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PubMed1983

Papillomavirus infection of the cervix. II. Relationship to intraepithelial neoplasia based on the presence of specific viral structural proteins.

Three hundred twenty-two cases of cervical dysplasia (mild, moderate, and severe) and carcinoma in situ (CIS) were examined for the presence of papillomavirus structural antigens with a peroxidase-antiperoxidase method on formalin-fixed, paraffin-embedded tissue. The primary antiserum, prepared from purified, detergent-disrupted bovine papillomavirus type 1 virions, is broadly reactive against the genus-specific (common) antigen(s) of the papillomaviruses. Using the peroxidase-antiperoxidase technique on cervical tissue obtained from biopsy, conization and hysterectomy specimens, papillomavirus structural proteins were identified in association with mild dysplasia in 65 of 152 (43%) cases, with moderate dysplasia in 12 of 82 (15%) cases, with severe dysplasia in eight of 47 (17%) cases, and with CIS in four of 41 (10%) cases. Papillomavirus antigens were found directly within the lesion in all the cases of mild and moderate dysplasia but in only two instances of severe dysplasia and in none of the examples of CIS. In the remaining 10 cases of severe dysplasia and CIS associated with the presence of papillomavirus antigens, cells containing papillomavirus structural proteins were present in areas of moderate dysplasia immediately adjacent to the high-grade lesions in seven instances and in areas of mild or moderate dysplasia not directly in contact with the high-grade lesions in three. Among the 12 high-grade lesions associated with the presence of papillomavirus antigens, a morphologic transition from areas of moderate dysplasia containing papillomavirus antigens to the areas of severe dysplasia and CIS was present in five instances. The results of this study, therefore, provide direct evidence demonstrating the relationship of papillomavirus to intraepithelial cervical neoplasia ranging from mild dysplasia to severe dysplasia and CIS.

Animals↗
PubMed1982

Histologic evidence for an association of cervical intraepithelial neoplasia with human papilloma virus infection.

All the cytologic and histologic material pertaining to 100 patients who underwent cervical conization for advanced cervical intraepithelial neoplasia (CIN) was reviewed. The revision of the histology of the biopsies and cones showed in 56 cases the association of CIN with viral cytopathic effects (VCE) attributable to human pappiloma virus (HPV) and in 52 the coexistence of a predominantly flat condyloma. The comparison of the two groups of CIN, with and without VCE, showed that in the first the association had favored in 20% of the cases the histologic overestimation of the severity of the lesion. Of the patients with CIN III, 46% showed additional changes due to VCE. The mean age of the patients with CIN and VCE was 39.8 years and that of the patients with CIN was 48.6 (p less than 0.0001). The exocervix was significantly more often involved by CIN + VCE than by CIN alone (p less than 0.00001). Follow-up studies revealed in both groups the same percentage of residual disease and, preliminarily, a trend to a better control of CIN with VCE. New disease developed more often in the group of patients with CIN without VCE. Cytologic sensitivity for VCE in cervical smears was high (95%) in the cases of CIN II and somewhat lower (81%) in those with CIN III. Cytologic follow-up showed the persistence of VCE in 17% of the patients treated surgically for CIN and VCE. The morphologic and clinical features displayed by CIN associated with VCE warrant its recognition as a distinct variant of CIN.

Adult↗
PubMed1983

Primary colon-type adenocarcinoma of the appendix.

A woman, 32 years of age, was admitted with classical symptoms of acute appendicitis. Peroperative findings were typical of the condition. Histology revealed a colloid adenocarcinoma of colon-type, penetrating all layers. A secondary hemicolectomy was performed. One month previously the patient had undergone a conization of the uterine cervix on account of a cancer in situ. The age, sex, and the histological findings, altogether, make this case an extremely rare one. The literature has been perused, and it is concluded that hemicolectomy should still be considered the correct treatment for carcinoma of the appendix. The necessity of all specimens removed by surgery being sent for histological examination is emphasized.

Adenocarcinoma, Mucinous↗
PubMed1983

[Studies on the etiology of infectious disease of female internal genitalia - bacterial flora in the female genitalia and surrounding tissues].

