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Cervical Dysplasia (cervical + dysplasia)
Selected AbstractsORIGINAL RESEARCH,SURGERY: Sexual Function after Loop Electrosurgical Excision Procedure for Cervical DysplasiaTHE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010Namfon Inna MD ABSTRACT Introduction., Loop electrosurgical excision procedure (LEEP) is an effective tool for management of cervical dysplasia. However, removal of a part of the cervix might have a negative impact on sexual function. Aim., To examine the effect of LEEP on overall sexual satisfaction and other specific aspects of sexual function in women with cervical dysplasia. Methods., Eighty-nine premenopausal women with cervical dysplasia who had undergone LEEP at least 3 months previously were interviewed once on post-LEEP follow-up visits with a questionnaire on pre- and post-procedural sexual function. Data on frequency of sexual intercourse, the presence of dysmenorrhea, dyspareunia, and postcoital bleeding were compared using the McNemar test. Data on specific aspects of sexual function rated by the 6-point Likert scale were analyzed using Wilcoxon signed ranks test. Main Outcome Measure., The main outcome is the overall sexual intercourse satisfaction. Results., The mean age was 41.7 years. The median interval from LEEP to the time of interview was 29.3 weeks. The time of resumption of sexual intercourse after LEEP was 8.1 weeks on the average. The changes in the frequency of sexual intercourse, dysmenorrhea, and dyspareunia after LEEP were not statistically significant. The changes in overall satisfaction, vaginal elasticity, and orgasmic satisfaction appeared statistically significant (P < 0.05). Conclusion., Having LEEP done along with other "non-surgical" parts of cervical pre-cancer management is associated with small but statistically significant decreases in overall sexual satisfaction, vaginal elasticity, and orgasmic satisfaction when interviewed near to the procedure at 29.3 weeks post-operation. However, the changes on other aspects of sexual function are insignificant. The LEEP procedure itself appears to have a minimal, if any, clinically important adverse effect on sexual function. Inna N, Phianmongkhol Y, and Charoenkwan K. Sexual function after loop electrosurgical excision procedure for cervical dysplasia. J Sex Med 2010;7:1291,1297. [source] Trials update in walesCYTOPATHOLOGY, Issue 2007A. Fiander Three ongoing studies will be presented and discussed. Prevalence of Human Papillomavirus Infection in a South Wales Screening population Methods: A total of 10 000 consecutive, anonymous liquid based cytology screening samples were collected over a five month period in 2004. Age, cytology result and social deprivation score was provided for each specimen. The methodology was chosen to ensure inclusion of all women attending routine cervical screening, avoiding potential constraints associated with obtaining individual informed consent. The liquid based cytology samples were processed and reported by the receiving cytology laboratory and the residual specimens sent to the HPV Research Laboratory, Wales College of Medicine, where they were processed and stored at -80°C until analysis. High risk and low risk HPV Typing was undertaken using PCR , EIA (Jacobs et al 1997). Full high risk typing was performed on HPV positive specimens. Results: The study population had a mean age of 38 years with 92% negative, 5% borderline and 3% dyskaryotic cytology. The average social deprivation score was 17.4 (based upon the Welsh Index of multiple deprivation). The following results will be presented: HPV prevalence by age. HPV prevalence by cytology result. Type specific HPV prevalence in single and multiple infection. Conclusion: This study represents the largest type specific HPV Prevalence Study in the UK to date. As such it will form a useful base line against which to access performance of marketed HPV tests and evaluating the impact following implementation of HPV vaccination. [Funded by Welsh Office for Research and Development] CRISP , 1 Study (Cervical Randomized Intervention Study Protocol -1) Background: Indole-3-carbinol (I3C) and Diindolylmethane (DIM) are found in cruciferous vegetables and have been identified as compounds that could potentially prevent or halt carcinogenesis. I3C spontaneously forms DIM in vivo during acid digestion. I3C has been shown to prevent the development of cervical cancer in HPV 16 transgenic mice and both I3C and DIM have been shown to promote cell death in cervical cancer cell models. DIM is the major active bi-product of I3C and preliminary data indicate that DIM is active in cervical dysplasia and may be better tolerated than I3C. Aim: To investigate chemoprevention of high grade cervical neoplasia using Diindolylmethane (DIM) supplementation in women with low grade cytological abnormalities