Human papilloma virus infection and cervical intraepithelial neoplasia in transplanted patients.

Progress in diagnosis and treatment has led to an increased number of transplantation patients who consequently have immunological depression and emergence of tumors. The incidence of cervical neoplasia, according to previous studies, is 11%; this tumor is the only one that can be investigated by screening before and after a graft. Our purpose was to evaluate whether transplanted patients showed an increased incidence of genital human papilloma virus (HPV) infection and whether this infection produced greater progression of disease in cases of low-risk HPV infections. Our study involved 151 transplant patients who underwent Papanicolaou (Pap) and HPV tests. Patients listed for grafts underwent Pap and HPV tests 6 months before and 6 months after transplantation. All patients had negative Pap tests before their grafts. After their grafts 16 patients (10.59%) had negative Pap tests, but positive viral typing. Eleven patients (7.28%) showed positive Pap tests, 6 of whom had low-grade squamous intraepithelial lesion (SIL) and 5 patients high-grade SIL. The final HPV infection incidence (15.23%) was consistent with the literature. The incidence of lower female genital tract intraepithelial lesions (7.28%) was higher than the healthy population or analogous studies (4.5%-8.5%). We showed a constant association between high-risk HPV infection and gynecologic intraepithelial neoplasia, whereas there was no association between low-risk broods HPV infection and neoplasia. In conclusion, screening should start at almost 6 months before grafting to avoid an irreversible situation that is difficult to treat.

Aggressive angiomyxoma of the vulva.

BACKGROUND: Aggressive angiomyxoma is a rare soft tissue tumour that carries a high risk of local relapse. It is a slowly growing and locally infiltrating tumour. CASE: We describe the case of an aggressive pelvic-perineal angiomyxoma arising in a 36-year-old woman. The patient had a mass that grew before, during and after her pregnancy. Transperineal surgery was performed. The resection margins were free of disease. CONCLUSION: Our case confirms what has previously been published concerning the possible hormone-dependence of this neoplasm. Given the positive estrogen and progesterone receptor status of this tumour, we will consider hormonal treatments in the case of a future relapse.

Multiple small intestinal stromal tumours in a patient with previously unrecognised neurofibromatosis type 1: immunohistochemical and ultrastructural evaluation.

Neurofibromatosis type 1 could be associated with multiple gastrointestinal stromal tumours, although their presence is not considered among the major diagnostic criteria. We present here a case of a 50-year-old female complaining of abdominal pain, with about 100 small intestinal stromal tumours. This finding prompted us to suspect a neurofibromatosis which was clinically confirmed afterwards. Light microscopy examination revealed a low-grade stromal tumour with skeinoid fibres. Mixed neural-interstitial cells of Cajal origin or, alternatively, neural differentiation of interstitial cells of Cajal are discussed on the basis of immunophenotype (CD117+, CD34+) and ultrastructure. A 2-year follow-up did not indicate an aggressive course in the case of this neoplasm.

Uterine malformations and pregnancy losses: is cervical cerclage effective?

For many years, we and others have reported the efficacy of cervical cerclage in the prevention of miscarriage in patients with uterine malformations. In this paper the experience of 275 cases collected between 1978 and 1998 is reported. Our data indicate that cervical cerclage is effective in preventing miscarriages, prevalently in those pregnancies bearing uterine malformations with simultaneous cervical incompetence.

Carbon dioxide laser surgery in colposcopy for cervicovaginal intraepithelial neoplasia treatment. 10 years experience and failure analysis.

CO2 laser vaporisation is an effective method in the treatment of cervico-vaginal pre-invasive lesions. In a case-series of 334 patients no case of invasive neoplasia development were registered at longterm follow-up. The failure rate is comparable to those described with traditional surgical methods and are due to the particular topography of the disease.