[Reevaluation for overlooked signs of cervical smears in cases of uterine cervical adenocarcinoma].

Though the incidence of adenocarcinoma is not high, this cancer has been a matter for discussion on the grounds that mass screening frequently shows "false negative" cases. The purpose of this study was to clarify the factors which had caused a misdiagnosis through the re-investigation of patients' previous cervical smears. In spite of continuous smear tests at various intervals, there was a long delay in the diagnosis, ranging from 6 months to 5 years, in 14 patients out of 51 cases of cervical adenocarcinoma treated in our hospitals during the past 6 years. In 12 of these 14 cases a careful re-examination of previously overlooked smear preparations revealed definite signs of adenocarcinoma in most cases (86%). A cause of the delay in diagnosing adenocarcinoma seems likely to be related to cytological inspections rather than to the process of taking smears. Characteristics overlooked signs in the misdiagnosed smears were either "rosette-like" arrangements or "irregular clusters of sheet-like" arrangements. The rosette-like arrangements a pattern indicative of cervical adenocarcinoma, were found in 10 of the above cases (71%). The findings obtained suggest that for the diagnosis of cervical adenocarcinoma, cytological diagnosis by smear could be made even in the early pre-clinical stage and when cervical adenocarcinoma is suspected on a cytological basis in this stage, conization is also strongly recommended despite the punch biopsy.