Carcinoma in Situ ; diagnosis ; pathology ; Cervical Intraepithelial Neoplasia ; diagnosis ; pathology ; Endometrial Hyperplasia ; pathology ; Female ; Humans ; Uterine Cervical Neoplasms ; pathology

Adult ; Cervix Uteri ; pathology ; Female ; Humans ; Sarcoma, Alveolar Soft Part ; diagnosis ; Uterine Cervical Neoplasms ; diagnosis

Carcinoma, Squamous Cell ; diagnosis ; Fallopian Tubes ; pathology ; Female ; Humans ; Middle Aged ; Uterine Cervical Neoplasms ; diagnosis

Objective: To evaluate the efficacy and safety of Nocardia rubra cell wall skeleton (Nr-CWS) in the treatment of persistent cervical high-risk human papillomavirus (HR-HPV) infection. Methods: A randomized, double blind, multi-center trial was conducted. A total of 688 patients with clinically and pathologically confirmed HR-HPV infection of the cervix diagnosed in 13 hispital nationwide were recruited and divided into: (1) patients with simple HR-HPV infection lasting for 12 months or more; (2) patients with cervical intraepithelial neoplasia (CIN) Ⅰ and HR-HPV infection lasting for 12 months or more; (3) patients with the same HR-HPV subtype with no CINⅡ and more lesions after treatment with CINⅡ or CIN Ⅲ (CINⅡ/CIN Ⅲ). All participants were randomly divided into the test group and the control group at a ratio of 2∶1. The test group was locally treated with Nr-CWS freeze-dried powder and the control group was treated with freeze-dried powder without Nr-CWS. The efficacy and negative conversion rate of various subtypes of HR-HPV were evaluated at 1, 4, 8, and 12 months after treatment. The safety indicators of initial diagnosis and treatment were observed. Results: (1) This study included 555 patients with HR-HPV infection in the cervix (included 368 in the test group and 187 in the control group), with an age of (44.1±10.0) years. The baseline characteristics of the two groups of subjects, including age, proportion of Han people, weight, composition of HR-HPV subtypes, and proportion of each subgroup, were compared with no statistically significant differences (all P>0.05). (2) After 12 months of treatment, the effective rates of the test group and the control group were 91.0% (335/368) and 44.9% (84/187), respectively. The difference between the two groups was statistically significant (χ²=142.520, P<0.001). After 12 months of treatment, the negative conversion rates of HPV 16, 18, 52, and 58 infection in the test group were 79.2% (84/106), 73.3% (22/30), 83.1% (54/65), and 77.4% (48/62), respectively. The control group were 21.6% (11/51), 1/9, 35.1% (13/37), and 20.0% (8/40), respectively. The differences between the two groups were statistically significant (all P<0.001). (3) There were no statistically significant differences in vital signs (body weight, body temperature, respiration, pulse rate, systolic blood pressure, diastolic blood pressure, etc.) and laboratory routine indicators (blood cell analysis, urine routine examination) between the test group and the control group before treatment and at 1, 4, 8, and 12 months after treatment (all P>0.05); there was no statistically significant difference in the incidence of adverse reactions related to the investigational drug between the two groups of subjects [8.7% (32/368) vs 8.0% (15/187), respectively; χ²=0.073, P=0.787]. Conclusion: External use of Nr-CWS has good efficacy and safety in the treatment of high-risk HPV persistent infection in the cervix.
Female ; Humans ; Adult ; Middle Aged ; Cervix Uteri/pathology* ; Uterine Cervical Neoplasms/pathology* ; Papillomavirus Infections/diagnosis* ; Cell Wall Skeleton ; Persistent Infection ; Powders ; Uterine Cervical Dysplasia/pathology* ; Immunotherapy ; Papillomaviridae

OBJECTIVETo study the value of endocervical curettage (ECC) in the detection of cervical intraepithelial neoplasia (CIN) and cervical cancer, and the necessity of ECC during colposcopic examination.

METHODSIn the high prevalent area of cervical cancer in Shanxi Province, China, a total of 1997 women aged 35 approximately 45 years old were enrolled. Cervical cytology, colposcopy and targeted multiple biopsies, as well as ECC were performed for all women.

RESULTSAmong the 1997 women received ECC, 31 was positive for abnormal histologic changes with a frequency of 1.6%. Of the 31 cases, 9 had low grade squamous intraepithelial lesions (LSIL, 0.5%), 20 had high grade squamous intraepithelial lesions (HSIL, 1.0%), and 2 had squamous-cell carcinoma. No pathologic diagnosis could be made in 131 women because the tissue curretaged was insufficient. The women with positive cytologic findings had higher frequency (5.3%) of abnormal ECC than those with negative cytologic findings (0.3%). There was positive correlation between the frequency of abnormal ECC and the grade of cytolologic findings. Abnormal ECC was present in 9.1% of those with unsatisfactory colposcopy while 1.3% of those with satisfactory colposcopy (P < 0.01). The frequency of abnormal ECC was 0.6% in patients with negative colpocopy, 0.9% in LSIL and 24.1% in HSIL. Frequency of abnormal ECC in women with a negative colposcopy or LSIL was significantly lower than that with HSIL. The positive rate of ECC pathologically verified was 3.3% in LSIL, 22.2% in HSIL and 50.0% in squamous carcinoma, respectively (P < 0.01). Of the 316 patients with positive cytology but negative colposcopy, ECC was abnormal in 8 (2.5%), of which HSIL cytologically verified was in 3.

CONCLUSIONIf cytology or colposcopy shows HSIL or more severe changes, and cytology is positive while colposcopy is unsatisfactory, ECC should be done routinely.

