Cytologic characteristics of adenoid cystic carcinoma of the cervix uteri: case report [Citološke karakteristike adenoid cističnog karcinoma vrata maternice: prikaz slučajeva]

Adenoid cystic carcinoma is a rare malignancy, usually found in the salivary glands, although this unusual tumor can be found at other sites of the body. In particular, regarding adenoid cystic carcinoma of the cervix (ACCC) most frequently reports are given for postmenopausal women. In this respect, our work is one among very few in the literature that considers a cytologic picture of this uncommon cervix carcinoma. The case of 74 year old patient with postmenopausal bleeding is described. Both Pap smear and air dried smear of the uterine cervix were analyzed. The cytologic findings revealed very few small clusters of abnormal glandular cells, as well as some amorphous eosinophilic globule-like material, with granulomatous and necrotic background. The latter includes a lot of histiocytes, multinucleated giant cells, large aggregates of epitheloid cells and lymphocytes. Histology revealed the diagnosis of ACCC. We emphasize the importance of careful screening of Pap smear that might be crucial in the case of suspicious clinical findings in postmenopausal women, when the possibility of ACCC has to be considered

Influence of the surface roughness of coated and uncoated papers on the digital print mottle

Many factors influence the occurrence of print mottle in prints. In printing process three main components are involved: printing press, substrate and toner. They can be considered as separate components, but in most cases their interaction influences the quality of the print. The goal of this work was to examine the influence of surface roughness of different types of paper (coated and uncoated on print mottle of electrophotographic digital prints. We set up a hypothesis that print mottle will be more apparent on rougher surfaces. In the experimental part we printed four different substrates with different surface properties on electrophotographic printing press. Morphology of the papers surface was analysed using atomic force microscopy (AFM) from which surface properties were calculated. For print mottle characterization Gray level co-occurrence matrix (GLCM) method was used. Based on the measurements and results we can conclude, contrary to the initial hypothesis, that uncoated papers with rougher surfaces produce smaller print mottle values

Atipične glandularne stanice u papa testu kao primarna prezentacija seroznog borderline tumora jajnika

The Pap test is designed as a screening test to detect primarily carcinoma of the cervix and its precursors, most often of squamous type. Rarely atypical or malignant cells found in cervical smear can be indication for the existence of an extrauterine disease. We present a case of a 26 year old woman with very small asymptomatic ovarian bilateral borderline tumors whose diagnosis was triggered by finding of atypical glandular cells with psammoma bodies on Pap smear. She had a history of abnormal Pap smears and was admitted to our Hospital for colposcopy. Pap smear was taken and reported as atypical glandular cells (AGC) with psammoma bodies. Colposcopically directed biopsy along with an endocervical curettage showed no abnormalities as well as transvaginal ultrasound examination. Three months later control Pap smear confirmed AGC with psammoma bodies (suggestive of endometrial or serous origin), ultrasound showed the presence of indistinctive, hyperechoic mass 2 cm in diameter in the left ovary along with slightly elevated CA-125 and diagnostic hysteroscopy and laparoscopy was performed. At laparascopy, both ovaries had surface cauliflower like papillary projections measuring up to 3 cm. A histological examination revealed bilateral serous borderline tumor.Papa test je test probira primarno namijenjen za rano otkrivanje karcinoma cerviksa i njegovih prekursora, najčešće pločastog tipa. Rijetko nalaz atipičnih ili malignih stanica u Papa testu može biti prvi znak tumora ekstrauterinog porijekla. U ovom radu prikazujemo slučaj 26 godišnje pacijentice s vrlo malim asimptomatskim bilateralnim borderline tumorima jajnika čija je dijagnoza pokrenuta nalazom atipičnih žljezdanih stanica sa psamomskim tjelešcima u Papa testu. Pacijentica je upućena u našu bolnicu na kolposkopiju radi abnormalnih nalaza Papa testa. Kod nas uzeti Papa test pokazao je atipične glandularne stanice (AGC) sa psamomskim tjelešcima. Kolposkopski vođena biopsija i endocervikalni ekskohleat nisu pokazali abnormalnosti, kao ni transvaginalni ultrazvučni pregled. Tri mjeseca kasnije ponovljeni Papa test potvrđuje AGC sa psamomskim tjelešcima (porijeklo endometralno ili serozno), ultrazvučni nalaz opisuje uz lijevi jajnik nejasnu hiperehogenu tvorbu promjera 2 cm, uz blago povišeni CA 125 zbog čega je učinjena dijagnostička histeroskopija i laparoskopija. Na operaciji su nađeni jajnici obostrano s tumorskim tvorbama karfiolastog izgleda veličine do 3 cm. Patohistološki je potvrđen serozni borderline tumor oba jajnika

