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PubMed1988

Diagnostic dilemmas in patients with cystic neoplasms of the pancreas.

Cystic neoplasms of the pancreas (CNP) are rare lesions that can be difficult to diagnose preoperatively. Twenty patients with cystic neoplasms of the pancreas including five microcystic adenomas, six benign mucinous cystic neoplasms, three malignant mucinous cystic neoplasms, two solid and papillary epithelial neoplasms, and four cystic neuroendocrine tumors were treated at a single institution between 1962 and 1987. The average duration of symptoms prior to diagnosis was 10 months. Five patients were asymptomatic. Forty percent of patients presented with an abdominal mass. Plain abdominal x-rays and UGI barium contrast studies were never diagnostic. Ultrasonography, computerized tomography (CT) and visceral angiography aided in the correct diagnosis in 28%, 36%, and 75% of patients studied, respectively. Overall a correct diagnosis was made preoperatively in only 35% of patients. Twelve of 13 patients were correctly diagnosed at laparotomy with intraoperative biopsy. Without biopsy the mass was misdiagnosed at laparotomy in five of six cases. CNP must be suspected in any patients who present with an upper abdominal mass with or without abdominal pain and no history of pancreatitis. CT may be diagnostic in up to one third of cases and should be obtained routinely to demonstrate the proximity of the lesion to other structures. Visceral angiography should also be obtained prior to operation. A generous incisional biopsy should be obtained of all pancreatic cysts that are not to be resected.

Adult↗

PubMed2000

Coronary artery bypass grafting in patient with malignant neoplasm. Efficacy of coronary artery bypass grafting on beating heart.

OBJECTIVE: Coronary artery bypass grafting (CABG) prior to noncardiac major surgery has effectively decreases short- and long-term mortality related to coronary ischemia. Coronary artery bypass on the beating heart is conducted to avoid the risk of cardiopulmonary bypass and it has contribute to shorten recovery time. METHODS: Subjects were 19 patients with malignant neoplasm for whom a retrospective chart review was made between Jan. 1, 1992 and July 31, 1998. In the early phase of this study, between Jan. 1, 1992, and Dec. 31, 1997, CABG was performed using cardiopulmonary bypass, and late phase, between Jan. 1, 1998, and July 1, 1998, CABG was done on the beating heart without cardiopulmonary bypass. RESULTS: Conventional CABG was performed in 12 patients with neoplasms (10 male and 2 female, age 64.7 +/- 6.1 years), and CABG on the beating heart was performed in 7 patients (6 male and 1 female, age 68.0 +/- 7.5 years). Fewer number of bypass grafts were made in the beating-heart CABG group (1.3 +/- 0.5 in beating-heart CABG versus 3.9 +/- 1.1 in conventional CABG). No cardiac events occurred in either group during the surgery for malignant tumors. The operative interval between CABG and cancer surgery was significantly shorter in the beating-heart CABG group (21.8 +/- 17.9 days in beating-heart CABG versus 53.5 +/- 42.9 days in conventional CABG, p < 0.05). CONCLUSION: Patients with severe coronary artery disease and malignant neoplasms should undergo coronary artery revascularization before the neoplasm is treated. CABG on the beating-heart was safe and effective procedure in those with malignant neoplasms.

Aged↗

PubMed2000

[Value of fine needle puncture cytology in neoplasms of the parotid gland].

BACKGROUND: In many parts of Germany fine-needle aspiration biopsy (FNAB) is still not part of the routine preoperative diagnostic evaluation of salivary gland neoplasms. Most opponents consider the study unnecessary and recommend that all salivary gland neoplasms should be excised. OBJECTIVE: Because of this an evaluated the ability of FNAB to provide an accurate diagnosis of parotid gland neoplasms. PATIENTS AND METHOD: Between January 1992 and October 1995, 336 patients referred for operative therapy of salivary gland neoplasms underwent retrospective analysis of preoperative FNAB compared with the excised tumor histology. RESULTS: Results showed that the FNAB had a sensitivity of 93.1%, a specificity of 99.2%, a positive predictive value of 93.1%, a negative predictive value of 99.2% and an accuracy of 98.6%. Complications were observed in less than 1%. DISCUSSION: Our findings demonstrated that the FNAB is a safe diagnostic tool that has a reliable sensitivity and high specificity for the assessment of salivary gland pathology. Since many malignant salivary gland neoplasms present with a virtual lack of symptoms indicating actual malignancy we believe that there is need for FNAB in routine preoperative diagnostic testing.

