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At least 1,477 records · Page 82Linked to original sources
PubMed1986

Carbon dioxide laser vaporization of cervical subclinical papillomaviral infection and intraepithelial neoplasia: short-term effectiveness.

134 patients with biopsy-proved cervical subclinical papillomaviral infection (SPI) (the so-called 'flat condylomas'), or with associated intraepithelial neoplasia (also called 'atypical condyloma' or 'CIN with features of condyloma'), or with isolated, apparently 'non-warty' intraepithelial neoplasia were treated by means of the carbon dioxide laser between July, 1982, and January, 1985, following a planned approach and on an outpatient clinic basis, without the use of anesthesia or analgesia. The complication rate was extremely low. The overall cure rate was 91.0%. This confirms that laser surgery, combined with colposcopic expertise, can offer acceptable treatment effectiveness, comparable to other techniques of local destruction. Moreover, rapid tissue healing allows early identification of persistent disease. Converging cytological, histopathological, immunochemical and serological evidence has established human papillomavirus - belonging as a subgroup to the papovavirus family - as an important etiologic factor in female genital tract carcinogenesis. The marked increase in prevalence of these mainly sexually transmitted cervical SPI lesions creates a growing problem of their management and/or follow-up.

Adolescent↗
PubMed1992

Unsuspected involvement of the female genitalia in pemphigus vulgaris.

A 56-year-old woman had erosions due to pemphigus vulgaris in the inner thighs and perineum. The cutaneous lesions cleared following intramuscular gold therapy. However, because of complaints of dyspareunia, a colposcopic examination was performed and involvement of the cervix was demonstrated. The need for a vaginal examination in the monitoring of pemphigus vulgaris is emphasized.

Colposcopy↗
PubMed1992

Prevalence, diagnosis and treatment of lower genital neoplasia in women with human immunodeficiency virus infection.

The prevalence of lower genital neoplasia and Human Papilloma-virus-related genital lesions were evaluated in a cohort of 75 women with Human Immunodeficiency Virus type 1 (HIV-1) infection at different stages of HIV disease. The overall rate of cervical intraepithelial neoplasia (CIN) in the group studied was 29.3% (22/75). Eight out of 10 high-grade CIN lesions contained 'high-risk' HPV-DNA 16/18 and/or 31/35/51 as demonstrated by 'in situ' hybridization with biotinylated probes. Vulvar and/or perianal condylomata were histologically diagnosed in 14 patients (18.7%); nine of these biopsies contained detectable HPV-DNA which was always related to HPV 6/11. The rate of high-grade CIN in symptomatic HIV-infected patients was 28% (7/25) as compared to 6% (3/50) of the other cases (P = 0.022). CD4 lymphocyte counts, white blood cell counts, CD4+/CD8+ cell ratio and percentage of CD4+ lymphocytes were lower in patients with high-grade CIN in comparison to the patients with negative colposcopical and/or cytological examination. After adequate standard treatment (cryotherapy, electrocauterization, cold-knife conization) only one case of CIN 2 recurred during the 2 years of follow-up period. The prevalence of lower genital neoplasia and HPV-related lesions among HIV-infected women is high and seems to correlate with the severity of HIV disease.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Carbon dioxide laser treatment of cervical dysplasia in teenagers.

Over a 6-year period, 40 young women under 20 years of age with cervical intraepithelial neoplasia (CIN) grade I (58%) to grade III (10%) were treated by laser vaporisation or excisional conisation. This prevalence of CIN in young women (nearly 4% of laser-treated cases) underscores the need for detection of cervical abnormalities in all teenagers engaged in sexual relations. The colposcopically-guided carbon dioxide laser technique is the treatment of choice for vaporisation and conisation of intraepithelial lesions (extending to the periphery of the cervix in 20% of cases) and for vaporisation of associated condylomatous lesions of the cervix (75%), vagina (23%), vulva (48%) and/or anus (8%).

Adolescent↗
PubMed1995

Clinical presentation of gynecologic infections among Indian women.

