Post-hysterectomy vaginal cuff cancer secondary to HPV infection and CIN

We present a case report of secondary vaginal cancer after complete hysterectomy due to myoma that was complicated by low-grade cervical intraepithelial neoplasia [CIN I] and human papilloma virus [HPV] infection. After complete hysterectomy, the HPV DNA level in the vaginal tissue was obviously increased, and vaginal cancer was diagnosed 6 months later. We conclude that HPV infection can cause vaginal cancer after complete hysterectomy in cases complicated by CIN. Therefore, HPV should be regularly assessed during the postoperative follow-up period

Squamous intraepithelial lesions associated with HIV infection and CD4+ cell counts in an Iranian population

To evaluate the association between cervical squamous intraepithelial lesions [SIL] and the human immunodeficiency virus [HIV] infection and CD4 counts among an Iranian population. Case-control study. North and East Tehran Health Centers, related to Shaheed Beheshti Medical University, Iran. Two hundred forty seven women including 58 HIV infected cases and 189 healthy controls recruited between 2007 and 2010. None. Cytology-based cervical Pap smears and hematologic findings were compared between cases and controls. The prevalence of abnormal smear was significantly higher in the study group [36.2%, 15 LSIL + 6 HSIL] compared with controls [3.2%, 6 ASCUS] [p < 0.001, OR = 2.4, 95% CI 1.2 - 4.6]. The mean of CD4 count was significantly lower in cases with abnormal smear compared with cases with normal smear [573.0 +/- 306.9 Vs 383.7 +/- 123.6; p = 0.042]. Our results suggest the need for undertaking a serious effort towards the provision of gynecological care and cervical cancer screening at the same health center as HIV care, in Iranian HIV infected women

Human papillomavirus infection is principally found with cervical intra-epithelial neoplasia-III in Toluca, State of Mexico

To describe the prevalence of human papillomavirus infection [HPV] in cases of cervical intra-epithelial neoplasia [CIN], micro-invasive carcinoma and invasive carcinoma in Toluca, State of Mexico. Cross-sectional study analysing slides with the diagnosis of CIN I to invasive carcinoma for one year and reporting the presence of HPV; also identifying these cervical-uterine cancer stages noted during one semester in the registery of histopathological studies, at the Department of Pathology, General Regional Hospital 220, Instituto Mexicano del Seguro Social [IMSS]. In one year, from a total of 5755 studies, 731 [13%] were of cervical-uterine cancer, 112 [16%] of these were positive for some stage of cervical cancer and 46.43% had HPV infection. In one semester, 2918 histopathological studies were done, 341 [11.68%] of these were cervix uterine biopsies, colposcopies and hysterectomies. 62 women [18.18%] diagnosed with CIN II-III, carcinoma in situ [CIS], micro-invasive carcinoma or invasive carcinoma and finding HPV infection in 51.92% of total cases. The prevalence of HPV was higher than that reported in developed world and CIN II-III are the most common stages in Toluca, State of Mexico

unusual case of virilizing ovarian tumor associated with carcinoma insitu of cervix

Arrhenoblastoma or Sertoli-Leydig cell tumor is a rare androgen secreting ovarian tumor of unknown pathogenesis, has been reported to co-exist with other neoplasms of the female genital tract. Mostly benign, the tumor originates from the ovarian stromal sex cords, its tissue structure being similar to the Sertoli and Leydig testicular cells. Followed in detail, around one-fifth of these ovarian tumors are found to be malignant. We describe a case of slow growing Sertoli-Leydig cell tumor presenting with androgenic alopecia and virilization, associated with cervical carcinoma in-situ

Cervical cancer: screening and therapeutic perspectives

Cervical cancer is a major cause of mortality and premature death among women in their most productive years in low- and medium-resourced countries in Asia, Africa and Latin America, despite the fact that it is an eminently preventable cancer. While cytology screening programmes have resulted in a substantial reduction of cervical cancer mortality in developed countries, they have been shown to have a wide range of sensitivity in most routine settings including in developing countries. Although liquid-based cytology improves sample adequacy, claims on improved sensitivity remain controversial. Human papillomavirus testing is more sensitive than cytology, but whether this gain represents protection against future cervical cancer is not clear. Recently, in a randomized trial, the use of visual inspection with 4% acetic acid was shown to reduce cervical cancer incidence and mortality. Cryotherapy and large loop excision of the transformation zone are effective and safe treatment methods for cervical intraepithelial neoplasia. The clinical stage of cancer is the single most important prognostic factor and should be carefully evaluated in choosing optimal treatment between surgery and radiotherapy, with or without chemotherapy. At the public health level, health care infrastructure, affordability and capacity for initiating and sustaining vaccination and screening programmes are critical factors in cervical cancer control. On the other hand, an informed practitioner can utilize the multiple opportunities in routine primary care interactions for prevention, screening, early detection and prompt referral for treatment

