Efectos de la enfermedad y tratamiento en la calidad de vida sexual de la mujer con cáncer cérvico uterino / Effects of the disease and treatment in the quality of sexual life of women with cervical uterine cancer

El cáncer cérvico uterino (CaCu) corresponde al 10% de los cánceres femeninos, se describe prevenible y con viabilidad de curación, no obstante, con la optimización de las terapias las sobrevivientes superan los cinco años en el 70% de los casos, evidenciando efectos adversos producto principalmente del tratamiento que deterioran la calidad de vida e impactan sobre su sexualidad. OBJETIVO: Identificar efectos de la enfermedad y tratamiento que comprometen la calidad de vida sexual de la mujer con CaCu. METODOLOGÍA: Revisión de artículos originales entre los años 2010 y 2019 desde las bases de datos Pubmed, Scopus, Scielo, Google Académico, Science Direct, Elsevier, Redalyc, Springer Link, Wiley Online Library, Dialnet y Ovid, seleccionando 51 artículos de 90 en inglés, español y portugués a texto completo, que reportaran efectos físicos y psicosociales que comprometieran la calidad de vida sexual de mujeres con CaCu. RESULTADOS: La sexualidad de estas mujeres es impactada por efectos físicos, relacionadas con el estadio de la enfermedad y tratamiento como dispareunia, anorgasmia, alteraciones digestivas, urinarias, insomnio, inapetencia, linfedema y neuropatía periférica. Desde el ámbito psicosocial manifiestan efectos sobre su autoestima, depresión e inseguridad en la permanencia del vínculo de pareja. Emerge la comunicación sexual de pareja como condición categórica en el nivel de afectación de la calidad de vida sexual. CONCLUSIONES: la sexualidad de la mujer con CaCu está comprometida por efectos físicas y psicosociales secundarias principalmente al tratamiento recibido. La comunicación sexual de pareja surge como interviniente para superar estos efectos y debe considerarse en la atención profesional.

Cervical uterine cancer (CaCu) corresponds to 10% of female cancers, it is described as preventable and with viability of cure, however, with the optimization of therapies the survivors exceed five years in 70% of the cases, evidencing adverse effects mainly due to the treatment that deteriorates the quality of life and impact on their sexuality. OBJECTIVE: To identify the effects of the disease and treatment that compromises the quality of sexual life of women with CaCu. METHODOLOGY: Review of original articles between 2010 and 2019 from Pubmed, Scopus, Scielo, Google Scholar, Science Direct, Elsevier, Redalyc, Springer Link, Wiley Online Library, Dialnet, and Ovid databases, selecting 51 articles out of 90 in English, Spanish, and Portuguese in full text, which reported physical and psychosocial effects that compromises the quality of sexual life of women with CaCu. RESULTS: The sexuality of these women is impacted by physical effects, related to the stage of the disease and treatment, such as dyspareunia, anorgasmia, digestive and urinary disorders, insomnia, inappetence, lymphedema and peripheral neuropathy. From the psychosocial perspective, they show effects on their self-esteem, depression and insecurity in the permanence of the couple's relationship. Sexual communication between couples is emerging as a categorical condition in the level of affectation of the quality of sexual life. CONCLUSIONS: The sexuality of women with CaCu is compromised by physical and psychosocial effects mainly secondary to the treatment received. Couple's sexual communication emerges as an intervention to overcome these effects and should be considered in professional care.

Sexually transmitted infections detected by multiplex real time PCR in asymptomatic women and association with cervical Intraepithelial neoplasia / Infecções sexualmente transmissíveis detectadas por PCR multiplex em tempo real em mulheres assintomáticas e associação com neoplasia intraepitelial cervical

Abstract Objective To determine the frequency of sexually transmitted infections (STIs) in asymptomatic women and the association of STIs with cervical intraepithelial neoplasia (CIN). Methods A cross-sectional studywas performed, enrollingwomen examined in a general gynecology clinic and in a colposcopy referral center fromOctober 2014 to October 2015. The colposcopy groupconsisted of 71women, and the general gynecologygroupconsisted of 55 women. Cervical samples were collected for cervical cytology and a multiplex realtime polymerase chain reaction (PCR) was developed to detect human papillomavirus (HPV) and the STIs caused by the following microorganisms: Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, and Neisseria gonorrhoeae. A multivariate analysis was performed by logistic regression, considering the significance level of 0.05. Results The general frequency of STIs was: 46.8% (HPV); 27.8% (C. trachomatis); 28.6% (M. genitalium); 0.8% (M. hominis); 4.8% (U. urealyticum); and 4.8% (N. gonorrhoeae). The significant risk factors for CIN were: HPV infection (odds ratio [OR] = 2.53; p = 0.024); C. trachomatis (OR = 3.04; p = 0.009); M. genitalium (OR = 2.37; p = 0.04); and HPV and C. trachomatis coinfection (OR = 3.11; p = 0.023). After the multivariate analysis, a significant associationwas found betweenHPVand CIN(OR = 2.48; 95% confidence interval [95%CI]: 1.04-5.92; p = 0.04); and between C. trachomatis and CIN (OR = 2.69; 95%CI: 1.11-6.53; p = 0.028). Conclusion The frequency of STIs was high in asymptomatic patients. Infections by HPV and C. trachomatis were independently associated with the presence of CIN. The high frequency of STIs in asymptomatic women suggests the need for routine screening of these infections.

