Frequency of human papillomavirus infection and genotype distribution among women with known cytological diagnosis in a Southern Italian region.

INTRODUCTION: In the Puglia region (South Italy) about 200 new hospitalizations for cervical cancer are registered every year. The study investigated the frequency of Human Papillomavirus (HPV) infection and the genotype distribution of HPV in a sample of women with known cytology attending the outpatient clinics of four Gynecological Departments of the University of Bari over a four-year period (2005-2008). METHODS: Cervical samples from 1,168 women were analyzed for the presence of HPV-DNA through Polymerase Chain Reaction (PCR) in L1 region and reverse hybridization. The cytological results were associated with HPV positivity and type-specific prevalence. RESULTS: Overall, HPV infection was found in 355 (30.4%) women. HPV-DNA was found in 34.4% of women with a cytological diagnosis of ASCUS, in 46.8% of women with Low-grade Squamous Intraepithelial Lesion (LSIL) and in 87.0% of women with High-grade Squamous Intraepithelial Lesion (HSIL)/carcinoma. Also 16.0% of women with normal Pap smear were found to be HPV-DNA positive. The most common HPVgenotype was type 16 found in 27.3% of positives, followed by type 53 (11.5%), type 66 (9.2%) and type 31 (9.0%). HPV genotype 18 was found in 6.4% of positives. Types 16 or 18 were detected in about 34% (120/355) of all infected women, in about 33% of LSIL and in 60% of HSIL/ carcinoma HPV-positive women. Among low risk (LR) genotypes, type 61 was found in 10.7% of HPV positive women, type 62 in 8.4%, type 42 in 8.1% and type CP6108 in 7.8%. DISCUSSION AND CONCLUSIONS: The findings of the study give evidence that HPV infection is frequent in the studied cohort of women. The most widespread genotypes found were 16 and 53. These data may represent a benchmark for future evaluation after the recent introduction of vaccination against HPV in 12-year-old girls.

Pharmacokinetics and endometrial effects of the vaginal administration of micronized progesterone in an oil-based solution to postmenopausal women.

OBJECTIVE: To study the pharmacokinetics of the transvaginal absorption of 100 mg micronized P from an oil-based solution in postmenopausal women before and after the estrogenization of the vaginal mucosa and to evaluate the endometrial effects of 10 days of once daily P vaginal administration. DESIGN: Prospective clinical trial. SETTING: University Medical School. PATIENTS: Nine postmenopausal women undergoing hormone replacement therapy. INTERVENTIONS: A micronized P (100 mg) oil-based solution currently available on the market for IM use was administered vaginally by means of a Teflon cannula without the aid of a speculum. Subsequently, the women received 4 weeks 0.1 mg/d transdermal E2 treatment combined on the last 10 days with the once daily vaginal administration of P in the same way as before. MAIN OUTCOME MEASURES: At the first (before estrogen) and second (during estrogen therapy) P administrations, P serum levels were measured at time 0, and then after 15, 30, 45, 60, 120, 240, 480, and 1440 minutes. Endometrial samples were collected at the end of treatment. RESULTS: After the first administration, a mean Cmax of 5.40 +/- 0.92 ng/mL (mean +/- SD) was reached at a Tmax of 45 minutes (range 30 to 480 minutes). The serum concentrations returned to their initial values after 24 hours. The second P administration reached a mean Cmax of 5.30 +/- 1.04 ng/mL at a Tmax of 60 minutes (range 30 to 240 minutes); after 24 hours, the serum P levels still were significantly higher than at baseline and at the same time after the first administration. None of the women complained of significant vaginal losses. No signs of vaginal phlogosis or irritation were observed. In all subjects, histologic evaluation showed clear endometrial secretory changes. CONCLUSIONS: The daily vaginal administration of one vial of micronized P for 10 days allowed useful serum P levels to be reached, especially after estrogen therapy, and induced clear secretory changes in the endometrium.

Morphological changes of the ovarian surface epithelium in women with ovarian polycystic disease or endometrial carcinoma and a control group.

The ovarian surface epithelium and that of related inclusion cysts were studied in 50 women with ovarian polycystic disease and they were compared with our preceding observations performed on women with endometrial carcinoma (n = 50) and on women without any hyperplastic or neoplastic genital tract pathology (n = 50). In 16 women (32%) the ovarian epithelium with normal aspect was found on the surface of the ovary and in inclusion cysts. In the remaining 34 women (68%) surface papillomatosis, hyperplastic and metaplastic changes were present on the ovarian surface and/or in the inclusion cysts. These findings were similar to those observed in the group of women with endometrial adenocarcinoma, while the surface epithelium was often normal in the control group. Our observations confirm the hypothesis of a hormonal influence in the hyperplastic and metaplastic modifications of the ovarian epithelium and in the related common epithelial tumors of the ovary.

Multifocal extraovarian serous carcinoma. A histochemical and immunohistochemical study.

Three cases of multifocal extraovarian serous carcinoma are presented. This rare, interesting tumor is characterized by a peritoneal carcinosis with ascites and by a histological pattern similar to one of the ovarian serous carcinoma without primary involvement of the ovaries. The pathological criteria for a differential diagnosis between this condition and a localization of ovarian carcinoma are discussed. Histochemical studies show the presence of mucins and the absence of ialuronic acid in the neoplastic cells. The positivity to the low molecular weight cytokeratins is strong in the normal mesothelial cells, and weak in the hyperplastic and neoplastic cells. The meaning of these findings in the tumoral histogenesis is discussed.

Hyperplasia and metaplasia of ovarian surface epithelium in women with endometrial carcinoma. Suggestion for a hormonal influence in ovarian carcinogenesis.

Surface ovarian epithelium and that of related inclusion cysts were comparatively studied in two groups of patients: one group of 50 non-pregnant women without myometrial, endometrial, or cervical hyperplasia and/or neoplasia; a second group of 50 women surgically treated for endometrial cancer and without evidence of ovarian pathology. Papillomatosis, hyperplasia and tubaric, squamoid, endometrioid and mucinous metaplasia were more frequently present in ovarian surface epithelium or in related inclusion cysts in patients with endometrial carcinoma. These findings may be correlated with a hormonal oncogenic stimulus involved in the genesis of endometrial cancer and suggests a new "hormonal" hypothesis in the pathogenesis of common epithelial tumors of the ovary.