Cervical cancer and cytomegalovirus

Paraffin embedded sections from 34 cases of cervical cancer in Uganda were examined for the presence of cytomegalovirus (CMV) using immunohistochemistry. CMV was detected in five of the 34 cases. In all cases; the reactivity was confined to the cervical epithelial tissue. These results provide further evidence for an association between CMV and cervical cancer and show that CMV may be readily detected in archival materials. It also suggests that cervical cancer may be associated with immune deficiency

[Anal hygiene in perianal skin diseases--compatibility of water moist and dry toilet paper]. / Analhygiene bei perianalen Hauterkrankungen Verträglichkeit von Wasser, feuchtem und trockenem Toilettenpapier.

The most common morphological changes in 485 of our ambulatory patients were found on external examination of the anal region (46%). These changes included erosions, fissur and eczema. Regarding the symptoms the predominant complaints were itching and burning in 42.1%. Anal hygiene after defaecation was most commonly done with dry toilet-paper (55%). A change in anal hygiene after defaecation relieves symptoms: By changing from water to moist toilet paper in 9%, from dry toilet paper to moist toilet paper in 30%, from moist toilet paper to water in 32%, an from dry toilet paper to water in 60%. These results confirm known facts regarding the influences of conserving agents an printing materials in dry (often recycled) and moist toilet papers on the skin. These side-effects to be even more pronounced in the compromised skin and suggest that anal hygiene should be done with water only.

Classification and grading of squamous cell carcinoma of the cervix

Two hundred and twenty three cases of squamous cell carcinoma of the cervix were classified according to their resemblance to cells in any of the layers in the ectocervix and a grade of low and high malignancy was also given to each case. Forty cases were classified as basal; 59 as prickle; 115 as intermediate and one as superficial cell types. Ninety cases were high grade (seven basal; 14 prickle; 63 intermediate and six superficial) and 133 were low grades (33 basal; 45 prickle; 52 intermediate; three superficial). This study shows that the intermediate cell type is the commonest and are usually high grade tumours. The findings also support the idea that squamous cell carcinoma of the cervix may arise from any of the normal layers in ectocervix and suggests that squamous cell carcinoma of the cervix is not a single disease entity; but heterogenous group of tumours like the non-Hodgkin's B cell or T cell lymphomas. Further study is needed to correlate the cyokeratin subtypes and clinical features of each histological type

Cervical cancer and cytomegalovirus.

Paraffin embedded sections from 34 cases of cervical cancer in Uganda were examined for the presence of cytomegalovirus (CMV) using immunohistochemistry. CMV was detected in five of the 34 cases. In all cases, the reactivity was confined to the cervical epithelial tissue. These results provide further evidence for an association between CMV and cervical cancer and show that CMV may be readily detected in archival materials. It also suggests that cervical cancer may be associated with immune deficiency.

Classification and grading of squamous cell carcinoma of the cervix.

Two hundred and twenty three cases of squamous cell carcinoma of the cervix were classified according to their resemblance to cells in any of the layers in the ectocervix and a grade of low and high malignancy was also given to each case. Forty cases were classified as basal, 59 as prickle, 115 as intermediate and nine as superficial cell types. Ninety cases were high grade (seven basal, 14 prickle, 63 intermediate and six superficial) and 133 were low grades (33 basal, 45 prickle, 52 intermediate, three superficial). This study shows that the intermediate cell type is the commonest and are usually high grade tumours. The findings also support the idea that squamous cell carcinoma of the cervix may arise from any of the normal layers in ectocervix and suggests that squamous cell carcinoma of the cervix is not a single disease entity, but heterogenous group of tumours like the non-Hodgkin's B cell or T cell lymphomas. Further study is needed to correlate the cytokeratin subtypes and clinical features of each histological type.

Pattern of malignant lymphomas in Rwanda.

