Cases Of Neoplastic Lesions Research Articles

HISTOPATHOLOGY OF THYROID LESIONS: A CROSS- SECTIONAL STUDY

Background- The thyroid gland lesions are the most common endocrine disorders encountered globally. Thyroid lesions may be developmental, inammatory, hyperplastic and neoplastic. - To nd out spectrum of various thyroid les Objectives Material & Methods- ions. A cross sectional study was conducted at ESIC Medical College, Kalaburagi from Jan 2019 to Jan 2022. Institutional Ethical Committee clearance was obtained. Patients who underwent Thyroidectomy procedures for various thyroid lesions were enrolled. Statistical analysis was done using SPSS version 16 and the data was analyzed and tabulated according to age and gender distribution. Results- Out of 148 specimens, 122 (82.43%) cases of nonneoplastic lesions and 26 (17.57%) cases of neoplastic lesions were present. There were 25 males and 123 females with a male to female ratio of 1:4.9. The age ranged from 16 to 73 years with most common age group of 21-40 years. In non-neoplastic lesions, the predominant lesion was the colloid goiter with 101 (82.78%) cases followed by lymphocytic thyroiditis with 10 (08.19%) cases and Graves disease with 07 (5.74%). In neoplastic lesions, papillary carcinoma was the commonest lesion with 14 (53.85%) cases followed by follicular carcinoma with 05 (19.23%) cases and follicular adenoma with 04 (15.38%) cases. There were also 02 (7.69%) cases of anaplastic carcinoma in neoplastic lesions. ConclusionColloid goiter and Papillary carcinoma were the most common benign and malignant thyroid lesions with a female predominance. Other uncommon lesions like anaplastic carcinoma were also noted.

The Correlation of age and gender with prevalence of histopathological patterns of thyroid diseases among Iraqi patients

Objectives: The aim of this study was to investigate the prevalence of histopathological patterns of thyroid lesions and their relation to age and gender in patients underwent total or near total and partial thyroidectomy. Methods: 430 biopsy blocks examined for patients who had undergone total or near total and partial thyroidectomy for both non-neoplastic and neoplastic thyroid lesions, between January 2018 to December 2020 at Surgical Department, Medical city, Baghdad, Iraq. Results: Out of 430 thyroidectomy specimens, 275 (64%) cases of non-neoplastic lesions, and 155 (36%) cases of neoplastic lesions were present. There were 63 males and 367 females with a male to female ratio of 1:5.6. The age ranged in males from 12 to 83 years with a mean age of 47.5 years and the age ranged in females from 10-68 years with a mean age of 39 years. In non-neoplastic lesions, the predominant lesion was the nodular hyperplasia with 233 (84.7%) cases followed by Hashimoto thyroiditis with 24 (8.7%) . In neoplastic lesions, papillary carcinoma was the commonest lesion with 98 (63.2%) cases followed by follicular carcinoma with 11 (7%) cases. Conclusion : Nodular colloid goiter was the most common non –neoplastic lesion with female predominance . Papillary carcinoma was the most frequent thyroid cancer accounting for 84.4% of thyroid cancers. with micropapillary variant making 44.89 % with most cases occurring in the third and forth decade.There appears to be a slightly increased trend of papillary carcinoma diagnosis. The present study highlights the necessity for time to time assessment of neoplastic lesions in young and middle-aged female for initial detection.

Cytomorphological Spectrum of Salivary Gland Lesions by Fine Needle Aspiration Cytology

