Correlation and clinical significance of VISTA expression and cervical squamous cell carcinoma / 中华肿瘤杂志

Objective: To explore the relationship between the expression of the T-cell activation suppressor-immunoglobulin variable region (VISTA) and the development of cervical squamous cell carcinoma (CSCC), and the impact on the prognosis of CSCC patients. Methods: Cervical tissue samples from 116 CSCC, including 23 cervical intraepithelial neoplasia (CIN) grade I, 23 CIN grade Ⅱ-Ⅲ, and 23 chronic cervicitis patients, were collected from the First Hospital of Soochow University between March 2014 and April 2019. The expression of VISTA in each group was detected by immunohistochemistry (IHC). Survival data of CSCC patients were obtained by follow-up. The survival analysis was performed by Kaplan-Meier method, and survival differences between groups were compared by Log rank test. Prognostic impact factors were analyzed using a multifactorial Cox proportional hazards model. Results: The positive rate of VISTA expression in CSCC group was 32.8% (38/116), and which of grade Ⅱ-Ⅲ was 17.4% (4/23). VISTA expression results showed no positive expression patients in the cervical intraepithelial neoplasia grade I and chronic cervicitis groups. The differences between the CSCC group and other groups were statistically significant (P<0.01). In 116 CSCC patients, VISTA expression was associated with International Federation of Gynecology and Obstetrics (FIGO) stage and lymph node metastasis (P<0.01). The mean survival time of patients in the VISTA positive expression group was 30.7 months, and the 3-year survival rate was 44.7% (17/38). However, the mean survival time of the patients in the VISTA negative expression group was 49.1 months, and the 3-year survival rate was 87.2% (68/78). The Cox regression model found that VISTA expression positivity (P=0.001) and FIGO stage (P=0.047) were prognostic factors for CSCC, and patients with VISTA-positive CSCC had a 4.130-fold risk of death higher than those with VISTA-negative expression. Conclusions: The VISTA protein is highly expressed in CSCC tissues, and its expression level is closely related to the occurrence and development of CSCC. The expression of VISTA can be used as an independent predictor of CSCC prognosis and can provide a strong basis for the treatment of CSCC with immune checkpoint inhibitors.

An immunohistochemistry and histopathological study of ankaferd blood stopper in a rat model of cervical inflammation

SUMMARY OBJECTIVE: Ankaferd Blood Stopper (ABS) is a medicinal plant extract used topically as a hemostatic, anti-inflammatory, and anti-oxidant agent. Its cytoprotective effect mainly depends on its pleiotropic properties by modulating inflammatory mediators such as IL-1β, IL-6, and TNF-α. This study aims to test the possible therapeutic effect of ABS in the treatment of erosive and inflammatory conditions occurring in the uterine cervix. METHODS: Twenty-four female Wistar Albino rats were used in the present study. Trichloracetic acid was applied intravaginally to establish an experimental rat model of cervicitis. The rats were randomly divided into three groups: group I (injury), group II (injury+isotoinc saline), and group III (injury+ABS). After 3 estrous cycles of ABS and isotonic saline treatment, the amount of inflammation, vascular congestion and erosion were evaluated in the cervical tissues by using a modified semi-quantitative scale of 0-3. Immunohistochemical staining with monoclonal antibodies against IL-1β was also performed. RESULTS: Compared with group I and II, the ABS group showed the least inflammatory cell infiltration, vascular congestion and cervical erosion, compared with the ABS group prominent IL-1β staining observed in group I and group II. CONCLUSION: Our data suggest that ABS is a highly effective alternative to induce normal cervical epithelium and can be used safely in the treatment of cervical inflammation with or without cervical erosion.

