[The diagnostic capacities of transvaginal echography and hysteroscopy in the characterization of endometrial pathology]. / Capacità diagnostica dell'ecografia transvaginale e dell'isteroscopia nella caratterizzazione della patologia endometriale.

The diagnostic accuracy of transvaginal sonography (TVS) and hysteroscopy in the assessment of endometrial pathology was studied comparing retrospectively both methods with the results of histologic findings after dilatation and curettage (D&C) performed in the last four years on 467 patients, 155 of whom were in postmenopause. Endometrial thickness, tissue texture, myometrial invasion and haemodynamic characteristics were studied with TVS. Uterine cavity, endometrial patterns and superficial vascularization were evaluated by hysteroscopy. For the purpose of this study all histologic findings were subdivided to a) normal (206 cases); b) benign lesions (240 cases); c) atypical hyperplasia or adenocarcinoma (21 cases). In our experience hysteroscopy was superior to TVS in detecting endometrial pathology. Both techniques were more sensitive in detecting premalignant and malignant lesions. Considering endometrial thickness evaluated with TVS as a single parameter in patients in postmenopause, we found that the most sensitive cut-off for defining normality was 3 mm; nevertheless, in the group of patients that had an endometrial thickness equal to or less than 3 mm there were 2 cases of malignancy. Therefore, neither TVS nor hysteroscopy are sufficiently reliable to replace curettage in the diagnosis of endometrial pathology.

Flow cytometric analysis of DNA content in cervical lesions.

Flow cytometry is used to screen gynaecologic specimens for Cervical Intraepithelial Neoplasia (CIN) and its precancerous lesions, possibly associated with human papilloma virus (HPV), in order to investigate the role of aneuploidy as a biological marker in HPV and CIN lesions. A total of 299 cervical samples was collected by scraping and the cellular DNA content was measured using the propidium iodide staining procedure. Two groups of patients were studied; a group of 142 negative controls for cytology and groups of patients assigned to mild, moderate or severe dysplasia, carcinoma in situ diagnosed by histologic classification according to the Papanicolaou staining technique. Pathological samples showing an alteration of the DNA index or perturbation of the cellular phase S compartment ranged from 6.4% to 41.9%. Our results confirm those obtained by other authors and suggest the hypothesis that aneuploidy is present with permanence of viral DNA in early stages of carcinogenesis, which can be used as a marker in the transition from benign to malignant cells. This work is of potential interest for the possible follow-up of patients having condyloma and could aid the early diagnosis of cervical carcinoma.

[Infection of Chlamydia trachomatis and dysplasia lesions of the cervix uteri (CIN)]. / Infezione da Chlamydia Trachomatis e lesioni displastiche della cervice uterina (CIN).

With the aim of evaluating the correlation between dysplastic lesions of the uterine cervix associated or not with condylomatosis and Chlamydia T. infection, we carried out a serological study of anti-Chlamydia species-specific antibodies and a direct and/or a cultural investigation on a sample of 320 women who performed a Pap-test. The serological examination showed positivity (titer greater than or equal to 1:32) in 49 control subjects (with negative cytology) (23.7%); in 27 cases (43.5%) with actual diagnosis of condylomatosis/CIN associated or not with condylomatosis and in 28 cases (54.9%) with previous diagnosis of condylomatosis/CIN associated or not with condylomatosis. The cultural investigation did not show any significant difference among the groups above mentioned. Finally, the frequency of positive cases for anti-Chlamydia antibodies was estimated for each grade of actual or previous CIN: a greater frequency of positivity was noted in cases with CIN 3 (75%).

Correlation between cervical intraepithelial neoplasia and invasive cervical carcinoma on the basis of their frequency in the Province of Trieste (1977-1986).

The Authors report the results of a study on the diffusion of CIN and of invasive carcinoma of the portio in the Trieste population over the 1977-1986 decade. In order to achieve this aim all the bioptical specimens analyzed in the Institute of Pathological Anatomy and Histology of Trieste University were reviewed. Over this period 313 cases of CIN 1-2, 314 cases of CIN 3 and 289 of invasive carcinoma were diagnosed. The average age for CIN 1-2 lesions was 33.5 (range 17-78), for CIN 3 39.9 (range 18-81) and for invasive carcinoma 58.6 (range 26-89). The distribution by age group was markedly different in the three types of lesion dealt with, showing a substantial presence of preinvasive lesions under the age of 50. During the period considered a significant decrease in the incidence of invasive carcinoma was not recorded, in contrast with other reports. This datum may be explained by the fact that the number of women undergoing cyto-oncological screening has not increased over the last decade.

Sonographic evaluation of ovarian volume in postmenopausal women: a screening test for ovarian cancer?

