During a recent study of 460 cases of cervical carcinoma from Malawi5 an assessment was made of cellular infiltration of the stroma within and adjacent to the tumour. In 13 cases (3 %) there was a very marked tissue eosinophilia with over 100 eosinophils per high power field of stroma. Eosinophils were seen both around and within the tumour, often separating the cells into small groups (Figs. 1-3). In some areas the tumour cells appeared to have lost cohesion, with individual cells lying separately encircled by eosinophils. The presence of eosinophils was not associated with tumour necrosis or with ulceration.The histological features of this group were characteristic, and appeared to be distinct from cases with minor degrees of tissue eosinophilia (37 % of the total), while in 60 % there were no eosinophils in the 10 fields examined. In all but one case the tumours with marked tissue eosinophilia were large cell nonkeratinising squamous carcinomas, which was the
Sonohysterography is a simple ultrasound (US) procedure that may be used to evaluate the endometrium. The technique involves placement of a 5-F catheter into the endometrial canal with subsequent instillation of sterile saline solution under US guidance. Fifty patients successfully underwent sonohysterography because of apparent abnormal endometrial thickening at transvaginal US, a nonspecific finding. Patients tolerated this procedure well, and no complications were encountered. In the 39 patients who proved to have endometrial pathologic conditions, sonohysterography demonstrated focal processes (polyps, carcinoma, hamartoma) in 15, diffuse processes (hyperplasia, secretory endometrium) in 21, and both focal and diffuse pathologic conditions in three. If a focal process can be delineated, a visually directed biopsy may be necessary. However, if the process is diffuse, a blind aspiration biopsy may be performed on an outpatient basis. In the majority of patients, the diffuse or focal nature of the disease could not be predicted on the basis of initial transvaginal US. Because sonohysterography allows distinction between diffuse and focal abnormalities, it provides physicians with a cost-effective way to plan the next step in case management.
Cervical carcinoma is the commonest malignancy seen in histopathologic material from Malawi. Between 1975 and 1978, 460 cases were diagnosed, of which 431 were invasive squamous carcinomas. These were reviewed for degree of differentiation and placed into three histologic types. Large cell non-keratinizing carcinoma was the commonest type, and presented at an earlier clinical stage than either large cell keratinizing or small cell non-keratinizing tumors. Of all tumors, 2.8% showed a massive eosinophil infiltrate which was not related to schistosome infection. The clinicopathologic features of cervical carcinoma in Malawi appear to be similar to those found in the United States and Europe.
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