The pattern of 115 cases of malignant lymphomas diagnosed in the years 1979-1987 is presented using the updated Kiel's classification for non Hodgkin's lymphomas and after application of monoclonal antibodies L 26 and UCHL1 for the identification of B and T lymphocytes. Ninety-six cases (83.5%) were non Hodgkin's lymphomas and 19 cases (16.5%) Hodgkin's disease. Among non Hodgkin's lymphomas, B-cell lymphomas were predominant with a total number of 91 cases (94.8%). An analysis of B-cell lymphomas showed the following relevant features: a high frequency of lymphoplasmacytic/oid immunocytoma, a low frequency of Burkitt's lymphoma with a predominance of abdominal localisations, a high frequency of extranodal lymphomas (47.3%) and high grade lymphomas (48.4%); a 65% increase in high grade and extranodal lymphomas and a 76% increase in Burkitt's lymphomas and immunoblastic lymphomas in the period 1984-87 compared to the period 1979-83. For T-cell lymphomas, relevant features were the presence of one case of pleomorphic T-large cell lymphoma or adult T-cell leukemia-lymphoma and the fact that four out of five cases were large cell (high grade) lymphomas. More than 50% (57.9%) of Hodgkin's disease were of mixed cellularity type, only 15.8% being of nodular sclerosing type. The disease seemed to affect adolescents and young adults, more than 80% (83.3%) being aged 15-40 years. These features are compared to those observed by other authors and possible pathogenetic mechanisms are discussed.

The distribution of non-Burkitt, non-Hodgkin's lymphomas in Uganda in relation to malarial endemicity.

Biopsies of malignant lymphomas collected from all districts of Uganda, filed in the Kampala Cancer Registry for the 8-year period 1966-1973, were reviewed. This review confirmed a relatively low frequency of follicle-centre-cell lymphomas with a follicular growth pattern and the geographical co-distribution between malaria and Burkitt's lymphoma (BL). It also showed a similar, though less marked, association between non-Burkitt, non-Hodgkin's lymphoma (NBNHL) and malarial endemicity, and a correlation in the regional incidence between BL and NBNHL. In both comparisons, these associations were strong for high-grade lymphomas and weak for low-grade neoplasms. BL and other NHL may therefore share, to a varying degree, some common pathogenesis. The excess in frequency of NBNHL of high-grade malignancy in malarial endemic areas appears to be in contrast to Western countries where most non-Hodgkin's lymphomas are of low-grade malignancy.

The distribution of non-Burkitt; non-Hodgkin's lymphomas in Uganda in relation to malarial endemicity

Biopsies of malignant lymphomas collected from all districts of Uganda; filed in the Kampala Cancer Registry for the 8-year period 1966-1973; were reviewed. This review confirmed a relatively low frequency of follicle-centre-cell lymphomas with a follicular growth pattern and the geographical co-distribution between malaria and Burkitt's lymphoma (BL). It also showed a similar; though less marked; association between non-Burkitt; non-Hodgkin's lymphoma (NBNHL) and malarial endemicity; and a correlation in the regional incidence between BL and NBNHL. In both comparisons; these associations were strong for high-grade lymphomas and weak for low-grade neoplasms. BL and other NHL may therefore share; to a varying degree; some common pathogenesis. The excess in frequency of NBNHL of high-grade malignancy in malarial endemic areas appears to be in contrast to Western countries where most non-Hodgkin's lymphomas are of low-grade malignancy

Multiple infections in cases of cervical cancer from a high-incidence area in tropical Africa.

The presence of several infections was determined in tissue and serum samples from 34 cases and 23 controls seen in 1984-85 at Mulago Hospital in Kampala, Uganda. When assessing single infections, association with cervical cancer could be shown for 5 agents, namely by Southern blot assay for human papillomavirus types 16 and 18 (HPV), and by serological tests at varying levels of antibody titres, for herpes simplex virus type I and/or 2 (HSV), cytomegalovirus (CMV), Epstein-Barr virus, viral capsid antigen (EBV-VCA), and Chlamydia trachomatis (CLT). Due to interaction, HSV and CMV were associated with cervical cancer only when infection by both of these agents was demonstrable. In the assessment of the simultaneous presence of these 5 infections, moderately high antibody titres were taken as the cut-off point for infection by HSV, CMV, EBV-VCA, and CLT. This showed that 3 and 4 infections at a time were seen in the majority of the cases in contrast to the controls with essentially no more than 2 such infections. A linear trend in the rise of risk for cervical cancer was noted with increasing number of infections.

