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Background The assessment of retroperitoneal lymph node status in patients with locally advanced cervical cancer is still a problem. This study aimed to explore the choice of these assessment methods. Methods Laparoscopic retroperitoneal lymphadenectomy was performed in 96 patients with advanced cervical cancer. The positive rates of lymph node metastasis were analyzed. The values of computed tomography lymph node minimum axial diameter (MAD) and squamous cell carcinoma antigen (SCC-Ag), and their combination in predicting retroperitoneal lymph node metastasis were compared. High-risk factors for common iliac lymph node (CILN) and/or para-aortic lymph node (PALN) metastasis were analyzed. Results The lymph node metastasis rate was 62.50% and the CILN and/or PALN metastasis rate was 31.25%. Overall, 96 patients had 172 visible lymph nodes. The positive rate of lymph node metastasis was significantly higher in the MAD ≥1.0 cm group (83.33%) than in the 0.5 cm ≤ MAD Conclusion Patients with MAD ≥1.0 cm and SCC-Ag ≥ 5.2 ng/mL, as well as high risk factors for CILN and/or PALN metastasis, should undergo resection of enlarged lymph nodes below the common iliac gland and lymphadenectomy of CILN/PALN to reduce tumor burden and to clarify lymph node metastasis status for accurate guidance in follow-up treatment. Patients with MAD

Background: Cervical cancer was the second most common cancer among women 15-44 years of age and in 2018 it was the fourth most frequent cancer and cause of cancer death among all women in the world Methods:Women (18-65 yrs) attending Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur were recruited for study. After applying inclusion and exclusion criteria written and informed consent were taken from all study participants Results: On histopathology report we found that 10% had normal inflammation followed by 9.33% had carcinoma in situ, 8% had CIN-2, 6.67% had CIN-1, 5.67% had CIN-3 and Squamous cell carcinoma each. Conclusion: Pap smear and colposcopy both the tests can be used to complement each other in a hospital based screening programme, where facilities for both modalities are available. Hence use of single visit approach in which cytology, colposcopy and guided biopsy all are done in single sitting, and treated accordingly in resource poor countries like ours will enable maximal utilization of scarce medical resources. Keywords: Pap smear, CIN, Cervical cancer

Objective To investigate the clinical significance of separate lateral parametrial lymph node dissection (LPLND) in improving parametrial lymph node (PLN) and its metastasis detection rate during radical hysterectomy for early-stage cervical cancer. Methods From July 2007 to August 2017, 2,695 patients with cervical cancer in stage IB1-IIA2 underwent radical hysterectomy were included. Of these patients, 368 underwent separate dissection of PLNs using the LPLND method, and 2,327 patients underwent conventional radical hysterectomy (CRH). We compared the surgical parameters, PLN detection rate and PLN metastasis rate between the two groups. Results Compared with CRH group, the rate of laparoscopic surgery was higher (60.3% vs. 15.9%, P

During the COVID-19 pandemic, there are concerns about medical delay, including confirmatory tests after screening for various cancers. We evaluated the lead time to a confirmatory test after an abnormal screening Papanicolaou (Pap) test in women before the COVID-19 period and during the COVID-19 period.The medical records of 1144 women who underwent colposcopy at a single institution located in Seoul after abnormal Pap results from January 2019 to December 2020 were reviewed. The lead time to colposcopy from the Pap test between 2019 and 2020 was compared; the adverse factors for a long lead time to colposcopy were also evaluated.Age, residence, institution, and the Pap results did not differ between women who underwent colposcopy in 2019 (n = 621) and 2020 (n = 523). The time to colposcopy from the Pap test was also not different. A higher number of women were diagnosed with high-grade dysplasia in 2020 and underwent excision procedures; however, the difference was not statistically significant. Instead, patients' residence, institution of the Pap test, and results of the Pap test were associated with a long lead time to colposcopy of >6 weeks.The lead time to colposcopy from the abnormal Pap test was not delayed in the COVID-19 era compared to before. However, regional factors could affect a long lead time.

Introduction: Cancer of uterine cervix is the most common genital tract malignancy. Pap smear though widely used screening test for cervical cancer has the disadvantage of low sensitivity. Colposcopy has higher sensitivity compared to Pap smear. Concurrent screening with Pap smear and colposcopy can overcome this problem. Aim: The aim of the study was correlation of Pap smear and colposcopic finding with directed biopsy in detection of cervical neoplasm. Methods: The Present study was conducted in the Department of Pathology, Gujarat Adani Institute of Medical Science, Bhuj, Kutch.During the study period in 57 symptomatic patient’s simultaneous Pap smear, colposcopic examination, followed by directed biopsy was performed. Data was recorded and analyzed. Results: In correlation between cytology and biopsy, sensitivity of cytology was 82.3%, specificity 96.9% and accuracy of 92%. In correlation between colposcopy and biopsy, sensitivity of colposcopy was 94.1%, specificity 87.8% and accuracy of 90%. Conclusion: High sensitivity in colposcopy as compared to cytology and high specificity in cytology as compared to colposcopy emphasizes the need for pairing these methods to achieve better results.

