Clinical errors in the diagnostic of cervical dysplasia. Clinical cases

Introduction/BackgroundErrors in the clinical management of patients with persistence of human papillomavirus infection occur in the practice of gynecologistsMethodologyAim of the study was to evaluate 5 clinically important complications of...

Human papillomavirus genotyping and p16INK4a expression in cervical intraepithelial neoplasia of adolescents

Factors associated with HPV persistence after treatment for high-grade cervical intra-epithelial neoplasia with large loop excision of the transformation zone (LLETZ)

Background. Despite the growing scientific interest in cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) infection, the prevalence and morphological variants of cervical ectopy in the context of various forms of infertility remain insufficiently studied. Objective. To assess the prevalence and histological features of cervical ectopy in women with different types of infertility and CIN, and to analyze the association of these changes with HPV infection. Methods. A total of 250 reproductive-aged women with histologically confirmed CIN in the setting of infertility were examined. All cervical biopsy specimens underwent standard histological processing and hematoxylin and eosin staining. The presence of cervical ectopy, squamous metaplasia, and CIN grade were evaluated, followed by analysis of their frequency in relation to the type of infertility and the presence of HPV infection. Statistical analysis was performed using the chi-square (χ²) test. Results and conclusions. Cervical ectopy was detected in 79.2% of patients with CIN, most commonly in cases of low-grade lesions (46.46%). The highest rate of cervical ectopy was observed in women with tubal infertility (44.94%). The frequency of squamous metaplasia within cervical ectopy increased proportionally with CIN severity: 13.04% in CIN I, 16.0% in CIN II, and 29.0% in CIN III. In groups with metaplastic ectopy, patients with tubal and combined types of infertility predominated. No statistically significant association was found between the type of infertility and the variant of ectopy (p>0.05). Cervical ectopy is a common morphological background in CIN, particularly in the presence of HPV infection, and is more frequently observed in women with tubal infertility. The identified trend of increasing squamous metaplasia in cervical ectopy with higher CIN grades, especially in patients with combined infertility, may indicate its potential role as a morphological predictor of CIN progression and warrants further investigation.

The expression of p53 and bcl-2 proteins by immunohistochemistry and the identification of human papillomavirus (HPV) infection by a non-isotopic polymerase chain reaction (PCR)based method were investigated in 30 patients with head and neck cancer. Ten cases were HPV-positive (33%), mostly as double or multiple infections by high- or intermediate-risk types. Twenty-one patients were p53-positive (70%), 9/10 with HPV-positive tumours and 12/20 with HPV-negative tumours; this difference was not statistically significant. Only four cases were bcl-2-positive, irrespective of the presence of either HPV or p53. No correlation was found between these biological factors and tumour stage, differentiation grade, and alcohol or tobacco use. Our findings indicate that p53 is involved in the majority of cases, bcl-2 is rare, and high-risk HPV could play a key role, especially in tumours of tongue and tonsil. In conclusion p53 and bcl-2 protein expression and the presence of HPV infection are independent events in these malignancies.

<div>Abstract<p>Genital tract infections, including vulvovaginal candidiasis and bacterial vaginosis, have emerged as potential modulators of persistent human papillomavirus (HPV) infections causing cervical cytologic abnormalities and cervical cancer. This study aimed to investigate whether vulvovaginal candidiasis or bacterial vaginosis had an additional effect on HPV infection and thus caused such abnormalities. ThinPrep cytologic tests were used to detect cytologic abnormalities, vulvovaginal candidiasis, and bacterial vaginosis in 14,679 women. Cytologic abnormalities included atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, atypical squamous cells-cannot exclude HSIL, and squamous cell carcinoma. Logistic regression Model 1 (univariate regression) and Model 2 (multivariate logistic regression analysis adjusted for age combined with HPV infection) were used to analyze the association between bacterial vaginosis and cytologic abnormalities, or vulvovaginal candidiasis and cytologic abnormalities, alone or in the presence of HPV infection. Bacterial vaginosis infection rates were found to be significantly higher in the cytology-negative group among all participants and those with HPV infection (<i>P</i> = 0.003, <i>P</i> < 0.001, respectively). Analyses using Model 1 and Model 2 both pointed to bacterial vaginosis as a protective factor against cytologic abnormalities for all participants (OR = 0.36, 0.17, respectively, <i>P</i> < 0.05) and for HPV-infected participants (OR = 0.17, 0.16, respectively, <i>P</i> < 0.05). Neither vulvovaginal candidiasis nor vulvovaginal candidiasis + HPV was significantly associated with the incidence of cytologic abnormalities based on Model 1 (OR = 0.94, 0.71, respectively, <i>P</i> > 0.05) and Model 2 (OR = 0.91, 0.74, respectively, <i>P</i> > 0.05). Furthermore, neither vulvovaginal candidiasis nor bacterial vaginosis increased the incidence of cytologic abnormalities regardless of HPV infection status, while bacterial vaginosis might possibly prevent cytologic abnormalities in women coinfected by HPV.</p>Prevention Relevance:<p>Neither vulvovaginal candidiasis nor bacterial vaginosis was found to increase the incidence of cervical cytologic abnormalities with or without the presence of HPV. On the contrary, bacterial vaginosis may play a role in preventing cytologic abnormalities in women with HPV coinfection.</p></div>

