Evaluation of the Therapeutic Effect of Quadrivalent Human Papillomavirus (HPV) Vaccination on Cervical Intraepithelial Neoplasia Lesions.

Cervical cancer is the most common health problem among global young women. Cervical intraepithelial neoplasia (CIN) is a pre-invasive stage of cervical cancer, the major cause of which is human papillomavirus (HPV), and vaccination has a promising effect on reducing the progression of CIN lesions. The current study was a retrospective case control investigation in two centers, Shiraz and Sari Universities of Medical Sciences from 2018 to 2020 to evaluate the effect of quadrivalent HPV vaccination on CIN lesions (I, II, and III). Eligible patients diagnosed with CIN were selected and divided into two groups: one group received HPV vaccine and the control group did not. The patients were followed up after 12 and 24 months. The information about tests (e.g., Pap smear, colposcopy, and pathology biopsy) and history of vaccination was recorded and statistically analyzed. 150 patients were classified into the control group (without HPV vaccination) and the other 150 patients were in the Gardasil group (with HPV vaccination). The patients' mean age was 32 years old. Two groups were not significantly different according to age and CIN grades. Between two groups in 1 and 2 years' follow-up examinations, the high-grade lesions in both Pap smear and pathology were significantly diminished in patients in the HPV vaccinated group in comparison with the control group with p-values 0.001 and 0.004 in 1 year follow-up respectively and 0.00 after 2 years follow-up. HPV vaccination can prevent the progression of CIN lesions in 2-year follow-up examination.

Comparison of Frozen and Permanent Section Diagnosis in Ovarian Neoplasms: Analysis of Factors Affecting Accuracy.

Ovarian cancer is the seventh most common form of cancer among women worldwide. The aim of the study was to determine the accuracy of a frozen section and the factors affecting the accuracy of frozen diagnosis of ovarian neoplasms. This retrospective, cross-sectional study was conducted on 401 patients with ovarian masses with frozen section diagnosis in Shahid Faghihi Hospital affiliated to Shiraz University of Medical Sciences between 2014 and 2018. Each ovarian tumor sample was evaluated for histopathologic diagnosis using frozen and paraffin-embedded sections, which were reviewed by an expert gynecologic pathologist. Accuracy and diagnostic values were estimated by comparing the results of the 2 techniques, using the paraffin section as the gold standard. The overall accuracy of the frozen section was 94.5%. Its sensitivity was 85.3% for malignant, 88.2% for borderline, and 99.6% for benign tumors. Its specificity was also 99.7% for malignant, 98.0% for borderline, and 90.9% for benign tumors. The positive predictive value was 98.9% for malignant, 86.5% for borderline, and 94.6% for benign tumors. Most false negatives occurred in mucinous and borderline tumors. The sensitivity of malignant tumors of germ cell and sex cord-stromal cell types were 64.3% and 95.5%, respectively. The specificity of germ cell and sex-cord stromal tumors were 100% and 93.8%, respectively. Frozen section seems to be a precise technique for histopathologic diagnosis of ovarian tumors. However, borderline and mucinous tumors are the most problematic issues during frozen section diagnosis and malignant germ cell tumors have the lowest sensitivity.

Re-evaluation of Negative Cone Biopsy Results with Ki-67 and p16 Immunostaining following Positive Cervical Biopsy.

