Adult ; Cervix Uteri ; pathology ; Female ; Humans ; Sarcoma, Alveolar Soft Part ; diagnosis ; Uterine Cervical Neoplasms ; diagnosis

The significance of cervical erosion with benign cellular change on Papanicolaou smear has not been evaluated. A retrospective review of 430 coloscopically directed punch biopsies performed over 15 months revealed 206 cases who had a benign cellular change on cytologic smear. Of these 206 smears, 48(23%) had clear cervix without erosion, 99(48%) had mild erosion on cervix, 41(20%) had moderate cervical erosion and 18(9%) had severe cervical erosion. The false negative rate that revealed more than mild dysplasia on histologic diagnosis was 2% in patients without cervical erosion, 3% in patients with mild cervical erosion, 5 % in patients with moderate cervical erosion, and 11% in patients with severe cervical er- osion. Koilocytotic change that suggested human papilloma virus infection was 17% in each group regardless cervical erosion. In conclusion, benign cellular change on Pap smears in patients with severe cervical erosion may be associated with significant cervical cancer pathology.
Biopsy ; Cervix Uteri ; Diagnosis ; Female ; Humans ; Papanicolaou Test* ; Papilloma ; Pathology ; Retrospective Studies ; Uterine Cervical Neoplasms

Endometrioid adenocarcinoma arising from endometriosis of the uterine cervix is rare in premenopausal woman. We describe here a patient with this condition and review the clinical and pathological features of these tumors. A 48-yr-old woman complaining of severe dysmenorrhea was referred for investigation of a pelvic mass. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Histological examination revealed an endometrioid adenocarcinoma directly adjacent to the endometriosis at the uterine cervix, with a transition observed between endometriosis and endometrioid adenocarcinoma. The patient was diagnosed as having endometrioid adenocarcinoma arising from endometriosis of the uterine cervix and underwent postoperative chemotherapy. Gynecologists and pathologists should be aware of the difficulties associated with a delay in diagnosis of endometrioid adenocarcinoma arising from endometriosis when the tumor presents as a benign looking endometrioma.
Carcinoma, Endometrioid/*diagnosis/etiology/pathology ; Cervix Uteri/*pathology ; Diagnosis, Differential ; Endometrial Neoplasms/*diagnosis/etiology/pathology ; Endometriosis/complications/*diagnosis/pathology ; Female ; Humans ; Hysterectomy ; Magnetic Resonance Imaging ; Middle Aged ; Ovariectomy

Adult ; Carcinoma, Endometrioid ; diagnosis ; pathology ; Cervix Uteri ; pathology ; Diagnosis, Differential ; Endometrial Neoplasms ; diagnosis ; pathology ; Endometrial Stromal Tumors ; diagnosis ; pathology ; Female ; Humans ; Middle Aged

The purpose of this study was to investigate the differences in MR findings of adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the uterine cervix and to compare MR findings with pathologic findings. MR images of 17 patients with pathologically proven AC, using a fast spin-echo (FSE) T2-weighted image (T2WI) with pelvic phased-array coil on a 1.5-T unit, were retrospectively evaluated. After measurement of the signal intensity (SI) ratios of the region of interest between tumors and gluteus maximus muscle, we compared the ratios of AC with those of 16 patients with SCC. AC showed relatively high SI on FSE T2WI with multiseptated lesions in four cases and hydrometrocolpos in three cases. The mean SI ratio was 3.82 +/- 1.68 in AC and 2.35 +/- 0.42 in SCC (p < 0.0001, t-test). Multiple tumorous glands with cytoplasmic and intraglandular mucin or serous fluid were pathologically found in AC, but SCC revealed the compact cellularity of stratified squamous tumor cells. The cervical AC showed higher SI than SCC on FSE T2WI with occasional multiseptated lesions and hydrometrocolpos. If the SI ratio of the tumor was more than 3.0, AC could be diagnosed with a sensitivity of 68.8% and a specificity of 100%.
Adenocarcinoma/pathology ; Adenocarcinoma/diagnosis* ; Adult ; Aged ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/diagnosis* ; Cervix Neoplasms/pathology ; Cervix Neoplasms/diagnosis* ; omparative Study ; Diagnosis, Differential ; Female ; Human ; Magnetic Resonance Imaging* ; Middle Age

OBJECTIVETo study the value of endocervical curettage (ECC) in the detection of cervical intraepithelial neoplasia (CIN) and cervical cancer, and the necessity of ECC during colposcopic examination.

