Central European Journal of Public Health, Apr 1, 2008
Background: Cohort studies have shown that for developing precancerous lesions of uterine cervix ... more Background: Cohort studies have shown that for developing precancerous lesions of uterine cervix HPV infection is crucial. But the main event in the carcinogenesis is not simple detection of infection, but its persistency and viral integration in association with HPV physical status (episomal or integrated). Objectives: Aim of the study is to investigate the prevalence of HPV L1 capsid protein in low grade and high grade squamous lesion (LSIL/HSIL) of the uterine cervix using cytoactive method and compare it with findings of p16INK4a protein in HSIL smears. Materials and Methods: Since the June 2007-December 2007 we analysed cervical smears from 67 patients. All of them are high risk HPV DNA positive. After decolourising slides we performed immunoassaying with cytoactiv screening set for HPV L1 (cytoimmun diagnostic GbmH, Pirmanses, Germany). In patients with HSIL after decolourising their prior cervical smears we performed p16 INK4a staining using DAKO monoclonal antibody. Results: Cytological diagnosis of LSIL was made in 53 patients (53/67), and 14 patients (14/67) had HSIL. In all 14 patients HSIL was confirmed by biopsy or cold knife conisation. After immunoassaying positive HPV L1 was found in 60, 4% (32/53) of LSIL and in 21, 4% (3/14) of HSIL specimens. Strong p16INK4a positive stain was seen in eleven HSIL smears (78, 6%). Conclusions: Lower L1 detection rate in HSIL can be explained by possible loss of viral L genes and consequently lower production of capsid proteins. On the other hand, positive p6INK4a stain represents viral integration in host genome and genetic instability of the host cells which can lead to its malignant transformation. Hence, in L1 negative and p16INK4a positive smears, lesions will most likely progress, so patients can be advised for shorter control period or sooner histological confirmation.
A case of primary squamous cell carcinoma of the endometrium (PSCCE) in a virgin treated with sur... more A case of primary squamous cell carcinoma of the endometrium (PSCCE) in a virgin treated with surgery--abdominal hysterectomy and bilateral salpingo-oophorectomy, and followed by whole pelvic radiation is presented. The tumor recurred 12 months later and the patient then underwent relaparotomy and excision of recurrent tumor of the pelvis; right hemicolectomy and rectosigmoidectomy were done due to recurrence and metastasis of the primary tumor. After re-operation, six courses of cisplatin and 5-fluorouracil were given intravenously for cytotoxic effects at 3-week intervals. The patient's disease progressed despite therapy, and she died three months after the last cycle or 21 months after the first diagnosis was made.
Vulvar Morbus Paget (MP) represents a rare intraepithelial adenocarcinoma. It accounts for less t... more Vulvar Morbus Paget (MP) represents a rare intraepithelial adenocarcinoma. It accounts for less than 1% of all vulvar neoplasia and usually appears in postmenopausal women. Histologically it is analogous to Paget's disease of the breast. The most common clinical symptom is pruritus. The lesion appears as an erythematous or as an eczematous lesion with islands of hyperkeratosis. Occasionally, single anaplastic Paget's cells can be found on the vulvar smears which make cytological diagnosis of the disease possible. However, the disease can be diagnosed only by biopsy. We present a case of 49-year old woman with vulvar symptoms of pruritus, who had liver and kidney transplantation two years ago. During the standard gynecological examination the vulvar smear was taken for cytological evaluation. The smear was scanty, with inflammatory background, overloaded with squamae. There were two types of cells: dysplastic squamous cells from lower layer of the epithelium and the single, anaplastic cells with a high nuclear:cytoplasmic ratio who possessed eccentric, large nucleus. Nucleoli were rare. Cytoplasm varied from pale and delicate to densely basophilic. Accordingly, cytological diagnosis vulvar intraepithelial neoplasia (VIN III) with differential diagnosis of vulvar Paget's disease was made. The pathological verification supported the diagnosis of MP and an immunohistochemistry panel confirmed type III of Paget's disease and an evaluation of bladder was suggested.
