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Esophageal squamous cell carcinoma (ESC) is one of the most common cancers worldwide [1]. Its prognosis remains poor despite recent advances in both diagnosis and therapy. Moreover, multiple primary ESC is not uncommon [2,3]. These reports support the concept that the entire esophagus may be considered as a single area of carcinogenesis. The elucidation of the carcinogenesis of ESC may have a considerable effect on early diagnosis and therapy.

5609 Background: Severe dysplasia on a cervical biopsy is often followed by an excisional procedure such as a loop electrosurgical excisional procedure (LEEP) or cone biopsy. The objective of this ...

Background & Aims: Endoscopic ultrasound (EUS) is often used as the gold standard to diagnose chronic pancreatitis (CP) despite concerns about its intra-operator reliability and validity. We sought to determine the benefit of repeat EUS in patients suspected of having CP but having an equivocal or negative initial EUS exam for CP. Methods: Patients who underwent at least two EUS exams at our medical center to evaluate for CP from 20012012 were identified. Demographic, procedural and etiologic factors were abstracted via chart review. Specifically, EUS minimal standard criteria (MST) for CP (hyperechoic foci, hyperechoic strands, lobularity, cysts, ectatic duct, hyperechoic ductal wall, dilated side branches, ductal stones, ductal dilation) were abstracted for all exams. Diagnosis of CP was based on physician impression following each EUS. Results: Between the first and second EUS exams, the number of patients diagnosed with CP increased from 49% to 76% (p

Some investigators have reported that presence of the inner border may be a colposcopic sign for the presence of high-grade cervical neoplasia. The inner border can be defined as a sharp acetowhite demarcation or transformation zone within a less opaque acetowhite area. The association of the colposcopic sign inner border with moderate/severe cervical intraepithelial lesions has not been thoroughly investigated. This retrospective study examined the correlation between the inner border and cervical intraepithelial neoplasia (CIN) 2 or 3, and also evaluated the correlation of the presence or absence of the inner border with specific types of human papillomavirus (HPV). Colpophotographs and cervicograms of 947 women (mean age, 32 years: range 15-79 years) who had been referred to a colposcopy clinic because of an abnormal cervical finding were reviewed by two independent colposcopists in order to evaluate retrospectively the occurrence of the colposcopic sign inner border. Histologic evaluation was based on colposcopy-directed punch or cone biopsies. Human papillomavirus testing and typing were performed using Hybrid capture I or a polymerase chain reaction-enzyme immunoassay. Among women with an atypical transformation zone, the prevalence of the colposcopic sign inner border was 7.6% (53/695). Histological examination detected CIN 2 or 3 in 70% of women with inner border. The sensitivity and specificity of the colposcopic sign inner border for detection of CIN 2 or 3 were 20% and 97%, respectively. The odds ratio for CIN 2 or 3 among patients with inner border was 7.7 (95% confidence interval, 4.2-14.3). No significant association was found between inner border and any high-risk HPV type. Inner border associated with CIN 2 or 3 was significantly more frequent in women younger than 35 years (P < 0.05). The investigators conclude from these findings that colposcopic sign inner border is a rare but valuable and highly specific marker for CIN 2 or 3 in young women.

Background Neoplastic large bowel lesions have been found that are flush with, or even depressed below, the colonic epithelium.1-5 These flat adenomas are reported to have an increased incidence of severe dysplasia when compared with polypoid lesions,1 4 6 7 and some have consisted exclusively of malignant cells. Thus, de novo development may be an alternative pathway of carcinogenesis.5 As a result, endoscopists are encouraged to be vigilant in discovering and removing these lesions. We report our experience of specific areas of normal depressed colonic mucosa that, macroscopically, have some features that are similar to true flat adenomas. Additionally, we suggest …

These are Major terminological problems relating to definitions of epithelial tumors of the whole gastrointestinal tract (squamous and glandular). Furthermore, the clinical implications vary from site to site. The definitional problems primarily involve epithelial atypia and the terminology of neoplastic lesions, namely dysplasia, adenomas, carcinoma in situ, and early cancer [1–8].