BACKGROUND: Cervical conization is a standard diagnostic method for precancerous lesions. However, its results could be negative despite an initially positive punch biopsy. The present study aimed to re-evaluate pathological biopsies with Ki-67 and p16 immunostaining to assess the diagnostic accuracy of punch biopsies. METHODS: This retrospective study performed in Motahhari Clinic and Shahid Faghihi Hospital, (Shiraz, Iran). 88 punch and cone biopsy slides from 2007-2016 were re-evaluated by two pathologists, and the results were compared with the original diagnoses. Agreement between the initial diagnoses and re-evaluations and between our pathologists were assessed with the kappa coefficient. Twenty-two negative conization results after positive punch biopsy were re-sectioned and evaluated with Ki-67 and p16 immunostaining. RESULTS: The overall agreement (kappa) between the primary punch diagnoses by the original pathologists and those made in the present study (by the first and second pathologists) before immunohistochemical (IHC) staining was 0.33 and 0.43, respectively. The kappa coefficient between punch biopsy diagnoses by the first and second pathologists before IHC staining was 0.73, while it increased to one after IHC staining with Ki-67 and p16. Out of the 22 specimens with the positive punch and negative cone biopsies on initial diagnosis, cervical intraepithelial neoplasia (CIN) was not confirmed in 11 specimens by our pathologists after IHC staining with Ki-67 and p16. These cases were reclassified as transitional metaplasia or acute/chronic cervicitis. CONCLUSION: Punch biopsy can be misdiagnosed as CIN positive, leading to unnecessary conization. The use of Ki-67 and p16 markers as appropriate ancillary tests are recommended.

Fine-needle aspiration findings of fibroadenoma with pseudolactational changes in the vulva: A case report.

Fibroadenoma is a common benign neoplasm of the breast and ectopic breast tissue, associated with possible lactational changes in pregnant or lactating women. Uncommon pseudolactational changes are possible in this neoplasm among nulliparous women. Fibroadenoma and lactating adenoma are rarely seen in the vulvar region. Theoretically, pseudolactational changes can occur in fibroadenomas of the vulva in young nulliparous women although there have been no reports so far. In this case report, we describe the fine-needle aspiration (FNA) cytology of a vulvar fibroadenoma with pseudolactational changes in a young nulliparous woman. This type of neoplasm has not been reported so far, and it may be misdiagnosed as a malignancy because of its cytological features, such as isolated cells with large nuclei and distinct nucleoli.

Parity as a Prognostic Factor in Patients with Advanced-Stage Epithelial Ovarian Cancer.

AIM: This study aimed to determine the prognostic factors influencing the overall survival (OS) of Iranian women with epithelial ovarian cancer (EOC). METHODS: Information about newly diagnosed patients with confirmed EOC at Motahari Clinic, Shiraz, Iran, from January 1, 2001, to December 31, 2016, was retrospectively reviewed and analyzed. Cox-adjusted proportional hazards (PH) and stratified Cox (SC) models were used to determine the potential prognostic factors. RESULTS: The mean (±SD) age at the diagnosis of 385 patients with EOC was 49.0 (±13.2) years old. Early-stage EOC (ESEOC) and advanced-stage EOC (ASEOC) were diagnosed in 34.3% and 65.7% of the total patients, respectively. The median (95% CI) OS was 35 (28-41) months. For ESEOC patients, a stage II-tumor led to a lower OS in the multivariable analysis compared to a lower stage tumor (P= 0.025). For ASEOC patients, age≥65 years at diagnosis (P=0.008) led to a lower OS. ASEOC patients with 2-5 parities (P=0.014) and >5 parity (P=0.001) demonstrated better OS than nulliparous women. CONCLUSION: Patients with ESEOC, higher tumor stage was associated with a shorter OS. The age at diagnosis harmed the OS of patients with ASEOC. More than one parity improved OS in ASEOC patients.

Founder Effect of KHDC3L, p.M1V Mutation, on Iranian Patients with Recurrent Hydatidiform Moles.

