Cervical Cancer Screening of Adolescents Should Not Be Encouraged.

OBJECTIVE: The study aims to assess the frequency of cytological abnormalities in adolescents and young women, to establish the optimum age to start screening. METHODS: A retrospective study of cervical cytology results were obtained from the data center at the Santa Casa Hospital of São Paulo between January 2006 and December 2014, adopting the Bethesda nomenclature system. The cytology exams were divided into 3 groups: group 1-adolescents (10-19 years old); group 2-young women (20-24 years old); and group 3-adults, comprising the remaining cytology exams. The frequency of cytological abnormalities in the 3 groups was compared using version 3.4.3 of the Epi Info software program and the chi-square statistical test (p < .05). RESULTS: A total of 177,075 satisfactory cytology exams were included in the study. The cytological abnormalities detected in the adolescent group were predominantly low-grade lesions (97.4%); in the young women group, low-grade lesions represented 89.12%, and in the adult group, 76.33%. A significantly greater proportion of high-grade lesions were noted in the adult group, accounting for approximately 24% of all abnormalities detected; in the young women group, it was approximately 11%, and in the adolescent group, it was 2.6%. CONCLUSIONS: The natural history of HPV infection shows it is transient in young women, with most cases regressing within 2 years of presentation. Our data confirm that screening of adolescents is not recommended because serious cytological abnormalities and cancer are rare in this group.

Neisseria gonorrhoeae prevalence in females in São Paulo, Brazil: surveillance of the infection over a 11-year period.

OBJECTIVES: The prevalence of infection by Neisseria gonorrhoeae is the second highest among bacterial sexually transmitted infections worldwide. It can lead to severe complications, especially in the female reproductive system. So, the objective of the present study was to assess the prevalence of Neisseria gonorrhoeae infection in a large population of female patients from a private health service in São Paulo (Brazil), thereby identifying the main age groups affected by the agent and how prevalence progressed over time. METHODS: A cross-sectional study was conducted based on the results of all molecular biology tests performed for detecting Neisseria gonorrhoeae. The tests were conducted between January 2005 and December 2015. Positive test results were grouped by year and age group. RESULTS: Of those tests, 35,886 were considered eligible for the statistical data. The overall prevalence of Neisseria gonorrhoeae infection in the study population was 0.4%. A higher prevalence of infection was observed in the group whose participants' age was ≤ 25 years, at a rate of 0.6%. There was no significant increase or decrease in the number of positive test results over time. The prevalence of the infection in those aged between 10 and 19 years, 20-29 years, 30-39 years, 40-49 years, 50-59 years, and 60 years or above was respectively 0.87%, 0.50%, 0.36%, 0.22%, 0.17%, and 0.26%. CONCLUSION: The screening of asymptomatic young women would have the potential to reduce infection, transmission, and sequelae of infection by this agent.

Evaluation of 1,030,482 Cervical Smear Results in Brazilian Population.

BACKGROUND: The objective was to determine the prevalence of abnormal cytologic smears in a large population of a Brazilian city. METHODS: Retrospective study of cervical cytology results performed at a private laboratory in São Paulo - Brazil. A total of 1,030,482 cytology tests were performed between January 2010 and December 2015. RESULTS: Among the satisfactory cytologies, we observed abnormal results in 8.9% (91,371). Analyzing the proportion of exams with altered results over the years, there was no change in these rates. We observed that the proportion of abnormal exams decreased with increasing age. Atypical squamous cells of undetermined significance, possibly non-neoplastic (ASC-US) cytology was the most common abnormality found in the general population with 73.19%, followed by low-grade intraepithelial lesion (LSIL) with 20.5%; these 2 cytological abnormalities add up to 93.69 % of all abnormal results. There was an increase in ASC-US with advancing age, a decrease in prevalence of LSIL, especially after the age of 30 and high-grade intraepithelial lesion (HSIL) shows two peaks of elevation, respectively in the age groups of 30-39 years and over 70 years. CONCLUSION: Women under the age of 30 showed a higher prevalence of cytological abnormalities, however most of these changes are low-grade lesions. In older women, cytological abnormalities are largely high-grade lesions, requiring greater care to prevent progression to cancer.

Diagnosis and treatment of infectious vaginitis: Proposal for a new algorithm.

