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Lynch syndrome (formerly known as hereditary non-polyposis colorectal cancer) is the most com-mon hereditary colorectal cancer syndrome. The syndrome is caused by a germline mutation of one of the mismatch repair (MMR) genes responsible for DNA replication error repair. Impaired function of the proteins encoded by these genes leads to microsatellite instability (MSI), which is associated with increased incidence of neoplasms: mainly colorectal cancer. According to recent estimates, up to 5% of all colorectal cancers are associated with Lynch syndrome. Due to this relatively high frequency, familial occurence, absence of premorbid phenotype, and development of malignant tumors at a reproductive age, a correct diagnosis is important not only from an ethical but also from an economical point of view. Unfortunately, clinical means of diagnosis, namely, the revised Bethesda guidelines designed to detect patients suitable for genetic testing for Lynch syndrome, lack sufficient sensitivity. The methods associated with modern pathology are more sensitive than the clinical criteria used to detect patients suspected of having Lynch syndrome. Pathological diagnostics are based on direct or indirect detection of MSI. Indirect methods include analysis of morphological signs associated with MSI in histological samples from colorectal carcinoma patients and immunohistochemical investigation of MMR protein expression. To rule out sporadic cases caused by epigenetic inactivation of an MMR gene, molecular genetic investigation of the BRAF gene and methylation analysis of the MLH1 promoter are performed during diagnostic workup. A suspicion of Lynch syndrome based on the results of the methods mentioned above should be proven by detection of a germline mutation in an MMR gene in peripheral blood leukocytes.

Urine cytology is a reliable method for identification and follow up of the patients who develop high-grade urothelial carcinoma. Reactive changes of superficial and intermediate urothelial cells cytologically often mimic low grade urothelial carcinoma. This is the cause of relatively high number of false positive and false negative results. Diagnostic accuracy can be improved introducing different procedures for material handling namely cytospin and liquid based cytology and new diagnostic protocols such as FISH for chromosomal aberrations or mRNA and miRNA analysis. Most recently Next Generation Sequencing for DNA analysis was applied. Availability of clinical information improves the diagnostic accuracy and shortens the time to diagnosis.

The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) was introduced in thyroid fine needle aspiration cytology (FNAC) in 2010. A six-tier system is generally accepted. Bethesda categories include morphologic description, risk of malignancy and follow-up suggestions in each group. The system has its advantages and disadvantages, that are discussed. The most problematic are the categories of "Atypia of undetermined significance" or "Follicular lesion of undetermined significance" (AUS/FLUS). The group is heterogenous and overused thus far. The possibilities of its improvement are discussed. The Bethesda system does not include any prognostic and predictive markers. However, they represent the promising direction in the improved version of the BSRTC. Novel molecular methods and alternative techniques such as core needle biopsy are briefly discussed.

