Prevalence of DNA-HPV in male sexual partners of HPV-infected women and concordance of viral types in infected couples.

Investigation of HPV infection in men remains important due to its association with genital warts and anorectal cancer, as well as to the role men play in HPV transmission to their female sexual partners. Asymptomatic men (n = 43), whose sexual partners had presented cervical HPV infection, were enrolled in this study. Among the 43 men, 23 had their female partner included and tested for HPV-DNA, totaling 23 couples. HPV-DNA was detected by PCR. Type specific PCR to detect HPV 16, 18, 31, 33, 45 and 6/11 was performed. At least one type of HPV was detected in 86.0% (37/43) of the male patients and more than one HPV type was identified in 39.5% (17/43) of the samples, including high and low risk HPV. HPV-16 proved to be the most prevalent viral type in both male and female samples. Concordance of at least one viral type was observed in 56.5% (13/23) of the couples. Among couples that have shown concordance of viral types, 84.6% (11/13) of the men had the same high risk viral type presented by the female sexual partner. These data suggest that HPV infected men is an important reservoir, contributing to a higher transmission to women and maintenance of infection, and consequently, a higher risk of developing cervical cancer. HPV vaccination in men will protect not only them but will also have implications for their sexual partners.

Minichromosome maintenance 7 protein is a reliable biological marker for human cervical progressive disease.

OBJECTIVE: This study focused on comparing the expression levels of p16, Ki-67, and minichromosome maintenance 7 (MCM7) protein in normal and affected cervical epithelium to ascertain the biological significance of these markers in detecting progressive cervical disease. METHODS: A quantitative and based on-scanning-microscopy analysis of the three markers expression was performed in normal and cervical intraepithelial neoplasia (CIN) I, II, and III tissues. p16 area as well as p16, Ki-67, and MCM7 positive cells or nuclei were evaluated according to their distribution and extent through the cervical epithelium. RESULTS: A clear p16 over-expression was observed in all the dysplastic epithelium tissue samples. The quantitative analysis of p16 area as well as the number of p16 positive cells was able to better discriminate the CIN lesions grades than the usual semi-quantitative analysis. The average Ki-67 labeling indexes for the normal epithelium, CIN I, CIN II, and CIN III groups were 19.8%, 27.3%, 32.8%, and 37.1%, respectively, whereas the mean MCM7 labeling indexes for the correspondent grades were 27.0%, 30.4%, 50.5%, and 67.2%. The Ki-67 and MCM7 labeling indexes were closely correlated with the CIN histological grade, with higher labeling indexe values obtained from the more severe lesions (p<0.05), being the MCM7 labeling indexes the highest values in all the CIN categories (p<0.05). CONCLUSION: We observed a good correlation among the p16, Ki-67, and MCM7 data. In addition, MCM7 demonstrated to be a more efficient and sensitive marker to assess disease progression in the uterine cervix.

Detection of human papillomavirus infection in penile samples through liquid-based cytology and polymerase chain reaction.

BACKGROUND: The human papillomavirus (HPV) is strongly related to cervical cancer and its precursor lesions. However, unlike in the case of women, there are limited data regarding HPV infection in men. Analysis of male HPV infection is frequently hindered by the lack of consistency in collection methods, sample adequacy, and low sensitivity of cytologic analysis. METHODS: The objective of the current study was to compare the results of liquid-based cytology and HPV DNA testing through polymerase chain reaction in 99 penile samples collected from men presenting with condyloma acuminate or male partners of HPV-infected women who had attended a public health service in the city of Belo Horizonte, Minas Gerais, Brazil. Classic and nonclassic cytomorphologic signs were adopted to evaluate the presence of HPV infections in penile smears. RESULTS: HPV DNA was detected in 93 (93.9%) of the 99 samples analyzed. Koilocytosis was detected in 1 smear and nonclassic signs were detected in 23 smears, 22 of which were found to be positive for HPV DNA. CONCLUSIONS: The cytopathologic detection of HPV infection in penile samples collected for liquid-based cytology is low, even when cytologic nonclassic signs are applied, and does not appear to improve the diagnosis of HPV infection in men.

