A description of 8 clinical cases]. / Diagnosi e prognosi del mesotelioma maligno. Descrizione di 8 casi clinici.

A retrospective study of patients at the Trento S. Chiara Hospital in the period 1982-86 showed up 8 cases of malignant mesothelioma (7 pleural and 1 peritoneal). The histology was re-examined for each case and clinical records was also looked at so as to identify onset symptomatology, diagnostic procedures and treatment. A standard questionnaire given to patients or close relations revealed previous exposure to asbestos in 2 of 3 males and in none of the 5 females. There was also a significant delay in formulation of correct diagnosis, attributable on the hand to the nonspecificity of the symptomatology of onset and on the other to the inadequacy of currently available clinical and radiological procedures. Only histology with the aid of immunocytochemical procedures was able to pinpoint correct diagnosis, in life. The ineffectiveness of conventional therapies and the poor overall prognosis for these patients is confirmed.

Aspiration cytology of cutaneous metastatic melanoma and epidermoid carcinoma of the penis.

Aspiration biopsy cytology is an accurate, safe, innocuous alternative to excisional biopsy in diagnosing the nature of concomitant superficial nodules or lymphadenopathy in patients with known cutaneous malignancy. In patients with penile cancer, aspiration biopsy cytology may avoid the morbidity (30-50%) and mortality (3%) of groin dissection staging. A positive aspirate is conclusive of Stage III tumor and, in patients with occult nodal metastases, may lead to early curative lymphadenectomy. In the present study of 28 patients with known cutaneous malignant melanoma, the aspiration biopsy cytology of 31 superficial nodules resulted in a cytologic diagnosis of metastasis in 29 nodules from 26 patients. In the management of patients with known melanoma, the positive cytology of superficial nodules is conclusive of metastatic disease and requires an accurate radiologic study to establish or exclude disseminated disease. Surgical removal of a metastatic superficial nodule is indicated when the lesion is considered localized disease and the patient, having been accurately examined, is determined to be apparently free of disease in other sites and organs. When systemic diffuse melanoma is found, the excision of metastatic superficial nodules is unnecessary. Positive aspiration cytology may avoid risk from ill-judged surgical procedures and indicate appropriate palliative treatment of the disease.

Primary osteosarcoma of the uterine corpus. Report of a case and critical review of the literature.

Uterine osteosarcoma represents an extremely rare pure heterologous sarcoma of the uterus. In the present case osteosarcoma occurred primarily in the uterine cavity of a 56-year-old woman. The tumor was anaplastic and the presence of different proliferative patterns caused differential diagnostic problems with various malignant tumor types. The osteoid features of extracellular matrix were demonstrated by electron microscopy. Clinical and pathological features of previously reported cases of uterine osteosarcoma are critically reviewed.

Urinary cytology of tuberculosis of the bladder.

The cytologic findings in the urinary sediment of 13 patients with tuberculosis (TB) of the bladder were compared with the histologic findings. TB was cytologically recognized in 11 patients because of the presence of epithelioid and/or Langhans' giant cells. The morphologic deviations of the urothelial cells and the urothelium were classified according to the criteria of Koss. The type I atypical urothelial cells found in ten patients were correlated to the urothelial hyperplasia found at histology; the follow-up data documented the benign reversible nature of the urothelial hyperplasia as the focal expression of the reactive potential of urothelium to various forms of inflammatory processes. The presence of type II atypical urothelial cells reflected moderate and severe atypia of the urothelium at biopsy. In order to assess the reactive, reversible or precancerous nature of these forms of atypia associated with TB, an accurate follow-up is necessary. Since TB of the bladder may cause the presence of atypical cells in the urine, this lesion is of special interest in the differential diagnosis between inflammatory processes and carcinoma.

Pseudomalignant cytologic presentation of spermatic hydrocele fluid.

An unusual cytologic presentation of spermatic hydrocele fluid is reported. The aspirate contained highly atypical cells, exhibiting marked anisocytosis and nuclear abnormalities strongly suggestive of cancer. On histologic examination the lesion displayed pseudosarcomatous fasciitis in the cyst wall and foci of atypical reactive mesothelial hyperplasia in the lining. This case illustrates a potential pitfall in the cytology of spermatic hydrocele fluid.

Cytologic presentation of renal adenocarcinoma in urinary sediment.

The role of cytology in 44 cases of renal adenocarcinoma was evaluated. The diagnosis of neoplasia was made with radiographic means in all cases; urinary cytology was positive in only 19 patients (43.18%) and is therefore considered unsatisfactory in the detection of renal adenocarcinoma. The cytologic presentation of this disease was characterized by four different malignant cellular types. Multinucleated cells with distinct nucleoli as well as large vacuolated cells with hyperchromatic, eccentric nuclei showed the same cellular morphology seen in the corresponding histologic pictures. Granular eosinophilic cells, with pyknotic nuclei and distinct and/or ill-defined cytoplasmic borders, are believed to be the result of degenerative changes caused by the urinary environment. The multinucleated cell type was almost benign in appearance and could be confused with benign urothelial cells. The malignancy and the renal origin of such cells were confirmed by the observation of strikingly similar cells in the parent neoplasms.

Cytologic detection of ureteral metastasis from breast carcinoma causing peripelvic extravasation.

We describe a patient with a cytologic diagnosis of ureteral metastasis from breast carcinoma with peripelvic extravasation, representing the beginning of metastatic spread of malignant disease.

[Breast metastasis as the initial clinical symptom of renal adenocarcinoma]. / Metastasi mammaria: esordio clinico di adenocarcinoma renale.

Renal adenocarcinoma shows an unpredictable clinical course. At autopsy, metastases are present in as many as 95 percent of patients with renal adenocarcinoma. The percentage of metastases from renal adenocarcinoma is greater than would be expected from the frequency of this carcinoma among all carcinomas. The breast is an exceptional site of metastasis, that is not described in literature. In the present report the metastasis in the breast represented the early symptom of renal adenocarcinoma.