Liquid-based cytology - new possibilities in the diagnosis of cervical lesions [Tekuća citologija - nove mogućnosti u dijagnostici lezija vrata maternice]

Liquid-based cytology (LBC) enables the use of supplementary methods in the diagnosis and prognosis of cervical lesions. The aim of this study was to analyze the correlation between p16INK4a immunoexpression in ThinPrep cervical cytologic samples and human papillomavirus (HPV) detection by polymerase chain reaction (PCR) from the same sample. LBC-ThinPrep (Cytyc, USA) cervical cytology samples, prepared and stained by Papanicolaou method, were analyzed using modified Bethesda cytologic classification named »Zagreb 2002«. A second ThinPrep slide, prepared from the same sample, was immunostained for p16INK4a using CINtec p16INK4a Cytology Kit (DakoCytomation, Denmark). Increased expression of the high-risk (HR) HPV E6 and E7 oncogenes results in a highly specific increase in p16 protein expression and overexpression of p16INK4a acts as a potential biomarker for cervical cancer progression from premalignant lesions. Brown nuclear and/or cytoplasmic staining of abnormal cells was considered a positive result. Residual material was used for 13 HR HPV-DNA detection by the PCR based AMPLICOR HPV test (Roche Molecular Systems). A total of 120 ThinPrep Pap tests with the following cytologic diagnoses: 17 within normal limits, 17 atypical squamous cell (ASC) (7 ASC of undetermined significance /ASCUS/ and 10 ASC of high-grade squamous intraepithelial lesions cannot be excluded /ASC-H/), 26 low-grade squamous intraepithelial lesions (LSIL) corresponding cervical intraepithelial neoplasia (CIN) I, 57 high-grade SIL (HSIL) i.e. 24 CIN II and 33 CIN III and 3 squamous cell carcinoma (SCC) were included in the study. All CIN III (n=33) and SCC (n=3) specimens expressed p16INK4a immunoreactivity, whereas the HR HPV test was positive in 97% (32/33) of CIN III and 100% (3/3) of SCC specimens. The p16INK4a biomarker was positive in 87.5% (21/24) of CIN II and 69% (18/26) of CIN I, while the HR HPV was positive in 75% (18/24) of CIN II and 50% (13/26) of CIN I. In ASCUS cytology, p16INK4a and HR HPV showed the same rate of positivity (28.5%; 2/7). Expression of p16INK4a was detected in all cytologic (10/10) ASC-H lesions, in contrast to HR HPV detected in only 20% (2/10) of ASC-H cases. These data suggest the p16INK4a evaluation in ThinPrep cervical samples to be significantly associated with HR HPV testing by PCR in the same sample for the diagnosis of HSIL lesions and cervical carcinomas. A prospective study with longer follow up may clarify the predictive values in the management of LSIL and ASC diagnosis

Cytologic Characteristics of Adenoid Cystic Carcinoma of the Cervix Uteri – Case Report

Adenoid cystic carcinoma is a rare malignancy, usually found in the salivary glands, although this unusual tumor can be found at other sites of the body. In particular, regarding adenoid cystic carcinoma of the cervix (ACCC) most frequently reports are given for postmenopausal women. In this respect, our work is one among very few in the literature that considers a cytologic picture of this uncommon cervix carcinoma. The case of 74 year old patient with postmenopausal bleeding is described. Both Pap smear and air dried smear of the uterine cervix were analyzed. The cytologic findings revealed very few small clusters of abnormal glandular cells, as well as some amorphous eosinophilic globule-like material, with granulomatous and necrotic background. The latter includes a lot of histiocytes, multinucleated giant cells, large aggregates of epitheloid cells and lymphocytes. Histology revealed the diagnosis of ACCC. We emphasize the importance of careful screening of Pap smear that might be crucial in the case of suspicious clinical findings in postmenopausal women, when the possibility of ACCC has to be considered

Cytologic Characteristics of Adenoid Cystic Carcinoma of the Cervix Uteri – Case Report

