Adenocarcinoma of the uterine cervix of small intestinal type containing numerous Paneth cells

A case of invasive adenocarcinoma of the uterine cervix with small intestinal differentiation to include numerous Paneth cells is presented. The light microscopic findings are confirmed by immunohistochemical and electron microscopic study. To our knowledge, this is only the second reported case of small intestinal cervical adenocarcinoma that contained Paneth cells and the first with ultrastructural and immunohistochemical confirmation. A small focus of in situ adenocarcinoma with similar features is seen adjacent to the invasive area.

[The relation of nucleoli to precancerous conditions of the cervix]

Oestrogens act at the nuclear level. To these steroids also a cancerogenic effect is ascribed. By staining for nuclear structures according to Smetana and Busch the authors proved morphological structures of the nucleolus in vaginal epithelia and in cells from cervical lesions. This applies to solid nucleoli -- which are active, annular nucleoli which are resting and nucleoli which have completed their activity -- micronucleoli. Hyperoestrogenic women have in their vaginal epithelia of the upper third of the vagina more active nucleoli (11.4%) than hypooestrogenic women (2.1%). Women suffering from cervical carcinoma during the menopause have more active nucleoli in the vaginal epithelia (30.8%), as compared with healthy hyperoestrogenic women of productive age. Patients during the menopause with grade III dysplasias have fewer active nucleoli in cervical epithelia than women with cervical cancer (25.0%), however, as compared with hyperoestrogenic women of productive age, much more. A large number of active nucleoli was proved by staining by Smetana's method also in cells taken from cervical lesions carcinoma type and grade III dysplasia in postmenopausal patients. Evaluation of morphological changes of the nucleoli suggests their activity, the activity of the whole nucleolus and is a sensitive indicator of the activity of the whole cell.

Pigmented melanocytic schwannoma of the uterine cervix

A 47-year-old woman had a lesion of the uterine cervix that presented clinically as a protruding or aborted leiomyoma. Grossly the tumor occupied a substantial portion of the cervical and endocervical region. Histologically it showed a spindle cell neoplasm arranged in large fascicles that penetrated deeply into the fibromuscular wall of the cervix. The tumor cells had abundant pink cytoplasm that contained considerable brown melanin granules confirmed by Fontana's stain. Cytologically nuclear pleomorphism, hyperchromatism, and giant nuclear forms were observed. Mitoses were also seen. Localized nuclear palisading was present. Electron microscopic examination of paraffin-embedded material revealed numerous premelanosomes and opaque granules that were compatible with mature melanosomes, thus confirming melanogenesis in the tumor. Tumor cells exhibited focal projections, and the connective tissue showed abnormal spacing of collagen. Basal lamina material was noted focally on tumor cell surfaces. Immunocytochemistry showed a positive reaction to S-100 protein and HMB-45 in tumor cell cytoplasm.

[Establishment and characterization of cell lines derived from nude mice transplanted squamous cell carcinoma of uterine cervix]

Two human cell lines, KIMI-1 and -2 were established from nude mice transplanted tumor originated from a human squamous cell carcinoma of the uterine cervix. These two cell lines have different shapes, chromosome numbers and tumor markers, respectively.

Characteristics of a cell line established from a Chinese patient with a squamous carcinoma of the uterine cervix

A new cell line, CC3/CUHK3, was established from a squamous carcinoma of the uterine cervix from a Chinese patient. Light microscopy of the cell line revealed keratin and electron microscopy demonstrated tonofilaments and desmosomes, thereby confirming its epithelial nature. The population doubling time of CC3/CUHK3, estimated from the exponential growth phase of the growth curve established from the cell line was 42 hours. When the tumour cells were inoculated into athymic mouse, a tumour, microscopically diagnosed as a well-differentiated carcinoma, developed. These cells are highly invasive in vitro.

Microphotometric DNA analysis in moderate dysplasia of the uterine cervix. Correlation to the progression and regression of the lesion

Nuclear DNA content was determined by microphotometry in 27 cases of moderate dysplasia of the uterine cervix. All these cases were followed from one to ten years to study the biological behavior of moderate dysplasia in relation to cervical carcinogenesis. Ten of them showed progression to carcinoma in situ during a period of one to six years (median 34.8 months) and 17 cases showed regression to inflammation and normalcy during a period of one to ten years (median 44.2 months). DNA analysis was performed both on initial cervical smear and on representative smears collected during follow-up. Amongst ten cases which progressed to malignancy, nine had aneuploid DNA pattern and one had polyploid DNA pattern throughout the follow-up period. Amongst 17 cases which regressed to inflammation, 11 had euploid and six polyploid DNA pattern. The observation that moderate dysplasia with aneuploid DNA value often develops into carcinoma in situ in contrast to dysplasia with euploid or polyploid DNA value strengthens the conception that DNA aneuploidy may be considered as 'high risk indicator' for cervical precancerous lesions.