Adolescent↗

PubMed2005

Prediction of the origin of intracanalicular neoplasms with high-resolution MR imaging.

Correct diagnosis of intracanalicular neoplasms is important to avoid unnecessary operations or an unsuitable surgical approach. We investigated the capability of high-resolution three-dimensional MR imaging in predicting the origin of intracanalicular neoplasms. Twenty cases underwent three-dimensional Fourier-transformation (3DFT) constructive interference in steady state and contrast-enhanced 3DFT-fast low angled shot MR imaging and surgery. Seventeen cases underwent caloric test. MR diagnosis on the origin of intracanalicular neoplasms was compared with surgical results. For MR diagnosis, the origin of intracanalicular neoplasms was predicted according to the location of the tumor in the internal auditory canal (IAC) in two ways, i.e., determining (1) a single specific nerve of origin and (2) whether the tumor originated from the superior or inferior aspect of the IAC. Surgery could determine the nerve of origin in 16 cases (14 inferior and 2 superior vestibular schwannomas), but it was indeterminate in 4. Comparison between MR prediction and surgical results on a single nerve origin revealed exact agreement in five, but inconsistent in three. Regarding whether the tumor was derived from superior or inferior aspect of the IAC, agreement was found in 10 of the 16 cases (62.5%). Caloric test was abnormal in all patients examined but one with superior vestibular schwannoma. 3DFT-MR imaging was not particularly useful in predicting a precise nerve of origin of intracanalicular neoplasms. The prediction on whether the tumor originated in the superior or inferior aspect of the IAC was superior to caloric test, which might have clinical significance in treatment planning especially for hearing preservation surgery.

Adult↗

PubMed1998

Malignant intraperitoneal neoplasms of childhood.

OBJECTIVE: The purpose of this paper is to review and categorize the CT appearances of primary and secondary intraperitoneal neoplasms in children. MATERIALS AND METHODS: We retrospectively reviewed the CT images of 14 cases of intraperitoneal neoplasms. They were reviewed for bowel wall thickening, mesenteric nodules, ascites, calcification, peritoneal nodules, omental caking, and contrast enhancement. RESULTS: Computed tomography images of 14 cases of intraperitoneal neoplasms were evaluated: rhabdomyosarcoma (5), lymphoma (3), neuroblastoma (2), germ cell tumor (1), mesothelioma (1), Wilms tumor (1), and hepatocellular carcinoma (1). Nodular enhancement was seen in all cases, ascites in most, significant bowel wall thickening only with lymphoma, and calcification only with germ cell tumors. Omental caking was present both with rhabdomyosarcoma and lymphoma. CONCLUSIONS: While rare in pediatrics, intraperitoneal neoplasms occur in children, and CT is useful in identifying these peritoneal neoplasms.

Child↗

PubMed2006

True smooth muscle neoplasms of the gastrointestinal tract: morphological spectrum and classification in a series of 85 cases from a single institute.

