Repositório RCAAP

Digital Cytology consists in the conversion of a glass slide into a digital image. The application of digital cytology in education, conferences, telecytology, publications and cytology websites has shown increased accessibility to cytology, along with the quality and efficiency improvement of the health services.In this study we intend to develop an Online Slide Library of gynecological cytology available to students for the gynecological cytologyOne hundred samples of gynecological cytology were selected and scanned by the whole slide imaging method. The Online Slide Library was created with HyperText Markup Language 5 and the digital images sharing within the Library was conducted using the institution network server.In education, the Online Slide Library developed allows the easier access to the study of gynecologic cytology as well as the access to rare and/or old samples. Also several students can observe the same case simultaneously with this method of digital cytology.The results of the present work allow to conclude that the Online Slide Library is a complementary tool for the gynecological cytology study.

The presence of endometrial cells is considered an alarming finding in gynecological smears of women in the second half of the menstrual cycle or after the age of 45 years. In particular, in post- menopausal women, the presence of atypical endometrial cells may represent a serious uterine pathology and requires a thorough evaluation.We report a case of a 77 year post-menopausal woman, who presented with vaginal bleeding without ecographic uterine alterations. Cervicovaginal cytology revealed the presence of abnormal endometrial cells in clusters, unusual in the clinical context of the woman. The cytological result was atypical glandular cells, favor neoplastic. Based on this result, the patient was submitted to an endometrial curettage, which was diagnosed as carcinosarcoma, and with a radical hysterectomy.Although the cytological result was not in accordance with the histological diagnosis, it indicates the necessity of studying the endometrium and the subsequent diagnosis of carcinosarcoma.

The incidence of endocervical adenocarcinoma is increasing, especially in women aged between 20 and 30 years. The increased incidence, according to recent studies, may be due to persistent HPV infections associated with endogenous and exogenous risk factors. The treatment of this cancer may require a total hysterectomy with consequent infertility and psychological trauma. This paper aims to draw attention to the development of adenocarcinoma in young women, and in addition, it is intended to reflect on the factors that may be associated with the appearance of this pathology and the causes related with late diagnosis, in order to avoid radical therapeutic actions. To this end, a clinical case is reported, following a screening cytology, of a 30 years-old woman with cytological diagnosis of atypical glandular cells not otherwise specified (AGC, NOS), that was sent to the Cervical Pathology Unit of the reference hospital. The second cytology has diagnosed endocervical adenocarcinoma, later confirmed histologically.

Metastatic colorectal adenocarcinoma in the vagina is rare and there are few reported cases in the literature. This paper reports a case of a woman with an infiltrative mass in the vagina and a previous diagnosis of colorectal adenocarcinoma. The use of cervicovaginal liquid based cytology together with CK20 and CDX2 immunostaining allowed to confirm the neoplasia’s colorectal origin. This case enhanced the importance of the clinical history as well as the immunohistochemical staining in a diagnosis, since without them and just with the cellular characteristics observed the diagnosis could be of endocervical or endometrial adenocarcinoma.

Cervical and supraclavicular adipose tissue masses are relatively rare, being lipoma and hibernoma the most e less frequent forms. The present paper deals with a case of a 72-year-old patient with clinical history of right supraclavicular nodular lipomatous mass, with cytological diagnosis of probable hibernoma. The histology of the surgical specimen confirmed the cytological suspicion.

Anal cancer is rare but its incidence has been increasing particularly in the HIV-positive population in which HPV infection has increased persistence. Infection with high-risk HPV types is associated with the presence and progression of dysplastic lesions into anal cancer. For this reason, HIV positive population are considered a risk group, which should be referred for screening of anal lesions. In this article we report a clinical case of a 53-year-old HIV-positive man with discrepant cyto-histological diagnosis in which cytology has been diagnosing lesions of a higher grade than histology. The present work intends to alert to the importance of anal screening, especially in the risk groups and to the evaluation of discrepant diagnoses between cytology and histology.