Molecular detection of HPV 16 and 18 in cervical samples of patients from Belo Horizonte, Minas Gerais, Brazil.

PURPOSE: The aim of this study was to investigate the frequency of HPV infection and the types 16 and 18 in cervical samples from patients attended at two public health services of the city of Belo Horizonte, MG. METHODS: Cervical samples from 174 patients were collected for cytopathological and molecular tests. HPV infection was searched by PCR utilizing MY09 and MY11 primers or HPV 16 and HPV 18 specific primers. RESULTS: Amongst the 174 samples analyzed, 20.7% presented squamous intraepithelial and/or invasive lesions detected on cytopathological analysis and of those, 94.4% were infected by HPV. HPV 16 was found in 20% of the cases of low-grade squamous intraepithelial lesions and in 40% and 50% of high-grade squamous intraepithelial lesion and squamous invasive carcinoma, respectively. HPV 18 was detected in 6.7% of the low-grade lesion samples and in two HPV16 co-infected samples. In 50% of the cases of high-grade lesion, the HPV type was not determined. CONCLUSION: The HPV 16 was the virus type more frequently detected. However, more than 50% of the positive samples at the cytopathological analysis were negative for HPV 16 and 18, indicating that possibly other virus types are present in relative high frequencies in the studied population.

Molecular detection of HPV 16 and 18 in cervical samples of patients from Belo Horizonte, Minas Gerais, Brazil

PURPOSE: The aim of this study was to investigate the frequency of HPV infection and the types 16 and 18 in cervical samples from patients attended at two public health services of the city of Belo Horizonte, MG. METHODS: Cervical samples from 174 patients were collected for cytopathological and molecular tests. HPV infection was searched by PCR utilizing MY09 and MY11 primers or HPV 16 and HPV 18 specific primers. RESULTS: Amongst the 174 samples analyzed, 20.7 percent presented squamous intraepithelial and/or invasive lesions detected on cytopathological analysis and of those, 94.4 percent were infected by HPV. HPV 16 was found in 20 percent of the cases of low-grade squamous intraepithelial lesions and in 40 percent and 50 percent of high-grade squamous intraepithelial lesion and squamous invasive carcinoma, respectively. HPV 18 was detected in 6.7 percent of the low-grade lesion samples and in two HPV16 co-infected samples. In 50 percent of the cases of high-grade lesion, the HPV type was not determined. CONCLUSION: The HPV 16 was the virus type more frequently detected. However, more than 50 percent of the positive samples at the cytopathological analysis were negative for HPV 16 and 18, indicating that possibly other virus types are present in relative high frequencies in the studied population.

OBJETIVOS: O objetivo deste estudo foi investigar a freqüência da infecção por HPV e dos tipos 16 e 18 em amostras cervicais de pacientes atendidas em dois serviços públicos da cidade de Belo Horizonte-MG. MÉTODOS: Amostras cervicais de 174 pacientes foram coletadas para estudo citopatológico e molecular. A pesquisa da infecção por HPV foi feita através da PCR utilizando os oligonucleotídeos MY09/MY11. Os tipos virais 16 e 18 foram pesquisados através da utilização de oligonucleotídeos específicos. RESULTADOS: Dentre as 174 amostras analisadas, 20,7 por cento apresentaram lesões escamosas intra-epiteliais e/ou invasoras detectadas na análise citopatológica, das quais 94,4 por cento mostraram infecção por HPV. O HPV 16 foi encontrado em torno de 20 por cento dos casos de lesão escamosa intra-epitelial de baixo grau e em 40 por cento e 50 por cento dos casos de lesão escamosa intra-epitelial de alto grau e carcinoma escamoso invasor, respectivamente. O HPV 18 foi encontrado em 6,7 por cento das amostras com lesão de baixo grau e em dois casos de co-infecção com HPV 16. Em 50 por cento dos casos de lesão de alto grau, o tipo de HPV não foi determinado. CONCLUSÕES: O HPV 16 foi o tipo viral mais freqüentemente detectado. No entanto, mais de 50 por cento das amostras positivas no exame citopatológico não apresentaram HPV 16 e 18, indicando que possivelmente outros tipos virais estejam presentes em freqüências relativamente altas na população estudada.

