Cytological classification of precancer and cancer of the cervix uteri

A cytological classification of dysplasia, intraepithelial and invasive cancer of the cervix uteri is suggested. Cytologic criteria for differential diagnosis are discussed. Cytologic diagnosis of precancer and cancer made on the basis of the said classification was verified in 63.5 and 97.3%, respectively.     

The importance of echography in the diagnosis of precancer and cancer of the endometrium

Ten-year experience with ultrasonography was gained at an outpatient center. Within this period, 27000 examinations were performed in 11996 females. The credibility of the method in diagnosing endometrial pathology was 85.8%. Cancer morbidity for the last 5 years was compared in the ultrasonography and no ultrasonography groups. Endometrial cancer morbidity was 6.2 times higher in the latter group. Large-scale application of the procedure followed by adequate treatment assures significantly lower incidence of said pathology.     

Prognostic value of the Kiel classification of malignant non-Hodgkin's lymphomas.

The aim of the present research was to evaluate the prognostic value of the Kiel classification of malignant non-Hodgkin's lymphomas. For this purpose a series of 100 consecutive, previously untreated adults with advanced malignant non-Hodgkin's lymphomas was analyzed. The median age of the patients was 54 years; 61 patients were males. Although the number of the various groups considered was limited, a statistically significant difference (p less than 0.001) was found in the median survival of patients with lymphomas of low-grade malignancy (lymphocytic, lymphoplasmacytoid, centrocytic, centroblastic-centrocytic lymphoma) and lymphomas of high-grade malignancy (centroblastic, lymphoblastic, immunoblastic lymphoma). A difference in survival (p less than 0.001) was also observed among the patients with lymphocytic lymphoma and those with centroblastic-centrocytic lymphoma, whereas no significant difference in survival was found between the histological subtypes of high-grade malignant lymphomas. Our observations support the opinion that the Kiel classification is useful in clinical practice to distinguish the histological types with a better prognosis from those with a worse one; in addition this classification appears to be of conceptual value.     

Cytologic scoring of endometrioid adenocarcinoma of the endometrium

BACKGROUND: Endometrial carcinoma is one of the most frequent malignancies in the female genital tract, and its incidence has been increasing in Japan. Histologic grade is an important factor for organizing treatment strategies, including hormone therapy, and for predicting the prognosis of the patient. The objective of this study was to evaluate the applicability and usefulness of cytologic scoring in assessing the morphologic differentiation of endometrioid adenocarcinomas of the endometrium using endometrial smears. METHODS: Sixty-four endometrial cytologic samples of endometrioid adenocarcinomas of the endometrium were used in this study. All patients underwent endometrial cytology before hysterectomy, and the diagnosis was confirmed by histologic examination of the extirpated uterus. Each cytologic specimen was scored according to a scoring system established by the authors. The cytologic grade based on those estimated scores was compared with the histologic grade and clinicopathologic parameters, respectively. RESULTS: The cytologic grade (CG) was correlated positively with the histologic grade. A high cytologic score was correlated with p53 mutation and myometrial invasion and was correlated negatively with estrogen receptor and progesterone receptor status. The concordance rates of cytologic grade with well differentiated (Grade 1), moderately differentiated (Grade 2), and poorly differentiated (Grade 3) histologic grades were 83.3% (35 of 42 tumors), 9.1% (1 of 11 tumors), and 100% (11 of 11 tumors), respectively. The total concordance rate was 73.4% (47 of 64 tumors). The best cut-off value for distinguishing histologic Grade 1 from the others was a cytologic score of 17, representing a sensitivity of 83% and a specificity of 81%. For distinguishing histologic Grade 3 from the others, the best cut-off value was a cytologic score of 20, representing a sensitivity of 100% and a specificity of 83%. CONCLUSIONS: The cytologic scoring system studied for endometrioid adenocarcinoma was useful for predicting histologic grade and tumor malignant potential.     

The Lukes-Collins classification and the Kiel classification of non-Hodgkin's lymphomas

280 cases of non-Hodgkin lymphoma were studied histologically according to the criteria of Lukes-Collins as well as Lennert's classifications. Nodularity was predominantly related to the SC and LC types according to the Lukes-Collins classification. Nodularity is indicative of better survival. The Burkitt and convoluted types were found to be predominantly related to childhood or to younger patients and the non-Burkitt type most frequently to the older groups. The Lukes-Collins classification separates well two clear prognostic groups--the favorable and the unfavorable one with overall median survivals of 44 and 11 months, respectively. Within the Kiel classification, nodularity was found mainly in the CB-CC type, but also in 27% of the CC cases. The relationship of the subtypes according to the Kiel classification and age resembles the same relation found with the Lukes-Collins classification, where according to the Kiel classification the Burkitt, convoluted and lymphoblastic types were related to children and adults. Three prognostic groups were identified with overall median survivals of 80, 38 and 13 months, respectively.     

Chemotherapy of malignant lymphomas

According to recent advances in chemotherapy containing adriamycin, now complete remission can be obtained in more than 80 percent of patients with stage 3 and 4 diffuse large cell lymphomas, and the cure rate could also be expected in more than 60 percent of patients. The easiest way to obtain better results would be the introduction of chemotherapy in stage 1 and 2. The kinds of chemotherapy chosen in planning the design of the treatment should be such as to eradicate microdisseminated disease, and only such chemotherapy will contribute to improvement in survival rates.     

Chromosome aberrations and malignant lymphomas

Chromosomal findings in malignant lymphomas are correlated to the histopathology and the immunologic phenotype of lymphoma subgroups. The prognostic significance of a cytogenetic analysis and its value for therapy planning are discussed. With respect to tumorigenesis it is emphasized that a number of proto-oncogenes and genes for cell differentiation, such as immunoglobulin and T-cell receptor genes, have been localized at sites of recurring chromosomal rearrangements. One chapter deals with cytogenetic data in correlation to findings of DNA recombination studies in Hodgkin's disease.     

Curative radiotherapy in the malignant lymphomas

The clinical experience and technologic improvements of the past 40 years are briefly summarized in terms of their contributions to the present optimistic and aggressive approach to the treatment of malignant lymphoma. The reasoning behind the large-field moderately high-dose technique that has evolved is reviewed and analyzed, and our treatment techniques are described in detail. Finally, the curability of malignant lymphoma is emphasized--through the use of vigorous and precisely planned irradiation of both the actual and the potential sites of lymph node involvement in either the upper or the lower trunk regions, or, in some cases, in both regions, we may now hope to produce cures or long-term survivals in a great majority of the patients treated; this results in a magnificent gain for humanity through the rescue or prolongation of many otherwise lost lives.     

原发性食管恶性黑色素瘤一例报告

Primary malignant melanoma of the esophagus （PMME） is an extremely rare and aggressive tumor, comprising less than 0.2% of all primary esophageal neoplasms. There are fewer than 270 reported cases in worldwide literature, most of which are scattered cases reported. This tumor has usually been reported as a pedunculated, polypoid tasion in the middle and lower third of the esophagus. Hematogenic and lymphogenic metastases are commonly reported for PMME cases. Although surgical resection has been considered as the best possible option, the prognosis has been nonetheless poor, even combined with adjuvant chemotherapy postoperatively, according to the literatures. Here we reported such a case on its clinical presentations and treatment.