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Microinvasive carcinoma of the cervix
Edited
by
LOUIS
M.
HELLMAN,
M.D.
Selected abstracts recurrence in this group which was discovered by cytological examination. There were 195 cases of proved recurrent carcinoma of the cervix within a 5 year period. Of these, there were 86 cases that had involvement of the pelvic wall or distant metastases and, of course, in these the cytologic material from the vagina was negative. In those cases with obvious clinical Iocal recurrence or unsuspected local recurrence, there were 96 cases; 32 per cent of the clinically obvious had positive smears. The above indicates the importance of the accuracy of the vaginal smear in the discovery of recurrent lesions. The author concludes that the vaginal smear is a useful tool in the detection of recurrence in the patient who has been treated for cancer of the cervix, corpus, or vulva. It is possible to discover recurrence at a time when they are still amenable to treatment. Five year survivals after recurrence can be achieved if the recurrences are discovered early. Thirty-three per cent of local recurrences in cancer of the cervix were discovered by the use of routine cytology in the treated patient. Postoperative vaginal smears are helpful in both cancer of the cervix and cancer of the vulva. The cytologic method is of practical value in determining the adequacy of the clinical procedure in cancer of the vulva where control of the disease depends on wide local excision. J. Edward Hall
Actu cytologica Vol 8, No. 1, January-February, 1964. *Graham, Ruth M.: Accuracy of Cytologic Diagnosis in the Treated Cancer Patient, p. 3. *Way, Stanley: Microinvasive Carcinoma of the Cervix, p. 14. Yaspersson, Olle: Quantitative Cytochemical Studies on Normal Malignant, Premalignant and Atypical Cell Populations from the Human Uterine Cervix, p. 45. Graham:
Accuracy of Cytologic Diagnosis in the Treated Cancer Patient, p. 3. The author divided the cases studied into those treated more than 10 years previously, namely, between the years 1927 and 1953, and those treated with radiation therapy within the last 5 years. There were 803 patients with invasive cancer of the cervix, treated more than 10 years previously, Of these 803, 60 (7 per cent), had a proved recurrence after the tenth year. The majority of these recurrences were local as indicated by the fact that 45 (75 per cent) had malignant cells in the vaginal smear. Twelve of these cases were detected by cytological examination before the patient had any symptoms suggestive of recurrence. Twenty per cent of all recurrences after the tenth year were discovered by examination of the vaginal smear. Of 248 cases of carcinoma of the corpus, 16 had recurrences after 10 years. Malignant cells were found in the vaginal smear of 10 (63 per cent) of these cases. There were 30 patients who had been treated for carcinoma of the vulva more than 10 years previously. There was one
*These
articles
have
Way:
Microinvasive Carcinoma of the Cervix, p. 14. The author presents a small article on the use of exfoliative cytology in discovering microcarcinema of the cervix. He defines this lesion as a condition of the cervix where it does not appear malignant, and where there are no svmpe
been abstracted.
1363
1364
Selected
abstracts
tams that arouse suspicion of carcinoma, but the microscopic picture is one of uniquivocal stromal invasion. The diagnosis will therefore be first established by exfoliative cytology, and then by careful histologic examination of a cone biopsy and/or hysterectomy specimens The author reports that between the. years 1948 and 1957 at Queen Elizabeth Hospital at Gateshead, 54 such cases were discovered by vaginal cytology. All of these cases have survived for at least 5 years. He compares the result in this lesion with Stage I carcinoma, where there is obvious clinical malignant disease, and reports 153 such cases. Of these, 73 were dead in 5 years so that the 5 year survival rate was only 52 per cent. The author concludes that exfoliative cytology has a definite place in the problem of cancer of the cervix, and that this place is one of the utmost importance and deserves even greater consideration than it has at present. J> Edward Ha0 Caspersson: Quantitative Cytochemical Studies on Normal, Ma.lignaut, Premalignaut and Atypical Cell Populations from the Human Uterine Cervix, p. 45. The author made measurements of the total content of individual cells of DNA, RNA and protein findings of scanty, high resolution, spectrophotometric, and interferometric procedures in scrapings from the human uterine cervix. Studies were made on specimens from normal cervices during the follicular and luteal phases, and from malignant, premalignant and atypical situations. Totally, about 15,000 cells were measured. Comparisons were made between the average values of the individual cells regarding the substances mentioned above, as well as between the shapes of the histograms representing the frequency distribution of the values of the individual cells belonging to different cell populations. In the material studied, pronounced differences were observed in both these respects for all substances in question between normal cell populations and cell populations from invasively growing tumors. Of special interest is the observation that deviations from the normal of the same type as found in the material from established tumors, were also found in premalignant situations. In some cases, these deviations were less pronounced than in the cell populations from invasively growing tumors. J. Edward Hczll
American Journal Vol. 4#, 1964. *Galton,
of Pathology
Michael: Studies of the Generalized Shwartzman Reaction in the Pregnant Golden I-Iamster, p. 613.