Introduction: Salivary gland lesions encompass a baffling subset of lesions with overlapping morphologies on cytomorphology, due to their heterogenous histologies and rare enough to sometimes bewilder even the most knowledgeable cytopathologists. The technique of fine needle aspiration (FNA) cytology in the evaluation of salivary gland lesion is simple to perform, saves time, reliable, safe and inexpensive. FNA is highly accurate when used in proper clinical setting and supported by appropriate clinical and relevant diagnostic data. Rapidity of obtaining a pathological diagnosis allows more intelligent therapeutic approach. Materials and Methods: It was a prospective study carried out in the cytology section of pathology department for a period of two years using fine needle aspiration as a diagnostic tool as per standard protocol. The clinical and radiological data were obtained from the patient’s case papers and collaboration with the operating surgeon, the lesions were analysed on cytology. Haematoxylin & Eosin, Papanicolaou stain and Giemsa were used as standard stains. Results: A total of 66 cases of salivary gland lesions were aspirated for a period of two years. Majority of cases were in the age group of 21-30 years with 36 male patients (55%) and 30 female patients (45%). About 44(66.7%), 19(28.8%), 1(1.5%) and 2(3.0%) cases occurred in parotid gland, submandibular gland, sublingual gland and minor salivary gland respectively. There were 21(32%) cases of non-neoplastic lesions and 45(68%) cases of neoplastic lesions. Histopathological specimens were available in 11 out of 66 cases and showed correlation with cytological findings. Conclusion: Fine needle aspiration cytology of salivary gland lesions has high diagnostic accuracy, helps in appropriate therapeutic management and is useful as a diagnostic procedure because of the availability of earlier diagnosis in comparison with the histopathology. Keywords: Salivary gland lesions, fine needle aspiration cytology, neoplastic, non-neoplastic.

Diagnosis of upper gastrointestinal lesions by endoscopy and its correlation with histopathology

Background: A wide spectrum of lesions can be encountered in the upper gastrointestinal tract (GIT) especially the stomach or the gastric cavity. Endoscopy forms a crucial diagnostic procedure; it gives good diagnostic results in non-neoplastic lesions, endoscopy with biopsy is usually done in neoplastic lesions where the differentiation of benign and malignant lesions cannot be made always. Materials and Methods: This is a retrospective cum prospective study and the duration of this study was 4 yearsfrom January 2015 to December 2019 and the total number of endoscopic procedures performed was 3978. All patients with symptoms pertaining to the upper GIT where Upper Gastro-Intestinal Endoscopy (UGI Endoscopy) is useful in diagnosis were included in this study. All age groups and both the sexes were included. Biopsy was taken wherever there was an indication. Results: In this study, a total of 3978 endoscopies were done, out of which 2689 patients were males (67.6%) and 1289 were females (32.4%), youngest patient age in this study was 13 years and the oldest was 79 years. Most of the lesions were located in the gastric cavity (48% - 1909 cases), followed by esophagus (34%-1353 cases) and least among the three in the duodenum (18%- 716 cases). Out of the 3978 lesions, 134 cases were diagnosed as carcinoma on endoscopy and they were confirmed by histopathological examination. Conclusion: Endoscopy plays a very important role in the diagnosis of upper GIT lesions and it is incomplete without histopathological examination of biopsied tissue in cases of neoplastic lesions

Histopathological Spectrum of Non-Neoplastic and Neoplastic Lesions of Thyroid: A Descriptive Cross-sectional Study.

Thyroid gland lesions are the most common endocrine disorders encountered globally. Diseases of the thyroid gland present with either an alteration of hormone secretion or as an enlargement of the thyroid gland. The objective of the study is to find the frequency of different thyroid lesions. A descriptive cross-sectional study was conducted at Manipal Teaching Hospital, Pokhara from Jan 2005 to Jan 2020. Ethical approval was taken from the Institutional Review Committee (Ref: 330). Patients who had undergone thyroidectomy procedures for both non-neoplastic and neoplastic thyroid lesions were enrolled. Convenient sampling was done. IBM Statistical Package for Social Sciences version 21 and Microsoft Excel were used. Out of 345 thyroidectomy specimens, 246 (71.3%) cases of non-neoplastic lesions, and 99 (28.69%) cases of neoplastic lesions were present. There were 54 males and 291 females with a male to female ratio of 1:5.4. The age ranged from 9 to 76 years with a mean age of 43.67 years. In non-neoplastic lesions, the predominant lesion was the colloid goiter with 205 (83.33%) cases followed by Grave's disease and lymphocytic thyroiditis with 14 (5.69%) cases each. In neoplastic lesions, papillary carcinoma was the commonest lesion with 56 (56.56%) cases followed by follicular carcinoma with 14 (14.14%) cases and follicular adenoma with 13 (13.13%) cases. There were also 9 (9.09%) cases of anaplastic carcinoma in neoplastic lesions. Colloid goiter and papillary carcinoma was the most commonly encountered non-neoplastic and neoplastic lesion with a female predominance. Rare tumors like anaplastic carcinoma, papillary carcinoma, and follicular carcinoma with anaplastic transformation were also encountered.