on cervical cytology. Objectives: To observe any reduction in the prevalence of histological proven high-grade cervical intraepithelial neoplasia (CIN) after 6 months of supplementation. ,,To observe any reduction in the prevalence of cytological abnormalities. ,,To observe any changes in the clinical appearance of the cervix. To assess acceptability and monitor any side effects of DIM supplementation. ,,To assess whether any benefit is seen in relation to Human Papillomavirus (HPV) status including HPV Type, Viral load and integration. Methods: This is a double blind randomized placebo-controlled trial involving 600,700 women with low grade cytological abnormalities on a cervical smear. Randomization is in the ratio of 2 : 1 in favour of active medication. Women with first mildly dyskaryotic smear or second borderline smear are eligible. They are asked to take two capsules daily for 6 months. At the end of 6 months they undergo repeat cervical cytology, HPV testing and colposcopy. Results: A progress report will be given for this ongoing study. [Funded: - Cancer Research UK] Type Specific HPV Infection in Welsh Cervical Cancers Background: Whilst there have been numerous studies of HPV infection associated with cervical cancer and on prevalence of Human Papillomavirus in diverse populations there have been no studies of these variables in the same population. Against a background of prophylactic HPV vaccination it is important to assess potential protection against cervical cancer within a given population. The most comprehensive analysis of HPV type specific cervical cancer is a meta-analysis published by the IARC in 2003. This however included only three UK based studies, totalling 118 cases, 75 of which were only investigated by HPV type PCR for four high risk types. None of this data was presented with associated population based prevalence data. Therefore, the research objectives for this study in combination with the first study above, are as follows: To determine the frequency of specific HPV types in cervical cancers in Wales. To compare the distribution of specific HPV types amongst cervical cancers with their prevalence in the general population. This will allow accurate delineation of the relationship between prevalence of specific HPV types in the general population and their association with clinically relevant disease. This information is a pre-requisite to assess the potential impact of prophylactic vaccination against HPV infection in Wales. Methods: Welsh Cervical Cancer specimens from 2000,2005 will be identified from pathology departments within Wales. The pathology of each tumour will be reviewed by a single Gynaecological Pathologist. The age of the patient and pathological features of the tumour will be noted. DNA will be extracted from the paraffin sections and HPV typed by PCR-EIA. Results: A progress report will be given for this ongoing study. [Funded by Welsh Office for Research and Development] [source] ThinPrep Pap test of endocervical adenocarcinoma with lymph node metastasis: Report of a case in a 17-year-old woman,DIAGNOSTIC CYTOPATHOLOGY, Issue 9 2010David G. Wagner M.D. Abstract Endocervical adenocarcinoma is an uncommon malignancy that is composed of multiple subtypes and accounts for ,15% of all cervical cancers. In this article, we describe the cytomorphology and differential diagnosis of an AJCC clinical stage IIIb, FIGO IB2 endocervical adenocarcinoma in a 17-year-old woman in a ThinPrep Pap test. The patient was a 17-year-old G0P0 white woman with no significant past medical history and no prior history of cervical dysplasia. She presented to her physician with a putrid vaginal discharge. A sample was sent to cytology that was interpreted as atypical endocervical cells, favor neoplasia. A subsequent cervical biopsy was diagnosed as endocervical adenocarcinoma with villoglandular features and ultimately, a hysterectomy with lymph node dissection was performed. The final diagnosis was endocervical adenocarcinoma with metastasis to three pelvic lymph nodes. The cytomorphology of endocervical adenocarcinoma on ThinPrep Pap test is similar to that described for conventionally-processed Pap smears. This difficult diagnosis should be considered on a ThinPrep Pap test, regardless of age when the characteristic cytomorphology is observed. On a cytology sample, it is advisable to state atypical endocervical cells, adenocarcinoma in situ, or endocervical adenocarcinoma without providing a specific subtype even if there is a predominance of features for a particular subtype. Diagn. Cytopathol. 