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PubMed1986

[Histologic analysis of carcinoma of the cervix uteri in situ with graphic reconstruction].

With 38 selected conization specimens of histologically confirmed carcinoma in situ (C.I.S.), detailed graphic reconstructions were prepared in the form of schematic drawings to obtain exact information about the nature and extent of epithelial lesions in the cervix uteri. Because of a noticeable diversity from the accepted view, the results obtained by extensive histologic analysis were reported as follows. C.I.S. was divided into 2 groups, one originating from surface epithelia (14 cases) and the other arising from cervical glands (24 cases). C.I.S. developing from surface epithelia formed a single peak-shaped extent of epithelial lesion with one-side maturation toward the portio. The characteristic of intraepithelial spreading resulted in a "moving backward" extension. The criterion of the rate of spread depended upon the finding of involvement of the entire circumference of the external cervical os with a rather smaller area of lesions and adjacent epithelial repair to the C.I.S. C.I.S. arising from cervical glands disclosed an irregularly shaped extent of epithelial lesions. Convincing evidence of cervical glandular origin indicated lateral invasion of glandular involvement and the existence of glandular involvement just beneath intact surface columnar epithelia. Intraepithelial spread of C.I.S. extending from glandular involvement also displayed "moving backward" extension. C.I.S. lesions extending over a wide field of the cervix were compatible with slow growing type and long term staying in Stage O.

Adult↗
PubMed1986

[Morphologic criteria in genital herpesvirus infections. Their value in diagnosis, their place in therapeutic indications].

A series of 155 observations has been made of uterocervical intraepithelial neoplasias treated by conization and examined by serial section. From the data obtained the author shows that colposcopic and microlposcopic criteria can be used to give a good evaluation of the participation of viruses of the HPV group in the histogenesis of infra-clinical lesions of the uterine neck. The specificity of the colposcopic and microcolposcopic method seems equal to that of exfoliative cytology, and its sensitivity is greater. Increased application of colposcopy and microcolposcopy is recommended in the screening of infraclinical lesions of the uterine neck.

Biopsy↗
PubMed1986

[Cryosurgical treatment of cervical intraepithelial neoplasia following cervical smears and curettage].

65 patients exhibiting colposcopically and cytologically atypical epithelium in the cervix were treated by cryosurgery with liquid nitrogen. 63 of whom were confirmed histologically after surface scraping and curettage of the cervix. The patient then were followed cytologically and colposcopically 8 and 12 weeks after cryosurgery. According to that the definitive histological diagnosis was performed after conization (48 patients) hysterectomy (12 patients) and surface scraping and curettage of the cervix (8 patients). Colposcopical, cytological and histological findings after surface scraping of the cervix showed a correlation rate in the 95% range. Treatment failure rate following cryosurgery showed an increased percentage with increased grade of CIN. A complete destruction of ectocervical pathologic tissue in CIN 1 and 2 is opposed to a persistent disease rate of 20 percent in patients with CIN 3. The failure rate was significantly higher in cases without fully visualization of squamocolumnar junction. Cytological follow-up predicted all cases with histologic diagnosis of persistent disease. Colposcopical evaluation was frequently unsatisfactory after cryosurgery. Cryosurgery of CIN should be reserved for the treatment of those patients in whom the criteria for patient selection are performed and the benefits of this method outweigh the possible drawbacks.

Carcinoma in Situ↗
PubMed1985

[Study of in situ cancer of the uterine cervix in the Provincial Hospital of Madrid].

Seventy nine cases of in situ cervical carcinoma (CIN III) treated between 1977 and 1985 are studied. CIN III appears ten years before invasive cervical carcinoma, at a mean age of 42.8 years. Parity may be a risk factor by itself or reflect the precocity and frequency of sexual intercourse. The study confirms that most of the times the combination of vaginal cytology and colposcopy attained the diagnosis. The best therapeutical methods are conization and then total hysterectomy, depending on lesion localization, patient age and early needs. Very young patients with lesions that do not reach the endocervical region may be treated by CO2 laser or cryotherapy.