BACKGROUND AND AIM: True smooth-muscle neoplasms of the GI tract have been only rarely studied in the KIT era. Their incidence among other GI mesenchymal tumours and their clinicopathological spectrum have not been sufficiently analysed. MATERIALS AND METHODS: We reviewed all GI mesenchymal lesions at the Pathology Institute of the Nuremberg Clinic Centre from 1994 through 2005. RESULTS: Among 262 lesions, there were 142 GISTs (54%) and 85 true smooth muscle neoplasms (32%). Smooth muscle neoplasms comprised 72 polypoid leiomyomas (78%, 5 oesophageal and 67 colorectal), 10 intramural leiomyomas (11%, 5 oesophageal, 4 gastric and one ileal), two intramural leiomyosarcomas in the sigmoid colon and ileum (2%) and one polypoid leiomyosarcoma involving the stomach, descending colon and the retroperitoneum concurrently. None of the leiomyomas with available follow-up have recurred or metastasised. CONCLUSION: Smooth muscle neoplasms are the second most common mesenchymal neoplasms in the GI tract after GISTs. They may arise either from the muscularis mucosae or proper muscle layer forming polypoid and intramural lesions, respectively. Polypoid leiomyomas are more common in the rectosigmoid, while intramural ones mainly arise in the vicinity of the oesophagogastric junction. Polypoid leiomyomas are sufficiently treated by endoscopic resection, and local surgical excision is the treatment of choice for intramural leiomyomas. Intramural leiomyosarcomas are rare high-grade sarcomas that commonly have infiltrated into the surrounding tissue or metastasised by the time of diagnosis.

Adult↗

PubMed1990

Bilateral ovarian neoplasms and the risk of malignancy.

Bilateral ovarian neoplasms are believed more likely to be malignant than are unilateral neoplasms. To our knowledge, this clinical tenet has not been evaluated or quantified. To test this hypothesis, we conducted a 10-year review of ovarian neoplasms found at the time of celiotomy at the Women's Hospital, Los Angeles County-University of Southern California Medical Center. Overall, women with bilateral neoplasms had a 2.6-fold increased risk of malignancy when compared with women who had unilateral neoplasms (95% confidence interval, 2.0 to 3.4; p less than 0.001). The age-standardized relative risk was 1.8 (95% confidence interval 1.4 to 2.3). When standardized for the effect of menopausal status, the relative risk was 2.0 (95% confidence interval, 1.6 to 2.5). Bilaterality is associated with a doubling in the risk of cancer, a highly significant difference.

Age Factors↗

PubMed1988

Effect of lifetime administration of dimethylaminoethanol on longevity, aging changes, and cryptogenic neoplasms in C3H mice.

The effects of lifetime treatment with dimethylaminoethanol on longevity and cryptogenic neoplasm formation were studied in females of two mouse sub-lines, the C3H/HeN which carries a germinal mammary tumor provirus and the C3H/HeJ(+) which also carries the exogenous mammary tumor virus. Administration in the drinking water of 10 mM dimethylaminoethanol to the C3H/HeN mice or 15 mM to the C3H/HeJ(+) mice did not result in significant differences between treated and untreated groups in average survival. No changes in age-related organ structure or morphology were observed with dimethylaminoethanol treatment, except for an apparent decrease in the amount of lipofuscin in the liver judged in histological sections. Among untreated C3H/HeJ(+) females, 89% developed neoplasms of the mammary gland, ovary, liver, lung and reticuloendothelial system, while the incidence was 88% in the treated mice. In C3H/HeN females, neoplasms of the mammary gland, ovary, liver, lung and lymphatic system occurred in 57% and in 60% of treated mice. Also, there was no statistically significant difference between control and treated animals in the age of onset or the type of specific neoplasms. Dimethylaminoethanol did not induce any neoplasms.

Aging↗

PubMed1992

Spontaneous neoplasms in B6C3F1 mice.

Spontaneous neoplasms in untreated B6C3F1 mice (200 males and 200 females) used as controls in 4 carcinogenicity studies were evaluated and tabulated. The most common neoplasms in male mice were hepatocellular adenomas/carcinomas (24.5%) followed by alveolar-bronchiolar adenomas/carcinomas (10.0%), lymphoreticular neoplasms (7.0%) [malignant lymphomas mixed (4.5%), histiocytic sarcomas (3.5%)], harderian gland adenoma (6.5%), and hemangiomas/hemangiosarcomas (5.5%). In the females, the most frequently occurring neoplasms were lymphoreticular neoplasms (22.0%) [malignant lymphoma mixed (10.0%), malignant lymphoma lymphocytic (6.5%), histiocytic sarcomas (5.5%)] followed by pituitary adenomas (15.5%), alveolar-bronchial adenomas/carcinomas (11.5%), hepatocellular adenomas/carcinomas (7.0%), harderian gland adenomas, uterine stromal polyps (2.5%), and hemangiomas/hemangiosarcoma (2.0%). The incidence of tumors in various other organs was found to be low.