Cyclooxygenase-2 expression in intraepithelial neoplasia and squamous cell carcinoma of the uterine cervix and its clinicopathological relations

Cyclooxygenase [COX]-2 is involved in the genesis of many tumors; multiple lines of evidence suggested that selective inhibitors of [COX-2] are a novel class of therapeutic and chemopreventive agents for epithelial malignancies. The aim of this study was to investigate the expression of COX-2 in cervical intraepithelial neoplasia [CIN] and squamous cell carcinoma [SCC] of the uterine cervix and its association with Clinicopathological parameters. Twenty one patients with stage I-IV SCC of the cervix, another 21 patients with CIN I-III and 6 patients with histologically normal cervices were included in this study. Patients in the SCC group were treated with radical hysterectomy plus pelvic and para-aortic lymphadenectomy or anterior pelvic exentration. Immunohistochemical study was performed on paraffin embedded tissue sections with COX-2 antibody. Expression of COX-2 was demonstrated in SCC and CIN groups, while it was undetectable in normal cervices. In this study, the prevalence of positive COX-2 expression in SCC group was significantly higher than its prevalence in CIN group [66.7% Vs. 38.1%, p=0.03]. Significantly higher expression of COX-2 was reported in patients with FIGO stage II-IV compared to patients with FIGO stage I [83.3% Vs. 44.4%, p=0.05]. Additionally, patients with parametrial invasion had significantly higher COX-2 expression than patients without [90.0% Vs. 45.5%, p=0.04]. Furthermore, there was significant relationship with respect to COX-2 expression and lymph node involvement [p=0.04]. Regarding the relation between COX-2 expression in both tumor cells and tumor associated tissue eosinophils [TATE], statistically significant inverse relation was reported [p=0.03]. However, the statistical evaluation of COX-2 expression according to age, tumor size, histological type, lymphovascular space invasion [LVSI] and grade of differentiation demonstrated no significant relationship. Our results suggested that, COX-2 expression may have a role in the development and progression of CIN. COX-2 expression is related to most of clinicopathologic and prognostic variables of cervical carcinoma and may be incorporated into the criteria for determination of tumor aggressiveness. The role of COX-2 expression in cancer development and progression makes it a good target for therapy and selective COX-2 inhibitors may be a promising strategy not only for chemoprevention but also for therapeutic approaches in SCC of the uterine cervix

HPV infection among patients with high grade cervical intraepithelial neoplasia and squamous cell carcinoma of cervix

Cervical cancer is the second most common cancer of the women worldwide. It is also an important cause of cancer-related mortality in women, after breast cancer. Nearly half million of new cases are identified yearly. The incidence rate in developing countries is greater than the developed countries. Epidemiologic studies have shown that the association of genital human papilloma virus [HPV] with cervical cancer is strong, independent of other risk factors, and consistent in several countries. The aim of this study was to determine the frequency of HPV in patients with high grade cervical intraepithelial neoplasia [CINIII, CIN II] and squamous cell carcinoma [SCC] of cervix. Hundred specimens from patients with SCC and CINIII, CIN II, confirmed by histological review, referring to Mirza Koochak Khan Hospital from 1999-2004 were enrolled in a cross sectional study. Polymerase chain reaction was utilized for identification and typing of HPV DNA. To increase the sensitivity of HPV detection, nested PCRs were performed using MY09/MY11 as outer and GP5/GP6 as inner primers. It was possible to extract 77 of 100 specimens that HPV DNA was detected in 47 of 77 specimens. Infection with HPV was present in 32 specimens [86.5%] among SCC patients and in 15 specimens [37.5%] among CINIII, CIN II patients. The most frequent HPV types in SCC patients were HPV 16 and 18 [59.38%] and then 33 [34.38%] and in CINIII, CIN II patients was 16 [53.33%] and 18 [40%]. the most frequent co-infection in both groups was HPV 16 and 18 which was present in 40.62% and 26.7% of cases respectively. The most frequent HPV types in patients with SCC and CINIII, CIN II was 16 and 18 that is identical to many other countries infection pattern

