Discriminant analysis on cells from developing squamous cancer of the respiratory tract

Cytologic preparations made from the tracheobronchial tree taken by the Schreiber catheter have been scanned by three color microphotometry. The digitized cell images were processed by the analytical cytodiagnostic programs of the TICAS system. Cells were sorted into two control groups and five groups of increasing atypia ranging from normal epithelium to invasive squamous cell carcinoma. Standard statistical tests, including Wilk's Lambda, Rao's V, and the Kruskal-Wallis tests are performed on these subsets of cell image features. This study demonstrates that discriminant analyses permit differentiation between normal cells and those from marked atypia or carcinoma and that the classification achieves a high degree of agreement with visual assignment.     

Immunoperoxidase staining of cervicovaginal smears after radiotherapy.

Cervicovaginal smears from 2 women with postirradiation dysplasia, 4 women with postirradiation squamous cell carcinoma of the cervix, 30 women with irradiation atypia and 5 healthy, nonirradiated women were stained immunohistochemically with six keratin antibodies. For four of the antibodies--CK19 (BA17), EMA, PKK-1 and CAM 5.2--squamous cells showing irradiation atypia, postirradiation dysplasia or postirradiation squamous cell carcinoma were more likely to stain positively than were nonirradiated squamous cells. For three of the antibodies in which multiple squamous cells stained positively, the proportion of squamous cells showing postirradiation dysplasia or postirradiation squamous cell carcinoma staining strongly was equal to or greater than the corresponding overall proportion for squamous cells showing irradiation atypia. This was statistically significant with only one antibody, PKK-1. No statistically significant differences were seen in staining of irradiated and nonirradiated squamous cells by MAK-6 and AE1:AE3. The data show that some keratin antigens are more often expressed in the irradiated groups and that there may be differences in the degree of antigen expression between squamous cells showing postirradiation dysplasia or postirradiation squamous cell carcinoma and squamous cells showing irradiation atypia.     

A comparative morphometric and cytophotometric study of intraductal hyperplasia and intraductal carcinoma of the breast

The Feulgen DNA content and the nuclear measurements of four groups of intraductal proliferations of the breast (hyperplasia, atypical hyperplasia, well-differentiated carcinoma without cytologic atypia and intraductal carcinoma with cytologic atypia) were compared. Intraductal carcinoma with atypia was the only group distinct from the others on the basis of DNA content, nuclear area and perimeter. Although the other groups were separable from intraductal carcinoma with atypia, they could not be reliably distinguished from each other by any combination of measurements. At best, 69% of well-differentiated intraductal carcinomas could be distinguished from atypical hyperplasias using a combination of DNA content and nuclear perimeter measurements. Thus, the difficult distinction of atypical hyperplasia from well-differentiated intraductal carcinoma by light microscopy was not aided by DNA analysis or by nuclear measurements.     

Fine needle aspiration cytology of radiation-induced changes in nonneoplastic breast lesions. Possible pitfalls in cytodiagnosis

The range of radiation-induced changes in fine needle aspiration (FNA) smears of the breast is described. In 41 of more than 800 patients who underwent breast-conserving treatment, a palpable breast lesion developed, and FNA was performed. In six cases, a recurrent carcinoma was present. In the remaining cases, three patterns of nonneoplastic lesions could be discerned: epithelial atypia (14 cases), fat necrosis (10 cases) and poorly cellular smears without epithelial atypia or fat necrosis (13 cases). It is important to be familiar with the patterns of radiation-induced epithelial atypia, since such atypia may lead to a misdiagnosis of recurrent carcinoma. These atypical cells may show impressive anisocytosis and anisonucleosis; however, the nuclear/cytoplasmic ratio remains normal and an admixture of bipolar cells is present. Cell dissociation and necrotic cell debris, as often seen in breast cancer smears, were never encountered in FNA smears from radiated nonneoplastic breasts.     

Cytology of cystic nephroma: a case report

BACKGROUND: Cystic nephroma is a rare benign multiloculated cystic renal neoplasm that is often confused with multicystic renal cell carcinoma radiographically and cytologically. CASE: A 58-year-old woman was incidentally found to have a multiloculated cystic right renal lesion. Cytologic examination of the fluid aspirated from the lesion was reported as highly suspicious for renal cell carcinoma, but a right nephrectomy revealed a cystic nephroma. CONCLUSION: Cystic nephroma fluid is characterized by the presence of sparse epithelial cells with moderate nuclear atypia. Conversely, the fluid of multicystic renal cell carcinoma is moderately cellular with no or mild nuclear atypia.     

