Human papilloma viruses and cervical intraepithelial neoplasia: the role of colposcopy.

To evaluate the reliability of colposcopy for distinguishing flat condyloma from cervical intraepithelial neoplasia (CIN), 211 patients with abnormal cytology, colposcopical evidence of an atypical transformation zone (ATZ), and a histological diagnosis of flat condyloma or CIN were studied. Colposcopic evidence of surface abnormalities, the presence of satellite lesions, and an irregular Lugol's uptake were tentatively considered to be features of condyloma. Histologically, koilocytotic lesions with a disorganized cytologically atypical basal/parabasal layer and with atypical mitotic figures (AMFs) were considered to be CIN cases, and designated as CIN with koilocytosis (CIN K). At least two colposcopic features of condyloma found in 98 of 99 flat condylomas, were also found in 89 of 112 CINs. When colposcopic features were matched with histology for every directed biopsy site, they correlated strongly with koilocytosis, regardless of the degree of atypia in the lesion. Moreover, these features often occurred at the periphery of poorly differentiated or undifferentiated, high grade CINs, in areas histologically indistinguishable from flat condyloma. Thus, colposcopic features are not of predictive value in distinguishing flat condyloma from CIN, do not show correspondence to the lesional degree of atypia and cannot be fully related to the biological characteristics of the cervices in which they are found. These findings confirm that colposcopy cannot be considered to be a diagnostic method.

[Histological aspects of lesions of the cervix uteri correlated with different types of human papillomavirus]. / Aspects histologiques des lésions du col uterin correlés aux différents types de papillomavirus humains.

Cervical biopsies from 66 women presenting an abnormal smear, with HPV related features were studied and histologic features were correlated to the HPV type, as determined by molecular hybridisation studies. HPV DNA sequences were evidenced in 13 of 19 lesions corresponding to exophytic or flat condyloma (HPV type 16 in seven cases, HPV type 11 in four cases, as yet uncharacterized HPV types, HPV X, in two cases). Fourty biopsies were histologically interpreted as CIN, on the basis of atypical mitotic figures (AMF) and/or basal-parabasal cell atypia. HPV type 16 was evidenced in 20 cases (3 cases of double infection: HPV types 16 and 18, HPV types 16 and 33, HPV types 16 and X). In 10 other cases, HPV DNA sequences corresponding to HPV type 11 (one case), HPV 18 (one case) and HPV X (8 cases) were evidenced. In this study, potentially oncogenic HPV types (HPV 16, HPV 18, HPV 33) have been found only in CIN lesions defined on the presence of AMFs and/or basal-parabasal cells atypia. These histologic criteria seem to allow a distinction between low and high risk cervical lesions.

[Papillomavirus and cervix atypia. Retrospective histo-colposcopic study of 175 cases]. / Papillomavirus et atypies cervicales. Etude rétrospective histo-colposcopique de 175 cas.

One hundred and seventy five CIN cases diagnosed during the years 1958-60 have been reviewed and histologic slides as well as colpographies have been reevaluated for the presence of Papillomavirus-related features. Histo-colposcopic features of HPV infection have been found in 70% of CIN cases, incidence comparable to the one actually observed. Thus, the relationship between HPVs and cervical cancer doesn't seem to be changed.

[Male genital lesions caused by papillomaviruses. Importance of colposcopy]. / Lésions génitales masculines à papillomavirus. Intérêt de la colposcopie.

Ten years after the description of cervical flat condyloma, it is now admitted that Human Papillomaviruses (HPVs) type 6 and 11 are responsible for condylomata acuminata and typical flat condyloma of the uterine cervix. HPV DNA type 16 and, less frequently, 18, 33 and other as yet uncharacterized HPV types (G. Orth, personal communication), are found in the majority of Cervical Intraepithelial Neoplasia (CIN), Vulvar Intraepithelial Neoplasia (VIN) and cervical and vulvar invasive cancers. Since HPVs are sexually transmissible, recent interest has focused on the "male factor". Clinically detectable lesions of male genitalia are condylomata acuminata, bowenoid papulosis and flat condyloma-like papules. The aim of our study was the colposcopical screening, recently suggested, of different groups of male patients in order to detect HPV-related lesions and the description of the colposcopical features of subclinical HPV-related lesions, since most of them have never been reported, to our knowledge, in the literature. A total of 114 men were examined. Among them, 18 presented clinically detected recalcitrant condylomata acuminata, 28 had been treated for the same pathology 1 to 5 days earlier and were clinically free of lesions, 46 were sexual partners of women with cervical atypia (flat condyloma and/or CIN) and 22 had a clinical diagnosis of genital infection without HPV-related lesions. A careful examination of external genitalia was performed. Then all patients underwent penile colposcopy before and after application of 5 p. 100 acetic acid. Selected biopsies were performed in all lesions which were clinically and colposcopically different from classic warts. Colpophotographs were taken in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Microhysteroscopy: a new approach to the diagnosis of cervical intraepithelial neoplasia.