BACKGROUND: Recurrent hydatidiform moles (RHMs) are an unusual pregnancy with at least two molar gestations that are associated with abnormal proliferation of trophoblastic tissue and a failure in the embryonic tissues development. Three maternal-effect genes, including NLRP7, KHDC3L, and PADI6 have been identified as the cause of RHMs. The present study aimed to understand the association of a founder mutation with the incidence and prevalence of a disease in different individuals of a population. METHODS: 14 unrelated Iranian patients with recurrent reproductive wastage, including at least two HMs, entered this study. In order to find a possible mutation in KHDC3L, all the 14 samples were Sanger sequenced. For haplotype analysis, three single nucleotide polymorphisms (SNPs) were selected with highest Minor Allele Frequency along KHDC3L. RESULTS: A common KHDC3L mutation with the same haplotype was identified in four out of 14 patients with RHM. Regarding the present study, c.1A>G is the highest reported mutation in KHDC3L so far and is also the first report of the homozygous state that has led to RHM. CONCLUSION: c.1A>G mutation in KHDC3L is the highest reported mutation around the world. Our data also demonstrated the presence of founder effects for this particular mutation in Iranian populations. These data suggest that the high frequency of this mutation is potentially responsible for a higher rate of RHM in Iran.

Evaluation of treatment results and prognostic factors of uterine sarcoma: A single-center experience.

BACKGROUND: Uterine sarcomas (US) constitute a rare heterogeneous group of gynecological malignancies with aggressive characteristics and poor prognosis. Identifying the histopathological factors that determine the prognosis of the tumor and efficacy of various treatment modalities provides a reliable source for efficient treatment of affected patients. This study presents our 11-year experience with US in the south of Iran. METHODS: Medical records of 42 patients (2001-2012) with endometrial stromal sarcoma (ESS), leiomyosarcoma (LMS), and malignant mixed Müllerian tumor (MMMT) were investigated. Hazard ratio (HR) and 2- and 5-year survival of patients were analyzed based on the patients' age, histopathological characteristics (tumor type, stage, necrosis, and mitotic index), and treatment modalities. RESULTS: Twenty-four patients survived with median follow-up of 42.5 months; 18 died within 17 months, and 52.4% had recurrence, of whom 12 died. Two- and five-year survival rate was 78.6% and 61.9%, respectively, longest for ESS and shortest for MMMT. Higher age, tumor stage, necrosis, and mitotic index increased the HR of mortality. Radiotherapy resulted in a better survival, compared with chemotherapy alone or combined with radiotherapy. CONCLUSION: Although ESS had the best prognosis, MMMT was the most aggressive tumor with the shortest survival time. Histological type of the tumor, staging, tumor necrosis, and mitotic index had prognostic roles. Adjuvant radiotherapy resulted in a better survival, compared with surgery alone in early stage.

A Novel Mutation in NLRP7 Related to Recurrent Hydatidiform Mole and Reproductive Failure.

BACKGROUND: Hydatidiform mole (HM) is an abnormal human pregnancy with excessive trophoblastic proliferation and abnormal embryonic development, dividing into two complete HM (CHM) and partial HM (PHM) groups. One subcategory of the CHMs is recurrent and familial, which is known as biparental HM (BiHMs) or recurrent HM (RHM). NLRP7, KHDC3L and PADI6 are maternal-effect genes involved in RHMs. NLRP7 is a major gene responsible for RHMs. This study was performed on patients with molar pregnancies and miscarriage. The aim of this study was to genetic screen for mutations in NLRP7 and KHDC3L genes in an affected woman with previous history of 5RHM and the sibling with history of miscarriage. MATERIALS AND METHODS: In this experimental study, DNA was extracted from blood samples. KHDC3L and NLRP7 were polymerase chain reaction (PCR) amplified. The PCR products were purified and Sanger sequenced. RESULTS: In this study, there is no mutation in KHDC3L gene but a novel mutation was identified in the NACHT domain of NLRP7 gene. Patient with five recurrent moles had this mutation in the homozygous state while her sister with one miscarriage and one normal child showed this mutation in the heterozygous state. CONCLUSION: In this study, we identified a new mutation in NLRP7 gene of a patient with recurrent HM. Following egg donation, this patient has a normal boy. The sister of this patient with heterozygous mutation has a spontaneous abortion and one normal child that confirm the impact of a defective allele of NLRP7 on reproductive wastage in a recent finding.

Comparison of Conventional Cytology, Liquid-Based Cytology, and Cell Block in the Evaluation of Peritoneal Fluid in Gynecology Malignancies.

