Comparsion of pathological differences between cervical high-grade intraepithelial lesions positive resection surgical margin after cold knife conization and hysterectomy / 临床与实验病理学杂志

Purpose To compare the pathological differences between cervical high-grade intraepithelial lesions (CHGIL) positive resection surgical margin after cold knife conization and total hysterectomy,and to explore how to take further clinical treatment measures.Methods The pathologic results of 74 patients with CHGIL positive surgical margin after cold knife conization and hysterectomy were analyzed retrospectively.Results There was a correlation between positive cervical incision margin and residual uterine lesion (P ＜ 0.01).Age,menopause status,gland involvement did not related to residual uterine lesions(P ＞ 0.05).There was significant correlation between the lesion-related quadrant and the residual rate of uterine lesion (P ＜ 0.01).Conclusion Cold knife conization and hysterectomy are safe and effective treatments for CHGIL.However,for the positive resection surgical margin after cold knife conization cases,hysterectomy should be carefully chosen and may choose conservative treatment or re-cone cutting.

Implications of continued upregulation of p16INK4a evolution from high-grade squamous intraepithelial lesion to invasive squamous carcinoma of the cervix

On integration into the host cervical keratinocyte genome, human papillomavirus (HPV) E7 protein binds pRB, releasing E2F from normally incompetent pRB-E2F complexes and allowing propagation of G1-S transition by the E2F. p16 INK4a, a tumour suppressor protein, increases in refl ex response to counter this. 29 histologically re-confi rmed low-grade squamous intraepithelial lesions (LSIL), 27 high-grade squamous intraepithelial lesions (HSIL) and 30 invasive cervical squamous carcinoma (SCC) were immunohistochemically stained for p16INK4a expression using the CINtec Histology Kit (REF 9511, mtm laboratories AG, Heidelberg, Germany) to re-affi rm the notion that integration of HPV occurs predominantly in SCC and possibly HSIL and less in LSIL and normal squamous epithelium (NSqE). Implicit was also the attempt to understand the role of E2F, as indicated by p16INK4a, in evolution of SCC from HSIL. No ethnic predilection was noted for LSIL, HSIL or SCC. Patients with SCC were signifi cantly older by about 14-years compared with HSIL (p<0.05) while there was no signifi cant age difference between HSIL and LSIL. p16INK4a expression was signifi cantly increased (p<0.05) in both HSIL (88.9%) and SCC (83.3%) compared with LSIL (3.4%) and NSqE (0%); the NSqE being normal squamous epithelium noted in 17 of the LSIL, 19 HSIL and 5 SCC. From these fi ndings there is suggestion that fundamental upstream events viz HPV integration, E7 upregulation followed by E2F activation occurs at point of transformation to HSIL and continues unrelentingly for another one to two decades before hitherto unclear factors convert a non-invasive lesion into an overtly invasive malignant counterpart. Interestingly, the occurrence of HSIL and LSIL in almost the same age group could mean that alteration from episomal to integrated form of HPV may not incur a prolonged incubation period, unlike from HSIL to SCC

Detección del virus papiloma humano: influencia del tipo de muestra y la severidad de la lesión intraepitelial cervical / Detection of human papillomavirus: the influence os sample type and severity od cervical intraepithelial lesion

Identificar la influencia del tipo de muestra y la severidad de la lesión, en la detección del ácido desoxirribonucleico del virus papiloma humano mediante reacción en cadena de polimerasa. Entre octubre 2008 y enero 2009, se seleccionaron 68 pacientes con diagnóstico histológico de lesión intraepitelial. Se realizó la detección del ácido desoxirribonucleico de virus papiloma humano a través de reacción en cadena de polimerasa, en muestra citológica e histológica de cuello uterino. Se analizaron los resultados agrupados según tipo de muestra (citológica o histológica) y tipo de lesión intraepitelial (alto o bajo grado). Servicio de Ginecología de la Maternidad "Concepción Palacios" La sensibilidad de la reacción en cadena de polimerasa para la detección del ácido desoxirribonucleico del virus papiloma humano en muestra histológica fue 92,98 por ciento, mayor que la citológica 72,06 por ciento (P < 0,05). La severidad de la lesión no afectó la capacidad global de detección de la prueba (P > 0,05). En lesiones de bajo grado la sensibilidad del extendido fue de 65 por ciento y la de la biopsia fue de 97,2 por ciento; mientras que en las lesiones de alto grado fue de 82,14 por ciento (extendidos) y 85,71 por ciento (biopsias). La severidad de la lesión intraepitelial (alto o bajo grado) no afecta la eficacia de la prueba para detectar el ácido desoxirribonucleico del virus papiloma humano. La detección fue más efectiva en muestras histológicas que en citológicas