ESTROGEN RECEPTORS

Objectives: Purpose of study is to determine Estrogen receptor status ininflammatory and neoplastic lesions of human gallbladder and to determine any relation ofER status with age, sex and histological grades of gallbladder carcinoma. Study Design:Retrospective observational study. Setting: Pathology Department Nishtar Medical CollegeMultan. Period: March 2016 to March 2017. Methodology: In this study total no. of 50 cases ofdifferent gallbladder diseases were included. Out of these 50 cases 30 were of neoplastic lesionsand other 20 were of non-neoplastic inflammatory lesions of gallbladder. The gallbladdersslides of these 50 cases were randomly selected from the records of Pathology Department.Demographic variables like age and gender were calculated and analyzed. Estrogen positivitywas the outcome variable of this study. Data was analyzed using computer software SPSSversion 23. Chi square Test was applied to check the association between different variables.Results: In this study, 100% (n=50) diagnosed cases of human gallbladder diseases includinginflammatory and neoplastic lesions were subjected to immunohistochemical staining for ERexpression. 100% (n=20) cases of inflammatory lesions and 100% (n=30) cases of neoplasticlesions were included, in this study. Estrogen positivity was noted in 36.7% (n=11) cases ofneoplastic lesions, while it was 25% (n=5) in inflammatory lesions cases. No association wasfound between estrogen positivity in groups, (÷2=0.751, p=0.386). (Table1).Histological typesof gallbladder carcinoma was noted as adenocarcinomas (well differentiated) in 60% (n=18)cases, adenocarcinomas (moderately differentiated) in 16.7% (n=5) cases, adenocarcinomas(poorly differentiated) in 13.4% (n=4) cases, mucinous adenocarcinomas in 1% (n=3.3) cases,adenosquamus carcinoma in 1% (n=3.3) cases and squamous cell carcinoma in 1% (n=3.3)cases. (Table2).No association was found between gender (p=0.780), stratified age (p=868)and estrogen positivity (p=0.386), after applying the chi-square. Conclusion: In this study itwas concluded that statistically no significant difference has been found between ER positivitywith age, gender and histological type of carcinoma. Presence of ER raises questions regardingthe role of estrogen in various gallbladder diseases and whether this hormone is functional ornot in neoplastic lesions is also questionable. Techniques more modified may be tried in searchof better and more reliable results. It is therefore too early to consider anti-estrogen trials ingallbladder carcinoma until the role of these steroid binding proteins is well characterized.

Effectiveness and Significance of Fine Needle Aspiration Cytology in the Diagnosis of Thyroid Swelling: A Single Institute Experience in a Series of 710 Patients

