Diathermic loop treatment for CIN and HPV lesions. A follow-up of 130 cases.

In order to evaluate the therapeutic value of Diathermic Loop Excision (DLE), the Authors consider the colpocytohistological follow-up findings (at 3, 6 and 12 months) made in a series of 130 women who underwent DLE for CIN and cervical HPV lesions. The percentages of regression of the lesions, ranging from 84.9% and 93.7% for CIN lesions, and from 62.9% to 71.0% for HPV lesions, confirm that DLE is a rational and effective technique in the treatment of circumscribed cervical intraepithelial neoplasia and HPV lesions.

The accuracy of colposcopically directed biopsy in the diagnosis of cervical intraepithelial neoplasia.

In order to evaluate the accuracy of colposcopically directed biopsy in the diagnosis of Cervical Intraepithelial Neoplasia (CIN), in a series of 164 patients we compared findings from histological serial section of colposcopically directed biopsy with those from histological serial section of the entire lesion after diathermic loop excision. Colposcopically directed biopsy allowed a correct diagnosis to be made in 73 to 76.3% of cases, depending on the importance of the cervical lesion.

Human papillomavirus infections of the genital region in human immunodeficiency virus seropositive women: integration of type 16 correlates with rapid progression.

The efficacy of treatment of HPV infections was evaluated in 14 HIV-1 seropositive women. Disease evolution was evaluated at follow-up examinations, and findings were compared to those in 14 historic HIV-negative women who had received similar treatment. HPV sequences were demonstrated by Southern blot in 13/14 HIV-positive women and by in situ hybridization in 5/13 HIV-negative women. Types 6/11, 16, and 31/33/35 were equally distributed in both groups; type 18 was never detected. In all but one case, the same viral type was present in different lesions, and in recurrences. Among the HIV-positive women, integration of viral sequences had occurred in the dysplastic lesions in 2 of the 3 HPV-16-positive cases; both cases showed progression to carcinoma in situ within 1 to 2 years. Despite comparable treatment, the HIV-positive women showed lesion persistence or progression, while all HIV-negative women experienced regression.

Risk of progression in low grade squamous intraepithelial lesions.

In order to evaluate the evolution of the low grade dysplasia using colpocytologic follow-up, 150 women, enrolled in this study, were submitted to yearly colpocytologic control for a period of four years. The rate of progression toward more severe forms was very low; three cases (2.14%) in the first year, one case (0.7%) in the second and two cases (2.32%) in the fourth. Eighty-eight per cent of the patients had cytologic signs of Human Papilloma Virus infection detected in cytologic and histologic examination.

Colposcopic pictures of Abnormal Transformation Zone (ANTZ): colpocytological and histological findings.

The Authors have examined the correlation between the colposcopic pictures of the Abnormal Transformation Zone (ANTZ), in its varying degrees, and the colpocytological and histological examinations in order to seek a better definition of the indications of carrying out aimed biopsies. From our results a good agreement has been observed from the colpocytological and histological examination and the colposcopic pictures of the ANTZ. In patients with colposcopic images of ANTZ G2 the colpocytological examination diagnosed a CIN 3 in 80.6% of cases, invasive carcinoma in 6.4%, and in histologic examination CIN 3 in 71% and microinvasive carcinoma in 10.7%. Instead in the ANTZ G1, CIN 3 was revealed colpocytologically in 7.9% of the cases and histologically in 7.3%. Among these last, in half of the cases, the focuses of CIN 3 were present at the level of third inferior of the cervical canal. Finally, in ANTZ G0 there was cytological evidence in 6.6% of cases of CIN 3 with a histological correspondence of 3.9%. In particular the focuses of CIN 3, small and limited, had resulted from biopsies carried out on some glandular openings not clearly attributable to ANTZ G1. With regard to the opportuneness of carrying out aimed biopsies, mandatory in the cases of ANTZ G2, we feel it would be useful to carry them out also for ANTZ G1, above all if alterations are diagnosed at the colpocytologic examinations, and in ANTZ G0 if colpocytological alterations are present. Therefore integrating colposcopic and colpocytologic examinations and aiming the biopsies would seem to lead to good diagnostic reliability and adequate successive personalized treatment.

[Endometrial changes in the presence of a progesterone-releasing IUD. Cytological evaluation]. / Modificazioni endometriali in presenza di IUD al progesterone. Valutazione citologica.

PIP: Progesterone-releasing IUDs provide effective contraception by foreign body reaction of the tissues, changes in the endometrial physiology and modification of sperm motility. Local atrophy then reduces bleeding and spotting, and local reduction of prostaglandins provides a reduction of pelvic cramping. Endometrial samples were taken from 28 women to observe cytological changes in the presence of a progesterone-releasing IUD. Inflammatory reaction was moderate and quite rare, as opposed to what is usually seen with copper-based IUDs; cytological changes were similar in the 2 kinds of IUDs, but no atypical cells were noticed in the presence of progesterone-releasing devices. The most frequent cellular change was regressive rather than regenerative, perhaps because of the chemical similarity between progesterone and cortisone.^ieng

Epidemiological aspects of vaginal intraepithelial neoplasia (VAIN).

In order to evaluate the natural history of Vaginal Intraepithelial Neoplasia (VAIN), its epidemiological characteristics and the risk of its evolving into Invasive Carcinoma, we studied direct vaginal biopsies from 376 outpatients, we ascertained the predominant disease site and investigated whether the lesions (uni or multicentric) were only vaginal, were present at both the cervix and the vagina or were an extension of cervical lesions (DES-like areas). Moreover, in cervical and vaginal biopsies from 265 patients, we compared the severity of intraepithelial neoplasia of the vagina and cervix. In our series, vaginal lesions accounted for over half (52.6%) of the alterations attributable to HPV infection, while VAIN accounted for 46.5%; in 84.8% of cases, VAIN was associated with HPV. In 49.8% of cases, biopsies were from the upper third of the vagina and in 74.8% the pathological areas involved both the cervix and the vagina. The DES-like zone accounted for 7.9% of cases, vaginal wall involvement being limited to the upper third. Finally, the comparison of histological findings, in the 265 patients, confirmed that in 69.8% cases vaginal and cervical lesions were of the same grade; in 18.8% vaginal lesions were more severe than cervical lesions. In our study a higher number of vaginal biopsies were taken than in previous years, and it is difficult to establish whether this depends on improved diagnostic methods or on changes in epithemiological factors, such as the reported increase in the incidence of HPV lesions. A systemic search for lesions and a study on their evolution are therefore required to clarify this aspect.

Vulvar intraepithelial neoplasia. Epidemiological and clinical study of 45 cases.

We observed 45 cases of Vulvar Intraepithelial Neoplasia (VIN) histologically diagnosed which came to our observation between 1986 and 1991. The average age of the patients and the grade of the VIN lesions were evaluated. We also examined the eventual association with Papillomavirus infection, with non-neoplastic epithelial disorders in the adjacent areas and with intraepithelial neoplasias of the cervix and/or the vagina (CIN and/or VAIN). These data were studied in relation to the vulvoscopic pictures and symptomatology presented by the patients at the moment of diagnosis.