Resumo Objetivo Determinar a frequência de infecções sexualmente transmissíveis (ISTs) em mulheres assintomáticas e a associação destas infecções com a neoplasia intraepitelial cervical (NIC). Métodos Foi realizado um estudo transversal recrutando mulheres atendidas em uma clínica ginecológica geral e em um centro de referência para colposcopia, de outubro de 2014 a outubro de 2015. O grupo de colposcopia consistiu de 71 mulheres, e o grupo de ginecologia geral consistiu de 55 mulheres. Amostras cervicais foram coletadas para citologia cervical e uma reação em cadeia de polimerase (RCP) multiplex em tempo real para detecção do vírus do papiloma humano (HPV) e das ISTs provocadas pelos seguintes micro-organismos: Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum e Neisseria gonorrhoeae. Foi realizada uma análise multivariada por regressão logística, considerando-se o nível de significância de 0,05. Resultados A frequência geral de ISTs foi: 46,8% (HPV); 27,8% (C. trachomatis); 28,6% (M. genitalium); 0,8% (M. hominis); 4,8% (U. urealyticum); e 4,8% (N. gonorrhoeae). Os fatores de risco significantes para NIC foram: infecção pelo HPV (razão de probabilidades [RP] = 2,53; p = 0,024); C. trachomatis (RP = 3,04; p = 0,009); M. genitalium (RP = 2,37; p = 0,04); e coinfecção por HPV e C. trachomatis (RP = 3,11; p = 0,023). Após a análise multivariada, foi encontrada uma associação significante entre HPV e NIC (RP = 2.48; intervalo de confiança de 95% [IC95%]: 1,04-5,92; p = 0,04) e entre C. trachomatis e NIC (RP = 2,69; IC95%: 1,11-6,53; p = 0,028). Conclusões A frequência de ISTs foi alta em mulheres assintomáticas. Infecções por HPV e C. trachomatis foram independentemente associadas com a presença de NIC. A alta frequência de ISTs em mulheres assintomáticas sugere a necessidade de rastreamento rotineiro dessas infecções.

Cryptococcus laurentii fungaemia in a cervical cancer patient

ABSTRACT Infections caused by emerging Cryptococcus non-neoformans species are being reported with increasingly frequency. Here, we present a case of fungaemia byCryptococcus laurentii in a woman receiving aggressive immunosuppressive therapy for cervical neoplasia. Three venous blood samples were aseptically collected on consecutive days and C. laurentiiwas isolated and identified through phenotypic and molecular methods. After central venous catheter removal and appropriate antifungal therapy, the patient showed significant improvement and blood culture became negative. Thus, patients following immunosuppressive therapies and using invasive medical devices are at risk of C. laurentii blood infections.

Prevalência da lesão HPV induzida em canal anal de mulheres com neoplasia intraepitelial cervical 2 e 3: um estudo de corte transversal / Prevalence of HPV-induced lesions in the anal canal among women with cervical intraepithelial neoplasia 2 and 3: cross-sectional study

OBJETIVO: Determinar a prevalência da lesão anal induzida por HPV em mulheres com neoplasia intraepitelial cervical grau 2/3 (NIC2/3).MÉTODOS: Estudo transversal, realizado no período de dezembro de 2008 a junho de 2009, no Estado de Pernambuco, nordeste do Brasil. Foram incluídas no estudo apenas mulheres com diagnóstico de NIC2/3 confirmado por biópsia e excluídas aquelas que não realizaram exame na primeira visita. As amostras para identificação do DNA de HPV anal por PCR e citologia anal foram coletadas com escovinha endocervical. A biópsia anal foi realizada nos casos de citologia anal anormal ou alterações maiores na anuscopia de alta resolução (AAR).RESULTADOS: Das AARs, 32,1% (n=37/115) foram normais e 63,5% (n=73/115) exibiram epitélio acetobranco. Vinte e dois por cento das citologias anais (n=26/115) foram anormais. Dentre elas, 12,2% (14/26) corresponderam à lesão intraepitelial anal de baixo grau e 3,4% (n=4/26), a lesão intraepitelial anal de alto grau. Foram realizadas 22 biópsias, das quais 13,7% (n=3/22) tiveram diagnóstico de neoplasia intraepitelial anal (NIA2) e 9% (n=2/22), NIA 3. Identificou-se 72,1% (n=83/115) de DNA do HPV nas amostras.CONCLUSÃO: Mulheres com NIC2/3 apresentam elevada prevalência de infecção por HPV e lesão HPV induzida em canal anal.