Identify the influence of the kind of sample and the severity of the injury, to detect the desoxyribonucleic acid of the human papilloma virus using polymerase chain reaction. Between October 2008 and January 2009, 68 patients with histological diagnosis of intraepithelial lesion were selected, making detection of human papilloma virus desoxyribonucleic acid in polymerase chain reaction, in both, histological and cytological cervical sample. Analysed the results grouped by type specimen (cytological and/or histological) and type of lesion (high or low grade). Service of Gynecology of the Maternidad "Concepcion Palacios", The sensitivity of the polymerase chain reaction for the detection of human papilloma virus desoxyribonucleic acid in histological sample was 92.98 percent, higher than the cytological 72.06 percent (P < 0.05). The severity of the lesions didn’t afect the detection capability of polymerase chain reaction. (P>0.05). The sensitivity of the extended in low grade lesions was 65 percent and the biopsy was 97.2 percent; while in high-grade lesions was 82.14 percent (extended) and 85.71 percent (biopsies). The severity of intraepithelial lesion (high or low grade) does not affect the effectiveness to detect human papilloma virus desoxyribonucleic acid. Detection was more effective in histological samples than in cytological

Relación colpohistológica en lesiones de cuello de alto grado / Colpohistological relation in high-grade cervical lesions

OBJETIVOS: Analizar la relación entre los resultados citológicos, colposcópicos e histológicos en pacientes conizadas con asa diatérmica por Lesiones de Alto Grado (LAG) de cuello uterino; clasificar la población con lesiones de alto grado en cuello uterino según edad, paridad, antecedentes familiares e inicio de relaciones sexuales; determinar relación entre citología con lesiones de alto grado y la videocolposcopia; identificar proporción de pacientes con diferentes resultados anatomopatológicos en las citologías de LAG; evaluar la utilidad del uso del asa diatérmica en lo referente a los bordes de sección en los conos realizados, así como el resultado de la prueba citológica poscono.MÉTODOS: Se estudiaron 107 pacientes de la consulta de patología de cuello del hospital "Ramón González Coro" en el año 2006, cuyos resultados iniciales de la prueba citológica fue LAG, a dichas pacientes se les realizó conización por asa diatérmica como proceder diagnóstico y terapéutico previa realización de la videocolposcopia.RESULTADOS: Se detectó que el 67 % (72 casos) de las pacientes con resultados citológicos de LAG,presentaron algún hallazgo colposcópico anormal. De las pacientes conizadas el 84,2 % tenían bordes libres de lesión. Detectamos 3 cánceres cérvicouterinos y en el 31,7 % de los casos se demostró la presencia de lesiones de bajo grado (LBG) de cuello uterino. La citología con cepillado de canal a los 6 meses posteriores al proceder quirúrgico, resultó anormal solo en seis de dichas pacientes. Comprobamos relación citohistológica en el 50 % de los casos estudiados.CONCLUSIÓN: La conización con asa diatérmica, según nuestros resultados, es un proceder seguro, eficaz y con mínimas complicaciones, que evita el ingreso hospitalario, así como, los riesgos anestésicos y quirúrgicos de la cirugía convencional

OBJECTIVES: To analyze the relationship among the cytologic, colposcopic and histologic results in patients underwent conization with diathermic loop from high grade lesions (HGL) of cervix; to classify the populations with above mentioned high grade lesions according to age, parity, family backgrounds and the onset of sexual intercourses; to determine the relation between cytology with high grade lesions and the video-colposcopy; to identify the patient's ratio presenting with different anatomical-pathological results in HGL cytologies; to assess the profit of diathermic loop use concerning to section edges in the conization carried out, as well as the result of the post-conization first results. METHODS: A total of 107 patients were studied in the cervix pathology consultation of the "Ram¾n Gonzßlez Coro" Gynecology and Obstetrics Hospital in 2006 whose first results of cytology test were HGLs, they underwent conization with diathermic loop as diagnostic and therapeutical procedure before videocolposcopy. RESULTS: The 67 percent (72 cases) of patients with cytologic results of HGLs had some abnormal colposcopic finding. From the conization patients the 84.2 percent had lesion-free edges. There were three cervicouterine cancers and in the 31.7 percent it was demonstrated the presence of cervix low-grade lesions (LGL). The cytology with channel brushing at 6 months after surgical procedure, it was abnormal in six of such patients. Also, there was a cytohistological relationship in the 50 percent of study cases. CONCLUSION: The conization with diathermic loop according to our results is a safe, effective and with minimal complications procedure avoiding the hospital admission, as well as the anesthetic and surgical risks of conventional surgery