Endometrial brush biopsy (Tao brush). Histologic diagnosis of 200 cases with complementary cytology: an accurate sampling technique for the detection of endometrial abnormalities

We examined 200 cases of endometrial brush biopsy (EBB) using the Tao brush and correlated findings with histologic findings from subsequent dilatation and curettage (D&C) or hysterectomy specimens. Diagnosis by EBB relied mainly on histologic evaluation of H&E-stained tissue sections and was complemented by additional cytologic smear examination. EBB correctly detected the following cases: endometrioid adenocarcinoma, 3; complex hyperplasia with atypia, 1; simple hyperplasia without atypia (SH), 2; and benign endometrium, 177. In 3 cases the diagnosis of atrophic endometrium was made by EBB; corresponding D&C specimens were nondiagnostic. Five cases of SH were interpreted by EBB as proliferative endometrium, and 13 endometrial polyps were not identified by EBB. Nine samples were nondiagnostic. Sensitivity and specificity were 100% for detecting atypical hyperplasia and carcinoma. However, it was difficult for EBB to distinguish SH from disordered proliferative endometrium or to diagnose endometrial polyps. We found that diagnosis by EBB is reproducible; a second pathologist blinded to histologic follow-up correctly identified all adenocarcinoma/atypical hyperplasia cases. EBB is an accurate, safe, and easy procedure that is well tolerated by patients and should be considered in the initial evaluation of high-risk outpatients.

Fine-needle aspiration cytology of well-differentiated inflammatory liposarcoma: a case report with histologic follow-up

Inflammatory liposarcoma is an unusual variant of well-differentiated liposarcoma. We report on the fine-needle aspiration (FNA) cytology findings of a retroperitoneal well-differentiated inflammatory liposarcoma from a 63-yr-old white female. The smears showed numerous dispersed inflammatory cells, with the majority being reactive lymphoid cells and plasma cells. There were scattered, large, atypical cells containing multiple or hyperlobated nuclei with coarse chromatin and abundant ill-defined cytoplasm. The large atypical cells, as well as the inflammatory cells, were also found within the fibrous tissue fragments. The follow-up surgical resection of the tumor demonstrated a well-differentiated inflammatory liposarcoma with coexistent dedifferentiated areas and lipoma-like, well-differentiated liposarcoma. With the appropriate anatomic and radiographic settings, the FNA cytology findings of abundant, reactive inflammatory cells and scattered, large, atypical tumor cells that are CD15-, CD30-, and cytokeratin-negative are highly suggestive of a well-differentiated inflammatory liposarcoma.

Postoperative granulomas of the endometrium: histological features after endometrial ablation

Postoperative granulomas of the male urogenital tract are a well-recognized phenomenon. Similar granulomas have also been described in the uterine cervix, fallopian tube, and other sites after various procedures, as well as in the endometrium after endometrial ablation procedures. Endometrial ablation is a procedure increasingly used by gynecologists to relieve symptoms associated with dysfunctional uterine bleeding. Occasionally, patients will not have a satisfactory result, and some will require subsequent hysterectomy. We describe the pathological findings in the hysterectomy specimens from 15 patients who had previously undergone endometrial ablation. Indications for subsequent hysterectomy included dysmenorrhea (7 patients), menorrhagia (7 patients), dysfunctional uterine bleeding (5 patients), and pelvic pain (4 patients). All patients had varying degrees of fibrosis of the endometrial cavity, with some endometrial cavities completely obliterated by fibrous tissue. Histological examination revealed fibrosis with varying degrees of granulomatous inflammation. The majority of the granulomas were associated with refractile brown hematoidin-like pigment, and most were also associated with uniform black pigment. In 8 cases, areas of faintly eosinophilic, homogenous, hyalinized material were present within the endometrium. Comparison is made to granulomas due to other causes, because the postoperative granulomas of the endometrium differ morphologically from granulomatous inflammation caused by other etiologies. As endometrial ablation gains popularity among gynecologists and their patients, it is likely that the practicing pathologist may encounter these sequelae with increasing frequency.

Performance of young calves fed soybean protein replacers

In two 12-wk trials we evaluated soybean protein in calf milk replacers. In trial 1, twelve 5-day-old Holstein calves were allotted randomly to three milk replacers. The diets contained 26% crude protein. In trial 2, 18 calves were used and the diet contained 30% crude protein. In trial 1 period 1 (10 to 15 days), mean coefficients of apparent digestibility (%) for milk protein, soy protein concentrate, and full fat soy flour replacers were dry matter 92.0, 70.0, 71.0; protein 90.1, 56.6, 61.3; fat 88.9, 55.0, 53.2;; and ash 85.8, 62.5, 61.2. Average daily nitrogen retentions were 10.8, -1.24, and -.7 g. Results in period 2 (30 to 35 days) for digestibilities and nitrogen retention showed considerable improvement over those in period 1. In trial 2 period 1, mean coefficients of apparent digestibility (%) for milk protein, soy protein concentrate, and defatted soy flour replacers were dry matter 87.5, 66.6, 47.9; protein 80.5, 57.2, 28.5; fat 81.5, 55.9, 33.5; and ash 83.8, 58.9, 48.4. Average daily nitrogen retentions were 10.8, 2.9, and -3.6 g. Results in period 2 for digestibilities and nitrogen retention also showed considerable improvement. Calves are able to use soy based replacers more effectively with age.