Human Papilloma Virus Infection and Associated Intraepithelial Neoplasia of the Cervix, Vagina and Vulva

A prospective colposcopic and histological study was performed on 333 patients with cytologically detected human papilloma virus infection (HPV) without cytological evidence of associated intraepithelial neoplasia. The colposcopic changes seen in the cervix, vagina and vulva were documented and target biopsies were taken from abnormal areas in these 3 sites. Colposcopic and histological evidence of HPV infection was found in the cervix of 314 patients (94%), vagina in 274 patients (82%) and vulva in 146 patients (44%). Histologically proven cervical intraepithelial neoplasia was found in 94 of 333 patients biopsied (28%), vaginal intraepithelial neoplasia in 3 of 333 patients biopsied (0.9%) and vulval intraepithelial neoplasia in 9 of 146 patients biopsied (6.2%). This study identified the colposcopic changes of HPV infection to be widespread throughout the lower female genital tract. The diagnosis of intraepithelial neoplasia undetected by cytology in 28% of patients with HPV infection indicates that such patients require colposcopy and target biopsy according to the colposcopic findings.     

Invasive Squamous Cell Carcinoma of the Vulva: Behaviour and Results in the Light of Changing Management Regimens

Ninety-nine patients with carcinoma of the vulva were referred to the Gynaecologic Oncology Unit, Royal Brisbane Hospital, over 10 years. Ninety of these patients had a squamous cell carcinoma (SCC). They were assessed by the 1969 FIGO clinical staging. Each stage was related to nodal involvement, size, depth, histological grade, lymphvascular space involvement, perineural permeation and multifocal disease site. The operability rate was 85%. Treatment was individualized in line with recent philosophies for more conservative surgery where appropriate. Mortality was 2.6%. Five-year survival of surgically treated patients was 60.3%; node negative patients 100%, and node positive patients 25.2%. After adjustment for stage and size, the only other independent statistically significant feature was perineural penetration. Local recurrence was more likely with increased stage and size, unclear margins and multifocal involvement. It is important to note that medically unfit patients who had vulvectomy alone and who later developed positive nodes had 100% mortality. This group of patients significantly decreases survival rates, confirming the importance of carrying out inguinofemoral lymphadenectomy at the time of initial surgery. Morbidity was decreased by conservative surgery. Lymphoedema remains the most common chronic complication. No significant difference was shown in local recurrence between different types of surgery, wide excision, hemivulvectomy, simple vulvectomy or radical vulvectomy (22%), confirming the safety of the more conservative approach of recent years.     

半乳凝素-3在宫颈上皮内瘤变及宫颈鳞状细胞癌中的表达及其意义

目的:探讨半乳凝素-3(Galectin-3)在宫颈上皮内瘤变(CIN)及宫颈鳞状细胞癌(SCC)中的表达及其意义。方法:选择经病理确诊为CIN和SCC患者的石蜡标本60例,以同时期因子宫肌瘤行全子宫切除患者的正常宫颈组织(NC)石蜡标本10例作为对照,采用免疫组化方法分析CIN及SCC中Galectin-3表达情况。结果:NC、CIN、SCC及SCCⅠ、SCCⅡ、SCCⅢ组Galectin-3表达阳性率分别为40.00%、50.00%、83.33%及70.00%、90.00%、90.00%。NC、CIN、SCC3组间Galectin-3表达阳性率差异有统计学意义(χ2=9.559,P=0.049);NC组Galectin-3表达阳性率与SCCⅡ期组及Ⅲ期组比较,差异有统计学意义(χ2=5.495,P=0.029)。宫颈肿瘤>2cm组Galectin-3表达阳性率高于≤2cm组,差异有统计学意义(χ2=4.690,P=0.047)。结论:SCC中Galectin-3的阳性表达与肿瘤大小有关;Galectin-3表达阳性率随宫颈病变发展而升高。Galectin-3可能在SCC的发生、进展中发挥作用。     

Synchronous Ovarian and Cervical Squamous Intraepithelial Neoplasia: An Analysis of HPV Status

In contrast to the strong association between human papillomavirus (HPV) and cervical intraepithelial neoplasia (CIN), the relationship between HPV and squamous epithelial lesions of the ovary is less clear. We report a case of synchronous ovarian and cervical squamous intraepithelial neoplasia. To investigate the possible association between HPV and squamous intraepithelial neoplasia/carcinomain situ(CIS) of the ovary, DNA was extracted from paraffin-embedded tissues including normal cervix, CIN, CIS from both ovaries, and an area of ovarian endometriosis. All samples were positive for HPV 16 E6 except for one of the two samples from the normal cervical squamous epithelium. These results support the hypothesis that HPV may be involved in the development of ovarian squamous intraepithelial neoplasia.     

