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Epidermoid carcinoma in situ of the cervix in a young girl
1154 Communications
In
brief
The only I'xtensive article reviewing a large number of cases of splenic torsion appl'ared in 1933. The author, Abell,' reviewed 97 casl's of wandering spleens with torsion of the pedide. Of these, 12 cases of torsion occurred durin!!; pregnancy with 3 of these occurring post partum. Of thc total number of cases (97), 7 showcd intestinal obstruction, variously due to twisting, kinking, adherence, and compression. Abl'lJI felt there were congenital and acquired factors in wandering spleens. The former are the length of the splenic pedicle and conformation of the abdominal cavity. Acquired factors can be groupl'd undl'r two headings: increased weight of the spleen and conditions which relax the abdominal wall and ligaments which support the abdominal viscera. The latter certainly are present III the pregnant state. Clifford and llano, in 1965,2 reported an accessory wandering spleen causing intestinal obstruction in a 26-year-old multipara at 3 y~ months' gestation. Pregnancy continued without incid('nt after splenectomy. The present case report is the only case reported since. REFERENCES
1. Abell, I.: Ann. Surg. 98: 722, 1933. 2. Clifford, W. J., and llano, A.: J. Internat. Coli. Surgeons 43: 26, 1965. 827 Grange Road Teaneck, New Jersey
Epidermoid carcinoma In situ of the cervix in a young girl
Am.
April 15, 1968 & Gynec.
J. Dbst.
The incid"lIce of cervical carcinoma under thl' a!!;(' of 20 is not dear dill' to the fact that th('re are very few rl'ports· has(,d on this age grollp. Similarly, there arc few places where rolltine can('('r screening is praniced regardless of agl'. t. 2 Th.· ('ytology s(TI'('ning at our hospital was en!arg('d to include all gYlwcologic and obstetric patients, regardll'ss of age, in 19(j(j. The youngest patipnt having positive snwar was 15 ypars old. Her case is worth reporting not only becalise she is prohahly the youngest woman reported in the literature with histologically proved (,pidermoid carcinoma in situ but also because this case confirms the statement "if a girl is old I'nough to have a vaginal examination, she is old ('nough to have a cervical cytologic examination."l The patient was a 15-year-old gravida 2, para 2, Negro female. She was first seen at the time of her first delivery in June, 1965, at the age of 14. The delivery and the postpartum period was uneventful and shortly aftcr she was lost to follow-up until the delivery of her second baby in August, 1966. Menarche was at age II and her subsequent periods came regularly at 28 days. She had her first intercourse at age 12. She was married during her second pregnancy in April. 1966. Her mother had had a superficially infiltrating epidermoid carcinoma of the cervix in 1962, at the age of 30. The patient returned to the clinic for examination following her second pregnancy in September, 1966, and cervical smears were taken and reported as "atypical dyskaryotic cells." Two subsequent smears were similar to the first ones. Physical examinations were negative until December, 1966, at which time a pelvic examination disclosed a circumoral cervical erosion.
STEVEN I. HAJDU, M.D. JULIET SO-BOSITA, M.D. A. BRIAN LITTLE, M.D.
Departments of Pathology and Obstetrics and Gynecology, Cleveland Metropolitan General Hospital and Western Reurve University School of Medicine, Cleveland, Ohio I N S PIT E of general agreement that increased cytologic screening has been responsible for earlier diagnosis of cervical cancer, many physicians believe there is no justification for routine cervical cytology examinations in women under the age of 20. 1
Supported in part by Grant 8-F3-CA-28,384 rrom the National Cancer In.titute, United State. Public Health Service.
Fig. 1. An area of the punch biopsy diagnosed as epidermoid carcinoma in situ. (Hematoxylin and eosin. x420.)
