Malignant lymphoma of the uterine cervix is rarely diagnosed by cytology because it presents as a subepithelial mass. We report three cases of diffuse large B-cell lymphoma in the uterine cervix with a description of liquid-based pap smear (LBP) findings. All patients were presented with cervical masses, but a suspicion of malignant lymphoma was made in only one case by preoperative LBP. The LBP of two cases showed several atypical lymphoid cells in a clear background. The other case revealed numerous atypical lymphoid cells in a necrotic background. Most tumor cells had an increased N/C ratio, round but focally irregular nuclei, coarse chromatin, and prominent nucleoli. Nuclear blebing, dimpling, and multi-lobulation were also found. Diagnosis of malignant lymphoma by LBP is usually more difficult than by conventional techniques, because of a sparse numbers of cells and the lack of necrotic background. However, well preserved morphological features and a better resolution of nuclear details could be the benefits of LBP.
Cervix Uteri ; Chromatin ; Female ; Humans ; Lymphocytes ; Lymphoma ; Lymphoma, B-Cell

OBJECTIVE: To evaluate the occurrence of residual or recurrent disease after conization for adenocarcinoma in situ (AIS) of the uterine cervix. METHODS: Medical records of 99 patients with a histologically diagnosis of AIS of the uterine cervix by conization between 1991 and 2008 were reviewed retrospectively. RESULTS: Seventy eight of 99 patients (78.8%) had negative and 18 (18.2%) had positive resection margins of the conization specimen, and 3 (3.0%) had unknown margin status. Of the 78 patients with negative margins, 45 underwent subsequent hysterectomy and residual AIS were present in 4.4% (2/45) of patients. Ten of the 18 patients with positive margins received subsequent hysterectomy and 3 patients (30%) had residual AIS. Twenty-eight patients had conservative treatment and during the median follow-up time of 23.5 months (range, 7 to 124 months), only one patient (3.6%) had recurrent AIS and was treated with a simple hysterectomy. Eight patients became pregnant after conization, 4 of them delivered healthy babies, one had a spontaneous abortion and 3 were ongoing pregnancies. CONCLUSION: Patients with positive resection margins after conization for AIS of the uterine cervix are significantly more likely to have residual disease. However, negative resection margin carries a lower risk for residual AIS, therefore conservative management with careful surveillance seems to be feasible in women who wish to preserve their fertility.
Abortion, Spontaneous ; Adenocarcinoma ; Cervix Uteri ; Conization ; Female ; Fertility ; Follow-Up Studies ; Humans ; Hysterectomy ; Medical Records ; Pregnancy

BACKGROUND: We examined cervicovaginal smears that contained definite low-grade squamous intraepithelial lesion (LSIL) cells and rare atypical cells suggestive of high-grade SIL (HSIL) (ASC-H) or contained borderline dysplastic cells between LSIL and HSIL. Such lesions were classified as LSIL-H. This study aimed to investigate the cytologic and histologic characteristics of LSIL-H category and we evaluated the associated clinical risk. METHODS: The histologic outcomes of LSIL-H were compared with those of LSIL and ASC-H. Both the cytologic and histologic findings of LSIL-H that were confirmed as cervical intraepithelial neoplasia 2 (CIN2) or greater (CIN2+) were investigated. RESULTS: LSIL-H accounted for 0.09% of the Pap tests. On the follow-up histology, the most frequent outcome was CIN2, and the risk of CIN2+ was higher than that for ASC-H. In the cases of LSIL-H that was histologically confirmed as CIN2+, most of the atypical cells suggestive of HSIL were cytologically similar to those of CIN2, and the corresponding cervical tissues were characterized by small CIN2+ lesions in a large background of flat condyloma/CIN1. The LSIL-H cases not confirmed on initial colposcopically-directed biopsy required further follow-up. CONCLUSIONS: LSIL-H may be a valid diagnostic category with distinctive features that are different from LSIL or ASC-H. LSIL-H needs further follow-up for the proper management.
Biopsy ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Female ; Follow-Up Studies ; Vaginal Smears