BACKGROUND: Peritoneal washing cytology has become an accepted method in evaluating gynecology malignancies. OBJECTIVE: The aim of this work was to compare the conventional cytology, liquid-based cytology (LBC), and cell block in the evaluation of peritoneal fluid. MATERIALS AND METHODS: A total of 48 cases with ovarian and uterine malignancy were included in this study. The age of the patients varied from 15 to 71 years. All the 48 cases were subjected to conventional smear, LBC, and cell block preparation. RESULTS: The results of LBC and conventional methods were in line with all cytological criteria, except for the background (p = 0.045), but no significant difference was found regarding adequacy (p = 0.12), cellularity (p = 0.13), cell architecture (p = 0.751), nuclear details (p = 0.96), and cytoplasmic details (p = 0.32). The kappa correlation between conventional cytology and LBC, conventional cytology and cell block, and LBC and cell block was 0.769, 0.791, and 0.945, respectively. The most prevalent malignancy which led to peritoneal fluid involvement was papillary serous carcinoma of the ovary. CONCLUSION: Compared to conventional cytology, the liquid-based method had no significant superiority in the evaluation of the peritoneal fluid method, but the combined usage of smears and cell block improved the diagnostic accuracy of the peritoneal washing samples in different gynecological malignancies.

Different Presentations of Five Rare Cases of Sclerosing Stromal Tumor of the Ovary.

A rare subtype of preceding neoplasm of ovary is sclerosing stromal cell tumor with few presented cases in the literature. In these case series, we describe five cases of ovarian sclerosing stromal cell tumor with different presentations in our department. Interestingly, one of our cases had elevated alfa-fetoprotein.

Predictive Value of Kanagawa Cancer Center Scoring System for Lymph Node Metastasis and Need for Lymphadenectomy in Patients With Endometrial Cancer: A Validation Study.

OBJECTIVES: The objective of this study was to determine the predictive value of Kanagawa Cancer Center (KCC) scoring system for lymph node metastasis and need for lymphadenectomy in patients with endometrial cancer. METHODS: This cross-sectional study was conducted during a 2-year period in a gynecologic oncology referral center in Southern Iran. We included a total number of 94 patients with endometrial cancer. Preoperative assessment included tumor volume, myometrium invasion, histology, and CA125. The KCC was calculated for all the patients. All the patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy along with dissection of pelvic and para-aortic lymph nodes. The histopathology of the dissected lymph nodes was considered as criterion standard, and the predictive value of KCC was evaluated accordingly. RESULTS: The mean ± SD age of the patients was 56.8 ± 10.2 years. Overall, 26 patients (27.7%) tested positive for lymph node involvement. The sensitivity, specificity, positive predictive value, and negative predictive value of KCC for lymph node involvement was found to be 35.3%, 100%, 100%, and 64.7%, respectively. Overall, the predictive value according to the area under the curve measured by receiver operating characteristic curve was found to be 0.890 (0.823-0.956) indicative of moderate accuracy. Lymph node involvement was associated with higher Federation of Gynecology and Obstetrics stage (P < 0.001), higher tumor volume (P = 0.003), higher histological subtype (P < 0.001), positive CA125 (P < 0.001), and higher KCC score (P < 0.001). CONCLUSIONS: The KCC scoring system has a moderate accuracy for predicting the lymph node involvement in patients with endometrial cancer.

Clinical and genetic-epignetic aspects of recurrent hydatidiform mole: A review of literature.

