HPV genotypes in high-grade cervical lesions and invasive cervical carcinoma detected in Gabonese women.

BACKGROUND: Cervical cancer is the third most common cancer among women worldwide, but particularly affects women living in sub-Saharan Africa. Screening and vaccination programs are two prevention approaches that can reduce cervical cancer incidence. However, effective vaccination campaigns require better knowledge of the prevalence of the main human papillomavirus (HPV) genotypes reported in high-grade neoplastic lesions and invasive carcinomas in women. METHODS: All samples collected in this study were processed using standard histopathological methods with haematoxylin and eosin staining of the sections. Areas with abnormal cells were then identified. The HPV genotype was determined on the DNA extracted from the same sections using nested PCR followed by amplicon sequencing and real-time PCR specific to five different HPV genotypes (16, 18, 33, 45 and 58). RESULTS: A total of 132 Gabonese patients with high-grade neoplastic lesions were included in this study; 81% were squamous cell carcinomas (SCC). At least one HPV was detected in 92.4% patients; HPV16 (75.4%) was the most frequent genotype, followed by HPV18, 58, 45, 33 and 35. Moreover, histological analysis showed that SCC samples had 50% and 58.2% stage III and IV tumor cells, respectively, according to the FIGO classification. Finally, 36.9% of these stage III and IV patients were less than 50 years old. CONCLUSIONS: Our results confirm the high prevalence of HPV16 and 18 genotypes among high-grade lesions in Gabonese women. This study confirms the need for a national strategy for early screening of precancerous lesions associated with a broad national vaccination program among non-sexually active women to significantly reduce the long-term cancer burden.

Molecular analysis of human Papillomavirus detected among women positive for cervical lesions by visual inspection with acetic acid/Lugol's iodine (VIA/VILI) in Libreville, Gabon.

BACKGROUND: The human papillomavirus (HPV) is the causative agent of cervical cancer, which is the leading cancer-related cause of death for women in Sub-Saharan Africa. In 2013, the Gabonese Ministry of Health and the Sylvia Bongo Ondimba Foundation implemented cervical cancer screening programs based on the detection of cancerous lesions by visual inspection with acetic acid and/or Lugol's iodine (VIA/VILI). This pilot study was set up to determine the HPV profile and analyze the nucleotide sequence variation of HPV16 circulating in patients with cervical abnormalities detected by VIA/VILI testing. METHODS: The cervical abnormalities observed upon VIA/VILI were confirmed by liquid-based cytology for all tested women. Nested PCR using the MY09/11 and GP5+/6+ primer sets was used to detect HPVs present in the extracted DNA. HPV genotypes were determined after sequencing of amplicons based on a high-throughput sequencing approach. For isolates of the HPV16 genotype, the E6 gene and the long control region (LCR) were directly sequenced using Sanger method. RESULTS: The study included 87 women who showed a positive VIA/VILI result. Cervical abnormalities were found in 40.23 % of women and 40 % were classified as high-grade lesions. The HPV detection rate was 82.9 % among women with abnormal cytology. Among all the identified high-risk HPV genotypes, HPV16, 18 and 33 were the most frequent. Multiple HPV infections were observed in 42.31 % of HPV-infected women. Analysis of the HPV16 sequence variation in the E6 gene and in the LCR showed that 85.3 and 14.7 % belonged to the African and European lineages, respectively. Among the African branch variants, Af2 was the most frequently identified in this study. CONCLUSION: This study offers the first report of the HPV detection rate and molecular epidemiology among Gabonese women with a positive result in a VIA/VILI screening test. Moreover, data on the HPV16 sequence variation confirm the predominance of African variants in high-grade lesions.

Angiolipoma of the breast in a male: a case report and review of the literature.

OBJECTIVE: Angiolipoma is an unusual variant of lipoma involving subcutaneous tissues on trunk and extremities. This tumor is rarely described in the breast and particularly in breast male. CASE REPORT: We report here the case of angiolipoma of the breast in a 55-year-old man complained of tenderness in the left breast. Ultrasonography showed a homogenously, well circumscribed, hyperechoic mass in the internal quadran of breast. The surgically resected tumor showed mature fat cells separated by proliferating branched vessels and intravascular hyaline thrombi. CONCLUSION: The existence of angiolipoma of the breast in the male must not to be forgotten because this tumor may be confused clinically, radiologically and pathologically with a malignant tumor.