Leukocyte esterase is an enzyme in neutrophils from which it is released into exudate; its detection by colorimetric test strips indicates the presence of neutrophils. This is a rapid method to find whether exudate is of infectious or non-infectious aetiology. The aim of the study was to determine the sensitivity and specificity of leukocyte esterase testing with use of AUTION Sticks (Arkray) for examination of exudates obtained in inflammatory diseases of the skeletal system.Exudates associated with skeletal system diseases were collected from 45 patients in the period from July 1st to December 31 st , 2012. Aspirates obtained under sterile conditions were examined for leukocyte esterase; cytological and microbiological examinations were also carried out. For the detection of leukocyte esterase, a drop of aspirate was placed on the reagent zone of a test strip and the resulting colour reaction was read after 90 minutes. Changes in colour were compared with a reference strip provided by the manufacturer. The results were assessed on a five-shade scale as follows: 0, no colour change; 1 to 4, gradual change from light pink to deep purple. The results were compared with those of cytological and microbiological examinations. Shade 4 on the strip corresponded to a positive cytological finding of bacterial infection, and shades 3 and 4 correlated with a positive microbial finding. The sensitivity and specificity of leukocyte esterase testing were statistically evaluated for both comparisons.Based on the results of cytological and microbiological examinations, an infectious aetiology of exudate was diagnosed in 21 (44.4%) and non-infectious aetiology in 24 (63.6%) patients. With leukocyte esterase reagent strips when shade 4 was taken as a positive result, the sensitivity and specificity of examination was assessed as 0.6190 and 0.9583, respectively. When taking both shade 3 and shade 4 for a positive result, sensitivity and specificity were 0.8571 and 0.8750, respectively. Shades 0 and 1 corresponded to the number of leukocytes in exudate that was no higher than 2 x 10⁹/ml.The detection of leukocyte esterase is a quick and easy examination. It is useful for readily excluding or confirming an infectious aetiology of exudate and can, to some extent, substitute a cytological examination. It can also help to make a quick decision whether one- or two-stage joint reimplantation should be performed and thus eliminate the need of intra-operative histological examination of frozen tissue samples. A drawback of the method was that exudate samples contaminated with blood interfered with an assessment of colour shades. However, this can be avoided by centrifugation of the sample and use of a supernatant free from erythrocytes.Diagnosing infectious aetiology of joint exudate or exudate from an abscess using leukocyte esterase reagent strips appears, according to our results, to be a promising, semi-quantitative method with high specificity and sensitivity which is rapid, simple and affordable. It can be useful particularly in out-patient institutions for a quick diagnosis of arthritis; intraoperatively, it can serve as an additional method to other exudate examinations.

Pleural effusion is a frequent reason for a pulmonologist´s investigation. The cornerstone is to distinguish transudative pleural effusion from exudative pleural effusion. In the case of the exudative pleural effusion the next step is detection of malignant etiology of pleural effusion. We have a variety of any non-invasive or invasive examinations. The pleural biopsy is one of the most important methods for diagnostics of malignant pleural effusion.Two hundred and twenty-two closed pleural biopsies (CPB) were performed in 208 patients with pleural effusion, where the cytologic examination of pleural fluid was negative. The authors evaluated the value of CPB for the diagnosis of malignant pleural involvement.Total sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 63.1%, 100%, 73.9%, 100% and 52.8%, but in the group of mesotheliomas these results were 59.1%, 100%, 79.4%, 100% and 70.7%. The incidence of complications and representative sampling of the pleura was mentioned. The authors compared the diagnostic value and the incidence of complications of various diagnostic methods in malignant pleural involvement by data in the literature.

Cell or tissue cultures (both terms are interchangeable) represent a complex process by which eukaryotic cells are maintained in vitro outside their natural environment. They have a broad usage covering not only scientific field but also diagnostic one since they represent the most important way of monoclonal antibodies production which are used for both diagnostic and therapeutic purposes. Cell cultures are also used as a "cultivation medium" in virology and for establishing proliferating cells in cytodiagnostics. They are well-established and easy-to-handle models in the area of research, e.g. as a precious source of nucleic acids or proteins. This paper briefly summarizes their importance and methods as well as the pitfalls of the cultivation and new trends in this field.