Context: Thyroid swelling is a relatively common problem encountered in clinical practice throughout the world. Early detection of thyroid neoplasm is the fundamental basis of thyroid screening. A quest for ease, simple and accurate diagnostic tool that would differentiate between benign and malignant lesion has facilitated fine needle aspiration cytology (FNAC) as the first line tool in the initial thyroid evaluation. Aims: The study was aimed at classifying thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology and to compare the diagnostic efficacy of fine needle aspiration cytology by correlating with gold standard histopathology. Settings and Design: This prospective cross-sectional study was conducted over a period of two years in a tertiary hospital, Kerala. Methods and Material: A total of 710 patients were included in the study. FNAC was performed and Staining was performed with Haematoxylin & Eosin (H&E), Papanicolaou and May-Grünwald Giemsa Stains. Diagnosis was made based on TBSRTC. Excision biopsies were fixed in 10% formalin. Statistical Analysis used: IBM Statistical Package for the Social Sciences Software version 21 was used to perform Pearson Chi-square test and Fischer Exact. Results: In this study 592 (83.4%) cases of non-neoplastic lesions, 111 (15.6%) cases of neoplastic lesions and seven cases were found unsatisfactory for diagnosis. FNAC showed high sensitivity and specificity in diagnosing neoplastic thyroid lesions and it showed high level of significance in diagnosing papillary thyroid carcinoma. Conclusions: FNAC is an excellent diagnostic tool in the management of thyroid lesions since it provides rapid diagnosis with high accuracy rate.

Pediatric lung lesions: a clinicopathological study of 215 cases

To investigate clinical and pathological features of lung lesions in children. Clinical manifestations, radiologic imaging, histopathological features and immunohistochemical results were analyzed in 215 cases of lung lesions in children. A total of 215 cases of lung lesions in children aged 0 day to 13 years (average age of 27.2 months and the median age of 18.0 months) were selected, including 137 male and 78 female patients with a male to female ratio of 1.76:1.00. The incidence of congenital lung disease was higher in patients of less than 1 year old than those of over 1 year old age, and the difference of the two groups was statistically significant (P = 0.004). 142 cases had acquired lung diseases, and 73 cases had congenital bronchopulmonary dysplasia. Lung abscess was the most common lesion seen in 86 cases (40.0%), including 1 case of fungal abscess. Congenital pulmonary airway malformation (CPAM) was the second most common, seen in 44 patients (20.5%), including 20 cases of type 1, 18 cases of type 2 and 6 cases of type 4 CPAM. Pulmonary sequestration was found in 25 cases (11.6%) including 14 cases of intralobar type and 11 cases of extralobar type. Two cases of extralobar pulmonary sequestration showed simultaneous CPAM2 type 2 lesion. Other lesions included tuberculosis (13 cases, 6.0%), emphysema (12 cases, 5.6%), interstitial pneumonia (7 cases, 3.2%), pulmonary hemorrhage (6 cases, 2.8%), bronchogenic cyst (4 cases, 1.9%), bronchiolitis obliterans (2 cases, 0.9%), idiopathic pulmonary hemosiderin deposition disease (2 cases, 0.9%) and 1 cases of lung non-specific changes. 13 cases of neoplastic lesions (6.0%) were found, of which 11 cases were primary tumors (5.1%), including inflammatory myofibroblastic tumor in 5 patients (2.3%), pleuropulmonary blastoma in 5 cases (1 case of type I, 2 type II and 2 type III) and 1 case of mucoepidermoid carcinoma (0.5%) and 2 cases of metastatic tumors (hepatoblastoma and Wilm's tumor, 0.9%). Infectious diseases are the most common lung diseases in children. Congenital bronchopulmonary dysplasia is the most common in children of less than 1 year old. Malignant lesions are rare.

The Role of Fine Needle Aspiration Cytology (Fnac) In the Evalution of Thyroid Lesions

