Verrucous carcinoma of the uterine cervix. A case report

The cytohistopathologic features of a verrucous cervical carcinoma are reported. The presence in a cervical smear of two distinct types of dyskaryotic cells, with regularity of size and shape, and of occasional vacuolated cells set in a bright, eosinophilic background should suggest the lesion. With the cytologic suggestion and the typical warty clinical appearance of the tumor, an accurate preoperative diagnosis may be established.     

Detection of malignant melanoma of the uterine cervix from Papanicolaou smears. A case report

A case of malignant amelanotic melanoma of the uterine cervix in a patient presenting with right hemiparesis and enlarged lymph nodes was diagnosed in Papanicolaou-stained cervical smears showing many melanoma cells. Melanoma cells with bizzare nuclear and cytoplasmic abnormalities, rarely seen in other tumors, helped to establish a positive diagnosis. The diagnosis was confirmed by histopathologic study of the endocervical surgical specimen, including a positive immunoperoxidase staining for S-100 protein.     

Pemphigus vulgaris and microinvasive squamous-cell carcinoma of the uterine cervix

Although patients with disseminated pemphigus vulgaris may have involvement of the uterine cervix, such involvement is often detected only after vaginal discharge or bleeding. When a cervical smear is obtained, distinctive cytologic abnormalities may be observed; these may be attributed to the changes of pemphigus or to an associated reparative/inflammatory reaction. This study documents the first two cases of microinvasive squamous-cell carcinoma of the uterine cervix developing in association with uterine cervical pemphigus. The gross pathologic, cytologic and histologic features of these lesions are illustrated. The cytologic criteria that may be helpful in distinguishing between cells derived from microinvasive squamous-cell carcinoma and pemphigus of the uterine cervix are described.     

Cytomorphology of verrucous carcinoma of the cervix. A case report

BACKGROUND: Verrucous carcinoma of the uterine cervix is rare. Cytology is thought not to be helpful in the diagnosis of this lesion due to its bland morphology. The cytologic features of this lesion remain poorly defined. CASE: The cytologic findings in a Pap smear facilitated the diagnosis of verrucous carcinoma of the cervix. The features included atypical polygonal and spindle cells with abundant, keratinizing cytoplasm; atypical squamous cells with pearl formation; and frequent, nonkoilocytic cytoplasmic vacuolization. CONCLUSION: There are 30 published reports on verrucous carcinoma involving the cervix and vagina that include the cytologic findings. In 70% of these cases, cytology was abnormal. Recognition of the cytologic characteristics may help in identifying this lesion on cytology, prevent delays in diagnosis and ensure that patients receive appropriate therapy.     

Exfoliative cytology of lymphoepitheliomalike carcinoma of the uterine cervix. A report of two cases

BACKGROUND: Lymphoepitheliomalike carcinomas (LECs) are morphologically similar to undifferentiated nasopharyngeal carcinoma but occur at sites other than the nasopharynx. They rarely occur in the uterine cervix. Sixty-five cases of LEC of the cervix have been published to date, and the pitfalls of histopathologic interpretation have been discussed. This undifferentiated carcinoma with a prominent lymphocytic infiltrate represents a challenge for the pathologist examining a scant cervical biopsy or Pap smear. Distinguishing LEC as a separate entity is important. Despite the fact that the epithelial component is poorly differentiated, this neoplasm is associated with a lower frequency of lymph node metastases, is potentially radiosensitive and has a better prognosis. Although mentioned in passing in several papers, the exfoliative cytology of this cervical neoplasm has not been adequately discussed. We report the cytologic features of LEC in cervical smears obtained from two patients. CASES: The first patient presented with menometrorrhagia and postcoital bleeding. The cervical smear taken at the time of presentation was reported as unsatisfactory for evaluation. ASCUS was diagnosed on a vaginal smear obtained one year earlier. The second patient presented with a complaint of postcoital bleeding. A cervical smear and the cervical biopsy taken at the time of presentation were reported as ASCUS and high grade dysplasia versus carcinoma, respectively. A retrospective review of the cervical smears revealed rare malignant cells occurring singly or in small groups. The tumor cells had a high nuclear/cytoplasmic ratio, irregular nuclear membrane and hyperchromatic nuclei with coarse chromatin and were obscured by heavy inflammation and blood. The background resembled that of a menstrual smear. CONCLUSION: The diagnosis of LEC of the cervix is often made on a loop electrical excision procedure or on a hysterectomy specimen. The presence of heavy inflammation and blood, which can obscure the malignant nature of the cells, presents the cytopathologist with a challenging diagnosis of LEC in cervical smears. In view of the prognostic implications, it is desirable for the pathologist to classify LEC as a distinct entity.     

Pemphigus vulgaris with subclinical involvement of the uterine cervix. Report of a case with persistence of abnormal Papanicolaou smears posthysterectomy

A case of pemphigus vulgaris is reported in which abnormal Papanicolaou smears continued prior to and after hysterectomy despite a normal pelvic examination. Microscopic foci of cervical pemphigus were found only in a retrospective study of the surgical material. Subclinical involvement of the cervicovaginal area with pemphigus, especially in a patient whose disease is apparently under control with steroids, can be a source of atypical Papanicolaou smears. The importance of careful colposcopic examination and clinical history is stressed for the gynecologist and cytopathologist, respectively.     

Enhanced expression of Mcm proteins in cancer cells derived from uterine cervix.

