Clinical outcomes of immunohistochemistry of the p53 Staining pattern in high-grade serous ovarian carcinoma.

OBJECTIVE: To investigate the prevalence of p53 mutations and associated factors between immunohistochemistry (IHC) and p53 staining patterns among patients with high-grade serous ovarian carcinoma (HGSOC). METHODS: This study is a retrospective review. A total of 62 patients with HGSOC underwent surgery at Srinagarind Hospital between January 2016 and December 2020. Histological examination was performed based on a combination of morphology and IHC staining with p53. The p53 immunostaining pattern was interpreted as a missense mutation, nonsense mutation, or a wild-type pattern. Missense (p53 overexpression pattern) and nonsense (null expression p53 pattern) mutations were considered p53 mutations. A wild-type pattern was defined as a p53 non-mutation. RESULTS: p53 mutations were identified in 93.6% of the patients. Subgroup analysis of the p53 mutation group between the p53 overexpression pattern and the p53 null expression pattern in terms of clinicopathological characteristics and initial treatment was performed. Patients with the p53 overexpression pattern had significantly more omental metastases than those with the p53 null expression pattern (87.8% vs. 64.7%, P=0.042). There were no statistically significant differences in median progression-free survival (PFS) (9 vs. 10 months, P=0.813) or median overall survival (OS) (12 vs. 17 months, P=0.526) between the two groups. CONCLUSION: The prevalence of p53 mutations in HGSOC patients in this study was 93.6%. Omental metastasis is a significant pathological factor in predicting overexpression p53 pattern in HGSC. However, IHC analysis of the p53 staining pattern did not affect OS or PFS among patients with HGSOC.

Predictive value of 'Smartscopy' for the detection of preinvasive cervical lesions during the COVID-19 pandemic: a diagnostic study.

OBJECTIVE: To evaluate the performance of "Smartscopy" in diagnosing preinvasive cervical lesions among patients with abnormal cervical cancer screening results obtained during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This diagnostic study enrolled non-pregnant women with abnormal cervical cancer screening results obtained at the colposcopy clinic at Srinagarind Hospital (Khon Kaen, Thailand) between September 2020 and March 2021. Two colposcopists independently evaluated the uterine cervix using a smartphone and colposcopy. Cervical biopsies and endocervical curettage were performed in accordance with standard procedures. The diagnostic performance of a smartphone in detecting low-grade squamous intraepithelial lesions or worse plus (LSIL+) and high-grade squamous intraepithelial lesions plus (HSIL+) was assessed. RESULTS: In total, 247 patients were included. There was high agreement between the two colposcopists (κ=0.88; 95% confidence interval [CI], 0.82-0.93). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the smartphone to detect LSIL+ were 96.6% (95% CI, 91.6-99.1), 12.9% (95% CI, 8.06-19.2), 46.2% (95% CI, 39.7-52.4), 83.3% (95% CI, 62.6-95.3), and 0.49% (95% CI, 0.43-0.55), respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of smartscopy in diagnosing HSIL+ were 67.6% (95% CI, 55.2- 78.5), 85.4% (95% CI, 79.9-90.0), 60.5% (95% CI, 48.6-71.6), 88.9% (95% CI, 83.7-92.9), and 81.0% (95% CI, 0.75-0.85), respectively. CONCLUSION: Smartscopy demonstrated a remarkable correlation with colposcopy and a high diagnostic performance value for the detection of preinvasive cervical lesions. Therefore, smartscopy may be an alternative tool for detecting abnormal cervical lesions in low to medium medical resource settings. Smartscopy may be applied in telemedicine during the COVID-19 pandemic.

Sexual behavior and infection with cervical human papillomavirus types 16 and 18.

OBJECTIVE: This study assessed whether sexual behavior, including engaging in early sexual intercourse and having had multiple sexual partners, can predict the risk of infection with cervical human papillomavirus (HPV) types 16 and 18. METHODS: Records were reviewed of women who underwent cervical cancer screening and were found to be infected with high-risk HPV. The genotypes of high-risk HPV were categorized as HPV 16, HPV 18, and other than 16 or 18. Early sexual intercourse was defined as first sexual intercourse at the age of 19 years or younger. Multiple sexual partners was defined as having more than three lifetime sexual partners. Associations between sexual behavior and HPV 16/18 infection were presented as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Of the 349 women included in the study, 72 (20.6%) and 30 (8.6%) were infected by HPV 16 and 18, respectively. Eighty-two women (26.0%) reported having engaged in early sexual intercourse, and 33 (10.4%) reported having had multiple sexual partners. After adjustment for age, parity, and smoking habits, we found that women who had engaged in early sexual intercourse tended to have a higher risk of HPV 16 (OR 1.74; 95% CI 0.93-3.29), and those who had had multiple sexual partners were found to be at a significantly higher risk for HPV 18 (OR 4.58; 95% CI 1.44-14.58). CONCLUSION: Sexual behavior was associated with an increased risk of HPV 16/18 infection. Engaging in early sexual intercourse increased the risk of HPV 16 infection, and having had multiple sexual partners increased that of HPV 18.

A Case Report of High-Grade Endometrial Stromal Sarcoma: A Rare Cause of Abnormal Uterine Bleeding in a Young Woman.

High-grade endometrial stromal sarcoma (HG-ESS) is a rare clinical entity, particularly among young women, and only few cases have been reported in the literature. Herein, we describe the case of a 21-year-old woman who presented with a four-month history of excessive bleeding per vagina. Endometrial curettage and cervical biopsy revealed a malignant round cell tumor suggestive of metastatic sarcoma of uterine origin. Computed tomography of the abdominopelvic region showed an enlarged uterus with diffused thickening throughout the entire endometrial cavity. Intraabdominal lymphadenopathy and ascites in the pelvic cavity were noted. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, resections of the enlarged pelvic nodes, omentectomy, and biopsy of the peritoneal nodules in the cul-de-sac. Histological examination revealed a tumor with a permeative growth pattern composed of uniformly high-grade round cells with brisk mitotic activity and extensive lymphovascular space invasion. Sections of the pelvic lymph nodes on both sides and the peritoneal nodule revealed multiple metastatic foci. Immunohistochemical studies showed positive diffuse staining for vimentin, CD 10, and cyclin D1. The pathological diagnosis was HG-ESS stage IIIC. The patient experienced rapid progression of the disease while receiving adjuvant treatment and succumbed eight months after the operation. HG-ESS is a rare cause of AUB in adolescents and young women but should be considered in the differential diagnosis.