Cervical intraepithelial neoplasia in adolescents: study of cytological findings between 1987 and 1995 in São Paulo State-Brazil.

The purpose of the present study was to ascertain the frequency of Pap smears abnormalities (SIL/carcinoma) in two populations in the State of S. Paulo (Brazil) who were screened for cervical cancer during the last nine years: adolescents (up to the age of 21) and adults (over 21). Statistical analysis showed a tendency to linear increase in frequency of abnormal Pap smears in both groups (adolescent: slope = 0.118 +/- 0.56; adult: slope = 0.079 +/- 0.021), being greater in the adolescent group (slope 0.039 +/- 0.038) than in the adult group. Between 1987 and 1995 the prevalence of abnormal smears tripled in the adult group (from 0.37 to 1.18) and almost quadruplicated in the adolescent group (from 0.64 to 2.10). Low grade squamous intraepithelial lesions (SIL) were the most frequent findings in cervical cytology in both groups: 92.3% in the adolescent group and 69.8% in the adult group. Few cases of high grade squamous intrapeithelial lesions (HSIL) (7.7%) and no cases of carcinoma were found in adolescent population. We suggested that sexually active adolescents should be included in cervical screening programs.

Silver staining method for nucleolar organizer regions in cervical smears.

The distribution of nucleolar organizer regions (NORs) was studied in Papanicolaou preparations of cervical smears in order to distinguish benign from preneoplastic lesions. Destained smears (six defined as normal, six as inflammatory with squamous metaplasia, six as CIN I, six as CIN II, and five as CIN III) were submitted to the Ag-NOR method after staining with Orange G and EA36. Ag-NOR count was performed in previously outlined fields on the smears. Statistically significant differences (P < .05) were found between the normal smears, inflammatory smears with squamous metaplasia, and each grade of CIN. We conclude that the Ag-NOR technique could be useful to evaluate cervical smears of doubtful interpretation, using previous demarcation of the abnormal fields/cells.

Image analysis of nuclear/cytoplasmic ratio in cervical smears to discriminate three grades of cervical intraepithelial neoplasia.

OBJECTIVE: To suggest which system of cytologic classification (Bethesda System or World Health Organization [WHO]) of cervical lesions is more adequate for the Public Health Service of São Paulo State, Brazil, based on morphometric study with the Jandel Videoanalysis (JAVA) System. STUDY DESIGN: The study comprised groups of typical smears: cervical intraepithelial neoplasia (CIN 1) separated into two subgroups: cytopathic effects of human papillomavirus associated or not with dyskaryosis, CIN 2 and CIN 3. The JAVA system of image analysis was used to determine the nuclear/cytoplasmic (N/C) ratio in abnormal cells from each group. RESULTS: Significant differences were detected between the three grades of CIN and between the two subgroups of CIN 1. CONCLUSION: Although image analysis is not applicable to large-scale population screening of cervical smears, its use in the present study favored the three-grade cytologic classification (WHO). In addition, the three-grade classification offers the clinician more options for treatment. Considering the clinical-laboratory characteristics of our public health service, the three-grade classification is more adequate.

Study of organizer nucleolar regions by the argyrophil technique in cervical intraepithelial neoplasias.

Thirty three biopsies of the uterine cervix were studied by the AgNOR method, that identifies the nucleolar organizer regions. These comprised 9 cases of cervicitis (with or without squamous metaplasia), 9 cases of cervical intraepithelial neoplasia grade I (CIN I), 8 CIN II and 10 CIN III. A hundred cells were counted and classified according to the number of AgNOR dots. We use a more practical and fast method of AgNOR dots counting in cervical intraepithelial neoplasia, in that we exclude the two basal layers and count only cells with 4 or more dots. Statistically significant differences for AgNOR dots were found between cervicitis or CIN I and CIN II cases (p < 0.02) and between CIN II and CIN III cases (p < 0.001). No statistical difference was found between the cases of cervicitis and CIN I. It was concluded that this method of AgNOR counting can be useful in the identification and classification of individual cases intraepithelial neoplasia and their differentiation from eventual difficult cases of cervicitis.

Cervico-vaginal Chlamydia trachomatis infection in pregnant adolescent and adult women. A morphologic and immunofluorescent study.

We studied the incidence of cervical Chlamydia trachomatis (CT) in 65 adolescents aged between 14 and 19 years and 65 adults aged 20 years or more. All subject were more than three months advanced in a normal pregnancy. Two samples for cytology were obtained from each patient, one ecto- and endocervical, with Ayre's spatula and cytobrush, and one only endocervical with cytobrush. The first one was examined after Papanicolaou staining and the second one was examined with the easily performed immunofluorescence reaction to CT (IF)--Microtrak, SYVA. Twenty seven adolescent patients (41.5%) and fourteen adults (21.5%) had a positive IF test for CT; the rate in adolescents was significantly higher (P < 0.01) than in adults. The Papanicolaou (Pap) stained slides, examined blind for evidence of CT infection showed a sensitivity of 70.7%, a specificity of 95.5% and positive and negative predictive values of 87.8% and 87.6% respectively. Seven adolescents showed cytological signs of Papillomavirus (HPV) infection, and six of them were also CT positive; five had signs of HPV infection and 4 of them were CT positive.