Galton:
Studies of the generalized Shwartzmau reaction in the preguant golden hamster, p. 613. Pregnant hamsters injected with colchicine develop the generaIized Shwartzman reaction, characterized by disseminated renal glomerular capillary thrombosis and cortical necrosis. The histopathologic lesions include marked degeneration of the trophoblast in both giant cell zone and labyrinth. The placentas are congested with maternal blood, with evidence of a small amount of fibrin. Pregnancy appears to “prepare” the animal in such a way that a single “provoking” stimulus is sufficient to elicit the generalized Shwartzman reaction. The author tentatively concludes that endogenous endotoxin derived from intestinal flora may play an important role in the events that culminate in the generalized reaction. Other factors such as the hypercoagulability of blood in pregnancy and the liberation of clot promoting factors from the placenta may play equally important roles. Ralph M. Wynn British
Medicul
Journal
November 2, l9fi3. *Berry, V., Booth, M-A., Chanarin, I., and Rothman, D.: Urinary Formamino-glutamic Acid Excretion in Pregnancy, p. 1103. November 9, 1963. *Osmond-Clark, F., and Murray, Cytology and Recurrent 1172.
M.: Vaginal Abortions, p.
November 30, 1963. *Cope, C. L., and Pearson J.. Aldosterone Secretion in Magnesium Deficiency, p. 1385. December *Box&am,
28, 1963. D. G.: Intramuscular Oxytocics and Cord Traction in the Third Stage of Labour, p. 1620.
January 11, 1964. *Chawla, S.: Intrauterine Osteogenesis fecta in Four Siblings, p. 99.
Imper-
Vol. 1, No. 5394, May 23, 1964. Scudamore, J. IX: Vulva1 and Vaginal tomata, p. 1357.
Haema-
by
LOUIS
M.
HELLMAN,
M.D.
Selected abstracts recurrence in this group which was discovered by cytological examination. There were 195 cases of proved recurrent carcinoma of the cervix within a 5 year period. Of these, there were 86 cases that had involvement of the pelvic wall or distant metastases and, of course, in these the cytologic material from the vagina was negative. In those cases with obvious clinical Iocal recurrence or unsuspected local recurrence, there were 96 cases; 32 per cent of the clinically obvious had positive smears. The above indicates the importance of the accuracy of the vaginal smear in the discovery of recurrent lesions. The author concludes that the vaginal smear is a useful tool in the detection of recurrence in the patient who has been treated for cancer of the cervix, corpus, or vulva. It is possible to discover recurrence at a time when they are still amenable to treatment. Five year survivals after recurrence can be achieved if the recurrences are discovered early. Thirty-three per cent of local recurrences in cancer of the cervix were discovered by the use of routine cytology in the treated patient. Postoperative vaginal smears are helpful in both cancer of the cervix and cancer of the vulva. The cytologic method is of practical value in determining the adequacy of the clinical procedure in cancer of the vulva where control of the disease depends on wide local excision. J. Edward Hall
Actu cytologica Vol 8, No. 1, January-February, 1964. *Graham, Ruth M.: Accuracy of Cytologic Diagnosis in the Treated Cancer Patient, p. 3. *Way, Stanley: Microinvasive Carcinoma of the Cervix, p. 14. Yaspersson, Olle: Quantitative Cytochemical Studies on Normal Malignant, Premalignant and Atypical Cell Populations from the Human Uterine Cervix, p. 45. Graham:
Accuracy of Cytologic Diagnosis in the Treated Cancer Patient, p. 3. The author divided the cases studied into those treated more than 10 years previously, namely, between the years 1927 and 1953, and those treated with radiation therapy within the last 5 years. There were 803 patients with invasive cancer of the cervix, treated more than 10 years previously, Of these 803, 60 (7 per cent), had a proved recurrence after the tenth year. The majority of these recurrences were local as indicated by the fact that 45 (75 per cent) had malignant cells in the vaginal smear. Twelve of these cases were detected by cytological examination before the patient had any symptoms suggestive of recurrence. Twenty per cent of all recurrences after the tenth year were discovered by examination of the vaginal smear. Of 248 cases of carcinoma of the corpus, 16 had recurrences after 10 years. Malignant cells were found in the vaginal smear of 10 (63 per cent) of these cases. There were 30 patients who had been treated for carcinoma of the vulva more than 10 years previously. There was one
*These
articles
have
Way:
Microinvasive Carcinoma of the Cervix, p. 14. The author presents a small article on the use of exfoliative cytology in discovering microcarcinema of the cervix. He defines this lesion as a condition of the cervix where it does not appear malignant, and where there are no svmpe
been abstracted.