Aim In the recent years, the number of cervical conization procedures performed for diagnostic or therapeutic purposes is increasing, accompanied by increased cervical neoplasia among young women. This study aimed to analyze the clinical data of patients who underwent conization in Japan. Methods Among the 14 832 cases of conization registered in 205 facilities over 2 years (2009-2011), the data of 2409 and 12 417 patients who underwent conization for diagnostic and therapeutic purposes, respectively, were retrospectively analyzed. Results The median age of the patients in diagnostic and therapeutic conization groups was 44 and 37 years, respectively. When comparing the diagnostic and therapeutic groups, 25.5% of the patients in the former were suspected with invasive cancer preoperatively, which is higher than that in the latter (2.7%). About 25.7% in the diagnostic and 14.1% in the therapeutic group had positive margin in the conization specimens. Additional treatment was required for 36.0% and 5.5% of the patients in the diagnostic and therapeutic groups, respectively, which are high figures for both. The risk factors of pathological upgrade in the conization specimens were diagnostic purpose, postmenopausal status and glandular lesion. Additional hysterectomy was performed in 1304 patients after conization, and pathological diagnosis was upgraded in 550 cases. Multivariate analysis revealed that postmenstrual status was an independent risk factor. Conclusion This study revealed that cervical lesions of glandular lineage and patients with postmenopausal status benefit from diagnostic conization. However, in postmenopausal patients, the underlying disease cannot be excluded in the preserved uterus even by diagnostic conization.

To investigate a unique procedure of joined transoral and retropharyngeal high cervical approach (JTRC) without mandibulectomy for treating upper cervical neoplasm involving both C2 and C3. A 23-year-old male patient had neoplasma involving C2 and C3 that caused pathologic fracture of C2 and bony destruction of C3. The neoplasm excision and cervical spine reconstruction were performed through JTRC approach without splitting up the mandible. In this approach, there were two surgery windows that could be applied in turns by closing or opening the mouth to gain an ideal exposure. By rotating the mandible, we could gain maximized exposure for either surgery windows. In addition, there was an overlay zone between transoral approach and high cervical retropharyngeal approach that could eliminate the blind area behind the mandible. All the procedures were successfully performed; the surgical incisions healed without infection. By operating alternatively between the two surgery windows, we have successfully performed neoplasm excision and cervical spine reconstruction involving both C2 and C3. Pathologic results showed metastatic renal cell cancer to the resected cervical tumor and confirmed the patient’s diagnosis of tuberous sclerosis (Bourneville disease). A 3-month postoperative cervical spine radiography and CT scan demonstrated a favorable placement of the bone implant as well as a favorable instrumentation. The JTRC approach could provide good surgical exposure for treating disorders involving both upper and lower cervical spine without splitting up the mandible.

When detected early, uterine cervical cancer is one of the most successfully treatable forms of cancer. The diagnostic accuracy of the standard method, the Pap smear test followed by colposcopy, remains unsatisfactory. To improve detection of early-stage cervical cancer, new diagnostic tools for uterine cervical intraepithelial neoplasm (CIN) need to be developed. Magnifying endoscopy with narrow- band imaging (ME-NBI), which allows the visualization of the micro-structure as well as micro-vascularity of the mucosal surface, has excellent diagnostic ability for early gastrointestinal neoplasms. In our previous investigation, ME-NBI was efficacious for diagnosis of CIN. We herein report two notable cases of CIN3 that were diagnosed by ME-NBI that were not detected by colposcopy. These cases illustrate the usefulness of ME-NBI for diagnosis of early-stage uterine cervical neoplasms.

Highlights • Cervical cancer may present with underlying mixed histopathology. • Sequencing revealed a FGFR2-TACC2 fusion in neuroendocrine small cell carcinoma of the cervix. • The understanding genomic heterogeneity of cervical cancer continues to evolve with expansion of clinical trial options., Neuroendocrine small cell carcinoma of the uterine cervix portends a dismal prognosis with limited treatment options. Rarely, tumors of mixed-lineage appear in gynecologic malignancies. Here, we report a 77-year-old woman who presented with complete uterine prolapse and 4-month history of vaginal bleeding. Histopathologic evaluation revealed a mixed adenoid cystic carcinoma and neuroendocrine small cell carcinoma of the uterine cervix. The tumor was PD-L1 and HPV 35 positive. The patient was treated with up-front surgery and adjuvant radiation. Independent, histology-specific alterations in FGFR2 and a FGFR2-TACC2 fusion were identified. Progression of disease occurred within 6 months for which she received chemotherapy and immunotherapy. However, the patient expired within a year. We comprehensively review how screening for and targeting of FGFR alterations in recurrent and metastatic cervical cancer might serve as a touchstone for future treatment regimens.

Objective Human papillomavirus testing by self-sampling and urine sampling might be alternatives to Papanicolaou test (Pap test) for cervical cancer screening (CCS), and may increase compliance and adherence thereto. The present study aimed to explore satisfaction and preferences for cervical screening modalities among Korean women. Methods In total, 732 women aged between 20 and 69 years responded to a questionnaire designed to survey the women's perceived satisfaction for the 3 CCS modalities: clinician-collected Pap test, self-collected vaginal sampling (self-sampling) and urine sampling. Results Overall satisfaction was significantly higher with both the self-sampling and urine sampling than the clinician-collected Pap test (odds ratio [OR]=2.01; 95% confidence interval [CI]=1.48–3.00 and OR=2.47; 95% CI=1.75–3.48, respectively). Psychological distress, including embarrassment, pain, anxiety, discomfort, and stress, with self-sampling and urine sampling were significantly lower than that with the Pap test. 52% of participants reported preferences for self-sampling in the next screening round. Conclusions Korean women were more likely to report satisfaction with alternative modalities (self-sampling and urine sampling) for CCS in comparison to the Pap test. This suggests that self-collected modalities may help with improving CCS uptake rates by eliminating burden related with the Pap test. However, further studies for test accuracy and cost-effective analysis of the alternative modalities should be conducted in order to apply CCS.