RESUMO OBJETIVO: Ankaferd Blood Stopper (ABS) é um extrato de plantas medicinais utilizado topicamente como um agente hemostático, anti-inflamatório e antioxidante. O seu efeito citoproteico depende principalmente das suas propriedades pleiotrópicas por meio da modulação de mediadores inflamatórios tais como IL-1β, IL-6 e TNF-a. O objetivo deste estudo é testar o possível efeito terapêutico do ABS no tratamento de condições erosivas e inflamatórias que ocorrem no colo uterino. MÉTODOS: Vinte e quatro ratas Wistar Albino foram utilizadas no presente estudo. O ácido tricloroacético foi aplicado intravaginalmente para estabelecer um modelo experimental de cervicite em ratos. Os ratos foram divididos aleatoriamente em três grupos: grupo I (lesão), grupo II (lesão + fisiológico sérico) e grupo III (lesão + ABS). Após três ciclos estrais de ABS e tratamento fisiológico sérico, as quantidades de inflamação, congestionamento vascular e erosão foram avaliadas nos tecidos cervicais usando uma escala semiquantitativa modificada de 0-3. Coloração imuno-histoquímica com anticorpos monoclonais contra IL-1β também foi realizada. RESULTADOS: Em comparação com os grupos I e II, o grupo ABS mostrou menos infiltração de células inflamatórias, congestionamento vascular e erosão cervical. Além disso, em comparação com o grupo ABS, observou-se uma coloração proeminente de IL-1β no grupo I e no grupo II. CONCLUSÃO: Nossos dados sugerem que o ABS é uma alternativa altamente eficaz para induzir o epitélio cervical normal e pode ser utilizado com segurança no tratamento da inflamação cervical com ou sem erosão cervical.

Progressive loss of E-cadherin immunoexpression during cervical carcinogenesis

PURPOSE: To investigate E-cadherin immunoexpression during cervical carcinogenesis. METHODS: We assessed the immunohistochemical expression of E-cadherin in squamous intraepithelial lesions (SIL - 52 cases), squamous cell carcinoma (SCC) of the uterine cervix (23 cases) and also in eight cases of cervicitis. RESULTS: The results show very different E-cadherin membrane expression levels when cervicitis (88%), SILs (73%) and SCC (17%) were compared. In SILs, higher E-cadherin loss was seen in less differentiated cells in the basal third of the epithelium. This study suggests that the absence of E-cadherin expression in the membrane is a molecular event that is observed more often in SCC of the uterine cervix than in SILs or cervicitis. CONCLUSIONS: E-cadherin is an essential molecule during the process of cervical carcinogenesis and in this context exhibits a different expression pattern according to the epithelial thickness layer. .

Comparative analysis of three methods for HPV DNA detection in cervical samples / Análisis comparativo de tres métodos para la detección del ADN de VPH en muestras de cuello uterino

High risk HPV infection is considered to play a central role in cervical carcinogenesis. HPV DNA testing has shown to be a very useful tool for screening and following cervical infections. The aim of this study was to compare three methods for HPV DNA detection, along with cytology and colposcopy analysis. Cervical samples were collected from 100 sexually active women in Mérida, western Venezuela. HPV infection was screened using Hybrid-Capture 2 (HC2), L1-Nested-PCR and E6/E7-PCR assays. 40% of the samples (40/100) were HPV positive by at least one of the DNA detection methods. HC2 detected HPV in 12% specimens. L1- and E6/E7-PCRs showed 50% sensitivity and 77% specificity.The agreement rate between HC2 and both PCR assays was 65%. Kappa value showed moderate concordance between HC2 and both PCR methods (κ=0.55; CI 95%). Also moderate concordance was seen when L1- and E6/E7-PCRs were compared (κ=0.48; CI 95%). There was a significant association between the Schiller test and E6/E7-PCR (p=0.006) for HPV infection. An acceptable agreement between all three assays for HPV detection was observed. Nevertheless, different PCR formats need to be further analyzed in order to make the right choice of method for HPV testing.