Studies using estimated blood loss show the association of either human papillomavirus (HPV) or cervical intraepithelial neoplasia (CIN) with postpartum hemorrhage (PPH). We study the association of HPV or CIN with either blood loss or PPH as measured by the more precise measure of quantitative blood loss (QBL). We retrospectively studied 2,334 peripartum women with a documented Pap smear prior to de- livery. The main predictor variable had categories for HPV and CIN as compared to normal cytology. Covariates included demographics, medical/surgical history, and pregnancy variables. Model 1 included the whole sample. Model 2 included only those with an operative vaginal delivery or a cesarean delivery. Outcome measures were QBL and PPH measured by QBL. We found in model 1 that those HPV positive and those with CIN were each not significantly associated with QBL. In model 2, those HPV positive were significantly associated with increased QBL (B = 0.11, SE = 0.05, p = 0.047), while CIN was not significantly associated with QBL. In model 1, those HPV positive and those with CIN were each not significantly associated with PPH. In model 2, those HPV positive were significantly associated with increased odds for PPH (OR:11.03, 9% CI:1.77, 68.74, p = 0.01) while CIN was not significantly associated with PPH. In conclusion, the presence of HPV was positively associated with an increase in the QBL and PPH at time of delivery for those with operative vaginal and cesarean deliveries. We suggest that clinicians take HPV results of Pap smears into consideration when considering a patient's risk of PPH.

Objective To investigate the correlation between human papillomavirus (HPV) -16, -18 and C-X-C chemokine receptor (CXCR) 7 in cervical cancer and intraepithelial neoplasm. Methods A total of 59 patients who underwent cervix resection and were diagnosed as cervical cancer by pathological detection, 86 patients who under went cervix resection and were diagnosed as cervical intraepithelial neoplasm (CIN) by pathological detection and 20 patients who underwent cervix resection due to other diseases were collected as study subjects in the Zhuhai People′s Hospital from March 2011 to March 2013. They were enrolled into cervical cancer group (n=59), CIN group (n=86) and control group (n=20), respectively. The expression of CXCR7 was examined by immunohistochemical, and the difference of CXCR7 expression among 3 groups were analyzed. Subsequently, the relative expression of HPV-16 DNA and HPV-18 DNA were verified with quantitative real-time PCR. Eventually, the protein expression profile of CXCR7 and stromal cell-derived factor (SDF)-1 were tested by Western blotting among 3 groups, and then the correlation analysis were performed between the expression HPV-16 DNA, HPV-18 DNA and CXCR7. There were no significant differences between two groups in age and other general clinical data (P>0.05). Results ①The expression positive rates of CXCR7 in cervical tissues of cervical cancer group and CIN group both were significantly higher than that of control group, which were 88.1% (52/59) vs 15.0% (3/20) and 46.5% (40/86) vs 15.0% (3/20), and both the differences were statistically significant (χ2=37.77, P<0.001; χ2=6.68, P=0.010). ②The expression of HPV-16 DNA in CIN Ⅰ, CIN Ⅱ, CIN Ⅲ and cervical cancer tissues were (1.50±0.05) times, (2.87±0.09) times, (3.17±0.12) times and (6.41±0.20) times as much as that in normal cervix tissues, respectively, and the expression of HPV-16 DNA in CIN Ⅲ and cervical cancer tissues both were significantly higher than that in normal cervix tissues, and both the differences were statistically significant (t=2.15, P=0.042; t=3.11, P=0.003). Likewise, the expression of HPV-18 DNA in CIN Ⅰ, CIN Ⅱ, CIN Ⅲ and cervical cancer tissues were (1.56±0.07) times, (2.45±0.11) times, (3.89±0.16) times and (6.12±0.17) times as much as that in normal cervix tissues, respectively, and the expression of HPV-18 DNA in CIN Ⅲ and cervical cancer tissues both were significantly higher than in normal cervix tissues, and both the differences were statistically significant (t=2.21, P=0.024; t=3.03, P=0.004). ③The expression of CXCR7 and SDF-1 increased as the the deterioration of the disease by Western blotting. Not only that, there were positive correlation between CXCR7 expression and HPV-16 DNA (r=0.74, P<0.001), and HPV-18 DNA (r=0.78, P<0.001). Conclusion HPV may contribute the progression of cervical cancer induced by high-risk HPV. Key words: Receptors, chemokine; Human papillomavirus 16; Human papillomavirus 18; Uterine cervical neoplasms; Cervical intraepithelial neoplasia