Aim: p53 and p63 are the important genes associated with oral cancer. The aim of this study was to evaluate and compare the immunohistochemical expression of p53 and p63 in oral epithelial dysplasia and squamous cell carcinoma (SCC). Materials and Methods: Immunohistochemical expression of p53 and p63 was graded in total of 60 archival cases, which included 30 cases of oral epithelial dysplasia (10 cases each of mild, moderate, and severe dysplasia) and 30 cases of oral SCC (10 cases each of well-differentiated, moderately differentiated, and poorly differentiated SCC). Results: Our study showed statistical significant difference on comparison of p53 and p63 expression in oral epithelial dysplasia. In oral SCC cases, p53 and p63 did not show significant correlation in expression. Conclusions: Our study demonstrated a progression in expression of p53 and p63 along the grades of oral epithelial dysplasia to SCC, suggesting their role in stages of carcinogenesis. However, p53 and p63 may have independent role in oral tumorigenesis.

Autosomal dominant, familial forms of colorectal adenocarcinoma are recognized, but more than 90% of cases are sporadic. Most familial and sporadic cases arise through malignant transformation of benign adenomas in a process known as the adenoma-to-carcinoma sequence. Adenomas are classified histologically as tubular, tubulovillous, or villous. As a neoplasm, adenomas all manifest mild, moderate, or severe dysplasia. The majority (> 90%) of adenomas are small (< 1 cm in diameter) and do not progress. Risk factors for carcinomatous progression include the presence of multiple adenomas, size greater than or equal to 1 cm, and villous histology or severe dysplasia in adenomas of any size. The adenoma-to-carcinoma sequence advances through the accumulation of lesions involving multiple genes. It appears that similar molecular genetic mechanisms are involved in familial and sporadic forms of colorectal neoplasia.

Since 1983, a long‐term clinical trial of esophageal carcinoma chemoprevention has been conducted in a high‐risk area in China. From this study, 25 esophageal severe dysplasia patients without therapy were selected for analysis. After 5‐year follow‐ups, 14 cases progressed to esophageal carcinoma, while the other 11 cases remained stable. Three Papanicolaou’s smears were used for each case, including one from the esophageal cytological examination at the beginning, two from the re‐examinations three and five years later respectively. About 100 visually normal intermediate cells were randomly collected per slide by high resolution image analysis. More than 100 features (morphologic, densitometric, textural) were extracted. The classifications were made by means of stepwise linear discriminate analysis at the single cell level as on the specimen level using up to ten features. In all three comparisons of patients with progression and with regression at time of diagnosis, three years after diagnosis and five years later, the correct cell classification rates were about 70%. The subsequent specimen classifications by means of thea posteriori probability(APOP) distribution of the cells in each case led to 80% correct classification. All selected features reflected the chromatin structure of nuclei. The result demonstrated that the chromatin structures of esophageal epithelial cells in severely dysplasic patients are different between cases with and without progression. These results suggest the possibility of the application of image analysis in the clinical trials to find the dysplasia patients with higher risk of progression, in order to reduce the number of patients for therapy.

The purpose of this study was to evaluate the efficacy and safety of endoscopic Nd:YAG laser photocoagulation for the treatment of flat colorectal adenomas. From January 1982 to December 1994, 222 lesions were treated in 216 patients. Initial eradication was obtained in 96% of lesions with a diameter less than 1 cm, in 89% of lesions with a diameter between 1 and 4 cm, and in 64% of lesions with a diameter greater than 4 cm. According to the histology, a complete disappearance was obtained in 94% of tubular, in 89% of tubulovillous, and in 80% of villous adenomas. Adenomas with severe dysplasia or foci of invasive carcinoma were eradicated in 76% and in 75% of cases, respectively. During a median follow- up of 24 months (3 - 129 months), recurrences developed in 46 of the 186 initially cured lesions (25%). All recurrent lesions were submitted to Nd:YAG laser photocoagulation, obtaining eradication in 37/46 (80%) of the cases. Malignant degeneration occurred in 6% of lesions. Complications related to laser treatments were observed in 5% of patients.© (1996) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Objectives Pathologists differ in their definition of “dysplasia’. This study was done to test the hypothesis that experienced oral pathologists are consistent in diagnosing epithelial dysplasia. Study Design Six board-certified oral pathologists examined 120 oral biopsies exhibiting simple hyperkeratosis to severe dysplasia. No clinical information was given, and presence of dysplasia was judged by histomorphology. Examiners' diagnoses were compared with sign-out diagnoses for each case. Months later, each examiner viewed 60 relabeled slides from the original 120. Each diagnosis was compared with the diagnosis in the first round. Results Exact agreement with the sign-out diagnosis averaged 50.5% (within one histologic grade 90.4%). Examiners agreed exactly with their own diagnoses 50.8% of the time (within one histologic grade 92.4%). Agreement distinguishing dysplasia from no dysplasia compared with original sign-out diagnosis was 81.5%. Agreement with themselves distinguishing dysplasia from no dysplasia was 80.3%. Conclusions Accurate reproducible agreement among experienced board-certified oral pathologists diagnosing oral epithelial dysplasia is difficult to achieve.

