Very early cytological and DNA-cytometric diagnosis of in situ carcinoma in an immunosuppressed liver transplant recipient

BACKGROUND: We describe a patient with an in situ carcinoma with the clinical presentation of an erythroplakia of the tongue in an area where DNA-aneuploidy was detected by means of exfoliative cytology (EC) and DNA-image-cytometry 32 months before. METHODS: Brush- and scalpel biopsies were obtained from a suspicious lesion of the right border of the tongue prior to scalpel biopsy. After Feulgen restaining of the specimens on glass slides, nuclear DNA-contents were measured using a TV image analysis system. RESULTS: A small reddish lesion of the tongue was diagnosed as malignant through EC and DNA-image-cytometry, whereas the synchronous histology from the same area showed only mild dysplasia. A subsequent scalpel biopsy 32 months after the first examination showed an in situ carcinoma. CONCLUSIONS: Non-invasive brush biopsies are of great importance for the very early identification of mucosal areas with a high risk for malignant transformation through cytological and DNA-cytometric examination.