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PubMed2003

Cervical carcinoma and pregnancy.

Abortion and conization of the cervix is the treatment of choice for patients with preinvasive cervical carcinoma combined with first-term pregnancy. With the second and third term, the pregnancy is led to delivery and a secondary examination is carried out. In case of preienvasive carcinoma only conization of the cervix is performed. In late-term pregnancy the surgical operation starts with a cesarean section. A combination of cervical carcinoma and pregnancy was observed in 31 (44%) of 6,890 patients admitted to the Gynecological Clinic of the National Cancer Center from 1964-2001. Of 1,911 patients with radical hysterectomy (Stage I--58.4%, Stage II--21.8%, Stage III--20%) a combination of cervical carcinoma and pregnancy was diagnosed in 31 women [Stage I--23 (74.2%), Stage II--4 (12.9%), Stage III--4 (12.9%)]; 93.5% of the patients had a first or second term pregnancy. Five-year survival of the patients with surgery only was 83.3%, while with combined therapy--60%. Twenty-nine percent of the patients were 30 and younger. Pregnancy contributed to early manifestation of cervical cancer and did not favor the aggression of malignant tumor growth. The five-year survival rate of patients without staging and those combined with pregnancy was 72.7%; five-year survival rate of patients with early pregnancy was worse compared to those with second or third term pregnancies. Pregnancy is not a contraindication for performance of radical hysterectomy.

Adult↗
PubMed1992

[Study on the management of dysplasia of the uterine cervix].

In this study, we investigated problems on the management of dysplasia on the basis of our clinical data obtained in the past ten years. In addition, we also examined the biological significance of protooncogene expression and human papilloma virus (HPV) infection in the initiation and promotion of dysplasia. Among 540 cases of dysplasia we have managed, 48.8% of the cases of mild, moderate and severe dysplasia which we followed up for more than 6 months regressed, and 24.1% of the cases progressed. The cure rate for laser therapy based on the follow up for 6 to 96 months was significantly high (97.9%) in 342 cases treated by the cone method, and low (89.5%) in 38 cases treated by the vaporization method. Preoperative histological findings confirmed 60.5% of postoperative findings, and several early cervical carcinomas were found in preoperative cases of dysplasia by laser conization. Among 28 cases (8.2%) of incomplete excision, 24 cases (85.7%) regressed spontaneously. On the other hand, the positive rate of immunostaining of epidermal growth factor receptor (EGF-R) and c-myc oncogene product (c-myc protein) increased from mild or moderate to severe dysplasia, and the positive rate for EGF-R was significantly high (80.0%) in the progressive group. The positive rate for HPV genome was quite low (16.0%) in dysplasia. Among them, EGF-R was most associated with the prognosis of dysplasia. These results suggest that laser conization should be performed for many cases of dysplasia because of the preoperative possibility of the existence of early cancer, and EGF-R is also useful in determining the necessity for therapy for dysplasia.

Adult↗
PubMed2004

Eradication of HPV post-surgical treatments, its correlation with specific types, types of surgery and the physical status.

Low-risk human papillomaviruses (HPVs) will be completely eradicated as long as most visible lesions are treated. However, it is uncertain whether this is also the case for high-risk HPVs that are capable of causing cervical cancer. Many recent studies have demonstrated a high incidence of HPV persistence during post-conization or loop electrosurgical excision (LEEP) due to high-grade cervical intraepithelial neoplasia (CIN). In this report, we correlated the post-operative HPV status with pre-operative HPV type, types of surgery and HPV's physical status. Post-operative HPV E6 amplification by nested PCR was carried out for 157 female patients with positive pre-operative HPV. They underwent LEEPs, therapeutic laser conizations, and simple or radical hysterectomies. We found that high-risk types of HPVs were eradicated in 26.4% (42/159) of patients after extirpation of the lesions. The clearance rate of HPVs increased to 39.2% (40/102), excluding patients with other high-risk (OHR) kinds of type 31, 52b and 58, since OHR persisted after almost all surgeries. Eradication of HPV after radical hysterectomies are highly expected for patients with invasive cancer (70.0%, when excluding OHR), while more than half of them with CIN continue to carry pre-operative types of HPV or some different types from before treatment. Type 33 is most frequently persistent among types 16, 18 and 33. Persistent high-risk HPVs increase the risk for recurrence of post-surgical treatments of CIN, but the incidence is not high as long as the lesion is completely removed.