Hydatidiform Mole (HM) is the most common form of Gestational Trophoblastic Disease (GTD), defined by hyper-proliferation of trophoblastic cells. HM is typified as abnormal proliferation of extraembryonic trophoblastic (placental) tissues and failure of embryonic tissues development and is the only GTD with Mendelian inheritance, which can reoccur in different pregnancies. Moles are categorized into Complete Hydatidiform Moles (CHM) or Partial Hydatidiform Moles (PHM) and a rare familial trait, which forms a CHM and despite having androgenetic pattern, shows normal biparental inheritance, conceived from one sperm and egg. Recessive maternal-effect mutations in NLRP7 (NACHT, leucine rich repeat and PYD containing 7) and KHDC3L (KH Domain Containing 3-Like) genes have been shown to be responsible for Recurrent Hydatidiform Moles (HYDM1 MIM# 231090 when is caused by mutation in the NLRP7 gene and HYDM2 MIM#614293 when is caused by mutation in the KHDC3L gene). Methylation aberration in multiple maternally imprinted genes is introduced as the cause of Recurrent HYDM pathology. The current article reviews the histopathology, risk factors, and genetic and epigenetic characteristics of Recurrent HYDMs.

Prevalence of Endometriosis in Malignant Epithelial Ovarian Tumor.

BACKGROUND: The present study aims to assess the prevalence and histological characteristics of endometriosis in different types of ovarian surface epithelial tumors. METHODS: Microscopic slides of 110 ovarian tumors (89 malignant and 21 borderlines) were reviewed from 2008 to 2013 in two major gynecological centers affiliated with the Shiraz University of Medical Sciences, Shiraz, Iran. The presence or absence of endometriosis and transitions from atypical endometriosis to carcinoma were also histologically evaluated. Chi-square and t-test were used to compare the study groups. RESULTS: The mean age of the patients was 49.93 ± 9.36 years in the Endometriosis-Associated Ovarian Carcinomas (EAOC) group and 50.18 ± 12.8 years in the non-EAOC group. Among the 110 patients, 28 (25.4%) had endometriosis. According to ovarian cancer subtype 67% (4/6) of clear cell adenocarcinoma, 65% (11/17) of endometrioid adenocarcinoma, 28% (7/25) of low grade serous adenocarcinoma, 4% (1/25) of high grade serous adenocarcinoma, 30% (4/13) of borderline serous tumor, and 25% (1/4) of mixed carcinoma had endometriosis. None of the mucinous borderline tumors and mucinous adenocarcinoma cases had endometriosis. Moreover, 23 cases had typical endometriosis, while 14 had atypical endometriosis. On the other hand, 19 cases had both typical and atypical endometriosis. Furthermore, transition from atypical endometriosis to carcinoma was seen in 11 cases. CONCLUSION: Clear cell and endometrioid carcinoma are the most common types of EACO. Atypical endometriosis was more commonly seen in endometrioid and clear cell carcinomas which are included in type I ovarian cancer. Thus, it can be concluded that atypical endometriosis is a precursor for type I ovarian cancer.

Cytokines, chemokines, and chemokine receptors quantitative expressions in patients with ovarian cancer.

BACKGROUND: Cytokines, chemokines, and chemokine receptors regulate the proliferation and survival of tumor cells, angiogenesis, and metastasis to other organs. This network of ligands and receptors has been used in molecular targeting of cancer. METHODS: We compared the mRNA expression of CXCR3, CXCL-10, CXCR4, CXCL-12, IL-4, and IL-10 in tissues of benign and malignant ovarian tumors by qRT-PCR method and evaluated serum IL-10 and CA-125 content of these patients by ELISA during one year. RESULTS: Our result showed a trend toward a higher expression of CXCR4 in malignant ovarian tissues compared with the benign ovarian cysts (P>0.05). However, SDF-1, IP-10, IL-4, CXCR3, and IL-10 had a lower trend in mRNA expression in malignant ovarian tissues compared to the benign cyst tissues. Except for IL-4 (P=0.01) and SDF-1 (P=0.02), the data for other factors were not statistically significant. A trend toward higher concentration of IL-10 was observed in the serum of ovarian cancer patients compared to those with benign cysts; however, the difference was not significant. CA-125 concentration in the serum of ovarian cancer patients was higher than that of benign cyst patients (P=0.05). CONCLUSION: According to results obtained, we hypothesize that the lower expression of SDF-1 in malignant tissues may have an important role in ovarian tumor growth. However, this hypothesis requires more investigation. Higher levels of CA125 and IL-10 in the serum of patients might indicate that the combination of these biomarkers could be used for distinguishing patients with ovarian cancer from those with benign cysts.

