Investigator
Massachusetts General Hospital
On the new (version 9) American Joint Committee on Cancer tumor, node, metastasis staging for cervical cancer—A commentary
Recently, the American Joint Committee on Cancer (AJCC), in conjunction with the International Union Against Cancer, released an update of their TNM staging for cervical cancer (version 9). Not only does the new version allow for better alignment with the International Federation of Obstetrics and Gynecology (FIGO) system, but there are also important changes that serve to better allow for integration of parameters that clinicians need for management planning and prognosis. These changes are herein outlined in this concise commentary.
Challenging lesions in cervical cytology: The elusive HSIL
AbstractCervical cytology has been an integral part of cervical cancer screening since the mid‐20th century with the implementation of screening protocols utilising Pap testing. During that time, cervical cancer has gone from the leading cause of cancer deaths in women to not even appearing in the top 10 causes of US cancer deaths. However, despite its long and widespread use, cervical cytology remains a diagnostically challenging area in the practice of cytopathology. Of particular importance for diagnosticians is the accurate diagnosis of high‐grade squamous intraepithelial lesions (HSILs), given the significant risk of progression to invasive cervical cancer and the importance to patient management. Therefore, this review is presented in order to highlight the diagnostic features of HSIL, its various appearances, and important benign and neoplastic differential considerations with an emphasis on morphological clues that can aid in distinguishing between these different processes.
Cervicovaginal Papanicolaou tests in transgender men: Cytomorphologic alterations, interpretation considerations, and clinical implications
AbstractBackgroundThe transgender population faces unique psychosocial and physical obstacles to cervical cancer screening. Additionally, most individuals undergo masculinizing testosterone hormone therapy, and the physiologic changes can cause cytomorphologic alterations that may mimic lesions. Although the literature on cervicovaginal cytology is growing in this patient population, it is still limited.MethodsThe pathology information system was queried for all Papanicolaou (Pap) tests from transgender men from January 2013 to February 2023. The original diagnostic categories were catalogued. Cases were reviewed to evaluate the cytomorphologic alterations. Clinical data were also sought, including whether the sample was self‐collected. Two comparison groups were established: one was a postpartum atrophic group and the other was an all‐comer group.ResultsA total of 51 cases from 43 individuals were identified, with a mean age of 31 years. Approximately a third of cases (18 of 51; 35%) were self‐collected. The abnormal rate was low, with 5.9% of cases rendered atypical squamous cells of undetermined significance on original review and no lesions identified. The Pap unsatisfactory rate according to original reports was 3.9%. This increased to 13.7% when the cases were rereviewed, which was significantly higher than the all‐comer comparison group. The unsatisfactory rate did not correlate with self‐collection. Atrophy was a prevalent cytomorphologic alteration, with the vast majority of cases (92%) showing at least mild atrophy. Small blue cells and transitional cell metaplasia were seen in many cases (53% and 43%, respectively).ConclusionsThere are clinical and morphologic considerations that are distinct to the transgender patient population. Laboratory personnel and diagnosticians need to be aware of these in order to optimize patient care.