The present studies were carried out to clarify the indigenous bacterial flora in the female internal genitalia and surrounding tissues and the pathogenesis of parametritis. Twenty nine patients with uterine tumors which consisted of sixteen carcinomas and thirteen benign tumors underwent abdominal total hysterectomies. Each tissue aseptically collected from the uterus and adnexae was cultured for 48 hours under aerobic or anaerobic conditions and the bacterial species were isolated and identified. In benign uterine tumors, anaerobic bacteria were isolated in six patients and aerobic or anaerobic bacteria were identified In the endometrium, fallopian tube and parametrium of five of the patients. In a group of carcinoma in situ (stage 0), many bacteria were isolated in two patients after conization. In the uterine carcinomas, as the stage advanced, the rate of bacterial isolation from parametrium and lymph node became higher. The rate of anaerobic bacterial isolation, except for one from the vagina, was nine out of sixteen patients with carcinomas but three out of thirteen patients with benign tumors. The results revealed that the bacterial flora in the vagina spread to the internal genital organ and surrounding tissues via the ascending or cervical lymphatic pathway and remained there as nonpathologically indigenous bacterial flora. These results suggest that these indigenous bacterial flora in the internal genitalia and the surrounding tissue may cause an opportunistic infection.

Adult↗
PubMed1978

[Value of suspicious and doubtful cytological findings in gynecologic serial examinations].

Cytological follow-up and histological results of 2336 patients with Pap III and 10584 with Pap II control of 1973 and 1974 were checked up to May 1976 and compared with new literature. 50% of Pap III became to negatives, 10% of Pap III and 0,82% of Pap II control became positive (Pap IV and Pap V). Up to now histological findings has been resulted in 10% invasive cancers; in 53% carcinomata in situ and severe dysplasia, in 16% moderate and mild dysplasias, and in 5% normal epithelium from repeated Pap III. To avoid to many conizations we have introduced Pap IIID for moderate and mild dysplasia into screening cytology.

Diagnosis, Differential↗
PubMed1984

[Determination of circulating immune complexes in the serum of patients with cytologically suspected and cytologically positive cervix smears].

In a pilot study there was taken away venous blood from 26 women for quantitative examination of circulating immune complexes because of cytologic suspected or positive diagnosis of the cervix uteri before planned conization. The concentration of immune complexes would be opposed to the colposcopic, cytologic and histologic diagnoses. In comparison to 26 women with cytological inconspicuous cervix diagnoses there is a light increase of immune complex concentration, but there is no significant difference between both groups.

Antigen-Antibody Complex↗
PubMed1984

[Reevaluation for overlooked signs of cervical smears in cases of uterine cervical adenocarcinoma].

Though the incidence of adenocarcinoma is not high, this cancer has been a matter for discussion on the grounds that mass screening frequently shows "false negative" cases. The purpose of this study was to clarify the factors which had caused a misdiagnosis through the re-investigation of patients' previous cervical smears. In spite of continuous smear tests at various intervals, there was a long delay in the diagnosis, ranging from 6 months to 5 years, in 14 patients out of 51 cases of cervical adenocarcinoma treated in our hospitals during the past 6 years. In 12 of these 14 cases a careful re-examination of previously overlooked smear preparations revealed definite signs of adenocarcinoma in most cases (86%). A cause of the delay in diagnosing adenocarcinoma seems likely to be related to cytological inspections rather than to the process of taking smears. Characteristics overlooked signs in the misdiagnosed smears were either "rosette-like" arrangements or "irregular clusters of sheet-like" arrangements. The rosette-like arrangements a pattern indicative of cervical adenocarcinoma, were found in 10 of the above cases (71%). The findings obtained suggest that for the diagnosis of cervical adenocarcinoma, cytological diagnosis by smear could be made even in the early pre-clinical stage and when cervical adenocarcinoma is suspected on a cytological basis in this stage, conization is also strongly recommended despite the punch biopsy.

Adenocarcinoma↗
PubMed1983

Infertility in women exposed to diethylstilbestrol in utero.

To evaluate the reproductive consequences of prenatal diethylstilbestrol (DES) exposure, 33 infertile couples were studied in whom the female had been exposed to DES in utero. Infertility was attributed to uterotubal junction obstruction in 3 couples, anovulation in 7, endometriosis in 11, cervical obstruction in 2, adnexal adhesions in 2, oligospermia in 1 and luteal insufficiency in 3; in 4 couples no cause of infertility could be identified. No unique intraabdominal abnormalities attributable to DES exposure were observed. Four tubal pregnancies occurred in women with grossly normal oviducts. Nine of 11 women who had previously undergone surgical manipulation of the cervix (cryosurgery, cautery or conization) developed cervical stenosis, and 8 of them were found to have endometriosis. Despite our not having an appropriate referral infertility population for comparison, these findings are consistent with the following hypotheses regarding women prenatally exposed to DES: (1) surgical manipulation of the cervix more frequently leads to cervical stenosis and ultimately pelvic endometriosis, (2) tubal pregnancies may occur by a mechanism unrelated to salpingitis, and (3) the spectrum of problems causing infertility is similar to that in the non-DES-exposed population.