Inadequate Pap smear by definition is a specimen in which detection of cervical epithelial abnorm... more Inadequate Pap smear by definition is a specimen in which detection of cervical epithelial abnormality is impossible or uncertain. This causes poorer detection of intraepithelial lesions of a mild and more severe grade, including the possible false-negative diagnosis. Sample adequacy is most crucial in the evaluation of the finding, alerting the gynecologist to the limitations of the finding, its possible inaccuracy, and need to repeat the examination in order to obtain as precise results as possible. The aim of the study was to establish the frequency and reasons of unsatisfactory cervicovaginal smear samples in the course of one year, during which 1594 of 12,242 conventionally obtained cervical samples were sorted out as inadequate. These were reassessed with respect to their adequacy. Eight percent of the smears in which the evaluation of cell abnormality failed due to sample inadequacy were identified and these smears were repeated and analyzed for adequacy and presence of abnormality. The most common reasons included insufficient endocervical epithelial cells, excessive smear thickness, cells obscured with numerous inflammatory elements and erythrocytes, and sample inadequacy due to the presence of foreign material, poor fixation or staining. Inadequate equipment, insufficient material for cytologic analysis, and poor preparation technique may lead to failure to observe abnormality and errors in microscopic analysis. This implies each team member's responsibility for the accuracy of the result as well for the assurance of specimen adequacy. Reduction in the frequency of the reasons mentioned above is possible if internal control, performance quality monitoring and continuing education of each team member are conducted on a regular basis. The necessity to repeat sampling adds to the cost of health care with no considerable increase in the detection rate of epithelial abnormalities, inadequate specimens being the most common cause of false-negative cytologic findings.
OBJECTIVES: Primary fallopian tube carcinoma is among the rarest gynaecologic malignancies. It´s ... more OBJECTIVES: Primary fallopian tube carcinoma is among the rarest gynaecologic malignancies. It´s clinical behaviour resembles in many ways to primary ovarian carcinoma. It is usually diagnosed in advanced stages.CASE: We present a case of a 56 year-old nuliparous patient with routine Pap smear presenting atypical glandular cells. Previous normal smear was taken two years before. The latest smear, constituted of vaginal pool, cervical scrape and endocervical brush sample had no tumour diathesis. The only abnormalities were papillary clusters of malignant glandular cells. Endometrial brush cytology revealed adenocarcinoma cells, similar to those found in Pap smear. Endometrial curettage showed no endometrial pathology but suspected malignant cells of extrauterine source. The level of CA-125 marker was in the normal range. Clinical examination and pelvic ultrasound showed no pathological finding. Based on positive cytology by Pap smear, endometrial aspiration and curretage we performed diagnostic laparotomy, during which an intraoperative cytology of the Douglas pouch lavage was performed showing positive cytology (adenomalignat cells) and positive immunocytochemical stain epithelial antigen (EA by DAKO). In spite no macroscopic morphologic pathology has been found, hysterectomy and bilateral adnexectomy was performed and the pathohystologic confirmation of primary adenocarcinoma of the right fallopian tube (Gr II/III, alveo-medullar type) was done. The 1, 0x0, 7x0, 6 mm big tumour invaded more than ½ of the muscular layer but not beyond. The uterus and the ovaries showed no pathological finding with bilateral hydrosalpinges.CONCLUSION: The presented case suggests that cytological examination although not specific may be a helpful tool in the rare cases of the stage I tubal carcinoma. Cytology has inevitable role in staging of the disease by detecting positive peritoneal lavage.
... Autori: Šentija, Karmela; Krivak Bolanča, Ines; Simon-Katalenić, Suzana. ... used for tha ana... more ... Autori: Šentija, Karmela; Krivak Bolanča, Ines; Simon-Katalenić, Suzana. ... used for tha analysis: koilocytosis, binucleation and parakeratosis for HPV infection, cytoplasmatic vacuolisation with presence of nebular and infectious bodies for Chlamydia trachomatis, and clue cells for ...
