A 21-year-old woman with a family history of von Hippel-Lindau disease presented with a mass in the head of the pancreas. Light microscopic features of the tumour suggested neuroendocrine differentiation and although it displayed positive immunostaining for the antigens expected in a neuroendocrine neoplasm, S-100 staining was also present. This unusual feature prompted further evaluation by routine and post-embedding protein-A gold immunoelectron microscopy, which demonstrated the presence of neuroendocrine granules. Tumour cell DNA content was normal by flow cytometry. Although this patient exhibited no other signs of von Hippel-Lindau disease, the presence of a pancreatic tumour with neuroendocrine differentiation demonstrated that she was affected. Future surveillance and genetic counselling will be influenced by this diagnosis.

Gynecol Oncol 2000;79:44–49 The authors retrospectively reviewed the records of 126 patients with ASCUS using the ThinPrep system and subdivided them into ASCUS favor reactive and ASCUS favor HGSIL. The overall prevalence of dysplasia in this group was 15.9% and was higher among patients in the ASCUS favor HGSIL group. The incidence of high‐grade dysplasia among the 63 patients in the ASCUS favor reactive group was 3.2%; the incidence in the ASCUS favor HGSIL group was 12.7%. Comment: This report appears to confirm that the finding of ASCUS favor HGSIL is associated with a significant risk of high‐grade dysplasia. These findings are true both in conventional smears and in liquid‐based cytology. The authors suggest that patients with ASCUS favor HGSIL should be offered colposcopic examination. (CJD)

The use of tamoxifen among women with breast cancer or at high risk of the disease has greatly expanded over the past several decades. Tamoxifen has a complex effect on the female reproductive tract and several tamoxifen-associated changes have been described among tamoxifen users. These include endometrial thickening, cervical and endometrial polyps, endometrial hyperplasia, endometrial adenocarcinoma, uterine sarcoma, increase in the size of uterine leiomyomata, exacerbation of endometriosis and ovarian cysts. The most common uterine change associated with tamoxifen is endometrial polyps. The annual incidence of endometrial cancer among women on tamoxifen is 2 per 1000 and seems to be related to the cumulative tamoxifen dose. It is not clear whether endometrial cancer occurring among women on tamoxifen is of worse prognosis than endometrial cancer occurring among women not receiving tamoxifen. Tamoxifen is associated with several sonographic changes which make the use of ultrasound in surveillance of these patients difficult. There is no indication to implement routine screening for endometrial cancer among all women on tamoxifen. However, endometrial biopsy, preferably via hysteroscopy, should be considered in women with uterine bleeding.