Background: Vaginitis is the most common gynecologic diagnosis in primary care, and most women have at least one episode during their lives. The need for standardized strategies to diagnose and treat vaginitis, both in primary care and among gynecologists, is emphasized. The Brazilian Group for Vaginal Infections (GBIV, acronym in Portuguese) aimed to update the practical approach to affected women by reviewing and discussing recent literature, and developing algorithms for diagnosis and treatment of vaginitis. Methods: A literature search within biomedical databases PubMed and SCieLo was conducted in January 2022. The available literature was evaluated by three experienced researchers, members of the GBIV, to summarize the main data and develop practical algorithms. Results and conclusion: Detailed algorithms were developed with the main goal to improve gynecological practice considering different scenarios and access to diagnostic tools, from the simplest to the most complex tests. Different age groups and specific contexts were also considered. The combination of anamnesis, gynecological examination, and complementary tests remains the basis of a proper diagnostic and therapeutic approach. Periodic updates of these algorithms are warranted as new evidence becomes available.

Chlamydia trachomatis prevalence in females in São Paulo, Brazil: 11 years' surveillance of the infection.

BACKGROUND: Chlamydia trachomatis (CT) infection is the most prevalent sexually transmitted bacterial disease worldwide whose greatest impact is on the female reproductive system. The objective was to assess the prevalence of Chlamydia infection in a large population of female patients from a private health service in São Paulo (Brazil), identifying the main age groups affected by the agent and the evolution of the prevalence. METHODS: A cross-sectional study was conducted based on the results of all molecular biology tests. The tests were carried out between January 2005 and December 2015. The positivity of test results was determined by year and age group. RESULTS: A total of 85,292 patients who performed 103,576 tests for Chlamydia were considered eligible for the statistical data. The overall prevalence of C. trachomatis infection in the study population was 2.2% (95% CI: 2.07-2.25). A higher prevalence of infection was observed in the ≤ 25 years and ≤ 30 years age groups, with rates of 6.0% (95% CI: 5.59-6.35) and 4.4% (95% CI: 4.08-4.50), respectively. There was a significant increase in the positivity of the exams over time, especially in the ≤ 35 years age group. The prevalence at 26-30 years was 3.1% (95% CI: 2.82-3.30); 31-35 years 1.7% (95% CI: 1.50-1.82); 36-40 years 1.0% (95% CI: 0.86-1.16); 41-60 years 0.6% (95% CI: 0.50-0.70) and the prevalence at ≥ 61 years was 0.4% (95% CI: 0.11-0.75). CONCLUSION: The screening of asymptomatic young women would have the potential to reduce infection, transmission, and sequelae of infection by this agent.

The effect of cigarette smoking on cell proliferation in normal uterine cervix epithelium.

BACKGROUND: The aim of this study was to evaluate the effect of smoking on cell proliferation in normal cervical epithelium. METHODS: A total of 45 women undergoing hysterectomies due to uterine leiomyomata were investigated. Thirty were nonsmokers and 15 were current smokers. A segment of tissue was taken from cervix after removal of the uterus, and the identification of cell proliferation was performed by immunohistochemical analysis employing Ki-67 staining. The number of positive cells colored by Ki-67 staining was finally expressed as number of cells per square millimeter (mm²) of epithelium. RESULTS: The comparison of the number of proliferating cells measured by ki-67 staining among smoking and nonsmoking women did not show significant difference. Among smoking women, there was no significant difference related to the number of cigarettes smoked per day or time of consumption and epithelial cell proliferation. However, the total amount of cigarettes smoked throughout presented significant association with Ki-67 staining (p < 0.001); the number of proliferating cells per mm² increased proportionally to the increase in consumption of cigarettes. CONCLUSIONS: The results indicated that there was no significant difference between cell proliferation in smokers and nonsmokers; however, it was shown that in the smokers' group, amount of cigarettes smoked during throughout lifetime can increase cell proliferation in normal cervical epithelium.

Cervical Cancer Screening of Adolescents and Young Women: Further Evidence Shows a Lack of Clinical Value.

STUDY OBJECTIVE: To assess the prevalence of cytological abnormalities among young people from a large population in the city of São Paulo (Brazil). DESIGN: Retrospective, observational analysis of data from the institution's data processing center. SETTING: A private laboratory in São Paulo (Brazil). PARTICIPANTS: Comparison of 3 different groups (ie, adolescent women [aged ≤19 years], young adult women [aged between 20 and 24 years], and adult women [aged 25 years and older]). INTERVENTIONS: Assessment of results from all cervical-vaginal smears collected for cytology between January 2010 and December 2015. MAIN OUTCOME MEASURES: Comparative analysis of cytological abnormalities in the 3 different groups. RESULTS: A total of 1,026,671 satisfactory cytology tests were performed. The proportion of cytological abnormalities was found to decrease with age (P < .001) and was similar in the groups comprised of adolescents and young adults, with 3.405/ 20.921 (16.3%) and 13,635/ 78,277 (17.4%), respectively, and 74,320/ 927,473 (8.0%) in the group of adult patients (P < .001). Among the positive cytologies in the group of adolescents, 3,331/ 3,405 (97.8%) represented low-grade lesions and 74/ 3,405 (2.2%) high-grade lesions, whereas among adults older than 25 years old, these figures were 69,092/ 74.320 (93%) and 5,228/ 74.320 (6.9%), respectively. No cases of cancer were found in the group of adolescents. CONCLUSION: Cytological screening of young people is not recommended because of the low prevalence of high-grade cytological abnormalities in this population, with cancer being a rare event. This inadvertent screening could lead to unnecessary complementary exams and overtreatment, which could compromise the reproductive future of these young women.