The basic praebioptic methods detecting the precancerous lesions of the uterine cervix are oncologic cytology (PAP smears) and colposcopy. However in the Czech Republic the incidence of the invasive carcinomas during the last 10 years did not considerably decrease. Therefore the goal of our study is to estimate the validity of the prebioptic methods and compare the results of praebioptic methods (procedures) versus biopsy.Analysis of the results of the oncologic cervical cytology comparing with the results of cervical biopsies performed during the years 2002-2003 were compared to those of the year 2009. THE SUBJECT AND METHODS OF THE STUDY: evaluation of the prebioptic methods (cytology, colposcopy) versus biopsy prior and during the start of the National Screening in the Czech Republic.1. Centre for Gynaecological Oncological prevention, 1st Faculty of Medicine, Charles University Prague, Department of Gynaecology and Obstetrics. 2. Institute of Physiology, Department of cybernetics, 1st Faculty of Medicine, Charles University, Prague. 3. Institute of Pathology, University of Ostrava. 4. Institue for Mother and Child Care, Prague.We screened the documentation related to the treatment of 423 women with cervical lesions, examined at the Oncological prevention centre of the Obstetrical and Gynaecological Department of the 1st Faculty of Medicine Charles University Prague and the General Teaching Hospital in Prague 2. Results of the oncologic cytology, colposcopy and biopsy were compared. The comparison revealed differences related to the time of examinations. During the years 2002 and 2003 the agreement between cytologic diagnosis and biopsies in the group of HSIL was 40 %. In the year 2009 the agreement between HSIL and CIN was 68% the colposcopic diagnosis of precancerous lesions with those of bioptic specimens, during the years 2002 and 2003 was 90% while in the year 2009, during the National Screening, the agreement reached 98%.

Cytopathology investigation of the uterine cervix transformation zone smear (Pap test) has been accepted during the last 80 years worldwide as a potent tool in lowering the incidence of squamous cell cervical cancer; it can reveal a proportion of adenocarcinomas as well and contributes to the diagnostics of cervicovaginal infections. The technique itself and diagnostic criteria have been internationally unified in the systems Bethesda I (1988) and Bethesda II (2002). Nevertheless, the cytodiagnostics of cervical precanceroses continues to develop vividly in the following fields of interest. In processing the cervical sample:Unified polychrome staining has been accepted as compulsory Processing of the sample acquired has split into two branches - conventional preparation - CP and liquid based preparation - LBP. In both types of processing (mainly in LBP) additional tests are employed.In evaluation of the cytology features:Differences of the petrified diagnostic features formulated formerly for CP in the LBP have been described. Differentially-diagnostic pitfalls (look-alikes) are studied. Sensitivity of precanceroses detection in a screening routine with the prevalence of negative findings has been improved with compulsory rescreening of 10-20% random selected negative cases as well as rapid pre- or postscreening of the whole material or involvement of automated pre- or postscreening using image analysis systems.Some cytomorphology findings are followed with additional tests - especially HR HPV detection.Cyto-bioptic correlations are constantly studied.In terms of lowering the incidence of uterine cervix carcinoma: Opportune screening is substituted with nationwide programs aimed at:Involvement of as many women of the target group as possible.Standardized investigation (CP or LBP) in an accredited laboratory with functioning systems of external and internal quality control.Selective additional investigation with non-morphological tests.Appropriate treatment of women with pathology findings.Some newly designed nationwide screening models start with a non-morphological test (HPV) followed by a pap test and colposcopy.Stern control of successful implementation of the achievements listed above is expressed in uterine cervix cancer incidence.

The Pap test represents a potent tool in reducing the incidence of cervical cancer, though it is unable to eradicate it totally. Under standardized application it has a (very low) failure rate unexpected by the public. In relation to the National screening program of cervical carcinoma an increase in number of litigation cases is to be expected started by women who took part in the screening program and still developed cervical cancer. Together with the international guidelines of Pap test administration and evaluation (Bethesda 2001), widely adopted guidelines for Expert review of histologic slides and Papanicolaou tests in the context of litigation or potential litigation have been formulated (College of American Pathologists 20001). Arguments for adoption of these guidelines by the Czech Society of Pathologists and their implementation into the National Program of Cervical Cancer Screening are presented.

