Correlación de resultados de los métodos diagnósticos de las patologías del cuello uterino en el Hospital "Camilo Cienfuegos" / Correlation of Diagnostic Methods Results of Cervical Pathologies at Camilo Cienfuegos Hospital

Introducción: El cáncer cérvico uterino es la segunda neoplasia más común en mujeres en el mundo. Una buena correlación entre las pruebas de tamizaje, diagnóstico y tratamiento de las lesiones cervicales optimiza su manejo, evita procedimientos innecesarios y maximiza recursos disponibles. Objetivo: Identificar la relación entre los métodos diagnósticos de las patologías del cuello uterino. Métodos: Se realizó un estudio observacional, descriptivo, transversal y prospectivo en el Hospital Provincial Camilo Cienfuegos de Sancti Spíritus, desde septiembre de 2015 a septiembre de 2017. Se tomó una población de 1172 pacientes de la consulta de patología de cuello uterino según los criterios de la investigación. Los métodos científicos fueron: de nivel teórico, empírico-experimental y matemático-estadístico. Se asumieron las variables: edad, factores de riesgo asociados, sintomatología, citología, colposcopia y biopsia. Resultados: El grupo de edad que con mayor frecuencia se presentó estuvo comprendido entre 26 y 35 años de edad. Los principales factores de riesgo asociados fueron: edad de inicio de las relaciones sexuales antes de los 18 años, virus del papiloma humano, paridad de más de dos hijos y antecedentes familiares de alguna patología de cuello. La sintomatología destacada fue el sangramiento poscoital e intermenstrual. Los resultados de los métodos diagnósticos fueron: virus del papiloma humano y displasia leve, tanto en la citología como en la biopsia, y lesiones de bajo grado en la colposcopia. Conclusiones: La asociación entre los métodos diagnósticos estudiados mostró una buena correlación citocolposcópica y colpohistológica, con diagnóstico de confirmación principalmente ante lesiones de alto grado(AU)

Introduction: Cervical cancer is the second most common neoplasm in women in the world. Good correlation between screening tests, diagnosis and treatment of cervical lesions optimizes management, avoiding unnecessary procedures and maximizing available resources. Objective: To identify the relationship between the diagnostic methods of cervical pathologies. Methods: An observational, descriptive, cross-sectional and prospective study was conducted at Camilo Cienfuegos Provincial Hospital in Sancti Spíritus, from September 2015 to September 2017. A population of 1172 patients was taken from the cervical pathology clinic according to the research criteria. The scientific methods were theoretical, empirical-experimental and mathematical-statistical. The assumed variables were age, associated risk factors, symptomatology, cytology, colposcopy and biopsy. Results: The age group that most frequently appeared was ages between 26 and 35 years. The main associated risk factors were age of first sexual intercourse before 18 years old, human papillomavirus, parity of more than two children and family history of some cervix pathology. The outstanding symptomatology was postcoital and intermenstrual bleeding. The results of the diagnostic methods were human papillomavirus and mild dysplasia, both in cytology and biopsy, and low-grade colposcopy lesions. Conclusions: The association between the diagnostic methods studied showed good cytocolposcopic and colpohistological correlation, with confirmation diagnosis mainly in cases of high-grade lesions(AU)

Arterioesclerosis de Monckeberg en vasos uterinos: un interesante hallazgo incidental / Arteriosclerose de Monckeberg nos vasos uterinos: um achado incidental interessante / Monckeberg arteriosclerosis in uterine vessels: an interesting incidental finding

Se realizó la comunicación de un caso clínico-patológico, diagnosticado en el Hospital Docente Clínico Quirúrgico "Joaquín Albarrán" de La Habana. En dicha entidad se presentó en una paciente femenina de 85 años de edad con antecedentes de diabetes mellitus tipo 2, ingresada por cuadro de insuficiencia arterial de miembro inferior izquierdo por lo cual se le realizan amputación supracondilia y al tercer día de su estadía hospitalaria, fallece. En la autopsia se arribó al diagnóstico anatomopatológico de arterioesclerosis de Mönckeberg de vasos del útero. Esta es una forma de arterioesclerosis muy relacionada con la senectud, pero factores de riesgo como diabetes mellitus y la enfermedad renal crónica pueden contribuir de forma directa en su desarrollo y progresión. Su diagnóstico es un hallazgo incidental en muestras histopatológicas(AU)