Adult↗
PubMed1986

Management of postconization cervical stenosis by laser vaporization.

In 18 patients with symptomatic cervical stenosis after conization, laser vaporization of the stenotic segment was performed. Total relief of symptoms was achieved in 12 patients and partial relief in four. In seven cases there was no evidence of stenosis at follow-up, and in a further nine cases the degree of stenosis was less. In seven cases it was possible to visualize the squamocolumnar junction at follow-up. This had not been possible in any cases before the procedure. Vaporization using the carbon dioxide laser provides a useful conservative management technique for postconization stenosis.

Adult↗
PubMed1985

Role of endocervical curettage in colposcopy.

Two-thousand three-hundred and four patients with abnormal cervical cytology were evaluated by colposcopy, cervical biopsy, and endocervical curettage. The endocervical curettage was more accurate than the cervical biopsy in 1.2% of patients with satisfactory colposcopic examinations, 15.7% of patients with unsatisfactory examinations, and 30.5% of patients with no lesions observed. The endocervical curettage contained neoplastic epithelium in all 15 of the patients with invasive cancer and in seven patients it was the only diagnostic parameter that indicated invasion. The information from the endocervical curettage, when correlated with the cervical cytology, colposcopic findings, and cervical biopsy, eliminated the need to do a diagnostic conization in 76% of patients with unsatisfactory examinations and 79% of patients with no lesion identified. It is recommended that the endocervical curettage be a part of every colposcopic examination.

Adult↗
PubMed1985

Colpohistologic correlations. A computerized study.

Data from 300 colposcopic cases were computerized to study the correlations between the colposcopic observations and the histologic and other data. Colposcopy was shown to be most useful in women under 35 years of age. Use of oral contraceptives (the Pill) seemed to relate to a higher level of successful colposcopic visualization and may even prevent the need for conization, based on a higher incidence of negative endocervical curettages. Although 14.5% of the cases were colposcopically undergraded and 17% overgraded when compared to the histopathology, the histologic predictability of the colposcopic observation of white epithelium and vascular changes (punctation and mosaicism) was excellent. Colposcopy remains an essential technique in the appraisal and management of cervical intraepithelial neoplasia.

Adult↗
PubMed1985

Outpatient management of cervical intraepithelial neoplasia. A summary of 279 cases.

Two hundred seventy-nine patients with cervical condylomas or cervical intraepithelial neoplasia (CIN) were treated as outpatients with cryotherapy. Every patient followed received a Papanicolaou smear, colposcopic evaluation, cervical biopsy and endocervical curettage four months following treatment. The treatment failure rates for CIN 1/condyloma, CIN 2 and CIN 3 were 2.9%, 5.7% and 4.3%, respectively. The percentage of patients eventually requiring conization was 0.7, 1.6 and 2.7, respectively. No patient who had a negative clinical and histologic examination at four months subsequently had a recurrence. The mean follow-up was 23.1, 26.0 and 35.0 months for CIN 1/condyloma, CIN 2 and CIN 3, respectively. Proper triage is important with CIN 3, and a complete colposcopic examination at the initial follow-up visit is valuable for predicting outcome.

Ambulatory Surgical Procedures↗
PubMed1985

Some remarks on preinvasive cervical neoplasia--an image analysis study.

By means of automated microscope image analysis 5275 normal cells as well as dyscaryotic cells were investigated in cytologic preparations from 53 cervical smears (26 negative cases, 27 positive cases). In this way, visually not conspicuous differences between normal cell populations of positive and negative cases could be demonstrated with multivariate statistic analysis of discriminant features. The examination of this phenomenon in 2910 epithelial cells from tissue sections of portio conizations has shown that the subvisually changed epithelial cells originate from circumscript regions in the margin and surroundings of CIN-lesions. The biological role of these changes in the formal genesis of cervical neoplasias has been discussed.