Modern pathomorphology tumour diagnostics involve comprehensive cytology cell examination and, importantly, tissue biopsy examination using the most up-to-date assessment techniques. To correctly classify a tumour process, it is essential not only to define its histological typology and identify its biological character but, at the same time, using immunohistochemistry and diagnostic molecular pathology, to evaluate prognostic and predictive indicators. As regards the prognostic indicators, it is mainly grading and staging as part of the TNM system, the sentinel lymph node assessment, if it is assessed, and other nodes extracted in this context. Histological specimens of invasive carcinomas and skin melanomas are assessed with respect to the depth of the invasion. Endocrine oestrogen and progesterone receptors are assessed in endocrine-dependent breast carcinomas. Predictive pathology uses biomarkers; biomarkers confirm the presence of target molecules following their reaction with the administered small molecule-like drugs, usually protein kinases or antibodies. HER2 gene amplification is estimated using the FISH method and predicts effectiveness of breast cancer therapies. In patients with a colon carcinoma, HER1 oncogene is identified immunohistochemically and the presence of a mutated K-ras is subsequently tested using the RT-PCR technique. CD 117 (c-kit) expression is determined in gastrointestinal stromal tumour and CD 20, 33 and 52 in malignant lymphomas and leukaemias. The most difficult task for a pathologist is defining the primary focus of the tumour in cases where only a fraction of a metastasis is available for examination. Nevertheless, at present, it is feasible to track the tumour differentiation down and, using an antibody battery, particularly against specific cytokeratines and vimentine and including organ-specific markers, to identify the primary source or at least to establish an assumption about the most likely organ affected by the tumour process.

Update screening of cervical cancer.Review article.Out-patient Gynaecology and Primary Care Centre, Brno.Study of the current literature.The persistent infection by human papillomavirus is a necessary condition for development of cervical cancer. Screening activity has an influence on it. Current screening is based on regular PAP smear. It should be evaluated by laboratory with accreditation and quality control. HPV test is too expansive for routine connection with screening for the most European countries.

The quantification of plasma cells in bone marrow is an essential step in plasma cell dyscrasia diagnostics. Besides cytological examination of bone marrow aspirates, plasma cells can also be quantified by histological examination of samples obtained by sternal puncture or trephine biopsy. Acquired bone marrow particles dispersed in aspirated marrow blood are usually sufficient for microscopic diagnosis. Histological examination offers, in comparison with cytology alone, several advantages. In this method, the number of plasmacytes is not distorted by their dilution by peripheral blood cells. Acquired material can be stored for a long time without showing any changes and it allows multiple re-use for purposes of prospective determination of other parameters. Plasmacyte count in histological sections is difficult and laborious and is not a routine practice. A qualified estimate ofplasmacyte percentage allows classification into the none/small/big criterion categories according to the WHO diagnostic scheme. Cell count using digital imaging is also possible, even using software image analysis, but this method requires a digital camera coupled with a microscope. Besides elementary plasmacyte count, it is also possible to determine their mono- or polyclonality. This reaction has certain technical pitfalls and its evaluation is sometimes impossible. Determination of some antigens' expression has prognostic (Ki67 index), predictive (CD56) or therapeutic (CD20, CD40, CD74, etc) significance. Histological material can also be used for interphase fluorescent in situ hybridisation.

The aim of this study is to give a current view of the importance of evaluating preparations of smears of bone marrow (BM) aspirates in the diagnosing and monitoring the course of multiple myeloma (MM). Special attention is given to the indication and technique of aspiration biopsy, diagnostic and differential-diagnostic importance of evaluating the percentage representation of plasmatic cells in the bone marrow and their morphological deviation from the point of view of distinguishing them from reactive plasmocytosis and monoclonal gammopathy of undetermined significance. Also addressed is the issue of selected morphological classification systems including their benefits in identifying and forecasting the prognosis for the disease. A large part of the report is dedicated to the interpretational limitations of evaluating BM smear samples for the diagnosis and monitoring of the course of MM, and due attention is also given to indication for and assessment of the importance of histological examination of a BM trepanobioptic sample of bone marrow and the benefits of particular specialized methods, especially the examination of immunophenotypic, proliferative and apoptotic qualities of plasmocytes. The report shows that quantitative and cytomorphological evaluation of bone marrow samples still forms integral part of the standard algorithm of methods used in MM diagnosing and monitoring, and requires an extremely qualified approach to BM collection, the preparation of the smear and to precise evaluation, as well from the point of view of clinical interpretation.

