Attitudes About the Human Papillomavirus Vaccine Among Patients With and Without Cervical Dysplasia.

OBJECTIVES: The aims of the study are to examine the perception of the human papillomavirus (HPV) vaccine among those with and without a history of cervical dysplasia and to examine perceptions of the vaccine for their children. MATERIALS AND METHODS: Patients were recruited to complete a survey about the HPV vaccine for both themselves and their children. Patients in a colposcopy clinic with a history of abnormal cervical cytology and patients in a benign gynecology clinic without a history of abnormal cervical cytology were recruited. Participants' medical records were reviewed. Demographics and survey answers were described, and Fisher exact test was used to compare the groups. RESULTS: One hundred eighty-three patients participated: 73 in colposcopy clinic and 110 in benign clinic. The majority self-identified as Black (74% colposcopy, 71% benign, p = .588) and reported an income less than $39,000 a year (77% colposcopy, 65% benign, p = .089). Fifty-six percent in benign clinic agreed the HPV vaccine is a good way to protect oneself from disease compared with 48% in colposcopy clinic ( p = .022). When examining results based on cytology, fewer patients in the highest-grade cytology group agreed the vaccine was effective (30% high-grade, 48% normal, 57% low-grade, p = .027) or a good way to protect themselves from disease (29% high-grade, 53% normal, 62% low-grade, p = .002). There was otherwise no statistically significant difference between the groups on questions regarding self or child vaccination. CONCLUSIONS: In a majority Black, low-income population, patients without a history of abnormal cervical cytology have more favorable perceptions of the HPV vaccine's effectiveness in preventing disease. Those with the highest-grade cytology had more negative perceptions of the vaccine's effectiveness and protectability.

Cervical conization for cervical intraepithelial neoplasia (CIN) 2 and 3 in HIV-positive women: a case-control study.

OBJECTIVE: The purposes of the study were to investigate the outcomes of cervical conization for cervical intraepithelial neoplasia (CIN) 2 and 3 in HIV-positive women and age-matched HIV-negative controls and to determine whether positive margin, positive endocervical curettage, CD4 count, or viral load was associated with the persistence of CIN 2,3 or residual CIN 2,3 on the specimen from repeat excision procedure or hysterectomy. MATERIALS AND METHODS: HIV-positive women and HIV-negative controls with CIN 2,3 on cervical conization were enrolled in the study. Patients who underwent repeat conization or hysterectomy were identified, and the specimens were evaluated for residual CIN 2,3. CD4 count and viral load within 8 weeks of procedure were analyzed. RESULTS: A total of 44 patients and 44 age-matched controls were identified. Persistent CIN 2,3 was diagnosed in 28 HIV-positive (63.6%) and 14 HIV-negative patients (31.8%; odds ratio [OR] = 4.7, 95% confidence interval [CI] = 1.9-11.5, p < .001). In HIV-positive women, a positive margin was associated with a higher persistence rate after cervical conization (OR = 5.3, 95% CI = 1.17-24.14, p = .03). In HIV-negative patients, positive endocervical curettage was associated with a higher persistence rate after conization (OR = 12, 95% CI = 2.24-64.23, p = .004). Of HIV-positive women, 75% had residual CIN 2,3 on the specimen from repeat procedure compared to 45.2% of controls (OR = 3.6, 95% CI = 1.3-10.6, p = .018). CD4 count or viral load was not associated with the rate of residual disease or persistence rate after cervical conization, but the lowest OR that the sample size allowed to assess with 90% power was 5.02. CONCLUSIONS: HIV-positive women have a higher rate of residual disease and higher persistence rate after conization for CIN 2,3 than age-matched HIV-negative controls.

Predicting persistent/recurrent disease in the cervix after excisional biopsy.

OBJECTIVE: To evaluate the ability of various factors to predict persistent/recurrent disease after excisional biopsy of the transformation zone (cold knife conization or loop electrosurgical excision procedure) with special attention to the endocervical curettage (ECC). STUDY DESIGN: We reviewed the charts and histopathology findings of 152 women who underwent endocervical curettage at the time of conization (cold knife conization) or loop electrosurgical excision procedure (LEEP). Age, histopathologic findings on the cervical conization specimen, ectocervical margin, endocervical margin, and ECC specimens were assessed. These findings were analyzed for a relationship with the presence of cervical disease on subsequent follow-up (to include hysterectomy, repeat conization, colposcopically directed biopsies, endocervical curettage, and/or cytology). RESULTS: Positive endocervical margin (odds ratio [OR], 9.168; 95% confidence interval [95% CI], 3.939, 23.488), positive ectocervical margin (OR, 3.561; 95% CI, 1.626, 7.799), positive specimens (OR, 17.683; 95% CI, 5.308, 58.912), and severity of disease (OR, 2.730; 95% CI 1.507, 4.947) on the conization were all individually significantly associated with the presence of persistent/recurrent disease. Age of the patient at the time of cervical conization was not statistically associated with the ability to predict persistent/recurrent disease. In the multivariate analysis, the endocervical curettage (OR, 8.710; 95% CI, 2.302, 32.958) and the endocervical margin status (OR, 9.170; 95% CI, 2.887, 29.125) together were significant predictors of persistent/recurrent disease after adjusting for the other variable. However, when the degree of dysplasia and ectocervical margin status was included in the multivariate analysis, endocervical margin status (OR, 6.761; 95% CI, 2.657, 17.202) and severity of cervical disease (OR, 1.930; 95% CI, 1.038, 3.59) were the only statistically significant predictors of persistent/recurrent cervical neoplasia. CONCLUSION: In this retrospective analysis, positive endocervical or ectocervical margin, positive ECC specimens, and severity of cervical disease were all predictors of persistent/recurrent disease. However, on the multivariate stepwise logistic regression analysis, only endocervical margin status and severity of neoplasia significantly predicted the occurrence of persistent/recurrent disease. The results of the ECC, after adjustment for the degree of dysplasia and the endocervical margin status, do not add incremental value to the prediction of persistent/recurrent disease. At this time, ECC does not need to be routinely performed at the time of excisional biopsy of the cervical transformation zone.