Adult↗
PubMed1983

[Diagnostic verification of Group III and III D cytological tests with special reference to follow-up].

The diagnostic verification of Pap III and Pap III D-smears from mass screening is described with special regard to the importance of colposcopical and cytological long-term controls. 233 (59.8%) out of 390 patients were verified within one year (1.1.-31.12. 1977). A high percentage (27.5%) of the first control smears was negative or the cytological picture had become normal (19.5%) after vaginal treatment by antibiotics and application of estrogens. 50 women were cured by conization or primary hysterectomy as the cytological diagnosis yielded suspicion of severe dysplasia or carcinoma in situ. Depending on cytological differential diagnosis, individual situations and the developmental tendency of the atypical epithelium 157 patients (40.2%) were observed for several years. The great diagnostical-therapeutical importance of colposcopy for the early recognition of cervical intraepithelial neoplasia (CIN) is demonstrated. A direct microbiopsy controlled by colposcopy is a valuable completing method if there are differences between colposcopical and cytological findings during a long-term control of the cases. A slight or moderate dysplasia can be observed for about 2 or 3 years, as most regressions are seen in this period. In problematic cases (young nullipare, patients treated because of infertility or sterility, pregnant women, old women) with severe dysplasia/carcinoma in situ it is possible and justifiable to control the patient temporarily in short distances. All cases which are suspicious of an early stromal invasion call for a definite diagnosis and therapy without any delay. Primary hysterectomy is preferred in patients aged 35 years or more.

Adolescent↗
PubMed1984

[Problems in the treatment of early carcinoma of the uterine cervix].

Limited operation is in side spread use recently in surgical treatment of in situ (Stage 0) and microinvasive (Stage Ia) carcinomas of the uterine cervix. Which purpose is to avoid such postoperative complications as vesical paralysis, therefore the simple total or modified radical hysterectomy is performed. However, the conization of the cervix may be received among the young women with strong desire to preserve their child-bearing potential. It is utmost importance to make a correct histological diagnosis prior to the performance of these procedures. In addition it is of importance to examine the histological rest of cancer, postoperatively. On the radiation therapy for Stage 0 and Stage Ia cancers, it is a general agreement that be treated only by intracavitary irradiation.

Female↗
PubMed1978

Cervical cytology: use and follow-up.

The Pat smear was introduced to clinical medicine 35 years ago. It is the most practical means of screening for precancerous lesions of the cervix. Endocervical and ectocervical samples improve detection. Colposcopy and colposcopically directed biopsy will document the most advanced lesion in almost all cases. The need for conization has been greatly reduced. Treatment of intraepithelial neoplasia will prevent the development of invasive cancer of the cervix.

Colposcopy↗
PubMedDate not supplied

Comparative evaluation of abnormal cytology, colposcopy and histopathology in preclinical cervical malignancy during pregnancy.

The results of a two-and-a half-year study on cytodetection of preclinical cervical malignancy during pregnancy are presented. Of 3,534 pregnant women, 125 (3.5%) had cytologic diagnoses of dysplasia, carcinoma in situ or microinvasive carcinoma of the uterine cervix. These results are compared with those obtained from colposcopy and from tissue diagnosis following biopsy, cervical conization and hysterectomy. They are also analyzed in relation to the patients' age, parity and age at first sexual intercourse. The management of these patients during pregnancy is discussed, especially with regard to the authors' experience in dealing with patients from very poor socioeconomic and cultural backgrounds.

Adolescent↗
PubMed1982

Topical 5-fluorouracil treatment of transformation zone intraepithelial neoplasia of cervix and vagina.

The authors present preliminary findings in 11 unselected patients with upper vaginal and/or cervical transformation zone intraepithelial neoplasia treated with a 5% topical 5-fluorouracil (5-FU) cream. Only 6 of 11 patients were found to be cured of disease when subsequently evaluated histologically by conization biopsy and/or hysterectomy. Although further clinical trials using differing concentrations and/or more prolonged exposure to the drug may be warranted, the authors cannot recommend topical 5-FU as a replacement for standard outpatient therapy for upper vaginal and/or cervical intraepithelial neoplasia.

Administration, Topical↗
PubMed1982

Diagnosis and treatment of preinvasive and microinvasive cervicocarcinoma.