Genotyping of human papilloma virus infections and phenotyping of tumor infiltrating lymphocytes in Iraqi patients with uterine cervical neoplasia

Among most basic and clinical investigations for detection and genotyping HPV, only In Situ Hybridization [ISH] is effective in studing the relation of HPV genome that histopathological entity. Tumor Infiltrating Lymphocytes [TlLs] represent the local cellular immui esponse against both cervical cancer and the associated HPV. This study is aimed to investigate ISH in detection and genotyping of HPV and immunohistochemical [IHC] study in phenotyping of TILs in Iraqi women with different grades of cervical neoplasia. This retrospective research included a total number of 129 cervical tissue blocks, 64 with invasive and 27 with pre-invasive cervical neoplasia,12 with condylomata acuminata, 11 with chronic cervicitis and 15 with apparently- healthy cervices Molecular detection and genotyping of HPV DNA were performed by using ISH whereas immunophenotyping was done by IHC using monoclonal antibodies for that specific CD markers representing some of TILs. The overall prevalence of HPV DNA in total group of invasive cervical neoplasia was 28.4%, 12 out of 48[25%] with squamous cell carcinoma[SCC] and 8 out of 16[50%] with adenocarcinoma [AC]. HPV 16 constituted [58.3%] of HPV- positive invasive cervical SCC, where as HPV 31/33 and lastly I-LPV 18 constituted [25%] and [16.7%], respectively .ln AC group, HPV 16, 18, 31/33 occupied 50%, 25%, 12.5% of this group, respectively.. The prevalence of HPV DNA in pre-invasive cervical neoplasia group was 22.2%. While no case with HPV 18 was detected, HPV 16 and HPV 31/33 genotypes occupied 40% and 60%, respectively. Although CD3+,CD4+ and CD8+ lymphocytes showed high mean values, significant differences present only between HPV DNA- positive tissue blocks and control group [p<0.05]. The CD20+and CD56+ lymphocytes showed low mean values.Compared to control group,however,statistical analysis showed significant differences [p<0.05] regarding CD20+ and non-significant regarding CD56+ lymphocytes. Using ISH proved more powerful and sensitive tool in revealing precised effects of HPV in cervical neoplasia compared to histopathological examination .High mean values of CD4+ and CD8+ versus low mean values of CD20+ and CD56+ lymphocytes could reflect an important and specific role of these cellular responses against HPV viruses during initiation and progression of HPV-associated cervical cancers

Cervical intraepithelial neoplasia [CIN] and Trichomonas vaginalis infection as revealed by polymerase chain reaction

The impact of sexually transmitted diseases [STDs] on the development of cervical intraepithelial neoplasia [CIN] has been increasingly recognized over the last 25 years. The role of bacterial vaginosis [BV] is the focus of several current investigations, not only in the genesis of CIN but also in the development of other gynecological and obstetric complications. Out of 150 women with vaginitis, 46 were diagnosed as T. vaginalis infection by different methods: wet mount, In-Pouch TV culture and PCR. Pap smear showed that 10 smears had atypical squamous cells of undetermined significance [ASCUS], 2 smears had atypical squamous cells of high grade [ASC-H], 8 smears had squamous intraepithelial lesions of low-grade [SIL-L] in the form of mild dysplasia, 4 smears showed squamous intraepithelial lesions of high-grade [SIL-H] in the form of moderate to severe dysplasia and carcinoma in-situ. So, the early detection and treatment of symptomatic and asymptomatic trichomoniasis minimize the complications of cervical neoplasia

Human papilloma virus-16/18 cervical infection among women attending a family medical clinic in Riyadh