Communications in brief 1155
VoIUIIll' liNt
Numbe .. 8
A four-quadrant punch biopsy was done on Dec. 15, 1966. The patholoR"Y report was "severe dysplasia with fO('al epidermoid carrinoma in situ" (Fig. 1). The lesion was not removed hy punch biopsy and a large cone biopsy was taken to remove the entire involved epithelium. Histologic examination disclosed the presence of a well-differentiated I'pidl'rmoid carcinoma in situ involving the squamocolumnar junction in all four cervical quadrants and extending deep into endocervical glands. The margins of the cone biopsy were free of malignant lesion. The patient returned to the gynecology clinic for examination in March, 1967. Her cervix was healed and stained completely with Schiller stain. Vaginal, cervical, and endocervical smears were taken and were reported as negative for malignant cells. It was recognized more than 20 years ago and confirmed recentlyl that there is no age barrier to the appearance of cervical cancers. Apparently, the youngest patient who was demonstrated to have histologically proved epidermoid carcinoma of the cervix was a 16-year-old girJ.l The recognition that cervical cancers can occur in young age groups is an indication for screening younger populations. I . 2 When considering the age of this group of patients, chronological age may not be as important as the number of years since first intercourse.
It has not heen demonstrated that her socioeconomic status, obstetric, or family history has contributed to the development of her disease. However, she is multiparous, a clinic patient, whose mother has had cancer, and these arc recognized etiologic factors in the development of cerviral lesions. I • 2 A young girl who has a SUSpICIOUS smear should have cervical biopsy for definite tissue diagnosis.I. 2 To achieve this, it is imperative that the lesion be excised completely and the spl'cimen handled, dissected, and evaluated with the utmost care. The patient must understand the nature of the disease and promise to return for regular follow-up examinations. Thi~ patient will be followed closely with cytology smears. It is hoped that the disease will not recur. The authors are grateful to Dr. Leopold G. Koss and Dr. James W. Reagan for their helpful discussion in this case. REFERENCES
1. Ferguson, J. H.: J. A. M. A. 178: 365, 1961. 2. Koss, L. G., Stewart, F. W., Foote, F. W., Jordan, M. L., Bader, G. M., and Day, E.: Cancer 16: 1160, 1963. 444 East 68th Street New York, New York 10021
In
brief
The only I'xtensive article reviewing a large number of cases of splenic torsion appl'ared in 1933. The author, Abell,' reviewed 97 casl's of wandering spleens with torsion of the pedide. Of these, 12 cases of torsion occurred durin!!; pregnancy with 3 of these occurring post partum. Of thc total number of cases (97), 7 showcd intestinal obstruction, variously due to twisting, kinking, adherence, and compression. Abl'lJI felt there were congenital and acquired factors in wandering spleens. The former are the length of the splenic pedicle and conformation of the abdominal cavity. Acquired factors can be groupl'd undl'r two headings: increased weight of the spleen and conditions which relax the abdominal wall and ligaments which support the abdominal viscera. The latter certainly are present III the pregnant state. Clifford and llano, in 1965,2 reported an accessory wandering spleen causing intestinal obstruction in a 26-year-old multipara at 3 y~ months' gestation. Pregnancy continued without incid('nt after splenectomy. The present case report is the only case reported since. REFERENCES
1. Abell, I.: Ann. Surg. 98: 722, 1933. 2. Clifford, W. J., and llano, A.: J. Internat. Coli. Surgeons 43: 26, 1965. 827 Grange Road Teaneck, New Jersey
Epidermoid carcinoma In situ of the cervix in a young girl
Am.
April 15, 1968 & Gynec.