Detection of transformation zone cells in liquid-based cytology and its comparison with conventional smears.

BACKGROUND: To compare the differences between liquid-based cytology (LBC) and conventional cytology in respect of the detection of transformation zone cells (TZC) by age group and to assess test performance by correlating results with cytological abnormalities. METHODS: A retrospective study assessing the results of cervical-vaginal cytology smears collected at a private laboratory in São Paulo (Brazil) between January 2010 and December 2015. RESULTS: A total of 1 030 482 cytology tests were performed; of these, 3811 (0.36%) unsatisfactory samples were excluded. Cytology sampling in the patients studied was performed using the conventional technique in 394 879 (38.5%) cases and the liquid-based techniques in 631 792 (61.5%) cases. The proportion of samples with TZC for interpretation was 73.2% (288 956 samples) in conventional cytology and 52.7% (333 115 samples) in LBC (P < .001). The presence of TZC rate declined in both groups with age, but was consistently lower for LBC (P < .001). The presence of endocervical and metaplastic cells was associated with higher high-grade intraepithelial lesion detection rates. CONCLUSION: Low representation of the transformation zone was found in the samples collected using the LBC technique, particularly in the over 50 age group. Conventional cytology was associated with a higher rate of detection of high-grade lesions.

Aspects of Langerhans cells and TNF-α in the cutaneous immunity of anogenital warts.

BACKGROUND: Anogenital warts are the leading sexually transmitted infection in patients seeking care at specialized clinics. They may display a vast array of forms, according to the interaction of the virus with the host's immunity. Cellular immunity is the epithelium's main form of defense against the virus, involving an active participation of the Langerhans cells and pro-inflammatory cytokines such as TNF-α. OBJECTIVE: To assess the epithelial immune response of anogenital warts in males, according to the number of lesions presented. METHODS: This is a prospective, cross-sectional study carried out at the dermatology outpatient clinic in a tertiary hospital. We included male patients over 18 years of age without comorbidities who had anogenital condylomata and no previous treatments.In order to evaluate the local epithelial immunity, the lesions were quantified, then removed and employed in CD1a immunohistochemistry assays for assessing the morphometry and morphology of Langerhans cells; TNF-α; reaction was used for determining cytokine positivity in the epithelium. RESULTS: 48 patients were included in the study. There was no statistically significant difference as to the number of Langerhans cells, in their morphology, or the presence of TNF-α. However, patients presenting with more Langerhans cells in the lesions had cells with a star-like and dendritic morphology, whereas in those with a lower cell count had cells with a rounded morphology and no dendrites (p<0.001). STUDY LIMITATIONS: Small number of patients analyzed. CONCLUSION: There was no difference in epithelial immunity between patients having few or many anogenital condyloma lesions as measured by the morphology and morphometry of Langerhans cells and TNF-α; positivity. Such an assessment employing immunity markers differing from the usual ones is expected to yield useful results.

The effect of cigarette smoking on cervical langerhans cells and T and B lymphocytes in normal uterine cervix epithelium.

The objective of our study was to evaluate the effect of smoking on intraepithelial Langerhans cells and T and B lymphocytes in normal cervical epithelium. A total of 47 women who underwent hysterectomies because of uterine leiomyomata were investigated. Thirty-two individuals were nonsmokers and 15 were current smokers. A segment of tissue was taken from the cervix after the removal of the uterus and was formalin-fixed and paraffin-embedded for histologic analysis. The identification of the Langerhans cells and T and B lymphocytes was carried out by immunohistochemical analysis. The number of intraepithelial Langerhans cells was expressed by the amount of cells per square millimeter of epithelium. For T and B lymphocytes, a score expressed the cell count. The comparison of the number of intraepithelial Langerhans cells between smoking and nonsmoking women showed a significant difference (P=0.045), but it did not occur in relation to the number of T and B cells between the 2 groups. There was also no significant difference in relation to the number of cigarettes smoked per day, time of consumption, and total amount of cigarettes smoked throughout the lifetime. It was shown that smoking reduces the number of intraepithelial Langerhans cells in a normal cervix but does not influence the number of T and B lymphocytes.