Sixty-seven patients (69 knees) with recurrent patellar dislocation underwent either a lateral release (20 knees), a proximal realignment (14 knees), a distal realignment (16 knees), or a combined realignment (19 knees) procedure. Average respective followup was 8, 8, 6, and 4 years. Patients undergoing lateral release experienced a 40% recurrence of patellar dislocation. After a realignment procedure, redislocation was uncommon (4%), but pain and swelling were reported by 12% of the patients. Significant patellofemoral crepitation was present in 35% of the realignments. The congruence angle was corrected satisfactorily in the proximal realignments, but it remained abnormal in 25% of the distal realignments. The distance from the tuberosity to the sulcus was restored to normal by transposition of the tibial tuberosity, but remained abnormal in 36% of the proximal realignments. However, it did not preclude a good clinical result. Lateral release cannot be recommended for knees with severe dysplasia of the extensor mechanism. Proximal, distal, and combined realignments yielded similar clinical results. Retensioning of the medial structures and lateral release are effective in reducing the patella within the sulcus. Although transposition of the tuberosity is appealing, clinical advantages are less evident.

In the Leiden region, the cervical cancer screening programme for the age group 35–54 years shifted in 1989 from one in which the smears were taken by specially trained paramedical personnel in health centres to a programme where the general practitioner is the smear taker. Hence, it is possible to compare the results of the two types of screening to evaluate whether involvement of general practitioners leads to better uptake of screening. In the 6 year period evaluated in this paper, the 3-yearly cytological rate per thousand for severe dysplasia or worse increased from 1.00 to 3.40; when stratified by age the positive rates were significantly higher. the histological rate per thousand for severe dysplasia increased from 0.60 to 2.09, and for carcinoma in situ from 0.35 to 1.36. All six invasive carcinomata were detected in the GP programme (0.31%). the general practitioner is clearly more able to attract the ‘high-risk’groups. Dans la reeion de Leiden, le programme de depistage du cancer du col pour les tranches d'âge de 35–54 ans a ete modifie en 1989. Le programme etait initialement base sur des frottis faits dans des centres de sante, par un personnel paramedical ayant suivi une formation particuliere. Apres 1989, le medecin generaliste est devenu le preleveur. II est done possible de comparer les resultats de ces 2 types de depistage et d'apprecier si la participation des medecins generalistes a pour consequence un meilleur depistage. Au cours de la periode d'etude, les taux pour 1000 de positivite cytologique pour les lesions graves (de type dysplasie severe et plus) et par periode de 3 ans ont augmente de 1,00 a 3,40. Lorsque l'on stratifie sur l'âge, les taux de cas positifs sont significativement superieurs. Le taux histologique des dysplasies severes pour 1000 passe de 0,60 a 2,09 et celui du carcinome in situ de 0,35 a 1,36. Les 6 cas de carcinome invasif ont ete detectes par le programme impliquant les medecins generalistes (0,31%). II est clair que le medecin generaliste est mieux place pour depister les patientes a“haut risque”. Im Bezirk von Leiden wurden die Abstriche der 35- bis 54 jahrigen vor 1989 von speziell ausgebildeten Hilfskraften in Gesundheitszentren hergestellt, wahrend diese Aufgabe dann von den Allgemeinmedizinern ubernommen wurde. Dies erlaubt einen Vergleich zwische den Praparaten von zwei jeweils 3 Jahre umfassenden Perioden. Der Anteil schwerer Dysplasien und starkerer Veranderungen nahm von 1.00 auf 3.40 pro Tausend zu. Der histologische Anteil der schweren Dysplasien erhohte sich von 0.60 auf 2.09 und der der Carcinomata in situ von 0.35 auf 1.36. Alle 6 nachgewiesenen invasiven Carcinome wurden in den Abstrichen der Allgemeinmediziner entdeckt (0.31%o). Damit ist klar, das die Allgemeinmediziner die Risikogruppen besser zu erfassen vermogen.