OBJECTIVE: To study the clinical presentation of different gynecologic infections among Indian women. METHODS: This was a cross-sectional study of 257 women that included clinical, cytologic, colposcopic, and microbiologic screening for various gynecologic infections. RESULTS: Human papillomavirus (HPV) was the leading infection, affecting 127 (49.4%) women; however, overt warts were only seen in seven (2.7%) patients. Women infected with HPV had a 60.3-fold higher risk of developing a bleeding ectopia compared to those with other infections; women with an unhealthy cervix and cervical ectopias also had an increased risk of HPV infection (7.6- and 2.8-fold, respectively). Bacterial vaginosis, detected in 33.5% of the women studied, had an increased risk of bleeding ectopia (9.3-fold), cervical ectopia (3.1-fold), cervicitis (2.9-fold), vaginitis (6.9-fold), and cervical hypertrophy (2.1-fold). Chlamydial infection, detected in 23.3% of the patient population, was associated with an eightfold increase in the risk of an unhealthy cervix and a fourfold increase in risk of a hypertrophied cervix. Immunoglobulin-A antibodies to the herpes simplex virus were detected in 53 (20.6%) women. More than half (55.2%) of the women had two or more infections, and the mean delay of seeking medical treatment was 7-13 months. CONCLUSION: The specific finding of bleeding cervices was associated with HPV and bacterial vaginosis, hypertrophied cervices with chlamydia and bacterial vaginosis, and unhealthy cervices with chlamydia and HPV infections.

Adult↗
PubMed1995

Low-grade Papanicolaou smears and the Bethesda system: a prospective cytohistopathologic analysis.

OBJECTIVE: To examine the clinical usefulness of the Bethesda classification system of low-grade cervicovaginal cytology as it relates to predicting underlying histology and aiding in triage to colposcopy. METHODS: We evaluated 1454 women with abnormal cytologic screening results: 782 with atypical squamous cells of uncertain significance (atypia), 355 with low-grade squamous intraepithelial lesions (SIL) determined by the presence of human papillomavirus (HPV) alone, and 317 with low-grade SIL determined by the presence of cytologic evidence of mild dysplasia (cervical intraepithelial neoplasia [CIN] I) devoid of HPV cytopathologic features. All women underwent colposcopy, directed-punch biopsy or loop electrosurgical excision, and/or endocervical curettage (ECC), as indicated. RESULTS: Women from the low-grade SIL-CIN I referral cytology group were significantly more likely to harbor all grades of biopsy-proven dysplasia than were those from the atypical squamous cells of uncertain significance and low-grade SIL-HPV groups, which showed no statistical differences. CONCLUSIONS: Contrary to the Bethesda system, which combines CIN I and HPV changes because of cytomorphologic similarities, this study suggests that patients with HPV cytologic smears are similar to patients with atypical smears and are less likely to harbor any biopsy-proven CIN lesions than are patients with CIN I cervicovaginal smears. If excluded from colposcopic triage, approximately 5% of patients with atypical cytologic smears from a well-screened population similar to ours will harbor high-grade lesions that may progress during any waiting period. Triage of low-grade cervicovaginal smears based on histopathologic correlation is encouraged.

Adult↗
PubMed1995

Histologic and biomolecular aspects of papillomatosis of the vulvar vestibule in relation to human papillomavirus.

OBJECTIVE: To determine whether human papillomavirus (HPV) plays a role in the genesis of papillomatosis of the vulvar vestibule. METHODS: We conducted a study based on molecular hybridization and histology of biopsy material obtained from the inner surface of the labia minora of 25 women with papillomatosis of the vulvar vestibule who presented no abnormal clinical, cytologic, or colposcopic changes in the cervix or vagina. These women were compared with 24 women with condyloma acuminatum of the vulvar vestibule and with ten women with normal vulvar epithelium and no cervicovaginal changes. All patients included in the study were 35 years or younger, and none was pregnant. RESULTS: Papillomatosis of the vulvar vestibule was rarely found to be HPV positive by molecular hybridization (one of 25, 4%, by dot blot hybridization and one of 15, 6.67%, by polymerase chain reaction [PCR]). This result did not differ significantly from that obtained for the group with normal vulvar epithelium (none of 10 by dot blot and none of six by PCR), but did differ (P = .001) from the result obtained for the group with condyloma acuminatum of the vestibule (12 of 24, 50%, by dot blot and six of six, 100%, by PCR). The biomolecular study of vestibular papillomatosis showed that focal koilocytosis was not correlated with HPV infection. CONCLUSION: Papillomatosis of the vulvar vestibule is not associated with HPV and should be considered a paraphysiologic formation of the vulvar epithelium. The diagnosis of vulvar HPV infection should be avoided in the absence of more explicit clinical-histologic evidence, with no need for biopsies or unnecessary treatments.