Angiomyofibroblastoma of the retroperitoneum: a case report.

BACKGROUND: Angiomyofibroblastoma is a rare soft tissue neoplasm that presents most frequently in the genital region of young to middle-aged women. CASE: A 28-year-old woman presented with nausea, vomiting and pelvic pain. Computed tomography revealed a well-circumscribed, brightly enhancing pararectal mass in the retroperitoneum. A core needle biopsy suggested the diagnosis of angiofibromyoblastoma. Due to the highly vascular nature of the lesion, the patient underwent angiographically guided embolization in an effort to minimize surgical blood loss. This was followed by exploratory laparotomy and resection of the mass. CONCLUSION: This case illustrates an unusual presentation of angiomyofibroblastoma in the pelvic retroperitoneum and its management with preoperative selective embolization, which may have contributed to the minimal blood loss at the time of resection.

Fertility-sparing surgery for persistent gestational trophoblastic neoplasia in the myometrium: a case report.

BACKGROUND: Persistently low-level "real" serum human chorionic gonadotropin (hCG) after treatment for gestational trophoblastic neoplasia (GTN) in patients desirous of preserving fertility is a diagnostic and management challenge. Among the possible explanations is the presence of false positive ("phantom") hCG or of trophoblasts in a myometrial sanctuary. CASE: An 18-year-old woman had persistent low-level hCG values in her serum after treatment for nonmetastatic GTN. Her only child had died, and she wanted to preserve her fertility potential. Phantom hCG was excluded. Positron emission tomography (PET) showed increased uptake in an area of the uterus in which magnetic resonance imaging had shown an ill-defined, ovoid lesion. Removal of the lesion with preservation of the uterus followed by 2 courses of multiagent chemotherapy (methotrexate, dactinomycin and cyclophosphamide) resuited in clinical remission. CONCLUSION: PET can prove useful in detecting persistent disease in a myometrial sanctuary in patients with resistant, nonmetastatic GTN. Conservative surgical excision with uterine preservation is possible and can be of value in achieving remission.

Premalignant lesions in the contralateral ovary of women with unilateral ovarian carcinoma.

OBJECTIVES: A limited number of studies have looked at premalignant lesions of ovaries and the results are conflicting. Our goal is to identify, histologically and by immunohistochemistry, any features that may represent premalignant changes in the ovaries. METHODS: Our cases included 29 patients with unilateral ovarian cancer. These were compared to 19 controls that had unilateral benign ovarian pathology and to 39 controls with bilateral normal ovaries. Tissue sections from the contralateral normal ovary were examined. Analysis of histological features and immunohistochemical staining for the apoptosis inhibitor Bcl-2, the proliferation marker Ki-67 and the tumor suppressor gene p53 was performed. RESULTS: Epithelial stratification, nuclear atypia, and inclusion cysts were more often seen in the cases than in the two control groups. Epithelial stratification and nuclear atypia was statistically significantly more common among the cases than the normal controls. Inclusion cysts were present in more of the cases (P = 0.017) and in higher numbers than in the normal controls. Bcl-2 overexpression was statistically more commonly seen in the cases with contralateral ovarian cancer (39%) than in the normal controls (15%), while it was present in 28% of cases with contralateral benign pathology. CONCLUSIONS: Epithelial alterations and Bcl-2 overexpression was seen in all three groups studied. However, the epithelial alterations and Bcl-2 overexpression was more commonly seen in the contralateral ovary of women with unilateral ovarian cancer. This suggests an association between these changes and ovarian cancer. Although it is tempting to label the above changes premalignant, women with the above changes are at possibly higher risk of developing ovarian cancer rather than having acquired an oncogenic change that would inevitably lead to ovarian cancer.

Melphalan for the treatment of patients with recurrent epithelial ovarian cancer.

The purpose of this study was to determine the response to melphalan in patients with recurrent epithelial ovarian cancer after platinum-based therapy. This retrospective observational study analyzed 10 patients with recurrent epithelial ovarian carcinoma treated with melphalan between August 1995 and April 2001. All had received primary platinum-based therapy. Nine of the 10 patients had chemosensitive disease. All but one patient had received one or more second-line therapies prior to melphalan. The median time to recurrence after first-line therapy was 26 months (range, 3-68). Treatment with melphalan resulted in 2 (20%) complete responses and 1 (10%) partial response (response rate, 30%; 95% CI 8%, 65%). The median progression-free interval after initiation of melphalan therapy was 8 months (range, 3-23). The most common side effects were grade I thrombocytopenia (20% of courses) and grade II leukopenia (18% of courses). The use of melphalan as palliative chemotherapy in patients with recurrent ovarian cancer results in response rates similar to those reported with other more expensive agents. Melphalan at the doses reported here has a favorable toxicity profile.