Department of Anaesthesia and Critical Care, Paras Global Hospital, Darbhanga, Bihar, India Address for correspondence: Dr. Pankaj Kumar, Flat No. 301, Jyotipuram Apartment, Bengali Tola, Laheriasarai, Darbhanga - 846 001, Bihar, India. E-mail: [email protected]

Junior doctors frequently rely on electronic access to clinical guidelines to inform assessment and management, particularly whilst on-call and occasionally during emergencies. Difficulties in locating and accessing up to date...

Surgical blunders and how to avoid them: “Frumious Bandersnatch,” Gainesville, Fla., 1990, Triad Publishing Co., 168 pages, $17.95

Unilateral adrenal hyperplasia causing primary aldosteronism: limitations of I-131 norcholesterol scanning

The aim of this study was to determine the prevalence of human papillomaviruses (HPV) types 6, 11, 16, 18, 31, 33, 42, 51, 52, 56 and 58 in laryngeal squamous cell carcinoma specimens using immunohistochemical reactions and to correlate the presence of HPV with the clinical and pathological characteristics of these patients. Tissue samples were collected from 40 patients with primary laryngeal squamous cell carcinoma (LSCC) and from 33 subjects with non-neoplastic laryngeal lesions or laryngeal nodules, which served as a control group. Human papilloma virus was detected in 6 (15%) of the 40 patients. Five (83.4%) of six patients with HPV positive tumors had G2 (moderately differentiated), one patient (16.6%) had G3 (poorly differentiated), and no patient with HPV positive tumor had a G1 (well-differentiated) tumor. Four (66.6%) of the six HPV positive tumors were in the supraglottic region, one (16.6%) tumor was located in the glottis, and one (16.6%) HPV positive tumor was in the subglotic region. Five (83.4%) of six HPV positive tumors were T3-T4, and one was T2. Three of six HPV positive patients had no clinically evident cervical lymph nodes (N0), and three of the HPV positive patients were N1 or N2. Human papillomavirus was not detected in any of the samples from the control group. The presence of HPV infection in 15% of the cases may suggest a possible role in the etiology of laryngeal squamous cell carcinoma. However, no significant correlation between HPV incidence and histological grading and clinical staging could be demonstrated.

Human Papilloma Virus Infection Does Not Predict Response to Interferon Therapy in Ocular Surface Squamous Neoplasia

Persistent human papillomavirus (HPV) infection can lead to cervical intraepithelial neoplasia (CIN) and cervical cancer, posing serious threats to the health of women. Although the cervicovaginal microbiota is strongly associated with CIN, the dynamics of the microbiota during CIN development are unknown. In this retrospective cohort study, we analyzed 3-year longitudinal data from 72 patients diagnosed with a persistent HPV infection almost all caused by high-risk HPV types. Patients were categorized into groups with HPV persistent infection (n = 37), progression to CIN (n = 16), and CIN regression (n = 19) based on infection outcome during the follow-up period. Furthermore, 16S rRNA gene sequencing was performed on consecutively collected cervical samples to explore the composition and dynamics of the cervicovaginal microbiota during the development and regression of CIN. Our results showed that the composition of the cervicovaginal microbiota varied among women with different HPV infection outcomes and remained relatively stable during the follow-up period. Notably, the serial follow-up data showed that these microbial alterations were present for at least 1-2 years and occurred before pathologic changes. In addition, microbial markers that were highly discriminatory for CIN progression or regression were identified. This study provides evidence for a temporal relationship between changes in the cervicovaginal microbiota and the development of CIN, and our findings provide support for future microbial intervention strategies for CIN.