Accuracy of visual inspection with acetic acid for cervical pathology screening in low cost setup

Background: Cancer cervix, a preventable disease continues to be a cause of great concern to women’s health, being associated with agonizing morbidity and high mortality. Approximately 493,100 new cases and more than 273,000 deaths occur each year, among women worldwide.IN India the screening is largely based on pap smear, which is cumbersome procedure due to transportation of samples and follow up of patients are not usually feasible. Visual inspection with Acetic acid (VIA) is simple and easy to teach procedure. Follow-up of patients usually doesn’t require.Methods: This study includes a total of 1000 patients who attended OPD of gynecology. Each patient is subjected to VIA examination. Biopsy is taken from women with abnormal findings on VIA. The objectives of this study were to evaluate the sensitivity and specificity and positive predictive value of inspection of cervix with acetic acid in precancerous lesions of cervix.Results: When biopsy is taken as reference standard, VIA has sensitivity of 97.7%, specificity of 76.6%, PPV of 62.9% and NPV of 98.5%. The accuracy rate for VIA is 84.8%.Conclusions: VIA is highly sensitive for diagnosis and treatment of cervical pathology at the same sitting. It can be done cost effectively in low resource set up.

Carcinoma epidermoide no queratinizante de células grandes y pequeñas en vagina / Large and small cells non-keratinizing epidermoid vaginal carcinoma

Se presentan 5 casos clínicos de pacientes atendidas en la consulta de patología de cuello del Hospital Provincial Ginecoobstétrico "Mariana Grajales Coello" de Santiago de Cuba por presentar sangrado vaginal, dolor en bajo vientre, leucorrea y lesiones vaginales. El estudio anatomopatológico confirmó el diagnóstico de carcinoma de células escamosas o epidermoide.

Five case reports of patients who were assisted at the cervix Pathology Department from "Mariana Grajales Coello" Provincial Gynecological Obstetrical Hospital in Santiago de Cuba due to vaginal bleeding, low abdominal pain, leukorrhea and vaginal injuries are presented. The pathological study confirmed the diagnosis of squamous or epidermoid cells carcinoma.

DNA Methylation Patterns of Ulcer-Healing Genes Associated with the Normal Gastric Mucosa of Gastric Cancers

Recent evidence suggests that gastric mucosal injury induces adaptive changes in DNA methylation. In this study, the methylation status of the key tissue-specific genes in normal gastric mucosa of healthy individuals and cancer patients was evaluated. The methylation-variable sites of 14 genes, including ulcer-healing genes (TFF1, TFF2, CDH1, and PPARG), were chosen from the CpG-island margins or non-island CpGs near the transcription start sites. The healthy individuals as well as the normal gastric mucosa of 23 ulcer, 21 non-invasive cancer, and 53 cancer patients were examined by semiquantitative methylation-specific polymerase chain reaction (PCR) analysis. The ulcer-healing genes were concurrently methylated with other genes depending on the presence or absence of CpG-islands in the normal mucosa of healthy individuals. Both the TFF2 and PPARG genes were frequently undermethylated in ulcer patients. The over- or intermediate-methylated TFF2 and undermethylated PPARG genes was more common in stage-1 cancer patients (71%) than in healthy individuals (10%; odds ratio [OR], 21.9) and non-invasive cancer patients (21%; OR, 8.9). The TFF2-PPARG methylation pattern of cancer patients was stronger in the older-age group (> or =55 yr; OR, 43.6). These results suggest that the combined methylation pattern of ulcer-healing genes serves as a sensitive marker for predicting cancer-prone gastric mucosa.

HPV type 18 is more oncopotent than HPV16 in uterine cervical carcinogenesis although HPV16 is the prevalent type in Chennai, India.

Context: The highest incidence of uterine cervical cancer in India is reported in Chennai. The prevalence and oncopotency are to be considered for the development of vaccines and therapeutic agents. Aims: The aim of the present study is to analyze the prevalence and oncopotency of high risk type HPV16 and 18 in cervical lesions. Settings and Design: This study is designed with 130 study subjects for analysis of selected types of HPV 6/11 and 16/18, in four groups, in a course of three years. The Bethesda system of classification is followed for grouping the samples, using histopathologic examination in biopsies. Materials and Methods: The biopsy samples were collected in 10% buffered formalin and were embedded in paraffin within 24 hours, for long-term preservation. The presence of HPV types were tested by PCR using type-specific primers for HPV16 and HPV18 in the DNA isolated from the subject's biopsies. The stages of cervical lesions were identified by histopathology using the Hematoxylin Eosin stain. Statistical Analysis Used: The data were subjected to statistical analysis, using the SPSS and INSTAT software packages for their associations and risk estimation, respectively. The Graph Pad Prism 2 x 2 contingency table was used for risk estimation and the Kruskel Wallis test was used for analysis of the associations. Results: In the study population, the data indicated a high prevalence of HPV 16. However, during the course of study (1999 - 2003), four (66.6%) dysplasia cases with HPV 18, three (21.4%) dysplasia cases with HPV 16, and none with low-risk HPV6/11, turned into invasive cancer, within one year. Conclusions: The observation of the study implied that HPV16 had a high prevalence in uterine cervical cancer compared with HPV18 cases. However, the development of invasive cancer from precancerous lesions was more for HPV18 infected cases than for HPV16 during the study period, which indicated the higher oncopotency of HPV type 18.