Objective: To determine the sensitivity, specificity and diagnostic accuracy of fine needle aspiration cytology in the management of thyroid lesions. Material and Methods: A prospective study of Fine needle aspiration cytology of the thyroid gland was undertaken to evaluate its diagnostic utility, during the period from June 2011 to December 2013 in the Department of Pathology, S.P. Medical College Bikaner. A total of 52 patients presenting with palpable thyroid nodule was included in the study. All the patients underwent fine needle aspiration of the nodule. Among 52 cases, 37 were biopsied subsequently and subjected to histopathological study. A comparison of FNA cytology and biopsy results was made. Results: Age of the patients ranged from 15-70 yrs with a mean age of 42.44 yrs. The majority of the patients were females in the present study with 45 (86.5%) females and 7 males, with a ratio of 6.41:1. Urban and rural distribution of sample population included 38 (73.1%) cases from rural and 14 (26.9%) cases from the urban population. Of the 52 cases of thyroid lesions, 39 were Non neoplastic lesions and 9 were Neoplastic lesions. Of the Non neoplastic lesions, 34 were Nodular colloid/ Adenomatous goiter, 4 Hashimoto thyroiditis, 1 neoplasm and 1 anaplastic neoplasm. Among 52 cases, 37 were biopsied subsequently and subjected to histopathological study. 28 cases were Non-neoplastic, 9 cases were Neoplastic. Out of 9 cases of Neoplastic lesions, 4 were Papillary carcinoma, 5 were Follicular adenoma. The diagnostic accuracy of non neoplastic and neoplastic lesions is 96.42% and 88.9% respectively. The sensitivity, specificity, positive predictive value and negative predictive value for FNAC of thyroid lesion neoplasm in the present study are 92.86%, 95.65%, 92.86% and 95.65% respectively. Conclusion: It helps to categorize Non-neoplastic from Neoplastic thyroid lesions. Its use has decreased the number of surgeries performed. FNAC of thyroid lesions has been shown to be safe, simple, cost effective and accurate method for the management of palpable thyroid lesions. However, in view of a small number of false negative results, the FNA results should be interpreted in the light of clinical findings. In case of doubt the true nature of the disease should be confirmed by biopsy.

Letter: gastric cancer and pernicious anaemia – often Helicobacter pylori in disguise

We read with great interest the systematic review by Vannella et al. addressing the incidence of gastric cancer (GC) in pernicious anaemia (PA).1 The meta-analysis concluded that PA is associated with a nearly sevenfold relative risk of GC.1 While we agree that PA, as a reflection of atrophic gastritis, is a precancerous condition, it is important to separate PA resulting from autoimmune gastritis, from the PA due to other causes, including Helicobacter pylori.2 Pooling may obscure risks, especially when a particular outcome arises from different pathogeneses. Most cases of PA associated with gastric atrophy are now considered as an outcome of chronic H. pylori infection, and thus PA may simply reflect the most severe injury (advanced atrophic gastritis spreading from antral to oxyntic mucosa; i.e. OLGA stage III-IV).3 Histologically, the ‘pure diseases’ are theoretically easy to separate, in that autoimmune gastritis spares the antrum and H. pylori does not.4, 5 We recently published a study addressing autoimmune gastritis. Among those with pure autoimmune phenotype (i.e. non-atrophic gastric antrum with corpus-restricted atrophic gastritis), neoplastic epithelial lesions (both intraepithelial or invasive) were never detected.2 All four cases of incidental epithelial neoplasia arose in extensive gastric atrophy (involving both antral and oxyntic mucosa; i.e. OLGA stages III–IV), and three had active H. pylori infection. Among the 562 patients considered, 116 had a repeat endoscopy/biopsy at least 24 months after the index endoscopy (mean interval between initial and last procedure: 54 months; in total 522 person-years). Among these 116 patients, 10 were H. pylori positive at the initial endoscopy and one still had H. pylori infection at the last check-up. No cases of neoplastic lesions (intraepithelial or invasive) were detected at the end of follow-up.2 By keeping together the available information, we would like to put forward few considerations. PA associated with atrophic gastritis is a constellation of clinico-biological situations, with the most common causes being H. pylori (pure environmental aetiology), autoimmune (primary autoimmunity), combined H. pylori -autoimmune aetiology and H. pylori-driven autoimmune corpus atrophy. The full range of causes is still only partially explored. The paucity of the literature included in Vannella's meta-analysis emphasises the need for prospective studies to examine the relationship and assign responsibility of host-related vs. environmental (H. pylori) oncogenetic factors. The availability of H. pylori-free generations (as well as the contemporary H. pylori-eradicated populations) will allow epidemiological panorama to clarify the (probably low) oncogenic relation of GC (in contrast with gastric carcinoids) related to autoimmune gastric diseases. Currently, it is thought that the greater the extent of atrophy (antrum and corpus), the higher the atrophy-related GC risk. As such, ‘pure autoimmune’ atrophy should theoretically be restricted only to a fraction of the gastric mucosa (the oxyntic target of the autoimmune attack) and should theoretically reduce the atrophy-associated cancer risk. In addition, H. pylori associated with ongoing inflammation and eradication is expected to result in a reduction in GC risk. The inflammation in ‘pure autoimmune’ gastritis likely burns out as the native (i.e. oxyntic) target is destroyed. Irrespective of the gastritis aetiology, any staging system of gastric atrophy (including scoring of pseudopyloric metaplasia, as proposed by OLGA) reflects the overall atrophy-associated GC risk. Therefore, gastritis staging could be usefully applied in supporting the clinical strategies for GC secondary prevention.6, 7 Declaration of personal and funding interests: None.

