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PubMed1990

[Preinvasive lesions and their treatment].

Pre-invasive lesions of the uterine cervix are histological abnormalities corresponding to dysplasias and also called cervical intraepithelial neoplasias (CIN). These lesions are more or less severe, but they do not cross the basal membrane. The histological diagnosis rests on disorders of maturation and differentiation and on the presence of nuclear abnormalities and abnormal mitotic activity. No cytological, histological or colposcopic criteria are available to assess the evolutive potential of these lesions. A CIN III lesion has a 60-70 p. 100 risk of becoming a cancer. One-third of pure condylomas are thought to be due to an oncogenic virus. The diagnosis of CIN rests on colposcopy, cytology and histology. Depending on the severity of the lesion, treatment consists of local destruction by cryotherapy, electrocoagulation or laser vaporization; conization may also be used. Laser vaporization is not contra-indicated in CIN III. Treating cervical dysplasias is the best way of preventing cancer.

Adult↗
PubMed1990

[Colposcopic, cyto- and histologic signs of papilloma virus infection in precancerous and early stages of cervix cancer].

Basis of present study are examinations in 100 women with colposcopic and/or cytologic abnormalities suspect of preinvasive or early invasive carcinoma of the uterine cervix. We found 76 colposcopic abnormal findings in 100 women examined. In 36 women there was a colposcopic suspicion on a papilloma virus infection, in 32 cases combined with abnormal colposcopic findings. All 100 patients had cytologic smears group III and/or IV according to Papanicolaou. In 71 women cytologic signs of a papilloma virus infection was detected in the cervical smears. We found histologic signs of a papilloma virus infection in 69 cases in the specimen of biopsy, conization or hysterectomy (5 times condylomata acuminata, 53 times flat condylomata and 11 times inverted condylomata). Preinvasive respectively invasive and papillomavirus caused lesions of the cervix are coexisting in 59 cases. Our examination demonstrates that also in GDR in about 70 per cent of the precancerous or invasive cervical lesions signs of an infection with human papilloma viruses are present histologically and/or cytologically.

Biopsy↗
PubMed1990

Immunocytochemical detection of S-phase cells in normal and neoplastic cervical epithelium by anti-BrdU monoclonal antibody.

The use of a monoclonal antibody (MAb) to bromodeoxyuridine (BrdU) to identify S-phase cells was examined in 30 cervical biopsy specimens and 30 cervical smears from 18 patients with cervical neoplasia. Each patient received a local injection of 300 mg to 500 mg of BrdU into the cervix, at the time of endocervical laser conization, to label S-phase cells in neoplastic tissue. Labeled cells in normal and neoplastic tissues were detected in biopsy specimens or smears by indirect immunoperoxidase staining using the anti-BrdU MAb. The BrdU labeling index (BrdU LI, defined as the percentage of labeled cells in relation to the total number of cells counted) was calculated for all specimens. The level of BrdU-positive cells was 5.1% in normal cervical squamous epithelium, 12.3% in slight-to-moderate dysplasia and 21.2% in severe dysplasia to carcinoma in situ. In tissues without any dysplasia, BrdU-positive cells were mainly confined to the parabasal layer of the epithelium. In tissues showing slight-to-moderate dysplasia, BrdU-positive cells were mainly found in the lower half of the epithelium. BrdU-positive cells in severe dysplasia to carcinoma in situ were distributed throughout the full thickness of the epithelium. In addition, the few samples of squamous metaplasia and reserve cell hyperplasia encountered in this study exhibited a higher BrdU LI than did normal squamous epithelium. In cytologic specimens, BrdU-positive cells were found only in the cases of carcinoma in situ and in two cases containing normal cervical columnar epithelial cells. These results suggest that the immunocytochemical detection of BrdU by MAb staining may be useful for evaluating the proliferative activity in normal and neoplastic cervical epithelium.

Antibodies, Monoclonal↗
PubMed1990

Assessment of endocervical curettage in colposcopy.

