Cervical cancer screening with HPV testing in the Valcamonica (Italy) screening programme.

OBJECTIVE: We present the results of the first screening round and the first year of the second round of the Valcamonica Human Papillomavirus (HPV) pilot screening project. SETTING: From 2010 to 2012, the entire target female population (aged 25-64) was invited to the first HPV screening round in an area where Pap test screening had been active since 2002. METHODS: For HPV-negative women, the interval was three years. For HPV-positive women, a cytological smear was stained and interpreted. Positive cytologies were referred to colposcopy; negatives were referred to repeat HPV after one year. If HPV was persistently positive, women were referred to colposcopy; if negative, to normal screening. RESULTS: In 2010-12 18728 women were screened, slightly higher participation than with Pap test (18233 64.7%); 1633 were HPV-positive (8.7%); 843 were positive at cytology triage (referral rate at baseline 4.5%). Of those referred at the one year HPV test, 84% complied (660/780); 356 were persistently positive (1.9%). The total referral rate was 6.4% compared with 3.7% for the Pap test. The detection rate was 9.2/1000 compared with 5.0% for the Pap test. The HPV positivity rate during the second round in women previously negative was 3.9% and the detection rate in HPV-positive cytology-positive women was 0.8/1000. CONCLUSIONS: HPV-based screening increases colposcopies at the first round, but also strongly increases the detection rate. At the second round, HPV prevalence was much lower and the detection rate also fell, corroborating the need for longer screening intervals in HPV-negative women.

Uterine endometrioid adenocarcinoma with extensive pilomatrixoma-like areas. A case report.

Shadow cells are typical features of pilomatrixoma, although they have been described in other benign cutaneous tumours with characteristics of differentiation toward the hair matrix. The finding of extensive shadow cell differentiation in visceral carcinomas is otherwise unusual. We report herein a case of uterine adenocarcinoma with extensive pilomatrixoma-like areas in a 74-year-old woman. The endometrial tumour showed an invasive poorly differentiated growth with squamous differentiation deeply extending into the myometrium intermixed with lobules of empty squamoid polyhedral cells with clear shadow like nuclei, focally exhibiting a 'ghost' appearance. The cervix, salpinges, ovaries and pelvic lymph nodes were free of disease and, taking all evidence into account, the tumour was diagnosed as poorly differentiated endometrial endometrioid adenocarcinoma (FIGO stage IB). The recognition of an extensive pilomatrixoma-like component in a high- grade endometrioid adenocarcinoma may be important to avoid diagnostic misinterpretation with uterine metastases of malignant cutaneous pilomatrical tumours, such as pilomatrix carcinomas.

Eficácia dos tratamentos estabelecidos pelo Manual da IETS, em oócitos, expostos à Leptospira interrogans / Effectiveness of treatments established by the Manual of IETS, in oocytes, exposed to Leptospira interrogans

Avaliou-se a eficácia dos tratamentos, definidos pela International Embryo Transfer Society (IETS), de oócitos bovinos, maturados in vitro e expostos experimentalmente à Leptospira interrogans sorovar Grippotyphosa. Os oócitos foram obtidos por meio de punção folicular, selecionados e distribuídos em quatro grupos, expostos ao patógeno e submetidos aos diferentes tipos de tratamentos. Foram expostos à cepa na concentração de 4,7.10(5)/µL, virulenta e não adaptada ao meio de manutenção EMJH, e, de 6,3.10(5)/µL, avirulenta e adaptada ao meio, por 24 horas. Os grupos tratados com tripsina ou antibióticos apresentaram eficácia de 21,7 por cento, e o grupo lavado sequencialmente 33,4 por cento. Os tratamentos não foram eficazes para os contaminados com a cepa avirulenta. Concluiu-se que as normas de controle de qualidade estabelecidas pela IETS poderiam ser revisadas e, possivelmente, redefinidas, uma vez que a eficácia dos tratamentos, provavelmente, não depende somente da espécie do patógeno, pois há interferência da virulência e de ação dos tratamentos sobre o tipo de patógeno.

The research purpose was to evaluate the effectiveness of treatments established by the IETS, in bovine oocytes maturated in vitro, exposed experimentally to Leptospira interrogans serovar Grippotyphosa. The oocytes were obtained through follicular puncture, selected and randomly allotted in four groups, exposed to the pathogen and subjected to different types of treatments. They were exposed to the strain in the concentration of 4.7x10(5)/µL virulent and not adapted to the EMJH, and to 6,3x10(5)/µL, virulent and adapted to the medium, for 24 hours. The treatments presented for the groups with trypsin or antibiotics, 21.7 percent efficiency, and the group washed sequentially presented 33.4 percent efficiency. The treatments were not effective for those infected with avirulent strain. In the statistical analysis, by χ², was found significance in the results obtained. The standards of quality control established by IETS could be reviewed and possibly redefined, since the effectiveness of treatment probably depends not only on the species of the pathogen, but is also affected by its virulence and treatment effectiveness.

