Positive Vaginal Smear Research Articles

Carcinoma In Situ of the Uterine Cervix:Conservative Management in 84 of 190 Cases

SummaryA series of 190 patients with cervical carcinoma in situ has been presented. All have been followed for at least 1 year, and more than half for at least 2 years.The definitive treatment was total hysterectomy in 106 patients and local excision in 84. Four of the latter patients ultimately had a hysterectomy.The method of cone biopsy used, and some of its complications, are described.Of the patients who underwent hysterectomy one had positive vaginal smears after operation.Eleven of the conservatively‐treated patients showed evidence of persistent disease and one with incomplete follow‐up is assumed to have it also. The investigation and outcome of these patients are considered in detail; all except one are cytologically free of disease at present.The relative efficiency of the various types of biopsy, in completely excising a carcinoma in situ, is discussed.

Intra-epithelial carcinoma of the uterine cervix.

The means for eliminating cancer of the uterine cervix appears to be within our grasp. The decline in mortality rate of cervical cancer is one of the most notable accomplishments in cancer therapy of this century. The outlook for cure is estimated as better than 98 per cent.Cytologic study of vaginal smears is by far the most important means of detecting intra-epithelial cervical cancer. When a positive vaginal smear is confirmed, the next step is to obtain adequate tissue for histologic study. The best method of biopsy is conization. The Schiller test is a useful adjunct in the diagnostic approach.

Effect of p H on Biological Activity of Chorionic Gonadotropin

Increasing the p H from 3.0 to 10.8 increased the uterine weight three-fold and the number of positive vaginal smears from 0 to 78 percent in immature rats injected with chorionic gonadotropin in aqueous solution. Activity of a solution held at p H 2.6 and 5°C for 24 hours was restored by neutralization.

Effect of pH on biological activity of chorionic gonadotropin.

Increasing the pH from 3.0 to 10.8 increased the uterine weight three-fold and the number of positive vaginal smears from 0 to 78 percent in immature rats injected with chorionic gonadotropin in aqueous solution. Activity of a solution held at pH 2.6 and 5 degrees C for 24 hours was restored by neutralization.

The Significance of Positive Vaginal Smears in Extrauterine Carcinomas

The Significance of Positive Vaginal Smears in Extrauterine Carcinomas

The interaction of oestrogen and progesterone on the vaginal cycle of the ewe.

SUMMARY The vaginal smear pattern of the intact ewe experiencing normal oestrous cycles was compared with that of the spayed untreated ewe, and with the spayed ewe injected with a physiological dose-level of oestradiol benzoate (ODB) administered either alone or alternating with progesterone (Prog.) injected in a time-dose relationship closely approximating that of the intact animal. Normal vaginal cornification appeared to be a result of oestrogen stimulation. The normal manifestation of leucocytic invasion and changes in the viscosity of mucus appeared to be dependent on an interaction between oestrogen and progesterone. Some vaginal cornification was apparent on the day of oestrus, or 48 hr after the injection of ODB, but maximum cornification occurred 2 days later. For a maximum response, as measured by the number of ewes which yielded one or more cornified smears, it was necessary to take smears daily for 4 days commencing on the day of oestrus. By relating the smear pattern of the ODB-injected spayed ewe to that of the normal intact ewe a standard method of appraisal of vaginal smears has been evolved. This is considered suitable for quantitative assay work. A positive vaginal smear is one which is virtually free of leucocytes but contains appreciable numbers of cornified cells either alone or in association with squamous and/or nucleated epithelial cells. The various types of typical cornified smears are illustrated.

A serial-section study of the cervix in cases with positive vaginal smears and negative biopsies; a report of ten cases.

A serial-section study of the cervix in cases with positive vaginal smears and negative biopsies; a report of ten cases.

The Significance of the Positive Vaginal Smear

The Significance of the Positive Vaginal Smear

Carcinoma of the breast metastatic to the peritoneum as a source of positive vaginal smears

T HE vaginal smear has proved itself to be a valuable adjunct in the detection and diagnosis of female genital cancer.L 2, 3 Exfoliation of cells from a primary malignant tumor of the uterus, vagina, or occasionall)the tubes4 is the usual source of the tumor cells appearing in the vaginal smear. Malignant lesions of other organs metastatic to the endometrium or endosalpinx can shed tumor cells that will likewise appear in the smear. Occasionally carcinoma of the ovary, either directly through the tubes or by means of metastatic spread, can also give rise to positive cells. The following case is an unusual one in that the primary lesion was a scirrhous carcinoma of the breast, and in addition the surfaces of the secondary lesion from which the exfoliated cells were derived were contiguous with the peritoneal cavity and not in contact with the internal surfaces of the uterus or tubes. Mrs. B. P., a 66-year-old woman, was first admitted to the Massachusetts General Hospital in October, 1946, at which time a right radical mastectomy was performed. The pathological report was scirrhous carcinoma of the breast with metastases to all 7 axillary lymph nodes. She was asymptomatic for 5 years. In October, 1951, at the age of 71, she noted the onset of a vaginal discharge. Pelvic examination performed 2 weeks later was negative, but a vaginal smear was reported as positive (Fig. 1). A second vaginal smear two weeks later was also positive. The patient was readmitted to.the hospital on Nov. 25, 1951. A preliminary dilatation and curettage were grossly negative and examination of the pelvic organs under anesthesia revealed the uterus and adnexa to be of normal size. However, because of the presence of a firm irregularity in the cul-de-sac and of ascites, exploratory laparotom: was carried out. The peritoneal cavity contained 300 C.C. of straw-colored fluid and was studded with careinomatous implants. The nodules were present over the surfaces of the omentum, broad ligaments, and tubes. The ovaries and uterus were negative. Ascitic fluid was obtained for cytological study. Bilateral oophorectomy was carried out to determine what effect the removal of these organs would have on the metastatic disease. At this point it seemed quite apparent that the peritoneal implants were the source of the positive tumor cells appearing in the vaginal smear, The tubes and fundus of the uterus were therefore removed to allow thorough pathological study of these organs and rule out a genital source of the tumor cells. The remainder of the uterus was thoroughly inspected, curetted, and closed. The patient made an uneventful recovery and was discharged on 1.5 mg. of ethinyl estradiol daily. Pathological examination of the operative specimen confirmed the presence of metristatic carcinoma of the omentum, broad ligaments, and serosal surfaces of the tubes. The ovaries, the tubal walls and endosalpinx, and the uterus were negative for tumor. The histological appearance of the tumor was consistent with a breast origin. Cytological examination of the aseitic fluid revealed tumor cells similar to those found in the previous vaginal smears (Fig. 2).