Endocervical villoglandular adenocarcinoma is a rare subtype of cervical adenocarcinoma. It arises mainly in young and reproductive age women and it has a lower incidence and better prognosis compared to cervical adenocarcinoma. The present case study refers to a conventional cytology performed on a 48-year-old woman within a screening program carried out at a health center of the Local Health Unit of Matosinhos. The objective of this study is to verify the importance of the cytological sample collection method for a better observation and interpretation of the cytological findings in rare neoplastic entities, as well as to reinforce the importance of the application of complementary tests for the elaboration of a conclusive diagnosis. The cytological result of the present case report was atypical glandular cells (AGC) of the endocervical type. Subsequently, a biopsy of the uterine cervix, a conization and a curettage of endocervix were performed, whose histological diagnosis was well differentiated villoglandular adenocarcinoma from the endocervix.

A ocorrência simultânea de duas neoplasias malignas primárias é uma condição pouco frequente, predisposta por fatores ambientais e genéticos. Descrevemos o caso clínico de uma mulher de 50 anos, fumadora, com diagnóstico de linfoma linfocítico/ leucemia linfocítica crónica (LLC). Após a deteção de um nódulo no lobo superior do pulmão direito e de múltiplas adenopatias mediastínicas, foi efetuada broncofibroscopia com citologia aspirativa transbrônquica por agulha fina guiada por ecografia endobrônquica dirigida aos gânglios linfáticos mediastínicos. Na amostra citológica identificaram-se células epiteliais malignas, que expressavam a proteína Fator de Transcrição da Tiroide 1 (TTF1) por imunocitoquímica, e uma população monomórfica de linfócitos cuja análise por citometria de fluxo caracterizou como linfoma linfocítico. Concluímos a existência de duas neoplasias no mesmo grupo adenopático: linfoma linfocítico e metástase de adenocarcinoma do pulmão. Este caso confirma os dados da literatura, que recomendam que o follow-up dos doentes com LLC deve contemplar a procura de tumores sólidos, dado estes doentes terem maior probabilidade de os desenvolver, nomeadamente tumores primários do pulmão, sendo o adenocarcinoma o mais frequente.

O carcinoma adenoescamoso é um tumor raro que representa cerca de 4% dos tumores cervicais. Este carcinoma ocorre maioritariamente em mulheres com cerca de 50 anos, podendo ocorrer em mulheres mais jovens e está também associado ao estado de gravidez e à infeção pelo Papiloma Vírus Humano.No presente trabalho, relata-se o caso de uma mulher de 45 anos, com coitorragias e uma lesão dura, elevada e hemorrágica no colo do útero, que foi submetida a citologia esfoliativa. O exame microscópico permitiu visualizar achados citológicos compatíveis com coexistência de componente pavimentosa- células pleomórficas com citoplasma denso com aumento da relação núcleo citoplasma - e componente glandular- pseudoestratificação, feathering e núcleos alongados. O relatório citológico foi de carcinoma pavimento celular, não excluindo a possibilidade de carcinoma adenoescamoso.No seguimento da doente, foi realizada biópsia ao colo uterino, cujo diagnóstico histológico foi de adenocarcinoma invasor produtor de muco com uma componente do tipo pavimentoso. Esta neoplasia faz diagnóstico diferencial principalmente com “tumores de colisão” onde ocorrem duas neoplasias primárias, uma glandular e outra pavimentosa.Para este tipo de tumor, a interpretação citológica pode ser desafiante, pela dificuldade de interpretar nos aspetos citomorfológicos a componente pavimentosa e glandular na mesma amostra.

