Clear cell endometrial adenocarcinoma in a young woman: report of a case detected by cytology.
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Biomedical subjects
Publications and source records attributed to W H Wolinska.
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There is a high probability of urethral carcinoma in patients who have had cystectomy for carcinoma of the urinary bladder, and their survival is poor when the disease is sufficiently advanced to be symptomatic or tumor is visible endoscopically. This study was undertaken to evaluate urethral cytology as a means of detecting and diagnosing in situ and invasive carcinoma of the urethral remnant following cystectomy. A total of 109 cytology specimens were examined from 65 patients who had cystectomy for bladder cancer. "Positive" or "suspicious" cytologic diagnoses of cancer were made on 28 patients; 24 had urethrectomy and 11 proved to have invasive carcinoma, 10 had carcinoma in situ and three had atypia or metaplastic changes in the urethra. One of 37 patients with "negative" cytologic diagnoses was found to have a low-grade carcinoma. It is suggested that all patients who undergo cystectomy without urethrectomy be followed with urethral cytological examination at regular intervals for an indefinite period.
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A review was undertaken of the 121 patients with cervical adenocarcinoma, ranging in age from 10 to 91 years, who had cytology specimens examined in this laboratory. All but two had cervicovaginal smears. Fifty-eight patients had cervical smears taken prior to treatment; 91% of these contained malignant cells. The commonest histologic subtype was mucinous adenocarcinoma (61 patients; 52%), followed by endometrioid carcinoma (26 cases; 22%), adenosquamous carcinoma (16 cases; 14%) and clear-cell carcinoma (12 cases; 10%). The cytologic characteristics were evaluated and correlated with the histopathology. During the follow-up period after definitive treatment, 119 patients had gynecologic smears taken; 24% were positive, representing 64% of those cases with central recurrences. In two patients, the abnormal smear was the first indicator of recurrence. Nine patients had 11 nongynecologic specimens revealing metastatic disease. Notable in this study were the 18 asymptomatic women, of whom 15 also had either no visible cervical lesion or minimal changes associated with benign conditions; cytology was abnormal in all but two. Cytology was effective in detecting disease. Its usefulness continued during the follow-up period in identifying or confirming recurrent or metastatic disease.
Eighty-four urinary cytology specimens from 51 patients known to have bladder papilloma were reviewed and compared with 30 specimens from patients without neoplastic urologic disease, 12 specimens from patients later found to have papillomas that were unsuspected at the time of examination and 6 specimens from patients with a history of papilloma but no present evidence of the disease. No specific findings were identified that could be used to make a cytologic diagnosis of papilloma. However, the specimens from patients with papilloma were likely to contain an increased number of exfoliated epithelial cells, including atypically shaped cells that were small and round or, less frequently, elongated; they were also likely to contain a small number of red blood cells. This combination of cytologic findings yielded a pattern that can be described as consistent with or suggestive of papilloma in the appropriate clinical setting. It is not diagnostic since the absence of this cytologic pattern does not rule out papilloma, and the same cytologic features can be found (less frequently) in patients with other urologic diseases.