Adenoid cystic carcinoma is a rare malignancy, usually found in the salivary glands, although this unusual tumor can be found at other sites of the body. In particular, regarding adenoid cystic carcinoma of the cervix (ACCC) most frequently reports are given for postmenopausal women. In this respect, our work is one among very few in the literature that considers a cytologic picture of this uncommon cervix carcinoma. The case of 74 year old patient with postmenopausal bleeding is described. Both Pap smear and air dried smear of the uterine cervix were analyzed. The cytologic findings revealed very few small clusters of abnormal glandular cells, as well as some amorphous eosinophilic globule-like material, with granulomatous and necrotic background. The latter includes a lot of histiocytes, multinucleated giant cells, large aggregates of epitheloid cells and lymphocytes. Histology revealed the diagnosis of ACCC. We emphasize the importance of careful screening of Pap smear that might be crucial in the case of suspicious clinical findings in postmenopausal women, when the possibility of ACCC has to be considered

Digital morphometry of cytologic aspirate endometrial samples [Digitalna morfometrijska analiza citoloških uzoraka aspirata endometrija]

Unlike cervical cytology, morphological cytology criteria in the differential diagnosis of endometrium have not yet been clearly defined, and methods to allow for more precise evaluation of endometrium status have been searched for. The aim of the present study was to assess the value of morphometric nucleus analysis of cytologic aspirate endometrial samples in proliferative, hyperplastic and malignant endometrium by use of digital image analysis. Morphometric analysis was performed on archival cytologic aspirate endometrial samples (at least 10 per group) stained according to Papanicolaou (n=77) and May-Grünwald-Giemsa (MGG; n=80) with the following histopathologic diagnoses: proliferative endometrium, hyperplasia simplex, hyperplasia complex, hyperplasia complex atypica, and adenocarcinoma endometriodes endometrii (grade I, II and III). Interactive image analysis (nuclear area, convex area, perimeter, maximum and minimum radius, length and breadth, as well as nucleus form factor and elongation factor) was performed by use of the SFORM software (VAMSTEC, Zagreb) on at least 50 (Papanicolaou stain) and 100 (MGG stain) well preserved endometrial epithelial cell nuclei without overlapping, at magnification of ´1000. Statistical data analysis was done by use of the Statistica Ver. 6 statistical package. Multivariate analysis (ANOVA) distinguished malignant, hyperplastic and proliferative endometrium according to all morphometric variables with both staining methods (p0.05) from atypical hyperplasia, adenocarcinoma and proliferative endometrium only according to the nucleus form factor and elongation factor (Papanicolaou stain), whereas malignant and atypical hyperplastic endometrium (MGG stain) differed statistically significantly (p0.05). According to the cytologic staining method, morphometric parameters were considerably higher in MGG stained endometrial samples, reaching the level of statistical significance (p0.05) in the groups of hyperplasia simplex and complex, well differentiated adenocarcinoma (form factor) and atypical hyperplasia (elongation factor). A combination of cytomorphology and the morphometric variables assessed in this study can yield useful information on the cytologic state of endometrium, with special reference to the possible differentiation of the group of hyperplasia without atypia from the group of adenocarcinoma and atypical hyperplasia

Uloga citologije u otkrivanju preinvazivnih i invazivnih promjena stidnice ovisno o načinu uzimanja uzorka

Eksfolijativna citologija stidnice kao neinvazivna metoda koristi se u dijagnostici i praćenju promjena na stidnici, osobito onih kod kojih nije indicirana biopsija. Dosad se tradicionalno obrisak uzimao špatulom te su citološki uzorci često bili slabo celularni. Kako bi se poboljšala celularnost uveden je postupak uzimanja endocervikalnom četkicom. U retrospektivnoj studiji obuhvaćeno je 1866 uzoraka sa stidnice uzetih u razdoblju od 1. srpnja 2011. do 31. prosinca 2013. Analizirana je primjerenost uzoraka kao i omjer nalaza atipičnih pločastih stanica (ASC) prema nalazu pločaste intraepitelne lezije ili karcinoma (SIL+), ovisno o ambulanti u kojoj je uzorak uzet, te citohistološka korelacija. U onkološkoj ambulanti specijaliziranoj za bolesti stidnice u kojoj je većina uzoraka uzimana četkicom bilo je najmanje neprimjerenih uzoraka zbog oskudnosti (3,4%), kao i zadovoljavajućih, ali oskudnih uzoraka (5,6%), a najviše ovakvih uzoraka bilo je u ginekološkim ambulantama primarne zdravstvene zaštite (13,7% odnosno 25,3%) u kojima su obrisci uglavnom uzimani na tradicionalan način – špatulom. Usporedili smo omjer ASC:SIL+ nalaza kod potpuno zadovoljavajućih nalaza ovisno o ambulanti u kojoj su uzeti uzorci: u ambulanti specijaliziranoj za bolesti stidnice bio je 2,6:1, u ostalim onkološkim ambulantama 1,9:1, u ostalim ambulantama klinike 3,5:1, dok je u ambulantama primarne ginekologije bio 2,3:1. Kod zadovoljavajućih, ali oskudnih nalaza ovaj omjer ASC:SIL+ varirao je od 5:1 do 11:0 ovisno o ambulanti u kojoj su uzorci uzeti. Citohistološka korelacija 159 slučajeva pokazala je visoku osjetljivost u otkrivanju preinvazivnih (94,1%) i invazivnih (100,0%) promjena, ali nisku specifičnost (35,4%). Uzorci sa stidnice uzeti endocervikalnom četkicom značajno su celularniji od uzoraka uzetih špatulom i time bolji za citološku analizu te je manji omjer ASC:SIL+ nalaza. Citološka analiza uzoraka sa stidnice ne može zamijeniti biopsiju, ali kod klinički nejasnih lezija može pomoći u postavljanju indikacije za daljnji postupak, kao i u praćenju bolesnica s potvrđenom bolesti