La infección con VPH de alto riesgo es el principal factor etiológico asociado al desarrollo de carcinogénesis cervical y las pruebas de detección de ADN-VPH han mostrado ser una herramienta esencial para la pesquisa y seguimiento de estas infecciones. El objetivo del estudio ha sido comparar tres métodos para la detección del ADN viral, en combinación con los análisis colposcópico y citológico. Se obtuvieron muestras cervicales de 100 mujeres sexualmente activas, en Mérida, Venezuela. La detección de infecciones por VPH se realizó por Captura Híbrida 2 (CH2) y los ensayos de PCR “L1-Nested-PCR” y “E6/E7-PCR”. 40% de las muestras (40/100) fueron positivas para VPH por al menos uno de los métodos aplicados. 12% de las muestras analizadas fueron positivas para VPH por CH2. Las dos PCR utilizadas mostraron un 50% de sensibilidad y 77% de especificidad. La coincidencia observada entre CH2 y las dos PCR fue del 65%. La determinación del valor Kappa mostró una concordancia moderada entre CH2 y ambos métodos de PCR (κ=0,55; CI 95%). También existió concordancia moderada al comparar las PCR de las regiones L1 y E6/E7 de VPH (κ=0,48; CI 95%). Hubo una asociación significativa entre el resultado del test de Schiller y la PCR E6/E7 (p=0,006) para la infección por VPH. Se determinó una concordancia aceptable entre los tres métodos aplicados para la detección de VPH; sin embargo, las PCR deben ser analizadas en trabajos futuros con el fin de establecer las pruebas más adecuadas para la detección viral.

Detección de virus papiloma humano (HPV) a partir de muestras celulares de cuello uterino en base líquida: Correlación con la inmunorreactividad de la proteína p16INK4a / Detection of human papilloma virus (HPV) in liquid-based cervical samples: Correlation with protein p16INK4a expression

La citología del cuello uterino en base líquida mejora la calidad de la muestra y el material residual podría ser utilizado para realizar pruebas complementarias, como la detección del virus papiloma humano (HPV) y estudio inmunocitoquímico de biomarcadores. El propósito de este estudio fue correlacionar la presencia de HPV y la inmunoexpresión de p16INK4a en las muestras citológicas en base líquida para examinar la utilidad de estas nuevas herramientas en la detección de cáncer de cuello uterino. Las pacientes incluidas (n=67) presentaban una citología anormal o patología cervical previa. La detección y genotipificación de HPV se realizó con PCR-SPF10/LiPA (INNOLiPA Extra Amp) y para la inmunodetección de p16INK4a se utilizó el anticuerpo clon E6H4. La citología convencional proporcionó los mismos hallazgos citológicos que la citología en base líquida. La prevalencia general del HPV fue de 43,3% (29/67). El HPV16 fue el tipo viral mas frecuente (31,03%) y el 48,3% de los casos presentó infección múltiple. En el 35,8% de las muestras cervicales se detectó inmunoexpresión de la p16INK4a y ésta fue significativamente (p<0,020) asociada a la presencia de HPV. Estos resultados apoyan la evidencia que la implementación de nuevas tecnologías en la rutina diaria del laboratorio contribuye significativamente en la detección precoz del cáncer de cuello uterino y en el aporte de datos importantes para facilitar en el manejo clínico adecuado de la paciente. La detección de HPV combinada con la p16INK4a podría ser utilizado en la evaluación de pacientes con mayor riesgo a desarrollar lesiones cervicales significativas.