Cytomorphologic and morphometric limitations of the assessment of atypia in fibroadenoma of the breast

OBJECTIVE: To investigate the relevance of nuclear morphometry in separating the categories of "fibroadenoma" and "fibroadenoma with atypia." STUDY DESIGN: Thirty consecutive breast lumps, on which a fine needle aspiration (FNA) diagnosis of fibroadenoma was followed by excision and histopathologic confirmation of the diagnosis, were included. Atypia on cytology was based on cell overlap, nuclear enlargement and cell dyscohesion. Nuclear morphometric comparison was carried out between the categories of fibroadenoma, fibroadenoma with atypia and grade 1 ductal carcinoma cases that formed part of an earlier study. The parameters employed were area, roundness, diameter, perimeter and grey level. RESULTS: Among the 30 cases of fibroadenoma reported on FNA, an additional component of atypia was noted in 5. On subsequent histopathology, atypia was not confirmed in any of the cases. On morphometric analysis, a significant difference was noted between fibroadenoma and fibroadenoma with atypia categories, as between fibroadenoma and grade 1 ductal carcinoma cases. However, no significant difference was noted between fibroadenoma with atypia and grade 1 ductal carcinoma cases. CONCLUSION: FNA assessment of atypia in cases of fibroadenoma is difficult. Even conventional nuclear morphometry, though supporting the initial impression of atypia, does not help with this assessment. Also, based on morphometry alone, there may be difficulty separating fibroadenomas with atypia and grade 1 ductal carcinomas. Larger studies, employing other morphometric parameters, such as chromatin texture and fractal dimension, may shed further light on the subject.     

Efficacy of Ki-67 antigen staining in Papanicolaou (Pap) smears in post-menopausal women with atypia—an audit

In cervical smears from post-menopausal women with mucosal atrophy it can be difficult to distinguish atrophic epithelial cell groups from neoplastic cell groups on cytomorphological criteria only. The consequence of post-menopausal atypia is that the woman is referred for a repeat smear after local oestrogen treatment or for colposcopy. We investigated whether immunocytochemical expression of Ki-67 (MIB-1) on the primary Papanicolaou-stained smear could be of any diagnostic help. Our data showed that negative Ki-67 expression is a very reliable indicator of a normal atrophic cell pattern, and by using this method on the original smear we were able to reduce the false-positive cytologic diagnoses by 86%.     

HIF-2α、VEGF在子宫颈鳞癌组织中的表达及其临床意义

目的检测宫颈鳞癌组织及正常宫颈组织中HIF-2α、VEGF基因与蛋白的表达情况,探讨其在子宫颈鳞癌的临床意义。方法随机选取64例子宫颈鳞癌组织和22例正常宫颈组织,收集年龄、FIGO分期和淋巴结转移等临床相关指标,采用实时荧光定量PCR法及免疫组织化学法(Elivision法)检测各组织中HIF-2α、VEGF的表达。结果实时荧光定量PCR分析结果表明HIF-2α、VEGF mRNA表达较正常宫颈组织显著增加,差异有统计学意义(P0.05),且二者mRNA水平呈正相关(r=0.778,P0.001)。免疫组织化学法结果表明HIF-2α、VEGF蛋白在宫颈组织中的阳性表达率分别为宫颈鳞癌组93.8%、正常宫颈组18.2%,两组比较差异有统计学意义,且HIF-2α与VEGF呈显著相关(r=0.514,P0.05)。HIF-2α、VEGF的mRNA表达均与年龄无关,但与FIGO分期、淋巴结转移关系密切(P0.05),FIGO分期高、有淋巴结转移的子宫颈癌组织HIF-2α、VEGFmRNA表达水平均相应对照组升高。结论与正常宫颈组织相比,HIF-2α、VEGF mRNA和蛋白在宫颈鳞癌中均呈高表达。     

Widespread posttracheostomy atypia simulating squamous cell carcinoma. A case report

Squamous atypia appears as a benign posttracheostomy phenomenon occasionally mistaken for squamous carcinoma. Most often seen are clumps of atypical metaplastic cells with irregular nuclear rims and chromatin that can be either finely dispersed or coarsely clumped. The cytoplasm is thick, and the cytoplasmic membrane is sharply outlined. We describe a case of squamous atypia occurring in a patient 30 years after laryngectomy. The atypia was so extreme that segmental bronchoscopy was performed to search for occult carcinoma. No carcinoma was found, but numerous atypical cells were found in the segmental bronchi sampled by endobronchial brushings. This finding indicates that posttracheostomy atypia can involve respiratory mucosa distant from the tracheal (stump) mucosa. Sputum and bronchoscopic samples received from patients with tracheostomies should be screened with a clear understanding of the morphologically distinct atypia encountered.     