Adult↗
PubMed1996

Significance of mild cytologic atypia in women infected with human immunodeficiency virus.

OBJECTIVE: To determine the prevalence of cervical intraepithelial neoplasia (CIN) in women who are infected with human immunodeficiency virus (HIV) and who have mild cytologic atypia. METHODS: As part of an ongoing, prospective study of cervical disease in HIV-infected women, Papanicolaou smears were analyzed cross-sectionally for the diagnosis of mild cytologic atypia. RESULTS: Mild cytologic atypia was diagnosed in 112 (25%) of the 453 HIV-infected women enrolled in this study, compared with 36 (9%) of the 401 HIV-uninfected women (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.2-5.1; P < .001). Mild cytologic atypia was diagnosed more frequently in HIV-infected women with lower CD4+ T-lymphocyte counts (chi2 for trend, P = .015) and in those with a history of an abnormal Papanicolaou smear or treatment for cervical disease (OR 3.0, 95% CI 1.2-7.6; P = .008). Coexistent CIN was detected by colposcopically directed biopsy in 42 (38%) of the 112 HIV-infected women with mild cytologic atypia, compared with five (14%) of the 36 HIV-uninfected women (OR 3.7, 95% CI 1.3-11.9; P = .008). Severe inflammation with associated epithelial reparative atypia was diagnosed in 90 (20%) of the HIV-infected women and in 87 (22%) of the HIV-uninfected women. Coexistent CIN was detected in 12% of the HIV-infected women with severe inflammation and associated epithelial reparative atypia, compared with 2% of the HIV-uninfected women with this cytologic diagnosis (OR 5.9, 95% CI 1.2-23; P = .01). CONCLUSION: Mild cytologic atypia, a frequent diagnosis on Papanicolaou smears from HIV-infected women, is associated with CIN. We recommend that all HIV-infected women with mild cytologic atypia be referred for colposcopy.

Adult↗
PubMed1986

Human papillomavirus types 16 and 18 sequences in early cervical neoplasia.

A total of 100 colposcopic biopsies from patients with abnormal Papanicolau's tests were surveyed for the presence of human papillomavirus (HPV) types 16 and 18 sequences by spot-blot hybridization. HPV 16 and 18 DNA sequences were detected in 58% of the biopsies. None of the cervical intraepithelial neoplasia grade I (CIN I) contained HPV 16 while 50% of the CIN III lesions (carcinoma in situ, CIS) contained HPV 16. HPV 18-related sequences were equally represented in CIN I, II, and III. Southern-blot hybridization of total undigested cellular DNA revealed the presence of HPV DNA sequences only in an episomal form. While the restriction enzyme patterns in HPV 16-positive samples were mostly identical to the originally cloned sequence, the restriction enzyme pattern for HPV 18-positive samples were different from that of HPV 18 but identical to each other. Furthermore, this DNA hybridized more strongly to HPV 18 under nonstringent conditions, suggesting a new type.

Colposcopy↗
PubMed1989

Human papillomavirus infection of morphologically normal cervical epithelium adjacent to squamous dysplasia and invasive carcinoma.

We have begun a systematic study of human papillomavirus (HPV) infection in colposcopically and/or morphologically normal epithelium of the uterine cervix. Paired biopsies were taken from the lesions (cervical intraepithelial neoplasia [CIN], condyloma, invasive carcinoma) and from the normal-appearing adjacent epithelium 3 to 5 mm from the edge of the lesion. Myometrium or ectocervical epithelium from patients who had undergone hysterectomy for reasons other than genital dysplasia or malignancy served as controls. One biopsy was examined histologically. DNA from the second biopsy was digested with Pst I, and the presence or absence of HPV was determined by Southern blotting using HPV-16 DNA as a probe. HPV was not detected in any of the 12 control samples. Of 30 patients with CIN and/or condyloma, five of 18 who were HPV-positive had either HPV-16 (three cases) or virus resembling HPV-31 (two cases) in the lesion and adjacent epithelium. Of seven patients with invasive carcinoma, four had HPV in the lesion and adjacent epithelium; two of these four patients had typical HPV-16. Such infection of apparently normal epithelium has major implications for our understanding of the pathogenesis, treatment, and follow-up of patients with cervical neoplasia.