A clinical-pathological case was reported, diagnosed at the Joaquín Albarrán Clinical Surgical Teaching Hospital in Havana. In this entity, an 85-year-old female patient with a history of type 2 diabetes mellitus was presented, admitted due to arterial insufficiency of the lower left limb, for which she underwent supracondylar amputation and died on the third day of her hospital stay. At the autopsy, the pathological diagnosis of Mönckeberg arteriosclerosis of vessels of the uterus was reached. This is a form of arteriosclerosis closely related to old age, but risk factors such as diabetes mellitus and chronic kidney disease can directly contribute to its development and progression. Its diagnosis is an incidental finding in histopathological samples(AU)

Um caso clínico-patológico foi relatado, diagnosticado no Hospital de Clínica Cirúrgica "Joaquín Albarrán" em Havana. Nessa entidade, apresentou-se uma paciente de 85 anos, com história de diabetes mellitus tipo 2, internada por insuficiência arterial do membro inferior esquerdo, para a qual sofreu amputação aupracondiliana e faleceu no terceiro dia de internação. Na autopsia, o diagnóstico patológico da arteriosclerose de Mönckeberg de navios do útero foi conseguido. Essa é uma forma de arteriosclerose intimamente relacionada à velhice, mas fatores de risco como diabetes mellitus e doença renal crônica podem contribuir diretamente para seu desenvolvimento e progressão. Seu diagnóstico é um achado incidental em amostras histopatológicas(AU)

The Effect of Mesenchymal Stem Cells on Fertility in Experimental Retrocervical Endometriosis / O efeito das células-tronco mesenquimais na fertilidade em endometriose retrocervical experimental

Abstract Purpose To evaluate the effect of mesenchymal stem cells (MSCs) on fertility in experimental retrocervical endometriosis. Methods A total of 27 New Zealand rabbits were divided into three groups: endometriosis, in which endometrial implants were created; mesenchymal, in which MSCs were applied in addition to the creation of endometrial implants; and control, the group without endometriosis. Fisher's exact test was performed to compare the dichotomous qualitative variables among the groups. The quantitative variables were compared by the nonparametric Mann-Whitney and Kruskal-Wallis tests. The MannWhitney test was used for post-hoc multiple comparison with Boniferroni correction. Results Regarding the beginning of the fertile period, the three groups had medians of 14±12.7, 40±5, and 33±8.9 days respectively (p = 0.005). With regard to fertility (number of pregnancies), the endometriosis and control groups showed a rate of 77.78%, whereas the mesenchymal group showed a rate of 11.20% (p = 0.015). No differences in Keenan's histological classification were observed among the groups (p = 0.730). With regard to the macroscopic appearance of the lesions, the mesenchymal group showed the most pelvic adhesions. Conclusion The use of MSCs in endometriosis negatively contributed to fertility, suggesting the role of these cells in the development of this disease.

Resumo Objetivo Avaliar o efeito das células-tronco mesenquimais sobre a fertilidade na endometriose retrocervical experimental. Métodos Um total de 27 coelhas da raça Nova Zelândia foram divididas em três grupos: endometriose, em que os implantes endometriais foram criados; mesenquimal, em que as células-tronco mesenquimais foram aplicadas complementarmente à criação implantes endometriais; e controle, sem endometriose. O teste exato de Fisher foi realizado para comparar variáveis dicotômicas qualitativas entre os grupos. As variáveis quantitativas foram comparadas pelos testes não paramétricos de MannWhitney e Kruskal-Wallis. O teste de Mann-Whitney foi utilizado para a comparação múltipla pós-hoc com correção de Boniferroni. Resultados em relação ao início do período fértil, os grupos endometriose, mesenquimal e controle tiveram medianas de 14±12,7; 40±5; e 33±8,9 dias, respectivamente (p = 0,005). Sobre a taxa de fertilidade (número de gravidezes), os grupos endometriose e controle mostraram uma taxa de 77,78%, enquanto o grupo mesenquimal mostrou uma taxa de 11,20% (p = 0,015). Não foram observadas diferenças na classificação histológica de Keenan entre os grupos (p = 0,730). No que diz respeito à aparência macroscópica das lesões, o grupo mesenquimal mostrou maiores adesões pélvicas. Conclusão O uso de células-tronco mesenquimais na endometriose contribuiu negativamente para a fertilidade, sugerindo o papel dessas células no desenvolvimento da doença.