Minichromosome maintenance proteins (Mcm) 2-7 play essential roles in eukaryotic DNA replication. Several reports have indicated the usefulness of Mcm proteins as markers of cancer cells in histopathological diagnosis. However, their mode of expression and pathophysiological significance in cancer cells remain to be clarified. We compared the level of expression of Mcm proteins among human HeLa uterine cervical carcinoma cells, SV40-transformed human fibroblast GM00637 cells and normal human fibroblast WI-38 cells. All the proteins examined were detected in HeLa and GM cells at 6-10 times the level found in WI-38 cells on average. This increase was observed both in total cellular proteins and in the chromatin-bound fraction. Consistently, Mcm2 mRNA was enriched in HeLa cells to approximately four times the level in WI-38 cells, and the synthesis of Mcm4, 6 and 7 proteins was accelerated in HeLa cells. Immunohistochemical studies of surgical materials from human uterine cervix showed that Mcm3 and 4 are ubiquitously expressed in cancer cells. Further, the positive rate and level of Mcm3 and 4 expression appeared to be higher in cancer cells than in normal proliferating cells of the uterine cervix and dysplastic cells, suggesting that they can be useful markers to distinguish these cells.     

Mesenchymal stem cells isolated from human uterine cervix cancer tissues

In the present study, MSCs (mesenchymal stem cells) were successfully isolated and identified from hUCC (human uterine cervix cancer) tissues. The morphological appearance, immunophenotype, growth curve, cell cycle, cytogenetic features and differentiation potential of these cells were investigated. Results showed that cells isolated from the uterine cervix cancer tissues displayed fibroblast‐like morphology and grew into colonies. Immunophenotyping by flow cytometry revealed that the isolated cells were positive for CD13, CD29, CD44, CD105 and HLA‐I, while negative for CD10, CD14, CD31, CD34, CD38 and HLA‐DR. The cells kept a normal karyotype by chromosome analysis. At the third passage, the percentages of cells in G₀‐/G₁‐, 2‐/M‐ and S‐phase were 84.94, 8.36 and 6.71%, respectively. Under appropriate induction conditions, these cells can differentiate into osteogenic, adipogenic cells and hepatocytes. Taken together, MSCs were confirmed to exist in hUCC tissues, which may provide a new target for clinical cancer therapy.     

Acute myelogenous leukemia relapsing as granulocytic sarcoma of the cervix. A case report

BACKGROUND: Granulocytic sarcoma of the uterine cervix is an unusual manifestation of acute myeloid leukemia, representing soft tissue masses of leukemic myeloblasts. An often misdiagnosed entity, it is often confused with other inflammatory or neoplastic conditions, including large cell lymphoma. CASE: A 67-year-old female presented with acute myelogenous leukemia and a normal karyotype. After eight years in complete remission, abdominal pain and an ulcerated mass in the uterine cervix developed, with a normal peripheral blood smear. Vaginal cytology examination revealed myeloid blasts, which, on subsequent cervical biopsy, stained positive for leukocyte common antigen, Kp-1 (CD68), antimyeloperoxidase, lysozyme and chloroacetate esterase, confirming the cytologic diagnosis. K-ras was not mutated at codon 12 or 13. Chemotherapy induced a complete remission, followed nine months later by central nervous system and then systemic relapse. The patient died 13 months after being diagnosed with granulocytic sarcoma of the cervix. CONCLUSION: This case illustrates the value of vaginal cytology and histologic biopsy evaluation in patients with acute myelogenous leukemia, including those without evidence of systemic disease. The characteristic cytologic features of granulocytic sarcoma led to the correct diagnosis. Histologic biopsy evaluation, including immunohistochemistry for myeloid markers, proved of value in confirming the diagnosis.     

Primary malignant lymphoma of the uterine cervix: report of a case with cytologic and immunohistochemical diagnosis

A non‐Hodgkin's lymphoma initially diagnosed on the cervical smear in a 69‐year‐old asymptomatic female is described. The cytologic findings strongly suggested the presence of a malignant lymphoid neoplasm: neoplastic cells were round, loosely arranged, with scanty cytoplasm and cleaved nuclei. Histological evaluation of the cervical biopsy revealed a diffuse lymphoid proliferation of mononucleated cleaved cells beneath an ulcerated epithelium. Immunohistochemically, the tumour cells were positive for B cell markers. Reports on cytologic features of primary malignant lymphoma of the cervix are not frequent in the literature. We emphasize the importance of their recognition and the differential diagnosis of cervical lymphoma from other neoplastic and non‐neoplastic lesions.     

Efficacy of cotton-tipped applicators for obtaining cells from the uterine cervix for Papanicolaou smears

A study was made of the efficacy of two techniques for the preparation of Papanicolaou smears. In one technique ("swab-spatula technique"), a scraping of the endocervix with a saline-moistened cotton-tipped applicator was combined with a scraping of the ectocervix with a plastic spatula. In the second technique ("swab technique"), the endocervix and ectocervix were scraped with only a saline-moistened cotton-tipped applicator. The swab technique produced more inadequate smears with a scanty cellular yield (24/408 = 6%) than did the swab-spatula technique (9/361 = 3%). The swab technique also produced higher false-negative rates (60% for CIN I, 42% for CIN II, 16% for CIN III, 20% for invasive cancer, and 32% overall) as compared with those of the swab-spatula technique (27% for CIN I, 29% for CIN II, 14% for CIN III, 0% for invasive cancer and 18% overall). Because of the higher rates of inadequate samples and false negativity in smears prepared by cotton-tipped applicators alone, it is recommended that the spatula not be omitted in taking cervical samples for the preparation of Papanicolaou smears for the detection of dysplasia or cancer. This study also reflects a poor performance of a cervical cancer detection system in the setting of a major medical school and suggests the need for instruction and periodic evaluation of the performance of the staff taking the smears. This study also substantiates doubt on the value of a second recent smear as a follow-up procedure for cervical dysplasia.