Introduction: Cervical cancer is the leading cause of cancerrelated deaths in the female population. Human Papillomavirus (HPV) genotypes 16 and 18 accounts for 70% of cervical cancer cases. HPV infection is associated with the development of cervical carcinoma and its precancerous lesions, and early intervention can effectively prevent cervical cancer. Therefore, it is essential to evaluate the prevalence of HPV types. Aim: To evaluate the incidence of HPV infection in a university hospital in Cheonan, Korea over 5 years and its changes over time. Materials and Methods: This was a retrospective study. HPV detection and genotyping were performed on 7,874 consecutive cervical swab specimens between 2013 and 2018. Cervical swab specimens were obtained from women aged 21-81 years using a cervical brush and specimen transport medium. HPV DNA was detected by multiplex real-time PCR. The detected HPV types were classified according to risk. HPV data were analysed using R. (version 3.3.3, Comprehensive R Archive Network; https://www.r-project.org) The chi-square test was performed to analyse categorical data. The prevalence and 95% confidence intervals were calculated for the overall HPV genotypes and each individual genotype. Statistical significance was considered at p

Introduction According to recent statistics, there is a high percentage of refusal of cervical cancer screening using the Pap smear test by women in rural communities in developing countries such as Peru. There are few studies on the reasons to explain said refusal in this country. The objective of this study was to determine the barriers related to the non-acceptance of cervical cancer screening using the Pap smear test in women of childbearing age from a rural Peruvian community. Methods Cross-sectional study, with a total of 892 women of childbearing age from the rural Peruvian community of Marián, Huaraz province, Ancash region, who did not accept screening for cervical cancer using the Pap smear test during their care at the Marián Health Centre. A questionnaire given from September 2017 to April 2018 was used. The information was processed with the statistics programme for social science 22.0 programme, using the Chi-square statistical test. Results For 4–6 years, 52.5% of women refused cervical cancer screening using the Pap smear test. The barriers that showed a statistically significant relationship to the non-acceptance of cervical cancer screening using the Pap test were socio-demographic (age, marital status, education level, occupation and home income) and institutional barriers (counselling for cervical cancer screening, importance of the gender of health personnel administering the screening, history of mistreatment by health personnel, fear or embarrassment of the screening procedure and a delay in sending the results) (p < 0.05); while a history of sexually transmitted infections and a feeling of physical well-being in sexual and reproductive health were the only related reproductive barriers (p 0.05). Conclusions Socio-demographic and institutional barriers are related to the non-acceptance of cervical cancer screening using the Pap test in women of childbearing age in the rural Peruvian community of Marián, with a lesser emphasis on reproductive barriers. With this in mind, we recommend undertaking broader studies in populations of different age groups, which should be oriented towards the design and application of preventive/promotional programmes by health institutions to promote the participation of community workers with the goal of aiding the identification and control of said barriers, reducing the refusal of cervical cancer screenings by women from rural areas.

INTRODUCTION This study aims to compare the antioxidant abilities of cervical squamous carcinoma cells and cervical adenocarcinoma cells and to study the related mechanisms. MATERIAL AND METHODS Cervical squamous carcinoma and adenocarcinoma cells were treated with H2O2. Cell proliferation was determined with the MTT assay. The reactive oxygen species (ROS) level was detected by the 2',7'-dichlorofluorescein-diacetate (DCFH-DA) method. The 5,5'-dithiobis-2-nitrobenzoic acid (DTNB) method was performed to measure intracellular concentrations of reduced glutathione (GSH) and oxidized glutathione (GSSG). The nitrite formation method, the molybdate colorimetric method, and the DTNB colorimetric method were used to determine activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), respectively. RESULTS Compared with untreated control cells, cell proliferation of cervical squamous carcinoma cells and cervical adenocarcinoma cells was significantly inhibited by H2O2 treatment (p < 0.05). Reactive oxygen species levels and GSSG levels were significantly increased (p < 0.01), whereas GSH levels were significantly decreased (p < 0.05 or 0.01) in both cells after H2O2 treatment. Thus the ratio of GSH/GSSG was significantly decreased by H2O2 treatment in both cells (p < 0.01). In addition, H2O2 treatment significantly increased activities of SOD, CAT, and GPx in both cells (p < 0.05 or 0.01). Furthermore, the above-mentioned changes induced by H2O2 treatment were more dramatic in cervical squamous carcinoma cells. CONCLUSIONS The antioxidant ability of cervical squamous carcinoma cells is lower than that of cervical adenocarcinoma cells, which may be related to the increased ROS levels in cervical squamous carcinoma cells induced by H2O2 treatments.

Melanotic schwannoma (MS) is an unusual variant of nerve sheath neoplasm. Only 10% of these tumors will undergo malignant degeneration, with exceedingly rare reported metastasis. We present a 32-year-old woman with a 6-month history of cervical pain and left arm progressive weakness. Neurological examination showed a left upper limb radicular pain, with pyramidal syndrome at C5 level. The magnetic resonance imaging (MRI) study highlighted an intradural extramedullary heterogeneous mass along the spinal cord at the C4–C5 level, slightly hyperintense with T1 and hypointense with T2-weighted sequences, invading the left neural foramen. The patient underwent C3–C5 laminectomy with total resection of a black tumor. In the postoperative period, a patent deficit of shoulder abduction ensued related to the nervous section. Microscopically, compactly fascicles of spindle-shaped cells with pleomorphic and hypercromatic nuclei, dark brown intracellular pigments, as well as some mitotic figures were seen. Immunohistochemical stains for S-100, Human Melanoma Black-45 (HMB-45), and vimentin were positive, with Ki-67 labelling index (LI) of 15% compatible with MS. Six months after radiotherapy she presents local recurrence and lung metastatic dissemination of the MS. She underwent left pulmonary segmentectomy, followed by chemotherapy and radiosurgery. The patient developed a febrile neutropenia and worsening of general status, and died after 3 months due to respiratory complications. MS are rare tumors with potential for local recurrence and distal metastasis. Complete surgical resection remains as the treatment of choice, once the uncommon cases with malignant progression shows low response to chemo and radiotherapy.