The recent development of the microhysteroscope permits observation of female genital tract surfaces at different magnifications ranging from 1:1 to contact microscopic examination of vitally stained living cells at a magnification of 150:1. One of the emerging applications of the microhysteroscope is in the diagnosis of cervical intraepithelial neoplasia (CIN). To evaluate the capabilities and reliability of microhysteroscopy, two studies were performed. The first study compared this technique with colposcopy, cytology, and histology in the evaluation of 92 patients with abnormal Papanicolaou smears (CIN II, III). The second study prospectively evaluated 800 patients using microhysteroscopy as a screening tool. Initial results of the two studies suggest that microhysteroscopy is a highly precise method of evaluating cervical precancerous lesions.

["Vestigial cells" of the transitional area of the uterine-cervix. Comparative morphological study with the subcylindrical-reserve-cells (author's transl)]. / Les cellules "vestigiaires" de la zone de transition du col utérin. Morphologie et rapports avec les cellules subcylindriques de réserve.

The squamo-cylindrical junction represents a transitional area of unstable epithelium. It consists of slightly differentiated cells which disclosed resemblance in morphological pattern with germinal cells of the basal layer in the exocervical squamous epithelium. These unstable cells, according to the authors, may be derived from the cranial, most cephalic extend of the sinusal vaginal plate which had formed the epithelium of the entire vagina and the vaginal portion of the cervix up to the squamo-columnar junction. Ultrastructural analysis disclosed no similarities between cells of the squamo-columnar junction and subcylindrical reserve cells which exhibited sometimes resemblance to the "mesenchymal cells" found within the surrounding stroma.

Laser in cervico-vaginal surgery: a clarification.

The gynecologic use of the CO2 Laser is neither miracle-way nor useless. It is a reliable surgical instrument which, in our opinion, has often shown more promising advantages of performance and therapeutical results than the conventional physical or chemical methods. Its main draw-backs are: the need for perfect mastery of colposcopy and the purchase price which will limit the availability of this instrument, still for a long time, to a few highly equipped centers.

A hypothesis on the origin of the subcylindrical reserve cells of the endocervix.

The structural features of subcylindrical reserve cells of the endocervix are presented. Reserve cells varied in shape. They were randomly oriented and most had a bean-like or spindle shape. Some were loosely apposed with no desmosomes while others were separated by an intercellular matrix. Their nuclei were oval or fusiform, with a prominent nucleolus. Coarse chromatin plaques are distributed irregularly within the nuclei, and surface membrane showed cytoplasmic projections. Within the connective tissue, close to the basal membrane, could be found cells that showed the same structural features; some of them were partially enveloped by amorphous ground substance and collagen, and had small processes extending from the cell surface in the direction of the epithelial layer. Ultrastructural analysis of these cells disclosed some similarities with fibroblasts in the surrounding stroma, and suggested that they were primitive mesenchymal cells originating from Müllerian mesenchyme.

[Cauterization of the uterine cervix: electrocauterization and cryotherapy]. / A propos de la coagulation du col utérin. Electrocoagulation, cryothérapie.

The authors review the controversies that still continue concerning electrocauterization of the uterine cervix. They emphasize the value of colposcopy in the evaluation of the cervix. This examination is indispensable in selecting the cases for treatment: ectropion and benign malpighian dysplasias are clear indications for cauterization. Contraindications and technical problems are discussed. The indications are given for bipolar biactive, and bipolar monoactive electrocauterization, respectively, or for electroresection by means of a metallic loop. The different cicatrization times after electrocauterization are reviewed as well as the possibility of sequelae: in certain cases sequelae can be more or less avoided by previous therapeutic precautions and by careful attention to the duration of cauterization. Cauterization of the uterine cervix by cryotherapy seems to be worthy of particular consideration: the first results are reported. It seems to be simpler to use than diathermocauterization and in the great majority of cases the results seem to have been good.

[Computing in gynaecology. Diagnosing cervical cancer]. / Informatique en gynécologie. Constitution du dossier "cancer du col".

After having proposed, in a previous paper, a coelioscopy examination card that can be computerized, the authors have devised here a similar trial applicable to carcinoma of the uterine cervix. It appeared necessary to establish three different cards, namely: identification and previous history; colpocytology; invasive carcinoma... in order to cover up the totality of data required for diagnosis, treatment and follow-up of such patients.