HLA expression in pre-invasive cervical neoplasia in relation to human papilloma virus infection.

A significant proportion of cervical carcinomas show loss of major histocompatibility complex human leucocyte antigen (HLA) class I expression while upregulating HLA class II expression. These changes may have direct consequences for immune surveillance of the human papilloma virus (HPV) infection which is strongly associated with cervical malignancy. A relationship between changes in HLA expression and HPV infection may be evident in the evolution of premalignant disease. This immunohistological study of 104 colposcopic biopsies establishes that HLA class II expression occurs in a significant proportion of squamous epithelia showing histological evidence of wart virus infection and cervical intraepithelial neoplasia (CIN) I to III. In comparison, alteration of HLA class I expression in cervical premalignant lesions is rare. There is no correlation between the detection of high risk HPV DNA (types 16, 18, 31 and 33) by polymerase chain reaction (PCR) and the MHC class II phenotype of the lesion. This suggests that altered HLA class II expression is neither a consequence nor a prerequisite for HPV infection.

A cervical smear review in women developing cervical carcinoma with particular reference to age, false negative cytology and the histologic type of the carcinoma.

A review of all available cervical smears from 96 women who subsequently developed invasive cervical carcinoma was undertaken. The aim of the study was to determine the incidence of confirmed negative smears prior to the histologic diagnosis of carcinoma and investigate the relationship between the duration and grade of smear abnormality, the patients' age and the histologic types of cervical carcinoma. The results indicate that only 10% of women had confirmed negative smears, the majority occurring more than 7 years before the diagnosis of carcinoma. In contrast, 89% of young women (under 40 years of age) had a significant abnormality (moderate dyskaryosis or worse) up to 6 years before diagnosis. There is evidence to suggest that the preinvasive phase of cervical carcinoma may be shorter in younger women and that the less common types of cervical carcinoma occur more frequently in this group. The combination of inadequate clinical follow up and false negative cytology may have allowed a significant proportion of these women to develop invasive cervical carcinoma. Possible reasons for false negative smears have been identified and methods aimed at decreasing their frequency are discussed.

Prevalence of occult human papillomavirus infection, determined by cytology and DNA hybridization, in heterosexual men attending a genitourinary medicine clinic.

One hundred and five heterosexual men without evidence of clinical anogenital warts and attending a genitourinary medicine clinic were studied. Three separate specimens for cytology were taken from (i) the distal urethra including the perimeatal area, (ii) the penile shaft and glans penis including the sub-preputial area, and (iii) from the anorectal area using a proctoscope. Pooled specimens of exfoliated cells from these sites were also taken for the detection of human papillomavirus (HPV) by DNA hybridization. Twenty-eight (27%) of the men had cytological evidence suggestive of HPV infection. HPV genome was detected in 21 (20%) of the men by DNA hybridization and 95% of them were carrying HPV 16 genotype either alone or in combination with other genotypes. A total of 42 (40%) of patients had evidence of occult HPV infection using cytology and/or DNA hybridization techniques collectively. None of the epidemiological risk factors were significantly associated with occult HPV infection in this study. The significance of this high incidence of sexually transmissible HPV genomes, mostly HPV16 in the anogenital area of heterosexual men attending genitourinary medicine clinics requires further study.

Cytological screening to detect subclinical anal human papillomavirus (HPV) infection in homosexual men attending genitourinary medicine clinic.

Unselected homosexual men attending a department of genitourinary medicine were screened for human papilloma virus (HPV) infection using anal cytology. Satisfactory smears were obtained from 221 patients, and 73 showed cytological abnormality with warty atypia. Abnormal cytology was detected in 55 (31%) of 178 patients in whom there was no macroscopic evidence of anal or perianal warts, and anal cytology may therefore be valuable to detect patients with subclinical condylomatous lesions and may also serve to identify those who possibly have intraepithelial neoplasia.

Condylomatous lesions of the lower female genital tract.

Current views on the aetiology of condylomatous lesions of the lower female genital tract are presented. In addition to the morphology of overt condylomata, the colposcopic, histological and cytological appearances are described, and association with epithelial neoplasia is considered in detail. Problems of nomenclature are discussed.

Human papillomavirus infection of the lower female genital tract: association with multicentric neoplasia.

Fifty-four patients with multiple condylomatous lesions and/or multicentric neoplasia were identified in a consecutive series of 2,627 colposcopic examinations (2%). Forty-one percent presented with condylomata only and 57% exhibited associated intraepithelial or invasive neoplasia in at least one site. Only one patient was found to have multicentric neoplasia with no condylomatous features. There was a significant increase in mean age between patients presenting with multiple condylomatous lesions and those who had intraepithelial neoplasia as well. An association with pregnancy was found in 17% of the cases, and with renal transplant in 5%. Virus particles compatible with human papillomavirus were found in 62% of the cases examined. Evidence for a causative role in the development of neoplasia of the lower female genital tract is considered.

Method for the removal of selected cells from cytological smear preparations for transmission electron microscopy.

The method described depends on fixing additional cytology smear preparations with glutaraldehyde to be used, if needed. Removal of cells from the slide makes use of partially polymerised resins in the usual way but a paper marker is used to localise the area in the resin block which contains the cells to be examined. Slides are placed in a freezing cabinet to facilitate easy separation of the resin block.

Demonstration of papilloma virus particles in cervical and vaginal scrape material: a report of 10 cases.

The finding of virus particles by transmission electron microscopy (TEM) in fixed cervical and vaginal scrape material and their identification as papilloma viruses by negative staining is described. The colposcopic, cytological, and histological appearances in a group of 10 patients in whom virus particles were seen are discussed and the possibly considered of an association between papilloma virus infection and the development of cervical intraepithelial neoplasia (CIN) and multifocal intraepithelial neoplasia of the female lower genital tract.