Deciduosis ulcerada y embarazo / Ulcerous deciduosis and pregnancy

Introducción: la deciduosis representa el cuadro colposcópico más peculiar del embarazo. El término indica una ectopia decidual Objetivo: presentar el caso clínico de una gestante con una lesión cervical que resultó una deciduosis tipo ulcerada. Resultados: mediante la colposcopia y posteriormente una biopsia por ponchamiento se confirmó el diagnóstico de deciduosis tipo ulcerada en gestante de 22,5 sem. Conclusiones: ante toda gestante con una lesión cervical sospechosa o no de malignidad, se puede utilizar la colposcopia como método diagnóstico, realizada por un personal entrenado y biopsia dirigida según el caso en particular

Introduction: The deciduosis is the more typical colposcopy picture of pregnancy. This term indicates a decidual ectopia. Objective: To present the clinical case of a pregnant presenting with a cervical lesion led to an ulcerated deciduosis. Results: By means of a colposcopy and later by a punch biopsy the diagnosis of ulcerated deciduosis was confirmed in a pregnant of 22.5 weeks. Conclusions: In front of that each pregnant with a cervical lesion suspected or not of malignancy, the colposcopy could be used as a diagnostic method provided that is performed by trained staff and a biopsy directed according to the case in particular

Algoritmos de derivación y confirmación diagnóstica de citología cervical atípica: desafíos para la actualización / Derivation algorithms for the clinical management of women with cytologic abnormalities

El Programa Nacional de Pesquisa y Control del Cáncer Cervicouterino de Chile ha contribuido al descenso sostenido de la mortalidad por cáncer de cuello uterino. Para la reducción de esta mortalidad ha sido fundamental la citología exfoliativa del cérvix, la que no está exenta de resultados inciertos. En este sentido, los frotis clasificados como atípicos se consideran ambiguos por la presencia de anomalías celulares de difícil determinación, lo que se traduce en un diagnóstico de probabilidad incierta. En la literatura nacional como internacional, se manifiesta un notorio interés por unificar la nomenclatura citológica cervical y los algoritmos de derivación y confirmación diagnóstica, para el manejo clínico de las mujeres con anomalías citológicas cervicales y lesiones precursoras de cáncer cervicouterino. Por lo anterior, se considera relevante los estudios que proporcionen evidencia clínica epidemiológica actualizada, que permitan optimizar el cumplimiento del Programa Nacional de Cáncer Cervicouterino, conducentes al logro de los Objetivos Sanitarios del período 2011-2020.

The National Research and Control of Cervical Cancer in Chile had contributed to the sustained decline in mortality from cervical cancer. The exfoliative cytology of the cervix has been to reduce this mortality, which is not without uncertain results. The smears classified as atypical are considered ambiguous by the presence of cellular abnormalities difficult to determine, resulting in a diagnosis of uncertain probability. The literature, both nationally and internationally, is widespread interest to unify the nomenclature cervical cytology and the support of the derivation algorithms for the clinical management of women with cytologic abnormalities cervical and cervical cancer precursor lesions. Therefore, it is relevant to perform studies the provide updated epidemiological clinical evidence, to optimize the performance of the National Program for the achievement of health objectives for the period 2011-2020.

Determinantes sociales del seguimiento y tratamiento de mujeres con PAP anormal en Avellaneda, Provincia de Buenos Aires / Social determinants of follow-up and treatment of women wiht abnormal PAP smear: a study in Avellaneda, Buenos Aires province