Blotting, Southern↗
PubMed1995

Morphological correlation of human papillomavirus infection of matched cervical smears and biopsies from patients with persistent mild cervical cytological abnormalities.

Human papillomavirus (HPV) analysis of cytological material has been advocated for determining those patients with low-grade cervical cytological abnormalities who have current high-grade squamous intraepithelial lesions (SILs). In this study, we analyzed concurrent cervical smears and biopsies from 167 patients with Papanicolaou (Pap) smears showing persistent atypical squamous cells of uncertain significance (ASCUS) or low grade SILs (1) to compare the detection of HPV by nonisotopic in situ hybridization (NISH) on matched smears and biopsies; (2) to analyze the type and distribution of NISH signal within lesions; and (3) to define further the ability of NISH techniques to distinguish between patients with low- and high-grade SIL. Whether present in cervical smears or biopsies, high-risk HPV types (16, 18, 31, 33, and related types) were significantly associated with high-grade SILs (P < .001) but were found in 15% of low-grade SILs. Ninety percent of high grade lesions were directly infected by these HPV types, and good concordance (92.2%) was found between NISH analysis of matched cervical smears and biopsies, indicating accurate colposcopic targetting of biopsies and excision specimens. Punctate signal morphology, which correlates with viral integration, was associated with high-grade SILs but was also observed in two low-grade SILs. Although the presence of high-risk HPV types in low-grade SILs limits the predictive ability of HPV testing by this means in this group of patients, those patients with high-risk HPV infection of low-grade SILs may be a greater risk of progression to high-grade SIL or invasive carcinoma. If this were the case, HPV testing would be of potential value in the management of patients with low-grade cytological abnormalities.

Biopsy↗
PubMed1984

The assessment of radio-response of cervical carcinoma by colposcopy.

Ninety-four patients with invasive carcinoma of the cervix were investigated for radio-response during treatment using colposcopy and serial biopsies. In 31 patients, the results were further correlated with pathological examination of the Wertheim hysterectomy specimen. It is established that colposcopy can be as reliable as biopsy in predicting radio-response and can be employed complementary to serial biopsies and clinical examinations. The colposcopic features of cervical carcinomas undergoing irradiation are described.

Adenocarcinoma↗
PubMed1985

Management of the mildly abnormal Pap smear: a conservative approach.

Follow-up and management of the mildly abnormal Pap smear has been the subject of controversy in the medical literature. At Fitzsimons Army Medical Center, patients with initial Pap smears reported as "inflammatory atypia" or mild dysplasia were treated with specific therapy for vaginitis and/or cervicitis. Follow-up smears were performed 6 to 8 weeks later. Of the above groups, 80 and 58%, respectively, were negative on repeat smear. A third group of patients with Pap smears reported as consistent with human papillomavirus (HPV) were not treated but had repeat smears performed at 6 to 8 weeks. Of these, 76.4% reverted to normal. The results of the colposcopically directed cervical biopsies obtained on patients with persistently abnormal smears are reported. These findings support a conservative plan for follow-up of mildly abnormal Pap smears.

Biopsy↗
PubMed1985

Intraepithelial neoplasia in the vulvar region.

From 1978 to 1982, 49 patients with intraepithelial neoplasia in the vulvar region were included in a prospective investigation. The main purpose was to evaluate the effect of treatment by local excision with a free margin of 2 mm and to estimate the importance of colposcopy. In 28% of the patients, the disease recurred after primary treatment, and in one patient microinvasion was shown. No patients died of cancer. A risk factor of recurrence was involvement of resection margins. Multicentric localization of the vulvar disease was found more frequently among patients treated for intraepithelial neoplasia of the cervix. In 66% of the patients the colposcopic findings were consistent with intraepithelial neoplasia. Local excision represents an improvement in the treatment of intraepithelial neoplasia of the vulva, but frequent follow-up is necessary.

Adult↗
PubMed1986

Predictive value of a positive endocervical curettage in diagnosis and treatment of CIN.