This narrative review identified, in the scientific production, the methods used for evaluating and classifying vaginal stenosis in women who have undergone brachytherapy. Data collection was undertaken in July 2013 in the publications of SciELO, MEDLINE and PubMed, without time limits, and in studies cited by two scientific reviews which addressed the issue investigated here. The search protocol included the description of the method for evaluating and classifying vaginal stenosis. Comparative analysis between the findings showed there to be diversity among the methods used by different researchers. In the light of this finding, this study proposes elements for making an evaluative instrument to be applied by nurses. The standardization of the technique will help in the early detection of vaginal stenosis and in the care for women subsequent to vaginal brachytherapy. RESUMEN Revisión narrativa que identificó en los métodos de producción científicos utilizados para la evaluación y clasificación de las estenosis vaginal en mujeres después de braquiterapia vaginal. La recolección de datos se llevó a cabo en julio de 2013 en las publicaciones de la SciELO, Medline y PubMed, sin límite de tiempo, y estudios citados dos revisiones científicas que abordan el tema investigado aquí. El protocolo de búsqueda incluyó la descripción del método para la evaluación y clasificación de la estenosis vaginal. Análisis comparativo de los resultados mostró que existen diferencias entre los métodos utilizados por diferentes investigadores. Teniendo en cuenta este resultado, este estudio propone constituyentes para hacer un instrumento de evaluación para ser utilizado por las enfermeras. La estandarización de la técnica le ayudará en la detección precoz de la estenosis vaginal y atención a la mujer después de la braquiterapia vaginal. RESUMO Revisão narrativa que identificou, na produção científica, os métodos utilizados para avaliação e classificação da estenose vaginal em mulheres pós-braquiterapia. A coleta de dados foi realizada em julho 2013 nas publicações da SciELO, MEDLINE e PubMed, sem limite de tempo, e em estudos citados por duas revisões científicas que abordam a temática aqui investigada. O protocolo de busca incluiu a descrição do método para avaliação e classificação da estenose vaginal. Análise comparativa entre os achados mostrou que há diversidade entre os métodos utilizados por diferentes pesquisadores. Diante deste achado, este estudo propõe constituintes para composição de instrumento avaliativo a ser aplicado por enfermeiros. A padronização da técnica auxiliará na detecção precoce da estenose vaginal e nos cuidados à mulher pós-braquiterapia vaginal.

Background Alterations in the host cellular immune response allow persistent infections with High-Risk Human Papillomavirus (HR-HPV) and development of premalignant cervical lesions and cervical cancer (CC). Variations of immunosuppressive cytokine levels in cervix are associated with the natural history of CC. To assess the potential role of genetic host immunity and cytokines serum levels in the risk of developing CC, we conducted a case–control study paired by age. Methods Peripheral blood samples from patients with CC (n = 200) and hospital controls (n = 200), were used to evaluate nine biallelic SNPs of six cytokine genes of the adaptive immune system by allelic discrimination and cytokines serum levels by ELISA. Results After analyzing the SNP association by multivariate logistic regression adjusted by age, CC history and smoking history, three Th2 cytokines (IL-4, IL-6 and IL-10) and one Th3 (TGFB1) cytokine were significantly associated with CC. Individuals with at least one copy of the following risk alleles: T of SNP (−590C > T IL-4), C of SNP (−573G > C IL-6), A of SNP (−592C > A IL-10), T of SNP (−819C > T IL-10) and T of SNP (−509C > T TGFB1), had an adjusted odds ratio (OR) of 2.08 (95 % CI 1.475–2.934, p = 0.0001), an OR of 1.70 (95 % CI 1.208–2.404, p = 0.002), an OR of 1.87 (95 % CI 1.332–2.630, p = 0.0001), an OR of 1.67 (95 % CI 1.192–2.353, p = 0.003) and an OR of 1.91 (95 % CI 1.354–2.701, p = 0.0001), respectively, for CC. The burden of carrying two or more of these risk alleles was found to have an additive effect on the risk of CC (p trend = 0.0001). Finally, the serum levels of Th2 and Th3 cytokines were higher in CC cases than the controls; whereas IFNG levels, a Th1 cytokine, were higher in controls than CC cases. Conclusion The significant associations of five SNPs with CC indicate that these polymorphisms are potential candidates for predicting the risk of development of CC, representing a risk allelic load for CC and can be used as a biomarker of susceptibility to this disease.

Introduction. Cervical cancer is the third most common malignancy in women with gynecological pathology. Most of the times, patients are admitted to hospital in advanced stages, with multiple secondary metastases. Case report. We report the case of a 70-year-old patient initially admitted in the Orthopedic Department of University Emergency Hospital in Bucharest with suspicion of pubis fracture. After clinical, imagistic and paraclinical evaluation, cervical cancer was suspected and the patient was transferred to the Obstetrics and Gynecology Department of University Emergency Hospital in Bucharest in order to identify etiology of the multiple secondary metastases. CT examination revealed liver determinations as well as pelvic lymphadenopathy, accompanied by suggestive neoplastic transformation of the cervix and invasion of the uterine body, parameters, and bladder; inferior branch of the pubis, and bilateral pubis, with a suggestive side-by-side aspect, were also distinguished from osteolysis. Histopathological examination following a cervical biopsy revealed non-keratinized squamous carcinoma with secondary imagistic findings, placing this case in FIGO IVB stage. Conclusions. Due to the insidious evolution, cervical cancer can reach advanced stages. The prognosis of patients with advanced stage cervical cancer and bone secondary determinations is reserved.