PURPOSE: To determine the prevalence of HPV-induced lesions in the anal canal of women with cervical intraepithelial neoplasia (CIN) grade 2/3.METHODS: A cross-sectional study was carried out from December 2008 to June 2009, in Pernambuco, northeastern Brazil. Only women with grade 2/3 CIN were included, and those who could not undergo anoscopy during their first visit were excluded. A cyttobrush was used for sample collection in order to identify HPV DNA through PCR and anal cytology. An anal biopsy was obtained in cases of abnormal anal cytology or major alterations in high resolution anoscopy (HRA).RESULTS: Thirty-two percent (n=37/115) of HRA were normal and 63.5% (n=73/115) showed acetowhite epithelium. Twenty-two percent (n=26/115) of anal cytologies were abnormal. Among the latter, 12.2% (n=14/26) were low-grade anal intraepithelial lesions and 3.4% (n=4/26) were high-grade anal intraepithelial lesions. Twenty-two anal biopsies were performed, 13.7% of which (n=3/22) were grade 2 anal intraepithelial neoplasia (AIN2) and 9% (n=2/22) were grade 3 AIN. Th HPV DNA was identified in 72.1% of cases (n=83/115).CONCLUSION: Women with CIN grade 2/3 showed a high prevalence of anal HPV infection and HPV-induced lesions.

Prevalência de infecção cervical por papilomavírus humano e neoplasia intraepitelial cervical em mulheres HIV-positivas e negativas / Prevalence of cervical infection by human papillomavirus and cervical intraepithelial neoplasia in HIV-positive and negative women

OBJETIVO: Realizar estudo comparativo entre mulheres positivas e negativas para o vírus da imunodeficiência humana (HIV), analisando: prevalência de neoplasia intraepitelial cervical (NIC) e infecção cervical pelo papilomavírus humano (HPV); risco viral e relação com desenvolvimento de NIC; parâmetros sociodemográficos e de comportamento que influenciaram na presença de infecção cervical por HPV e NIC. MÉTODOS: Estudo comparativo entre mulheres positivas e negativas para o HIV, sendo analisadas, respectivamente, 202 e 171 mulheres para avaliar a prevalência de NIC e 164 e 100 mulheres para avaliar a prevalência de infecção cervical pelo HPV. Em todas as consultas foram realizados: coleta de amostras cervicais para realização de citologia oncótica e reação em cadeia da polimerase (PCR) para detecção do DNA-HPV; colposcopia; questionário padronizado para coleta de dados demográficos/comportamentais; biópsia de todas as alterações colposcópicas. O exame histopatológico foi o padrão-ouro para o diagnóstico de NIC. RESULTADOS: A prevalência de NIC foi de 2,4 e 15,3% (p<0,001) e de infecção cervical pelo HPV foi de 37,1 e 55,5% (p=0,002), respectivamente, nas negativas e positivas para o HIV. As soropositivas tiveram mais infecção por HPV de alto risco (35,7 e 23,6%; p=0,02) e por múltiplos tipos (6,2 e 0%). O HPV 16 foi o tipo prevalente, ocorrendo em 11,3 e 10,2% das positivas e negativas para o HIV e também nas mulheres que tiveram NIC nos dois grupos. Os fatores associados ao desenvolvimento de NIC foram: infecção pelo HIV (HT=4,64; IC95% 2,23-9,65), idade (HT=0,95; IC95% 0,93-0,98 para cada ano de vida) e estado civil (HT=0,49; IC95% 0,30-0,80). Os fatores associados à infecção pelo HPV foram: presença do HIV (HT=2,72; IC95% 1,77-4,17), maior número de parceiros sexuais (HT=1,87; IC95% 1,23-2,84), idade (HT=0,97; IC95% 0,95-0,99 para cada ano de vida) e estado civil (HT=0,65: IC95% 0,42-1,0 para união estável/viúvas). CONCLUSÃO: A ...