The liquid-based cervical cytology improves the quality of the sample and the residual sample could be used efficiently to carry out complementary tests, such as the detection of HPV DNA and the immunocytochemical biomarkers study. The purpose of this study was to correlate the presence of HPV and immunoexpression of p16INK4a in liquid-based cervical samples to examine the utility of these new tools in the detection of cervical cancer. The included patients (n=67) presented an abnormal cytology or previous cervical pathology. The HPV detection and genotyping were carried out with PCR-SPF10/LiPA (INNOLiPA Extra Amp) and for p16INK4a immunodetection was used antibody clone E6H4. The conventional cytology provided the same cytologic interpretations that those of liquid-based cytology. The overall HPV prevalence was 43.3% (29/67). HPV16 was the most frequent viral type (31.03%) and 48.3% of the cases were infected with multiple HPV types. p16INK4a immunoexpression was observed in 35.8% of liquid-based cytological samples and this was significantly (p < 0.020) associated to the HPV presence. These results support the evidence that the implementation of new technologies in the daily routine of the laboratory, contribute significantly in the early detection of cervical cancer and provide important data to help in the patient’s efficient management. The combined use of HPV detection and p16INK4a expression could be used for evaluation of patients with more risk to develop significant cervical lesions.

Short-term risk of cervical intraepithelial neoplasia grades 2 and 3 for women with normal cytology and human papillomavirus infection / Riesgo a corto plazo de lesiones intraepiteliales cervicales grados 2 y 3 en mujeres con citología vaginal normal e infección por el virus del papiloma humano

OBJECTIVE. To assess the risk of cervical intraepithelial neoplasia grades 2, 3 or higher (CIN 2/3+) for women with normal cytology and concurrent high-risk human papillomavirus infection (HR-HPV). MATERIAL AND METHODS. We examined 2 200 women every 6 months for an average of 9 years. Cervical smears and samples for HPV DNA were obtained at each visit. Absolute risk of subsequent CIN2/CIN3+ was estimated using the Kaplan-Meier method. RESULTS. The absolute risk of CIN2/CIN3+ among HR-HPV-positive women with normal Pap smear results was 1.06 percent (95 percentCI, 0.57-2.20), 5 times higher the risk among all women with normal Pap smears (0.20 percent; 95 percentCI, 0.12-0.32) but 7 times lower than that for women with HR-HPV infection and LSIL (7.24 percent; 95 percentCI, 3.78-15.2). CONCLUSION. Short-term absolute risk of CIN2/3+ after a normal Pap smear with concurrent HR-HPV infection is low (~1 percent), suggesting that the HR-HPV test has limited utility in short-term clinical decision-making for women with normal cytology.

OBJETIVO. Evaluar el riesgo a corto plazo de neoplasia intraepitelial cervical de alto grado (CIN2/CIN3+) en mujeres con citologí-a cervicouterina normal e infección por virus del papiloma humano de alto riesgo (HR-HPV). MATERIAL Y MÉTODOS. Cohorte prospectiva de 2200 mujeres evaluadas cada seis meses durante 9 años en promedio. En cada visita se tomó muestra cervical para extendido y detección de HPV DNA. El riesgo absoluto de CIN2/CIN3+ a la siguiente visita fue calculado utilizando el método de Kaplan-Meier. RESULTADOS. En mujeres con citologí-a normal e infección concomitante por HR-HPV el riesgo absoluto de presentar CIN2/CIN3+ fue de 1.06 por ciento (95 por cientoCI, 0.57-2.20). Este riesgo fue cinco veces mayor al observado en todas las mujeres con citologí-a normal (0.20 por ciento; 95 por cientoCI, 0.12-0.32) pero siete veces menor que el observado en mujeres con lesiones intraepiteliales escamosas de bajo grado con infección concomitante (7.24 por ciento; 95 por cientoCI, 3.78-15.2). CONCLUSIÓN. El riesgo absoluto de CIN2/3+ a corto plazo luego de una citologí-a normal e infección por HR-HPV es baja (~1 por ciento), sugiriendo que, a corto plazo, la prueba de HR-HPV tiene utilidad clí-nica muy limitada en mujeres con citologí-a normal.