Ovarian cancer is the first cause of death from gynaecological malignancy. The poor over-all five year survival rate requires a specific procedure for early detection of ovarian carcinoma. An evaluation of ultrasonography as a screening test in early ovarian cancer is currently used in our Institute. A group of 500 volunteers without clinical symptoms, older than 45 years, and/or in postmenopausal period, were submitted to the procedure. We used a real-time mechanical sector scanner with 3 mHz transducer. The morphology and size of both ovaries were assessed. Abnormal results were obtained in 11 women. Four (4) postmenopausal patients underwent surgery. At the moment our study proves that ultrasonography is a valid procedure in the investigation of the ovaries in postmenopausal women. We need further evaluations to assess the real effectiveness of ultrasound examination as a screening test for early detection of ovarian cancer.

Cervical intraepithelial neoplasia with conization: early complications and follow-up.

The authors made a review of the last 100 cases who underwent a conization of the cervix during the period 1980-1986. Cyto-histological evaluation was compatible in 78% of the cases with a cervical intraepithelial neoplasia of third degree and in 22% with a CIN of first and second degree. Early post-operative complications consisted of a hemorrhage in 3% of the cases, easily stopped with a vaginal packing. In 2% of the cases a risuture under general anaesthesia was required. In 1 case the stitches loosened and in another a urinary infection was present. Twenty-six patients underwent total hysterectomy after conization for different indications; only one patient had a relapse after six months as there was a moderate dysplasia localized in the vaginal vault. During the follow-up, 14 patient became pregnant. Among these, 5 underwent legal termination during the first trimester and 9 delivered at term without any complication. During these follow-up of 7 years in the older cases and 6 months in the more recent ones, 6 cases displayed a persistence of the disease after 3 months, (CIN of variable degree) and 2 cases relapsed at the second colpocytological control. These patients, according to the age and the presence of clinical indications, underwent total hysterectomy or diathermic coagulation with resolution of the disease. A relapsing invasive tumor was never observed.)

Tumoral markers (CA 125--CEA) in the screening of ovarian cancer.

Ovarian cancer has high rate of mortality among malignant gynecologic tumors. Because of its aggressiveness and low rate of 5 year survival of patients treated, it is important to realise a screening program for its early diagnosis. Today, immunologic research is directed to the study of tumoral markers that allow us to detect the presence of still clinically silent ovarian neoplasms. Some tumoral markers such as CEA and CA 125 are available for post-surgical monitoring of patients treated for ovarian cancer. The Authors have carried out a study to evaluate the possibility of their use in the depistage of ovarian neoplastic pathology. A blood sample was taken for the evaluation of serum CEA and CA 125 in a series of 520 patients older than 45 years, who did not complain signs or symptoms of pelvic pathology. A pathologic value for CEA was considered higher than 7.3 ng/ml and for CA 125 greater than 37 U/ml. For CEA 2.5% (13 cases) presented pathologic values compared to 2.88% (15 cases) for CA 125. One third of cases (0.5%) with high levels of CEA had repeated blood samples. 3 of them had confirmed high levels of CEA but echotomography performed in these patients was negative for pathologic ovarian masses. 15 patients had CA 125 high levels. 3 out of 15 cases repeated the blood sample that resulted normal. On 11 of these cases an echotomography was also performed that diagnosed a uterine myomatosis in 4 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Frequency of cervico-vaginal infections (Trichomonas vaginalis; Chlamydia trachomatis -CHL-; herpes simplex virus -HSV-; human papilloma virus -HPV-) in cervical intraepithelial neoplasia.

The Authors have carried out a cyto-hystologic study on 533 cervical intraepithelial neoplasias (CIN) devoted to identifying the association frequency between cervical dysplastic lesions and cervico-vaginal infections caused by Trichomonas vaginalis, Chlamydia Trachomatis, Herpes Simplex virus and Human Papilloma virus. HPV lesions have revealed the pathology found more frequently in CIN lesions (33.2%) compared to 0.19% in the normal population, while the other infections have not shown significant differences between dysplastic lesions and normal control. In patients with CIN, the assumption of the estro-progestinic pill does not seem to contribute to the increase of frequency of cervico-vaginal infections.

Recurrence incidence in follow-up of patients affected by condylomatosis of the uterine cervix with VCE (viral cytopathic effect).

The frequent association of HPV lesions with cytological and/or hystological alterations of CIN in the uterine portio and in the lower genital tract suggests their possible role in the genesis of precancerous lesions of the cervix. In the systematic cytological screening, condylomatous lesions present an incidence varying from 0.52% to 1.5%. With the aim of verifying the incidence rate of condylomatosis of the portio, in the population of the women followed in the Colpocytological Service of obstetrics and gynaecology (Institute for Childhood of Trieste), the authors have performed a retrospective analysis on 17273 colpocytological examinations and have found 72 cases (0.41%) with cytological and/or histological evidence of viral-cytopathic effect produced by HPV. These patients have undergone various treatments of this pathology and have performed a follow-up. In some patients 12 cases, treated only with antiflogistic therapy or no therapy, 50% of these has shown a complete regression of viral infection in the first control after 4 months. In these patients, it is suggestive to suppose that a good immunological reactivity has brought the patient to recovery. For that, in their next work, the Authors will investigate the immunological responsiveness of patients affected by HPV lesions of the cervix.