We present the case of a 36-year-old premenopausal woman with a background of surgically-treated cervical neoplasm. She underwent a positron emission tomography-computed tomography (PET-CT) for evaluation of the new appearance of abnormal inguinal lymph nodes. The study showed two hypermetabolic nodules in the pelvic region suggestive of corresponding to an implant and to tumor involvement of the lymph node, respectively. After a clinical evaluation and a new PET-CT scan, it was considered that these uptake foci corresponded to physiological activity of the FDG secondary to ovarian activity in a patient with ovariopexy. This article shows the importance of having complete clinical information about the patients before evaluating the studies. We also present a review of the medical literature on the cervical neoplasm and metabolic behavior of the adnexa in relationship with the menstrual cycle of pre-menopausal women.

Poland has one of the highest cervical cancer mortality rates in Europe. It is related to the problem of late diagnosis and low attendance rate in screening programs. The objective of the study has been to assess the annual production loss due to the cervical cancer morbidity and mortality in Poland in 2012. The outcomes have been to provide comprehensive information on cervical cancer's influence on population's ability to work and its overall economic burden for the society. The study has also provided the methodological framework for disease-related production losses in Polish settings.The human capital method was used. The production losses were calculated in both monetary and quantitative terms (working days lost) due to 4 following reasons: 1) temporary disability to work, 2) permanent disability, 3) informal care, and 4) mortality.Cervical cancer resulted in approx. 702 964 working days lost in 2012 due to absence at work for both patients and care givers and a total number of 957 678 working days lost due to patients' mortality. The total value of production lost was assessed at 111.4 million euros. More than 66% of this value was attributed to women's mortality.The calculation of production lost due to cervical cancer burden provides strong evidence to support adequate health promotion and disease prevention actions. Actions promoting cervical cancer screening should be intensified including workplace health promotion activities. Med Pr 2016;67(3):289-299.Polska ma jeden z najwyższych w Europie wskaźników umieralności kobiet z powodu nowotworu szyjki macicy. Niewiele kobiet uczestniczy w programach przesiewowych, a u wielu choroba jest późno diagnozowana. Celem badania było oszacowanie produkcji utraconej z powodu występowania nowotworu szyjki macicy w Polsce w 2012 r., a tym samym ocena wpływu choroby na zdolność populacji do pracy. Analizę można traktować również jako przykład metodyki szacowania strat produkcyjnych z powodu występowania określonej jednostki chorobowej przy wykorzystaniu dostępnych w Polsce danych.Wykorzystano metodę kapitału ludzkiego i oszacowano produkcję utraconą z 4 powodów – 1) czasowej niezdolności do pracy, 2) trwałej niezdolności do pracy, 3) opieki członków rodziny nad osobą chorą i 4) umieralności – w kategoriach monetarnych i ilościowych (dni utraconej produkcji).Nowotwór szyjki macicy spowodował w 2012 r. utratę 702 964 dni produkcji z powodu chorobowości i 957 678 dni z powodu umieralności. Całkowitą produkcję utraconą oszacowano na 111,4 mln euro, z czego ponad 66% było spowodowanych zgonami osób chorych na nowotwór.Oszacowanie produkcji utraconej z powodu nowotworu szyjki macicy dostarcza silnych argumentów w procesie alokacji zasobów w sektorze zdrowia na rzecz prewencji nowotworów. Należy zintensyfikować również działania z zakresu promocji badań przesiewowych, m.in. z uwzględnieniem roli pracodawcy. Med. Pr. 2016;67(3):289–299.

Objective To investigate the factors that can accurately predict the prognosis for patients with FIGO stage-IB cervical squamous cell carcinoma treated with radical surgery.

Introducción: En pacientes posmenopáusicas los cambios atróficos del cérvix dificultan el diagnóstico colposcópico y cito-histológico, pues pueden simular lesiones premalignas, por lo cual, la detección inmunohistoquimica de p16INK4a sería útil como herramienta diagnóstica diferencial entre estos cambios; sin embargo, es necesario aportar evidencias desde la perspectiva clínica. Caso clínico: Paciente posmenopáusica con colposcopia insatisfactoria y hallazgos cito-histológicos sugestivos pero no conclusivos de neoplasia intraepitelial cervical de alto grado (NIC III). La detección inmunohistoquímica de p16INK4a fue negativa. El estudio histológico de la conización diagnóstica/terapéutica no reportó lesión intraepitelial o maligna. Este caso permite aportar evidencia a favor del p16INK4a como biomarcador diferencial entre cambios atróficos y premalignos, con lo cual se podrían evitar intervenciones innecesarias. Para el desarrollo del manuscrito se contó con consentimiento informado de la paciente objeto de estudio y consentimiento institucional de la Universidad de Cartagena y la subdirección científica de la E.S.E. Clínica “Maternidad Rafael Calvo”.

This article builds a bridge between cultural research and clinical practice by applying insights from an ethnographic study of cervical cancer in Iquitos, Peru, to a cervical cancer focused cultural assessment tool and teaching guide for use with immigrant patients. This application is grounded in Campinha-Bacote’s model of cultural competency. Ethnographic research is recommended as a source of knowledge from which insights can be drawn to build assessment skill in cross-cultural clinical encounters—insights into asking the right questions.