When the new developments in gynecologic cytology became known in German-speaking countries after World War Two, Papanicolaou and Traut (1943) had established the classification in five groups. Older colleagues who witnessed those years may remember negative evidence, group III - unclear, groups IV and V—positive findings. In particular group IV reflected the presence of some isolated abnormal cells, group V that of numerous abnormal cells in the smears.

Ninetynine patients, 67 male and 32 female, who applied to endoscopy laboratory of gastroenterology department of the Ankara University School of Medicine were diagnosed to esophageal carcinoma between the years 1986 and 1993. Lugol was routinely used in selective cases. Four out of 99 cases were in early stages. Two cases had submucosal invasion without lymph node metastasis. One case showed flat undyed area with lugol and she was proved to have squamous cell carcinoma but she refused the operation. One case showed severe dysplasia and she had liver metastasis after three years of operation.

Squamous epithelial dysplasia is frequently encountered in the esophagus with squamous cell carcinoma, and several studies have suggested its significance as a precancerous lesion.

Through diagnosis a clinician approaches disorders by applying an explanatory account that allows the patient to be cast in a clinical category and therapy role. Because diagnosis usually involves understanding and undertaking clinical problems through pathoanatomical and pathophysiological frameworks, clinical diagnosis is theory-ladened. Diagnosis also involves judgments about the worthiness of particular conditions for special attention. These judgments involve evaluative considerations, and turn in part on accepted norms of scientific investigation and therapeutic success. As a result, diagnosis is pursued not solely for its own sake, but also for the sake of satisfying certain evaluative frameworks. In other words, clinicians seek to know well, as opposed to simply knowing truly the character of clinical problems. In short, diagnosis is contextual and intervention-oriented.

Recent developments in tumor virology have shown that specific human papillomaviruses (HPV) play an important role in the development of cervical cancer (Gissmann and Schneider 1987; Zur Hausen 1989). In general, HPV 6 and 11 have been associated with benign cervical lesions (Gissmann et al. 1983; McCane et al. 1985; Lorincz et al. 1986a) while HPV 16, 18 and to a lesser extent HPV 31, 33, and 35 have been found mainly in mild and severe dysplasia and cervical carcinoma (Durst et al. 1983; Boshart et al. 1984; Beaudenon et al. 1986; Lorincz et al. 1986b).

The two most well known and well defined grading systems for dysplasia in colorectal adenomas were compared with regard to reproducibility. The Konishi-Morson system (KMS) operates with several histological and cytological variables and grades of mild, moderate, and severe dysplasia. The Kozuka system is based on the extent of nuclear pseudostratification and also has three grades of dysplasia (III-V). As the group of severe dysplasia is very large in this system, it was extended with two higher grades, similarly based on individual histological criteria, known hereafter as the extended Kozuka system (EKS). Fifty six adenomas were graded by two observers, each observer grading twice according to the KMS criteria and twice according to EKS criteria. Intraobserver reproducibility was excellent for the KMS and moderate for the EKS, but this was not significant. The overall interobserver reproducibility was similar (moderate) for the KMS and for the EKS. Kappa values for interobserver reproducibility on individual categories were excellent for severe dysplasia according to the KMS, but low for all other categories in both systems. By simplifying both systems into two groups a high reproducibility can be obtained, but this implies that all the original grades (III-V) for the EKS must be grouped together. It is therefore recommended that a simplified KMS is used for further studies on the biological importance of dysplasia and for comparison between histological changes and other markers for colorectal neoplasia.