PURPOSE: To conduct a comparative study between two groups of women (HIV positive and negative) analyzing: the prevalence of cervical intraepithelial neoplasia (CIN) and cervical HPV infection; viral risk and relationship with development of CIN; and sociodemographic and behavioral parameters that influence cervical HPV infection and the development of CIN. METHODS: A cross-sectional study in which 202 HIV-positive women and 164 HIV-negative women were analyzed to assess the prevalence of CIN and 171 HIV-positive women and 160 HIV-negative women were analyzed to assess the prevalence of cervical HPV infection. The following procedures were performed on the occasion of each medical visit: collection of cervical samples for cytology and polymerase chain reaction (PCR) to detect HPV DNA; colposcopy; standardized questionnaire to collect demographic and behavioral data; and biopsy of all colposcopic changes. Histopathology was the gold standard for the diagnosis of CIN. RESULTS: The prevalence of CIN was 2.4 and 15.3% (p<0.001) and the prevalence of cervical HPV infection was 37.1 and 55.5% (p=0.002), respectively, among HIV-negative and -positive women. HIV-positive women had a higher risk of HPV infection (35.7 and 23.6%) (p=0.02). HPV 16 was the most prevalent virus type, occurring in 11.3 and 10.2% of HIV-positive and negative women and was also more prevalent among women presenting CIN in both groups. Factors associated fwith the development of CIN were: HIV infection (HT=4.64; 95%CI 2.23-9.65), age (HT=0.95; 95%CI 0.93-0.98 for each year of life) and marital status (HT=0.49; 95%CI 0.30-0.80). Associated factors for HPV infection were: HIV presence (HT=2.72; 95%CI 1.77-4.17), greater number of sexual partners (HT=1.87; 95%CI 1.23-2.84), age (HT=0.97; 95%CI 0.95-0.99 for each year of life) and marital status (HT=0.65; 95%CI 0.42-1.0 for stable union/widows). CONCLUSION: The prevalence of CIN and cervical HPV infection was higher in ...

Lesión intraepitelial cervical en adolescentes / cervical intraepithelial lesion teen

Objetivo: Evaluar las lesiones intraepiteliales cervicales en pacientes adolescentes que acuden a la consulta del Servicio de Ginecología de la Maternidad “Concepción Palacios”. Métodos: Estudio prospectivo, descriptivo, transversal. Se incluyeron 76 pacientes adolescentes en edades comprendidas entre los 10 y 19 años que hubiesen iniciado relaciones sexuales, con hallazgos citológicos y/o histológicos de patología cervical, a las cuales se les tomó muestra para determinar ácido desoxirribonucleico de virus de papiloma humano por reacción en cadena de polimerasa, se realizó colposcopia y de presentar cambios, se tomó biopsia. Se registraron factores de riesgo a partir de la historia clínica. Resultados: La edad promedio fue 17 ± 1 años, el inicio de las relaciones sexuales fue 15 ± 1 años, el número de parejas sexuales tuvo una mediana de 2. En 41 pacientes se encontró un solo tipo viral (53,9 %), el más frecuente fue el tipo 6 (43,1 %). El hallazgo citológico más frecuente fue lesión intraepitelial cervical de bajo grado con 52 pacientes. El epitelio acetoblanco plano se presentó en 32 pacientes, en 57 casos (75 %) las lesiones fueron exocervicales. El diagnóstico histológico más frecuente fue neoplasia intraepitelial 1 (77,6 %). Conclusiones: El tipo viral más frecuente fue el tipo 6, el alcohol fue el factor de riesgo con importancia estadística.

Objective: To evaluate cervical intraepithelial lesions in adolescent patients attending the Gynecology Service Consultation to the Concepción Palacios Maternity Hospital. Methods: Prospective, descriptive, transversal. 76 patients were included, adolescents aged between 10 and 19 who had initiated sex with cytologic findings and/or histological cervical pathology, to which sample was taken to determine deoxyribonucleic acid from human papilloma virus by reaction polymerase chain. We practice colposcopy and biopsy was taken, when it was necessary. The risk factors were registration for the medical history. Results: The mean age was 17 ± 1 years, the onset of sexual intercourse was 15 ± 1 years, the number of sexual partners had a median of 2. In 41 patients there was a single viral type (53.9 %), the most frequent was type 6 (43.1 %). The most common cytologic finding was cervical intraepithelial lesion low grade with 52 patients. Flat acetowhite epithelium occurred in 32 patients, 57 cases (75 %) were ectocervical lesions. The most frequent histological diagnosis was intraepithelial neoplasia I (77.6 %). Conclusions: The most frequent viral type was type 6, the alcohol was the risk factor with statistical significance.