AgNOR polymorphism association with squamous intraepithelial lesions and invasive carcinoma with HPV infection / Asociación de los polimorfismos AgNORs con lesiones intraepiteliales escamosas, carcinoma cervical e infección por VPH

OBJECTIVE: Evaluate the relationships between AgNORs polymorphisms and squamous intraepithelial lesions (SIL) and squamous cell carcinoma (SCC) with HPV infection. MATERIALS AND METHODS: A study was carried out on sixty women from the state of Guerrero, Mexico. HPV detection was performed by PCR. AgNORs were identified by argentic impregnation. One hundred cells per slide were counted and classified according to the polymorphism of AgNORs dots; typical (spherical) and atypical (large, kidney-shaped and clustered). RESULTS: A total of 100 percent of the cases were positive for HPV infection. Nine different high-risk HPV genotypes were found, type16 was the most common (48.6 percent). The AgNORs showed a significant decrease in spherical shape according to neoplastic development. The three atypical shapes showed a significant increase in SIL and SCC (p-trend<0.001). CONCLUSIONS: AgNORs polymorphism rises progressively according to the grade of histological lesions that can be useful as a prognosis for progression of SCC.

OBJETIVO: Evaluar la relación entre los polimorfismos de AgNORs con las lesiones intraepiteliales escamosas (LIE) y carcinoma de células escamosas (CCE). MATERIAL Y MÉTODOS: Se estudiaron sesenta mujeres del estado de Guerrero, México. La detección del VPH fue por PCR y los AgNORs por impregnación argéntica; se contaron 100 células y se clasificaron por tipo de polimorfismo de AgNORs: típico (esférico) y atípicos (largo, forma de riñón o de racimo). RESULTADOS: El 100 por ciento de los casos presentaron infección por VPH, se encontraron nueve genotipos diferentes de VPH de alto riesgo, el 16 fue el más común (48.6 por ciento). La forma esférica de los polimorfismos de AgNORs mostró una disminución con el desarrollo neoplásico y las atípicas incrementaron progresivamente con SIL y SCC (p-tendencia<0.001). CONCLUSIONES: Los polimorfismos AgNORs se incrementan progresivamente con el grado de lesión histológica, y pueden ser útiles en el pronóstico de progresión del carcinoma cervical.

Prevalence of micronuclei in exfoliated uterine cervical cells from patients with risk factors for cervical cancer / Prevalência de micronúcleos em células esfoliativas do colo uterino de pacientes com fatores de risco para o câncer de colo uterino

CONTEXT AND OBJECTIVE: Pap smears are the most common and inexpensive screening method for cervical cancer. We analyzed micronucleus prevalence in exfoliated cervical mucosa cells, to investigate associations between increased numbers of micronuclei and risk factors for cervical cancer. DESIGN AND SETTING: Analytical cross-sectional study, at Instituto de Pesquisa em Oncologia (IPON). METHODS: Exfoliated cervical cells were obtained from 101 patients between September 2004 and November 2005. Patients' ages, habits (passive or active smoking, alcoholism and numbers of sexual partners), age at first sexual intercourse, contraceptive methods used, histories of sexually transmitted diseases, use of hormone replacement therapy, numbers of pregnancies and abortions, inflammatory cytology and cervical intraepithelial neoplasia (CIN) were obtained. Cells were collected using Ayre spatulas, transferred to vials containing 0.9 percent saline solution for micronucleus tests and analyzed at 1000x magnification. The number of micronuclei in 1,000 epithelial cells per patient sample was counted. RESULTS: Comparisons between groups with active (7.9 ± 7.8) and passive (7.2 ± 10.6) smoking versus no smoking (3.7 ± 5.1); with/without alcoholism (7.8 ± 1.4 and 6.9 ± 10.1); with/without inflammatory cytology (10.7 ± 10.5 and 1.3 ± 1.7); and with CIN I, II and III and no CIN (respectively 4.3 ± 4.3, 10.6 ± 5.3, 22.7 ± 11.9 and 1.3 ± 1.4) found elevated micronucleus prevalence (P < 0.05). CONCLUSIONS: We concluded that the prevalence of micronuclei in exfoliated uterine cervical cells was greater in patients with one or more risk factors for uterine cervical cancer than in patients without risk factors.