The idea that colorectal carcinoma arises from dysplasia is widely accepted nowadays. Within the framework of this dysplasia-carcinoma sequence, there are different morphological presentations which range from mild dysplasia to obvious invasive and metastasising carcinoma (Fig. 1). The stepwise transitions have not yet been uniformly named, so that up to now different clinical conclusions can still be drawn from the same histological findings.

The application of HPV-DNA cloning and hybridization techniques in the clinical diagnosis of cervical, vaginal and vulvar cancer and their precursor lesions has provided strong evidence that HPV infections constitute an essential factor for the genesis of these neoplasias.

The effect of regular 3-yearly screening over a period of 12 years, on the incidence of cervical cancer in 25 000 women aged 35–54 years, is examined. The rate of squamous cell carcinoma decreased from 0.38 per 1000 women in the first round to zero in the fourth round. Similarly, the rate of carcinoma in situ declined from 1.69 per 1000 women in the first round to 0.35 per 1000 in the fourth round. The rates of severe dysplasia showed no decline. Cytologic under diagnosis of carcinoma-in-situ and cervical carcinoma increased with each round. Widowed and divorced women and those living in urban areas were identified as high risk groups.

A. Thanks for your question. The role of AFB is still somewhat controversial. With the new more sophisticated conventional white light bronchosopies, the role of fluorescence itself may be receding. Recent abstracts at the British Thoracic Society tended to suggest that, with modern equipment, an experienced bronchoscopist will identify as many abnormalities in the mucosa as they would with AFB. Having said that, there is no evidence yet that AFB has a place in routine bronchoscopy. It is being used as a surveillance tool in patients in whom routine bronchoscopy or follow-up bronchoscopy after resection identifies abnormal mucosa. Our policy at University College Hospital (UCH) is to repeat AFB every 4–6 months in individuals who have either severe dysplasia or carcinoma in situ (CIS). It is still controversial whether all CIS lesions become invasive.

4178 Background: Barrett esophagus is the precursor of most esophageal adenocarcinomas. Dysplasia or intraepithelial neoplasia (IEN) is the first step in the sequence which can be recognized with r...

5106 Background: We evaluated the efficacy of daily Celecoxib in the regression of moderate and severe cervical dysplasia, when compared to placebo. Methods: All women, over the age of 18, with the...

AIMS To study the association of the duration of the test with the polyps yield and the miss rate for polyps of sigmoidoscopy (FS) among patients undergoing FS screening for coloretal cancer (CRC). METHODS We compared the polyps yield of FS and colonoscopy (TC) among subjects referred for TC in Turin in the context of the SCORE trial of FS screening for CRC, conducted as parallel study to the UK trial (coordinator:W Atkin). Endoscopists were instructed to excise all small (=5 mm) polyps detected at FS and to record the duration of the test, as well as shape, size and location of all polyps detected. Patients detected with polyps >5 mm, CRC, high-risk polyps=5 mm (villous component, severe dysplasia), >2 adenomas were referred for TC.TCs were performed within 1 month from FS in the same Endoscopy Unit. Only subjects with complete FS (instrument passed beyond the sigmoid-descending colon junction, under adequate bowel preparation) were included in this analysis.Patients with distal CRC were excluded. RESULTS Out of 3540 FSs performed in Turin, 2888 (81.6%) were completed. Complete information for the analysis is available for 2225 tests (duration of the procedure was not recorded in 557 and polyp size in 6 cases). FS was completed within 5 minutes in 64.6% of the cases, between 6 and 10 minutes in 29.6% and it required >10 minutes in 5.7% of the patients. Polyps yield was 11%, 27.3%, and 45.9% (p-trend-: 10 minutes respectively. The observed increase in the detection rate was associated with an increase in the proportion of polyps=5 mm: 56.7%, 68.1% and 88.5% for tests completed within 5, 10 and >10 minutes respectively (p-trend- : 10 minutes respectively. CONCLUSIONS Only a small proportion of the screening FS lasted more than 10 minutes.A positive association was observed between polyps yield and duration of the test, mainly attributable to a trend toward a higher detection rate for small polyps. The time devoted to the excision of small polyps might explain the longer duration of the tests in these cases. Accuracy of the screening FS was apparently not reduced if the test was completed within 5 minutes.