[Comparison of the methods of cytobrush and Ayre spatula in the concentration of endocervical cells]. / Comparação dos métodos de "cytobrush" e espátula de Ayre na concentração de células endocervicais.

A comparison between two sampling methods of cervicovaginal material--cytobrush and Ayre's spatula--was performed to verify the endocervical cell concentration in a group of 163 asymptomatic women. Age ranged from 18 to 57 years, with an average of 30. Smears of both methods showed satisfactory cellularity for study. Cytobrush showed endocervical cells (columnar and/or metaplastic) in 100 cases (61.3%) and Ayre's spatula in 39 (20.2%). Cytobrush showed more efficient results in terms of endocervical cell concentration; according to literature, this can be an important factor in the sensitivity of the cytologic method to detect intraepithelial neoplasia.

Detection of Chlamydia trachomatis cervical infection: a comparison of Papanicolaou and immunofluorescent staining in smears obtained by Ayre's spatula and cytobrush.

Two methods of staining (Papanicolaou versus direct immunofluorescence) and two methods of collection of the samples (Ayre's wooden spatula versus cervical Cytobrush) were compared in order to verify the efficiency in detecting Chlamydia trachomatis (CT) infections in the female genital tract. Out of 166 asymptomatic patients, 59 were positive for CT by means of direct immunofluorescence: 36 were detected in Cytobrush samples, 16 in Ayre's spatula samples, and 7 in the samples collected by both methods. Papanicolaou smears showed "moth-eaten" features suggestive of CT infection in a great number of metaplastic cells present in 35 cases: 24 collected by Cytobrush, 4 by Ayre's spatula and 7 by both methods. Our data show that Cytobrush is more efficient that Ayre's spatula in concentrating cellular material. It is thus possible to detect CT infection with more accuracy by means of direct immunofluorescence, and to suspect CT infection in smears collected by means of Cytobrush and stained by Papanicolaou's method.

Changes in myelinated nerve fibers and skeletal muscle of rats exposed to high doses of permethrin.

Neurological signs and segmental demyelination in a cervical nerve were observed in rats treated orally with permethrin (300 mg/kg/day) for 5 days. Inflammatory and degenerative signals were recorded in the diaphragm muscle. These effects were more intense with the trade grade than with the technical grade product. The possible influence of the percentage of cis:trans isomers on the intensity of the observed effects is discussed.

Chlamydia trachomatis in cervical uterine irradiated cancer patients.

Twenty-two women with uterine carcinoma with morphological alterations postradiation treatment suggestive of Chlamydia trachomatis infection were analyzed by direct immunofluorescence. The diagnosis was confirmed in 12 (54.4%) cases. Discussions of the presence of Chlamydia in irradiated cells were not found in the literature. This finding may signify a posttherapeutic morbidity or a preradiation infection.

[Chlamydia trachomatis in smears of irradiated uterine cervix: cytologic and immunocytochemical aspects]. / "Chlamydia trachomatis" em esfregaços de colo uterino irradiado: aspectos citológicos e imunocitoquímicos.

Some authors recently suggested the role of Chlamydia trachomatis as a potentiating agent of female genital tract neoplasias. Cervicovaginal smears of women with uterine carcinoma treated with radiotherapy are analyzed in the present work. A series of such smears showed morphological changes suggestive of Chlamydia infection with the Papanicolaou stain. Confirmation of the presence of such agent was done using an avidin-biotin-peroxidase technique. A higher prevalence of Chlamydia in the group of patients with carcinoma of the uterus treated with irradiation than in the population without ionizing treatment was verified. The presence of cells with radiotherapic changes infected by Chlamydia is a new finding in cytology.

[Chlamydia trachomatis: significance of endocervical sampling in diagnosis by the Papanicolaou method]. / "Chlamydia trachomatis": importância da colheita endocervical no diagnóstico pelo método de Papanicolaou.

One hundred and sixty-one cervicovaginal smears of women seen at the Instituto Adolfo Lutz, Laboratory I, in Taubaté (SP) were examined cytologically by the Papanicolaou method and by direct immunofluorescence (IF) for Chlamydia trachomatis (Ct). Thirty-three cases (20.5%) had positive results for Ct in the IF. With the Papanicolaou method, those cases presenting fine vacuolation in endocervical metaplastic cells according to recent criteria were suggestive of Ct infection. Compared to IF, the Papanicolaou method showed high sensitivity (91.6%) in the group of smears containing endocervical cells. The IF is a high sensitivity and specificity method, but its cost cannot be afforded by a great portion of our population. In view of the high incidence of Ct infection in the female genital tract, the authors concluded that the Papanicolaou method in smears containing endocervical cells may be considered the first option for the detection of this agent.