The mortality rate of cervicocarcinoma has significantly decreased over the last few years, thanks to early diagnosis. Prophylactic and therapeutical interventions, at different stages, are therefore necessary to eliminate or, at least, decrease the incidence of this pathology. Between 1975 and 1980, during a cytologic depistage carried out at the Institute of Gynecologic and Obstretic Clinic of Padua University, we examined 72 cases of patients who had undergone the following diagnostic iter: colposcopy, cytology, direct biopsy and conization. Various parameters were analyzed, notably with regard to cases of serious dysplasia, carcinoma in situ, neoplasia with beginning invasion of the glandular necks and microinvasive forms.

Adult↗
PubMed1982

Post treatment behaviour of cervical intraepithelial neoplasia - grade III.

The behaviour in time of cervical intraepithelial neoplasia grade III has been evaluated in 141 patients treated for CIN III. It was observed that surgery ensures the higher healing-rate, whether hysterectomy or conization are performed, while diathermocoagulation seems unsatisfactory. Colposcopy, colpocytology and sight biopsies of the cervical canal, portio and vagina, which provide a precise lesion-map, are then essential investigations to make the subsequent treatment a truly radical one. A very close monitoring of patients, treated for CIN III, seems required in the first year after surgery, when we observed the highest rate of persistence and recurrences, while, subsequently, their incidence decreases as time passes by.

Biopsy↗
PubMed1981

[A clinicopathological study on microinvasive carcinoma (stage Ia) of the uterine cervix (author's transl)].

A pathological study of 142 cases of stage I carcinoma of the uterine cervix with a depth of invasion of less than 5 mm showed 119 of them, 104 stage Ia (87.4%) and 15 stage Ib (12.6%), to have a depth of invasion of less than 3 mm. As to the histological pattern of invasion in stage Ia, advanced bulky outgrowth from glands and early stromal invasion were observed at nearly the same frequency. Of 15 cases of stage Ib cervical carcinoma with depth of invasion of less than 3 mm, 10 were of reticular invasion, 4 were of "frühe Stroma-arrosion" and 1 was of vessel permeation. With either pattern of invasion, annular and longitudinal extension of the lesion tended to be wider in stage Ib than in stage Ia. Spread to the ectocervix was also wider in stage Ib. Modalities of treatment used for stage Ia carcinoma of the cervix were extended radical hysterectomy in 28 cases, sub-extended hysterectomy in 68 cases, simple hysterectomy in 3 cases, conization in 1 case and radiotherapy in 4 cases. Lymph node metastasis was noted in none of stage I cervical cancer cases with a radiotherapy in 4 cases. Lymph node metastasis was noted in none of stage I cervical cancer cases with a depth of invasion of less than 5 mm.

Adult↗
PubMed1981

Cryosurgery of cervical intraepithelial neoplasia.

Nine hundred sixty-eight patients with cervical intraepithelial neoplasia (CIN) were evaluated with colposcopy and treated with cryosurgery; 722 had a pretreatment diagnosis of CIN I or II and 246 had CIN III. Of those patients available for 2 follow-up smears, histologically proved persistence of CIN was found in 10% of patients with CIN I and II and 20% of patients with CIN III. Recurrent disease was detected in 3.2 and 3.8%, respectively. No patients had a recurrence after 5 negative Papanicolaou smears. One patient had invasive carcinoma 30 months after treatment. Failure of patients to return for follow-up was a significant problem. When the present results were compared to those published in the literature, cryosurgery was found to be less effective than conization in treating CIN III.

Carcinoma, Squamous Cell↗
PubMed1981

Accuracy of colposcopically directed biopsy in patients with cervical neoplasia.

The histologic diagnoses of premalignant and malignant lesions of the cervix obtained by examining the colposcopically directed biopsy material from 643 patients were compared with those of the surgical material subsequently obtained. The procedures during which samples were acquired included hysterectomy (370), cervical conization (263), cervical amputation (2), and removal of a retained cervical stump (8). The diagnostic accuracy of colposcopically directed biopsy was 93.0% in those patients with satisfactory colposcopy, ie, the final diagnosis did not differ by more than 1 grade from that of the directed biopsy diagnosis. Two patients with widespread stage III cervical intraepithelial neoplasia on directed biopsy had microinvasive carcinoma in the therapeutic cone specimen. All invasive carcinomas (stage IB, occult) were diagnosed by directed biopsy and confirmed by subsequent examination of the surgical specimen.

Adolescent↗