2010;38:633,638. © 2009 Wiley-Liss, Inc. [source] Human papillomavirus prevalence and cytopathology correlation in young Ugandan women using a low-cost liquid-based pap preparationDIAGNOSTIC CYTOPATHOLOGY, Issue 8 2010Janis M. Taube M.D. Abstract Screening for HPV-driven cervical dysplasia and neoplasia is a significant public health concern in the developing world. The purpose of this study was to use a manual, low-cost liquid-based Pap preparation to determine HPV prevalence in HIV-positive and HIV-negative young women in Kampala, Uganda and to correlate cervical cytopathology with HPV-DNA genotype. About 196 post-partum women aged 18,30 years underwent rapid HIV testing and pelvic examination. Liquid-based cervical cytology samples were processed using a low-cost manual technique. A DNA collection device was used to collect specimens for HPV genotyping. HIV and HPV prevalence was 18 and 64%, respectively. Overall, 49% of women were infected with a high-risk HPV genotype. The most common high-risk HPV genotypes were 16 (8.2%), 33 (7.7%), 35 (6.6%), 45 (5.1%), and 58 (5.1%). The prevalence of HPV 18 was 3.6%. HIV-positive women had an HPV prevalence of 86% compared to 59% in HIV-negative women (P = 0.003). The prevalence of HPV 16/18 did not differ by HIV status. HIV-positive women were infected with a significantly greater number of HPV genotypes compared to HIV-negative women. By multivariate analysis, the main risk factor for HPV infection was coinfection with HIV. HIV-positive women were four times more likely to have abnormal cytology than HIV-negative women (43% vs. 11.6%, P < 0.001). These data highlight that HIV infection is a strong risk factor for HPV infection and resultant abnormal cervical cytology. Notably, the manual low-cost liquid-based Pap preparation is practical in this setting and offers an alternate method for local studies of HPV vaccine efficacy. Diagn. Cytopathol. 2010;38:555,563. 2009 Wiley-Liss, Inc. [source] CD4+CD25hi regulatory T-cell frequency correlates with persistence of human papillomavirus type 16 and T helper cell responses in patients with cervical intraepithelial neoplasiaINTERNATIONAL JOURNAL OF CANCER, Issue 8 2007Johan W. Molling Abstract CD4+CD25hiCTLA4+FoxP3+ regulatory T cells (Treg) have been shown to maintain immune tolerance against self antigens and increased circulating frequencies have been reported in various types of cancers. Circulating invariant natural killer T-cells (iNKT) are reduced in cancer patients and low iNKT frequency is related to poor prognosis. It is not yet clear whether high Treg numbers and low iNKT cell numbers pose an increased risk for the progression of premalignant lesions or whether Treg and iNKT cell numbers are influenced by dysplasia. We therefore studied prospectively the relation between iNKT cell and Treg frequencies and the natural course of human papillomavirus type 16 (HPV16) induced pre-malignant cervical dysplasia in 82 patients who participated in a nonintervention cohort study of women with abnormal cytology. Treg frequencies were significantly increased in women who had persistent HPV16 infection. Within the HPV16 persistence group there was no difference in Treg frequencies among patients who developed a CIN3 lesion and patients who did not progress to CIN3. Furthermore, Treg frequencies were increased in patients who had detectable HPV16 E7 specific IL-2 producing T-helper cells, which suggests a causal role of HPV infection in Treg development in parallel with HPV16 specific T helper cells. No evidence was found for a role for iNKT cells in persistence of HPV16 and progression of HPV16 induced CIN lesions. However, HPV-persistence-associated Tregs may explain the inefficacy of concomitant persistence associated immunity and may contribute to subsequent progression to neoplasia. © 2007 Wiley-Liss, Inc. [source] Prevalence of Human Papillomavirus Infection and Its Correlation with Cervical Lesions in Commercial-Sex Workers in JapanJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2000Dr. Kazuhisa Ishi Abstract Objective: To investigate the prevalence of the human papillomavirus (HPV) infection and its correlation with cervical lesions in commercial-sex workers (CSWs) who attended a sexually transmitted disease (STD) clinic in an entertainment area in Tokyo. Methods: Surveys were conducted on 546 prostitutes and 233 control subjects. In all subjects, HPV detection was performed by the hybrid capture method. A cervical cytological examination was performed on 247 prostitutes and 233 control subjects. Results: The HPV-positive rates in the two periods of study were higher (p < 0.01) in CSWs than in the control subjects. When the cytological grades were examined according to HPV-positive rates, the proportion of cytologic Class IIIa to Class IV was significantly higher (p < 0.01) in the HPV-positive CSWs than in the HPV-negative CSWs or in the normal subjects. Conclusion: The high frequencies of HPV infection and cervical dysplasia in the CSWs in the present series might predict a higher risk of cervical cancer in this group of subjects. [source] Immunohistochemical expression of 14-3-3 sigma protein in various histological