Prevalence information is lacking on human papillomavirus types 16 and 18 [HPV-16/18] infection in cervical tissues of women residing in Riyadh, Saudi Arabia. In addition, there are no observations on progression to cervical intraepithelial neoplasia [CIN]. Pap smear and HPV-16/18 DNA detection by PCR followed by Southern blotting was performed on 120 subjects [Saudi and other Arab nationals] during routine gynecological examination. Some HPV-positive subjects were followed for 4 years, by Pap smear every 6 months and by HPV DNA detection at the end of 4 years. Overall HPV-16/18 prevalence was 31.6%. HPV-16 prevalence alone was 13.3%, HPV-16 as a mixed infection with HPV-18 was 15%, and all HPV-16 was 28.3%. HPV-18 alone was 3.3%, HPV-18 as a mixed infection with HPV-16 was 15%, and all HPV-18 was 18.3%. Ten subjects had cervical abnormalities with the Pap smear test, six of whom were HPV-16/18 positive, 1 with HPV-16, 1 with HPV-18, and 4 with a mixed infection of HPV-16/18. Of all 23 HPV-16/18-positive subjects, either as individual or mixed infection, followed for 4 years, 7 showed abnormal cytology 6 at initial examination and 1 during follow-up. Of these 7, 6 reverted to normal without treatment and 1 was treated and became normal after 3 years. None of the subjects progressed to CIN-III. A high prevalence of HPV-16/18 was found, but with a low rate of progression to CIN. A significant association with abnormal cytology was found only in patients with HPV-16/18 mixed infection

Prevalence of abnormal cervical cytology and its relation with age and parity

This screening study was carried out in Gynae Unit II, Sir Ganga Ram Hospital, Lahore. The aim of study was to find out prevalence of abnormal pap smears and its correlation to age and parity so that we can formulate a policy to screen at risk population with Utilization of minimum resources in our setup. Role of Pap smear in detection of cervical pre-malignant and malignant lesions can not be over emphasized. The Cervical smears of 310 women have been evaluated. The frequency of mild to severe cervical intraepithelial neoplasia was found to be 8% while smear positive for malignant cells was in 0.9% of cases. This study reveals 41-60 years of age and Para three and above a high risk group for Cervical Intraepithelial Neoplasia [CIN] and cytology positive for malignant cells. In view of the expenditure involved and technical constraints in mass screening, an approach of selective screening of high risk population could be an effective strategy for control of carcinoma of cervix in developing countries like ours

PAP smear screening for precancerous conditions of the cervical cancer

To find the presence of cervical cancer in PAP smears taken from Pakistani women of different age groups. Department of Cytology, Public Health Laboratory Division. National Institute of Health, Islamabad. Data of all cervical smears sent to the cytology department of NIH between 1st January 2001 to 31st December 2004 was retrospectively analysed to see the presence of malignancy. A total of 546 smears were assessed during the study period. Of these, 302[55.31%] showed inflammatory changes, 124[22.71%] were normal, 40[7.33%] were atrophic, 17[3.12%] showed dysplastic changes, in which 10 cases were of low grade squamous intraepithelial lesion [LSIL], and 07 cases were of high grade squamous intraepithelial lesion [HSIL]. Carcinoma in situ, was seen in 11 [2.02%]. Inadequate sample was reported in 52 [9.52%] cases with an advise to repeat the test. Awareness campaigns and screening program for cervical cancer in women of reproductive age is recommended especially in those having prolonged symptoms

Cervical intra-epithelial neoplasia recent trends in diagnosis and management

A study was carried out with a view to provide the facility of cervical screening in Gynae OPD at Nishtar Hospital, Multan and to detect and manage pre-malignant lesion of the cervix at an earlier stage. Cervical smear was taken from 526 women of 20-65 years age group attending Gynae OPD. 313 smears [59.50%] were reported to be normal, 159 [30.22%] inflammatory; 13 [2.47%] mild dykaryosis, 10 [1.90%] moderate and 2 [0.38%] severe dyskaryosis. 29 cases were considered inadequate because of blood stained specimen or artifacts. Patients with mild dyskaryosis were advised careful follow-up and repeat cervical smear after 6 months. Colposcopy was performed in 12 cases of moderate to severe dyskaryosis and 10 patients had abnormal aceto-white areas and directed punch biopsy was taken from all these cases. Histopathology of the cervical tissue revealed CIN-2 in 8 cases of moderate dyskaryosis and CIN-3 in 2 cases of severe dyskaryosis. Patients with CIN-2 were managed by local destruction with electro-cautery and followed up for 2 years. Women with CIN-3 were treated by abdominal hysterectomy. Cervical intra-epithelial neoplasia - a pre-malignant condition can be treated effectively if diagnosed at an earlier stage