1363
1364
Selected
abstracts
tams that arouse suspicion of carcinoma, but the microscopic picture is one of uniquivocal stromal invasion. The diagnosis will therefore be first established by exfoliative cytology, and then by careful histologic examination of a cone biopsy and/or hysterectomy specimens The author reports that between the. years 1948 and 1957 at Queen Elizabeth Hospital at Gateshead, 54 such cases were discovered by vaginal cytology. All of these cases have survived for at least 5 years. He compares the result in this lesion with Stage I carcinoma, where there is obvious clinical malignant disease, and reports 153 such cases. Of these, 73 were dead in 5 years so that the 5 year survival rate was only 52 per cent. The author concludes that exfoliative cytology has a definite place in the problem of cancer of the cervix, and that this place is one of the utmost importance and deserves even greater consideration than it has at present. J> Edward Ha0 Caspersson: Quantitative Cytochemical Studies on Normal, Ma.lignaut, Premalignaut and Atypical Cell Populations from the Human Uterine Cervix, p. 45. The author made measurements of the total content of individual cells of DNA, RNA and protein findings of scanty, high resolution, spectrophotometric, and interferometric procedures in scrapings from the human uterine cervix. Studies were made on specimens from normal cervices during the follicular and luteal phases, and from malignant, premalignant and atypical situations. Totally, about 15,000 cells were measured. Comparisons were made between the average values of the individual cells regarding the substances mentioned above, as well as between the shapes of the histograms representing the frequency distribution of the values of the individual cells belonging to different cell populations. In the material studied, pronounced differences were observed in both these respects for all substances in question between normal cell populations and cell populations from invasively growing tumors. Of special interest is the observation that deviations from the normal of the same type as found in the material from established tumors, were also found in premalignant situations. In some cases, these deviations were less pronounced than in the cell populations from invasively growing tumors. J. Edward Hczll
American Journal Vol. 4#, 1964. *Galton,
of Pathology
Michael: Studies of the Generalized Shwartzman Reaction in the Pregnant Golden I-Iamster, p. 613.
Galton:
Studies of the generalized Shwartzmau reaction in the preguant golden hamster, p. 613. Pregnant hamsters injected with colchicine develop the generaIized Shwartzman reaction, characterized by disseminated renal glomerular capillary thrombosis and cortical necrosis. The histopathologic lesions include marked degeneration of the trophoblast in both giant cell zone and labyrinth. The placentas are congested with maternal blood, with evidence of a small amount of fibrin. Pregnancy appears to “prepare” the animal in such a way that a single “provoking” stimulus is sufficient to elicit the generalized Shwartzman reaction. The author tentatively concludes that endogenous endotoxin derived from intestinal flora may play an important role in the events that culminate in the generalized reaction. Other factors such as the hypercoagulability of blood in pregnancy and the liberation of clot promoting factors from the placenta may play equally important roles. Ralph M. Wynn British
Medicul
Journal
November 2, l9fi3. *Berry, V., Booth, M-A., Chanarin, I., and Rothman, D.: Urinary Formamino-glutamic Acid Excretion in Pregnancy, p. 1103. November 9, 1963. *Osmond-Clark, F., and Murray, Cytology and Recurrent 1172.
M.: Vaginal Abortions, p.
November 30, 1963. *Cope, C. L., and Pearson J.. Aldosterone Secretion in Magnesium Deficiency, p. 1385. December *Box&am,
28, 1963. D. G.: Intramuscular Oxytocics and Cord Traction in the Third Stage of Labour, p. 1620.
January 11, 1964. *Chawla, S.: Intrauterine Osteogenesis fecta in Four Siblings, p. 99.
Imper-
Vol. 1, No. 5394, May 23, 1964. Scudamore, J. IX: Vulva1 and Vaginal tomata, p. 1357.
Haema-