Relationship between intraepithelial neoplasia of the cervix and the size and number of nucleolar organizer regions

A silver colloid technique was applied to 18 colposcopic biopsies of the cervix. These comprised 7 cases of cervical intraepithelial neoplasia I (CIN I), 5 cases of CIN II, and 6 cases of CIN III. The nucleolar organizer regions subsequently visualized (AgNORs) were enumerated using an oil immersion lens. The maximum diameters of the AgNORs and aggregates thereof were measured, by hand, from carefully calibrated monochrome photographs. The mean numbers of AgNORs subsequently identified steadily increased, whereas the mean sizes of AgNORs decreased from CIN I to CIN III. In CIN I the mean AgNOR number was 2.3 (range 1.8-3.4) and the AgNOR mean maximum diameter (Dmax) was 1.28 microns (range 0.75-1.75). In CIN II the mean number was 3.5 (range 3.1-4.6) and the AgNOR Dmax was 0.98 micron (range 0.9-1.18). In CIN III the mean number was 4.7 (range 4.0-6.1) and the Dmax was 0.62 micron (range 0.51-0.9). CIN III could be distinguished from CIN I and CIN II on the basis of AgNOR sizes, and an inverse relationship between AgNOR numbers and sizes was established.

Ultrastructural and immunohistochemical study of infiltration in microinvasive carcinoma of the uterine cervix

Carcinoma in situ and microinvasive cancer of the cervix were compared by transmission electron microscopy to examine ultrastructural features of the locally infiltrating lesion of microinvasive cancer. Many pseudopod-like cytoplasmic protrusions of the cancer cells and abundant microfilaments parallel to the direction of the protrusion were seen. Concomitant with the disappearance of part of the basal lamina, many vesicles 70-90 nm in diameter were observed, suggesting a role for these vesicles in cancer infiltration. With the immunoperoxidase method, the distribution of fibronectin around the invasive lesion also was examined. Fibronectin is a component of extracellular matrices and presumably, in view of its action on cell adhesion, is a resistant factor against cancer cell infiltration. Fibronectin decreased in the transitional area between the cancer nest and the stroma during the stage of microinvasion.

Minimal-deviation adenocarcinoma (adenoma malignum) of the uterine cervix; four case reports

Four cases of minimal-deviation adenocarcinoma (adenoma malignum) of the uterine cervix are analysed in this clinicopathological study. Four patients, one Ib, two IIb and one IIIb stage, showed poor prognosis, which included three patients who died within 36 months, because of diagnostic delays of 5 years, 6 months and 1 year due to cytohistologically benign appearances. Cytologically, the nuclei were somewhat more irregular in size and shape than those of normal columnar epitherial cells. Slightly multilayered cell clusters were arranged as honeycombs, palisades or sheets with glandular openings. The characteristic histological features were the presence of sharp points projecting from the glands and marked variation in the size and shape of the glands. Ultrastructurally, intestinal metaplastic cells containing both microvilli with core filaments and rootlets, and secretary granules in the same cell were present in the specimens of two evaluable patients. These features indicate a disorder of differentiation. In order to diagnose this tumor accurately, comprehensive analysis should be required concerning the clinical features, cytohistological findings and ultrastructural findings.

A study of nucleolar organizer regions in cervical intraepithelial neoplasia and human papillomavirus infection

A silver colloid technique for nucleolar organizer region-associated proteins (AgNORs) was applied to sections of cervix that comprised cervical intraepithelial neoplasia (CIN) grades I to III, koilocytosis indicative of human papillomavirus infection, squamous metaplasia, and basal cell hyperplasia. The AgNOR count was compared both within and between specimens. Proliferative activity was investigated by flow cytometric analysis. Significant differences in AgNOR numbers were found between normal internal controls and the lesions investigated. A correlation was found between the proliferative index (%S + G2) determined by flow cytometry and the number of AgNORs in cases of CIN.

Immunohistochemical investigations of steroid receptors in normal and neoplastic squamous epithelium of the uterine cervix

The proliferation of squamous cells of the vagina and cervix uteri is induced by steroid hormones during the menstrual cycle. However, carcinoma of the cervix cannot be influenced by any hormone therapy. Forty-four different cervical specimens (different days in the menstrual cycle of healthy women and those with dysplastic lesions and carcinomas of the cervix) have been tested for estrogen (ER) and progesterone (PR) receptor protein content by means of immunohistochemistry. The ER content of the squamous epithelium depends upon the menstrual cycle: in the early proliferative phase cells of all layers are negative. In the midphase of proliferation the basal and parabasal layers become positive, and in the secretory phase positive cell nuclei can be found up to the superficial layers. A weak reaction to ER staining is found only in mild dysplastic lesions of the uterine cervix; severe dysplastic forms and invasive carcinomas were all negative. No positive PR was found in any squamous cell tissue. Stroma cells of the uterine cervix showed different straining intensity for ER and PR, regardless of the menstrual cycle. The loss of ER in the neoplastic cell could be an explanation for three clinical experiences: premenopausal patients have no tumor progression of the cervix uteri despite normal ovarian function; the duration of survival shows no relation to the receptor status of cervical carcinomas; and antihormonal treatment of cervical carcinomas produces no appreciable therapeutic success.