Central European Journal of Public Health, Apr 1, 2008
Background: Cohort studies have shown that for developing precancerous lesions of uterine cervix ... more Background: Cohort studies have shown that for developing precancerous lesions of uterine cervix HPV infection is crucial. But the main event in the carcinogenesis is not simple detection of infection, but its persistency and viral integration in association with HPV physical status (episomal or integrated). Objectives: Aim of the study is to investigate the prevalence of HPV L1 capsid protein in low grade and high grade squamous lesion (LSIL/HSIL) of the uterine cervix using cytoactive method and compare it with findings of p16INK4a protein in HSIL smears. Materials and Methods: Since the June 2007-December 2007 we analysed cervical smears from 67 patients. All of them are high risk HPV DNA positive. After decolourising slides we performed immunoassaying with cytoactiv screening set for HPV L1 (cytoimmun diagnostic GbmH, Pirmanses, Germany). In patients with HSIL after decolourising their prior cervical smears we performed p16 INK4a staining using DAKO monoclonal antibody. Results: Cytological diagnosis of LSIL was made in 53 patients (53/67), and 14 patients (14/67) had HSIL. In all 14 patients HSIL was confirmed by biopsy or cold knife conisation. After immunoassaying positive HPV L1 was found in 60, 4% (32/53) of LSIL and in 21, 4% (3/14) of HSIL specimens. Strong p16INK4a positive stain was seen in eleven HSIL smears (78, 6%). Conclusions: Lower L1 detection rate in HSIL can be explained by possible loss of viral L genes and consequently lower production of capsid proteins. On the other hand, positive p6INK4a stain represents viral integration in host genome and genetic instability of the host cells which can lead to its malignant transformation. Hence, in L1 negative and p16INK4a positive smears, lesions will most likely progress, so patients can be advised for shorter control period or sooner histological confirmation.
A case of primary squamous cell carcinoma of the endometrium (PSCCE) in a virgin treated with sur... more A case of primary squamous cell carcinoma of the endometrium (PSCCE) in a virgin treated with surgery--abdominal hysterectomy and bilateral salpingo-oophorectomy, and followed by whole pelvic radiation is presented. The tumor recurred 12 months later and the patient then underwent relaparotomy and excision of recurrent tumor of the pelvis; right hemicolectomy and rectosigmoidectomy were done due to recurrence and metastasis of the primary tumor. After re-operation, six courses of cisplatin and 5-fluorouracil were given intravenously for cytotoxic effects at 3-week intervals. The patient's disease progressed despite therapy, and she died three months after the last cycle or 21 months after the first diagnosis was made.
Vulvar Morbus Paget (MP) represents a rare intraepithelial adenocarcinoma. It accounts for less t... more Vulvar Morbus Paget (MP) represents a rare intraepithelial adenocarcinoma. It accounts for less than 1% of all vulvar neoplasia and usually appears in postmenopausal women. Histologically it is analogous to Paget's disease of the breast. The most common clinical symptom is pruritus. The lesion appears as an erythematous or as an eczematous lesion with islands of hyperkeratosis. Occasionally, single anaplastic Paget's cells can be found on the vulvar smears which make cytological diagnosis of the disease possible. However, the disease can be diagnosed only by biopsy. We present a case of 49-year old woman with vulvar symptoms of pruritus, who had liver and kidney transplantation two years ago. During the standard gynecological examination the vulvar smear was taken for cytological evaluation. The smear was scanty, with inflammatory background, overloaded with squamae. There were two types of cells: dysplastic squamous cells from lower layer of the epithelium and the single, anaplastic cells with a high nuclear:cytoplasmic ratio who possessed eccentric, large nucleus. Nucleoli were rare. Cytoplasm varied from pale and delicate to densely basophilic. Accordingly, cytological diagnosis vulvar intraepithelial neoplasia (VIN III) with differential diagnosis of vulvar Paget's disease was made. The pathological verification supported the diagnosis of MP and an immunohistochemistry panel confirmed type III of Paget's disease and an evaluation of bladder was suggested.
