2007 Winter Meeting - London - The Pathological Society of Great ...

P53Audit of PPV of cervical biopsies: compliance with NationalGuidelines{P} S Deen, JR Patel, RH Hammond, D Nunns, KW WilliamsonNottingham University Hospital, Nottingham, United KingdomThe NHSCSP guidelines for colposcopy indicate that a biopsy should be carriedout unless an excisional treatment is planned, when the cytology indicatespersisting moderate dyskaryosis or worse. The clinical practice for colposcopydirected punch biopsies varies between submitting one pot with one or morebiopsies from the worst area (team 1) or submitting two pots from suspectedareas of CIN (team 2). Whilst the latter practice may show the distribution ofthe disease around the cervix, it also produces an extra specimen to be dealtwith by the department.Aim: Do we need to identify biopsy sites separately in different pots?Methods: We audited the reported data of cases received from January- March2006 for team 1 and from November 2005- March 2006 (team 2) that had morethan one pot. All cases followed by a LLETZ. Cases with one biopsy only fromteam 2 or without a following LLETZ were excluded. The PPV of CIN for thecervical smear and individual cervical biopsies (as biopsy one and biopsy two)has been calculated.Results: 70 cases fulfilled the stated criteria. Tabulated results bearing in minddifferent teams of reporting pathologists.ColposcopyPPVSmearPPVBiopsy 1PPVBiopsy 2PPVTeam 1 0.83 0.86 0.68 00Team 2 0.87 0.76 0.84 0.84P54Is Microscopic Examination of Hysterectomy SpecimensPerformed for Clinically Benign Disease Necessary?{P} TD Andrews, H MonaghanRoyal Infirmary of Edinburgh, Edinburgh, United KingdomIntroduction: The recent Royal College of Pathologists report “Histopathologyof Limited or no clinical value” raises the possibility that Pathologists’ timecould be saved by macroscopic examination only of hysterectomy specimensfor certain benign processes, however, the authors conclude that further study isneeded in this area. We present the results of an audit of 5 years experience ofhysterectomy specimens undertaken for clinically benign disease.Materials and Methods: The reports of all hysterectomy specimens removed forbenign disease, over a 5-year period, were reviewed and cases showing asignificant abnormality reviewed.Results: Of 851 cases, only 14 (1.6%) of these showed a significant unexpectedabnormality, including 2 invasive cancers and 7 cases of CIN. If hysterectomywas performed for menorrhagia and was macroscopically normal, or if thepatient had a normal smear history and a negative endometrial biopsy in the 12months prior to hysterectomy there were no significant unexpected findings.Discussion: Although the chance of finding an unexpected abnormality in ahysterectomy specimen for benign disease is low, 9 (1.1%) of cases did containeither pre-invasive or invasive disease, therefore we recommend that allspecimens should be examined microscopically, however, excessive blocktaking is unnecessary.Conclusion: 1) The PPV of both biopsies is the same suggesting that perhapsthere is no need to identify them separately.2) The inevitable question is that do we need a biopsy? This is considering that56 out of the total 120 cases were suspected high grade at colposcopy.3) Re-audit with independent review of the histological picture of the biopsiesand loops.P55Endometrial Small Cell Carcinoma With Endometrioid,Serous Papillary and Clear Cell Components{P} NP West, N WilkinsonSt. James' University Hospital, Leeds, United KingdomEndometrial carcinomas with a neuroendocrine small cell component arerare. These tumours may occur admixed with other components but to datethere is only one previous case report of a mixed serous papillary and small cellcarcinoma of the endometrium. We report a case of endometrial carcinomashowing mixed small cell, endometrioid, serous papillary and clear cellcomponents.The patient was a 69 year old female who presented with post-menopausalbleeding. A hysteroscopy was performed and histology of the curettingsrevealed an endometrioid adenocarcinoma with small foci of small cell andhigh grade serous carcinoma. She then proceeded to a staging laparotomy.Macroscopically the endocervix and uterine cavity were replaced bytumour. Microscopically the tumour was predominantly a small cell carcinomawith areas of moderately differentiated endometrioid, high grade serous andclear cell carcinoma. No sarcomatous elements were identified. There wasevidence of serosal involvement and vascular space permeation by mixedserous papillary and small cell carcinoma. Two out of ten lymph nodes showedmicroscopic deposits of pure serous papillary carcinoma.This unusual tumour is the first case report in the English literature of anendometrial small cell carcinoma admixed with endometrioid, serous papillaryand clear cell components.P56Stereological Analysis of Villous Trophoblast in Intra UterineGrowth Restricted Placentae{P} KL Widdows 1 , C Jayadewa 2 , JCP Kingdom 1 , PD Sibbons 1 ,TAnsari 11 Department of Surgical Research, NPIMR, Harrow, United Kingdom,2 Dept. Obs & Gyn, Mount Sinai Hospital, University of Toronto, Toronto,CanadaIUGR placentae are characterised by altered villous and vascular morphology.Alterations in the morphology of the villous membrane are yet to be describedfor IUGR placentae but it is hypothesised that altered trophoblast differentiationand proliferation may lead to perturbed maternofetal exchange and ultimatelycompromised fetal growth.Placentae samples were obtained uniform-randomly from preterm control (n=6)and preterm IUGR (n=6) pregnancies. 5µm and 25µm formalin-fixed paraffinembedded sections were stained with H&E. Stereological analysis includedvolume, total number and density estimates of cytotrophoblast andsyncytiotrophoblast nuclei for both study groups.Placental volume was significantly decreased in the IUGR group comparedwith controls (p=0.015). Significant reductions were observed for both thevolume (V) and total number (N TOT) of cytotrophoblast (p=0.009, p=0.004) andsyncytiotrophoblast nuclei (p=0.009, p=0.004) in the IUGR group whencompared with controls. The density of the cytotrophoblast andsyncytiotrophoblast remained unchanged in the IUGR group compared withcontrols.IUGR placentae exhibit unaltered functional intergrity in terms of membranemorphology and the reduction in the total number of trophoblast nuclei is likelydue to a smaller IUGR placentae.Winter Meeting (191 st ) 3–5 January 2007 Scientific Programme41