Resume Environ 30 % des cancers du col surviennent chez des femmes en âge de procreer. La grossesse est l’occasion de depister une population parfois peu ou pas suivie sur le plan gynecologique. Le frottis en cours de grossesse presente de nombreux artefacts qu’il faut connaitre. Il reste toutefois un bon outil de depistage. La frequence des frottis anormaux est de 5 a 8 % chez la femme enceinte. Tout frottis anormal est refere en colposcopie. La sensibilite de la colposcopie, un peu moins bonne en cours de grossesse, est de 87 % avec une concordance histologique de 72,6 %. La zone de jonction est explorable dans presque 100 % des cas. Les biopsies ne posent guere de complications du fait de la grossesse. Elles ont une bonne concordance avec le diagnostic final. Le taux non negligeable de complications (hemorragies, avortement, prematurite) et l’absence de resection complete dans plus de la moitie des cas font de la conisation une exception en cours de grossesse. Le traitement est assure, moyennant une surveillance reguliere, en post-partum. En cas de suspicion de micro-invasion ou d’invasion et dans certaines colposcopies non satisfaisantes avec un frottis de haut grade, le recours a une electroresection diagnostique permettra de faire le diagnostic d’invasion et ainsi d’envisager une prise en charge adaptee. Les modalites d’accouchement ne sont pas dictees par l’etat du col. Le taux eleve de perdues de vue en post-partum (6 a 33 %) doit nous inciter a prendre en charge rapidement apres l’accouchement ces patientes.

Introduction: HIV-positive women are more likely to develop cervical neoplasm. HIV-positive women with low CD4 T-lymphocyte cell count may be more predisposed to cervical squamous intraepithelial lesions (SILs). This study aimed to determine the association between low cellular immunity of HIV positive women, and the prevalence and grade of cervical squamous intraepithelial lesions. Materials and Methods: Pap smear was carried out on two cohorts of Highly Active Anti Retroviral Therapy (HAART) experienced HIV-positive women (178 per group) at the AIDS Prevention Initiative in Nigeria-Centre for Disease Control Adult Anti-Retroviral clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria from June to November, 2012. The study group had CD4 cell count of < 200 cells/µl while the control group had CD4 cell count of ≥200 cells/µl. Results: The mean CD4 cell counts of participants in the study (low CD4) group was 127.9 ± 47.49 cells/ml while that of the control (high CD4) group was 489.2 ± 186.36 cells/ml (p < 0.001). The prevalence of SIL was 10.2% (18/176) for the low CD4 group, and 5.7% (10/176) for the high CD4 group [OR = 1.9 (95% CI: 0.85, 4.22)]. The commonest category of SILs identified was Low-grade Squamous Intraepithelial Lesion (LSIL), thus 11 (6.3%) in the study versus 7 (4.0%) in the control group (p = 0.703). Conclusion: Prevalence of cervical SILs among HIV positive women on HAART in Enugu, Nigeria is low and has no significant relationship with their CD4 cell count.

The aim of this study is to review a cohort of cases with vaginal intraepithelial neoplasia (VAIN) in a Chinese tertiary centre and to analyze the relationship between VAIN and cervical neoplasm, the treatment of the disease, and the outcomes. We retrospectively reviewed patients undergoing treatment for VAIN from January 2007 to June 2013. All the data of demographics, history, histological information, and HPV testing results were recorded. Statistical analysis was performed with SPSS 10.0 software. The study comprised of 184 patients. 132 out of 184 cases were diagnosed with cervical cancer or cervical intraepithelial neoplasia (CIN). 19 cases occurred after treatment of cervical neoplasia, and 33 patients were without any cervical lesion at the time of diagnosis. The average age of total patients was 48.30 ± 11.58. There were no significant differences in age, parity, and HPV infection among different groups. No significant differences were found in age, parity, and HPV infection between low-grade VAIN1 and high-grade VAIN (VAIN2 and VAIN3). The main treatment was electrofulguration and focal resection. The primary remission rate was 87.62 %. Four patients of VAIN1 were observed with the result of no recurrence in three cases. VAIN is a disease which has a close relationship with cervical neoplasia. Electrofulguration treatment with local resection is a suitable treatment with a much lower recurrence rate. For VAIN 1, observation may be a good choice especially for younger patients.

Colposcopy was first introduced in 1925 in Germany by Hans Hinselman. A colposcopeworks on the hypothesis that by magnifying the cervix and applying good illumination, early stages of cervical cancer could be picked -up. Other workers in the field include Schiller, Papanicolou, and Ayres who all contributed to the early detection of cervical cancer. The basic issue is the transformation zone (TZ). It is an area that forms from squamous metaplasia of columnar epithelium. The area where the two epithelia meet is referred to as the squamo-columnar junction SCJ. It is the most important landmark in cytology and colposcopy, where 90% of cervical neoplasm originates. More units are incorporating colposcopy into their practice so as to improve care of women with abnormal smears. Therefore, understanding of the scientific basis of colposcopy is important in carrying out the procedure according to agreed international standards.

Cervical cytology specimens prepared as monolayers were analyzed with a combination of high-resolution single-cell image analysis and lower-resolution contextual image analysis. For the latter, quantitative features of cluster architecture, object distribution and background were used to mimic the pathologists global assessment of a specimen. Contextual analysis correctly calssified 81% of the cases for diagnosis, about on a par with the companion single-cell cytometric analysis. Contextual and single cell analysis complemented each other, yielding greater accuracy when the two methods were combined. Additional applications of contextual analysis are discussed.