AgNOR technique could be useful for differential diagnosis of squamous carcinomatous cells and atypical cells related to human papillomavirus in cervical smears

The human papillomavirus (HPV)-associated effect can mimic invasive squamous cell carcinoma. Measurements of the argyrophilic nucleolar organizer region (AgNOR) area of cells from smears with HPV infection of the cervix with marked atypia were carried out to differentiate this pathology from keratinizing carcinomas. After destaining, the smears were incubated in the dark for 25 min with a mixture of silver nitrate and gelatin in formic acid. After washing with deionized water and sodium thiosulfate, the slides were dehydrated and mounted with Canada balsam. The average AgNOR area was determined by image cytometry using the immersion oil objective and selecting 100 cells in each smear. Twenty-three patients with a mean AgNOR area of 1.32 µm² among their samples showed normal colposcopies and cervical smears after 18 months. In four patients, whose samples were diagnosed as atypical squamous cells of undetermined significance with viral atypia, the average AgNOR area was 7.70 µm²; biopsies showed keratinizing squamous carcinomas in three of these cases and moderately differentiated squamous carcinoma in one of them. We propose a cutoff of 2.2 µm² for the AgNOR area of cells from smears with HPV infection of the cervix with marked atypia to differentiate this group from keratinizing carcinomas.     

Color image analysis of cervical neoplasia using RGB computer color specification

OBJECTIVE: To establish quantitative color image analysis for cytology, red, green and blue (RGB) color specification was applied to Papanicolaou-stained cervical smears. STUDY DESIGN: Cell samples used in this study was those from 300 cervical specimens. We analyzed the color tone of nuclei and cytoplasm of the squamous cells in the cervical smear by means of computer image analysis. RESULTS: Papanicolaou stained nuclei displayed basophilic blue to purple. When they were hyperchromatic and deeply stained, B and G values decreased in value. The RGB values of cytoplasm and nuclei decreased significantly (P < .01) as their degree of cellular atypia increased. CONCLUSION: Using RGB color specification to analyze Papanicolaou-stained cervical smears, a significant difference was perceived in the nucleus and cytoplasm between different groups of squamous cells, from normal, dysplastic and squamous cell carcinoma. These findings may help to establish automated cytology.     

Potential of the learning vector quantizer in the cell classification of endometrial lesions in postmenopausal women

OBJECTIVE: To investigate the potential of artificial neural networks for cell identification in endometrial lesions from postmenopausal women. STUDY DESIGN: The study was performed on cytologic material obtained by the Gynoscann endometrial cell samplerfrom 12 cases of atrophic endometrium, 48 cases of hyperplasia without cytologic atypia (18 cases of simple hyperplasia and 30 cases of complex hyperplasia), 12 cases of hyperplasia with cytologic atypia (complex atypical hyperplasia) and 48 cases of adenocarcinoma (30 cases of well-differentiated, 12 cases of moderately differentiated and 6 cases of poorly differentiated carcinoma). From each case approximately 100 cells were examined using a custom image analysis system. A learning vector quantizer (LVQ) identified the collected data. RESULTS: Investigation of cells from Endometrial Alterations with LVQ proved that according to the nuclear characteristics, as expressed by morphometric and textural measures, the endometrial cells from postmenopausal women may be identified as belonging to one of thefollowing three groups: atrophy, hyperplasia without cytologic atypia (simple and complex hyperplasia) and malignant neoplastic lesions (atypical complex and adenocarcinoma). CONCLUSION: The role of nuclear morphologic features in the cytologic diagnosis of endometrial alterations was confirmed. The overlap in thefeature space observed indicates that cell characteristics do not form strictly separate clusters. Thatfact explains the difficulty that morphologists have with the reproducible identification of cells from endometrial lesions in postmenopausal women. Application of LVQ offers a good classification at the cell level and promises to be a powerful toolfor classification on the individual patient level andfor the clarification of the natural history of endometrial pathology.     