METHODSIn the high prevalent area of cervical cancer in Shanxi Province, China, a total of 1997 women aged 35 approximately 45 years old were enrolled. Cervical cytology, colposcopy and targeted multiple biopsies, as well as ECC were performed for all women.

RESULTSAmong the 1997 women received ECC, 31 was positive for abnormal histologic changes with a frequency of 1.6%. Of the 31 cases, 9 had low grade squamous intraepithelial lesions (LSIL, 0.5%), 20 had high grade squamous intraepithelial lesions (HSIL, 1.0%), and 2 had squamous-cell carcinoma. No pathologic diagnosis could be made in 131 women because the tissue curretaged was insufficient. The women with positive cytologic findings had higher frequency (5.3%) of abnormal ECC than those with negative cytologic findings (0.3%). There was positive correlation between the frequency of abnormal ECC and the grade of cytolologic findings. Abnormal ECC was present in 9.1% of those with unsatisfactory colposcopy while 1.3% of those with satisfactory colposcopy (P < 0.01). The frequency of abnormal ECC was 0.6% in patients with negative colpocopy, 0.9% in LSIL and 24.1% in HSIL. Frequency of abnormal ECC in women with a negative colposcopy or LSIL was significantly lower than that with HSIL. The positive rate of ECC pathologically verified was 3.3% in LSIL, 22.2% in HSIL and 50.0% in squamous carcinoma, respectively (P < 0.01). Of the 316 patients with positive cytology but negative colposcopy, ECC was abnormal in 8 (2.5%), of which HSIL cytologically verified was in 3.

CONCLUSIONIf cytology or colposcopy shows HSIL or more severe changes, and cytology is positive while colposcopy is unsatisfactory, ECC should be done routinely.

Adult ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; Cervical Intraepithelial Neoplasia ; diagnosis ; pathology ; Cervix Uteri ; pathology ; Colposcopy ; Dilatation and Curettage ; Female ; Humans ; Middle Aged ; Uterine Cervical Neoplasms ; diagnosis ; pathology

OBJECTIVEMinimal deviation adenocarcinoma (MDA) is frequently underdiagnosed in pathology tests due to its benign histopathological features. Therefore, its clinical and pathological characters need to be further analyzed and to establish useful immunohistochemical markers to improve the accuracy of pathological diagnosis.

METHODSClinical pathology data were of 13 MDA cases collected and analyzed in the First and Second Hospitals attached to the University, the pathological characters were compared with matched benign hyperplastic and atypical hyperplastic controls of the glandular epithelial cells to find histochemical and immunohistochemical indices valuable for the pathological diagnosis. 8 of these 13 cases were followed and their conditions were discussed.

RESULTSThe main clinical symptoms were watery leucorrhagia, enlargement of the cervix with erosion and hardening. Thickened ligaments were also detected in some cases. The pathological findings included hyperplasia and mild abnormality of the glands, invasion effects into the stroma could be observed in some glands and abortive glands with desmoplastic changes, or edema and inflammatory infiltration around the glands were also observed. The invasion presented in the deep part of the cervix as well, some were found near larger blood vessels or in the small vessels. Compared with benign glands, the immunohistochemical indices of most MDA glands were demonstrated as cancer embryo antigen (CEA) + + +, Ki-67 +--+ + +, P53 +--+ + +, AB/PAS +/+ +, and focal defect on the basement membrane.

CONCLUSIONSOnce any of the diagnostic characters summarized as above was determined, the probability of MDA should be seriously considered, at least atypical hyperplasia in cervical glands must be diagnosed, and follow-up on the patients and histological biopsy of deep tissues (> 5 mm) of the cervix will be necessary to determine the inclusion/exclusion of MDA. Obviously, a correct pathological diagnosis is extremely important for the patient to receive proper treatment in time and thereby improve her quality of life.