Animals↗

PubMed2006

Incidence of neoplasms in patients who develop sustained leukopenia during or after treatment with 6-mercaptopurine for inflammatory bowel disease.

BACKGROUND & AIMS: Studies to date have not confirmed an association between neoplasms and inflammatory bowel disease (IBD) treated with 6-mercaptopurine (6-MP). We have observed the occurrence of some neoplasms in IBD patients who developed sustained leukopenia as a result of treatment with 6-MP. As a result, we sought to compare the incidence of neoplasms in patients who developed sustained leukopenia after taking 6-MP compared with patients treated with 6-MP without sustained leukopenia. METHODS: A database containing the medical records of more than 600 patients treated with 6-MP for IBD at 1 center between 1965 and 2002 was searched. The patients were divided into 2 groups. The study group consisted of patients who developed sustained leukopenia, defined as a white blood cell count of less than 4000 for 20 or more days. The control group patients matched those in the study group for age and sex. There were 3 matched controls for each patient in the study group. RESULTS: Eighteen patients developed sustained leukopenia and, of these, 4 developed neoplasms (22%)-2 leukemias, 1 non-Hodgkin's lymphoma, and 1 breast cancer. Of the 54 patients in the control group, 4 developed neoplasms (7%) (P = .10). Post hoc analysis revealed a statistically significant difference in the number of hematologic malignancies in the group with sustained leukopenia (P = .014). There was no significant difference between the 2 groups for all confounding variables examined. CONCLUSIONS: There was a trend toward a greater number of total malignancies in the sustained leukopenic patients. The data suggest that it is those patients who develop sustained leukopenia while taking 6-MP/azathioprine who are most at risk.

Adult↗

PubMedDate not supplied

Impact of menopausal status on the behavior of pancreatic cystic neoplasms in women.

PURPOSE: Pancreatic cystic neoplasms have predilections for occurring in young women, for containing "ovarian-like" stroma, and for expressing estrogen and progesterone receptors; these factors suggest a potentially important influence of the hormonal milieu on the biology of these tumors. Therefore, we examined the impact of menopausal status on the clinical features of pancreatic cystic neoplasms in women. METHODS: Seventy-six women with pancreatic cystic neoplasms treated at our institution from 1992 to 2003 were classified into 2 groups according to menopausal status based on the U.S. average menopausal age of 51 years: group I (premenopausal, ages 22-50; n = 36) and group II (postmenopausal, ages 51-80; n = 40). Chi-square and the 2-tailed t-tests compared categorical and continuous variables, respectively. Kaplan-Meier survival estimates were determined and compared with the log rank test. RESULTS: Abdominal pain at presentation occurred more commonly among group I than among group II patients (78% vs 48%, p < 0.05). Solid pseudopapillary tumors were more prevalent among group I than among group II patients (21% vs 3%, p = 0.02). CONCLUSIONS: The clinicopathologic features of pancreatic cystic neoplasms in premenopausal women are not significantly different from those in postmenopausal women. Menopausal status should not bias diagnostic and treatment algorithms for women with these neoplasms.

Adult↗

PubMed2006

Histologic grading of noninvasive papillary urothelial neoplasms.