Colposcopy has become an accepted diagnostic procedure in the management of patients with abnormal cervical cytology. To assess the value of the endocervical curettage in colposcopy, a retrospective review of 125 cases who had the procedure done during the 20-month period (January 1986-August 1988) was carried out. The ECC were positive in 3 out of 57 (5.3%) patients with satisfactory examination and 24 out of 68 (35.3%) patients with unsatisfactory examination. In all 27 cases, there was insufficient tissue to make a diagnosis of invasive carcinoma. Of the 125 patients studied seventy-two (29 in the satisfactory group and 43 in the unsatisfactory group) underwent conization and/or hysterectomy. Endocervical curettage did not eliminate the need for cone biopsy in all cases of unsatisfactory colposcopy. The tissue diagnosis on ECC did not increase the diagnostic accuracy derived from the colposcopic directed biopsies in either group. There were 20 cases of invasive carcinoma (13 MIC, 7 invasive) in this study, the ECC were positive in 9. We concluded that the ECC has limited value in colposcopy.

Colposcopy↗
PubMed1988

[Morphologic changes in the epithelium of the uterine cervix in long-term administration of the 19-norsteroid-containing oral hormonal contraceptives Non-Ovlon and gravistat].

The objective of this study was to give a contribution to the question whether there are changes in the uterine cervix after longterm application of 19-norsteroid-containing contraceptives Non-Ovlon and Gravistat relating to carcinogenesis. Histologic examinations have been performed on 19,760 cervical sections obtained from 280 women aged 25-45 years. 141 women had taken Non-Ovlon or Gravistat for at least 5 years, 139 women had never taken hormonal contraceptives. The cervices were equally obtained from surgical- and conization material from 1976 to 1982. The evaluation was made according to 108 single characteristics of quality, semiquantity and topography. These characteristics were evaluated by electronic data processing. Our investigations revealed no morphological evidence for a relation between longterm application of Non-Ovlon or Gravistat and the occurrence of squamous epithelial or adenomatous cervical neoplasias.

Adult↗
PubMed1989

[Diagnosis and treatment of dysplasia of the uterine cervix].

The accuracy of diagnosis and the results of treatment for dysplasia of the uterine cervix are analyzed. Three hundred and thirty-seven cases of mild, 231 of moderate and 200 of severe dysplasias have been treated at Kitasato University Hospital. By cytology 40.4% of mild, 74.5% of moderate and 89.0% of severe dysplasias were judged suspicious or positive, and the accurate cytopathological detection rate was 19.8%, 16.1% and 60.1%, respectively. Abnormal colposcopic findings such as M, P and W were observed in more than 95% of cases with dysplasia. The area of abnormal findings tends to be large as the lesion becomes more severe. Mild dysplasia progressed to cervical cancer in 1.5%, moderate dysplasia in 2.4% and severe dysplasia in 9.4%. Conservative therapy by laser vaporization or conization was used for 31 mild, 96 moderate and 114 severe dysplasias. The cure rate of each dysplasia was 100%, and pregnancy following laser therapy was encountered in 28 cases without abnormal course. It is concluded that colposcopy is more useful in diagnosis of mild and moderate dysplasia than cytology, and conservative laser treatment is an effective method for dysplasia.

Adult↗
PubMed1989

[Intraepithelial neoplasm of the uterine cervix and angiogenesis: morphologic study].

Thirty uterine cervix specimens sampled following conization or total hysterectomy were studied using histology, histoenzymology (vessel phosphatase alkaline activity), and immunohistochemistry (demonstration of laminin and type IV collagen in epithelium and vessel basement membranes). Pathologic conditions included dystrophia, moderate dysplasia, severe dysplasia, and intraepithelial carcinoma. Results were compared to findings in a control group. We found that the severity of vascular abnormalities correlated positively with the severity of histologic epithelial lesions; this finding is consistent with colposcopic results. Anarchic angiogenesis with large, moniliform, tortuous vessels was seen in severe dysplasias and carcinomas. The vascular anomalies seem to precede the development of histologic lesions in some instances. Histogenesis of the abnormal vessels may involve production of an angiogenic factor by the cancerized epithelia.

Cervix Uteri↗
PubMed1989

Post-cone biopsy traumatic neuroma of the uterine cervix.

Traumatic neuroma rarely occurs in the female genital tract and is probably the rarest complication of cone biopsy. A traumatic neuroma of the cervix found incidentally in the hysterectomy specimen of a 40-year-old woman who had previous conization for cervical squamous intraepithelial neoplasia grade 3 is presented. Significance of the finding is described.

Adult↗
PubMed1987

[Morphologic evaluation and clinical significance of papillomavirus (HPV)-associated changes in the portio vaginalis uteri].