An external evaluation of the quality of diagnosis of gynecological cytology specimens (Papanicolaou or “Pap” tests) in the Cytopathological Laboratory at the Mexico General Hospital was performed, with evaluation of 6,011 Pap tests randomly selected from 31,378 Pap studies previously reported as negative during 1988–1989. These tests were part of the early detection program for cervical cancer run by the Ministry of Health of Mexico City. A quality index for specimens was constructed based on the presence of endocervical cells, mucus, and squamous metaplastic cells. The index of false negatives for the diagnosis of cervical neoplasm in this sample which correspond to diagnostic error by the examiner was 0.18% (11). The constructed quality index revealed that 64.1% of specimens were low quality. The correlation between diagnostic error and low quality was .87. Results indicate that laboratories participating in early detection programs for cervical cancer in developing countries need to implement (1) external evaluation programs for Pap diagnosis; (2) permanent training programs in registration; and (3) monitoring procedures for collection, fixation, and transportation of cytologic materials. © 1994 Wiley-Liss, Inc.

Original Articles Rafan Oday Fahad*, Saad Abdulbaqi# & Hassan J Hasony@ *MBChB, MSc Microbiology. #MBChB, CABP, Department of Pathology. @ MPhil, PhD, Department of Microbiology, College of Medicine, University of Basrah, Basrah, Iraq. Abstract Cervical cytobrush and Pap smears were collected from 103 women attending the outpatient department at Basrah Maternity and children hospital during the period from October 2009 till the end of January 2010. DNA was successfully extracted from 91 cytobrush samples, amplified for the detection of human papilloma viruses (HPVs) using GP5+/GP6+ primers, in addition to typing using type-specific primers for HPV-16 and HPV-18 genotypes. The overall HPV prevalence was 20.8% with the dominance of genotype 16 (36.6%) over the genotype 18 (10.5%) and the presence of non-16, non-18 genotype(s) in 42.1% of all HPV positive cases. Younger women aged 25 years or less were more infected (26.3%) with the dominance of genotype-16 (21.1%) and among women aged 36-45 years, the non-16/non-18 genotype(s) were the more frequently observed (13.3%). Infection rates were more frequent among women married above 30 years (33.3%) and those with more than one lifetime husband (28.6%). Women's husband with polygamy practice significantly covariate with HPV infections (P< 0.05). Significant association (P

Objective Hypoxia has been established as a key factor influencing the pathophysiology of malignant growth. Hypoxia-induced changes in gene expression are coordinated primarily by hypoxia inducible factor-1 alpha (HIF-1α) and HIF-2α. The purpose of this study was to determine whether or not HIF-2α expression is associated with survival and response to radiation in patients with cervical cancer. Methods After reviewing the medical records of 119 patients treated in our institution by primary therapy for stage IIB-IVA cervical cancer, we performed a case-control study. Cases (n=12) were selected from patients with local recurrence or radiation failure after primary radiation therapy with or without concurrent chemoradiation. For each case, we selected two controls from patients who had no evidence of local recurrence. Using pre-treatment paraffin-embedded tissues, we evaluated the expression of HIF-2α by immunohistochemistry. Staining was scored based on intensity (intensity score [IS], 0-3) and proportion (proportion score [PS], 0-100). The results were analyzed by the Student t-test, Mann-Whitney U test, Fisher's exact test, and Cox proportional hazards regression model. Results Cytoplasmic expression of HIF-2α, representing the degree of hypoxia, had a relationship with poor response to radiotherapy. The hazard ratio of recurrence was 1.71 for the HIF-2α IS (p=0.110) and 1.04 for the HIF-2α PS (p

The recent surge of interest in the mechanisms of action of biomodulators, also known as biological response modifiers, offers a new avenue of approach in the treatment of cancer. The in vitro antitumor activities of these agents, such as interferons, when combined with chemo- or radiotherapy, have generated enthusiasm among clinicians for developing clinical trials. In recent years many antineoplastic agents have been investigated as neoadjuvant or adjuvant therapy for patients with cervical cancer in an attempt to improve local control and to decrease incidence of metastasis. Normal tissue tolerance limits the potential combinations of standard cytotoxic chemotherapeutic agents with radiation. Interferon used as a radiomodulator has been studied mainly for the treatment of lung cancer with promising results. In this paper we report the rationale of combining interferon and radiation for the treatment of patients with cervical cancer.

Adenoid basal carcinoma is an uncommon cervical neoplasm characterized by slow growth, rare metastasis, and infrequent recurrence. Twelve years after subtotal hysterectomy, a postmenopausa...

Raman spectroscopy was applied to distinguish the spectroscopic information between normal cervical tissues (14) and cervical neoplasia (17), including low grade squamous intraepithelial lesions (6) and high grade squamous intraepithelial lesions (11). Standard pathological sections of these cervical tissues were measured from superficial to stroma layers. We have normalized significant Raman peaks, 1250 and 1579-1656 cm -1 by taking a ratio over a stationary Raman at 1004 cm -1 , and successfully discriminated between normal and neoplasm cervical tissues.

