Although invasive adenocarcinoma of the cervix constitutes 5--15% of all cervical cancers, the in situ counterpart is underrepresented in the published series of percursor lesions of cervical cancer. Moreover, no cases are known to have been published in which in situ adenocarcinoma preceded invasive cancer. Partly, this can be explained by the fact that in situ adenocarcinoma is an underdiagnosed lesion. In a series of 52 cases of adenocarcinoma of the uterine cervix, 18 "negative" endocervical biopsies, taken 3--7 years prior to the clinical presentation of cancer, were available for study. In five of these cases, areas of adenocarcinoma in situ were found. The quantitative parameters of these "missed" adenocarcinomas in situ and adenocarcinomas in situ adjacent to invasive cancer were the same. The in situ lesions differed significantly from benign endocervical epithelium. This study strongly suggests that these lesions may progress to invasive cancer. With the acquired information on the quantitative features of adenocarcinoma in situ cells, the most significant criteria for routine diagnostic practice can be identified.
Cells aspirated from breast lesions and smeared on slides were subjected to computer assisted morphometric analysis. Three groups of cases were studied. The first were those collected from patients with known benign and malignant lesions. The second group were 143 unselected consecutive aspirates from breast lesions and the third, a group with a needle aspirate cytodiagnosis "suspicious of malignancy". The analysis showed the malignant cells to have larger nuclei with more anisokaryosis and more variation in the nuclear cytoplasmic ratios when compared with benign cells. When this form of semiautomatic analysis was applied to the "suspicious" group the accuracy of cytodiagnosis was improved.
A histological study of 208 cases found a strong association between the occurrence of precancerous cervical columnar and squamous lesions. This was not, however, directly related to cellular abnormalities. The criteria for adenocarcinoma in situ (AIS) and its precursor lesions were defined morphometrically. With increasing abnormalities of the columnar cells, changes of the glandular and epithelial architecture were more frequently observed. Of the 20 cases morphometrically classified as AIS, only four were initially diagnosed as such, of which three were cases of 'pure' AIS lacking squamous cell abnormalities. Quantifying abnormalities of columnar epithelium is an important aid in the identification and classification of AIS.
SUMMARY The morphometric differences between the urothelial cells (wet-fixed Papanicolaoustained) in the voided urine of 20 patients with low grade and high grade bladder tumours were measured. The morphometrical data of this learning set resulted in a cytomorphometrical classification rule, which was applied to a test set of 21 cases with low grade and high grade bladder tumours.The results of the cytomorphometrical classification rule correspond very well with the histomorphometrical classification and the histological grade of the parent tumours.The results indicate that it is feasible to classify bladder tumours using the cytomorphometrical data of the exfoliated urothelial cells alone.In a previous study' it was shown that cellular and nuclear dimensions of urothelial cells in the voided urine of patients with grade I and grade II tumours differ, and that normal urothelial cells cannot be distinguished from cells exfoliated from grade I tumours. However, it was not possible to separate all grade I tumours from all grade II tumours. For therapeutic reasons it is important to discriminate between these low grade bladder tumours (grade I and II) and high grade (grade III) tumours; it is clinically less important to separate grade I and II tumours.2 An objective method of distinguishing low grade from high grade tumours is desirable.For the classification rule (learning set) were used: mean nuclear area, mean nuclear diameter, standard deviation nuclear area, mean nuclear/cytoplasm (N/C) area ratio, mean N/C diameter ratio, standard deviation N/C area ratio and mean cytoplasmic area. Material and methods LEARNING SEITwenty cases of bladder tumour were selected for the learning set: 10 patients with a low grade tumour (grade I and II) and 10 cases with a high grade bladder tumour (grade III). The test set consisted of 21 cases, of which voided urine and the transurethrally resected bladder tumour were available for this study. HISTOMORPHOMETRYThe parent tumours of the test set were histomorphometrically classified using a classification rule. For this classification the nuclear areas of the superficial cells are measured.10 CYTOLOGICAL MATERIAL Voided urine was used for this study. Two consecutive samples were taken from each patient and the smears with the highest cytological grading were used. Wet-fixed Papanicolaou-stained smears were used for this study. The wet-fixation was achieved by spray-fixing (coating fixative 80 ml polyethylene glycol (MW 300), 690 ml isopropanol, 170 ml acetone, 60 ml distilled water).
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