Molecular detection of Chlamydia trachomatis and HPV infections in cervical samples with normal and abnormal cytopathological findings.

It has been suggested that Chlamydia trachomatis (CT) and human papillomaviruses (HPV) co-infection could contribute to development of intraepithelial lesions. In this study, HPV and CT-DNA were investigated in 250 cervicovaginal samples of patients from Minas Gerais, Brazil. The cytological analysis revealed that 70% of samples (175) were negative, 5.2% (13) presented atypical squamous or glandular cells of undetermined significance (ASCUS/AGUS), 12.4% (31) presented low-grade squamous intraepithelial lesion (LSIL), 10.8% (27) high-grade squamous intraepithelial lesion (HSIL), and 1.6% (4) invasive carcinoma. HPV-DNA and HPV/CT co-infection was observed in 40% (100/250) and in 5.2% (13/250) of samples, respectively. Among the positive cytological samples, HPV-DNA was detected in 73.3% and CT-DNA in 9.33% and in 13%, if only the HPV positive samples were considered. The highest co-infection rate (15.4%) was observed among ASCUS/AGUS samples. Although a significant association was found for HPV infection and the precursor lesions of cervical cancer, it was not possible to establish a significant association between these lesions and CT or HPV/CT co-infection.

Campanha Nacional de Combate ao Câncer do Colo Uterino: a contribuição do laboratório de anatomia patológica da Santa Casa de Misericórdia de Passos (MG) / National Cervical Cancer Screening Program: the contribution of anatomic pathology laboratory of Santa Casa de Misericórdia de Passos (MG)

O exame citológico de amostras cérvico-vaginais tem sido amplamente usado na prevenção e detecção precoce do carcinoma do colo uterino. Nos países onde há programas de prevenção organizados têm-se conseguido diminuir as taxas de mortalidade desta doença. No Brasil, a primeira Campanha Nacional de Combate ao Câncer de Colo Uterino foi realizada no período de agosto a setembro de 1998. No presente trabalho, avaliamos os resultados dos exames citopatológicos realizados durante esta Campanha no Laboratório de Anatomia Patológica da Santa Casa de Misericórdia de Passos (MG). Foram realizados 2.905 exames colpocitológicos em mulheres na faixa compreendida entre 25 e 62 anos de idade, dos quais 16 (0,54 por cento) apresentaram algum tipo de alteração epitelial atípica. O maior número de exames foi procedente da cidade de Passos e a maior freqüência de exames ocorreu na faixa etária entre 36 e 49 anos de idade. Apesar da freqüência dos diagnósticos de células escamosas atípicas de significado indeterminado (ASCUS) estar dentro dos valores propostos pela literatura para a relação ASCUS/Neoplasia Intra-epitelial Cervical (NIC) de 1:16, é possível que alguns casos de infecção pelo Papiloma Vírus Humano (HPV) tenham sido diagnosticados como ASCUS.