Multiparametric quantitation of the progression of uterine cervix preneoplasia towards neoplasia

The aim of the research was to quantify the malignancy progression of preneoplastic lesions towards carcinoma of the uterine cervix. The study has shown that the modifications to nuclear area, perimeter, DNA content, percentage of nuclei with nucleoli, nuclear/cytoplasmic ratio and percentage of SOYA BEAN AGGLUTININ stained cells are progressively greater moving from normal epithelium and mild dysplasia towards infiltrating carcinoma. In particular all the morphologic and histochemical parameters have shown an increasing derangement which appears to parallel the diploid reduction and the appearance of aneuploidy. In order to identify the changes in the stroma, the modifications to the capillaries were investigated: in mild dysplasia only the vessel density increases; the capillary area, perimeter and diameter increase in moderate and severe dysplasia, and in CIS; the values of these features are similar in the carcinoma groups. The capillary density increases mainly in the invasive carcinoma. The data obtained in the study have shown that: 1) the process of malignancy progression is characterised by a gradual and continuous derangement of cell characteristics and modifications to capillaries of the stroma; 2) the mild dysplastic changes have the characteristics of hyperplastic lesions; 3) CIS, qualitatively similar to severe dysplasia from which it differs quantitatively, has features of neoplastic proliferation; 4) the appearance of invasion is associated with DNA parameter changes which may indicate a ploidy reduction.

Alveolar soft part sarcoma of the uterine cervix

We describe two cases of alveolar soft part sarcoma (ASPS) that occurred as a primary lesion in the uterine cervix. In both cases, the tumor exhibited the typical histologic features of ASPS. In one case, the material for immunohistochemical staining and electron microscopy was available, and the findings of these studies were consistent with the diagnosis of ASPS. A review of the literature disclosed seven previous cases of ASPS occurring in the female genital tract. The tumor was located in the uterine cervix in only three cases. Although ASPS most commonly involves the soft tissues of the extremities and the head and neck region, it can also occur in rather unusual locations such as the female genital tract. Pathologists should be aware of these unexpected occurrences.

Alveolar soft-part sarcoma in the uterine cervix

We describe a case of an alveolar soft-part sarcoma of the cervix in a 35-year-old woman. The light- and electron-microscopic and immunohistochemical findings are described. Periodic acid-Schiff-positive, diastase resistant, intracytoplasmic crystals, pathognomonic for alveolar soft-part sarcoma, were present. The cells expressed immunoreactivity for neuron-specific enolase and protein S100. The results of our own immunohistochemical examinations and those presented in the literature are discussed.

Nucleolar organizer regions in the normal and carcinomatous epithelium of the uterine cervix. A morphometric study

Nonhistone nucleoproteins associated with the nucleolar organizer regions (NORs), the genes coding for the ribosomal RNA precursor, can be visualized by silver staining. The black dots (AgNORs) appearing on the nuclei are thought to reflect cell differentiation. In this study, AgNORs were counted and their area was measured and compared with the area of the nuclei in normal and carcinomatous cells of the uterine cervix. The number of AgNORs per nucleus was significantly higher in the endocervical than in the basal exocervical epithelium (p less than 0.005) and in the carcinomatous epithelium, either in situ or invasive, than in both normal epithelia (p less than 0.002). Individual AgNORs were significantly smaller in carcinoma in situ than in endocervical epithelium (p less than 0.05) or in invasive carcinoma (p less than 0.01). Significant differences were also found in the total AgNORs area per nucleus between the following groups: basal exocervical versus endocervical epithelium (p less than 0.01), basal exocervical and endocervical epithelium versus invasive carcinoma (p less than 0.001), and in-situ versus invasive carcinoma (p = 0.02). The conclusions are that the number and the total area of AgNORs per nucleus increase with the differentiation of the cell or with its carcinomatous transformation, but no prognostic significance can be drawn so far from our measurements.