CONTEXTO E OBJETIVO: O câncer do colo uterino é uma das mais freqüentes neoplasias na mulher. O exame de Papanicolaou é o método mais comum e econômico para rastreamento. As células esfoliativas epiteliais podem ser úteis para o monitoramento de pacientes expostas a fatores de risco para o câncer. O objetivo foi analisar a prevalência de micronúcleos em células esfoliativas da mucosa cervical uterina e associar com fatores de risco para o câncer de colo uterino. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico, no Instituto de Pesquisa em Oncologia (IPON). MÉTODOS: Células esfoliativas do colo uterino foram obtidas de 101 pacientes ambulatoriais entre setembro/2004 e novembro/2005. As células foram coletadas usando espátula de Ayre e transferidas para um tubo de ensaio com soro fisiológico 0,9 por cento para o teste do micronúcleo. Informações obtidas das pacientes foram: idade, hábitos (fumo e número de parceiros sexuais), métodos contraceptivos, história de doença sexualmente transmissível e uso de terapia hormonal. Células foram analisadas com magnificação de 1000 X e os micronúcleos contados em 1.000 células epiteliais por paciente. RESULTADOS: A comparação do grupo de pacientes fumantes ativas (7,9 ± 7,8) e passivas (7,2 ± 10,6) versus não fumantes (3,7 ± 5,1); alcoolismo e não alcoolismo (7,8 ± 1,4 e 6,9 ± 10,1); citologia inflamatória e citologia normal (10,7 ± 10,5 e 1,3 ± 1,7); neoplasia intraepitelial cervical (NIC) I, II e III e a ausência de NIC, respectivamente, (4,3 ± 4,3; 10,6 ± 5,3; 22,7 ± 11,9 e 1.3 ± 1.4) mostrou maior prevalência de micronúcleos (P < 0,05). CONCLUSÕES: A prevalência de micronúcleo nas células esfoliativas do colo uterino foi maior no grupo de pacientes com pelo menos um dos fatores de risco para câncer do colo uterino do que no grupo controle (sem fatores de risco).

Histopathological analysis of hysterectomy specimens.

The objective of this study was to explore the histopathological findings and the rate of removal of ovaries in hysterectomy specimens. This study took into account 328 hysterectomy specimens examined in the Department of Pathology, Mymensingh Medical College and in one private Pathology Laboratory in Mymensingh town from March to August, 2005. Formalin fixed paraffin embedded tissue sections stained with haematoxylin and eosin were examined under light microscope. Patients' age, parts of uterus examined and their histopathological findings were retrieved from laboratory records. The common histopathological findings were: chronic cervicitis (87.80%), leiomyoma (17.07%), uterine prolapse (16.72%), adenomyosis (3.96), non-specific endometritis (3.35%), squamous cell carcinoma of cervix (2.44%), endometrial polyp (2.44%), serous cystadenoma of ovary (2.44%) and endometrial hyperplasia (1.83%). Some of the specimens show more than one lesions in the body of uterus, of which coexistence of adenomyosis and leiomyoma was the most common. Neoplastic lesions in cervix were 4.27%, in body 16.92% and in ovaries 5.06%. Malignant neoplasms were found in cervix 71.43%, in uterine corpus 3.03% and in ovaries 25%. Ovaries of both sides were removed in 48.17% of total cases. Their median age was 45 years, lowest age 23 years and maximum age was 82. The rate of removal of both ovaries was found to be increasing with the increase of age. Only one case was found to be subtotal hysterectomy and others were total hysterectomy. The present study revealed that the most common histopathological cause of hysterectomy is chronic cervicitis. Most common neoplastic cause of hysterectomy is leiomyoma. The rationalities and the possible after effect of hysterectomy in sexual functions and other physiological impairment should be followed up.

