Histopathological characteristics and HPV status in cervical biopsy specimens diagnosed as flat condyloma.

Background and Objectives: HPV infections cause a wide spectrum of pathological changes in lower anogenital epithelium. The aim of this study was to investigate the HPV DNA status and histological findings in cervical biopsy specimens diagnosed as flat condyloma. Materials and Methods: This study included 20 cervical biopsy specimens diagnosed as flat condyloma. The histopathological criteria and presence of HPV DNA were evaluated. HPV genotyping was determined in HPV-positive specimens using BioEdit software and the results were analyzed in SPSS software. Results: HPV DNA was not found in 30% of specimens and relative frequency of HPV genotypes was: 15% HPV6, 15% HPV11, 5% HPV16, 5% HPV18, 5% HPV53, 5% HPV68, 5% HPV84, 10% HPV45. Relative frequency of histopathological criteria was as below: 100% of specimens had koilocytosis, 100% acanthosis, 15% nuclear immaturity, 100% atypia, 15% mitotic activity, 50% dyskeratosis, 35% parakeratosis and 10% hyperkeratosis. Conclusion: There were significant differences between HPV positivity and two pathologic criteria; multinucleation and hyperkeratosis (P Value: 0.02). Nuclear immaturity was significantly more prevalent in high risk HPV-positive specimens (P Value: 0.03).

Prevalence and Genotype Distribution of Human Papillomavirus Infection among 12 076 Iranian Women.

INTRODUCTION: Human papillomavirus (HPV) infection is one of the major health concerns of women in developing countries. This study gives an insight into the prevalence and genotype distribution of HPV infection and compares it with Pap smear results among Iranian women. METHODS: In this study, 12 076 Iranian women underwent routine examination from November 2016 to November 2018 using HPV Direct Flow CHIP System for HPV DNA typing. Cytology was undertaken for 5138 samples. RESULTS: Overall HPV prevalence was calculated at 38.68%. The most frequent HPV types were HPV 6, 16, 11, 62/81, 52 and 54. The most high-risk HPV (HR-HPV) types were HPV 16, 52, 18, 39, 31 and 51. These 2 groups represent approximately half of all HPV types detected, 47% and 55%, respectively. Among individuals who underwent cytological tests, 135 individuals (2.63%) were cytologically positive. In this group, 81 individuals (60%) were HPV positive, 62 (76%) of whom were HR-HPV positive, most frequently with HPV 16 (34%). CONCLUSION: This study highlights the urgent need for public education and early diagnosis using HPV screening tests to prevent cervical cancer.

The prevalence and risk factors of group B streptococcus colonization in Iranian pregnant women.

BACKGROUND: Group B Streptococcus (GBS) is a leading cause of serious neonatal infections. Although great progress has been made in preventing prenatal GBS, its colonization rate in different regions of Iran remains unknown. AIM: To determine GBS colonization prevalence and its risk factors among Iranian pregnant women. METHODS: This prospective cross-sectional study was performed on 186 pregnant women, who attended Boo-Ali hospital which is affiliated with Islamic Azad University in Tehran, Iran, from March 2014 to June 2015. The demographic, obstetric and gynecological data were gathered. A recto-vaginal culture was taken from each patient, with a sterile swab, in lithotomy position without using speculum, and vaginal pH was measured. Patients with positive GBS received IV antibiotic therapy during labor (penicillin G 3 gram at first dose then 1.5 gram Q/4h until delivery). Data were analyzed by statistical software SPSS version 21. Statistical tests for differences were performed by Chi-square test. Potential confounding was assessed by logistic regression. Level of significance was set at p<0.05. RESULTS: Twenty-two (11.8%) patients had positive recto-vaginal colonization. No significant differences between colonized and GBS-negative women with regard to age, obstetrics history and socio-economic factor were noticed. In contrast, smoking, history of previous infection with HPV, presence of vulvitis and a vaginal pH>4.5 were associated with GBS colonization (p≤0.05). CONCLUSIONS: With a relatively low prevalence and few significantly correlated factors, it is hardly possible to define a high risk group of pregnant women for GBS colonization. Therefore, thorough measures should be taken in order to prevent infection complications in mothers and neonates in the Iranian population.

Survival of ovarian cancer in Iran: 2000-2004.