Chlamydia trachomatis and cellular DNA content in cervical ectopy

The study was conducted on 68 women with cervical ectopy referred to the Early Cancer Detection Unit of Ain Shams University Maternity Hospital from November 1997 to October 1998 to study chlamydia trachomatis infection serologically in cases of cervical ectopy and its relation to DNA abnormalities. 38 out of 68 women were diagnosed cytologically to have chlamydia trachomatis. 36 of them were also confirmed by positive IgA antibodies of chlamydia trachomatis by solid phase ELISA technique so immuno-enzymatic and cytological methods were both accurate in the diagnosis. Chlamydia was found to be the commonest infections in cervical ectopy 55.8% followed by the HIPV 35.3%. 44% of patients with cervicalectopy had inflammatory atypia, 26.5% of which were found to be chlamydia positive, low grade squamous intraepithelial lesion [LSIL] was diagnosed in 35.2% of patients, 29.4% of which were chlamydia positive and 35.3% were associated with HPV infection. On DNA analysis of chlamydia positive smears, four had aneuploidy, two slides were suspicious for aneuploidy and the rest were diploid. It can be concluded that, the immuno-enzymatic method and cytological method are accurate in diagnosis of chlamydia trachomatis which was found to be the commonest infection in cases of cervical ectopy and there is no relation between chlamydial infection and DNA changes in cervical ectopy

Colposcopy, cervical cytology and human papillomavirus detection as screening tools for cervical cancer

A cohort of 77 women referred for routine screening or investigation of Pap test abnormality underwent colposcopic examination. Pap-stained liquid-based preparations were diagnosed and categorized according to the Bethesda system. Residual material on the sampling device was used to detect high-risk oncogenic human papillomavirus DNA. Although the colposcopic failure rate was higher than that of cytology, no lesion was missed when both methods were used together. High-risk types were recorded in 24% of patients with atypical squamous cells of undetermined significance, 45% with low-grade squamous intraepithelial lesions and 79% with high-grade squamous intraepithelial lesions-indicating that the efficacy of cytological screening can be improved by papillomavirus detection

[Detection and typing of human papilloma virus DNA in cervical cancer with in situ hybridization method]

Cervical cancer is one of the most frequently found cancers in women and appears to have a viral aetiology certain types of the human papillomavirus [HPV] are well established as the primary causes of cervical cancer. Clinical follow-up data, histopathologic diagnosis, in situ hybridization [ISH] and HPV DNA typing were available from 60 patients. ISH technique was performed with comercial biotinylated probes. The presence of 7 high risk HPV was evaluated in 60 cervical biopsies with squamous cell carcinoma [SCC] and Cervical Intraepithelial neoplasia [CIN] of different degrees by ISH. We analysed 60 biopsies from Iranian women. 42 of 60 [70%] carcinoma specimens were positive for HPV-DNA. HPV 31/33/51 [25%] was most frequently found, followed by HPV 16/18 [23.33%] and HPV 6/11 [21.66%] while HPV negative cases were 18[30%]. High risk HPV types appear to be most frequently associated with SCC and CIN. ISH is a sensitive test in the detection and typing of HPV DNA both in clinical and latent infections

Evaluation of the advatages and limitations of a two-year cervical cancer screening programme: a retrospective pilot study from a teaching hospital in riyadh

The aim of the study was to determine the pattern of uterine cervical abnormalities among Saudi and non-Saudi women who were sampled during a two year cervical cancer "opportunistic" screening programme in order to suggest a more efficient and reliable cervical cytology screening policy for the Kingdom of Saudi Arabia and other countries in the Arabian Gulf This study is a two-year retrospective study of women who had cervical smear tests while attending post-natal and gynaecology clinics at King Khalid University Hospital. Out of a total of 8814 cervical smears taken, 415 [4.7%] were abnormal with 355 [4.02%] and 60[0.68%] showing inflammatory changes and variable degrees of cervical intraepithelial neoplasia [CIN] respectively. The remaining 8399 cervical smears were reported as normal with a recommendation for a repeat smear within a maximum period of 3 years. Despite non-compliance with follow-up, severe dyskaryosis equivalent to CIN III was detected and confirmed in approximately 0.002% of the total number of cervical smears studied. Our findings suggest that, in the population studied, the incidence of high grade squamous intraepithelial neoplasia is relatively low. Poor follow-up and the lack of an organized national screening programme for cervical cancer are major problems that should be addressed by the health authorities in the Kingdom of Saudi Arabia and other countries with similar ethnic and social structures