Cervical intraepithelial neoplasia in a cohort of HIV-positive women at the University Hospital of the West Indies: management and outcome / Neoplasia intraepitelial cervical en una cohorte de mujeres VIH-positivas en el Hospital Universitario de West Indies: manejo y resultados

OBJECTIVE: To determine the rate of recurrence of cervical intraepithelial neoplasia (CIN) in HIVpositive women evaluated at the University H ospital of the West Indies (UHWI). METHOD: A chart review of all non-pregnant HIV-positive women who attended the gynaecologic and colposcopic clinics between January 1994 and December 2004 identified 21 such women. Fifteen of these patients who had CIN and had at least one follow-up Pap smear were the main subjects of this study. These patients were compared to 21 HIV-negative controls who were seen during the same period and who also had at least one follow-up Pap smear. Treatment modalities for the groups included cold coagulation and large loop excision of the transformation zone (LLETZ). Cox proportional hazards analysis was used to determine the effect of HIV status on the time to first recurrence of CIN. RESULTS: The mean ages of the subjects were 32.7 ± 8.0 and 33.2 ± 8.1 years, respectively. With a mean follow-up period of 1.7 years, the rate of recurrence of CIN in patients with and without HIV was 66.24 (95% CI 27.6, 159.1) and 3.0 (95% CI 1.3, 7.3) per 100 person years. The hazards rate ratio for recurrence in subjects with HIV after adjusting for age and CIN stage was 19.1 (95% CI 4.4, 82.1). CONCLUSION: HIV increases the risk of recurrence of CIN.

OBJETIVO: Determinar la tasa de recurrencia de la neoplasia intraepitelial cervical (NIC) en las mujeres VIH-positivas evaluadas en el Hospital Universitario de West Indies (HUWI). MÉTODO: Una revisión de las historias clínicas de todas las mujeres VIH-positivas no embarazadas que asistieron a la clínica ginecológica y la clínica colposcópica entre enero de 1994 y diciembre de 2004, identificó 21 de estas mujeres. Quince de estas pacientes que tenían NIC y habían tenido al menos una prueba de Papanicolaou de seguimiento, fueron los sujetos principales de este estudio. Estas pacientes fueron comparadas con 21 controles de VIH-negativos que fueron vistos durante el mismo período y que también tuvieron al menos una prueba de Papanicolaou de seguimiento. Las modalidades de tratamiento para los grupos incluyeron coagulación fría y escisión con asa grande de la zona de transformación (LLETZ). El modelo de análisis de riesgos proporcionales de Cox fue utilizado para determinar el efecto del estatus de VIH al momento de la primera recurrencia de CIN. RESULTADOS: Las edades promedios de los sujetos fueron 32.7 ± 8.0 y 33.2 ± 8.1 años, respectivamente. Con un período de seguimiento promedio de 1.7 años, la tasa de recurrencia de NIC en pacientes con y sin VIH fue 66.24 (95% IC 27.6, 159.1) y 3.0 (95% IC 1.3, 7.3) por 100 persona/años. El cociente de tasas de riesgo de recurrencia en pacientes con VIH después de ajustar por edad y etapa de CIN fue 19.1 (95% IC 4.4, 82.1). CONCLUSIÓN: El VIH aumenta el riesgo de recurrencia de la NIC.

An evaluation of p16INK4a expression in cervical intraepithelial neoplasia specimens, including women with HIV-1

Although several studies have evaluated the role of p16INK4a as a diagnostic marker of cervical intraepithelial neoplasia (CIN) and its association with disease progression, studies regarding the role of p16INK4a in human immunodeficiency virus (HIV)-infected patients remain scarce. The present study was designed to determine the potential utility of p16INK4a as a diagnostic marker for CIN and invasive cervical cancer in HIV-positive and negative cervical specimens. An immunohistochemical analysis of p16INK4a was performed in 326 cervical tissue microarray specimens. Performance indicators were calculated and compared using receiving operating characteristics curve (ROC)/area under the curve. In HIV-1-negative women, the percentage of cells that was positive for p16INK4a expression was significantly correlated with the severity of CIN (p < 0.0001). A ROC curve with a cut-off value of 55.28% resulted in a sensitivity of 89%, a specificity of 81%, a positive predictive value of 91% and a negative predictive value of 78%. HIV-seropositive women exhibited decreased expression of p16INK4a in CIN2-3 specimens compared with HIV-negative specimens (p = 0.031). The ROC data underscore the potential utility of p16INK4a under defined conditions as a diagnostic marker for CIN 2-3 staging and invasive cervical cancer. HIV-1 infection, however, is associated with relatively reduced p16INK4a expression in CIN 2-3.