subtypes of uterine cervical cancersPATHOLOGY INTERNATIONAL, Issue 10 2004Takaaki Sano 14-3-3 sigma (,) has been a major G2/M checkpoint control gene and has demonstrated that its inactivation in various cancers occurs mostly by epigenetic hypermethylation, not by genetic change. In order to confirm 14-3-3, protein expression together with p16 and p53 in cervical cancers, immunohistochemistry was performed using various histological subtypes of cervical cancers and dysplasia. Strong and diffuse immunoreactivity for 14-3-3, was uniformly observed in all the cervical dysplasia (17/17) and squamous cell carcinomas (29/29) including human papillomavirus (HPV)-negative cases. Even in adenosquamous carcinomas and adenocarcinomas of the cervix, immunohistochemical expression of 14-3-3, was shown with relatively high frequency (13/15, 87% and 22/27, 81%). In the in situ hybridization study, mRNA of 14-3-3, was expressed in six of eight immunohistochemical-negative cases. Therefore, the undetectable expression of 14-3-3, protein in cervical cancers might, at least in part, be due to a proteolysis not epigenetic hypermethylation. It is of interest that cancers without 14-3-3, expression were predominantly those lacking HPV DNA, and that there were no cases with concomitant inactivation of 14-3-3, and p16 in the present study. These observations are consistent with the hypothesis that inactivation of either 14-3-3, or p16 has an effect equivalent to the expression of E6 and E7 oncoproteins of HPV. [source] ORIGINAL RESEARCH,SURGERY: Sexual Function after Loop Electrosurgical Excision Procedure for Cervical DysplasiaTHE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010Namfon Inna MD ABSTRACT Introduction., Loop electrosurgical excision procedure (LEEP) is an effective tool for management of cervical dysplasia. However, removal of a part of the cervix might have a negative impact on sexual function. Aim., To examine the effect of LEEP on overall sexual satisfaction and other specific aspects of sexual function in women with cervical dysplasia. Methods., Eighty-nine premenopausal women with cervical dysplasia who had undergone LEEP at least 3 months previously were interviewed once on post-LEEP follow-up visits with a questionnaire on pre- and post-procedural sexual function. Data on frequency of sexual intercourse, the presence of dysmenorrhea, dyspareunia, and postcoital bleeding were compared using the McNemar test. Data on specific aspects of sexual function rated by the 6-point Likert scale were analyzed using Wilcoxon signed ranks test. Main Outcome Measure., The main outcome is the overall sexual intercourse satisfaction. Results., The mean age was 41.7 years. The median interval from LEEP to the time of interview was 29.3 weeks. The time of resumption of sexual intercourse after LEEP was 8.1 weeks on the average. The changes in the frequency of sexual intercourse, dysmenorrhea, and dyspareunia after LEEP were not statistically significant. The changes in overall satisfaction, vaginal elasticity, and orgasmic satisfaction appeared statistically significant (P < 0.05). Conclusion., Having LEEP done along with other "non-surgical" parts of cervical pre-cancer management is associated with small but statistically significant decreases in overall sexual satisfaction, vaginal elasticity, and orgasmic satisfaction when interviewed near to the procedure at 29.3 weeks post-operation. However, the changes on other aspects of sexual function are insignificant. The LEEP procedure itself appears to have a minimal, if any, clinically important adverse effect on sexual function. Inna N, Phianmongkhol Y, and Charoenkwan K. Sexual function after loop electrosurgical excision procedure for cervical dysplasia. J Sex Med 2010;7:1291,1297. [source] HER2/neu (c-erbB-2) gene amplification and protein expression are rare in uterine cervical neoplasia: a tissue microarray study of 814 archival specimensAPMIS, Issue 10 2009IANA LESNIKOVA Published studies have reported widely variable incidence of HER2/neu (c-erbB-2) protein expression and HER2/neu (c-erbB-2) gene amplification in cervical carcinoma. We examined tissue microarrays (TMAs) constructed from 814 formaldehyde-fixed paraffin-embedded archival specimens of cervical intraepithelial neoplasia (CIN)1 (n = 262), CIN2 (n = 230), CIN3 (n = 186) and invasive carcinoma (n = 136), for HER2/neu protein expression by immunohistochemistry (IHC) and for HER2/neu gene amplification by chromogenic in situ hybridization (CISH). We found moderate or strong immunohistochemical positivity for HER2/neu in 64 of 814 specimens (7.9%). Using CISH, polysomy of the HER2/neu gene was detected in 87 cases (10.7%), low/borderline amplification in five cases (0.6%) and true amplification in four cases (0.5%). The correlation between IHC and CISH was statistically significant in CIN2, CIN3 and invasive cervical carcinoma