INTRODUCCIÓN: El adecuado seguimiento y tratamiento de las mujeres con lesiones precancerosas y cáncer es un importante problema de salud pública. OBJETIVO: El objetivo de esta investigación fue describir los factores que influyen en el proceso de atención de las mujeres con Pap anormal. MÉTODOS: Se realizó una investigación cuantitativa-cualitativa, con análisis de datos secundarios y de entrevistas a mujeres con Pap anormal que concurrieron a servicios públicos de salud y a los profesionales de salud de Avellaneda, provincia de Buenos Aires. RESULTADOS: De las mujeres entrevistadas, solo una había abandonado el proceso de atención. Casi el 50% había abandonado el servicio de origen y culminado su tratamiento en instituciones públicas de la Ciudad de Buenos Aires o en la obra social. Tanto los médicos como las mujeres señalaron obstáculos institucionales, como demoras en la entrega de resultados o cancelación de cirugías. Los facilitadores identificados fueron el buen vínculo con los profesionales, que localizan a las mujeres para la entrega de resultados y usan redes informales para acortar los tiempos de espera. CONCLUSIONES: Si bien en esta población las barreras mencionadas no llevaron al abandono del proceso, generaron situaciones que atentan contra el derecho de acceso a la atención de la salud. Las mujeres con lesiones precancerosas y cáncer están en una situación de extrema vulnerabilidad, por lo cual requieren de especial atención y de estrategias tendientes a facilitar su paso por el sistema de salud.

INTRODUCTION: Adequate follow-up and treatment of women with abnormal Pap smear is an important public health concern. OBJECTIVE: This research aimed to describe the determinants of follow-up and treatment of women diagnosed with an abnormal Pap smear. METHODS: A quali-quantitative research was performed. Information sources were medical records and questionnaires administered to women with an abnormal Pap smear that attended public health services, and to health professionals of Avellaneda in Buenos Aires province. RESULTS: Only one woman quit the follow-up and treatment. Almost 50% did not continue treatment at the same health service where they had the first Pap smear; they finished treatment in a public institution in Buenos Aires city or in a social security service. Results showed that both women and health professionals mentioned institutional obstacles, such as long waiting times and cancellation of surgeries. Positive aspects were attributed to a good doctor-patient relationship and to the behavior of professionals who track down women to give them the test results and who use informal networks to shorten waiting times. CONCLUSIONS: Although in this population the above mentioned barriers did not lead to treatment interruption, they proved to be detrimental to the right of women to access health services. Women with precancerous lesions and cancer are in a situation of extreme vulnerability, requiring a special attention and strategies geared to facilitating their passage through the health system.

Evaluación de la calidad citológica a través de tres espátulas para la toma del PAP / Evaluation of cytological quality in three different spatulas for PAP testing

Objetivo: identificar la espátula que presente el menor porcentaje de PAP “menos que óptimos”. Metodología: estudio transversal, cuya muestra fue de carácter intencional y estratificada proporcionalmente, constituida por 761 mujeres entre 25 años y 64 años de los consultorios del Servicio de Salud Metropolitano Norte (SSMN). A cada mujer se le tomó PAP por parte de las matronas del servicio utilizando una de tres espátulas: Ayre; espátula plástica y la combinación Citobrush – Ayre (C+A). Los PAP se clasificaron en “satisfactorios” o “menos que óptimos” según el Sistema Bethesda.Resultados: el mayor porcentaje de “menos que óptimas” (17,4 por ciento), se ubicó entre los 25 a 34 años de edad, y el mínimo -0,8 por ciento - entre los 55 a 64 años, siendo este resultado estadísticamente significativo (pvalue<0,000 Prueba Chi2). Al comparar la “calidad citológica” con cada una de las espátulas utilizadas se encontraron diferencias significativas (pvalue < 0,014). La combinación (C+A) y la espátula plástica tuvieron los menores porcentajes de “menos que óptimas” (9,8 por ciento y 10 por ciento, respectivamente) comparado con la espátula de Ayre (17,3 por ciento). Conclusión: La combinación (C+A) presentó el menor porcentaje de “menos que óptimos” y la mejor “calidad citológica”. La combinación (C+A) se comportó como un factor favorecedor de la “calidad citológica”. La mejor “calidad citológica” está asociada a las mayores edades con todas las espátulas utilizadas en este estudio.