Carcinoma in Situ↗
PubMed1992

Reasons for inappropriate simple hysterectomy in the presence of invasive cancer of the cervix.

We evaluated 148 women who had had simple hysterectomy in the presence of invasive cervical cancer between the years 1973-1987. Two had microinvasive squamous carcinoma for which hysterectomy was not a planned procedure. The remaining 146 women all had either adenocarcinoma or squamous carcinoma exhibiting greater than 3 mm of stromal invasion of lymph-vascular space involvement. Medical records were reviewed retrospectively to determine the reasons for hysterectomy. Causes of inappropriate hysterectomy were as follows: inadequate evaluation of an abnormal Papanicolaou smear or cervical biopsy (21%), failure to perform an indicated conization (12%), deliberate hysterectomy for grossly invasive cancer of the cervix (11%), lack of preoperative Papanicolaou smear (7%), conization margins positive or not evaluated (7%), misreading of pathology results (5%), emergent operation because of bleeding (3%), failure to check cytology preoperatively (1.5%), and failure to biopsy a gross cervical lesion (1.5%). The remaining 31% of cases had normal or inflammatory Papanicolaou smears and negative cervical examinations. Although 93% of this latter group complained of abnormal bleeding, 78% did not have endocervical or endometrial sampling preoperatively. Despite the increasing emphasis on cervical cancer screening, the number of referrals following hysterectomy performed in the presence of cervical carcinoma is not decreasing. Most cases could be avoided by careful adherence to well-established guidelines for cervical cancer detection.

Adenocarcinoma↗
PubMed2004

Correlation of immunochemical detection of HPV L1 capsid protein in pap smears with regression of high-risk HPV positive mild/moderate dysplasia.

OBJECTIVE: To immunostain Pap smears of high-risk (hr) HPV DNA-positive early squamous lesions for detecting HPV L1 protein. STUDY DESIGN: Routinely stained archival slides from 84 mild and moderate hrHPV DNA-positive dysplasias were immunostained using a panreactive HPV L1 antibody. Follow-up smears were taken from women with remission for a mean period of 22.8 months (range, 6-46). Conization was done in patients with persistence or progression (3 and 48 patients, respectively) after a mean time of 12 months (range, 9-48). RESULTS: Twenty-nine of 84 smears (34.5%) had positively stained squamous epithelial cell nuclei. In 9 of 29 (31%) women progressive disease occurred (2 cervical intraepithelial neoplasia [CIN] 2 and 7 CIN 3 lesions on conization) 20 (69%) had remission. Of the 55 L1-negative cases, 13 (23.6%) had remission, 42 (76.4%) progressed (3 CIN 2, 38 CIN 3, 1 microinvasive carcinoma). The difference in follow-up between L1 positive and negative cases was statistically significant (chi2 test, p< or =0.001). CONCLUSION: Low and moderate dysplastic squamous lesions without immunochemically detectable HPV L1 protein are significantly more likely to progress than are L1-positive cases. Immunochemical L1 capsid detection in routine Pap smears thus offers prognostic information about early dysplastic lesions.

Adult↗
PubMedDate not supplied

Cytologic study of the tissue repair cells of the uterine cervix. With special reference to their origin.

In order to characterize tissue repair cells (TR) of the uterine cervix and clarify their origin, exfoliated cells obtained after laser conization for early cervical lesions were examined. One specimen was first examined by Papanicolaou staining and then examined for epithelial membrane antigen (EMA) and vimentin by immunocytochemical staining, using a restaining method. The other specimen was observed by phosphotungstic acid-hematoxylin (PTAH) staining. Morphologic findings on TR were investigated together with the histologic findings on the wound healing process. TR were classified morphologically into three groups: stromal (STR), epithelial (ETR) and of unknown origin (UTR). Validity of this classification was confirmed by the findings of immunocytochemical staining with EMA and vimentin. These cells appeared one to eight weeks after laser conization. TR with relatively large nuclei, or atypical TR (ATR), appeared when each type of TR was most plentiful, at two to five weeks. Regarding the origins of each TR, cytologic and histologic findings could be considered to offer evidence that ETR originated with hyperplasia of immature cells of the squamous epithelium or reserve cells below the columnar epithelium. The presence of myofibrils in cytoplasm, demonstrated by PTAH staining for STR and some UTR, strongly suggested the possibility that these cells were myofibroblasts in granulation tissue.