Cell Differentiation↗
PubMed1979

Cryotherapy of the cervix.

Cryotherapy is most useful in treating mild and moderate dysplasia of the ectocervix and symptomatic benign chronic cervicitis. It has almost replaced electrocauterization of the cervix and has reduced the need for conization. Cytology and colposcopy are essential in the selection of patients for this procedure and in evaluating their response to therapy.

Colposcopy↗
PubMed1979

Evaluation of colposcopic accuracy without endocervical curettage.

A study was undertaken to evaluate the accuracy of colposcopic examination when performed without the use of endocervical curettage. It included 763 cases of suspected cervical-vaginal pathology. An additional evaluation of colposcopic accuracy was made for special-case categories of 1) stromal invasion, 2) pregnancy, 3) menopause, and 4) diethylstilbestrol (DES) exposure. Colposcopic accuracy was determined by cytologic and histologic material obtained either at the initial colposcopic evaluation or during follow-up surgery. With the literature as a standard for accuracy, it was concluded that the omission of endocervical curettage from the colposcopic examination did not reduce accuracy. In addition, the diagnostic conization rate was lower than in most reported series. Finally, the rate of missed invasive lesions was not increased by the omission of endocervical curettage.

Adolescent↗
PubMed1979

[Preoperative evaluation by colposcopy and cytology in cervical intraepithelial neoplasia (cin) (author's transl)].

Before conization in 108 patients with cervical intraepithelial neoplasia (CIN) colposcopic findings and the results of triple cervical smears (anterior and posterior cervical lip and endocervical canal) have been evaluated and compared with the microscopic findings, limiting the comparison to the separately investigated anterior and posterior cervical lips. Colposcopically and cytologically suspicious findings agreed with the microscopic findings of CIN in 48.3% (anterior lip) resp. 41.7% (posterior lip). Cytologically suspicious findings alone have been determined in 80.5% resp. 84.8%; colposcopically suspicious findings were found in 55.2% resp. 48.1%. The main causes of false negative smears may have been failures of sampling, of false negative colposcopical findings a wrong estimation of an atypical transformation zone. A combined application of colposcopy and triple cervical smear technique in patients with abnormal smears is strongly recommended. This may improve the results of localizing a lesion of CIN.

Adult↗
PubMed1979

[On the therapy of uterine cervix carcinoma in situ].

It is reported of 607 cases of uterine cervix carcinoma in situ from the years 1963 to 1977. During this period, the diagnostic and therapeutic procedures as well as the histological preparation technique have advanced. -- 75% of the cases were primarily conized. About half of these cases were surely radically excised. 323 patients (53,2%) were treated actively by simple hysterectomy, 242 patients (46,8%) were treated conservatively (190 conisations, 19 reconisations, 60 portioamputations, 12 ringbiopsies, 3 radiations). -- After 323 total exstirpations, 2 recurrences of carcinoma in situ in vaginal stump were observed (0,6%). After local treatment of 242 patients, 17 recurrences of the disease appeared (6%), among them 4 cases as invasive cervix carcinoma. 11 cases belong to the group of primarily nonexcised or uncertainly radically excised carcinoma in situ, and in 4 cases a possibility of recurrence has been discussed. -- It has been refered to the importance of the exact conisation technique and subtile histotechnical obtaining of slides in step sections. If the carcinoma in situ radically excised and followed by an attentive follow up in women below 40 years, a conservative procedure is adviced. For women above 40 years an active procedure is indicated, because it offers a high therapeutic reliability and a minimal risk. For cases of nonradically excised carcinoma in situ hysterectomy is indicated. The removal of the vaginal cuff is considered as unnecessary.

Adult↗
PubMed1979

[Recurrent carcinoma in situ of the uterine cervix (author's transl)].