BACKGROUND: We examined cervicovaginal smears that contained definite low-grade squamous intraepithelial lesion (LSIL) cells and rare atypical cells suggestive of high-grade SIL (HSIL) (ASC-H) or contained borderline dysplastic cells between LSIL and HSIL. Such lesions were classified as LSIL-H. This study aimed to investigate the cytologic and histologic characteristics of LSIL-H category and we evaluated the associated clinical risk. METHODS: The histologic outcomes of LSIL-H were compared with those of LSIL and ASC-H. Both the cytologic and histologic findings of LSIL-H that were confirmed as cervical intraepithelial neoplasia 2 (CIN2) or greater (CIN2+) were investigated. RESULTS: LSIL-H accounted for 0.09% of the Pap tests. On the follow-up histology, the most frequent outcome was CIN2, and the risk of CIN2+ was higher than that for ASC-H. In the cases of LSIL-H that was histologically confirmed as CIN2+, most of the atypical cells suggestive of HSIL were cytologically similar to those of CIN2, and the corresponding cervical tissues were characterized by small CIN2+ lesions in a large background of flat condyloma/CIN1. The LSIL-H cases not confirmed on initial colposcopically-directed biopsy required further follow-up. CONCLUSIONS: LSIL-H may be a valid diagnostic category with distinctive features that are different from LSIL or ASC-H. LSIL-H needs further follow-up for the proper management.
Biopsy ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Female ; Follow-Up Studies ; Vaginal Smears

BACKGROUND: The study evaluated the histologic correlation and clinical significance of atypical glandular cells (AGC) detected either on conventional smears (CS) or liquid-based cytology (LBC). METHODS: Two hundred and seventy-seven (0.11%) of 261,925 cervical smears were interpreted as AGC by the Bethesda system 2001 from January 2006 to December 2008. Cytohistological correlation was performed on 192 cases. RESULTS: The prevalence of AGC was 0.07% and 0.13% for CS and LBC smears, respectively. Distribution of AGC subcategories were as follows: atypical endometrial cells 53.8%, atypical endocervical cells 22.7%, atypical glandular cells 19.5%, atypical endocervical cells favoring neoplasia 2.2%, and atypical glandular cells favoring neoplasia 1.8%. Fifty-nine (27.4%) of 192 patients were confirmed as having clinically significant lesions comprising endometrial adenocarcinoma (12.5%), endometrial hyperplasia (6.0%), cervical adenocarcinoma (2.3%), high-grade squamous intraepithelial lesion (HSIL) (1.9%), low-grade SIL (1.9%), adenocarcinoma in situ (1.4%), or ovarian metastasis (1.4%). Conclusion: Compared with CS, LBC was presently associated with a higher prevalence of AGC. Histologic follow-up showed a very low HSIL rate compared to other studies. Endometrial adenocarcinoma was the most common malignant lesion detected because of increasing prevalence of endometrial adenocarcinoma, concentration on endometrial cytology, and introduction of LBC.
Adenocarcinoma ; Endometrial Hyperplasia ; Female ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Prevalence ; Vaginal Smears

Synovial fluid (SF) aspiration cytology is a useful diagnostic tool. For patients with gouty arthritis, the diagnosis is confirmed by the presence of monosodium uric acid (MSU) crystals in the SF, and these crystals are long, pointed ended and needle-shaped and they show strongly negative birefringence. Sometimes, it is difficult to diagnosis between gouty arthritis and other type of inflammatory arthritis. We experienced two unusual cases of gouty arthritis that we performed SF analysis for. The first patient was a 35 year old male who presented with relatively typical clinical symptoms with hyperuricemia, but the SF showed acute inflammatory cells without crystals on light microscopy. Only a few suspected crystals of MSU were identified on polarizing microscopy. The second patient was a 45 year old male who presented with atypical symptoms and pain and swelling of the left ankle and knee joint for 3 weeks. The uric acid level in the serum and urine was increased, but not over the normal limit. However, on light and polarizing microscopy, there were numerous MSU crystals in the SF. Conclusively, in some cases of gouty arthritis, the crystals are not identified on light microscopy or the uric acid level is not dramatically increased. So, the polarizing microscopy, the clinical information and the laboratory findings are all included in the work-up when evaluating the SF cytology of arthritis patients.
Animals ; Ankle ; Arthritis ; Arthritis, Gouty ; Birefringence ; Gout ; Humans ; Hyperuricemia ; Knee Joint ; Light ; Male ; Microscopy ; Synovial Fluid ; Uric Acid

Two women presented with history of vaginal bleeding and abnormal transvaginal ultrasound findings. Saline infusion sonohysterography was done for preoperative evaluation and this imaging study revealed centrally located uterine mass with internal cystic portion. Our initial impression was submucosal myoma with cystic degeneration and hysteroscopic removal of the mass was performed. During the procedure, dark brownish cystic fluid was drained. The excised submucosal mass was pathologically diagnosed as adenomyosis and clinically as submucosal adenomyotic cyst. Submucosal adenomyotic cyst should be part of the differential diagnosis of submucosal uterine masses with cystic portion. We report two cases of submucosal adenomyotic cyst successfully treated with hysteroscopic resection and brief review on this topic.
Adenomyosis ; Diagnosis, Differential ; Female ; Humans ; Myoma ; Uterine Hemorrhage