Pancreatic mucinous cystic neoplasms (MCNs) provide a spectrum of neoplastic changes ranging from benign to malignant. The authors have correlated K-ras mutations and p53 overexpression with the evolution of these tumors.Areas of mild, moderate, or severe dysplasia were microdissected from paraffin-embedded tissue sections of 28 different MCNs (10 benign, 9 borderline, 9 malignant). Nonneoplastic pancreatic ducts were also microdissected from tissues adjacent to the tumors. Ten serous cystadenomas served as negative controls. K-ras codon 12 mutations were identified by a mutant-enriched nested polymerase chain reaction-restriction fragment length polymorphism assay and confirmed by sequencing. p53 overexpression was demonstrated by immunohistochemistry.K-ras mutations were detected in 20% of benign, 33% of borderline, and 89% of malignant MCNs. Histologically, mutations were found in 26% (7/27) of MCN epithelia with mild dysplasia, 38% (5/13) of MCN epithelia with moderate dysplasia, and 89% (8/9) of MCN epithelia with severe dysplasia or carcinoma. Ten percent (4/39) of nonneoplastic pancreatic ducts at the margins of MCN harbored mutations, all associated with borderline or malignant tumors. Overexpression of p53 occurred in none of the benign or borderline MCNs but in 44% (4/9) of the malignant tumors (p = 0.006 benign/borderline vs. malignant). p53 immunoreactivity was concentrated in areas of severe dysplasia/carcinoma or invasion, where K-ras mutation had been detected.These findings demonstrate a sequential accumulation of genetic changes in the carcinogenesis of MCN. K-ras mutations appear early and increase in proportion with increasing dysplasia. Overexpression of p53 is a late finding observed only in carcinomas, and in combination with mutated K-ras genes. The presence of K-ras mutations in nonneoplastic ducts supports formal pancreatic resection over enucleation for treatment. Mucinous cystic neoplasms may be a useful model to study the evolution of pancreatic ductal adenocarcinomas, in which precursor lesions remain unknown.

To the Editor .—Twelve years ago, we described seven patients with a particular congenital deformity of the labyrinth of the inner ear, two of whom developed a cerebrospinal fluid fistula through the oval window. 1 We agreed with Jensen who, in a previous article in the US literature, 2 stated that this was not the defect described in detail by Carlo Mondini in 1791 3 but, rather, a more severe dysplasia. We have now seen 30 patients with this more severe type of dysplasia, 12 of whom have developed a spontaneous cerebrospinal fluid fistula through the inner ear or presented with meningitis. These cases have been described in various publications. 4-7 Other European publications have described the difference between the true Mondini and the "pseudo-Mondini" deformity, 8,9 although we consider the latter a term to be deprecated. 10,11 We are dismayed, therefore, that so much confusion persists in the US

Summary: The significance of the gland openings with a white ring, in the colposcopic transformation zone, is reviewed and its importance discussed. This picture was present in 9.8% of colposcopic examinations on 914 patients selected on cytological and/or clinical basis. In these 90 patients cytology suggested mild dysplasia in 22.4% and severe dysplasia, carcinoma in situ or invasive carcinoma in 14.4%. Histological study in 73 of the 90 patients showed mild dysplasia in 20.5%, severe dysplasia in 13.7%, carcinoma in situ in 9.6% and invasive carcinoma in 1.3%. We were impressed by the fact that these carcinomas showed very striking, easily identifiable glandular openings. We believe that the colposcopic study of the white gland openings is important, since they can be the only site where lesions are detected.