OBJECTIVES: In 1998, a revised system of classifying noninvasive papillary urothelial neoplasms of the urinary bladder was proposed and subsequently formally adopted by the World Health Organization (WHO). The introduction of this new system was justified as being potentially superior on a number of levels to the 1973 WHO classification system that it replaced. Specifically, a new category of neoplasms, designated papillary urothelial neoplasm of low malignant potential (PUNLMP), was considered advantageous for several reasons. The new system was expected to gain widespread acceptance, improve reproducibility of diagnoses among pathologists, and enhance the correlation between urine cytology and tumor histology. We examine the history of the changes in terminology for these lesions, the relative merits of PUNLMP terminology, the extent to which the expectations accompanying the new grading system have been met, and the extent to which the new system has enhanced the management of patients with noninvasive papillary urothelial neoplasms of the bladder. METHODS: A PubMed literature search after the introduction of this new classification was performed and relevant papers reviewed. RESULTS AND CONCLUSIONS: The 2004 WHO classification is a positive initiative in attempting to standardize urothelial tumor grading by expanding and clearly defining the morphologic characteristics of noninvasive papillary urothelial neoplasms. The new terminology used in this system is of questionable validity and utility. Full-genome searches for prognostic and predictive molecular gene expression signatures, GeneChip technology and proteomics techniques, and several new biomarkers and molecular tests may be useful in future grading schemes after their clinical utility is better established.

Carcinoma, Transitional Cell↗

PubMed2025

Clinical, Morphologic, and Molecular Findings in Neurotrophic Tyrosine Receptor Kinase 3 (NTRK3) Fusion Spitz Neoplasms.

Neurotrophic tyrosine receptor kinase 3 (NTRK3) fusions are a relatively common driver of Spitz neoplasms. This subset of Spitz neoplasms may have smaller cells without the typical abundant glassy eosinophilic cytoplasm seen in most Spitz neoplasms. This can make it difficult to recognize them as belonging to the Spitz family and potentially result in misdiagnosis as melanoma. In this study, we assessed the clinical, morphologic, and genomic features of 60 NTRK3 fusion Spitz neoplasms (13 previously reported and 47 new cases) and performed a comprehensive review of the literature. We identified 5 characteristic morphologic patterns: (1) conventional Spitz nevus (SN) or Spitz tumor (ST), (2) spindle cell nevus of Reed, (3) spindle cell tumor of Reed, (4) dysplastic SN, and (5) exclusively spindle cell variant of SN/ST. The most common fusion partners were MYO5A and ETV6. DNA copy number changes were infrequent (18% of cases), with an average of 1 copy number variant per case. Among 54 cases tested for a TERT promoter mutation, all were negative. One case had a homozygous deletion of 9p21. The majority of cases were diagnosed as SN or Reed nevi (n = 37), rather than ST or Reed tumor (n = 23), and none were diagnosed as Spitz melanoma. Among the 30 patients with outcome data, none experienced recurrence following excision (mean follow-up time was 15 months). NTRK3 fusions can produce morphologic variants of Spitz neoplasms that may be difficult to recognize as belonging to the Spitz family. Familiarity with these morphologic patterns can facilitate identification of the NTRK3 fusion, optimizing classification and distinction from melanoma.

Humans↗

PubMed2026

An Integrative Morphological and Genomic Analysis With a Refined Fluorescence In Situ Hybridization (FISH) Threshold and Novel Kinase Fusions in a Large Asian Cohort of Spitzoid Neoplasms.