Merkel cell carcinoma of the face. Case report and review of the literature.

Merkel cell carcinoma of the skin has only recently been described. From the literature 115 cases are analysed. This carcinoma is most probably far more common than would be assumed from the few publications presently available. Between 40 to 50% of tumours are found in the head and neck area. Clinically the tumour presents as a typical bluish red firm intracutaneous nodule with the overlying skin intact, and sometimes malignant melanoma-like intracutaneous satellites. Regional lymph node metastasis is frequent and the five year survival rate, although not yet available, may well be about 50% or less. Clinical diagnosis is of paramount importance, as final diagnosis is only confirmed by electron microscopy and routine light microscopy leaves a wide range of differential diagnoses. In our case all typical characteristics are present. A cervicofacial flap which utilizes the abundant cervical skin for direct closure of the secondary defect in a U-Y manner was used to cover the primary defect. The flap is based on the preauricular area. Advantages and indications for the cervicofacial as opposed to Esser's cheek rotation flap are discussed.

Epidemiological aspects of cervical cancer in tropical Africa.

Cervical cancer is one of the most common malignant tumours in tropical Africa accounting, for example, for nearly one-quarter of female cancer cases overall in Uganda. The disease is likely to be under-reported and available incidence rates are probably gross underestimates. Spread is through sexual contacts. Both female and male promiscuity and a low standard of sexual hygiene lead to a high incidence within a given community. A number of investigations show that the risk of cervical cancer varies little, whether or not the male partner has been circumcised, but these findings seem to indicate only that extreme cleanliness is more effective than circumcision alone. Populations of Uganda who practise male circumcision have a lower incidence than those who do not, favouring the view that partial protection is provided by this custom. Herpes simplex virus type 2 remains a candidate oncogenic agent, but the results of comparative seroepidemiological surveys of titres among cases and controls are inconsistent, not only in Uganda, but also in other areas of the world. Human papillomaviruses are clearly more important. Analyses of the geographical and age distribution of cancer in Uganda, based on the results of a country-wide biopsy service, show that cervical cancer and cancer of the vulva, vagina, and penis share common causes and are related to genital warts. Recently, a number of different papillomaviruses have been found in various forms of squamous-cell neoplasia of the genital tract, and similar studies would be worthwhile in tropical Africa.

Condylomata acuminata and their possible relation to cancer of the uterine cervix. Case report and geographic observations.

A unique case is described of a 21-year-old female with gonorrhea, condylomata acuminata of the vulva and the uterine cervix, a squamous-cell papilloma and precancerous changes in the cervix. In the observed lesion, a very gradual transition was seen from benign areas, displaying marked cytoplasmic vacuolization, to moderately dysplastic areas, with only slight vacuolization. Giant squamous cells with centrally located vesicular or hyperchromatic nuclei were a prominent feature of both the condylomatous and premalignant portions of the lesion. A geographic correlation was observed in the 18 districts of Uganda between the incidence of vulvar and vaginal condylomata acuminata and cervical cancer; the finding may include cervical warts since vulvovaginal changes often extend to the cervix uteri. In addition to the common flat condyloma, the acuminate variant may be a precursor of cervical cancer and progress to malignancy through the stage of a squamous-cell papilloma.

Epidemiology of malignant degeneration of condylomata acuminata in Uganda.

A series of 73, 28 and 172 cases of condylomata acuminata and 133, 44 and 1,237 cases of carcinoma of vulva, vagina and penis is analysed. This material was derived from a country-wide biopsy service in Uganda between the years 1964-1975. Condylomata acuminata occurred mainly in young and elderly persons and thus preceded the cases of carcinoma by decades and years in age-distribution, respectively. Geographical correlations with cancer observed in the 18 districts of the country were high for all condylomata acuminata combined and for cases occurring in young and elderly persons. 12 cases were observed in which histological features suggestive of transition to malignancy had been noted in the biopsy report, and 7 out of 10 such cases with known age were seen among the elderly. A high rate of malignant degeneration was observed in the age-group 40 years and over, namely 5 or possibly 6 cases among 36 condylomata acuminata whereas in the lower age-groups none or possibly one example was found out of 210 cases. Another feature varying with age of the patient was the time-interval between the biopsy diagnosis of condylomata acuminata and cancer. The values amounted to months and several years in the higher age-groups in contrast to 8 years observed in the one case occurring in young age. Moreover, in a review of 35 cases found in the literature duration of malignant degeneration differed between decades in young and years and months in high age except in a medium age-range of 30-45 years in which observations varied widely. These findings adduce indirect, and, in the case of the observed rate of malignant degeneration, perhaps tentative direct evidence for the long postulated association between cancer, condylomata acuminata and thus possibly an underlying viral agent. Condylomata acuminata could be precancerous lesions showing a low risk and long time-interval to malignancy in young and a high risk and short time-interval in later age.