Influence of Paper Properties and Printing Machines Properties on Optical Density in Electrophotography

Electrophotography is affected by several parameters, including printing machines and paper type, which determine the final quality of reproduction. For the investigation of those effects, tests were done on the three types of electrophotography printing machines and eight types of uncoated paper with different properties of weight, surface roughness, whiteness, brightness and opacity. Samples were printed with cyan, magenta, yellow and black toner under the standard, identical conditions. The assessment of standard print quality parameter (optical density) was done using spectrodensitometer Techkon Spectro Dens. At the same time, the paper substrates were characterized using the atomic force microscopy (AFM) as well as by spectrophotometric measurements (X Rite Eye-One, i1). Obtained results showed that the reproducibility significantly depends on the type of printing machine rather than optical and mechanical properties of paper

Liquid-Based Cytology – New Possibilities in the Diagnosis of Cervical Lesions

Liquid-based cytology (LBC) enables the use of supplementary methods in the diagnosis and prognosis of cervical lesions. The aim of this study was to analyze the correlation between p16INK4a immunoexpression in ThinPrep cervical cytologic samples and human papillomavirus (HPV) detection by polymerase chain reaction (PCR) from the same sample. LBC-ThinPrep (Cytyc, USA) cervical cytology samples, prepared and stained by Papanicolaou method, were analyzed using modified Bethesda cytologic classification named »Zagreb 2002«. A second ThinPrep slide, prepared from the same sample, was immunostained for p16INK4a using CINtec p16INK4a Cytology Kit (DakoCytomation, Denmark). Increased expression of the high-risk (HR) HPV E6 and E7 oncogenes results in a highly specific increase in p16 protein expression and overexpression of p16INK4a acts as a potential biomarker for cervical cancer progression from premalignant lesions. Brown nuclear and/or cytoplasmic staining of abnormal cells was considered a positive result. Residual material was used for 13 HR HPV-DNA detection by the PCR based AMPLICOR HPV test (Roche Molecular Systems). A total of 120 ThinPrep Pap tests with the following cytologic diagnoses: 17 within normal limits, 17 atypical squamous cell (ASC) (7 ASC of undetermined significance /ASCUS/ and 10 ASC of high-grade squamous intraepithelial lesions cannot be excluded /ASC-H/), 26 low-grade squamous intraepithelial lesions (LSIL) corresponding cervical intraepithelial neoplasia (CIN) I, 57 high-grade SIL (HSIL) i.e. 24 CIN II and 33 CIN III and 3 squamous cell carcinoma (SCC) were included in the study. All CIN III (n=33) and SCC (n=3) specimens expressed p16INK4a immunoreactivity, whereas the HR HPV test was positive in 97% (32/33) of CIN III and 100% (3/3) of SCC specimens. The p16INK4a biomarker was positive in 87.5% (21/24) of CIN II and 69% (18/26) of CIN I, while the HR HPV was positive in 75% (18/24) of CIN II and 50% (13/26) of CIN I. In ASCUS cytology, p16INK4a and HR HPV showed the same rate of positivity (28.5%; 2/7). Expression of p16INK4a was detected in all cytologic (10/10) ASC-H lesions, in contrast to HR HPV detected in only 20% (2/10) of ASC-H cases. These data suggest the p16INK4a evaluation in ThinPrep cervical samples to be significantly associated with HR HPV testing by PCR in the same sample for the diagnosis of HSIL lesions and cervical carcinomas. A prospective study with longer follow up may clarify the predictive values in the management of LSIL and ASC diagnosis