specimens. When present, Her-2/neu positivity is more commonly seen in higher grades of cervical dysplasia and in carcinoma. However, this large TMA study shows that HER2/neu oncoprotein expression and HER2/neu gene amplification overall are uncommon events in cervical neoplasia. This provides compelling evidence that HER2/neu plays no major role in the development and progression of cervical neoplasia. [source] Outcome in women with no endocervical component on cervical cytology after treatment for high-grade cervical dysplasiaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Alice HUANG Background:, Cervical cancer and its precursors still remain an important cause of morbidity and mortality despite adequate screening programs. It is now established practice in Australia that a Pap smear without an endocervical component, which is otherwise negative, does not warrant an earlier repeat smear. This study aims to determine if the lack of an endocervical component in women with previously treated high-grade abnormalities of the cervix increases the risk of subsequent cytological abnormalities. Method:, Data were retrieved from an electronic database in the Oncology and Dysplasia Unit at The Royal Women's Hospital in Melbourne, Australia. Women who underwent treatment for high-grade cervical abnormalities from 2000,2004 were included in the study. Women with negative cytology immediately after their operations were first identified, and the incidence of subsequent cytological abnormalities was calculated and then separated according to their endocervical status. Results:, Of the 1260 women in the study population, seven developed high-grade abnormalities (six with an endocervical component and one without) and 107 developed low-grade abnormalities (98 with an endocervical component and nine without). Conclusion:, The lack of an endocervical component was not statistically significantly associated with a higher incidence of either high-grade or low-grade abnormalities. Therefore, women who have had previous treatments for high-grade abnormalities do not need to have earlier repeat smears or intervention if the cytology lacks an endocervical component. [source] Recurrence after treatment for high-grade dysplasia: Should we modify our post-treatment surveillance protocols?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2006Jonathan CARTER Abstract A cohort of women, having undergone an excisional procedure for high-grade cervical dysplasia, was studied to identify those patients who developed recurrent high-grade cervical dysplasia post-treatment. We have confirmed that recurrent histologically confirmed high-grade cervical dysplasia is uncommon after complete excision and appears not to occur within the first 6 months post-treatment. Post-treatment surveillance protocols should incorporate these findings. [source] Expression of FasL in squamous cell carcinomas of the cervix and cervical intraepithelial neoplasia and its role in tumor escape mechanism,CANCER, Issue 5 2006Ramy Ibrahim M.D. Abstract BACKGROUND To date, several mechanisms have been described by which malignant cells escape from the immune system. One of these is through the expression of FasL. The authors hypothesized that the Fas/FasL interaction enables cervical carcinoma cells to induce apoptosis of the cells of the immune system and thereby escape from them. METHODS The authors tested the expression of FASL on the surface of cervical carcinoma tissues. Next, they stained the same cervical tissues with anti-human leukocyte common antigen and TUNEL to identify apoptotic cells. An in vitro functional assay was then done to test if the FASL expressed on the surface of cervical carcinoma cell lines was or was not responsible for inducing apoptosis in T-cells. Finally, they compared the expression of FASL on normal and dysplastic cervical tissues. RESULTS Ninety-four percent of the cervical carcinoma tissues the authors tested expressed FasL and the majority of the apoptotic cells in the specimens were leukocytes with very few tumor cells. In the in vitro functional assay, only the Fasl expressing cell line and not the Fasl negative cell line was able to induce apoptosis of the Fas-expressing Jurkat cells. On examining the normal cervical tissues, the authors found that the expression of Fasl was confined to the basal cell layer with loss of expression observed in the suprabasal layers, which made it an immune privileged site. Conversely, there was persistent expression of FasL in the dysplastic layers in cervical dysplasia and squamous cell carcinoma specimens. CONCLUSIONS The findings of the current study support the authors' hypothesis that persistent expression of FasL plays a role in the ability of cervical carcinoma cells to escape from the immune system. Cancer 2006. Published 2006 by the American Cancer Society. [source] | |||||||||||||||||||||||||