Adipose derived stem cells isolated from omentum: a novel source of chemokines for ovarian cancer growth.

BACKGROUND: The main site of ovarian cancer metastasis is the omentum. Omental adipose tissue is known for contribution to the tumor growth and metastasis through different mechanisms. AIMS: In the present study, adipose derived stem cells (ASCs) were isolated from the omentum of patients with ovarian cancer and those with ovarian cysts and the expression of chemokines, chemokine receptors and cytokines were analyzed. MATERIALS AND METHODS: ASCs were isolated from omental adipose tissues obtained of 10 ovarian cancer and 25 ovarian benign cyst patients. Our investigations were done by quantitative real time-polymerase chain reaction, flowcytometry, western blot and also enzyme-linked immunosorbent assay. RESULT: Expression of CXCL-10 and CCR5 showed statistically significant difference between omentum derived ASCs of ovarian cancer patients compared with those with benign cysts (P < 0.05). Expression of interleukin-10 also detected in the supernatant of cultured malignant ASCs. CONCLUSION: Omental adipose tissue may play crucial roles for tumor promotion through the expression of tumor promoting chemokines. Accordingly, tumor surrounding adipose tissue may be a novel target for immunotherapy of cancer.

Evaluation of Ki67, p16 and CK17 Markers in Differentiating Cervical Intraepithelial Neoplasia and Benign Lesions.

BACKGROUND: Cervical intraepithelial neoplasia (CIN) is a premalignant lesion capable of progressing to cervical cancer. Despite the existing well-defined criteria, the histomorphologic diagnosis is subject to high rates of discordance among pathologists. The aim of this study was to evaluate Ki-67 (MIB-1), CK17 and p16 (INK4a) (p16) markers by immunohistochemical methods in differentiating CIN from benign cervical lesions. METHODS: The present study reviewed and re-classified 77 cervical biopsies, originally diagnosed as 31 non-CIN, and 46 CIN, as 54 non-CIN, and 23 CIN based on at least two similar diagnoses. Immunostaining by Ki67, p16 and CK17 markers was performed on all cases and the results were compared with pervious and consensus diagnosis. RESULTS: The overall agreement between pervious and consensus diagnosis was 67.5% (Kappa=0.39, P<0.001). The sensitivity and specificity of Ki67 immunostaining were 95.6% and 85.1% respectively, while for p16 the corresponding values were 91.3% and 98.1%. The overall agreement, for both p16 and Ki67, with consensus diagnosis were significant (P<0.001). The sensitivity and specificity of CK17 negative staining in CIN detection were 39.1% and 40.7% respectively. CONCLUSION: Ki67 and p16 markers are recommended as complementary tests for differentiating between dysplastic and non-dysplastic lesions. CK17 does not discriminate between immature metaplasia with and without dysplasia.

The Effect of Extrafascial Hysterectomy After Completion of External Beam Radiotherapy for Treatment of Locally Advanced Stages (IIB-III) of Cervical Cancer.