Fine‐needle aspiration cytology: a reliable tool in the diagnosis of salivary gland lesions

Fine-needle aspiration cytology (FNAC) is used as the main initial diagnostic investigation for lumps in the head and neck region. Major salivary glands and some minor salivary glands are easily accessible; therefore, they are optimal targets for FNAC. The aim of this study was to discuss the advantages and pitfalls of FNAC as compared to histopathology in the salivary gland lesions. A total of 127 FNAC were carried out on salivary gland lesions from January 2006 to December 2010--a 5-year period. Histopathological follow-up data were obtained in 56 cases. The study was conducted to examine the sensitivity, specificity, and accuracy of FNAC for salivary gland swellings in comparison with histopathology. The male-to-female ratio was 2.4:1. Parotid gland was involved in 51.1%, submandibular gland in 37%, sublingual gland in 4.7%, and minor salivary glands in 7% of patients. There were 55.9% cases of non-neoplastic lesions and 44.1% cases of neoplastic lesions on biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of FNAC for malignant neoplastic lesions were 84.61%, 86.48%, 68.75%, and 94.11%, respectively, whereas for benign neoplastic lesions, they were 84.61%, 91.66%, 91.6%, and 85%, respectively. Fine-needle aspiration cytology is found to be a good sensitive and specific technique for the diagnosis of most of the salivary gland lesions. FNAC should be adopted as an initial investigation for all salivary gland swellings in conjunction with other investigations where appropriate.

Diagnostic reliability of FNAC for salivary gland swellings: A comparative study

A prospective study was conducted to see the sensitivity, specificity, and accuracy of fine needle aspiration cytology (FNAC) for 100 salivary gland swellings in comparison with biopsy. These randomized samples were submitted and reported at the department of pathology, Allama Iqbal Medical College, Lahore. The male to female ratio was 1:1.5. Ages of the patients ranged from 8.5 to 58 years with mean age 33.39 +/- 12.37 years. Maximum number of lesions was found in age group between 21 and 40 years. Parotid gland was involved in 68%, submandibular gland in 30%, and minor salivary glands in 2% patients. Sublingual gland was not involved in any of our subjects. There were 14% cases of non-neoplastic lesions and 86% cases of neoplastic lesions on biopsy. Non-neoplastic lesions included 12 cases of inflammations (three cases of granulomatous inflammation and nine cases of nonspecific chronic inflammation) and two cases of inclusion cysts. Among neoplastic lesions, biopsy revealed 68 cases of benign neoplasia and 18 cases of malignant neoplasia. Non-neoplastic lesions did not show any difference in diagnosis by both techniques. FNAC misdiagnosed four malignant and one benign lesion. Sensitivity, specificity, positive predictive value, and negative predictive value of FNAC for benign neoplastic lesions were 98.52, 87.05, 94.36, and 96.55%, respectively, whereas for malignant neoplastic lesions they were 77.77, 98.78, 93.33, and 95.29%, respectively. In conclusion, FNAC is found to be a highly sensitive and specific technique for diagnosis of most of salivary gland swellings, except for malignant neoplastic lesions where its sensitivity is intermediate. We strongly recommend that FNAC should be adopted as an initial investigation for all salivary gland swellings.