Carcinoma in Situ↗
PubMed1991

[Organ-preserving operations on patients with microinvasive carcinoma of the cervix uteri].

Organ-preserving operative treatment was performed on 29 women with microinvasive operative microinvasive carcinoma of the uterine cervix at lal clinical stages. After conization of the uterine cervix the patients were observed actively by cytology, colposcopy and, when it was necessary, a colposcopic-directed biopsy was made during a period of 3-98 as there was no relapse of the disease in neither case. The authors think that it is possible to perform conization in young women with minimal stromal invasion up to 1000 microns as their reproductive function is preserved without any risk for occurrence of a relapse.

Adult↗
PubMed1991

[The conservative treatment of carcinoma in situ of the cervix uteri by the local application of 5-fluorouracil].

Local treatment with 5% of 5-Fluorouracil (5-Fu) in the form of globules was carried out on 37 patients with carcinoma in situ of the uterine cervix, established histologically, as the application was performed once daily for a period of 14-20 days. There was a complete correlation between the cytological investigation after the conservative treatment and the histological examination of the operative material from the conization, which was made within 1-2 weeks after local application of 5-Fu. It could be possible to use cytology for objective determination of the therapeutic effect as well as a possible usage of colposcopic-directed biopsy. The conservative treatment with 5-Fu should be the first stage of treatment of these patients, but in the absence of therapeutic effect conization of the uterine cervix should be made, which reduces the risk of spontaneous abortion. The conservative treatment with local application of 5% of 5-Fu is recommended in young women, with not large lesions of carcinoma in situ of the uterine cervix and still at their reproductive age.

Administration, Topical↗
PubMed1991

The histologic reliability of laser cone biopsy of the cervix.

Laser conization of the cervix has been advocated as the technique of choice for the treatment of cervical intraepithelial neoplasia (CIN) in preference to ablative techniques, because it provides a specimen for histologic diagnosis while retaining the advantages of an outpatient procedure with minimal short- and long-term morbidity. To determine whether specimens so obtained are adequate for reliable histologic diagnosis, we reviewed 77 laser conizations performed for lesions confirmed to contain CIN in a colposcopically directed biopsy and satisfying the criteria for local ablation and scored the cones for the presence of epithelial denudation and laser coagulation artifact that interfered with the diagnosis of CIN or the assessment of the margins of excision. Thirty specimens (39%) were negative for CIN. Twenty-eight (36%) showed extensive epithelial denudation, ten (13%) contained coagulation artifact that made recognition of CIN extremely difficult or impossible, and in 11 (14%), assessment of margins was extremely difficult or impossible because of laser coagulation artifact. We conclude that these difficulties with the histologic interpretation of laser cone specimens make it an unsuitable excisional technique when reliable histologic diagnosis of cervical lesions is required.

Adult↗
PubMed1990

The management and treatment of an abnormal Pap smear.

Table 2 summarizes the management of the abnormal Pap smear. Management of dysplasia in this institution is aggressive--as destructive therapy of mild dysplasia is advised, opposed to watching the patient and treating only if the disease persists. The rationale for this is the 33% to 45% failure rate for follow-up appointments in the primarily inner-city population served. The key to follow-up is to repeat cervical cytology in all patients treated, even those treated with hysterectomy, every three months until two consecutive normal smears are obtained. At that time, surveillance and intervals may be modified, but screening should continue at least annually. The mortality rate of carcinoma of the cervix has dropped precipitously during the last 40 years, in part, from simple screening of the cervix with the Papanicolaou smear. The effort to treat premalignant changes has been rewarded. The use of the colposcope and destructive forms of therapy have allowed successful treatment of patients with less morbidity and mortality than the immediate reliance on cervical conization. Remember, conization is still indicated and prudent in selected patients. Following these guidelines may contribute to the downward trend.

Female↗
PubMed1990

Colposcopy as a method of management strategy in CIN and microinvasive cancer.