Morphologic criteria associated with Trichomonas vaginalis in liquid-based cytology.

OBJECTIVE: To evaluate the morphologic criteria associated with Trichomonas vaginalis on Cytyc (Marlborough, Massachusetts, U.S.A.) liquid-based cytology and to compare results between 2 types of liquid-based cytology-Cytyc and SurePath (BD Diagnostics-TriPath, Burlington, Vermont, U.S.A). STUDY DESIGN: Forty thousand Cytyc liquid-based cytology cases were tested between January 2005 and 2008. Among these, 80 cases (0.2%) had aT vaginalis infection without intraepithelial lesions or other associated infectious organism. The 80 ThinPrep (Cytyc) slides were reexamined, and for each case, morphologic characteristics associated with the parasite were listed. Concerning the SurePath technique, only 1 paper has been found in the literature based on 60,104 cases with 88 cases of T vaginalis (0.17%). RESULTS: Among the 80 T vaginalis patients, the most frequent features associated with the infection were the presence of cannonballs (93%), perinuclear halo (90%), reactive nuclear changes (88%) and attachment of T vaginalis to squamous cells (86%). Moreover, the presence of ghost cells was significantly more frequent in SurePath than Cytyc liquid-based cytology (p = 0.00001), and the presence of neutrophils, reactive nuclear changes, dirty background and karyorrhexis and the predominance of coccobacilli were significantly more frequent in Cytyc than SurePath liquid-based cytology (p < 0.05). CONCLUSION: On the basis of these results, we conclude that SurePath and Cytyc, which are the both commonly used liquid-based cytologic techniques, are useful and have the same efficacy in the detection of T vaginalis infection (p = 0.99).

Low-grade adenosquamous carcinoma of the breast--A case report with a BRCA1 germline mutation.

Breast cancers occurring in women with germline BRCA1 mutations tend to fall into the category of triple-negative or basal-like phenotypes, such as metaplastic carcinoma. Low-grade adenosquamous carcinoma of the breast is a rare variant of metaplastic carcinoma. We present the case of a 49-year-old woman with a past medical history of invasive ductal breast carcinoma 13 years ago, and who was recently diagnosed as having a low-grade adenosquamous carcinoma in the same breast. Genetic analysis of blood DNA revealed a BRCA1 mutation. To our knowledge, BRCA1 mutation in association with a low-grade adenosquamous carcinoma of the breast has not yet been reported. Thus, it may be important to consider the possibility of an association, but supplemental studies are needed.

High prevalence of high-risk human papillomavirus infection among women with Trichomonas vaginalis infection on monolayer cytology.

OBJECTIVE: To evaluate the risk of high-risk human papillomavirus (HPV) infection in women with Trichomonas vaginalis infection, and the reason remains unclear. METHODS: A total of 40,000 liquid-based cytology specimens were tested from 2005 to 2008. Among these, high-risk HPV testing using the hybrid capture II assay was performed in positive cases of T. vaginalis according to the age of patients (<30 years old, between 30 and 50 years old, more than 50 years old). As controls, HPV detection was also performed in 450 normal smears. RESULTS: T. vaginalis was found in 80 cases (0.2%). From these 80 cases, 57 were available for HPV testing (8 patients <30 years old, 42 patients between 30 and 50 years old and 7 patients more than 50 years old). As controls, high-risk HPV was tested in 150 patients with normal cytology for each of these three age categories. High-risk HPV was significantly more frequently detected in women with T. vaginalis than in women with normal smear irrespective of the categories of age (P < 0.01). CONCLUSION: For the first time, we demonstrated a significant prevalence of high-risk HPV in women with cytological proved T. vaginalis infection independent of the age ranges. Our data suggest a potential association between these two infectious agents by the way of a sexual intercourse and probably by a biochemical or immunological reasons.

Accuracy of lymph nodes cell block preparation according to ultrasound features in preoperative staging of breast cancer.

To analyse the correlation between axillary ultrasonography (US), cell block (CBs) preparation, and histological diagnosis of lymph nodes from patients with primary breast cancer with the intention to assess the accuracy of cell block (CB) technique in preoperative staging. We tested a series of 26 patients who underwent axillary cell blocks from ultrasound guided fine-needle aspiration with histologic follow-up (axillary lymph nodes dissection). The specificity of axillary cell block was 100% vs. 14% for axillary ultrasound and the sensitivity was 73% for axillary cell block and 87% for axillary ultrasound. The positive and negative predictive values of cell block were respectively, 100 and 78%. Based on these results, we concluded that CB preparation was a feasible and specific technique to evaluate axillary lymph nodes status of patients with primary invasive breast cancer.