Polyploidy In Pleomorphic Adenomas With Cytological Atypia

Occasionally, in fine-needle aspirates of pleomorphic salivary gland adenomas, considerable cytonuclear atypia is present, which may give rise to a false-positive diagnosis. In this study DNA cytophotometry was performed on Feulgen restained smears prepared from material obtained by needle aspirates of normal salivary glands (n = 4), pleomorphic adenomas with (n = 5) and without (n = 4) atypia and a carcinoma in a pleomorphic adenoma. The results showed a clear diploid DNA histogram in the specimens of normal salivary gland and pleomorphic adenomas without atypia. In contrast, in the pleomorphic adenomas with atypia a distinct polyploid pattern was present in three out of the five DNA histograms with DNA values in 2c, 4c and 8c ranges. In two of these cases a 16c peak was also present and in the two remaining cases tetraploidy was demonstrated. In the carcinoma a main stemline at 4c was found. This report once more emphasizes the possible atypia which may be present in FNA of pleomorphic adenomas of the salivary gland. The atypia is due to polyploidy in a histologically benign tumour.     

Centrifugal separation of carcinoma or atypical cells in voided urine

A simple density gradient method was used to separate atypical and cancer cells from non-cancer cells in voided urine from patients with transitional cell atypia (moderate and grave atypia) and bladder cancer (squamous cell carcinoma and transitional cell carcinoma). Prior to cell separation, the Saccomanno preserved cells were dispersed by homogenization. After cell separation (5 min x 1400 rpm), atypical and cancer cells were enriched up to 20-fold. Also, most of the leucocytes (68-98%) and squamous cells (47-82%) were absent from density gradient specimen fractions containing the largest percentages of atypical and cancer cells. Peak purity ranges of atypical or cancer cells from different sample classes showed a large degree of overlap. This permitted the pooling of density gradient fractions enriched for atypical or cancer cells, thus increasing the efficiency of the method. Also, following centrifugation, the Papanicolaou-stained specimen fractions showed less background staining than the unprocessed controls, and the cells retained diagnostic morphologic features. We infer that this method may be a useful, low-cost approach for the morphologic study of developing cancers, not only from the urinary bladder, but also from the respiratory tract.     

Histochemistry of small intestinal dysplasia in familial polyposis coli

Biopsies of duodenal and ileal mucosa from patients with familial polyposis coli were studied. Areas of atypia were identified in the duodenum of six patients and in the ileum of three patients. Grade I atypia was characterized by crowding and elongation of cells and nuclei, a slight reduction in the number of goblet cells and the presence of a brush border; grade II atypia was further characterized by pseudo- or pluristratification of cells, a marked reduction in the number of goblet cells and the absence of a brush border. In areas of atypia, columnar cells often contained PAS-positive apical granules, which were diastase-resistant and unstained by alcian blue at any pH; the brush border, even where recognizable in haematoxylin-eosin and PAS-stained sections, was unreactive histochemically for alkaline phosphatase. Goblet cells were few in areas of atypia, but those present were regularly stained by PAS and alcian blue pH 2.6. Apical granules, similar in their histochemical characteristics to those observed in columnar cells in areas of atypia, were also found in otherwise normal mucosal areas, even in some patients with no overt areas of atypia in the biopsies studied. These granules have been interpreted as an abnormality, possibly preceding the onset of atypia. Hyperplasia of goblet cells, secreting mucins with the same staining pattern as in normal intestine, was found in some patients, either adjacent to areas of atypia or independent of them. Intervening columnar cells had a normal morphology, alkaline phosphatase-reactive brush borders and no sign of mucus secretion. This goblet cell hyperplasia has been interpreted as a reactive, nonspecific alteration of the mucosa.     

Nuclear DNA changes during pathogenesis of squamous carcinoma of the cervix in 3,4-benzopyrene-treated mice

The pathogenesis of squamous carcinoma of the uterine cervix was studied by means of morphologic and cytochemical techniques in mice treated with 3,4-benzopyrene. The results indicate that carcinogen-induced transformation of normal cervical epithelium into squamous carcinoma occurs through a sequence of cellular alterations, demonstrated by progressively increasing cellular atypia and a progressively increasing and scattered DNA content.     

Quantitative DNA analysis of low grade cervical intraepithelial neoplasia and human papillomavirus infection by static and flow cytometry.