ObjetivoO presente artigo pretende expor um caso de ausência de correlação entre os exames colposcópico, citológico e histológico.Apresentação do casoNuma consulta de ginecologia de rotina, a paciente, de 54 anos, realizou uma citologia ginecológica em meio líquido, cuja observação microscópica resultou no diagnóstico de carcinoma epidermóide. Posteriormente, a paciente foi encaminhada para uma sequência de consultas de follow-up, tendo realizado uma biópsia do colo que demonstrou marcada atrofia, sendo negativa para lesão intraepitelial; uma pesquisa e tipificação do vírus do Papiloma Humano positiva para os genótipos 35 e 56 (alto risco); e uma conização, da qual resultou um diagnóstico de lesão intraepitelial pavimentosa de baixo grau.DiscussãoApós a realização de pesquisa bibliográfica que relatasse exemplos de casos de discrepância entre a colposcopia, a citologia e a histologia, verificou-se que os falsos negativos, tanto na colposcopia, como nos exames histológicos, bem como a sobrevalorização do diagnóstico citológico, poderão ser hipóteses causais para a disparidade de resultados apresentados neste caso.ConclusãoEste estudo remete para a importância da correlação entre a citologia e a histologia, assim como a necessidade de comunicação entre os vários profissionais de saúde das diversas áreas envolvidas.

This article reports a case of a 42 year-old female patient diagnosed in 2011 with adenocarcinoma in situ and severe cervical intraepithelial neoplasia that was treated with trachelectomy. In November 2013 a vaginal vault cytology was performed, with cytological findings consistent with low-grade squamous intraepithelial lesion but also with the presence of cells that favour the diagnosis of high-grade intraepithelial lesion. Since it was not possible to grade the lesion as clearly low or high, it was attributed the result of squamous intraepithelial lesion of undetermined grade. In order to confirm and clarify the diagnosis, a biopsy was performed which showed results of severe squamous intraepithelial neoplasia without evidence of stromal invasion. Finally, the specimen was tested for human papillomavirus genotype, with a positive result for type 16. Cytologic diagnosis of intraepithelial lesions of undetermined grade present histologic outcomes that are statistically different from intraepithelial lesions of high and low grade, and are mostly associated with infection by high-risk human papillomavirus. This findings support retaining intraepithelial lesions of undetermined grade as a unique category in the Bethesda System, and define the management guidelines for this patients.

Ovarian cancer presents the highest mortality rate of all gynecological pathologies, since it is only diagnosed in an advanced stadium, when first symptoms appear. The study case represents a follow-up cytology, after a total hysterectomy for an undifferentiated ovary carcinoma. The cytological evaluation suggested an Adenocarcinoma, while the histological diagnosis of the nodular lesion revealed a relapse of Papillary Serous Ovarian Carcinoma. Performing the histological examination, in this and other cases, is a fundamental piece for the confirmation of the cytological diagnosis as well as for the differential diagnosis.

Portugal is the Western European country with the highest incidence rate of cervical cancer, being the Human Papillomavirus (HPV) infection its main cause. Cervical cytology is the most widely used screening method for the prevention and detection of cervical cancer, either by conventional means or by liquid basis. Conventional cytological preparations have more limitations than liquid-based preparations, however, when dealing with glandular lesions, both conventional and liquid-based cytology have some drawbacks. We report the case of a 31-year-old woman whose results from the screening cytology tests diverge from histological diagnosis. With this study we intend to highlight the limitations of conventional cytology in relation to the liquid-based cytology in the diagnostic of glandular lesions.

Introduction The breast is a glandular organ responsive to hormonal changes, therefore, according to the woman’s reproductive stage, the prevalence of different types of breast diseases varies. Breast cancer is the most prevalent (34,6%) in Portuguese women, its incidence has been rising and is most common in postmenopausal women (75%). However, younger women often present worst prognosis and more aggressive behaviour. Age, histological type and grade, axillary lymph node metastases and molecular subtypes are all important factors for therapeutic selection, patient’s follow-up and prognosis. Purpose The aim of this investigation was to correlate five variables: age, lymph node status, histological type-grade and molecular biomarkers, in women with breast lumps submitted to core biopsy of the breast and fine-needle aspiration cytology of the axillary lymph nodes. Materials and Methods The sample included 41 patients that were submitted to core biopsy of the breast and fine-needle aspiration cytology of the axillary lymph nodes. Breast tissue samples were stained with Hematoxylin-Eosin technique, which allowed the assessment of histological type and grade of the lesion. Besides that, immunohistochemistry techniques were performed, to evaluate the expression of estrogen and/or progesterone receptors, HER-2 and Ki67. In fine-needle aspiration cytology of the axillary lymph node, half of the slides were stained with May-Grünwald-Giemsa technique, and the other half with Papanicolaou technique. Fisher’s Exact Test was used with a confidence level of 95% and a p-value<0.05. Results It was ascertained a correlation between histological grade and molecular subtype (p-value=0.047), and between histological grade and the expression of Ki67 (p-value=0.004). There was no significant association between other variables. Conclusion In conclusion, it was established that there is a correlation between histological grade and the proliferative index and with the molecular subtype of the carcinoma.