BACKGROUND: Worldwide, cervical cancer is one of the most challenging gynecologic cancers in treatment. OBJECTIVES: This study was designed with the aim of comparing patients treated with External Beam Radiotherapy (EBRT) and Interactivity Brachytherapy (ICBT) with EBRT and extrafascial hysterectomy in locally advanced stages of cervical cancer (IIB-III). PATIENTS AND METHODS: The present study was designed as a case-control which was performed on the patients with cervical cancer in locally advanced stages (IIB-III) admitted to Namazi and Faghihi hospitals (university hospitals in Shiraz) between 2008-2011. 51 patients were included in two distinct groups: 25 patients were treated with EBRT and Interactivity Brachytherapy (group A). 26 patients were treated with EBRT and extrafascial hysterectomy group B. RESULTS: In group A, the number of patients with FIGO stage IIb and III were 16 and 9, respectively, and 17 and 9 in group B. The median duration of follow-up was 24 months. There were no significant differences between two groups in metastasis and recurrence rate (P > 0.05). 5-years overall survival rate was 54.8% [95% CI: 39-70.9] in group A and in group B was 50.9% [95% CI: 41.5-60] and The LOG-rank test which controls the effect of treatment modalities on overall survival rate, did not show any significant difference between two groups (P = 0.407). CONCLUSION: The results of our study showed that the trend of treatment using EBRT along with intracavity brachytherapy may have the same outcome as the method of using EBRT and extrafascial hysterectomy. Overall, it seems that external beam radiation followed by extrafascial hysterectomy could be a proper substitute for brachytherapy.

Detection of high-risk human papillomavirus types 16 and 18 but not 33 and 52 in external genital warts from Iranian females.

BACKGROUND: External genital warts (EGW) are relatively common sexually transmitted diseases. In the majority of cases, low-risk human papilomaviruses (HPV), such as HPV-6 and HPV-11, are responsible but, high-risk types may also be detected and this has a bearing on vaccines for cervical cancer prevention. In this study the incidence of the high-risk HPV types 16, 18, 33 and 52 in EGWs of females from the southwest of Iran was assessed. METHODS: Seventy-nine women with EGWs participated in this study. Quantitative real-time PCR with gene specific primers and probes for the E6 gene of HPV-16, 18, 33 and 52, were used for the detection of HPV DNA in the tissue and blood samples. RESULTS: Of the 79 tissue specimens, 13 (16.5%) were HPV positive, only genetic materials of HPV-16 and HPV-18 being detected, twelve patients (15.2%) were positive only for HPV-18 and the coexistence of HPV-16 and HPV-18 was shown in one patient. Only one plasma sample showed evidence of HPV-16 with very low viral load. CONCLUSION: Our data showed that high-risk HPV types can be found in the tissue specimens of EGW samples obtained from female patients in the Southwest of Iran, with HPV-18 as the most abundant type; however, additional studies with a larger population are required to prove the finding and help to determine the most appropriate type of virus for vaccine design for Iranian women.

The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion.

OBJECTIVES: We performed this study in order to investigate the role of chronic endometritis (CE) in unexplained recurrent spontaneous abortion (RSA) and to determine the correlation between hysteroscopic and histologic findings of CE in patients with unexplained RSA. We also tried to find out the relation between CE and primary vs. secondary RSA. STUDY DESIGN: One hundred and forty-two consecutive patients with unexplained RSA and 154 fertile women were enrolled in this study. All the patients and controls underwent hysteroscopy and, at the same time, endometrial biopsy. CE was suspected when hysteroscopy revealed signs of focal or diffuse endometrial hyperemia or endometrial endopolyps (less than 1mm in size). Histopathologic diagnosis of CE was based on superficial stromal edema, increased stromal density, and pleomorphic stromal inflammatory infiltrate dominated by lymphocytes and plasma cells. Results were compared between cases and controls as well as those with primary (n=61) and secondary (n=81) RSA. RESULTS: Patients with RSA had a significantly higher incidence of CE both hysteroscopically (67.6% vs. 27.3%; p<0.0001) and pathologically (42.9% vs. 18.2%; p<0.0001). The sensitivity, specificity, positive predictive value and negative predictive value of hysteroscopy in the diagnosis of CE were found to be 98.4%, 56.23%, 63.5% and 97.82% respectively. Patients with secondary RSA had a higher prevalence of CE both pathologically (83.9% vs. 45.9%; p<0.0001) and hysteroscopically (58.1% vs. 24.6%; p<0.0001). CONCLUSION: CE is associated with unexplained RSA. Hysteroscopy, with high sensitivity and acceptable specificity, is suitable for the diagnosis of CE in those with unexplained RSA. CE should be taken into consideration in those with secondary unexplained RSA.