Fine needle aspiration cytology is a basic type of examination in thyreology today. It is primarily indicated for thyroid node to exclude a malignant tumour. The presence of multiple nodes or of one node only has shown to be indicative of the same amount of risk of a malignant tumour for the patient. Ultrasound characteristics are insufficient for the determination of the nature of the focus and all the existing nodes greater than 10 mm are an indication for puncture. As for other diseases, aspiration cytology is indicated in granulomatose thyreoiditis, while in Hashimoto thyreoiditis it is usually indicated only if a node is present. In addition to clearly benignant and clearly malignant results, large part of cytological conclusions fall within the category of suspicious (unclear) findings. All of them are an indication for histological verification, and the predictive value of the results depends on their type. It is approximately 20% in the case of follicular neoplasia, and preoperative histology is useless. Therefore we mostly opt for hemithyreoidectomy, further procedure depending on the final histological finding.

Information about new possibilities of early diagnostics in mammary lesions.Review.Gynecology-Obstetrics Clinic, 1st Medical Faculty and General Teaching Hospital, Prague.Most malignant tumors of the breast originate from ductal epithelium. A direct examination of the ductal system, could significantly improve diagnostics of breast cancer as well as its preinvasive stages (DCIS) and to influence mortality. The concept of ductal approaches includes several techniques and ductal lavage and duscoscopy.Ductal approaches represent an attractive area for minimal load upon the patients. Specificity and sensitivity of these methods have some limits, which will be subject to change in relation to understanding of carcinogenesis and in a close relation to the knowledge of biomarkers, genomics and proteomics. Ductoscopy appears to be the ideal method for the future due to possibilities of direct visualization of epithelium in combination with biopsy and ductal lavage. It other advantages include minimal invasiveness, minimal risk and the origin of possible complications for the patient.

Immunophenotyping of malignant lymphomas becomes necessary for the correct classification, for the design of therapy and for prognosis projection (WHO). Although the spectrum of classic immunohistochemical (IHC) examinations in paraffin embedded or frozen sections has recently considerably extended, IHC should preferably be combined with flow cytometry. The main advantage of flow cytometry is a synchronous application of two or more antibodies marked with various fluorochromes in one sample. The method is limited by utilizing native material only.The flow cytometry combined with histological and IHC investigations were used in diagnosis of primary non-Hodgkin's lymphomas of B-cell origin (B-NHL) and for bone marrow staging or restaging. We studied 90 patients with confirmed or suspected B-NHL and we found a good correlation in 89% of samples of primary lymphomas and in 85% of bone marrow samples when IHC and flow cytometry results were compared. The overall efficacy of the flow cytometry determination in lymphoma infiltration of the samples was 89%.Immunophenotyping utilizing flow cytometry contributes to diagnosis and classification of B-cell lymphomas in the significant proportion of investigated patients. In some cases it is even unnecessary to employ IHC examination of tissue sections. The method is especially suitable for determination of monoclonal populations of B-cells by detection of cell surface markers because it is more specific and sensitive than IHC. The immunophenotyping by flow cytometry as an auxiliary method and in correlation with morphological findings it can make the diagnosis of B-cell lymphomas faster and more specific.