HPV-induced changes in the portio vaginalis uteri can and have lead to misinterpretations since they frequently occur in combination with or resemble precancerous or cancerous changes. The morphological peculiarities and growth patterns of koilocytotic changes in the portio vaginalis uteri are described. Among 684 conizations performed, 169 (24.7%) were found to have features of an HPV-infection. Of these, 75.7% also had preneoplastic or neoplastic changes. Review of the cytological findings revealed that in 66.7% of the cases with histologically verified koilocytosis a false positive finding of malignancy had been recorded.

Adult↗
PubMed1985

Natural history of cervical human papillomavirus (HPV) infections based on prospective follow-up.

To assess the natural history of human papillomavirus (HPV) lesions in the uterine cervix, a prospective follow-up of untreated lesions has been conducted since late 1981. The present report summarizes the data on 343 women with cervical HPV lesions currently followed-up for a mean of 18.7 (SD 15.2) months by colposcopy and PAP smears (group B) or by additional punch biopsy (group A). Initially these two groups were classified on the first PAP smears, presenting with HPV-induced cytopathic changes, and either with (group A) or without (group B) concomitant changes suggestive of cervical intraepithelial neoplasia (CIN). The clinical course of the HPV lesions could not be predicted adequately from the findings of the first PAP smears, as evidenced by the higher progression rate (15.4%) in the 214 women initially classified in group B, compared with 11.6% in the 129 women classified in group A. Furthermore, the number progressing to carcinoma in situ requiring conization was equal (seven patients) in the two groups. This necessitated a more flexible approach to follow-up, permitting transfer of patients between groups, which resulted in a final allocation of 261 women to group A, and 82 to group B. To date, 25% of the total of 343 HPV lesions have regressed, 61% have persisted, and 14% have progressed. Of the latter, a total of 14 (4.1%) have been coned due to progression to carcinoma in situ. The rate of regression seems to be inversely related, and progression directly related, to the degree of HPV-associated CIN.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Cervical cytology and the evaluation of the abnormal Papanicolaou smear.

The pap smear is a safe, easy, and inexpensive method for the screening of large numbers of sexually active women for the presence of neoplasia of the cervix. When the pap smear is reported as being abnormal, it is highly accurate. Unfortunately, some cytology laboratories report lesions as "Class II" or "atypical." These reports are not helpful to the clinician and require further evaluation. Most sexually active women are at "high risk" for the development of cervical neoplasia because of early sexual activity for multiple sexual partners. All women at high risk should have annual pap smears. If a woman has a pap smear that suggests the presence of CIN (dysplasia or carcinoma in situ), colposcopy should be performed. This office procedure allows for the detection of the areas causing the abnormal cytology. Colposcopy can often allow outpatient therapy of CIN lesions. Conization should be performed only when the colposcopic examination is unsatisfactory or patient or lesion factors are not favorable for office therapy. Hysterectomy is not recommended for treatment of cervical dysplasia or carcinoma in situ.

Colposcopy↗
PubMed1988

Endocervical brush cytology. An alternative to endocervical curettage?

The usefulness of an endocervical brush for cytologic sampling was studied in 288 consecutive women attending a colposcopy clinic. One hundred sixty had initial colposcopic examinations with directed biopsies and endocervical curettage (ECC). One hundred twenty-eight had follow-up examinations that included Papanicolaou smears and ECC some time after evaluation and/or treatment for cervical dysplasia. Within an established protocol for the evaluation and management of abnormal Papanicolaou smears, the endocervical brush was compared to ECC. When the combination of colposcopy and cervical conization showed that dysplasia was confined to the endocervix, the endocervical brush was significantly more sensitive than ECC in detecting this endocervical disease (P less than .05). In follow-up evaluations and in patients with unsatisfactory colposcopic examinations, endocervical brush cytology could replace ECC without affecting clinical management. In patients with a satisfactory colposcopic examination, ECC may be required only when endocervical brush cytology is abnormal. Endocervical brush cytology is less costly and painful and could prove to be a reasonable alternative to ECC for the initial evaluation of the endocervix. Endocervical brush cytology shows promise as a safe adjunct to the colposcopic evaluation of pregnant women, whereas ECC is contraindicated in such women.

Adenocarcinoma↗
PubMed1988

[Progress in the treatment of cervical cancer].