Objective: Identify the spatula that achieves the lowest percentage of “less tan optimal” PAP smears.Methodology: Cross-sectional study, with an intentional and proportionally stratified simple, consistingof 761 women between 25 and 64 years of age, in the public health centers of the Northern Metropolitan Health Service. Midwives took the PAP sample from each women using one of the three spatulas: Ayre, a plastic spatula and the combination Citobrush-Ayre (C+A). (Fig 1, 2, 3). The PAP samples were classified as “satisfactory” or “less tan optimal” according to the Bethesda System. Results: The highest percentage of “less tan optimal” samples, (17.4%), was found in women between 25 and 34 years of age, and the minimum (0.8 per cent) in women from 55 to 64 years. This result was statistically significant (p value <0.000 Chi2). Comparing the “cytological quality” of each spatula, significant differences were also found (p value < 0.014). The combination (C+A) and the plastic spatula had lower percentages of “less than optimal” samples (9.8 per cent and 10 per cent, respectively) compared with the Ayre spatula (17.3 per cent). Conclusion: The combination (C+A) achieved the lowest percentage of “less than optimal” samples, and the best “cytological quality.” The combination (C+A) was a factor favoring “cytological quality.” The best “cytological quality” is associated with older age groups with all spatulas used in this study.

Seguimiento de mujeres con anormalidad citológica de cuello uterino, en Colombia / Following-up females having an abnormal Pap smear in Colombia

Objetivo Evaluar el acceso y la oportunidad al diagnóstico y al tratamiento que tienen las pacientes con lesiones cervicales de alto grado o cáncer de acuerdo con el reporte citológico, en Colombia entre junio 2005 a junio del 2006. Metodología Estudio retrospectivo mediante encuestas a una muestra de mujeres con anormalidad citológica residentes de cuatro departamentos de Colombia seleccionados por conveniencia en relación con diferentes tasas de mortalidad. Se realizó análisis descriptivo y se compararon las diferencias entre los departamentos. Resultados El 27 por ciento de las mujeres con lesiones de alto grado o invasoras no tuvieron acceso a alguno de los servicios diagnósticos o terapéuticos por razones de tipo administrativo de los servicios de salud, razones clínicas y culturales de las mujeres. Discusión Un elemento crítico que explica el bajo impacto en la mortalidad por cáncer de cuello uterino en la mayoría de los países de Latino América es la disociación entre actividades de tamización y las de tratamiento.

Objective Evaluating the opportunity and access to diagnosis and treatment for females having had an abnormal Pap smear (high-grade epithelial lesion and cervical cancer) in Colombia from June 2005 to June 2006. Materials and Methods This was a retrospective appraisal using a semi-closed survey of females having had an abnormal Pap smear with high squamous intraepithelial lesions or cervical cancer living in four Colombian departments. These areas were conveniently selected according to their different mortality rates. A descriptive analysis was made and the departments differences compared. Results It was found that 27 percent of females having high-grade squamous intraepithelial lesion or cervical cancer had no access to any of the diagnostic or therapeutic services. Health service administration problems and clinical and cultural ones affecting the females in the study could explain such results. Discussion Follow-up care after abnormal cytology was very poor and could explain the lack of cervical cancer screening impact in Colombia and in most Latin-American countries.

Factores de riesgo de alteraciones citológicas del cuello uterino en mujeres chilenas: Un estudio de casos y controles / Risk factors associated with abnormal cervical cytology among Chilean women: A case control study

Background: Cervical cancer is the third cause of cancer death among Chilean women, affecting mainly women from low socioeconomic status. Aim: To determine main risk factors (RF) including human papilomavirus (HPV) types associated with abnormal cervical cytology (Atypical Squamous Cells of Undetermined Significance or ASCUS) among Chilean women from low socioeconomic status in Santiago, Chile. Material and Methods: A random population based sample of616 women from La Pintana (a low-income district in Santiago) participated in 2001 in a HPV prevalence study and were re-evaluated in 2006 through a risk factors questionnaire, Papanicolaou test and DNA detection for HPV. The Papanicolaou test was analyzed in Santiago and HPV analysis (PCR_GP5+/GP6+) was conducted in Vrije University, Amsterdam. Cases included 42 women with cervical lesions and controls included 574 women with normal cytology during the period 2001-2006. Logistic regression with uni and multivariate analysis was performed to identify RF for cervical lesions. Results: During the study period, there was a significant increase in the proportion of single women, from 8.3 to 14.8 percent (p < 0.05), of women with 3 or more sexual partners from 8.9 to 13.3 and of women high risk HPV, from 9.1 to 14.3 percent. The proportion of abnormal Papanicolaou tests remained stable (3.08 and 3.9 percent > ASCUS). High risk HPV was the most significant factor associated with cervical lesions (odds ratio (OR) = 9.695 percent> confidence intervals (CI) = 4.4-21.1) followed by oral contraceptive use (OR = 2.58 95 percent> CI= 1.2-5.7). Among women infected by high risk HPV, the use of oral contraceptives was a risk factor while compliance with screening was protective for cervical lesions. Conclusions: From 2001 to 2006, there was an increase in the proportion of women with high-risk HPV infections.