To investigate the association between genetic polymorphisms ofX-ray repair crosscomplementing group 1 (XRCC1) codons 194, 280, and 399 and cervical neoplasm susceptibility. A community-based nested case-control study was conducted. The study population consisted of women living in Chiayi City, located in southwestern Taiwan, who had received pap smear screening between October, 1999, and December, 2000 (n=32,466). The potential cases were women having lesions greater than cervical intraepithelium neoplasm II (C1N2) reconfirmed by cervical biopsy. The potential controls (case: control=1∶2) were age matched (±2 yrs) and residency matched women who had had normal pap smears. In total, 100 cases (39 C1N2, 12 C1N3, 46 carcinoma in situ (CIS), and 3 invasive cancer) and 196 controls had the information on both questionnaire and data ofXRCC1 polymorphisms. The frequency ofArg/Arg, Arg/Gln, andGln/Gln in codon 399 among cases and controls was 54% (54/100), 38% (38/100), and 8% (8/100) and 58% (114/196), 37% (73/196), and 5% (9/196), respectively, which were not significantly different. No associations were also observed betweenXRCC1 codon 194 and 280 genotypes and cervical neoplasm. While dichotomized by age (

Primary primitive neuroectodermal tumors (PNETs) are rare and high-grade malignant tumors that mostly occur in children and young adults. The most common sites are the trunk, limbs, and retroperitoneum. Herein, we present a case of a PNET involving the cervix uteri in a 27-year-old woman. The lesion showed characteristic histologic features of a PNET and was positive for the immunohistochemical markers cluster of differentiation (CD) 99, vimentin, neuron-specific enolase, neural cell adhesion molecule 1 (CD56), and CD117 (c-kit), further defining the tumor while helping to confirm PNET. The clinical Stage IIIB tumor was treated with chemotherapy and radiotherapy.

Objective : The uterine cervical neoplasia is one of the most frequent gynecologic tumor in Korean women. Though the precise pathogenic mechanisms were not elucidated, human papillomaviruses (HPVs) has been considered as a strong candidate for the cause of uterine cervical neoplasm. Methods : About 100 subtypes of HPV were known, and they were divided into two groups as “high-risk HPVs” and “low-risk HPVs” according to their oncogenic potentialities. It was known that arginine (Arg) residue at codon 72 of p53 tumor suppressor gene could be used as a marker for the risk of cervical epithelial neoplasia associated human appilloma virus infection. But the notions are still controversal. Studies to date have focused mainly on Caucasians despite marked ethnic variations in both the p53 polymorphism and the different genotypes of human papillomavirus associated with cervical neoplasia. In this study, the p53 codon 72 status in 125 Korean women with cervical neoplasia and 200 Korean healthy women was determined. In addition, the different genotypes of human papillomavirus associated with cervical neoplasia was also determined by DNA Chip. Results : The most frequent subtypes of HPV associated with uterine cervical neoplasia in Korean women were 16 (25.6%), 58 (16%), other type (10.4%), 52 (10%) and 18 (4.8%) in order of frequency. The polymorphic rate of p53 codon 72 in 200 Korean women was Arg/Ar (47%), Arg/Pro (43%) and Pro/Pro (10%) respectively. The polymorphic rate of p53 codon 72 in HPV associated uterine cervical neoplasia was Arg/Ar (55.5%), Arg/Pro (38.9%) and Pro/Pro (5.50%) respectively, which was not statistically significant compared to the normal control. In 16/18 genotypes associated cervical neoplasia, the polymorphic rate of p53 codon 72 was 44.8% (Arg/Arg), 42.1% (Arg/Pro) and 13.1% (Pro/Pro) respectively, while in 58/52/other type/33/35/40/44 genotypes, it was 36.5% (Arg/Arg), 50% (Ar/Pro), and 13.5% (Pro/Pro) respectively. There was no statistical significance between two groups. Conclusion : Above results showed that the genotypes of HPV associated with uterine cervical neoplasia in Korean women were different from those of Western countries, and there was not significant difference between the polymorphism of p53 codon 72 and genotypes of HPV associated with uterine epithelial neoplasia.

34 patients suffering from a metastatic cervical neoplasm with unknown origin of the primary tumour were examined between 1977 and 1981. The site of the primary tumour was detected in 61% (= 21 cases) of the patients. In the literature (4158 cases, 61 authors) a 32% success rate only was stated. Diagnostic improvement was achieved via "panendoscopy". This method allows a complete systematic evaluation of the upper respiratory and gastrointestinal tract.

Basaloid carcinoma is an uncommon tumor of the uterine cervix which has received little recognition in the medical literature. It is characterized by: 1) an ulcerated infiltrating growth pattern, 2) nests or cords of small basaloid cells, 3) prominent peripheral palisading of cells in the tumor nests, and 4) no significant stromal reaction. This cervical neoplasm is an entity distinguishable from adenoid cystic carcinoma, undifferentiated small-cell carcinoma, carcinoid tumor, and regional basaloid patterns in otherwise typical squamous cell carcinoma.

Cervical location of esophageal carcinoma is generally accepted as a contra-indication for palliative intubation. Seven patients with a cervical neoplasm were treated by placement of a tube. Four patients tolerated the tube well, 2 patients complained of a persistent sensation of pressure and had their tube removed. The 4 successfully treated patients were able to swallow normal food. We are of the opinion that cervical esophageal cancer does not represent an absolute contra-indication for palliative intubation.

The limitations of radical surgical and radiotherapeutic techniques have long been apparent and it is understandable that interest in gynaecological cancer should pass increasingly to early detection and the prevention of invasive cancer. In particular this applies to cervical neoplasm, but it will be many years before the female population at risk is effectively screened by means of exfoliative cytology. Gynaecological clinics, at least in this century, will continue to deal with cases of pelvic cancer for whom the outlook, in terms of five-year survival, is poor. At least half and in some forms of cancer as many as three-quarters of these patients die within five years. In the Royal Victoria Infirmary between 100 and 120 new patients with pelvic cancer are admitted to the gynaecological department each year, and after radiotherapeutic or surgical treatment their progress is checked regularly at a combined follow-up clinic. Many develop recurrent growths and other serious complications, and we have long been aware of the need for special study of the formidable social and medical problems faced by these women. Since October 1960 one of us (M. R. M.) has kept these particular patients under close and continuous observation during the period of terminal illness, and we report here the result of our investigation.