Establishment and characterization of cell line SFCC from clear cell adenocarcinoma of the uterine cervix

A human cervical clear cell adenocarcinoma cell line was established and named SFCC. The tumor cells were obtained from ascites of a 39-year-old woman who underwent a radical hysterectomy. She had no history of exposure to diethylstilbestrol (DES). The histologic feature of the tumor cells at autopsy showed abundant clear cytoplasm with diastase digested glycogen granule growing in solid nest and tubular pattern. SFCC cells were continuously propagated in vitro during the past 29 months and grown in a monolayered sheet with a doubling time of about 67 hours. SFCC cells resembled the structure of the original tumor and had abundant glycogen granules, lipid droplets in the cytoplasm, and numerous microvilli. Immunohistochemically, SFCC cells had carcinoembryonic antigen (CEA) immunoreactivity in some parts of the cell population. Moreover, they had a relatively high amount of progesterone receptor (20.0 fmol/mg protein; kd, 6.6 nM) but did not have either an estrogen receptor or EGF receptor. The SFCC cell line secreted a high content of tissue peptide antigen (TPA) into the medium, indicating that the SFCC cell line is useful for analyzing the progesterone receptor and TPA production in clear cell adenocarcinoma of uterine cervix.

Heterogeneous expression of keratin, involucrin, and extracellular matrix among subpopulations of a poorly differentiated human cervical carcinoma: possible relationships to patterns of invasion

Undifferentiated cervical carcinomas vary considerably in their intercellular organization and patterns of invasion. In spite of its clinical significance, the basis for such variation is poorly understood. We investigated the cellular properties that may be responsible for this diversity, using as a model two human cervical carcinoma cell lines that were derived from the same tumor specimen and the same clone. It was shown previously that, in spite of their common origin, each line forms a histologically distinct type of undifferentiated carcinoma when heterotransplanted in vivo: cells of line C-4I grow as compact expanding masses with central necrosis, while tumors of line C-4II infiltrate host tissues as small, well-vascularized, dispersed cell groups. The characteristic behavior of each line was retained in culture, where C-4I cells formed highly multilayered cohesive colonies, while C-4II cells formed diffuse, monolayered colonies and shed into the culture medium. These observations as well as ultrastructural data suggested that each line may be arrested at a different stage of stratified squamous differentiation. In the present study, this hypothesis was tested by examining specific differentiation markers. An analysis of the cultures by immunofluorescence microscopy and immunoblotting revealed that keratin was more abundant in the compact C-4I line than in the dispersed C-4II line. C-4I cells expressed keratins 5, 6, 8, 16, 18, and 19, while C-4II expressed only keratins 8, 16, 18, and 19. In the multilayered C-4I colonies, involucrin-positive cells occurred in the apical cell layers only. In C-4II, involucrin-positive cells occurred in monolayers and domes, and they were most consistently located apically in crowded cultures. Laminin was secreted by both lines, but only C-4II cells deposited a fibronectin matrix. The results suggest that C-4I cells resemble normal cervical cells at the spinous stage of stratified squamous differentiation, while C-4II cells resemble basal/suprabasal cells. The different growth patterns of the tumors, formed by the lines in vivo, therefore likely reflect functional and behavioral differences that normally exist between spinous and basal cervical epithelial cells. The results suggest that differentiation-related functional properties may lead to histological diversity among cervical carcinomas that are categorized as undifferentiated by histopathological criteria.

Ayre v Aylesbury cervical spatulas

A single blind crossover study compared the traditional Ayre spatula with the new Aylesbury spatula. The study group consisted of all women attending the department of genitourinary medicine during a 16 month period. The same incidence (3.6%) of dyskaryotic smears was found using the Ayre spatula (74/2077) as the Aylesbury spatula (72/2003). The incidence of smears with endocervical cells, however, was significantly greater using the Aylesbury (33.4%) than the Ayre (20.4%) spatulas, despite there being no difference in the incidence of smears with epithelial abnormalities. Quantitative studies thus showed that the Aylesbury gave no more accurate results than the Ayre spatula.

Granulocytic sarcoma of the cervix: an immunohistochemical, histochemical, and ultrastructural study

Light microscopical and routine immunohistochemical studies of a cervical neoplasm in a 32 year old woman initially suggested a histiocytic lymphoma, but histochemical staining for chloroacetate esterase established the correct diagnosis. This was supported by electron microscopic findings. Eight months later the patient developed a granulocytic sarcoma in her left breast and haemotological features of acute myeloid leukaemia. Accurate initial diagnosis of granulocytic sarcoma in a non-leukaemic patient may reduce the risk of subsequent acute myeloid leukaemia if appropriate chemotherapy is begun in time.

Cervical schwannoma with intranuclear vacuoles by fine-needle sampling without aspiration

In a 49-yr-old woman who presented with a cervical mass, a fine-needle specimen without aspiration was suggestive of paraganglioma; there were spindle-shaped cells with pseudoacinar structures and prominent intranuclear vacuoles. Subsequent examination of a mass removed from the vagus nerve clearly identified a schwannoma. The differential diagnosis is discussed, particularly in relation to the presence of intranuclear vacuoles, and it is concluded that this cytological characteristic should not in itself define the diagnosis.