The morphologic features of 307 colorectal adenomas among 159 patients are reviewed. Most adenomas (66.4%) were located in the sigmoid colon and the rectum, and the percentage decreased proximally to the right colon. The 307 adenomas comprised 244 (79.5%) tubular, 41 (13.3%) tubulovillous, and 22 (7.2%) villous adenomas. The epithelial dysplasia was graded as mild in 260 (84.7%) adenomas, moderate in 33 (10.7%), and severe in 14 (4.6%). The percentage of severe dysplasia was greater in villous adenomas than in tubular adenomas (p less than 0.05) and correlated with the increasing size (greater than 5 mm) of the adenomas (p less than 0.01). The risk of metachronous adenomas could be evaluated among 56 patients, 34 men and 22 women with a history of removed adenoma(s). Fourteen of 56 patients (25%) with 6:1 male to female ratio developed 18 new adenomas, after an average of 34.3 months (range, from 12 to 88 months). Eleven of the 14 patients had multiple adenomas at the initial examination. In addition, a carcinoma of the rectum was found in one male patient. Of the 48 patients, 17 men and 31 women, operated on for colorectal cancer 16 patients (34%) with 1.3:1 male to female ratio had 40 new adenomas after an average of 51.8 months (range, 12 to 252 months) after the surgical excision of their carcinomas. One patient had a recurrent carcinoma at the site of the anastomosis 22 months after anterior resection of his carcinoma. Our data suggest that a history of colorectal carcinoma, multiple adenomas, and male sex predict a higher risk of having future colorectal tumours.

Of a total of 1321 cases of severe dysplasia of the uterine cervix, 237 lesions (18%) were found by punch biopsy and cytological examination to have progressed to carcinoma in situ or microinvasive carcinoma later in the course of follow-up. The changes in exfoliated cells during the progression to malignancy were examined in 95 of the 237 cases. Results obtained were as follows: (1) The ratio of parabasal (immature) cells to the whole dysplastic cells gradually increased in each specimen. (2) Immature dysplastic cells showing increased nuclear membrane tension and irregular staining of the nuclear membrane gradually increased. (3) The number of immature dysplastic cells with finely or coarsely granular chromatin patterns gradually increased.

Since 1943 when Papanicolaou introduced cytology into gynecology the method has changed from a simple screening test into a sophisticated morphologic technique, the differential cytology. In Germany this development is documented by an improved cytologic classification (Munchner Nomenklatur). An own material is presented consisting of 520 cases of histologically proven severe dysplasias and in situ carcinomas. It can be shown that careful and critical use of differential cytology with due regard to its limits can improve the accuracy of the cytologic prediction of a cervical lesion. A delineation against invasive cancer is possible with a hundred percent accuracy. On the basis of these results it seems justifiable to perform a primary hysterectomy without pretherapeutic cone-biopsy. It is pointed out that this procedure is only possible in institutions were the possibilities of differential cytology are well-known and--which is more important--where the limits of the method are known and respected. In any case of doubt the procedure of diagnosis and therapy has to be discussed and planned in close cooperation between the clinicians and the morphologists.

We report a young patient with a solitary intrahepatic cyst without demonstrable connection with the biliary tree. The operative appearances suggested hydatid disease but histological examination of the resected cyst showed that it was the result of Caroli's disease already complicated by severe dysplasia. This case provides further evidence for the premalignant nature of Caroli's disease.

Tissue levels of N1-acetylspermidine, polyamines and CEA were measured in colorectal polyps, which had been either endoscopically polypectomized or surgically removed. The polyps examined were either adenomas with mild, moderate or severe dysplasia, or adenocarcinomas. Control mucosae were taken from macroscopically and microscopically normal regions of surgicallyremoved colorectal tissues.The colorectal polyps contained approximately 13-fold higher levels of CEA than control mucosae. The CEA levels of adenocarcinomas were twice as high as those of adenomas, though the difference was not statistically significant. The N1-acetylspermidine levels were significantly higher in severe dysplasia and adenocarcinomas than in control mucosae, and in adenomas with mild or moderate dysplasia. There was a significant positive correlation between the levels of N1-acetylspermidine and the size of colorectal polyps, whereas no significant correlation was found between the levels of N1-acetylspermidine and CEA. The results of the present study suggest that N1-acetylspermidine could be used as a more specific marker of colorectal adenocarcinoma than CEA.

One hundred and seventeen teenagers with abnormal cervical cytology were evaluated using colposcopy and directed biopsies. Eighty-eight cases of cervical intraepithelial neoplasia were discovered including 24 cases of severe dysplasia or carcinoma in situ. Erradication of these lesions is essential as a preventative measure. The importance of routine cytologic screening and early evaluation of abnormal Papanicolaou smears in the teenager is emphasized.