Significance of Atypical Squamous Cells and Atypical Glandular Cells: Similar but Dissimilar

Since 1988 when the Bethesda System (TBS) was first adopted(1), two modifications were subsequently carried out in 1991 and 2001(2,3). One of the major changes in TBS 2001 is the revision of a terminology used for atypical squamous and glandular cells. TBS 2001 replaced “atypical squamous cells of undetermined significance (ASCUS)” and “atypical glandular cells of undetermined significance (AGUS or AGCUS)” in TBS 1988 and 1991 with simply “atypical squamous cells (ASC)” and “atypical glandular cells (AGC)”, respectively. Attempts have always been made to qualify or subcategorize these equivocal diagnoses in a manner to indicate that it can define a patient at increased risk of significant clinical lesions which generally include high grade pre-invasive and invasive cancers. These two acronyms are similar for being classified as cells which are more atypical than reactive response but are not justified to be classified as preinvasive or invasive lesions. However, they are dissimilar in terms of having different cytologic backgrounds and underlying histopathology as well as clinical implication. When these abnormal cytologic diagnoses and their qualifiers or subcategories are given, a gynecologist who confronts with the women should thoroughly understand the messages from a cytopathologist through his/ her report of these cytologic interpretations. Some important issues of these two particular cytologic abnormalities will be briefly pointed out here in a light of hope that this will lead to an optimal management for a woman

Prevalence of Clinical Significant Lesions in Atypical Glandular Cell of Undetermined Significance (AGUS) From Cervical Pap Smear

Objective: To determine the prevalence of clinical significant lesions from the underlying pathology of women with atypical glandular cell of undetermined significance (AGUS) from cervical Pap smear. Materials and Methods: Women with cytologic diagnosis of AGUS from cervicovaginal Pap smears in our institution from January 2000 to June 2008 were identified. Clinical data and their subsequent tissue histologic diagnoses were reviewed. Results: The prevalence of AGUS in 100,648 Pap smears was 0.26% (266 smears); 151 of them had further investigations and were included in the study. The histology/histopathology turned out to be normal and cervicitis in 35 cases (23.2%) and 28 cases (18.6%), respectively, cervical intraepithelial neoplasia (CIN) I in 51 cases (33.9%), CIN II in 18 cases (11.9%), CIN III in 4 cases (2.7%) adenocarcinoma in situ (AIS) in 4 cases (2.7%), invasive adenocarcinoma of cervix in 4 cases( 2.7%), complex hyperplasia with atypia in 2 cases (1.3%) and endometrial adenocarcinoma in 5 cases (3.3%). Conclusions: The clinical significant lesions were found in 37 cases (24.5%) of AGUS cervical cytology, with 6% prevalence of invasive cancers

Intraoperative frozen section analysis of the proximal bile ducts in hilar cholangiocarcinoma is of limited value

Frozen section analysis (FS) during cancer surgery is widely used to assess resection margins. However, in hilar cholangiocarcinoma (HCCA), FS may be less reliable because of the specific growth characteristics of the tumor. The aim of this study was to determine the accuracy and consequences of intraoperative FS of the proximal bile duct margins in HCCA. Between 1990 and 2014, 67 patients underwent combined extrahepatic bile duct resection and partial liver resection for HCCA with the use of FS. Sensitivity and specificity of FS was 68% and 97%, respectively. Seventeen of 67 patients (25%) displayed a positive bile duct margin at FS. The false-negative rate was 16% (eight patients). Ten patients (15%) with a positive bile duct margin underwent an additional resection in an attempt to achieve negative margins, which succeeded in three patients (4%). However, only one of these three patients did not have concomitant lymph node metastases, which are associated with a poor prognosis by itself. The use of FS of the proximal bile duct is of limited clinical value because of the relatively low sensitivity, high risk of false-negative results, and the low rate of secondary obtained tumor-free resection margins. Supported by the literature, a new approach to the use of FS in HCCA should be adopted, reserving the technique only for cases in which a substantial additional resection is possible.</p