The evaluation of the risk of hysteroscopy (HSC) in patients with endometrial carcinoma with regard to the dissemination of disease and the deterioration of its prognosis.A prospective multicentric study.Department of Obstetrics and Gynaecology and Institute of Pathology of the Palacky Univerzity Medical School and University Hospital, Olomouc; Obstetrical and Gynecological Departments of collaborating hospitals.Two groups of patients with endometrial carcinoma were compared on the basis of cytological examinations from the peritoneal cavity. The study group (n = 156) consisted of patients whose diagnosis was made on the base of HSC and targeted biopsy. The control group (n = 71) included patients with the classical DC. Both groups were comparable as to the distribution of clinical stages of the disease (P0.05). Cytological examinations were performed from the fluid obtained by the puncture of the cul de sac at the end of the HSC procedure and from the peritoneal lavage at the beginning of the following operation. Results of both groups were compared and statistically evaluated.The comparison of the cytological findings from the punctures of the cul de sac after the HSC and from the lavages at the following operation did not show an increased penetration of malignant cells from the uterus into the abdominal cavity. Similarly, the comparison of cytological findings from the peritoneal lavages after HSC and probatory curettage did not show a statistically significant difference between both groups. We assume that HSC does not increase the risk of dissemination of tumour cells into the peritoneal cavity and does not deteriorate the prognosis of the disease.

MALT lymphoma is raised from lymphoid cells of mucosa associated lymphoid tissues in a long-term, multistep process of the accumulation of genomic damage very often under the influence of chronic (e.g. Helicobacter pylori) infection. Cytoimmunofluorometric analysis of cell suspensions obtained from mechanically disintegrated bioptic samples of gut mucosa is a very useful approach to detect the presence of MALT lymphoma cells. MALT lymphoma cells are in a great majority of B cell origin. Malignant cells are characterized by the typical characteristic SS parameter, strong expression of CD20 and CD79b molecules, and by the absence of CD5 and CD23 molecules. The ultimate evidence of clonality is immunoglobulin light chains either kappa or lambda expression determination.

As the whole spectrum of morphological patterns encountered in surgical pathology cannot be, in its entirety, diagnosed correctly by a general pathologist alone, one has to seek consultation for difficult or unusual cases with specialised experts. In the Czech Republic, the consultation practice performed by specialists from different medical institutions is the only way to assess the quality of histopathological diagnostic performance, i.e. it represents an audit system. Audit systems functioning in other countries are described here. A proposal of a standard consultation process as well as problems concerning the financial costs and increased workload of consultants are discussed.

Retinoblastoma is a malignant tumourous which occurs in childhood. The most important factors which influence possible cure of patients with a retinoblastoma are early detection of the disease, correct diagnosis and adequate therapy. In the submitted case-record the authors provide evidence of the importance of cytological examination of cerebrospinal fluid which is important in retinoblastoma in particular for the follow-up of treatment. Cytological examination of cerebrospinal fluid in this type of tumour is very reliable and can reveal infiltration of tumour cells into the CNS much sooner than imaging methods.

Cytological diagnostic of the lung cancer belongs to routine examinations. The aim of our study was to describe the development of the method in the Czech Republic during the last 20 years, and to evaluate the contribution of clinical cytologist and pathologists in this diagnostical method of the bronchogenic carcinoma.61 stations of bronchology in the Czech Republic were requested (interrogatory method), evaluable responses were obtained from 58 stations (95.0%). Samples for micromorphological examination were send to laboratories of clinical cytology (20) or pathology (23). Samples from 15 stations are send to both departments. From the total of 91,477 of evaluated samples 64,404 were examined at departments of clinical cytology (70.4%) and 27,073 at departments of pathology (29.6%). Results from departments of clinical cytology arrive earlier (in average after 2.3 days) than from pathologies (4.9 days). Out of 4547 micro-morphologically proved lung carcinomas, 3913 (86%) were diagnosed at departments of clinical cytology and 634 (14%) at departments of pathology.At present, 70% of the micromorphological diagnostics is being done at laboratories of clinical cytology, 30% at departments of pathology. 86% of diagnoses of the bronchogenic cancer verified micro-morphologically come from laboratories of clinical cytology, 14% from departments of pathology.