The cure rate of cervical cancer is undoubtedly improved by early detection accomplished by mass-screening programs. Improvements in surgical technique have also reduced the incidence of complications. Conization or laser vaporization for stage 0 and extended hysterectomy for stage Ia are demonstrated to be appropriate treatment modalities. Extended surgery, such as total pelvic exenteration, is applied for advanced cancer. For radiation treatment, fast-neutron irradiation, intraoperative irradiation and interstitial irradiation have been tested. Hyperthermia combined with irradiation is one of the most attractive methods, which deserves further investigation. Irradiation of the para-aortic lymph nodes has been started by many institutions. Great progress has been achieved in chemotherapy for cervical cancer. Multi-drug combination chemotherapy including cis-platinum has yielded promising results, and intra-arterial infusion and long-term maintenance chemotherapy have been tried with the expectation of favorable outcome. It is concluded that individualized multi-disciplinary treatment will be the best approach for cervical cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

[Micro-invasive carcinoma of the cervix uteri].

Micro-invasive carcinomas of the cervix (Stage Ia of the IFGO) are characterized by an absence of clinical signs. Among the prognostic criteria are the depth of the invasion (5 mm for the IFGO, 3 mm for us), the superficial extension (7 mm in the largest diameter) and the possible presence of lymphatic or vascular emboli in the connective tissue of the cervix. Only semi-successive secretions (every 300 microns) enable to accurately define these lesions. It is then possible to individualize two types of micro-invasive carcinoma. Group A (less than 3 mm deep, less than 7 mm on the surface and without emboli) may be treated by conization if the resection line is in healthy tissue and the operative specimen studied in semi-successive sections. In the other cases (group B) a Wertheim procedure with lymphadenectomy is indicated.

Carcinoma↗
PubMed1987

[Gynecological surgery under local anesthesia].

Local anesthesia allows interruptions of pregnancy until the 16th week; it also permits endo-uterine exploration, conization and treatment of synechiae. In terms of the breast, local anesthesia is indicated for the excision of palpable lesions, benign a priori, regardless of their size or location. The risk of overdose and vascular crossing is lower than with general anesthesia. It reduces hospital stay to a few hours but must be performed in a well-equipped operating suite in case of a possible complication.

Anesthesia, Local↗
PubMed1986

Immunoreactivity of involucrin in cervical condyloma and intraepithelial neoplasia.

Ninety-three cervical conization specimens with condyloma or intraepithelial neoplasia were stained by the peroxidase-antiperoxidase technique for involucrin. Diffuse, homogeneous suprabasal staining was observed in the ectocervical squamous mucosa and mature squamous metaplasia. In immature squamous metaplasia, staining was limited to cells with apparent squamous differentiation. Although diffusely reactive in the upper layers of condyloma and cervical intraepithelial neoplasia (CIN) grade I, the stain was uneven in the former and lacking in the parabasal layers of the latter. The staining intensity, distribution, and pattern were more variable in CIN grade II and grade III. With increasing severity, a patchy pattern with a mixture of reactive and nonreactive cells predominated. Although immunoreactivity with involucrin could not distinguish immature squamous metaplasia from neoplasia, the staining patterns in CIN correlated with extent of disease, degree of squamous differentiation, and cellular disorganization.

Carcinoma in Situ↗
PubMed1987

Diagnostic problems of in situ and invasive adenocarcinomas of the uterine cervix.

In this study of 58 cervical in situ and invasive adenocarcinomas, the diagnostic accuracy of cervical biopsies was found to be closely related to the extent and the degree of differentiation of the neoplasm. Biopsies of in situ and early, well-differentiated adenocarcinomas were often limited in amount, precluding an accurate assessment of stromal invasion. In such cases, a comprehensive sample, e.g., by conization, was required to establish the diagnosis. Invasive adenocarcinoma could be distinguished from the in situ change by the loss of branching pattern of normal endocervical glands, a marked variation in the size and shape of the glands, and a complex papillary or solid growth pattern. The presence of a desmoplastic reaction further supported the invasive nature of the neoplasm.

Adenocarcinoma↗
PubMed1987

[The role of cytological studies in evaluating the severity of dysplasia during prophylactic gynecological examinations (cooperative study)].

Cytologic examination of scrapings from the uterine cervix was carried out in 498 patients in whom moderate or severe dysplasia of the squamous epithelium or suspicion for cancer were established in the course of gynecologic screening. The said pathology was diagnosed in 0.63% of screeneses. Cytologic follow-up of 57 cases of severe dysplasia established that, in patients over 40 years of age, it tended to progress to Ca in situ. This tendency was registered within 6-36 months and continued after a second biopsy. Severe dysplasia did not recur in the 20-40 year-old group. The extent of cervical biopsy (excision or conization) in severe dysplasia should be considered versus patients' age.

Adult↗