During nearly 40 years of using colposcopy, an original management strategy in CIN and early cervical cancer was developed and confirmed in 2 study groups of cervical lesions containing respectively 1228 and 6001 cases. This approach is based on colposcopy as the main method in early detection of CIN and cancer, with supplementary cytology in necessary cases, and on a coloposcopic-histological staging of these lesions for treatment qualification. Colposcopy alone is a fairly adequate method for diagnosis of 60% of examined cases, and coloscopy with directed biopsy in the next 20% of colposcopically highly suspect findings. Only in the remaining 20% of colposcopically less suspect findings and in the cases of "unsatisfactory colposcopy", supplementary was cytology required. In this study colposcopy findings connected with histological evaluation of the specimens provided a basic way for determining the advancement of processes and the selection method for the appropriate type and extent of treatment. CIN 1 and 2 and small focuses of CIN 3 including CIS entirely visible on the ectocervix, in childless young women were treated by cryosurgery. In all remaining cases of CIN 3, the basic therapeutic method was cold-knife conization. In exceptional cases simple hysterectomy can be a more adequate treatment. Depending on our colposcopic-histological staging, in Stage IA1--conization, whereas in Stage IA2--a moderately extended hysterectomy should be optionally performed. The management strategy introduced is an economical, fully effective and quick way of detection and selection of the method for the treatment of CIN and early cervical cancer.

Biopsy↗
PubMed1989

The rationale for treatment of cervical lesions (HPV +/- CIN).

In the laser surgery service of the 2nd Department of the Obstetric and Gynecologic Clinic of the University of Rome "La Sapienza", from October 1984 to March 1987, we have treated with CO2 laser surgery (vaporization and conization) 228 patients affected with cervical lesions (HPV +/- CIN). The choice of the treatment must be based on two parameters: site and extension of the lesion. The results we have obtained with CO2 laser vaporization (201 cases) are most satisfactory (92%); patients have been followed-up from two to twenty-six months. As far as the CO2 laser conization is concerned (27 cases), patients were followed-up from two to twenty-two months and the percentage of success was 96.1%. The Authors evaluated also the side effects of the CO2 laser surgery.

Adult↗
PubMed1989

Necessity for endocervical curettage in elderly women undergoing colposcopy.

A retrospective study of 164 women aged 45 and older undergoing colposcopy for abnormal Papanicolaou smears showed that 49% had adequate colposcopy and 51%, inadequate colposcopy. Of those with adequate colposcopy, 23% had positive endocervical curettage (ECC). That finding required conization, which detected one case of microinvasive and two of invasive cervical carcinoma. Of those with inadequate colposcopy, 64% had positive ECC. All patients with inadequate colposcopy underwent conization, which detected 4 cases of microinvasive and 11 of invasive carcinoma. Therefore, women with inadequate colposcopy had a higher risk of invasive disease. ECC is a necessary step in the colposcopic evaluation of elderly women.

Age Factors↗
PubMed1989

Microcolposcopy vs. cone histology in evaluation of the endocervix in women with inadequate colposcopy or positive endocervical curettage.

Microcolposcopy (MC) can magnify cervical and endocervical surface cytology from 1:1 to 1:150. MC examination of the exocervix has been found to be equivalent to colposcopy. We compared MC to cone histology in evaluating the endocervix in women with inadequate colposcopy or positive endocervical curettage (ECC). Thirty-one patients were studied. All had standard colposcopic examinations that were deemed inadequate or resulted in positive ECC. MC was then performed and followed by cervical conization. Histologic specimens were obtained from serial sections of the surgical specimen. All 31 patients had adequate MC examinations. MC had a positive predictive value of 87% in evaluation of the endocervix as compared to cone histology specimens. Sensitivity and specificity were 99% and 70%, respectively. MC had a sensitivity of 92% in identifying the cervical segment with the worst histologic diagnosis. MC can evaluate the endocervix in patients with inadequate colposcopy or positive ECC. Biopsy of the worst histologic region in those patients can be guided by MC examination; thus, conization of the cervix can be avoided.

Adult↗
PubMed1988

Endocervical curettage in the evaluation of cervical disease in patients with adequate colposcopy.

