The cytomorphology of ocular surface squamous neoplasia by using impression cytology.

BACKGROUND: The term ocular surface squamous neoplasia (OSSN) encompasses conjunctival and corneal intraepithelial neoplasia through to invasive squamous cell carcinoma of the ocular surface. The disease is related to prolonged exposure to solar ultraviolet light and has been proposed as an acquired immune deficiency syndrome-associated tumor. To the authors' knowledge, very few reports describing the cytology of these lesions have been published. METHODS: Impression cytology (IC) samples collected from the eyes of patients with a range of ocular surface diseases were available for study. From these, 267 sets of impressions had subsequent histopathology that had been collected within 6 months of the IC, and which indicated the presence of OSSN. The IC from these cases was used to describe the cytomorphology of intraepithelial and invasive OSSN. RESULTS: Within the intraepithelial group, keratinized dysplastic cells that often were accompanied by hyperkeratosis, syncytial-like groupings, and nonkeratinized dysplastic cells were described. Within the invasive group, cases with significant keratinization and an additional group of cases with little keratinization and sometimes also prominent macronucleoli were described. Keratinized cases were the most numerous in both the intraepithelial and invasive groups. A description also was given of a low number of cases with cytology and also subsequent histopathology indicating the presence of intraepithelial OSSN, in the absence of a clinically detectable lesion. CONCLUSIONS: This detailed description of the cytomorphology of a high number of cases of OSSN with confirmation by histopathology should assist others with little experience of the cytology of these lesions to examine them with increased confidence. Cancer (Cancer Cytopathol)

Improving cervical cytology screening in a remote, high risk population.

OBJECTIVE: To evaluate the use of the ThinPrep method to reduce rates of unsatisfactory Papanicolaou (Pap) smears in women in remote communities. DESIGN: Prospectively collected samples were split and screened conventionally and by ThinPrep at the Queensland Cytology Service. PATIENTS: Three hundred women having cervical smears taken by a Mobile Women's Health Service nurse or at the antenatal and sexual health clinics of a remote north Queensland community. MAIN OUTCOME MEASURE: Number of Pap smears reported as unsatisfactory for evaluation and requiring a repeat smear request. RESULTS: 17.3% of conventionally prepared smears were technically unsatisfactory, compared with 6.3% prepared with ThinPrep. The overall rate of unsatisfactory smears was only 4.3% when both ThinPrep and conventional smears were assessed for a combined report. CONCLUSION: A significant reduction in the proportion of unsatisfactory Pap smears is possible with the ThinPrep method. Targeted use of ThinPrep in communities with high rates of unsatisfactory smears may prove cost-effective.

Efficacy of a training programme designed to teach cervical smear screeners to identify ocular surface squamous neoplasia using conjunctival impression cytology.

Ocular surface squamous neoplasia (OSSN) is a recently proposed term introduced to encompass both intraepithelial neoplasia and invasive squamous cell carcinoma of the conjunctiva and cornea. A teaching programme incorporating a manual, slide sets, and an evaluation test was developed. The aim was to teach experienced cervical smear screeners to evaluate ocular surface specimens collected by conjunctival impression cytology, with a minimum of individual tuition. The use of the manual was well accepted and half of the original six candidates were able to master the new skill adequately within 8 h. It was considered that the differences between the cytology of OSSN and the equivalent lesions of the uterine cervix are sufficient to prevent some experienced screeners acquiring these skills rapidly.

Application of impression cytology to the diagnosis of conjunctival neoplasms.

Conjunctival impression cytology using cellulose acetate filter paper was employed to obtain multiple samples of conjunctival epithelium from 192 normal and abnormal eyes. Modifications of an established technique were used and the impressions were stained by the Papanicolaou method and mounted on glass slides. The impressions were examined for their effectiveness in demonstrating the morphological characteristics of normal epithelium and the features of the more common conjunctival neoplasms. The technique was found to be successful at both removing cells and preserving cytologic features. It also had several advantages over other collection techniques. Overlapping cells were not a detrimental feature of the preparations from this study.

Hereditary xerocytosis. A case history and review of the literature.

A case of hereditary xerocytosis, a rare hemolytic anemia with dehydrated erythrocytes resulting from excess potassium efflux through the red cell membrane, is presented and the literature on the subject reviewed. This is one of the first cases reported from Australia.