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Biomedical subjects

M Hilgarth

Publications and source records attributed to M Hilgarth.

69 records · Page 4Linked to original sources
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Colposcopy, cervicography, speculoscopy and endoscopy. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: The colposcope was developed in 1925 and is well established in clinical gynecologic practice for defining and delineating cytologically detected lesions mainly of the cervix but also the vagina and vulva. Additionally, various endoscopic procedures in gastroenterology, pulmonary and urologic lesions enhance the cytologic detection and histologic verification of precancerous and cancerous lesions. The cost-effectiveness of all these devices and their applicability, particularly in countries with a limited health budget, is a major issue. This task force considered aspects of the present state of the art and the challenges in the 21st century. CONSENSUS POSITION: Automated cytology can interface with colposcopic examination in a number of significant ways. Automated cytologic analysis of conventional cervical smears can potentially direct colposcopic examination by predicting the nature of a lesion, assist in determining which patients should receive colposcopy and, in some settings, thereby reduce the number of colposcopies. Potentially, various combinations of automated cytology and colposcopy may be used to generate screening protocols that might result in more effective and inexpensive screening. The role of cervicography, or high-resolution cervical photography, as a screening device remains to be defined. Sensitivity for high grade lesions is generally no greater than that in cytology, and specificity appears lower. The interpretation of cervical photographs in triage of mildly abnormal cytology may prove to be useful in countries with established cytology programs. In areas of the world where cytology screening programs are not in place, the interpretation of cervical photographs may have its most dramatic effect. Cost-effectiveness analyses are needed. There are, at present, insufficient data for the evaluation of speculoscopy, a procedure using chemiluminescent illumination of the cervix for visualization of acetowhite areas. Basic training in colposcopy should be integrated into the residency programs of obstetrics and gynecology. Criteria for the adequate training of colposcopists should be developed. Continuing education programs in colposcopy should be developed when they are not already in existence. The cost-effectiveness of integrating colposcopy as a primary screening technique should be evaluated. Following a high-grade squamous intraepithelial lesion (HSIL) cytology result, colposcopically directed punch biopsy should be taken with or without endocervical curettage. This generally should precede the loop electrosurgical excision procedure (LEEP); however, in certain circumstances direct LEEP may be indicated. LEEP under colposcopic vision is an efficient way to treat an HSIL lesion of the cervix because the histologic extent and margins can be determined, unlike with laser surgery or cryosurgery. It is also more cost-effective than cold knife conization because general anesthesia and an operating room are unnecessary. Following LEEP, the endocervical canal should be examined colposcopically for any evidence of involvement. Lesions in the endocervix can then be removed with a different-shaped loop. Further research into Raman spectroscopy as a diagnostic aid in cervical pathology is needed, as is the use of micrococolpohysteroscopy for in vivo cytologic analyses, especially of the endocervical canal and transformation zone. Hysteroscopy is the most direct method for the diagnosis and treatment of intrauterine diseases. Hysteroscopic endometrial biopsy is more accurate than conventional biopsy methods. Cervical invasion of endometrial cancer can be detected by hysteroscopy. The depth of invasion, however, is more accurately determined by magnetic resonance imaging or computed tomography. ONGOING ISSUES: Many topics for ongoing research and/or implementation are mentioned under "Consensus Position," above. (ABSTRACT TRUNCATED)

Automation↗
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[An immunohistochemical study of the steroid hormone receptors in endometrial hyperplasia].

AIM: Evaluation of the estrogen and progesterone receptors (ER and PR) in different degrees of endometrial hyperplasias. METHODS: 10 cases of each degree of endometrial hyperplasia (simple, complex and atypical) were analyzed using the avidin-biotin-peroxidase technique and monoclonal antibodies applied to formalin-fixed, paraffin-embedded tissue. RESULTS: We found similar, high level of both ER and PR in simple and complex hyperplasias and a significant decrease of these in atypical hyperplasia. CONCLUSIONS: Endometrial hyperplasias develop in a setting of estrogen excess. This explains the high level of endometrial receptors and the response to progesterone in typical hyperplasia. In atypical hyperplasia, the decrease of steroid receptors results in a low sensibility of this lesion to progestative therapy, but there are cases with high receptor levels which could have a chance for hormonal therapy.

Biomarkers↗
PubMedDate not supplied

[p53 and steroid receptors support double endometrial carcinogenesis].

AIM: This study investigated the p53 positivity correlated with the receptor status, in different grades and stages of endometrial carcinoma. METHODS: The study included 88 endometrioid-type carcinomas and 5 non-endometrioid-type carcinomas. Paraffin sections were used for the ordinary histological diagnosis and for immunohistochemical diagnosis by avidin-biotin-peroxidase technique. RESULTS: p53 positivity was identified in 10 endometrioid-type carcinomas (11.4%) and 3 non-endometrioid type carcinomas (60%). Most of the p53 positive cases were receptor negative and observed in advanced stages and histological grades. No associated endometrial hyperplasia was p53 positive, while a positive intraepithelial non-endometrioid carcinoma was identified. CONCLUSIONS: p53 positivity is most frequently identified in non-endometrioid type, receptor negative adenocarcinomas, even in a precursor lesion as it is intraepithelial carcinoma, while in endometrioid, receptor positive carcinomas it appear in late stages of development, never being identified in precursor lesions.