Adenocarcinoma ; pathology ; Adult ; Aged ; Cervix Uteri ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Middle Aged ; Uterine Cervical Neoplasms ; pathology

Objective: To investigate the natural regression and related factors of high-grade squamous intraepithelial lesion (HSIL) in the cervix of childbearing age women, and to evaluate the applicability of conservative management for future fertility needs. Methods: This study included 275 patients of reproductive age with fertility needs, who were diagnosed as HSIL by biopsy from April 30, 2015 to April 30, 2022, including 229 cases (83.3%) cervical intraepithelial neoplasia (CIN) Ⅱ and 46 cases (16.7%) CIN Ⅱ-Ⅲ. They were followed-up without immediate surgery in the First Affiliated Hospital of Nanjing Medical University. The median follow-up time was 12 months (range: 3-66 months). The regression, persistence and progression of lesions in patients with HSIL were analyzed during the follow-up period, the influencing factors related to regression and the time of regression were analyzed. Results: (1) Of the 275 HSIL patients, 213 cases (77.5%, 213/275) experienced regression of the lesion during the follow-up period. In 229 CIN Ⅱ patients, 180 cases (78.6%) regressed, 21 cases (9.2%) persisted, and 28 cases (12.2%) progressed. In 46 CIN Ⅱ-Ⅲ patients, 33 cases (71.7%) regressed, 12 cases (26.1%) persisted, and 1 case (2.2%) progressed to invasive squamous cell carcinoma stage Ⅰ a1. There was no significant difference in the regression rate between the two groups (χ²=1.03, P=0.309). (2) The average age at diagnosis, age <25 years old at diagnosis were independent influencing factor of HSIL regression in univariate analysis (all P<0.05). There was no significant difference between HSIL regression and pathological grading, the severity of screening results, human papillomavirus (HPV) genotype, colposcopy image characteristics, number of biopsies during follow-up and pregnancy experience (all P>0.05). (3) The median regression times for patients aged ≥25 years and <25 years at diagnosis were 15 and 12 months, respectively. Kaplan-Meier analysis showed that age ≥25 years at diagnosis significantly increased the median regression time compared to <25 years (χ²=6.02, P=0.014). Conclusions: For HSIL patients of childbearing age, conservative management without immediate surgical intervention is preferred if CINⅡ is fully evaluated through colposcopy examination. Age ≥25 years at diagnosis is a risk factor affecting the prognosis of HSIL patients.
Pregnancy ; Humans ; Female ; Adult ; Cervix Uteri/pathology* ; Uterine Cervical Neoplasms/pathology* ; Uterine Cervical Dysplasia/pathology* ; Biopsy ; Colposcopy/methods* ; Squamous Intraepithelial Lesions/pathology* ; Carcinoma in Situ/pathology* ; Papillomaviridae/genetics* ; Papillomavirus Infections/diagnosis* ; Squamous Intraepithelial Lesions of the Cervix/pathology*

A case of granulocytic sarcoma involving the uterine cerivx as the primary manifestation, before the peripheral blood and bone marrow showed evidences of overt leukemia, is presented. Six weeks after the onset of the genital tract symptom the patient developed acute myelogenous leukemia. The uterine tumor was initially believed to be a histiocytic lymphoma. The diagnosis of granulocytic sarcoma was confirmed by the naphthol AS-D chloracetate stain for esterase, which was performed on the uterine cervix and obturator lymphnodes taken by hysterectomy and pelvic node dissection. The literatrue was reviewed with emphasis on the differential diagnosis of granulocytic sarcoma and histiocytic lymphoma, and the clinical and pathological problems that arise when the tumor presents at an unusual location and without peripheral blood manifestation of leukemia.
Adult ; Cervix Neoplasms/diagnosis* ; Diagnosis, Differential ; Female ; Human ; Leukemia, Myelocytic, Acute/diagnosis* ; Leukemia, Myelocytic, Acute/pathology ; Leukemia, Myeloid/diagnosis* ; Lymphoma/diagnosis

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.
Adenocarcinoma ; Biopsy ; Carcinoma, Squamous Cell ; Cervix Uteri ; Diagnosis ; Endometrial Neoplasms ; Female ; Follow-Up Studies ; Humans ; Mass Screening ; Pathology ; Stomach