Differentiating atypical Spitz tumors (ASTs) from true Spitz melanomas (SMs) and conventional melanomas with spitzoid features (MSFs) remains a formidable diagnostic challenge. Because current molecular epidemiological data are overwhelmingly derived from Caucasian cohorts, the genomic landscape of Asian populations remains largely unexplored. To elucidate the molecular progression landscape and refine the diagnostic criteria, we performed a comprehensive multimodal analysis-integrating histomorphology, immunohistochemistry, multiprobe fluorescence in situ hybridization (FISH), and targeted RNA/DNA-based next-generation sequencing (NGS)-on a cohort of 140 spitzoid neoplasms. This cohort, comprising 126 ASTs, 8 SMs, and 6 MSFs, represents the largest Asian cohort to date. Malignant phenotype strongly correlated with lesional asymmetry, deep atypical mitoses, a sheet-like growth pattern, diffuse preferentially expressed antigen of melanoma positivity, and significant loss of p16 expression (64.3% in SM/MSF vs 9.5% in ASTs; P < .0001). Building upon the established melanoma FISH criteria, we optimized a prognostic threshold of ≥2 FISH abnormalities specifically tailored for spitzoid neoplasms. We demonstrated that isolated single chromosomal aberrations (particularly MYB loss) are relatively stable events that are frequent in indolent ASTs, whereas our refined ≥2 threshold yielded 100% sensitivity and 92.5% specificity for predicting regional lymph node metastasis/local recurrence. Molecularly, NGS identified mutually exclusive initiating driver alterations (comprising kinase fusions and HRAS mutations) in 89.9% of true Spitz neoplasms, a remarkably high prevalence suggesting a distinct genetic background in Asian populations. We also characterized 5 entirely novel kinase fusions (ZNF24::ROS1, PCBP1::ROS1, NUMA1::RET, CBWD1::ALK, and TPR::NTRK1). Furthermore, NGS definitively segregated true Spitz neoplasms from morphological mimics (MSF), which lacked fusions and were driven by canonical genomic alterations of the conventional melanoma pathway. Integrating these genomic landscapes validated a stepwise progression model. Although isolated kinase fusions drove indolent ASTs, malignant SM invariably harbored concurrent pathogenic secondary alterations, demonstrating a profound reliance on CDKN2A/B, TP53, and CDK4 aberrations. Ultimately, we propose an integrated diagnostic algorithm combining morphological evaluation, the refined FISH threshold, and comprehensive NGS profiling, providing a precise, evidence-based framework for pathway classification and clinical management of spitzoid neoplasms.

fluorescence in situ hybridization↗

PubMed2004

Diagnostic imaging of cystic pancreatic neoplasms.

Cystic pancreatic neoplasms are being diagnosed with growing frequency due to improving imaging technologies and increasing clinician awareness. Distinguishing cystic neoplasms from pseudocysts and discriminating among the various cystic neoplasms is essential to appropriate management. The backbone of diagnosis of these tumors continues to be cross-sectional imaging by CT and MRI. Despite refinements in technology and significant progress in characterizing these lesions, the overall accuracy of CT and MR is limited. EUS, especially as means of FNA, will have an increasing role in the evaluation of selected cases as experience grows. No radiologic investigation can reliably distinguish cystic neoplasms from pseudocysts nor differentiate among cystic neoplasms in all cases. For uncertain lesions, surgeons should favor either careful observation with serial imaging or surgical resection.

Cystadenoma↗

PubMed2006

Intraductal papillary mucinous neoplasms of the pancreas: a surgical perspective.

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas represent a relatively "new", but increasingly recognized entity. The emergence of this entity is due primarily to the widespread use of modern imaging methods, but also to a heightened awareness of physicians regarding this cystic neoplasm of the pancreas. No signs or symptoms are pathognomonic of IPMNs, but frequently, patients have a pancreatitis-like abdominal pain. Fully one-third of patients with IPMN are asymptomatic at the time of diagnosis. Cross-sectional imaging (ultrasonography, computed tomography, magnetic resonance cholangiopancreatography), endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography are the diagnostic and staging methods of choice in the evaluation of patients with IPMNs. IPMNs show a wide spectrum of histologic changes, ranging from adenoma to invasive neoplasm, even within the same neoplasm, suggesting a "field defect" predisposing major segments or even the entire ductal epithelium to the development of IPMN. Fine-needle aspiration/cytology and/or analysis of the cystic fluid may be useful diagnostic tools; however, these examinations are associated with high false-negative rates. Complete surgical resection is the therapeutic method of choice. The extent and type of pancreatectomy remain somewhat controversial but should be based on morphologic changes of the pancreas. Even the role of adjuvant therapy remains unclear; however, being "duct-derived" neoplasms of potential malignant character, some form of adjuvant chemo- or ratio-therapy seems indicated in the presence of invasive disease, despite a "curative" resection. In the absence of invasive disease, prognosis after R0 resection is highly favorable with recurrences of 5-10%. However, invasive IPMNs behave quite similar to ductal adenocarcinoma of the pancreas when analyzed stage-by-stage, with a slightly better prognosis; however, even after an R0 resection, recurrence is common.