Cancer of the cervix: A realistic program of cancer control for teh general practitioner

Prevention rather than early diagnosis should be the primary goal of the general practitioner in any program of cancer control. Office electrocauterization of all chronically infected cervices is an excellent prophylaxis against carcinoma of the cervix. All cases of cauterized cervical erosions which do not heal properly should be considered carcinomatous until proved otherwise. Patients with these unhealed cervical erosions should then be referred to a Diagnostic Cancer Clinic or gynecologist for further tests and study. At that time, a cervical biopsy should be done with the Schiller test to point out areas most suitable for biopsy. The Papanicolaou vaginal smear should be used to complement the cervical biopsy but never to replace it since the expected 10 per cent false negative vaginal smear does not reliably indicate that no cancer is present. Although a positive Papanicolaou vaginal smear suggests that cancer is present, the final diagnosis is dependent on the microscopic examination of the cervical biopsy.

Occurrence of Positive Vaginal Smears in Spayed Mice.

We1 reported that spayed mice painted with 1:2:5:6 dibenzanthracene had positive vaginal smears sporadically. In preparing to repeat this experiment we2 found that effective amounts of estrone may be transmitted from animal to animal. The animals used in this experiment were kept segregated as a group throughout the experiment. They were spayed. No accessory ovaries were found at autopsy. Smears were made twice daily for 5 days before treatment was begun; and they were all negative. Smears were omitted until 11 weeks after treatment began, to avoid pseudo-estrus3 effects from mechanical stimulation of the vagina. Smears were made twice a week throughout the rest of the experiment, which terminated 41 weeks after treatment with 1:2:5:6 dibenzanthracene was begun. If a positive or plus-minus smear was found all animals were smeared daily until there was a return to negative. Two untreated spayed controls were kept in the box with the treated mice. Later 4 old spayed females with uterine implants of dibenzan...

Estrogenic Activity of 3-4 Benzpyrene.

Cook and Dodds reported that 3 of the carcinogenic hydrocarbons were estrogenic. The carcinogenic and estrogenic effects were not quantitatively or temporally related. A causal relationship is a matter for speculation. Of these 3 estrogenic carcinogens 3-4 benzpyrene has been the most extensively experimented with. Cook and Dodds injected 100 mg of the carcinogenic hydrocarbon in oil subcutaneously into each of 10 rats. Three of the 10 rats receiving 3-4 benzpyrene had positive vaginal smears for 150 hours. Carminati reported that 3-4 benzpyrene was not estrogenic. He used the same dose as Cook and Dodds for 2 rats, and various smaller doses for 9 other rats. We injected 31 mg of 3-4 benzpyrene in 0.75 cc of lard subcutaneously into each of 4 mice standardized according to Palmer's method. In 48 hours 3 had positive vaginal smears. On the fifth day the fourth mouse had plus-minus reaction. On the sixth day all were negative, and remained so. Twenty spayed but not standardized mice were injected subcutaneously with 4 mg of 3-4 benzpyrene in lard. They did not develop estrus. Much of the injection mass was present in the 2 mice dying without tumor and a moderate amount present in those developing tumors so the estrogenic amount must lie between 31 and 4 mg. One of the 4 animals receiving 31 mg of 3-4 benzpyrene died in the third week. A second animal died at 2½ months. Neither of these had tumors. One month after being injected 2 animals developed tumors at the site of injection. One of these animals was the one that did not go into estrus. The other was not in estrus when the tumor began.

THE NATURE OF THE ESTROGENIC SUBSTANCE IN HUMAN MALE URINE AND BULL TESTIS*†

The fact that male urine and testis tissue contain estrogenic activity has been known for some time. Fee, Marrian, Parkes (1), Glimm and Wadehn (2), Lacqueur and de Jongh (3), Zondek (4, 5), and Loewe (6) have reported the presence of estrogenic substance in male urines. Dodds, Greenwood, and Gallimore (7), Laqueur and de Jongh (3), and Brouha and Simmonet (8) have reported estrogenic activity in testis. Most of the workers have confined themselves to a qualitative study by means of the reaction on spayed mice or rats. Fee, Marrian, and Parkes have suggested that the active material is identical with the female sex hormone “estrin” on the basis of the marked uterine hypertrophy observed in spayed female rats and the positive vaginal smear reaction. Zondek§ makes the assertion that the estrogenic substance in stallion urine is similar to the follicular hormone on the basis of the production of uterine hypertrophy, an antimasculine action, the induction of lactation in the male guinea pig, and the positive ...