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The cytology reportThe cytology report on abnormal findings should consist of a concise description of cells in precisely defined and generally accepted cytological terms. This may be followed, if appropriate, by a prediction of the histological condition based on the overall picture and should include a recommendation for the further management of the patient.When a prediction of histology is included as a supplementary statement to a description of the cytology use of the terminology, cervical intraepithelial neoplasia (CIN) is preferred: it has the advantage of relating the histological report more clearly to the prognosis and management than the artificial separation implied by classification into dysplasia and carcinoma in situ. Caution is advised, however, in the

SUMMARY Human polyomavirus (BK) was detected in two renal allograft recipients as a result of routine examination of Papanicolaou-stained smears of urinary sediment in the light microscope. Infection with this recently identified virus was confirmed by virus isolation and electron microscopy. The cytological, histological, and ultrastructural changes due to the virus are described, and virus excretion is correlated with the clinical progress of the patients and the pathological findings. The transplant ureters in both patients were found to be ulcerated and stenosed, and virus-infected cells were observed in the ureteric epithelium. We suggest that the administration of high-dose steroids in transplantation may permit active infection with human polyomavirus to occur in ureteric epithelium which has been damaged by ischaemia or inflammation.Infection with human polyomavirus (BK) was first described by Gardner et al. (1971), who isolated the virus from the urinary tract of a renal allograft recipient. The patient (BK) developed clinical evidence of ureteric obstruction coincident with the virus infection, and at laparotomy a segment ofdonor ureter was found to be ulcerated and stenosed. Since this initial observation was made, serological studies have shown that reactivation of latent BK virus is common in renal allograft recipients (Coleman et al., 1973b) and polyomavirus particles have been observed in the urine of 44% of transplant patients (Lecatsas et al., 1973); but, despite the frequency of infection, there have been no further case reports of BK virus infection associated with ureteric stenosis or obstruction.In this paper we report pathological changes in two patients who were found to have active infection with human polyomavirus (BK) after renal transplantation. BK virus infection was suspected when numerous large inclusion-bearing cells were seen in routine Papanicolaou smears of the urinary sediment, and the cytological diagnosis was confirmed by electron microscopy and virus isolation. Examination of postmortem material and surgical specimens revealed that, in both cases, BK virus infection was associated with narrowing, fibrosis, and ulceration of the donor ureter.Received for publication 20 October 1977 Special methods of investigation CYTOLOGY Ten millilitres of freshly voided urine were concentrated by centrifugation and the deposit was resuspended in 1 ml of the supernatant urine. Three slides were made from the cell suspension by cytocentrifugation (Shandon-Elliot). Two slides were stained by the Papanicolaou method and the third by methyl green pyronin. The slides were screened by light microscopy for activated lymphocytes, inclusionbearing cells, renal tubular cells, and casts. ELECTRON MICROSCOPYTen millilitres of urine were concentrated by centrifugation and the deposit was resuspended in 0 5 ml of supernatant placed in a conical polyethylene embedding capsule and centrifuged again. The supernatant in the capsule was discarded, leaving a button of cells in the point of the capsule. A 1 ...

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Objective-To follow up and assess the significance of borderline change in cervical smears. Design-Retrospective study of women undergoing routine cervical cytological screening in 1981. Setting-Avon Cervical Screening Programme, covering 250 000 women in Bristol and Weston super Mare. Subjects-437 women showing borderline cervical changes in 1981 and 437 age matched controls with normal results in 1981. Main outcome measures-Cytological progression to high grade dyskaryosis (cervical intraepithelial neoplasia grade III or invasive carcinoma). Results-During follow up ranging from 13 to 106 months 98 of the 437 women (22.4%) with borderline cytological changes on routine cervical cytology screening had a subsequent smear test showing high grade dyskaryosis compared with three of the 437 women (0.9%) in the control group. The risk of progression was greater in women aged 20 to 39 than in those aged 40 and over. Human papillomavirus infection had initially been diagnosed cytologically in 101 of the 437 (23%) women with borderline results. Significantly fewer of these women developed high grade dyskaryosis (13/98 (13%) v 88/339 (26%), p<005). Conclusions-Women with borderline smear test results are at increased risk of developing high grade dyskaryosis, particularly if the borderline changes occur without cytological features of human papil-lomavirus infection. Progression occurs within three years in 50% of cases, although a linearly increasing risk was sustained over the nine years of foliow up and was greatest in women aged 20 to 39. Careful follow up of these women is indicated.