Neoplasia intraepitelial cervical de alto grado en mujeres menores de 25 años y mayores de 45 años / Cervical intraepithelial neoplasia of high degree in women younger than 25 and older than 45 years old

Evaluar las características de pacientes menores de 25 y mayores de 45 años con diagnóstico de neoplasia intraepitelial cervical II-III. Estudio retrospectivo, descriptivo y comparativo de 334 historias de neoplasia intraepitelial cervical II-III consultantes a la Maternidad "Concepción Palacios" entre 2005 y 2009, distribuidas en: 20,7 por ciento menores de 25 años (Grupo A), 64,8 por ciento entre 25-45 (Grupo B) y 14,4 por ciento mayores de 45 (Grupo C). En 23,1 por ciento la lesión era grado II y en 76,9 por ciento grado III. El inicio de la actividad sexual fue 15,5 ± 2, 16,9 ± 2,6 y 17,8 ± 3 años, respectivamente (P=0,001), el primer embarazo ocurrió a los 15, 19 y 20 años para cada grupo (P=0,001). El número de gestaciones fue 1, 2 y 4 respectivamente (P=0,01). Hubo 43,9 por ciento de fumadoras en el Grupo C (P=0,001) y 29,6 por ciento de pacientes inmunosuprimidas en el Grupo A (P< 0,05). Predominaron las alteraciones de las células epiteliales en la citología de los 3 grupos. No hubo diferencias en la colposcopia, la terapéutica utilizada ni en las tasas de curación, persistencia o recidiva. En el grupo A, 85,7 por ciento de las lesiones persistentes fueron lesiones de bajo grado (P< 0,05). Los factores de riesgo importantes en el grupo A fueron: inicio precoz de relaciones sexuales, primer embarazo temprano, número de gestaciones e inmunosupresión. En el grupo C fueron mayor paridad, tabaquismo, y mayor índice de masa corporal. La clínica, tratamiento y evolución fueron similares con 20 por ciento de persistencia y menos de 10 por ciento de recidivas

To assess the characteristics of patients under the age of 25 and over 45 years with diagnosis of cervical intraepithelial neoplasia II-III. Retrospective, descriptive and comparative study of 334 patients with cervical intraepithelial neoplasia II-III diagnostic consulting to Maternidad Concepcion Palacios, in 2005-2009, distributed in:20.7 percent under the age of 25 (Group A) 64.8 percent between 25-45 (Group B) and 14.4 percent over the age of 45 (Group C). El 23.1 percent had cervical intraepithelial neoplasia II and 76.9 percent cervical intraepithelial neoplasia III. The onset of sexual activity was 15.5 ± 2, 16.9 ± 2.6 and 17.8 ± 3 years, respectively (P=0.001), the first pregnancy occurred 15, 19 and 20 years for each group (P=0.001). The number of pregnancies was 1, 2 and 4 respectively (P=0.01). There was 43.9 percent of smokers in Group C (P=0,001) and 29.6 percent of patients who are immunosuppressed in Group A (P< 0,05). The disturbances of epithelial cells on cytologyof 3 groups were predominated. There were no differences in the colposcopy, therapeutic or in rates of healing, persistence or recurrence. In Group A, 85.7 percent of persistent injuries were low grade (P< 0.05). The more important risk factors in Group A were: early onset of sexual relations, early first pregnancy, number of pregnancies and immunosuppression. In Group C were: greater parity, smoking, and higher body mass index. The clinic, treatment and evolution were similar with 20 percent of persistence and less than 10 percent of relapses

Papiloma virus humano. ]Asociación a neoplasia intraepitelial cervical en mujeres del municipio Boyeros / Human papilomavirus. Association to intraepithelial cervical neoplasia in women municipaly Boyeros

Se realizó un estudio retrospectivo de los resultados de las biopsias de cuello uterino con el objetivo de caracterizar la asociación de la Neoplasia Intraepitelial Cervical (NIC) con la infección por Papiloma Virus Humano (PVH) durante el período 2004-2006. Se analizaron las biopsias realizadas en el Laboratorio de Anatomía Patológica del Hospital General Docente Dr. Enrique Cabrera, a todas las mujeres del municipio Boyeros con más de 15 años de edad. Se colectaron datos de 297 biopsias de cuello, de ellas 181 eran portadoras de NIC, en 23 se constató carcinoma in situ y 4 presentaron infección por PVH y no NIC. La asociación NIC infección por PVH fue significativa (p < 0.05). Concluimos que en el grupo de mujeres estudiadas se encontró una elevada prevalencia de infección por PVH en las NIC. Se hace evidente la necesidad de ajustar las pautas para la detección de la infección en etapas temprana(AU)

A retrospective study was carried out with the results of biopsies of cervix with the objective to characterize the association of the Cervical Intraepitelial Neoplasia (NIC) with the infection by Human Papiloma Virus (PVH) during 2004-2006 year. The biopsies were taken in the General Hospital Enrique Cabrera (Laboratory of Pathology), to all women of 15 years old and more resident at Boyeros municipality. Data of 297 biopsies of cervix were collected, of them 181 they were positive of NIC, in 23 carcinoma was verified in situ and 4 were positive to infection by PVH and negative to NIC. The association NIC infection by PVH was significant (p <0.05). We conclude that in the group of women studied a high prevalence of infection was found by PVH in those positive to NIC. Is evident the need to adjust guidelines for early phases detection of the infection(AU)