OBJECTIVE: Paclitaxel is one of the most effective antineoplastic drugs. HPV-related cervical lesions have only managed with invasive procedure. Topical drug administration with temperature sensitive copolymer gels are useful approaches to clinical situation. In this study, we evaluated the activity of multiblock copolymers of PEG/PLA (poly(L-lactic acid)/polyethylene glycol) gels with paclitaxel (PTX) formulation administered by topical treatment to mice bearing human cervical cancer cell lines (HeLa). METHODS: We have synthesized gels of PEG/PLLA (poly(L-lactic acid)/polyethylene glycol) multiblock copolymers containing Paclitaxel which have temperature-sensitivecharacteristics. This Paclitaxel-containg copolymers has the sol-gel-sol transition temperature at body temperature. The efficacy of PTX in PEG/PLA mutiblock copolymer micelle were conducted in HeLa-tumor bearing Balb/c Nu/Nu athymic mice at an equivalent paclitaxel dose of 10 mg/kg with 48 hr interval. The inhibition of tumor growth was evaluated after 8 days of treatment. Tumors were harvested at day 10 and stained with hematoxylin and eosine to measure tumor. RESULTS: PTX-containing PEG/PLA mutiblock copolymer significantly decreased tumor growth at day 8, as measured by tumor size; ie, PEG/PLA mutiblock copolymer only goup ; 1.43+/-0.26 m versus intraperitoneal treatment of Paclitaxel : 0.75+/-0.07 mm and topical treatment of PTX-containing PEG/PLA copolymer containing Paclitaxel : 0.28 mm (Min; 0.1 mm-Maxu0.8 mm). CONCLUSION: This demonstration that PTX-containing PEG/PLA mutiblock copolymer have a useful topical drug deliversy system carrying temperature sensitive characetersitics in HPV-related cervical lesions.
Administration, Topical ; Animals ; Antineoplastic Agents ; Body Temperature ; Cell Line ; Eosine Yellowish-(YS) ; Gels ; Hematoxylin ; Humans ; Lifting ; Mice ; Mice, Nude ; Models, Animal ; Paclitaxel ; Polymers ; Transition Temperature ; Ursidae ; Uterine Cervical Neoplasms

Malakoplakia is an uncommon chronic granulomatous inflammation that usually involves the urinary and gastrointestinal tracts, but rarely affects the female genital tract. We experienced a case of malakoplakia in a cervicovaginal smear in a 54-year-old woman. Colposcopic examination showed a friable, easily bleeding tissue in the uterine cervix and the vaginal fornix. The cervicovaginal smear consisted of numerous isolated histiocytes, polymorphonuclear leukocytes, lymphocytes, and plasma cells. The histiocytes had an abundant, granular, and degenerated cytoplasm with inflammatory cell debris. Michaelis-Gutmann bodies were readily identified.
Cervix Uteri ; Cytoplasm ; Female ; Gastrointestinal Tract ; Hemorrhage ; Histiocytes ; Humans ; Inflammation ; Lymphocytes ; Malacoplakia ; Middle Aged ; Neutrophils ; Plasma Cells ; Vagina

OBJECTIVE: The aim of this study was to evaluate the correlation between the results of preoperative PAP smears and known poor prognostic factors in patients with endometrial carcinoma. METHODS: Between Jan. 2000 and Dec. 2003, preoperative evaluation of PAP smears were done in 111 patients with endometrial carcinoma who underwent surgical staging. Pathologic parameters of permanent specimens were evaluated and correlated with the results of PAP smears. chi-square-test was used for statistical analysis and p-values <0.05 was considered as statistically significant result. RESULTS: The mean age of patients was 49 years with range between 24 and 75 years old. The results of preoperative PAP smears were normal in 70 patients (57.7%), atypical glandular cells of undetermined significance (AGUS) in 22 patients (22.5%), adenocarcnoma in 19 patients (19.8%) on preoperative PAP smears. Statistically significant associations were found between preoperative PAP smears and poor histologic grade (p=0.000), depth of myometrial invasion (p=0.000), lymph-vascular space invasion (p=0.003), cervical involvement (p=0.004), adnexal involvement (p=0.024), positive peritoneal cytology (p=0.042). However, old age, poor histologic type, higher surgical staging, pelvic nodes metastasis and para-aortic lymph node metastases were not statistically significant. CONCLUSION: This study revealed glandular cell abnormalities on preoperative PAP smears in patients with endometrial carcinoma were significantly associated with poor histologic grade, deep myometrial invasion, lympho-vascular invasion, cervical involvement, adnexal involvement, positive peritoneal cytology. Therefore, the results of preoperative PAP smears could be considered as an important part of the preoperative evaluation in patients with endometrial carcinoma.
Aged ; Endometrial Neoplasms* ; Female ; Humans ; Lymph Nodes ; Neoplasm Metastasis