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Objective:To investigate the clinical pathologic features of high-grade squamous intraepithelial lesions (HSIL) in postmenopausal women.Methods:The clinical data of hospital patients with HSIL admitted to the Department of Gynecology of The First People's Hospital of Lianyungang, Jiangsu Province from January 2019 to December 2020 were retrospectively analyzed. Patients undergoing liquid-based thin-layer cytology, high-risk human papillomavirus (HR-HPV), colposcopy, cervical biopsy and Endocervical curettage (ECC), pathological diagnosis of HSIL, followed by cold knife conization (CKC). The diagnosis and treatment process conformed to the cervical cancer diagnosis and treatment norms, and there were a total of 594 patients with no previous cervical surgery history,including 463 cases in the premenopausal group and 131 cases in the menopausal group, and the age, contact bleeding, gynecological examination, HR-HPV, liquid-based thin layer cytology, colposcopy and biopsy results, and post-cervical cone surgery pathological results were compared and analyzed, and multivariate Logistic regression analysis was carried out for statistically different factors to identify the clinical pathological characteristics of postmenopausal HSIL patients. T-test was used for the comparison between measurement data groups with normal distribution, and rank sum test was used for the comparison between measurement data groups with non normal distribution. Counting data use χ 2 test or Fisher exact probability method. Logistic regression analysis was used in multivariate analysis. Results:There was no significant difference in the positive rate of contact bleeding (12.98%(17/131)) and HR-HPV (77.86%(102/131)) between postmenopausal group and non postmenopausal group (11.45%(53/463) and 80.56% (373/463))(χ 2 values were 0.23 and 0.46; P values were 0.632 and 0.496). The proportion of cervical columnar epithelium displacement (43.51% (57/131)) and abnormal liquid-based thin-layer cytology (87.79%(115/131)) in the postmenopausal group were lower than those in the non postmenopausal group (64.36%(298/463) and 93.74%(434/463)). There was significant difference between the two groups (χ 2 values were 18.46 and 5.16; P values were < 0.001 and 0.023). The positive rate of ECC (62.60%(82/131)), cervical type Ⅲ transformation area (73.28%(96/131)), the proportion of pathological upgrading after conization (9.92%(13/131)) and the positive rate of cutting edge after conization (24.43%(32/131)) in menopausal group were higher than those in non menopausal patients (46.22%(214/463), 26.78%(124/463), 1.73%(8/463) and 5.40%(25/463)). There were significant differences between the two groups (χ 2 values were 10.95, 94.68, 20.11 and 42.62; P values were 0.001, <0.001, <0.001 and <0.001). Multivariate Logistic regression analysis showed a high proportion of cervical type Ⅲ transformational zones ( OR=6.569, 95% CI 4.130-10.446), high ECC positivity ( OR=1.978, 95% CI 1.250-3.128), the positive rate of cone incision margins was high ( OR=4.581, 95% CI 2.386-8.794), the proportion of pathological escalation after cone surgery ( OR=4.612, 95% CI 1.557-13.668) and the proportion of smooth cervical appearance were high ( OR=0.464, 95% CI 0.294-0.731), which was the clinicopathological feature of postmenopausal HSIL ( P values were <0.001, 0.004, <0.001, 0.006 and 0.001). Conclusion:There were differences in HSIL in patients before and after menopause, clinical symptoms and screening manifestations were atypical, and lesions are easy to involve the cervical canal, the positive rate of the cut margin after coneectomy was high, and the proportion of pathological escalation was high, so more aggressive intervention should be taken for women diagnosed with precancerous cervical lesions after menopause
Résumé
Background:Cervical cancer is the second most common cancer world wide. It is preventable and curable if detected at early stages. Conventional cervical cytology using pap smears is most commonly used cervical screening method throughout the world. The aim of the study is to evaluate and interpret the cervical pap smear cytology in a tertiary care hospital . The interpretation and reporting of the cervical pap smears is based on the Bethesda system. Material and methods: This is a retrosceptive study conducted in a tertiary care hospital in Jammu over a period of 3 years. All the cervical pap smears received in the Department of Pathology, GMC Jammu, in the study period were included (expect menstruating women, pregnant women and women who had undergone hysterectomy). Results: A total of 300 cases were reported in the Cytology section of the Department of Pathology in the study period of three years. Majority of the cases were Negative for Intraepithelial lesions or malignancy(79%). Reactive cellular changes associated with inflammation were the most common finding (71.6%) followed by bacterial vaginosis(3.33%), candiasis(2%) and trichomanas(2%). Epithelial cell abnormality (6.33%) comprised of ASCUS, LSIL,HSIL& SCC. Conclusion : Pap smears is a simple and cost effective screening method to detect various preinvasive cervical lesions. It should be done routinely in all women in reproductive age group.
Résumé
Since Folkman's novel hypothesis, it is well known that tumors depend on the angiogenesis for their growth, expansion, and possibly metastasis. Several angiogenic factors have been identified and shown to be produced by tumors. In some cancers, the angoigenic activity in the tumor is correlated with the clinical outcome. Clinically, the presence of macroscopic or colposcopic abnormal vascular patterns of the uterine cervical lesions would suggest that the angiogenic activities are associated with various cervical squamous epithelial lesions. This study was designed to look at the relationship between angiogenesis and squamous epithelial lesions of the uterine cervix and to determine whether squamous intraepithelial lesions are angiogenic as cervical cancers are. Tissue sections from 53 surgical specimens(6 normal cervix, 4 chronic cervictis, 9 low grade SII, 8 high grade SIL, 7 MIC, 19 squamous cell carcinoma) were immunohistochemically stained for CD 34 a specific marker for endothelial cels. Stained vessels in the most intense area on a X200 light microscopic field were selected and counted automatically using computer software for color-image analysis. Stained vessel counts were 19.7 +/- 9.1 in normal cervix, 33.5 +/-5.8 in chronic cervicitis, 38.8 +/- 10.9 in LGSIL, 67.0 +/- 23.6 in HGSIL, and 73.4 +/- 20.6 in microinvasive carcinoma, 77.8 +/- 28.7 in squamous cell carcinoma, respectively. Vessel counts showed a statistically increasing tendency in more advanced squamous epithelial lesins. Tumor angiogenesis is not related to inflammatory response. Also, the process of the angiogenic switching may begin from low grade SIL to high grade SIL. This study suggests that the angiogenic activity also involved in SILs as invasive cancer are and may be related to grade of SELs.