Neoplasia Intraepitelial Cervical. Preámbulo del cáncer cérvicouterino / Cervical intraepithelial neoplasia. Preamble of cervicouterine cancer

La neoplasia intraepitelial cervical es una lesión que se considera la antesala del cáncer cérvicouterino. La infección por el virus del papiloma humano (VPH) en el aparato genital, sobre todo algunos subtipos llamados oncogénicos, juegan un papel relevante en la aparición de las lesiones intraepiteliales y su posible evolución al cáncer invasor en esas localizaciones. Existe además un importante grupo de factores de riesgo o cofactores que asociados a la infección por el VPH pueden producir esos cambios celulares en el cérvix. En el presente artículo se analizan esos factores de riesgo y se tienen en consideración la participación de ambos miembros de la pareja en la infección por el VPH. Se señalan algunas modalidades terapéuticas conservadoras de las NIC.

Cervical intraepithelial neoplasia is a lesion considered as the preamble of cervicouterine cancer. HPV infection in the genital apparatus, mainly some subtypes called oncogenic, plays an important role in the appearance of some intraepithelial lesions and in its possible evolution to invasive cancer in these localizations. There is a significant group of risk factors or cofactors that associated with HPV infection may produce these cellular changes in the cervix. These risk factors are analyzed in the present article, and the participation of both members of the couple in the HPV infection is taken into consideration. Some conservative therapeutic modalities used to treat CIN are stressed.

Human immunodeficiency virus infection in women undergoing treatment for cervical neoplasia: prevalence and the feasibility of routine screening.

This study was undertaken to evaluate the prevalence of human immunodeficiency virus (HIV) infection and the feasibility of routine HIV screening in women undergoing various treatment of cervical neoplasia at Chiang Mai University Hospital between October 2004 and October 2006. Four hundred and ninety five women were recruited for HIV screening with the opt-out approach performed. In this study, thirty-seven (7.47%) women had a previous diagnosis of HIV infection with a mean duration 4.16 years (range: 1-15 years). The remaining 458 women consented to have an HIV test. Six women (1.31%) were newly identified as HIV seropositive, giving an overall prevalence of 8.69%. In conclusion, the prevalence of HIV infection in this study was considerably high and routine HIV screening is feasible because of the high acceptance rate.

Cáncer cervical en embarazo de la primera mitad con placenta previa. Reporte de un caso / Cervical cancer in pregnancy of the first half with placenta previa. A case report

El cáncer cervical invasor es una de las causas más frecuentes de muerte en las mujeres de los países en desarrollo. Ocupa el tercer lugar entre las mujeres de todo el mundo. Es raro en mujeres con menos de 30 años y más común en mujeres de 40 años. Se reporta el caso de una pacientede 30 años, atendida en el servicio de Patología de Cuello del Hospital Materno Provincial Ana Josefa Betancourt de Mora, con el diagnóstico de carcinoma epidermoide infiltrante bien diferenciado de cuello uterino en etapa Ib2 y embarazo de la primera mitad con inserción baja placentaria oclusiva total. Se interrumpió este embarazo con el objetivo de mejorar el estado de inmunodepresión de esta paciente y comenzar un tratamiento precoz y oportuno para lograr la supervivencia de esta paciente.

The invasive cervical cancer is one of the most frequent causes of death in women of the developing countries. It occupies the third place among the women of the entire world. Is rare in women with less than 30 years and more common in women of 40 years. The case of a 30 years patient is reported, attended in the Cervix Pathology service at Ana Josefa Betancourt de Mora Provincial Maternal Hospital, with the diagnosis of infiltrating epidermoid carcinoma well differentiated of cervix uteri in phase Ib2 and pregnancy of the first half with total occlusive placental low insertion.This pregnancy was interrupted with the objective to improve the immunodepression state of this patient and to begin an opportune and precocious treatment to achieve the survival of this patient.

Villoglandular papillary adenocarcinoma of cervix associated with cervical intraepithelial neoplasia: a case report and review of literature.

Well differentiated villoglandular adenocarcinoma of uterine cervix is a rare tumour which usually occurs in young women. It is considered to be an indolent tumour with favorable prognosis and most of them were treated by conservative procedures. We report a 35 year old lady who came with complaints of 3 months amenorrhoea and an episode of spontaneous bleeding. Urine pregnancy test was negative. Physical examination revealed a cervical polyp. Histopathological findings were consistent with villoglandular papillary adenocarcinoma associated with high grade cervical intraepithelial neoplasia (CIN-3). Left parametrial and left ureteral involvement, proved by biopsy, causing left hydroureteronephrosis was detected. The patient was thus found to be in an advanced stage, stage- III b (FIGO). The patient is currently undergoing radiotherapy. A review of literature showed that only occasional cases showing disease spread have been reported, suggesting caution in the management and regular follow up of the patient.