The purpose of this study was to investigate the importance of endocervical curettage in the outpatient management of women with cervical neoplasia. From 1975-1985, 1500 patients were evaluated in our colposcopy clinic. Endocervical curettage was done routinely, even when colposcopy was adequate; 122 patients with abnormal cytology, an adequate colposcopic examination, and dysplastic epithelium in the endocervical curettings underwent conization. Of these 122 patients, 111 (91%) had cervical intraepithelial neoplasia on cone, one had microinvasion, and none had invasive cancer. In this group, there were 11 patients with abnormal cytology, normal coloposcopically directed biopsies of the ectocervix, and positive endocervical curettages. Nine of these 11 had dysplasia confirmed by conization, which would have been missed if endocervical curettage had not been performed.

Biopsy↗
PubMed1988

[Reduced operation for cervical carcinoma and its evaluation].

Cervical carcinoma is usually treated by extensive total hysterectomy such as Okabayashi's procedure. However, since the introduction of the criteria for classification of stage Ia lesions in 1978 by the Registration Committee for Cervical Carcinoma of the Japan Association of Obstetrics and Gynecology, surgical procedures have been categorized in greater detail, and reduced operations have begun to be performed. Generally, simple hysterectomy is performed for stage 0 cervical carcinoma, and semi-extensive hysterectomy is indicated for stage Ia lesions. In this study, reduced operations were evaluated in 254 patients with stage 0 and 288 with stage Ia cervical carcinoma selected from 1,412 patients with cervical carcinoma treated at our department between 1976 and 1985. The time required for the operation was 90.8 +/- 34.8 min for simple, 126.7 +/- 36.5 min for semi-extensive, and 173.5 +/- 42.5 min for extensive hysterectomy. The volume of bleeding was 274.5 +/- 257.7 ml for simple, 545.4 +/- 758.2 ml for semi-extensive, and 805.7 +/- 441.6 ml for extensive hysterectomy. The frequency of blood transfusion increased with the increase in the extent of surgery, being 9.0, 22.9, and 61.8% for the respective operations. The incidence of postoperative complications (cystoplegia, renal disorders, fistula of the urinary tract, ileus and hepatitis) also increased to 12.4% for semi-extensive and 44.8% for extensive hysterectomy. Simple hysterectomy was sufficient for stage 0 lesions, and side effects associated with this operation were infrequent and mild. Curative conization was performed for 14 patients who expressed a desire to have babies, and no recurrence has been observed to date. Semi-extensive hysterectomy was performed in 77% of stage Ia patients, and extensive and simple operations were performed in 8.0% and 10.4%, respectively. Close histological evaluation and postoperative care were carried out, particularly for patients who underwent simple hysterectomy. All these patients are currently alive without signs of recurrence. Two patients received only curative conization due to their strong desire to have babies and are currently being followed up. Both of these patients showed small degrees of interstitial invasion of less than 2mm.

Adult↗
PubMed1988

The colposcopy and the cone biopsy in the diagnosis, treatment and follow-up of 81 cases of cervical intraepithelial neoplasia.

A conization was performed on 81 patients with histological diagnosis of cervical intraepitelial neoplasia (CIN), whom and previously a rigorous colposcopic examination. 64 patients were younger than 35 years. The previous strict colposcopic examination determined that in none of the cases were the surgical margins of the cone biopsy affected: In 26 cases there was no correlation between the previous biopsy and the histological diagnosis of the cone biopsy. The latter was--higher in degree in 9 cases and, in addition to this, in the 23 histerectomies that were performed after the conization, 7 surgical specimens showed CIN in their histological study. The non-involved surgical margins--that could be obtained in those cases with a careful previous colposcopy,--can not guarantee the exeresis of all the CIN zones. The biopsy of an atypical zone, in a colposcopic extensive lesion, cannot be representative of the whole lesion. In the follow-up--5 years maximum and 1 year minimum--3 relapses had appeared and 9 pregnancies had been diagnosed, that had not showed an increase in the number of premature labours, nor in the cesareas-rate.

Adolescent↗
PubMed1987

[Optimization of the treatment of patients with malignant polyps of the cervix uteri].

The study was concerned with an analysis of 5-year results of treatment of Ca in situ (II) and invasive cancer (53 patients) arising in cervical polyps. Recurrences were observed in 15.1% of cases undergoing sparing procedures. Conization assures an optimal removal of tissue for Ca in situ. Reproductive patients with invasive carcinoma should also undergo conization. Extirpation of the uterus with appendages should be carried out in menopausal patients and cases of concomitant uterine pathology.

Cervix Uteri↗