Cystic sebaceous lymphadenoma of the parotid gland: case report and review of the literature.

Sebaceous lymphadenoma (SL) of the salivary glands is a very rare, benign tumour with distinct histopathologic characteristics and uncertain histogenesis. It is almost exclusively confined to the parotid gland where it occurs generally as a slowly growing mass in elderly patients. Several imaging techniques and fine-needle aspiration cytology (FNAC) can be used for diagnosis, but definitive diagnosis is usually established only by histopathological examination. Such lesions are composed of a varying admixture of islands, duct-like structures and cysts covered with squamous or cuboid and columnar epithelium intermingled with a background of lymphoid stroma, sometimes with lymph follicles. Accurate diagnosis of SL is important since many salivary masses in adults are malignant. We report a case of cystic sebaceous lymphadenoma of the left parotid gland surgically resected in a 70-year-old woman. Fifteen months after surgery, the patient is well, with no evidence of recurrence. Differential diagnostic problems and histogenetic considerations are provided; a comprehensive review of the literature has also been performed.

Management and triage of women with human papillomavirus infection in follow-up for low-grade cervical disease: association of HPV-DNA and RNA-based methods.

Type-specific persistent infection with Human Papillomavirus (HPV) is a significant risk factor for the development of cervical diseases. Persistent infection could be further refined by a sequencing approach to detect early cervical lesions that are at high risk of developing an invasive squamous cervical cancer. The aim of the present study is to investigate the clinical utility of detecting mRNA transcripts of HPV oncogenes E6/E7 by using a Real-time NASBA technology (mRNA test) and to identify women with low-grade cytological disease but with an increased risk of developing high-grade cervical abnormalities or invasive squamous cervical cancer. Our preliminary results show that E6/E7 is detected in only a subset of HR-HPV-positive cases. Since viral persistence is considered to be the true precursor of neoplastic progression, only the detection of E6/E7 mRNA can identify the infection which is more likely to persist and induce neoplasia in future. For these reasons we believe that this test would be useful for the characterization of women with HR-HPV DNA positivity who should be effectively treated because at high-risk of developing a high grade cervical lesion or an invasive squamous cervical cancer.

Serum and mucosal cytokine profiles in patients with active Helicobacter pylori and ischemic heart disease: is there a relationship?

This study is designed to investigate, for the first time, circulating and gastric mucosal levels of IL1-alpha, IL-6, IL-8 and TNF-alpha in patients with ischemic heart disease (IHD) and matched controls, according to the presence or absence of active Helicobacter pylori infection. Furthermore, in order to evaluate whether modified lipid profile was associated to an increased cardiovascular risk, this was determined in the same groups. Cytokine levels were measured using ELISA in 58 patients with IHD and 52 controls. Active H. pylori infection was assessed if either culture of H. pylori or rapid urease test gave a positive result. Our findings indicate increasing cytokine mucosal levels in H. pylori-positive patients compared to H. pylori-negative subjects. However, the increase was statistically significant only for IL-6 and TNF-alpha in the gastric mucosa of IHD patients. In H. pylori-positive controls, IL-8 mucosal levels positively correlated with both IL1-alpha (r = 0.98; P = 0.0003) and IL-6 (r = 0.83; P = 0.03) levels. Circulating cytokine levels were comparable in IHD and healthy subjects, regardless of H. pylori status. There were no correlations between mucosal and circulating cytokine levels. Active H. pylori infection was not associated with a modified lipid profile in either controls or IHD patients, although ApoAI levels were significantly higher in H. pylori-positive controls compared to those H. pylori-negative. Taken together, the results of the present study provide evidence that active H. pylori infection may play a role as a trigger factor in the pathophysiology of IHD by inducing an inflammatory cascade concentrated on gastric mucosa.

Detection of Helicobacter pylori by PCR on gastric biopsy specimens taken for CP test: comparison with histopathological analysis.

The aims of the present study were: (i) to assess whether H. pylori could be successfully detected by PCR from the same biopsy sample used for CPtest; and ii) to evaluate CPtest comparatively to both PCR and histology for detection of H. pylori infection in dyspeptic patients. Three antral gastric biopsies were collected from each of 80 consecutive dyspeptic patients undergoing oesophago-gastroduodenoscopy. Two biopsies were for histology (gold standard), one for CPtest, scored at 20min, 1h and 24h for the presence of urease activity. Gastric biopsy was then removed from CPtest and used for ureC-targeted PCR. Fifty-five (68.7%) patients were positive for H. pylori infection by histology. CPtest yielded an overall diagnostic accuracy of 93.8% (95% CI: 91-96.4%), regardless of observation period. No erroneous categorization of H. pylori status occurred using PCR, yielding sensitivity, specificity, positive and negative predictive values, and overall diagnostic accuracy of 100%. Our results suggest that H. pylori can be detected by PCR in gastric biopsies previously taken for CPtest, so reducing the workload of the endoscopist by saving additional biopsies for culture analysis and susceptibility tests.