Asociación de la citología cervico-vaginal inflamatoria con la lesión intraepitelial cervical en pacientes de una Clínica de Salud Sexual y Reproductiva en Bogotá, Colombia 1999- 2003 / Association between the cervico-vaginal inflammatory citology and the intraepithelial cervical lesion in patients from a Sexual and Reproductive Health Clinic in Bogotá, Colombia, 1999-2003

OBJETIVOS: El cáncer de cervix es la neoplasia más frecuente de la mujer en Colombia. La citología cervical es la prueba de tamizaje para las lesiones intra-epiteliales-LIE, predecesoras del cáncer de cervix. La lesión intraepitelial podría manifestarse por la presencia de células inflamatorias. El objetivo del presente trabajo fue evaluar el papel de la citología inflamatoria como marcador de LIE. MATERIALES Y MÉTODOS: Estudio de corte transversal, para establecer las características operativas de la citología cervical en pacientes de la consulta de colposcopia de la Clínica Piloto Profamilia de Bogotá, entre Enero de 1999 y Diciembre de 2003. Se compararon pacientes que presentaron patología de LIE con quienes presentaron patología benigna del cervix. Se evaluó la sensibilidad y especificidad de la citología en diferentes puntos de corte, al compararla con la biopsia como patrón de oro. RESULTADOS: La prevalencia de LIE de bajo grado fue del 48,7 por ciento y la prevalencia de LIE de alto grado fue del 9,7 por ciento. La citología mostró mejor desempeño al considerar la citología atipia epitelial de significado indeterminado-AESI como anormal. La citología inflamatoria severa mostró similar asociación a la LIE que a la AESI. CONCLUSIONES: La exclusión de las atipias epiteliales de significado indeterminado como punto de corte, reduce la sensibilidad de la prueba de tamizaje. Se recomienda incluir la lectura inflamatoria en el informe citológico estratificado por severidad, hasta que se aclaresu real utilidad para el diagnóstico de la lesión intraepitelial.

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.

AgNOR counts in cervical lesions.

Present study was undertaken with a view to assess the utility of AgNOR counts in differentiating cervical lesions. One hundred cases of cervical lesions including normal, chronic cervicitis, CIN (I, II, III) and carcinoma were taken up for study during the period December 1995 to November 1996. Three micron thick sections of paraffin were subjected to AgNOR staining as described by Crocker and Smith with a little modification of 0.01% safranin counterstain. Statistical counts of AgNORs were done. The mean AgNOR counts in cervical epithelium showed a progressive and statistically significant increase from normal to chronic cervicitis to CIN, I, II and III (P<0.001). Scores in carcinoma also exceeded that of CIN (P<0.05). This can prove to be a useful adjunct to routine histopathology to evaluate cervical lesions.

Re-classification of carcinoma cervix uteri by mucin histochemistry.

Biopsies of cervix uteri from 166 patients with benign and malignant lesions (12 normal, 48 inflammatory lesion, 6 adenocarcinoma, 2 adenosquamous carcinoma and 98 from squamous cell carcinomas) were studied histochemically. The stains used were PAS with/without diastase, AB/PAS (pH 2.5) and OR/AB. In inflammatory lesions neutral mucin was predominent which was replaced by sialomucin and sulphomucin in endocervical polyps. In malignant lesions sulphomucin was predominent. Seventeen percent cases of squamous cell carcinomas needed reclassification after mucin staining. Of the fourteen large cell non-keratinizing squamous cell carcinomas, 12 were reclassified as squamous cell carcinoma with mucin secretion and 2 as adenosquamous carcinoma. One case of small cell non-keratinizing squamous cell carcinoma was reclassified as moderately differentiated adenocarcinoma. None of the keratinizing carcinomas had evidence of mucin secretion. Mucin histochemistry should be done routinely on non-keratinizing squamous cell carcinomas to pick up more cases of carcinoma with evidence of mucin secretion which can be missed on routine haematoxylin and eosin stains. Such carcinomas are known to pursue a more aggressive clinical course and have a poorer prognosis than non-mucin secreting type of squamous cell carcinoma.