Immediate surgical resection of residual microcalcifications after a diagnosis of pure flat epithelial atypia on core biopsy: a word of caution.

The entity of pure flat epithelial atypia remains a challenge due to controversy of the surgical management of residual microcalcifications after core needle biopsies. This study aims to assess the morphological data observed in immediate surgical resection specimen of residual microcalcifications after a diagnosis of pure flat epithelial atypia on mammotome core biopsy. Sixty-two mammotome core biopsy with a diagnosis of pure flat epithelial atypia (flat epithelial atypia without associated atypical ductal hyperplasia, in situ and/or invasive carcinoma) were identified. From these 62 cases, 20 presented residual microcalcifications and underwent an immediate surgical excision after mammotome. Of the 20 patients with excised microcalcifications, 8 (40%)cases had residual pure flat epithelial atypia, 4 (20%) cases had atypical ductal hyperplasia, 4 (20%) cases had lobular in situ neoplasia, no lesions were retrieved in 4 (20%) case. None of the patients had either in situ ductal carcinoma and/or invasive carcinoma. Surgical resection of residual microcalcifications after the diagnosis of pure flat epithelial atypia on core needle biopsy remains still a debate. The present study shows no cases of in situ ductal and/or invasive carcinoma on immediate excision of residual microcalcifications after mammotome core biopsies.

Ovarian involvement by desmoplastic small round cell tumor with leydig cell hyperplasia showing an unusual immunophenotype (cytokeratin negative, calretinin and inhibin positive) mimicking poorly differentiated sertoli leydig cell tumor.

Desmoplastic small round cell tumor (DSRCT) is a rare aggressive tumor primarily involving serosal surfaces in adolescents and young men. Diagnosis is based on specific clinicomorphologic, immunohistochemical, and genetic features. We report here a variant of DSRCT involving the ovaries that mimics the Sertoli-Leydig cell tumor in a 21-year-old woman complaining of abdominal pain. Abdominal ultrasonography and computed tomography showed a right adnexal mass. She had a slightly raised serum CA-125 level. Frozen section examination identified the right ovarian mass as a poorly differentiated Sertoli-Leydig cell tumor. The surgically resected tumor and left ovary and omentum implants found during laparoscopy were diagnosed as DSRCT with Leydig cell hyperplasia. Immunohistochemically, the tumor cells were negative for epithelial markers but were positive for calretinin and inhibin. The patient is still undergoing chemotherapy at 8 months after initial presentation with partial response. This case showed that DSRCT with unusual immunohistochemical profiles and Leydig cells hyperplasia pose a diagnostic challenge. Molecular genetic techniques may help in these cases.

Lymph node involvement in multicystic peritoneal mesothelioma.

Multicystic peritoneal mesothelioma is an uncommon lesion most frequently encountered in women of reproductive age. Although the pathologic characteristics have been documented, the lymph node status associated with this pathology, the etiopathogenesis and prognosis of which remain unclear, is unknown. We report here the case of a 35-year-old woman with a 5.5 cm multicystic mesothelioma affecting the pelvic peritoneum of the rectum. Involvement by multicystic mesothelioma was observed within two lymph nodes simultaneously resected with the tumor. To the best of our knowledge, lymph node involvement has not been described in previous studies.

Primary ovarian carcinoid tumor with luteinized stromal cells.

BACKGROUND: Primary ovarian carcinoid tumors are rare. Distinct histologic patterns have been described in the literature as insular, trabecular, mucinous and mixed types. CASE REPORT: We describe a case of 71-year-old woman diagnosed with a left ovarian tumor. Frozen section examination identified the mass as a sex-cord stromal tumor. The surgically resected tumor was diagnosed as an insular carcinoid tumor with unusual luteinized stromal cells. Histologic diagnosis complied with results acquired by immunohistochemical with positivity of tumor cells for neuroendocrine markers and positivity of luteinized stromal cells for alpha-inhibin, calretinin and Melan A. CONCLUSION: Ovarian carcinoid tumor can be extremely heterogeneous. The purpose of our report was to show that the ovarian carcinoid tumor can be associated with stromal luteinization, mimicking a sex-cord stromal tumor.