Quantitative deoxyribonucleic acid (DNA) analysis of cervical biopsy specimens from 26 women with cytological, colposcopic, and histological evidence of mild cervical atypia consistent with cervical intraepithelial neoplasia grade I, reactive atypia, or human papillomavirus infection alone or in combination was performed in a comparative evaluation of Feulgen microspectrophotometry, the fast interval processor image analysis system, and flow cytometry. The fast interval processor image analysis system showed a distinct advantage over the other methods, being faster and allowing the operator to see the cells that were selected for measurement. The three methods of measurement together showed that the DNA content of at least 2% of the cells measured exceeded 5C (C being the haploid amount of DNA in a normal cell and 2C representing the diploid complement of a normal cell) in all cases of cervical intraepithelial neoplasia grade I and reactive atypia and in 87% of those reported as showing human papillomavirus infection alone. In contrast, the DNA content of cervical biopsy specimens from the transformation zone of 11 normal controls did not exceed 4C. This study shows the value of using a DNA threshold--that is, the "5C exceeding rate"--to distinguish between normal and neoplastic appearances of the cervix. These results support the view that cervical infection by human papillomavirus is a true precursor of neoplasia.     

The role of morphometry in the cytology of well-differentiated hepatocarcinoma and cirrhosis with atypia

A morphometric study was performed on 200 nuclei per case in six well-differentiated hepatocarcinomas and in six cirrhoses with cytologic atypia, using samples obtained by fine needle aspiration (FNA) biopsy of the liver. The parameters measured were the nuclear area, the nuclear perimeter and the maximum nuclear diameter. The nuclei of well-differentiated hepatocarcinomas could be distinguished from those of cirrhoses on the basis of the larger size and greater anisonucleosis of the former. A statistical analysis (using a two-sided t-test) of the means of the parameters showed significant differences between the two diagnostic groups. These results suggest that morphometric analysis can help in the differential diagnosis between well-differentiated hepatocellular carcinoma and cirrhosis with cytologic atypia in FNA biopsy samples.     

Morphologic scales and relative distances between lesions identified on Papanicolaou smears.

We fit a Gaussian-type curve to a nonmonotonic transform of initial arbitrarily given scales (pseudoscalar transform) of a two-way discrete classification table by maximizing the likelihood (entropy) and computing morphologic scales of clusters of objects identified by visual judgments. The scales give the relative distance between pairs of categories or states. Morphologic scales of histologic lesions (states) identified on Papanicolaou smears were computed from a confusion matrix consisting of 3,545 matched pairs of observations on Papanicolaou smears and colposcopically directed biopsies available from the Gynecologic Cytology Laboratory, University of Minnesota, between 1985 and 1987. The original (uncollapsed) confusion matrix consisted of eight cytologic categories and histologic states: normal plus atypical benign, reactive atypia (including condylomatous changes); mild, moderate and severe dysplasia; squamous carcinoma in situ; invasive squamous cell carcinoma; and other malignancies. The morphologic scales are expressed numerically, which reflects a degree of confusion between two diagnostic categories or states. Except for malignancies other than squamous cell carcinoma, morphologic scales of histologic states seen from cytology retained the order of clinical severity. We detected a high degree of confusion between severe dysplasia and carcinoma in situ. Malignancies other than squamous cell carcinoma fell between moderate and severe dysplasia. Such a transposition of the scales in this group containing adenocarcinoma was likely due to frequent association of adenocarcinoma with cervical intraepithelial neoplasia. Morphologic scales of cytologic categories seen from histology showed high degrees of confusion and transpositions between mild and moderate dysplasia and between severe dysplasia and carcinoma in situ.(ABSTRACT TRUNCATED AT 250 WORDS)     

A monoclonal antibody that binds to tumor-associated antigens of exfoliated cells in the smears of patients with cervical intraepithelial neoplasia

The reactivity of CE 407, a monoclonal antibody (MAb) known to bind to the cells of invasive cervical squamous cell carcinoma, was tested by the immunoperoxidase technique in samples from precursor lesions with and without associated condylomatous atypia. Antibody CE 407 bound with a high frequency to cells from cases of cervical intraepithelial neoplasia (CIN) and to cells showing condylomatous changes. Antibody CE 407 gave a positive reaction in 16 (64%) of 25 patients with CIN only. When the morphologic characteristics of human papillomavirus infection were present along with CIN, there was a higher frequency of positivity, with 27 (93%) of 29 such cases positive for CE 407. Reactivity of this MAb with normal exfoliated cervical epithelial cells was not observed.