Predictive Factors of Residual Invasive Breast Cancer after Core Biopsy for Ductal Carcinoma in Situ / 한국유방암학회지

PURPOSE: We wanted to identify the clinicopathologic factors that predict the presence of invasive cancer after core biopsy for ductal carcinoma in situ (DCIS). METHODS: The patients diagnosed with ductal carcinoma in situ on core biopsy (stereotactic or ultrasound) from February 2003 to May 2007 were identified by retrospectively reviewing the collected data. We analyzed the demographic data, the characteristics on the imaging studies and the histologic features on DCIS. We assessed the factors that included age, the physical examination, the radiologic findings, the biopsy method, and the histologic findings related to the presence of invasive cancer after core biopsy. RESULTS: Fifty-one patients were diagnosed with DCIS after core biopsy. Of the 51 patients, 19 patients had invasive carcinoma diagnosed on final excision. The factors that correlated with invasion were the biopsy method, a palpable mass and a mammographic mass, regardless of calcification. A high nuclear grade, the comedo type, age, and the tumor size were not related to presence of invasive cancer. CONCLUSION: A mass lesion on mammography, a palpable mass, and 14G core needle biopsy were significant predictors of invasion in patients with ductal carcinoma in situ. Surgeons always recognize the possibility of invasive cancer in patients with ductal carcinoma in situ on the core needle biopsy.

Methylation Patterns of Tumor Suppressor Genes in Breast DCIS Tumors

PURPOSE: The methylation of tumor suppressor genes has been implicated in the development of breast cancer. However, the role of methylation in the progression of cancer is still unclear. In this study, the methylation stati of nine tumor suppressor genes (p14, p16, DAPK, E-cadherin, RASSF1 alpha, TWIST, RAR beta, HIN-1, cyclin D2) in normal, benign, DCIS and invasive cancer tissues were examined, and the methylation patterns in DCIS and hypermethylated genes investigated to see if a change in the methylation status would lead to the development of cancer and progression to an invasive tumor. METHODS: A total of 96 patients, who underwent surgery between March 2003 and March 2005, were retrospectively studied. DNA was extracted from tumor tissues, and the samples examined for aberrant hypermethylation using methylation-specific PCR (MSP). RESULTS: The total number of methylated genes in each tissue type (normal tissues; 2.97+/-1.74, benign tumors; 4.36+/-1.42, DCIS; 5.73+/-1.35, invasive cancers; 5.42+/-2.05) increased with tumor progression (P<0.001). In benign tumors, HIN-1 (83%) was the most frequently methylated gene, but in DCIS, p14 (100%), RASSF (100%) and TWIST (91%) were frequently methylated. In invasive cancer, RAR beta (60%) and p16 (37%) were frequently methylated compared to the other tissue types. In a multivariate study, TWIST was commonly hypermethylated in DCIS and invasive cancer; whereas, RAR beta and p14 were frequently independently hypermethylated in invasive cancers. CONCLUSION: Methylation induced gene silencing appears to affect multiple genes in breast tissues, which increases with cancer progression. TWIST was hypermethylated in both DCIS and invasive cancers; therefore, it was concluded that methylation of the TWIST promoter may be an early event in the development of breast cancer. The hypermethylations of RAR beta and p16 are useful marker for the progression of a DCIS lesion to invasive cancer. The methylation patterns of tumor suppressor genes in DCIS were similar to those found in invasive cancer, but also showed intermediate levels of methylation between benign tumors and invasive cancers.