A Conização como abordagem para lesões endocervicais / Conization as an approach for the treatment of endocervical lesions

O tratamento de lesões intra-epiteliais no colo uterino é fundamental para prevenção secundária do câncer invasor. Neste trabalho discute-se a abordagem adequada para tratar as lesões intra-epiteliais de alto grau em função de sua localização ecto ou endocervical. O procedimento eletrocirúrgico é uma opção equivalente a outras técnicas de conização do colo uterino; entretanto, apresenta a vantagem do baixo custo, a facilidade técnica e baixa morbidade do método. A caracterização colposcópica da lesão, quanto a localização, extensão e visualização é fator determinante para dimensionar o cone a ser excisado. As complicações provocadas pelos métodos excisionais estão relacionadas com o tamanho da excisão; por isto, determinar em cada paciente a extensão da excisão em função do comprometimento da ecto e endocérvice é uma abordagem correta no tratamento das lesões precursoras no câncer de colo uterino.

Patología de cuello uterino en adolescentes con vida sexual activa / Uterine cervical pathology in sexually active adolescents

Conocer la frecuencia de patología de cuello en las adolescentes que acudieron a la consulta de Ginecología Infantil Juvenil del Hospital "Dr. Domingo Luciani", durante el período septiembre 2001 a septiembre de 2002. Se realizó un estudio descriptivo, y prospectivo. La muestra estuvo constituida por 125 pacientes, con edades entre 14-19 años, la edad promedio fue 17,28 años. Las citologías reportaron inflamación inespecíficas (58.4%), inflamación específicas (32%) y de éstas el 57% presentó Garnerella, 25% Cándida, 12,5 Tricomona y 5% Leptotrix. 95 colposcopias fueron normales (76%), 12 (10%) insatisfactorias y 18 (14%) reportaron epitelio blanco. De 18 biopsias 14 no presentaron lesiones (78%) y 4 (22%) reportaron VPH, a éstas se les realizó PCR, siendo negativas. Las adolescentes representan un grupo de riesgo por lo que se deben establecer programa sanitario para despistaje de patología de cuello, programas escolares para evitar ETS y orientar a las pacientes de riesgo elevado para tener un adecuado control ginecológico.

Mast cell profile in uterine cervix.

Mast cell profile was studied in 50 neoplastic and 50 non-neoplastic conditions of the uterine cervix. The mean number of mast cells decreased to 44.8 in chronic cervicitis with ulceration, whereas the highest number of mast cells was observed in cervical polyp with a mean of 250. The mean number of mast cells was also higher in papillary endocervicitis (102.57) and chronic cervicitis (103.8). Mast cells were found in close proximity to the cervical glands and around blood vessels in non-neoplastic lesions. Mast cell count in carcinoma of cervix ranged from 0 to 210 per 10 HPF with a mean of 48.08. When the invasion by tumour was extensive the total count of mast cells was lower when compared to minimal invasion. The distribution of mast cells was found to be around the tumour deposits. Comparison of mast cell densities in neoplastic and non-neoplastic conditions revealed an increase in chronic inflammatory processes, while in cancers there was diminution in number or total absence of mast cells. There is no conclusive correlation between the age of the patients and the density of mast cells. An inverse relationship existed between the mast cell population and degree of anaplasia as well as of mitotic figures.

Hydatidosis of female genital tract: a case report.

Hydatidosis of female genital tract mostly occurs as secondary involvement and is very rare. A case of primary hydatid cyst of genital tract i.e., uterine cervix and parametrium in a fifty five year old lady is reported, who was admitted in hospital in emergency with acute retention of urine.