Predictive values of endocervical curettage (ECC) in the investigation of patients with abnormal Pap-smears were calculated with regard to a second histological diagnosis and with regard to results of conservative treatment of CIN. By using the combined follow up data of all 290 patients with colposcopically directed biopsies and ECC, the predictive value of a positive ECC for invasive cancer in patients with satisfactory colposcopy was 2%, and for unsatisfactory colposcopy 15%. Predictive value of a negative ECC was 100% in patients with satisfactory colposcopy, and 98% for unsatisfactory colposcopy. It is concluded that ECC should be used routinely in the investigation of patients with abnormal Pap smears. However, a positive ECC is not considered an absolute contraindication to conservative treatment, provided that colposcopy is satisfactory, that there is no suspicion of invasive cancer, and that a strict follow-up scheme can be maintained during the first year.

Biopsy↗
PubMed1988

Correlation of histology with human papillomavirus DNA detection in the female genital tract.

Genital condyloma and intraepithelial neoplasia secondary to Human Papillomavirus (HPV) infection are characterized by perinuclear halos and marked nuclear atypia (koilocytotic atypia) on cytologic and histologic examination. However, at times the histologic findings, including the degree of nuclear atypia, may be suggestive but not absolutely diagnostic of an HPV related neoplasm. HPV DNA sequences were detected in 63 and 56% of colposcopically visible vaginal and cervical lesions, respectively, that were diagnosed as condyloma or intraepithelial neoplasia. HPV DNA sequences were detected in 14 and 47% of vaginal and cervical lesions, respectively, that did not fulfill the histologic criteria of condyloma or intraepithelial neoplasia (i.e., "nondiagnostic"). When examining cervices from patients with no visible lesion and no recent history of an abnormal pap smear, 5.5% had detectable HPV DNA sequences. The histologic findings in this group were equivalent to the virus-negative cases and similar to the "nondiagnostic" cervical lesions. These findings suggest that the detection rate of HPV DNA in "nondiagnostic" tissues is dependent on the site and presence or absence of a visible lesion. The rate is similar in cervical lesions regardless of the histologic findings whereas it is less in vaginal lesions when the histologic criteria of condyloma or intraepithelial neoplasia are not detected.

Biopsy↗
PubMed1989

Impact of cervical intraepithelial neoplasia diagnosis and treatment on self-esteem and body image.

Most women commonly take an abnormal Pap smear to be indicative of invasive cancer. This fear can permeate their lifestyle to the degree that it may influence receptivity to medical procedures as well as promote cervical intraepithelial neoplasia (CIN) to invasive squamous cell carcinoma of the cervix. This longitudinal study was undertaken to provide baseline data on self-esteem and body image as the patient progresses from the initial visit through the postsurgery visit. Twenty patients ranging in age from 15 to 40 years were followed through diagnosis and treatment with colposcopic biopsy showing 25% CIN I, 45% CIN II, and 30% CIN III. Concern for cancer overrode all other concerns except during the postsurgery visit, at which time loss of attractiveness was paramount. Loss of sexual functioning ranked high in all visits. Self-esteem was lowest and anxiety highest during the initial and postsurgery visits. Positive body image was greatest when the results of the biopsy were received and during the postsurgery visit. Patients and sexual partners exhibited similar patterns of anxiety about the medical condition. Psychological repercussions from CIN occurred even prior to diagnosis.

Adolescent↗
PubMed1990

20-year experience of follow-up of the abnormal smear with colposcopy and histology and treatment by conization or cryosurgery.

During the period 1967 to 1977, 1466 women with Pap smears suggesting cervical epithelial neoplasia (CIN) II or worse were evaluated by colposcopy, portio biopsy, and endocervical curettage. Women who had CIN III were treated first by conization and later by cryosurgery. Cytological diagnosis was inaccurate compared to colposcopical and histological diagnosis, with 27% having a worse histological diagnosis. In 22% of the cases histology was two degrees less or worse than suggested by cytology. Presence of atypical vessels was associated with invasive cancer in 17% of cases. A total of 635 patients were treated by conization. After an average follow-up of 10 years, the cure rate was 96% compared to 87% by cryosurgery (104 cases). Hysterectomy was, mainly because of old age, performed on 154 patients; the cure rate was 97%. Although most treatment failures occurred within the first 5 years, some were seen after as long as 15-20 years.

Adult↗