Variação interobservador no diagnóstico das lesões escamosas intra-epiteliais cervicais / Interobserver variability in the diagnosis of cervical squamous intraepithelial lesions

Empregou-se um dos métodos de controle da qualidade em citologia cérvico-vaginal através do estudo da variação interobservador nos diagnósticos citológicos de lesões escamosas intraepiteliais. Trinta e nove esfregaços cérvico-vaginais provenientes de um único laboratório de anatomia patológica foram revisados por 5 observadores. Estes esfregaços representavam 20 casos de lesão escamosa intra-epitelial de baixo grau (LEIBG) e 19 casos de lesão escamosa intra-epitelial de alto grau (LEIAG). Houve concordância entre os 5 observadores em 10% dos casos revisados e entre três ou mais observadores em 72% dos casos. O grau de concordância foi maior em LEIBG (15%)do que em LEIAG (5%). O maior grau de concordância entre dois observadores em nosso estudo, tanto para os casos de LEIBG (75%) como para os casos de LEIAG (58%) ocorreu entre um observador mais experiente e outro observador treinado por ele. As alterações citológicas compatíveis com infecção pelo HPV foram relatadas pelos 5 observadores em 31% dos esfregaços com diagnóstico original de infecção pelo HPV e pela maioria em 85%.

Esofagite ulcerativa associada ao uso de alendronato de sódio: achados histopatológicos e endoscópicos / Ulcerative esophagitis associated with the use of alendronate sodium: histopathological and endoscopic features

RACIONAL: A esofagite induzida por drogas pode ser decorrente do contato prolongado do medicamento com a mucosa ou de alteraçöes das condiçöes locais da mucosa esofágica. O uso de alendronato de sódio, um inibidor da reabsorçäo óssea utilizado na prevençäo e tratamento da osteoporose, tem sido recentemente citado como causa de lesöes no trato gastrointestinal superior. OBJETIVO: Descrever os achados clínicos, endoscópicos e histopatológicos de pacientes com esofagite ulcerativa associada ao uso de alendronato de sódio. PACIENTES: Quatro pacientes do sexo feminino e um do sexo masculino, em tratamento de osteoporose com alendronato de sódio, submetidos a endoscopia digestiva alta seguida de biopsia esofágica. RESULTADOS: Os pacientes apresentavam idade entre 64 e 84 anos e sintomatologia dispéptica após um período de 2 a 12 meses de uso de alendronato de sódio. A endoscopia digestiva mostrou área de mucosa friável, com erosäo e/ou ulceraçäo recobertas por fibrina, localizadas no terço distal do esôfago. O exame histopatológico mostrou esofagite ulcerativa caracterizada por material necrofibrinopurulento e tecido de granulaçäo, além de material amarelado e refringente à luz polarizada. Os pacientes evoluíram com remissäo completa dos sintomas após suspensäo da droga. CONCLUSÖES: As lesöes esofágicas associadas ao uso de alendronato de sódio näo säo freqüentes e parecem estar relacionadas ao uso incorreto da medicaçäo. Os endoscopistas e patologistas devem ficar atentos à possibilidade do uso de alendronato de sódio diante do diagnóstico de úlceras esofágicas em pacientes idosos, principalmente do sexo feminino. Esta identificaçäo implicaria em melhor tratamento dos pacientes

[Ulcerative esophagitis associated with the use of alendronate sodium: histopathological and endoscopic features]. / Esofagite ulcerativa associada ao uso de alendronato de sódio: achados histopatológicos e endoscópicos.

BACKGROUND: Drug-induced or "pill-induced" esophagitis may be secondary to the prolonged contact of the drug with the esophageal mucosa or secondary to the drug ability to alter the local conditions. The alendronate sodium, a bone resorption inhibitor used in the treatment and prevention of osteoporosis, has been cited, recently, as one of the causes of adverse upper gastrointestinal tract injury. AIM: To describe the clinical, endoscopic and histopathological features of patients with ulcerative esophagitis associated with alendronate sodium. PATIENTS: Four women and one man with osteoporosis were treated with alendronate sodium and submitted to endoscopy followed esophageal biopsy. RESULTS: The age range of the patients was from 64 to 84 years old. The patients showed dyspeptic symptoms after taking alendronate sodium during a period of 2-12 months. At endoscopic evaluation, the mucosa was friable, with erosion and/or ulceration covered by fibrin in the distal esophagus. The pathological examination of the esophageal biopsies revealed ulcerative esophagitis characterized by necrofibrinpurulent material, granulation tissue, and yellow refractile polarizable crystal. The patients' symptoms resolved after stopping alendronate sodium use. CONCLUSIONS: The esophagus injuries associated with alendronate sodium are not frequent and seem to be associated with the incorrect use of medication. The endoscopists and pathologists should be alert to the possibility of alendronate sodium therapy in cases of diagnosis of ulcerative esophagitis in ancient patients, particularly in women. The recognition of this condition would improve the patient care.