J. Dbst.
The incid"lIce of cervical carcinoma under thl' a!!;(' of 20 is not dear dill' to the fact that th('re are very few rl'ports· has(,d on this age grollp. Similarly, there arc few places where rolltine can('('r screening is praniced regardless of agl'. t. 2 Th.· ('ytology s(TI'('ning at our hospital was en!arg('d to include all gYlwcologic and obstetric patients, regardll'ss of age, in 19(j(j. The youngest patipnt having positive snwar was 15 ypars old. Her case is worth reporting not only becalise she is prohahly the youngest woman reported in the literature with histologically proved (,pidermoid carcinoma in situ but also because this case confirms the statement "if a girl is old I'nough to have a vaginal examination, she is old ('nough to have a cervical cytologic examination."l The patient was a 15-year-old gravida 2, para 2, Negro female. She was first seen at the time of her first delivery in June, 1965, at the age of 14. The delivery and the postpartum period was uneventful and shortly aftcr she was lost to follow-up until the delivery of her second baby in August, 1966. Menarche was at age II and her subsequent periods came regularly at 28 days. She had her first intercourse at age 12. She was married during her second pregnancy in April. 1966. Her mother had had a superficially infiltrating epidermoid carcinoma of the cervix in 1962, at the age of 30. The patient returned to the clinic for examination following her second pregnancy in September, 1966, and cervical smears were taken and reported as "atypical dyskaryotic cells." Two subsequent smears were similar to the first ones. Physical examinations were negative until December, 1966, at which time a pelvic examination disclosed a circumoral cervical erosion.
STEVEN I. HAJDU, M.D. JULIET SO-BOSITA, M.D. A. BRIAN LITTLE, M.D.
Departments of Pathology and Obstetrics and Gynecology, Cleveland Metropolitan General Hospital and Western Reurve University School of Medicine, Cleveland, Ohio I N S PIT E of general agreement that increased cytologic screening has been responsible for earlier diagnosis of cervical cancer, many physicians believe there is no justification for routine cervical cytology examinations in women under the age of 20. 1
Supported in part by Grant 8-F3-CA-28,384 rrom the National Cancer In.titute, United State. Public Health Service.
Fig. 1. An area of the punch biopsy diagnosed as epidermoid carcinoma in situ. (Hematoxylin and eosin. x420.)
Communications in brief 1155
VoIUIIll' liNt
Numbe .. 8
A four-quadrant punch biopsy was done on Dec. 15, 1966. The patholoR"Y report was "severe dysplasia with fO('al epidermoid carrinoma in situ" (Fig. 1). The lesion was not removed hy punch biopsy and a large cone biopsy was taken to remove the entire involved epithelium. Histologic examination disclosed the presence of a well-differentiated I'pidl'rmoid carcinoma in situ involving the squamocolumnar junction in all four cervical quadrants and extending deep into endocervical glands. The margins of the cone biopsy were free of malignant lesion. The patient returned to the gynecology clinic for examination in March, 1967. Her cervix was healed and stained completely with Schiller stain. Vaginal, cervical, and endocervical smears were taken and were reported as negative for malignant cells. It was recognized more than 20 years ago and confirmed recentlyl that there is no age barrier to the appearance of cervical cancers. Apparently, the youngest patient who was demonstrated to have histologically proved epidermoid carcinoma of the cervix was a 16-year-old girJ.l The recognition that cervical cancers can occur in young age groups is an indication for screening younger populations. I . 2 When considering the age of this group of patients, chronological age may not be as important as the number of years since first intercourse.
It has not heen demonstrated that her socioeconomic status, obstetric, or family history has contributed to the development of her disease. However, she is multiparous, a clinic patient, whose mother has had cancer, and these arc recognized etiologic factors in the development of cerviral lesions. I • 2 A young girl who has a SUSpICIOUS smear should have cervical biopsy for definite tissue diagnosis.I. 2 To achieve this, it is imperative that the lesion be excised completely and the spl'cimen handled, dissected, and evaluated with the utmost care. The patient must understand the nature of the disease and promise to return for regular follow-up examinations. Thi~ patient will be followed closely with cytology smears. It is hoped that the disease will not recur. The authors are grateful to Dr. Leopold G. Koss and Dr. James W. Reagan for their helpful discussion in this case. REFERENCES
1. Ferguson, J. H.: J. A. M. A. 178: 365, 1961. 2. Koss, L. G., Stewart, F. W., Foote, F. W., Jordan, M. L., Bader, G. M., and Day, E.: Cancer 16: 1160, 1963. 444 East 68th Street New York, New York 10021