Primary Retroperitoneal Mucinous Cystadenocarcinoma: A Case Report and Review of the Literature

Primary retroperitoneal mucinous cystadenocarcinoma is a rare tumor. Only about 30 such cases have been reported in the worldwide literature, and a few Korean cases have been reported. The pathogenesis is not clear, and coelomic metaplasia of the retroperitoneal mesothelium has gained wide support. There is no consensus on the appropriate treatment, but surgical exploration is needed for the diagnosis and treatment, and adjuvant chemotherapy may be recommended following complete surgical excision. The long-term prognosis has not been established

Large-cell neuroendocrine carcinoma of the cervix

Large cell neuroendocrine carcinoma (LCNEC) of the uterine cervix is a rare and aggressive malignancy with poor prognosis even in its early stage, despite multimodality treatment strategy. Here, we report a case of a woman with clinical polypoid stage IB LCNEC of the cervix, which was detected in her 6-week postpartum checkup. A literature review was also conducted to evaluate current therapeutic approaches and potential new strategies

Primary retroperitoneal mucinous cystadenocarcinoma: report of two cases

BACKGROUND: Retroperitoneal cystadenocarcinomas are rare lesions, the majority of cases presented as one-patient reports. METHODS: We present two cases of retroperitoneal cystadenocarcinoma, both in women of reproductive age: one with aggressive behavior, and the remaining case, with a more indolent clinical evolution. RESULTS: One case presented as pelvic tumor, was treated with surgical resection of the disease, but manifested with recurrent disease a few months later despite use of chemotherapy. The second case involved a patient with diagnosis of abdominal tumor; during laparotomy, a retroperitoneal tumor was found and was totally removed. At follow-up, the patient is disease-free with no other treatment. CONCLUSION: The behavior and treatment of retroperitoneal cystadenocarcinoma are controversial. We suggest aggressive surgery including radical hysterectomy and bilateral salpingoopherectomy with adjuvant chemotherapy in these cases

Primary retroperitoneal mucinous cystadenoma of borderline malignancy in a male patient. Case report and review of the literature

<p>Abstract</p> <p>Background</p> <p>Primary retroperitoneal mucinous cystadenoma of borderline malignancy represents a rare tumor, with unclear histogenesis, concerning almost exclusively women. Only two cases concerning male patients have been reported.</p> <p>Case report</p> <p>We herein report a case of a 37 year old man undergone laparotomy for a sizable retroperitoneal tumor resulting after the histological examination to a primary retroperitoneal mucinous cystadenoma of borderline malignancy.</p> <p>Conclusion</p> <p>This is the third case of primary retroperitoneal mucinous cystadenoma of borderline malignancy in a male patient reported in the literature. The preoperative diagnosis is impossible. Laparotomy constitutes the only diagnostic and curative approach.</p

Ovarian germ cell tumors with rhabdomyosarcomatous components and later development of growing teratoma syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Development of a sarcomatous component in a germ cell tumor is an uncommon phenomenon. Most cases reported have a grim prognosis. Growing teratoma syndrome is also an uncommon phenomenon and occurs in approximately 2% to 7% of non seminomatous germ cell tumors and should be treated surgically.</p> <p>Case presentation</p> <p>We report the case of a 12-year-old Asian girl with an ovarian mixed germ cell tumor containing a rhabdomyosarcomatous component. She was treated with a germ cell tumor chemotherapy regimen and rhabdomyosarcoma-specific chemotherapy. Towards the end of her treatment, she developed a retroperitoneal mass that was increasing in size. It was completely resected, revealing a mature teratoma, consistent with growing teratoma syndrome. She is still in complete remission approximately three years after presentation.</p> <p>Conclusion</p> <p>The presence of rhabdomyosarcoma in a germ cell tumor should be treated by a combined chemotherapy regimen (for germ cell tumor and rhabdomyosarcoma). In addition, development of a mass during or after therapy with normal serum markers should raise the possibility of growing teratoma syndrome that should be treated surgically.</p