Effectiveness of imiquimod 5% cream for treatment of extensive anogenital warts in a seven-year-old child.

Conventional treatment options for anogenital warts in prepubertal children rely on chemical and physical destruction methods that can be difficult and painful and frequently require the use of general anesthesia. Other approaches include the use of immunotherapies, as topical imiquimod and intralesional or systemic interferon. We report a 7-year-old girl with extensive anogenital warts who was successfully treated with topical 5% imiquimod cream.

Verrucous carcinoma of the vulva: diagnosis and treatment.

Vulvar cancer accounts for less than 1% of malignancies in women. Verrucous carcinoma of the vulva is a rare histological variation, comprising less than 1% of vulvar cancer cases. Although it is characterized as being locally invasive, the condition is not associated with metastatic spreading. Lesions present in the form of a verrucous, ulcerated, and bleeding tumor that can reach large dimensions. This type of tumor can be mistaken for condylomata, both macroscopically and microscopically. We report the case of an 81-year-old patient with a large vulvar tumor presented for eight years, initially considered as a Buschke-Löwenstein tumor. The patient underwent radical vulvectomy with a V-Y advancement flap technique. This type of tumor should be considered by clinicians dealing with condylomatous ulcerative lesions that do not respond to the usual treatment.

Vulvar melanoma: relevant aspects in therapeutic management.

Cancer of the vulva accounts for at least 1% of malignant neoplasms among women. Although rare, vulvar melanoma is the second most common histological type of vulvar cancer, representing 7-10% of all malignant vulvar neoplasms. Initial symptoms are non-specific and complete excision of the lesion is indicated in cases with suspected diagnosis. Prognosis of patients with these neoplasms is poor and remains unchanged despite the treatment approach. Hemivulvectomy with lymph node dissection is the current procedure of choice, associated or not with adjuvant therapies. We report two cases of patients presenting with late diagnosed vulvar melanoma and the relevant aspects in their therapeutic management.

Prevalence of High-Grade Intraepithelial Neoplasia in Patients with Cytology Presenting Atypical Squamous Cells of Undetermined Significance.

OBJECTIVES: To evaluate the prevalence of histological high-grade lesions and cervical cancer in patients with ASCUS cytology. METHODS: This is a cross-sectional prospective study involving 703 women with a uterus and atypical squamous cells of undetermined significance (ASCUS). The patients were submitted to a colposcopy and underwent a guided biopsy when changes on the colposcopy were detected. RESULTS: The findings revealed 456 (64.9%) women with a normal colposcopy and 247 (35.1%) with colposcopic abnormalities. The biopsy results were: cervical intraepithelial neoplasia grade 1 (CIN 1) in 51 (20.6%) patients, CIN 2 in 11 (4.5%) patients, CIN 3 in 8 (3.2%) patients, and a negative result in 177 (71.7%) patients; no cases of cancer were detected. Tallying of 456 normal colposcopies and 177 negative biopsies yielded a total of 90.04% negative exams. Furthermore, around 7.2% (51/703) of the patients exhibited CIN 1, a lesion associated with a high potential for regression. The biopsy results were not associated with patient age or menopausal status. CONCLUSION: We conclude that cytological surveillance of patients with ASCUS is feasible and safe given the low risk of CIN 2/3 or cervical cancer.

Porokeratosis ptychotropica: a rare manifestation with typical histological exam.

Porokeratosis is a disorder of epidermal keratinization characterized clinically by a distinctive ridge-like border, and histologically by cornoid lamellae. The known clinical variants of porokeratosis are: classic porokeratosis of Mibelli, disseminated superficial (actinic) porokeratosis (DSAP), porokeratosis palmaris et plantaris disseminata, linear porokeratosis and punctate porokeratosis. In 1995, a seventh form was described as porokeratosis ptychotropica: a verrucous form resembling psoriasis involving the gluteal cleft presenting on the histological exam multiple cornoid lamellae. There are very few reports in the literature of this clinical variant. The present study describes the case of a healthy male presenting gluteal hyperkeratotic plaques for 22 years. He had been to several dermatologists, none of them had achieved a definitive diagnosis. We present a typical clinical presentation and its dermoscopy findings, in addition to histological examination that confirmed the diagnosis.