Fibroadenoma and phyllodes tumor are the two main prototypes of breast fibroepithelial lesions. Fibroadenoma is the most common benign tumor in the female breast. The phyllodes tumor is rare and may have a benign, borderline or malignant character and in some cases may recur after excision and/or metastasize. Both neoplasms manifest clinically in the form of a breast lump. In their presence, the diagnostic approach currently adopted is the “Diagnostic Triad”, which includes clinical evaluation of the lump, imaging exams and fine needle aspiration. However, the clinical, mammographic, ultrasonographic and cytological features of fibroadenoma and phyllodes tumor may overlap. Due to the different clinical behavior and prognosis associated with these two entities, and consequently, different therapeutic approaches, their differential diagnosis is very important. Thus, it is essential to optimize existing methodologies and / or resort to other diagnostic methodologies in order to differentiate these two entities. This study was carried out with the objective of acquiring a clearer view of how the diagnosis of these two pathologies is performed, as well as highlighting the most relevant cytological and histological features, in addition to addressing other studied methodologies not yet used in the diagnosis

Neuroendocrine tumors of the cervix are extremely rare, so their diagnosis is difficult and sometimes confused with some other neoplastic entities. We present a case of a 43-year-old woman with complaints of uterine bleeding and fibroids, proposed for an elective hysterectomy, diagnosed in routine preoperative cytology, as Adenocarcinoma with no other specification. After a colpocytology with biopsy, a cervix neuroendocrine carcinoma was diagnosed, using complementary immunohystochemistry techniques. The patient experienced several treatments, having died about one year later, with metastatic disease.

Angiomyofibroblastoma-like tumor of male is an extremely rare benign mesenchymal tumor. It commonly occurs in middle-age and is mainly localized in the inguinoscrotal region. It is originated from perivascular stem cells and has the capacity of lipoid and myofibroblastic differentiation that may allow the observation of lipomatous differentiation. We report a case of lipomatous variant of angiomyofibroblastoma-like tumor of male using fine needle aspiration biopsy from the scrotal region of a 53 years-old man. Differential diagnosis could be a real bane for the pathologist in this particular variant. This diagnose should be kept in mind to prevent overlapping with the malignant lipomatous tumors.

Total hysterectomy is a very common surgical technique, that removes the cervix and should eliminate the presence of glandular cells in vaginal smears. However, this fact does not always happen.  In this study, it is related the case of a 49-year-old woman, hysterectomized 6 years before, which control vaginal smear presents ciliated cylindrical cells without atypia. The cytological diagnosis was the presence of ciliated cylindrical cells, which, with the clinical information provided, were suggestive of possible tubal prolapse. Subsequent histological study confirmed the suspected cytological diagnosis.

Metastasis of thyroid carcinoma comprise a low percentage of the total observed in the skullcap. We present a case of a 72-year-old female patient with an osteolytic lesion on the right frontal skullcap, subjected to a fine needle aspiration, whose diagnosis suggested thyroid tissue. On the thyroid ultrasound, a detected nodule was punctured, as well as the osteolytic lesion, whose cellular characteristics were similar, classifying the lesion as a follicular tumor. The patient underwent a total thyroidectomy, and her histological diagnosis was Follicular Carcinoma.

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