Microflora in postirradiated cancer cervix.

Cases of cancer cervix receiving radiation therapy revealed more anaerobes (50%) in comparison to normal controls (44.6%). The aerobic organisms were suppressed in the former cases (63.6%) in contrast to the latter group (90.7%). Of the anaerobes, the Gram-negative bacilli were more notable (18.1%) in cancer cervix than the normal controls (4.6%). The anaerobes like Peptococcus prevotii (18.1%) and Bacteroides oralis (9%) and the aerobes, Staph aureus (13.6%) and klebsiella (13.6%) were prevalent in cancer cervix. The higher incidence of aerobic and anaerobic organisms in stage III elderly (> 45 years) patients of cancer cervix may necessitate antibacterial therapy.

Abordagem do paciente com massa cervical / Approach to the patient with neck mass

Na pratica clinica e muito frequente o medico deparar-se com um paciente que apresenta uma massa cervical. Esta pode representar varias patologias, primarias ou secundarias, de etiologia variada: congenita, inflamatoria, traumatica ou neoplasica. Uma abordagem criteriosa deste paciente, incluindo uma anamnese completa, um exame fisico detalhado e uma solicitacao pertinente de exames complementares, geralmente permite o estabelecimento do diagnostico. Quando necessaria, a biopsia da massa cervical deve ser realizada, destacando-se que o procedimento mais indicado e a biopsia excisional com exame histopatologico transoperatorio programado, bem como condicoes para uma possivel cirurgia mais abrangente

Cervicitis: riesgo epidemiológico y clínico para infección por chlamydia trachomatis en estudiantes universitarias / Cervicitis: epidemiological and clinical risk for chlamydia trachomatis infection in universitary students

Se encuestaron y examinaron 50 estudiantes universitarias sexualmente activas, asintomáticas y voluntarias, a fin de determinar factores de riesgo predictivos de infección por chlamydia trachomatis. Se encontró que los factores epidemiológicos y conductuales eran similares a lo descrito para estudiantes norteamericanas, en cuanto a edad, número de parejas sexuales, uso de anticonceptivos orales y antecedentes de enfermedad de transmisión sexual previa. Había diferencia en el uso de métodos anticonceptivos de barrera. Un 22 por ciento de la muestra presentaba cervicitis clínica y un 30 por ciento cervicitis subclínica. Si se hubiera aplicado los criterios de screening propuestos por los diferentes autores norteamericanos, entre un 32 por ciento y 73 por ciento de las estudiantes debieran haber sido sometidas a estudio selectivo para pesquisa de Chlamydia trachomatis, porcentaje similar al de los trabajos originales. Se concluye que existiendo similares factores de riesgo pudiera existir una similar prevalencia de infección y debieran adoptarse las sugerencias foráneas a pesquisas mientras no se cuente con estudios nacionales

Experience of the large loop excision of the transformation zone (LLETZ) for the treatment of women with abnormal pap's smear at Ang Thong Hospital.

From October 1990 to September 1991 2,471 women in Ang Thong Province had Pap's smear screening at both Gynecological and mobile clinics. Of these women 267 had abnormal smears. The Large Loop Excision of the Transformation Zone (LLETZ) was carried out in 30 selected women. The final microscopic findings were 5 cases of CIN I, 2 cases of CIN II, 1 case of CIN III and 22 cases of chronic cervicitis.

Cervical dysplasia and chronic cervicitis

Seventy five cervices were collected from hysterectomy specimens and autopsies performed at Faculty of Medicine, Cairo University on female patients dying from reasons other than malignancy of female genital tract. Histopathological studies showed chronic cervicitis in 73.3% of cases, dysplasia in 16.4% in cases with chronic cervicitis and 5% dysplasia in cases without cervicitis. 90% of cases of cervicitis was associated with dysplastic changes. Koilocytosis and dysplasia was found affecting more younger age group