Clinical Significance of Depressed-Type Colorectal Neoplasms Based on Growth and Development

A route of colorectal cancer development other than the adenoma-carcinoma sequence has recently become an issue due to the discovery of depressed-type early colorectal cancers. Moreover, the fact that some polyp-like cancers actually originate from depressed-type lesions has become obvious. Despite the protruding shapes of depressed-type early colorectal cancers, they probably have biological characteristics, which are different from those of the usual polyp lesions. We undertook this study to evaluate the clinical significance of depressed-type colorectal neoplasms. The authors recently experienced 87 cases of depressed-type colorectal neoplasms. Using Kudo's classification, we classified these 87 cases into three types based on their growth patterns, type IIc, type IIa + IIc, and type Is + IIc, and then analyzed these types on the basis of size, type, and submucosal invasion rate. The submucosal invasion rate of cancers of type IIa + IIc was significantly higher than that of type IIc (p < 0.05), and the rate for cancers of types IIa + IIc and Is + IIc together was significantly higher than that of type IIc (p < 0.05). However, no significant difference was found between the rates of types IIa + IIc and Is + IIc. In conclusion, the IIa + IIc and Is + IIc sub-types of depressed-type colorectal neoplasms, individually and together, have higher rates of submucosal invasion than type IIc lesions. Accordingly, type IIa + IIc and type Is + IIc must be differentiated from the usual polyps and should be managed cautiously, despite their protruding shapes.

Clinical Profiles and Survivals of 489 patients with Invasive Cancer of the Cervix ; A Review of One-year Experience / 대한산부인과학회잡지

OBJECTIVES: This non-randomized retrospective study was to investigate the clinical characteristics and to evaluate the actual 5-year survival rate of the patients with invasive cancer of the cervix. METHODS: 489 evaluable patients with invasive cancer of the cervix were treated at Korea Cancer Center Hospital from January to December 1992. In this retrospective study, we studied the clinico-pathologic characteristics(age, FIGO stage, histologic type, nodal metastasis) and treatment modalities by the review of medical records. Especially, the survival was confirmed by the support of the police and government office. RESULTS: The most common subsets of patients were found in the group of FIGO stage IIb(32.5%) and age between 51 and 60(33%). Surgery was the main treatment in stage Ib/IIa(65%) and radiation in stage IIb or more(97%). Nodal metastasis were surgically identified in 6% of stage Ib, 29% of stage IIa and 36% of stage IIb. Overall actual 5-year survival rate was 72.2%; stage Ia(100%), Ib(94%), IIa(82%), IIb(63%), IIIa(36%), IIIb(47%), and IV(0%). The five-year survival rate according to LN status in surgically confirmed FIGO stage Ib-II patients were 91.9% in negative patients and 73.1% in positive patients respectively. Five-year survival rate was significantly different according to stage(P < 0.02) and nodal metastasis(p < 0.01). However, age and histologic type did not show any significant differences in survival. CONCLUSION: Overall actual five-year survival rate of 489 evaluable patients with invasive cancer of the cervix who were treated at Korea Cancer Center Hospital from January to December 1992 was 72.2%. Five-year survival rate was different according to stage and nodal metastasis.

Submucosal Invasive Cancer in the Colon / 대한소화기내시경학회지

BACKGROUND AND AIMS: A superficially invasive cancer in the colon is considered a candidate for an endoscopic resection. Therefore, detecting a superficially invasive cancer and differentiating it from a massively invasive cancer is an important key in selecting proper treatment. In order to accomplish this purpose, exact knowledge of the characteristics of submucosal invasive cancers is required. In this study, attempts to define those endoscopic features and draw guidelines for treatment were made. METHODS: Recently, 23 submucosal invasive cancers were experienced. All of them were detected by an endoscopic examination, and were treated by endoscopic therapy and/or surgical resection. These cancers were reviewed and analyzed with emphasis on size, configuration, differentiation, and treatment. RESULTS: The most common sizes ranged from 10 mm to 19 mm (47.8%). There were two minute lesions below 5 mm. The most common type of lesions was sessile (43.5%). Most lesions showed redness and 60.9% showed hardness. Many cases had characteristic features such as nodules (47.8%), bleeding easily upon touch (39.1%), erosion (39.1%), and white spots (34.8%). Other characteristic features were expanded figures, depressions, and mucosal convergence. Moderately-differentiated adenocarcinomas were predominant (8/15, 53.3%), and there were four polypoid cancers (4/17, 23.5%). In 43.5% of the lesions, only endoscopic treatment was enough. Forty-four percent of all patients treated endoscopically needed additional surgical resections because of uncertainty with respect to complete excision of the cancer and/or a poorly-differentiated adenocarcinoma with lymphatic invasion. There was no lymph node metastasis in any of the patients who underwent surgical resections, and three of them had no residual tumors, as the endoscopic treatment had completely excised the cancer. CONCLUSIONS: Accurate information on submucosal invasive cancers and recognition of the endoscopic characteristics of submucosal invasive cancers are necessary for their detection and management in an early stage. Moreover, it is possible to differentiate superficially invasive cancers from massively invasive ones by their characteristic features. Therefore, in selected patients with superficially invasive cancers, surgical resections can be avoided.