Infecçäo pelo Papiloma Vírus Humano: correlaçäo cito-histológica e avaliaçäo dos sinais citológicos näo clássicos / Human papillomavirus infection: cyto-histologic correlation and analysis of the non classic cytologic signs

Foram avaliados 55 esfregaços citológicos e respectivas biópsias cervicais de 55 pacientes, no período compreendido entre janeiro e julho de 1997 em laboratório de Belo Horizonte. Foi estabelecida a correlaçäo cito-histológica e avaliada a frequência de 4 sinais näo clássicos da infecçäo pelo HPV. A infecçäo pelo HPV foi diagnosticada na biópsia cervical em 69 porcento dos casos, havendo concordância com o diagnóstico citológico em 21,8 porcento dos casos. A sensibilidade do exame citológico foi de 31,5 porcento e a especificidade de 100 porcento. Os sinais näo clássicos estudados mostraram-se associados à infecçäo pelo HPV. A bi ou multinucleaçäo foi o sinal que apresentou maior sensibilidade (69,2 porcento), enquanto que os sinais: coilocitose leve, disceratose leve e clareamento do citoplasma, mostraram alta especificidade (88,2 porcento, 88,0 porcento, 70,6 porcento, respectivamente). O uso desses sinais no diagnóstico dessa innfecçäo deve ser limitado, tendo em vista a baixa sensibilidade encontrada para cada sinal. A avaliaçäo da representatividade da amostra dos esfregaços demonstrou que os casos verdadeiramente positivos para a infecçäo pelo HPV apresentaram células da junçäo escamo-colunar em alta percentagem (83,3 porcento), enquanto que nos casos falso-negativos, essa percentagem foi de 46 porcento

Diagnósticos citológicos cérvico-vaginais em laboratório de médio porte de Belo Horizonte - MG / Cervicovaginal cytologic diagnoses by medium-sized pathology laboratory in Belo Horizonte-MG

Foram avaliados os diagnósticos citológicos cérvico-vaginais de 5000 exames consecutivos realizados no ano de 1993, em laboratório de médio porte de Belo Horizonte. A idade média das pacientes foi de 34 anos e 75,20 porcento dos esfregaços continham alteraçöes celulares compatíveis com inflamaçäo. As frequências dos agentes específicos, dos tipos de flora bacteriana vaginal, dos processos inflamatórios e das células displásicas nos esfregaços cérvico-vaginais foram estabelecidos. Verificou-se a correlaçäo entre a presença de displasia e a representatividade da amostra segundo o critério proposto pela classificaçäo de Bethesda, bem como a frequência das displasias em relaçäo a diferentes faixas etárias. Foram identificados agentes específicos em 22,54 porcento dos exames, sendo o diagnóstico de infecçäo por Gardnerella vaginalis e outros anaeróbicos o mais frequente. O tipo de flora bacteriana mais frequentemente detectado foi a flora de padräo lactobacilar. A frequência das displasias e da infecçäo pelo HPV foi, respectivamente, 0,78 porcento e 0,80 porcento. Näo foram identificados casos de carcinoma de células escamosas "in situ" e invasor. As lesöes displásicas foram mais frequentes em pacientes com 21-40 anos, sendo diagnosticadas predominantemente 84,62 porcento em esfregaços que apresentavam células da junçäo escamo-colunar