OBJECTIVE: The aim of this study was to estimate the 5-year survival of ovarian cancer in Iran between 2000 and 2004, according to age and histology. METHODS: Cancer registry of Iran, 2000-2004, was used covering nearly 80% of all ovarian cancers and 100% of all pathologically diagnosed ovarian cancers. RESULTS: Of 1,246 new ovarian cancer cases, 451 were available for further follow-up, which revealed 169 deaths and 282 live cases. The 5-year survival was 61%; 85% for germ cell tumors and 59% for epithelial tumors. Survival of serous, mucinous, endometrioid and clear cell histologic subtypes of epithelial tumors was 41%, 62%, 76% and 78%, respectively. Young patients with epithelial tumors (below 45) displayed significantly better 5-year survival rates (63% versus 53%). CONCLUSION: we found that ovarian cancer had a better survival rate in Iran in comparison to other regions. We also reviewed all probable confounding factors or real causes. In this study, age and histology affected survival.

Weekly intramuscular methotrexate in the treatment of low-risk gestational trophoblastic neoplasia.

OBJECTIVE: The objective of this study was to determine the efficacy of weekly intramuscular (IM) methotrexate without dose escalation as first-line chemotherapy for low-risk gestational trophoblastic neoplasia (LRGTN). METHODS: Thirty-three women with post-molar LRGTN in the division of gynecology oncology at the Shiraz University of Medical Sciences were treated with weekly IM methotrexate at 30 mg/m(2) without dose escalation. The serum level of beta-hCG was detected every week. After the first negative beta-hCG level, one more cycle was administered as consolidation. Complete response (CR) was defined as the attainment of serum beta-hCG level of 5 IU/L or less measured on three consecutive weeks. RESULTS: Twenty-one of 33 women (63.6%) achieved CR with weekly IM injection of 30 mg/m(2) methotrexate. Ten of 12 patients with weekly IM methotrexate failure had a CR after one to three courses of dactinomycin administered at 1.25 mg/m(2) intravenously every 2 weeks. Two patients needed multiple-agent chemotherapy for remission. CONCLUSIONS: Weekly methotrexate without dose escalation may be an appropriate option for primary chemotherapy of patients with LRGTN.

Evaluation of women presenting with postcoital bleeding by cytology and colposcopy.

OBJECTIVE: To evaluate women with postcoital bleeding (PCB) by clinical examination, cytology, colposcopy, and histopathology. METHODS: A cross-sectional study of 123 women with PCB, who were referred to the Colposcopy Clinic of Arash Hospital, Tehran, over a 2-year period. RESULTS: Clinical examinations revealed cervical polyps in 18 women and ectropion in 14. Cervical cytology identified 13 patients with atypical squamous cells of undetermined significance, 2 with atypical glandular cells, 4 with low-grade squamous intraepithelial lesions, and 3 with high-grade squamous intraepithelial lesions. Colposcopy indicated invasive cancer in 1 patient. Transitional zones appeared normal in 39.8% of the cohort, were atypical grade 1 in 33.3%, and atypical grade 2 in 4.9%. Fourteen abnormalities were detected at histology, including 1 squamous cell carcinoma, 1 low-grade glandular neoplasm, 9 cervical intraepithelial neoplasia (CIN) grade 1, 2 CIN grade 2, and 1 CIN grade 3. The sensitivity and specificity of cytology were 50% and 86.5%, respectively. A total of 21.4% of abnormal pathologies were missed using colposcopy, which had a sensitivity of 79%. CONCLUSION: Because of its higher sensitivity, colposcopy can be recommended for the investigation of persistent PCB, even in the presence of normal cytology.

Familial dysgerminoma associated with 46, XX pure gonadal dysgenesis.

Although the occurrence of pure gonadal dysgenesis PGD is usually sporadic and nonfamilial, here we present 3 sisters with 46, XX PGD, who are born from a first cousin marriage. Review of their family pedigree is compatible with autosomal recessive inheritance. Surprisingly, 2 of these sisters developed ovarian tumors. Both showed the pathological result of dysgerminoma with syncytiotrophoblastic giant cells. These 2 cases are examples of tumorigenesis in PGD without an identifiable Y chromosome. Therefore, malignant degeneration of the streak gonads should be considered in the patients with 46, XX PGD.