Carcinoma↗
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Lymphocyte subpopulations in malignant ascites of serous papillary ovarian adenocarcinoma. An immunocytochemical study.

The aim of this study was to investigate lymphocyte subpopulations in 17 patients with malignant ascites due to serous papillary adenocarcinoma of the ovary. Eight patients had not been treated prior to the study whereas nine patients had been treated by surgery and chemotherapy. A panel of monoclonal antibodies against surface markers that correlate with the immune functions of the lymphocytes was used. The lymphocyte subpopulations were identified by the immunoperoxidase adhesive slide assay, and the results in treated and untreated patients were compared. Both groups of patients showed lymphocytosis (41 +/- 25% and 33 +/- 14% of the total cells, respectively). The untreated patients had a significantly higher proportion of B cells (14 +/- 4% of lymphocytes) than did treated patients (7 +/- 2%). No differences were found between both groups regarding the helper-inducer/suppressor-cytotoxic T lymphocyte ratio. The proportion of lymphocytes expressing interleukin-2-receptors was higher in treated patients (6 +/- 2%) than in untreated patients (1.2 +/- 1%). Both groups showed a high percentage of natural killer/cytotoxic cells (17 +/- 7% and 18 +/- 5%, respectively). In the only chylous effusion in this study, there was an increase in helper-inducer and activated T lymphocytes. Future studies are required to document whether surface marker analysis of lymphocytes in malignant effusions may be useful for assessment of the prognosis and the results of treatment.

Adult↗
PubMedDate not supplied

Malignant ascites of serous papillary ovarian adenocarcinoma. An immunocytochemical study of the tumor cells.

In 17 malignant peritoneal effusions due to papillary serous adenocarcinoma of the ovary, the reaction patterns of the tumor cells to monoclonal antibodies (MAbs) against surface antigens were studied and compared with the reaction patterns of mesothelial cells in the same effusions. The following surface markers were used with the adhesive slide method: epithelial membrane antigen (EMA), human epithelium-specific cell surface antigen (HEA-125), human endothelial antigen (BMA-120), carcinoembryonic antigen (CEA 3-13), an antibody against natural killer cells and cytotoxic cells (BMA-070), granulocyte antigen (Leu M1) and leukocyte antigen of class I (HLA-1). In all cases, from 30% to 95% of the tumor cells reacted with EMA and HEA-125. Tumor cells showed a positive staining with CEA 3-13 in only five cases. In all cases, from 75% to 95% of the tumor cells reacted positively with BMA-120. The reactivity of a few mesothelial cells with EMA and of all mesothelial cells with BMA-120 did not interfere with the identification of positive tumor cells since the reaction patterns were different. Interestingly, our study demonstrated that BMA-070, an MAb identifying natural killer cells and cytotoxic cells, is also a most useful tumor marker. The same was found to be true for Leu M1, an MAb originally thought to react only with granulocytes. The tumor cells showed a partial or total loss of the expression of HLA-1 reactivity. Since all cases were immunocytochemically positive for tumor cells while conventional cytology was positive in only 13 of the cases, the immunocytochemical analysis of malignant peritoneal effusions due to papillary serous adenocarcinoma of the ovary seems able to improve the cytologic diagnosis of the fluids.

Adenocarcinoma, Papillary↗
PubMedDate not supplied

DNA-cytometric diagnosis of prospective malignancy in borderline lesions of the uterine cervix.

Interactive DNA cytometry was used for the diagnosis of prospective malignancy in 48 smears with borderline lesions (mild and moderate dysplasias) of the uterine cervix. In addition, 183 smears with benign squamous epithelia, 38 with carcinoma in situ and 7 with invasive squamous carcinoma were also measured. Nuclear Feulgen-DNA measurements were performed using various methods, and the resulting data were analyzed by an algorithm for a DNA-cytophotometric diagnosis of malignancy. The results were compared with the data on follow-up and subsequent histologic studies in these cases. There was no false-positive diagnosis in the 183 benign smears and only 1 false-negative diagnosis in the 76 histologically proven squamous-cell carcinomas, which yields a specificity of 100% and a sensitivity of 98.6%. The sensitivity for the detection of subsequent histologically proven malignancy in cases with cytologically mild or moderate dysplasia amounted to 97%. In 13 borderline cases, there was a mean interval of 21 months between the taking of the cytologic smear on which the DNA diagnosis of malignancy was made and the date on which the histologic confirmation of malignancy was made. In 17% of the cytologically dysplastic cases, the DNA diagnosis of malignancy was not verified by subsequent histologic investigation. These results indicate that interactive DNA cytometry is able to detect prospective malignancy in smears from borderline lesions of the uterine cervix with a high sensitivity.

Carcinoma in Situ↗