Among 228 patients who had previous treatment for carcinoma in situ of the cervix, most by hysterectomy, 3 recurrences in vaginal stumps were detected in women age 36, 46, and 56. In another case a carcinoma in situ of the cervix was found in a 25 year old patient who had a diagnostic and therapeutic conization because of desire for childbearing. The histology of the cone showed no residual carcinoma. Concommitent to the recurrent carcinoma in situ of the cervix a carcinoma of the vulva was detected. Recurrences of carcinoma in situ could occur because of incomplete resection of primary lesion. Wrong classification in the laboratory is possible if the invasion is missed on the microscopic examination and the case therefore receives the wrong treatment. Recurrences which are not true recurrences could arise from multicentric atypical foci of the squamous epitheleum of the -ower female genital tract. These considerations lead to the following recommendations: 1. When the suspected diagnosis carcinoma in situ of the uterine cervix is made a large enough cone biopsy which is appropriately marked is obtained and a complete microscopic examination of the cone must be obtained. 2. A hysterectomy with a large vaginal cuff is the treatment of choice. 3. A careful workup of the operative specimen in the microscopic laboratory is expecially essential. 4. A patient with such previous treatment for carcinoma in situ of the uterine cervix must be urged to continue with regular preventive examinations for cancer. The vaginal stump must be regularly re-examined both by colposcopy and by cytology.

Adult↗
PubMed1979

Adenocarcinoma in situ of the cervix during pregnancy.

A case of adenocarcinoma in situ of the cervix during pregnancy, appropriately diagnosed by conization, is reported. A review of the literature reveals that this neoplasm is rarely encountered during pregnancy. Guidelines for diagnosis and treatment of this unusual lesion are suggested.

Adenocarcinoma↗
PubMed1979

The incomplete cone in carcinoma in situ of the cervix: A prospective study in a developing country.

The diagnostic procedures and treatment of carcinoma in situ and severe dysplasia of the cervix are becoming more conservative. In a developing country special problems make such an approach more hazardous. During a 15-month period the diagnosis in 25 of 206 patients (12,1%) with a smear positive for carcinoma in situ could not be confirmed histologically at Tygerberg Hospital. A prospective study of 147 cases (71,4%) in which the diagnosis was confirmed revealed that they were mostly young patients of relatively high gravidity. The difficulty of assessing the completeness of a cervical cone and of evaluating a postconization smear is confirmed. The danger of a too conservative approach in our patients is confirmed by the fact that only 8,2% of patients came for regular follow-up examinations and that 34,7% did not return for follow-up smears. The high incidence of total hysterectomy (51,7%) as the definitive form of treatment is defended, and a more conservative future approach of confirming the diagnosis and reducing the incidence of cervical conization is suggested.

Adolescent↗
PubMed1983

[Value of differential cytology in the diagnosis of preclinical forms of cervix uteri cancer].

The value of "differential cytology" in the diagnosis of preclinical carcinoma of the cervix uteri was assessed from serial sections of operative specimens in a series of 452 patients. Although not absolute, this value was found to be considerable. Used to supplement colposcopy-guided biopsy, it makes it possible to decide on the therapeutic approach (notably simple destruction by laser) without having recourse to conization. However, the results are only valid for the team which presents them, and before deciding to treat intra-epithelial carcinomas by laser destruction, each team must perform the same "quality control".

Carcinoma↗
PubMed1982

[Carbon dioxide laser in the treatment of premalignant lesions of the cervix (author's transl)].

Cervical dysplasia is classified in various groups according to the extent of the epithelial anomalies. Severe dysplasia, in which the entire depth of the epithelium is diseased, is assimilated to the situ carcinoma. The diagnosis is established by cytology and above all by colposcopy which enables to guide the biopsy. Since all dysplasias, whether mild, moderate or severe, may lead to cancer, their treatment is always warranted. The carbon dioxide laser appears to be superior to the other methods of local therapy. Exocervical dysplasia requires ablation for histological examination, followed by a 7 mm-deep tissue destruction. The carbon dioxide laser also allows conization for endocervical dysplasias. A perfect knowledge of colposcopy is indispensable for this therapeutic procedure.

Adolescent↗