Synchronous vulvar intraepithelial neoplasia (VIN) of warty type and cervical intraepithelial neoplasia (CIN): case report.

Vulvar intraepithelial neoplasia is a precancerous lesion of the vulva, which has been referred to in the past with varied terminology. It can be associated with multicentricity of other neoplastic squamous lesions in the cervix and vagina. We report a case of vaginal intraepithelial neoplasia and concomitant cervical intraepithelial neoplasia in a 30 year old female. An attempt is made to put forth the recent terminology of vulvar intraepithelial neoplasia.

Prevalence of SIL and SCCA in human immunodeficiency virus-seropositive women at anonymous clinic in Chonburi Hospital.

The series of 231 HIV-infected women were recruited in Chonburi Hospital, Thailand. Demographic, gynecologic factors were interviewed Pap smear was performed and classified based on the Bethasda system (1991) by a cytotechnologist. All abnormal Pap smear slides were reviewed by a cytopathologist. The prevalence of LSIL, HSIL and SCCA were 2.2%, 8.3% and 2.2%, respectively. There was statistically significant association between the duration of HIV infection and occurrence of SIL and SCCA. (p = 0.007) CONCLUSION: The present study showed a high prevalence of SIL and SCCA in-HIV-infected women at Chonburi Hospital.

Immune response in cervical dysplasia induced by human papillomavirus: the influence of human immunodeficiency virus-1 co-infection - review

Human immunodeficiency virus (HIV-1) has become an important risk factor for human papillomavirus (HPV) infection and the development of HPV associated lesions in the female genital tract. HIV-1 may also increase the oncogenicity of high risk HPV types and the activation of low risk types. The Center for Disease Control and Prevention declared invasive cervical cancer an acquired immunodeficience virus (AIDS) defining illness in HIV positive women. Furthermore, cervical cancer happens to be the second most common female cancer worldwide. The host's local immune response plays a critical factor in controlling these conditions, as well as in changes in the number of professional antigen-presenting cells, cytokine, and MHC molecules expression. Also, the production of cytokines may determine which arm of the immune response will be stimulated and may influence the magnitude of immune protection. Although there are many studies describing the inflammatory response in HPV infection, few data are available to demonstrate the influence of the HIV infection and several questions regarding the cervical immune response are still unknown. In this review we present a brief account of the current understanding of HIV/HPV co-infection, emphasizing cervical immune response.

Associated risk factors of human papillomavirus cervical infection among human immunodificiency virus-seropositive women at Siriraj Hospital.

This cross sectional type sub-study was established to assess the potential risk factor associated with human papillomavirus (HPV) cervical infection in Human immunodeficiency virus (HIV)-seropositive women. The series of 178 HIV-seropositive women was enrolled in the Department of Obstetrics & Gynecology, Siriraj Hospital. Demographic, obstetrical and behavioral risk factors were interviewed. Laboratory results were recorded. Clinical gynecologic examination was performed including Pap smear. The patients were assigned into two groups, HPV and non-HPV group. The comparison of the potential risk factors between the groups was calculated statistically. It was found that the prevalence of HPV infection was reported in 17 patients (9.6%). HIV-seropositive women, who were infected with HPV, had a significantly more probability to have a single partner in their lifetime than those who were not infected. It could be that HPV cervical infection and HIV-seropositive women share common potential risk factors, as well as, the recognition of sexual intercourse as the important route of HPV transmission.

Relationship between human papilloma virus infection and abnormal Pap smear in HIV-seropositive women at Siriraj Hospital.

The purpose of this prospective study was to determine the prevalence of human papillomavirus and abnormal Pap smear in HIV-seropositive women, particularly in HIV-seropositive women who undertook antiretroviral drug. The consecutive series of 178 HIV-seropositive women was enrolled in the Department of Obstetrics and Gynecology, Siriraj Hospital. All general information and laboratory results of the patients were recorded. Pap smears are obtained from the endocervix, cervical transformation zone and vagina by using a cotton tip stick and Ayre spatula, as described in the VCE technique. The patients were assigned into two groups, the AZT and non-AZT group. The comparison between the groups was calculated statistically. It was found that 88 of 178 HIV-seropositive women (49.4%) undertook Zidovudine. The prevalence of abnormal Pap smear in HIV-seropositive women, who had an abnormal Pap smear, was 59.6 per cent. However, the prevalence of human papillomavirus infection detected by Pap smear was reported in 17 patients (9.6%). There was no difference between the AZT and non-AZT group statistically. There was a significantly higher probability of finding an abnormal Pap smear for cervical dysplasia in HIV-seropositive women who were infected with human papillomavirus compared to. It is concluded that there is a higher risk of developing cervical dysplasia in HIV-seropositive women who carry the human papillomavirus.