The quantification in pathology includes items of daily routine in some applications (measurement of the melanoma thickness acc. Breslow, area in the slide occupied with microcarcinoma, the calcified and non-calcified bone ratio), as well as selected applications (ploidy in some tumours), or rather research oriented applications that might become a daily routine in the future (AgNOR evaluation, papillary carcinoma nuclei features measurement). A wide spectrum of use is represented by picture storage, archivation, alba creation, and tasks automation. The possibilities of the LUCIA system starting with grabbing, shading correction, image enhancement, preprocessing, continuing with picture binarisation, measurement of objects and textures using restriction and are of interest, and data presentation, evaluation and export as well as archivation of images and text information will be discussed.

Two cases of fine needle aspiration cytology of parathyroid adenoma were not misinterpreted as microfollicular nodules of the thyroid. Discrimination of those two lesion is a diagnostic pitfall in cytological material. Authors pointed out criteria for differential diagnosis. Radioimmunoanalysis of parathormone in aspirate served as a simple, safe and reliable method in these cases.

The activation of the hypothalamo-pituitary thyroidal axis during pregnancy and puerperal period may provoke an unusual morphological response that is hard to distinguish from malignancy. Moreover, autoimmune thyroiditis (postpartum thyroiditis--PPT) becomes manifest or aggravated in some predisposed women prone to contract thyroiditis with the termination of the physiological gestation immunosuppression. In five cytologically investigated women (some of whom were examined repeatedly) during the postpartum period less typical goitre and lymphoplasmacytic thyroiditis were observed. In two of them, a tumour was diagnosed (borderline oncocytic lesion and medullary carcinoma). Evaluating the dynamics of the process in the patients investigated repeatedly and the histological findings in others we conclude: 1) given thorough clinical observation and favorable development of the cytology picture the less typical lesions may be treated conservatively. 2) The diagnostic features of malignancy are maintained in the puerperal period. Taking into account the age distribution of thyroid malignancies this risk should be taken into account in the puerperal period too.

1. Evaluation of cytological cervico-vaginal smears by the Bethesda system enlisted cytodiagnostics among important laboratory methods which can be used also in risk pregnancies. 2. Vaginal cytology makes it possible to test at the same time the hormonal situation during pregnancy, which reflects the placental function, and to evaluate also the vaginal biocenosis. 3. The authors provided evidence that the large number of superficial cells on the cytological smear (more than 10%) is associated with low oestriol and pregnandiol levels which are warning signs of the approaching termination of pregnancy. 4. By the action of microorganisms on the vaginal epithelium typical morphological changes develop in the cell nucleus and in the cytoplasm. By polychromatic staining also the causal agents of inflammations and infections threatening the mother and foetus are apparent. 5. The authors assume that cytological examination and evaluation according to the Bethesda system should be included in the complex of antenatal examinations also in women without clinical symptoms of premature delivery or without signs of vaginal infection.

The presented investigation is concerned with contemporary diagnostic possibilities of HPV Infection of the Cervix. The authors present the results of virological examinations of 228 female patients in the Centre for Oncological Prevention. The examination was made by hybridization techniques, using probes specific for HPV 6, 11, 16 and 18 and by serological methods where IgG antibodies were assessed against synthetic peptides, corresponding to several HPV epitopes, as antigens. 156 women (68.4%) were virologically positive, 72 (31.6%) were negative. Subsequently the authors investigated the diagnostic accuracy of HPV changes of the cervix by clinical methods, i.e. colposcopy and cytology, as compared with virological methods. On colposcopic examination uncertain--i.e. insignificant--results were recorded in 24.6%, on cytological examination in 19.7%. In patients where these methods gave unequivocal results (either + or-) a correct forecast of the presence of HPV during colposcopic examination was recorded in 71.1%, in cytological examinations in 66.9%. At least one of the clinical methods assessing papilloma virus infection was prognostically correct in 90.4%. From the investigation ensures that prebioptic methods provide the clinician with relatively reliable information on the presence of HPV infection and enable him to select a therapeutic and dispensarization procedure adequate to the finding. However, they cannot replace virological examination among other reasons also because they cannot assess the HPV type.