Condylomatous tumours of vulva, vagina, and penis. Relation between histological appearance and age.

Among 237 cases of condyloma diagnosed in Uganda between 1964 and 1975 seven types of lesions were defined. Three of these were found within a wide age range in both young and elderly people, namely, the common (49.4%) and the flat (2.0%) condyloma acuminatum, and condyloma acuminatum of irregular outline (13.5%). Four variants, on the other hand, fell into different age groups. Condyloma acuminatum, showing marked cell death (5.1%) and observed exclusively among girls in the first decade of life, displayed numerous aciophil bodies, presumably reflecting single cell necroses. Condylomata acuminata showing marked acanthosis (16.9%) were found in patients between 12 and 30 years, dysplastic condylomata acuminata (5.9%) between 20 and 62 years, and proliferative (giant) condylomata acuminata (7.2%) between 31 and 80 years of age. In the latter two groups of lesions, the inflammatory stromal infiltrate was more prominent, but cytoplasmic vacuolation, often believed to be a sign of viral infection, was seen less frequently than in the remaining types. In young people, the features seen resemble, therefore, a cytocidal and/or vacuolating viral infection, whereas the dysplastic and proliferative changes observed in older patients are compatible with malignant transformation being under way.

Variation in the appearance of giant condyloma in an Ungandan series of cases of carcinoma of the penis.

Whole mount sections were made from all amputation specimen of patients treated for carcinoma of the penis in Mulago Hospital, Kampala, Uganda, during a 21-month period in 1968-1970. Among a total of 55 cases four tumors were found which were large, but histologically showed low invasiveness suggestive of absence of metastatic spread. There were two giant condylomas, and two giant condylomas showing possible microinvasion. Two further cases showed a small squamous cell carcinoma together with a giant condyloma in the remainder of tumor. The most chracteristic feature was an orderly, well-circumscribed, expansive downgrowth, leaving little stroma to be seen between the epithelial masses to tumor. Within these limits, however, the spectrum of growth pattern, differentiation, and malignant change was very wide and much more varied than in tumors recorded form Western countries. This should be remembered when a presumptive diagnosis of the condition is to be made on small routine biopsies. Additional changes showing marked similarities to condylomata acuminata were often seen in superficial portions of tumor. This transition in histological picture within one tumor favors the view that giant condyloma is an intermediate lesion in the development of cancer in condylomata acuminata.

Cancer mortality in Württemberg, 1910 and 1970.

The results of a special survey of cancer mortality statistics in selected areas of the Ober- and Unterland of Württemberg in the period 1908--1912 were compared with the official mortality statistics of the same region for 1969--1972. In the Oberland, formerly part of an area of high cancer mortality comprising the adjacent regions of Bavaria, Austria, Switzerland, and Baden, the overall cancer mortality showed a marked fall in both sexes. In the Unterland, where cancer mortality was previously low, the overall death rate increased in men and did not change in women. These variations are largely accounted for by changes in mortality from cancer of the stomach and bronchus. The death rates from gastric cancer observed around 1900 in the Oberland of Württemberg and adjacent regions of the neighbouring countries are among the highest recorded even in the world. Since the fall of gastric cancer noted is very marked and this disease is still the leading cause of death from cancer today, the Oberland of Württemberg seems to be uniquely suited for the search of environmental factors which associate with this decline. In theremainder of cancer sites changes over time were less striking and/or observed already in other countries.