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1.
Am J Obstet Gynecol ; 156(1): 212-22, 1987 Jan.
Article in English | MEDLINE | ID: mdl-3026185

ABSTRACT

Multiple colposcopic biopsy specimens were collected from 160 women, with sampling of principal cervical and vulvar lesions as well as secondary areas of either minor acetowhitening or normal epithelium. Papillomaviral deoxyribonucleic acid was detected by Southern blot hybridization in 197 (90%) of the 218 principal biopsy specimens and 93 (46%) of 198 secondary biopsy specimens. Although different papillomaviruses were found at different sites in 31 women, only six of 416 specimens contained multiple types within the same sample. Specific viral types were associated with specific disease patterns. Only one of 80 type 6 or 11 infections had a diagnosis greater than cervical intraepithelial neoplasia, grade 2. In contrast, 42 of 48 (90%) biopsy specimens of cervical intraepithelial neoplasia, grade 3, or invasive cancer contained type 16, 18, or 31. Nonetheless, 12 of 124 (10%) cases of condyloma and cervical intraepithelial neoplasia, grade 1, were associated with types 16, 18, and 31 infections. Of 58 women with multicentric disease, 46 had positive hybridizations for both cervical and vulvar lesions (32 showing the same type in both samples and 14 showing different viruses). Differing patterns of papillomavirus-induced disease arise partly from the predilection of specific viral types for certain anatomic sites and partly through variations in host response. Detection of viral deoxyribonucleic acid in 46% of the secondary biopsy specimens suggests that disease expression may represent focal breakdown of host surveillance within a field of latent papillomaviral infection.


Subject(s)
Condylomata Acuminata/pathology , DNA, Viral/analysis , Sexually Transmitted Diseases/pathology , Tumor Virus Infections/pathology , Uterine Cervical Neoplasms/pathology , Vulvar Neoplasms/pathology , Biopsy , Cervix Uteri/pathology , Female , Humans , Papillomaviridae/isolation & purification , Uterine Cervical Neoplasms/etiology , Vulva/pathology , Vulvar Neoplasms/etiology
2.
Am J Obstet Gynecol ; 147(6): 611-7, 1983 Nov 15.
Article in English | MEDLINE | ID: mdl-6638105

ABSTRACT

Forty-two patients with ovarian cancer underwent "second-look" laparotomy to determine disease status. Seventeen patients were free of disease; 15 demonstrated tumor regression, but microscopic (3) or macroscopic (12) cancer persisted; and 10 had progressive disease. A significantly increased correlation between positive biopsy sites at second look and sites of known initial residual cancer was noted (76.7% versus 42.3% total positive), particularly in patients with minute disease, at second look. This correlation increased (85.3% versus 64.8%) when both the initial tumor reduction and documentation of residual disease and the second-look procedure were performed by the same surgeon. No such difference was noted in patients with progressive disease. In no instance was disease found at new sites when sites of previous residual cancer were disease free. These results underscore the need for accurate documentation of residual tumor after initial tumor reduction in order to direct the biopsy pattern more accurately, particularly in patients with minute or microscopic disease at second look.


Subject(s)
Ovarian Neoplasms/pathology , Female , Humans , Neoplasm Staging , Ovarian Neoplasms/surgery , Reoperation
3.
Obstet Gynecol ; 61(5): 624-7, 1983 May.
Article in English | MEDLINE | ID: mdl-6835616

ABSTRACT

Lower genital tract intraepithelial neoplasia was the predominant indication for CO2 laser surgery in 203 patients treated at Wayne State University. One hundred nineteen patients had cervical intraepithelial neoplasia (CIN) III and, in the 99 patients who were adequately followed, the failure rate following the first treatment was 9%. Secondary treatment with laser surgery, cryosurgery or, in one instance, hysterectomy, was effective in treating all persistent CIN. Success in treating vaginal intraepithelial neoplasia with laser surgery was most favorable in patients who had not had prior pelvic irradiation. Small (less than 1.5 cm) vulvar intraepithelial neoplasia III was successfully treated in seven patients. Recalcitrant condyloma acuminata responded well to laser surgery in 31 patients.


Subject(s)
Genital Neoplasms, Female/surgery , Laser Therapy , Condylomata Acuminata/surgery , Female , Humans , Lasers/adverse effects , Reoperation , Uterine Cervical Dysplasia/surgery , Vaginal Neoplasms/surgery , Vulvar Neoplasms/surgery
4.
Cancer ; 50(2): 377-87, 1982 Jul 15.
Article in English | MEDLINE | ID: mdl-6282442

ABSTRACT

A blind comparative survey was undertaken to study the prevalence of subclinical papillomavirus infection (SPI) in a representative sample of women treated surgically for invasive or preinvasive cervical neoplasia. According to a semiobjective rating system, 73 of 80 women (91%) with cervical neoplasia and ten of 80 matched controls (12.5%) showed histologic evidence of human papillomavirus (HPV) infection. Sixty of the controls (75%), but none of the study group, had normal cervicovaginal epithelium. A highly significant statistical relationship exists between subclinical papillomavirus infection of the lower genital tract and the occurrence of cervical neoplasia (F = 378; P less than 0.001; X2 = 109, P less than 0.001). The prevalence of SPI was seven times greater in the study group than in comparable controls of equivalent disease status. Because both are covariables of promiscuity, statistical association exist between cervical neoplasia and all sexually transmitted diseases. However, the strength, specificity and consistency of this relationship suggest that SPI may be a precursor or cervical malignancy. This contention is given biologic plausibility by a broad fabric of supporting epidemiology, virologic and clinicopathologic evidence.


Subject(s)
Genital Diseases, Female/complications , Precancerous Conditions/etiology , Tumor Virus Infections , Uterine Cervical Neoplasms/etiology , Warts/complications , Adult , Analysis of Variance , Animals , Computers , Epithelium/pathology , Female , Genital Diseases, Female/pathology , Humans , Hyperplasia , Middle Aged , Papillomaviridae , Precancerous Conditions/pathology , Probability , Uterine Cervical Neoplasms/pathology , Warts/pathology
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