Inadequate Pap smear by definition is a specimen in which detection of cervical epithelial abnorm... more Inadequate Pap smear by definition is a specimen in which detection of cervical epithelial abnormality is impossible or uncertain. This causes poorer detection of intraepithelial lesions of a mild and more severe grade, including the possible false-negative diagnosis. Sample adequacy is most crucial in the evaluation of the finding, alerting the gynecologist to the limitations of the finding, its possible inaccuracy, and need to repeat the examination in order to obtain as precise results as possible. The aim of the study was to establish the frequency and reasons of unsatisfactory cervicovaginal smear samples in the course of one year, during which 1594 of 12,242 conventionally obtained cervical samples were sorted out as inadequate. These were reassessed with respect to their adequacy. Eight percent of the smears in which the evaluation of cell abnormality failed due to sample inadequacy were identified and these smears were repeated and analyzed for adequacy and presence of abnormality. The most common reasons included insufficient endocervical epithelial cells, excessive smear thickness, cells obscured with numerous inflammatory elements and erythrocytes, and sample inadequacy due to the presence of foreign material, poor fixation or staining. Inadequate equipment, insufficient material for cytologic analysis, and poor preparation technique may lead to failure to observe abnormality and errors in microscopic analysis. This implies each team member's responsibility for the accuracy of the result as well for the assurance of specimen adequacy. Reduction in the frequency of the reasons mentioned above is possible if internal control, performance quality monitoring and continuing education of each team member are conducted on a regular basis. The necessity to repeat sampling adds to the cost of health care with no considerable increase in the detection rate of epithelial abnormalities, inadequate specimens being the most common cause of false-negative cytologic findings.
OBJECTIVES: Primary fallopian tube carcinoma is among the rarest gynaecologic malignancies. It´s ... more OBJECTIVES: Primary fallopian tube carcinoma is among the rarest gynaecologic malignancies. It´s clinical behaviour resembles in many ways to primary ovarian carcinoma. It is usually diagnosed in advanced stages.CASE: We present a case of a 56 year-old nuliparous patient with routine Pap smear presenting atypical glandular cells. Previous normal smear was taken two years before. The latest smear, constituted of vaginal pool, cervical scrape and endocervical brush sample had no tumour diathesis. The only abnormalities were papillary clusters of malignant glandular cells. Endometrial brush cytology revealed adenocarcinoma cells, similar to those found in Pap smear. Endometrial curettage showed no endometrial pathology but suspected malignant cells of extrauterine source. The level of CA-125 marker was in the normal range. Clinical examination and pelvic ultrasound showed no pathological finding. Based on positive cytology by Pap smear, endometrial aspiration and curretage we performed diagnostic laparotomy, during which an intraoperative cytology of the Douglas pouch lavage was performed showing positive cytology (adenomalignat cells) and positive immunocytochemical stain epithelial antigen (EA by DAKO). In spite no macroscopic morphologic pathology has been found, hysterectomy and bilateral adnexectomy was performed and the pathohystologic confirmation of primary adenocarcinoma of the right fallopian tube (Gr II/III, alveo-medullar type) was done. The 1, 0x0, 7x0, 6 mm big tumour invaded more than ½ of the muscular layer but not beyond. The uterus and the ovaries showed no pathological finding with bilateral hydrosalpinges.CONCLUSION: The presented case suggests that cytological examination although not specific may be a helpful tool in the rare cases of the stage I tubal carcinoma. Cytology has inevitable role in staging of the disease by detecting positive peritoneal lavage.
... Autori: Šentija, Karmela; Krivak Bolanča, Ines; Simon-Katalenić, Suzana. ... used for tha ana... more ... Autori: Šentija, Karmela; Krivak Bolanča, Ines; Simon-Katalenić, Suzana. ... used for tha analysis: koilocytosis, binucleation and parakeratosis for HPV infection, cytoplasmatic vacuolisation with presence of nebular and infectious bodies for Chlamydia trachomatis, and clue cells for ...
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