Carcinoma, Pancreatic Ductal↗

PubMed2003

Expression of B-lymphocyte-associated transcription factors in human T-cell neoplasms.

In this study we have investigated the expression of three B-cell-associated transcription factors in normal lymphoid tissue and in T-cell neoplasms (three cell lines, and more than 50 biopsy samples). Nuclear OCT-1 immunoreactivity was seen in normal B cells, in many extrafollicular T cells, and in a heterogeneous pattern (ranging in intensity from weak to moderate) in most T-cell neoplasms. OCT-2 immunostaining was primarily restricted in normal lymphoid tissue to B cells, and was absent from most T-cell neoplasms. In contrast, immunostaining for BOB-1/OCA-B--essentially restricted to B cells in normal lymphoid tissue, with the exception of activated T-lymphocytes--was seen in all of the T-cell lines tested and the majority of the tumor cells in all categories of T-cell lymphoma. Thus labeling for each of these three B-cell-associated transcription factors can be seen to varying degrees in T-cell neoplasms. However, the high frequency of BOB-1 expression in T-cell neoplasms, in contrast to its absence from resting peripheral T cells, suggests that its expression might be a prerequisite for neoplastic transformation, and prompts a search for the transcriptional target(s) of this factor in T cells.

Antigens, Neoplasm↗

PubMed2004

Environmental exposure to cooking oil fumes and cervical intraepithelial neoplasm.

The fumes from cooking oil, similar to cigarette smoke, contain numerous carcinogens such as polycyclic aromatic hydrocarbons, aromatic amines, nitro-polycyclic aromatic hydrocarbons, etc. In this study, we examined the association between exposure to cooking oil fumes and the risk of cervical intraepithelial neoplasm. The study population in this nested case-control study consisted of women above the age of 19 years living in Chia-Yi County, located in the southwestern Taiwan, who had received pap smear screening between October, 1999, and December, 2000 (n=32,466). The potential cases were women having lesions greater than cervical intraepithelium neoplasm II (> or =CIN2) reconfirmed by cervical biopsy (n=116). The potential controls (case: control=1:2) were age-matched (+/-2 years) and residence-matched women who had normal pap smears within 6 months of the cases. In total, 100 cases and 197 controls were completely interviewed by public health nurses about cooking methods, ventilation, and other potential risk factors. Women who cooked at home in a kitchen (n=269) without the presence of a fume extractor at least once a week between the ages of 20 and 40 had a 2.29 times higher risk [95% confidence interval (CI)=1.08-4.87] of developing cervical intraepithelial neoplasm than those who did not cook once a week in such a kitchen during the same age span, after adjusting for other potential confounders. This finding was further strengthened by the finding that women who did not use the fume extractors had a 2.47 times higher risk (95% CI=1.15-5.32) of developing cervical intraepithelial neoplasm than women who cooked in kitchens with fume extractors that were always switched on while cooking. We also found a joint protective effect of fume extractor use among women older than 40 years (n=202) if they used the extractors during both age spans of their lives, ages 20-40 and >40 years. Comparing our findings on women more than 40 years old who used fume extractors during both periods, we found a 2.05-fold greater risk (95% CI=0.86-4.86) for those who used exhaust fans during only one of the two age spans and a 3.46-fold greater risk in those who had not used an exhaust fan for either period (95% CI=1.08-11.10) (trend test, P=0.02). While exposure to cooking oil fumes may cause cervical intraepithelial neoplasm, women can be protected from this risk by always cooking in kitchens equipped with fume extractors and by keeping them on while cooking.

Adult↗