Programme setting using an actualized register of inhabitants was described. It has been serving in a cytocentre of the pathology department and for actualization of a district oncological register of patients suffering from cervical carcinoma.

Over a five year period 50 malignant tumours (3.8% of investigations) has been histologically proved in a group of 1378 patients who underwent fine needle aspiration biopsy of thyroid. Five of these were medullary carcinomas (0.38% of investigation, 10% of malignancies). During revision and cytohistological correlation the most important cytologic diagnostic features for the sequential diagnosis of medullary carcinoma especially in cases without indicative clinical symptomatology have been checked. The following proved to be indicative especially if coinciding: a) background formed by blood with minimum or no colloid; b) clusters of epithelial cells with poor cohesion, sometimes multilayered, microfollicular, or stroma-like fusiform cells; c) striking anisocytosis, polygonal, plasmacytoid, fusiform, polyploid, and binucleated cells and naked nuclei in the background; d) striking anisokaryosis, at least part of the nuclei ovoid or elongated, chromatin rough, giant nuclei; e) amyloid identifiable in some tissue micro-fragments. If additional smears or cyto-block material are available it may be possible to establish the diagnosis at the cytology level using amyloid staining, argyrophilia test or immunohistochemistry. However if there is any cytological suspicion of medullary carcinoma, serum calcitonin should be investigated to confirm the preoperative diagnosis of medullary carcinoma enabling the patient to undergo one-step radical surgery.

Fine needle biopsy was performed in 48 patients suffering from X-ray detected osteolytic lesions, during two years. A representative sample was obtained in 38 of them (79.2 percent). Cytologic conclusions could be proved in 35 patients by histology or clinical finding of primary tumour (in cases with bone secondaries). Cytologic diagnosis was correct in 30 patients (87.7 per cent). Especially good results were found out in bone metastases, plasmacytomas, and Ewing's sarcomas. Fine needle biopsy is to be recommended as an integral part of complex diagnosis of bone tumours.

Author performed intraoperative cytology of 236 pneumomediastinal processes, 251 mammary and 45 other focal lesions. He used fine needle asperation or scraping of pathological tissue and hematoxylin-eosin staining of smears. Diagnosis of pulmomediastinal processes was reliable in carcinomas, chondrohartomas, and polymorphocellular sarcomas. Unreliability as to biological behaviour was found in identification of low grade malignant mesenchymal tumours which needed histology. Cytokeratin expression verified the diagnosis of thymoma from routine staining and enabled cytological and histological identification of extensive bronchioloalveolar epithelial hyperplasia associated with specific and unspecific inflammations or marginally with primary as well as secondary epithelial and mesenchymal malignant tumours and melanomas. Intraoperative cytology of mammary lesions succeeded in identification of nonmalignant processes and of 94 from 97 carcinomas (remaining 3 having been left for histology). As a rule, intraoperative cytology yielded a prompt information about investigated process' nature which was necessary for defining the extent of surgery, further information was completed by histology.

The laboratory was engaged in exfoliative cytology, mainly of sputa and investigated 1450 hospitalized patients and 1410 smokers in a screening campaign during the last year. Another programme included cytology of bronchoscopical materials (2480 patients a year), fine needle aspiration cytology (550 patients), and peroperation cytology, mostly pulmonary and mammary (125 patients). A limited number of exfoliative and bronchoscopical materials could have been examined in correlation with the number of medical technologists for screening and preliminary evaluation. The laboratory shared immunochemical facilities and computerized registration of results with the others in the Institute. For future, the laboratory reckons with an increase of aspirations taken by visualization methods and with development of special technologies of material processing and evaluation.

Spontaneous settling of consulting centres for special fields in pathology is recommended in advance to general reform of the Czechoslovak medical services. Principles of their functioning and main tasks are outlined.