Adult ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; Cervical Intraepithelial Neoplasia ; diagnosis ; pathology ; Cervix Uteri ; pathology ; Colposcopy ; Dilatation and Curettage ; Female ; Humans ; Middle Aged ; Uterine Cervical Neoplasms ; diagnosis ; pathology

The significance of cervical erosion with benign cellular change on Papanicolaou smear has not been evaluated. A retrospective review of 430 coloscopically directed punch biopsies performed over 15 months revealed 206 cases who had a benign cellular change on cytologic smear. Of these 206 smears, 48(23%) had clear cervix without erosion, 99(48%) had mild erosion on cervix, 41(20%) had moderate cervical erosion and 18(9%) had severe cervical erosion. The false negative rate that revealed more than mild dysplasia on histologic diagnosis was 2% in patients without cervical erosion, 3% in patients with mild cervical erosion, 5 % in patients with moderate cervical erosion, and 11% in patients with severe cervical er- osion. Koilocytotic change that suggested human papilloma virus infection was 17% in each group regardless cervical erosion. In conclusion, benign cellular change on Pap smears in patients with severe cervical erosion may be associated with significant cervical cancer pathology.
Biopsy ; Cervix Uteri ; Diagnosis ; Female ; Humans ; Papanicolaou Test* ; Papilloma ; Pathology ; Retrospective Studies ; Uterine Cervical Neoplasms

For women who have abnormal Pap test results, the biopsy under colposcopic evaluation is the gold standard for determining the treatment modality. To increase the effectiveness of colposcopic communication, the International Federation for Cervical Pathology and Colposcopy (IFCPC) recently published fourth new nomenclature, aiming to create an evidence-based terminology. To increase the diagnostic accuracy of colposcopy, multiple biopsies of two or more sites are recommended. Recently, with the introduction of human papillomavirus (HPV) vaccine for cervical cancer prevention, pre-cancerous diseases caused by virus types 16 and 18 have been reduced, which is expected to reduce the number of colposcopic examinations and make colposcopic diagnosis more difficult.
Biopsy ; Colposcopy ; Diagnosis ; Female ; Humans ; Papanicolaou Test ; Papillomaviridae ; Pathology ; Uterine Cervical Neoplasms

OBJECTIVE: Cervical intraepithelial neoplasia (CIN) and invasive cervix cancer were detected in some cases of atypical squamous cells of undetermined significance (ASCUS) PAP smear. So it is reasonable to evaluate and manage ASCUS PAP smear. In this study, we attempted to assess the clinical significance of a cytologic diagnosis of ASCUS and determine the usefulness of HPV DNA chip test (which is a new diagnostic method for HPV) in management and evaluation of ASCUS patients. METHODS: This study was performed from November 2001 to June 2002 and included 48 cases of ASCUS. They were evaluated by HPV DNA chip test and the pathology was evaluated by punch biopsy, cone biopsy or hysterectomy. The result of type 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 and 69 in HPV DNA chip test were categorized as high risk. RESULTS: The rate of CIN II or above in ASCUS was 18.8% (9/48). The detection rate of high risk HPV DNA in ASCUS was 41.7% (20/48). The detection rate of high risk HPV DNA was 30.6% (11/36) in normal or reactive, 33.3% (1/3) in CIN I, 80% (4/5) in CIN II, 100% (2/2) in CIN III, 100% (2/2) in invasive cervix cancer. Higher the grade of pathology, more the detection rate of high risk HPV DNA chip test. The sensitivity for the prediction of CIN II or above by HPV DNA chip test was 88.9% and specificity was 69.2%, respectively. CONCLUSION: The use of HPV DNA chip test in patients with ASCUS may provide usefulness in detection of CIN II, CIN III and invasive cervix cancer.
Biopsy ; Cervical Intraepithelial Neoplasia ; Diagnosis ; DNA* ; Humans ; Hysterectomy ; Oligonucleotide Array Sequence Analysis* ; Pathology ; Sensitivity and Specificity ; Uterine Cervical Neoplasms

Carcinoma in Situ ; pathology ; Carcinoma, Squamous Cell ; classification ; pathology ; Cervical Intraepithelial Neoplasia ; classification ; pathology ; Diagnosis, Differential ; Female ; Humans ; Precancerous Conditions ; classification ; pathology ; Uterine Cervical Neoplasms ; classification ; pathology

Basaloid squamous cell carcinoma of the uterine cervix is an extremely rare malignancy of the female genital tract with a poorer clinical outcome than squamous cell carcinoma of the uterine cervix. We report a case of pure basaloid squamous cell carcinoma of the uterine cervix. A 70-yr-old woman with vaginal bleeding was referred to our institute. A basaloid squamous cell carcinoma of the uterine cervix, of International Federation of Gynecology and Obstetrics (FIGO) stage Ib1, was diagnosed by a loop electrosurgical excision procedure cone biopsy. A radical hysterectomy was performed, along with bilateral salpingo-oophorectomy, pelvic lymph node dissection, and para-aortic lymph node sampling. Pathologic findings were consistent with a basaloid squamous cell carcinoma confined to the cervix without an extracervical tumor. No further treatment was administered and there was no clinical evidence of recurrence during the 12 months of follow-up. Follow-up for the patient is ongoing. Although basaloid squamous cell carcinoma of the uterine cervix is thought to behave aggressively, accumulation of data on these rare tumors is necessary to determine whether their behavior differs significantly from that of conventional cervical squamous cell carcinoma of similar clinical stage. These data would be useful for defining the best diagnosis and treatment for these rare tumors.
Aged ; Carcinoma, Squamous Cell/*diagnosis/pathology/surgery ; Colonoscopy ; Female ; Humans ; Hysterectomy ; Magnetic Resonance Angiography ; Uterine Cervical Neoplasms/*diagnosis/pathology/surgery