Melanosis of uterine cervix: a report of two cases.

Uterine prolapse is a common gynecological problem which is associated with complications like keratinisation, thickening and ulceration of cervical mucosal epithelium. Two cases of second degree uterine prolapse are being reported here showing heavy melanotic pigmentation of the basal layers of ectocervical epithelium. It appears to be a metaplastic change in response to local trauma or chronic irritation.

Implementation and evaluation of a national external quality control program for cervical cytology in Mexico

OBJECTIVE: To evaluate cytology laboratories and the performance of cytotechnologists for establishing efficient external quality control for Mexico's National Program for the Prevention and Control of Cervical Cancer. MATERIAL AND METHODS: During January and February 1998, an onsite evaluation of all cytology laboratories of the Ministry of Health found that only 70 of the microscopes were in adequate working conditions, reagents were out of date, and working conditions were sub-optimal. A program for external quality control based on proficiency testing was established for cytotechnologists. Fifty slide sets with 20 Papanicolaou slides and 10 photographic slides were prepared. The sets were given to the cytotechnologists for evaluation and again one year later by courier. RESULTS: Twenty-one percent of microscopes were repaired and 9 replaced; reagents were distributed and laboratory facilities improved. Only 16 of cytotechnologists passed the initial proficiency test. Cytotechnologists received a refresher training course: one year later 67 of them passed the proficiency test. To ascertain that each slide was correctly diagnosed, 41 sets were rescreened by expert cytopathologists or cytologists and their diagnoses compared to the original ones. Thirty-seven sets had 86 to 96 concordance. CONCLUSIONS: This new system for external quality control of cervical cytology allowed the opportune and reliable evaluation of the performance of cytotechnologists.

Isolated necrotising arteritis of the cervix and myometrium: a much neglected but puzzling entity.

Arteritis of the uterine cervix and corpus described here was an incidental finding at the routine histopathological examination of the hysterectomy specimen resected from a 62 year old female who underwent laparotomy for twisted ovarian cyst. Investigations and eleven months of follow up without any specific treatment for arteritis, have shown no systemic involvement. This case highlights that a knowledge of such isolated arteritis is of importance to the physician to avoid misdiagnosing it as polyarteritis nodosa and treat with systemic steroids.

Evaluation of 500 cases of Pap's test in Mymensingh.

Papaniculaou test (Pap's test) is a screening test for cervical pre-malignant and malignant lesions. A total of 500 cases of Pap's smear were examined in a private laboratory in Mymensingh during the period from May, 1997 to April 1998. The aim of the present study was to find out the patterns of cytologically detected lesions in these cases. The age of the case range from 17 to 65 years. Majority of the cases was in the age group of 21-30 years (53%). The pattern of cytologically detected lesion was as follows: within normal limit 13.8% (69), Chronic non-specific inflammation 82.8% (414), inflammation associated with Tricomonus vaginalis 1.6% (8), candidiasis 3.2% (16), Herpes simplex 0.6% (3), low grade squamous cells of undetermined significant (ASCUS) 0.6% (3), low grade squamous intraepithelial lesion (LSIL) 1.2% (6), high grade squamous intraepithelial lesion (HSIL) 0.6% (3), squamous cell carcinoma (SCC) 0.2% (1) and squamous metaplasia 1.4% (7).

Revisäo das alteraçöes citomorfológicas da infecçäo pelo vírus do papiloma humano em citologia cervicovaginal / Cytological effects of human papillomavirus infection in cervical smears: a review article

Os autores revisam os principais critérios propostos pela literatura para o diagnóstico da infecçäo pelo vírus do papiloma humano (HPV) em esfregaçös cervicovaginais. A evoluçäo do conhecimento sobre as lesöes pré-malignas escamosas do colo uterino, os diferentes tipos de hpv e a interligaçäo entre estas entidades resultaram em diversas mdificaçöes no conceito e na nomenclatura cito-histológica destas lesöes. No decorrer deste artigo de revisäo, estas informaçöes säo equacionadas, e validade da aplicaçäo de critérios para o diagnóstico indireto do HPV pelo citopatologista é discutida