Aspects of Langerhans cells and TNF-α in the cutaneous immunity of anogenital warts

Abstract Background: Anogenital warts are the leading sexually transmitted infection in patients seeking care at specialized clinics. They may display a vast array of forms, according to the interaction of the virus with the host's immunity. Cellular immunity is the epithelium's main form of defense against the virus, involving an active participation of the Langerhans cells and pro-inflammatory cytokines such as TNF-α. Objective: To assess the epithelial immune response of anogenital warts in males, according to the number of lesions presented. Methods: This is a prospective, cross-sectional study carried out at the dermatology outpatient clinic in a tertiary hospital. We included male patients over 18 years of age without comorbidities who had anogenital condylomata and no previous treatments.In order to evaluate the local epithelial immunity, the lesions were quantified, then removed and employed in CD1a immunohistochemistry assays for assessing the morphometry and morphology of Langerhans cells; TNF-α; reaction was used for determining cytokine positivity in the epithelium. Results: 48 patients were included in the study. There was no statistically significant difference as to the number of Langerhans cells, in their morphology, or the presence of TNF-α. However, patients presenting with more Langerhans cells in the lesions had cells with a star-like and dendritic morphology, whereas in those with a lower cell count had cells with a rounded morphology and no dendrites (p < 0.001). Study limitations: Small number of patients analyzed. Conclusion: There was no difference in epithelial immunity between patients having few or many anogenital condyloma lesions as measured by the morphology and morphometry of Langerhans cells and TNF-α; positivity. Such an assessment employing immunity markers differing from the usual ones is expected to yield useful results.

Apoptosis Phenomena in Squamous Cell Carcinomas and Adenocarcinomas of the Uterine Cervix.

To investigate the relationship between apoptosis and histologic types in invasive squamous cell carcinoma and adenocarcinoma of the uterine cervix. The present study involved the assessment of surgical specimens from 74 women with cervical carcinomas FIGO stage IB1 (54 squamous cell carcinomas and 20 adenocarcinomas). The study samples were obtained from selected paraffin blocks containing specimens from patients submitted to surgical procedures. The respective medical charts of patients were reviewed and epidemiologic, clinical and disease-related data were collected. Cervical specimens were assessed by the immunohistochemistry technique using the Bcl-2 protein as a marker. The reactions were considered positive when the cells became stained in brown color. Bcl-2 positive cells were counted in 10 fields under a high magnification (400x) using light microscopy, in the slides area containing squamous carcinoma and adenocarcinoma of the cervix. The total cell count was expressed as the number of positive Bcl-2 cells per mm(2). No significant difference in the number of cells marked by the Bcl-2 protein was found for the variables age, tumor diameter, angiolymphatic invasion or number of lymph nodes affected. Comparison of the number of cells marked by the Bcl-2 protein in the two histological groups revealed a statistically significant difference, with squamous tumors presenting a greater number of marked cells. Squamous cervical tumors present a greater number of positive Bcl-2 cells per mm(2), suggesting that that the rate of cell death in squamous cell carcinomas of the cervix is lower than in adenocarcinomas.

Prognostic value of p16(INK4a) as a marker of clinical evolution in patients with cervical intraepithelial neoplasia grade 3 (CIN 3) treated by cervical conization.

The aim of this study was to assess the prognostic value of p16(INK4a) as a marker of post-conization relapse in patients treated for cervical intraepithelial neoplasia grade 3 (CIN 3). A retrospective study of 76 women with CIN 3 diagnoses, treated at the Hospital of Santa Casa de Misericórdia of São Paulo (Brazil) between January 2003 and September 2004, was performed. The study samples were obtained from cervical conization procedures, where paraffin blocks containing areas with the greatest amount of neoplastic tissue were selected. Immunohistochemical techniques were used on individual paraffin blocks for each case to detect p16(INK4a) protein expression. The p16(INK4a) cell counts were performed in 10 different high-amplification fields (400x) by light microscopy and total cell count expressed as number of cells per mm(2) . Patients involved in this study were followed up at the colposcopy outpatient unit for at least 48 months after cervical conization. The correlation of p16(INK4a) values with post-conization evolution in the patients (disease relapse or disease free) was determined. A significantly higher count of cells expressing p16(INK4a) was found in those patients with disease relapse during follow-up (p < 0.001). The variables age, number of gestations, and births correlated positively with number of cells expressing p16(INK4a) cells (p < 0.001; p = 0.001; 0.009, respectively). No correlation was found for the variables menopause, hormonal contraception, or smoking (p = 0.369, 0.425 and 0.853, respectively). p16(INK4a) can be considered a biomarker of cervical intraepithelial neoplasia grade 3 cases presenting high risk of relapse or evolution to invasive carcinoma.