Clinicopathologic study of pelvic lesions managed by surgeons in a medical college in Kolkata in the last 2 years

The pelvic cavity is a basin-like space in the lowermost part of the abdomen where various neoplastic and non neoplastic lesions can occur involving its contents. When the nature of lesions are not clearly gynecological, patients are managed by surgeons. Our study aims to asses the clinicopathologic analysis of neoplastic lesions of the pelvic cavity managed by surgeons particularly over a period of 2 years. Out of 162 total lesions, 102 cases were non neoplastic, such as appendicular lump, Tubo-ovarian (TO) mass, hematoma and 60 cases were neoplastic. Among the 60 cases of neoplastic lesions, 40 cases were benign comprised of twisted ovarian cyst, broad-ligament fibroid, and neurofibroma and 20 cases were malignant comprised of colorectal carcinoma, ovarian carcinoma, liposarcoma, Primitive nurectodermal tumor (PNET), seminoma, and lymphnode metastasis. The lesions in such closed, difficult to approach areas throws clinicians into a diagnostic dilemma during both the preoperative and intraoperative period. Even pathologists cannot ascertain some diagnosis without the help of immunohistochemistry. So, to adopt early and concise management protocol, there should be more such studies in different institutions that are currently lacking in world literature.

Cytologic features of neoplastic lesions in endocervical glands.

Cytologic criteria for classifying atypical endocervical cells on Pap smears are poorly defined. In this study we evaluated cytologic parameters that are useful in predicting the presence of neoplastic lesions (NL) and those that help distinguish squamous intraepithelial lesion (SIL) from glandular neoplastic lesions. The recently proposed Bethesda System (TBS) terminology for reporting atypical glandular cells of undetermined significance (AGUS) was also evaluated for its significance on patient management. Sixteen cases of biopsy-proven endocervical glandular NL that had cytologic smears available for review were included. Thirty-five smears with atypical endocervical cells and follow-up biopsies showing benign/reactive change (n = 22) and SIL involving glands (n = 13) were reviewed for comparison. Our results show that squamous NL often coexist with glandular NL. The presence of rosettes, hyperchromasia and increased N/C ratio is useful in distinguishing NL from benign/reactive conditions. Architectural features are helpful in distinguishing SIL from glandular NL. While a haphazard arrangement is more often seen with SIL, glandular NL are more likely to maintain polarity and to show glandular rosettes. Using TBS criteria, a conservative management seems justified in patients with AGUS-favor reactive and AGUS diagnosis on Pap smear, and colposcopy is indicated for patients with AGUS-favor NL.

Laser phototherapy following HpD administration in superficial neoplastic lesions.

We report our preliminary clinical experience with hematoporphyrin derivative (HpD) injection and argon or dye laser irradiation for the treatment of 61 surface neoplastic lesions in 7 patients. Forty-three sites were multiple basal cell carcinoma in 5 patients, and the remaining 18 were cutaneous and subcutaneous recurrent breast carcinoma after mastectomy in the thoracic wall. The patients were selected on the basis of the lack of indication for conventional therapeutic modalities. The selection of irradiation procedures and laser source was based on the thickness of the lesion and extension of the disease. The photochemical reaction between HpD injected i.v. at a dose of 3 mg/kg body weight and the laser beam at a dose of 60 to 120 J/cm2 resulted in 75% favorable responses at the treated sites. Optimal therapeutic effects appeared to be critically dependent on total light dose and tumor infiltration patterns. The phototherapeutic technique proved to be effective in selected cases of neoplastic lesions, especially when conventional treatment modalities were poorly indicated or contraindicated.