CD44v6与人乳头瘤病毒在宫颈鳞癌及癌前病变中的相关性研究

目的:观察CD44v6与人乳头瘤病毒(HPV)在宫颈鳞癌及癌前病变中的相关性,以探讨两者联合检测在宫颈癌早期诊断中的意义。方法:采用免疫组化(SP)法检测宫颈鳞癌、宫颈上皮内瘤变(CIN)Ⅰ、CINⅡ、CINⅢ及正常宫颈组织各20例石蜡标本中CD44v6的表达,同时用荧光定量聚合酶链反应(FQ-PCR)法检测上述组织中HPV-DNA的相对含量,将两者检测的结果进行统计学分析并研究其相关性。结果:CD44v6在对照组、CINⅠ组、CINⅡ组、CINⅢ组及宫颈鳞癌组中细胞表达的阳性率逐渐升高,5组比较差异有统计学意义(P<0.05);HPV感染率也逐渐升高,5组比较差异有统计学意义(P<0.05);CD44v6与HPV感染呈正相关(rs=0.341,P=0.01)。结论 :CD44v6的异常表达和HPV感染与宫颈癌的发生、发展关系密切,两者联合检测对宫颈癌的早期诊断有一定的临床意义。     

高级别宫颈鳞状上皮内病变治疗后病灶残留、复发及妊娠

摘要：高度宫颈鳞状上皮内病变（HSIL）是宫颈癌前病变。未接受治疗的HSIL约17%的概率可进展为浸润癌。因此,准确规范地处理宫颈病变,特别是HSIL是预防宫颈癌的重要手段。ASCCP推荐冷刀锥切术（CKC）和宫颈环形电切（LEEP）为主要诊疗手段。然而部分患者接受治疗后仍存在病灶残留、复发及进展的风险。目前各研究报道HSIL治疗后发生病灶残留、复发及进展的差异较大,且术后病灶残留、复发的危险因素、术后随访方式尚无定论。本文旨在综述HSIL治疗后病灶残留及复发危险因素、处理、随访及妊娠相关问题,从而临指导临床治疗。     

Cervical Cancer in South Australia: Trends in Incidence, Mortality and Case Survival

Summary: Approximately 90% of cervical cancers are considered preventable through regular screening and the treatment of precursor lesions, but fewer than 20% of South Australian women were found to have been screened in 1984.
Data from the State Cancer Registry have shown an increase in cervical cancer incidence of approximately 80% in women under 50 years of age in the 9-year period to 1986, but a decrease of about 25% in older women. Mortality data have shown similar patterns by age, although the increase in younger women tended to extend to an older age.
Case survival was unchanged between the diagnostic periods 1977–1981 and 1982–1987 and there was little change in the proportion of cases that were adeno-carcinomas.     

宫颈上皮内瘤变诊治的相关研究进展

宫颈上皮内瘤变(CIN)是与宫颈癌密切相关的癌前病变。随着宫颈癌生物学研究的进展和筛查技术的进步,宫颈癌的筛查目标已转变为早期检出高级别CIN并行阻断性治疗。在CIN治疗策略的原则中,首要目的应是预防宫颈癌的发生。目前CIN的诊断仍依靠宫颈细胞学、阴道镜与组织病理学这三阶梯技术("three step"technique)。治疗方面,推荐期待治疗作为CINⅠ女性的标准治疗。对于CINⅡ与CINⅢ,宫颈环形电切术(LEEP)和激光锥切是推荐的治疗方法。术后主要通过细胞学、人乳头瘤病毒(HPV)检测对低至中度疾病残留及复发风险患者进行随访,对高度疾病残留及复发风险患者,推荐阴道镜随诊。现拟从CIN的诊断、转归、治疗、CIN合并妊娠、CIN治疗后对妊娠结局的影响以及随访等方面进行综述。     

p53抑癌基因蛋白在外阴鳞癌和不典型增生组织中的表达

应用免疫组化方法，对外阴鳞癌、外阴白色病变和不典型增生组织中ｐ５３基因蛋白的表达进行检测。并与胸腹壁、腿部及外阴鳞癌旁正常皮肤（正常皮肤）组织进行对照。结果：外阴鳞癌组织中ｐ５３基因蛋白的阳性率为５２．９％（９／１７）；外阴硬化苔癣型营养不良组织中为１３．６％（３／２２）；增生型营养不良组织中为１４．７％（５／３４）；混合型营养不良组织中为２０．８％（１０／４８）；不典型增生组织中为５４．５％（６／１１）。正常皮肤组织中均为阴性。提示：ｐ５３基因蛋白在外阴鳞癌和外阴白色病变的各型营养不良组织中，均有不同程度的过度表达，外阴鳞癌和不典型增生组织中的表达阳性率，显著高于外阴白色病变的各型营养不良组织（Ｐ＜０．０１）。     

Endometrial Cancer: Trends in Incidence and Survival: A Preventable Disease?

Summary: Endometrial cancer is the commonest gynaecological cancer. Its relative increase in incidence over recent decades has been generally associated with a reduction in mortality. Evidence is presented to show a considerable variation in incidence worldwide; Australia, like England and Wales, has a comparatively low incidence. The incidence is highest in parts of the United States where it has shown an annual fall of nearly 3% between 1973 and 1987. The influence of hysterectomy, oral contraception and hormone replacement therapy at the menopause are discussed relative to incidence and prevention of the disease. Obesity and its prevention are also shown to have an influence on incidence and its ethnic variation worldwide. Despite a minor improvement in survival in FIGO published figures, the recent COSA-UK-NZ 'high risk' trial highlights the importance to the patient of closely monitored clinical trials.     

阴道上皮内瘤变诊治方法进展

阴道上皮内瘤变是包括阴道鳞状上皮不典型增生及原位癌的一组病变,是一种少见的阴道浸润癌癌前病变,与持续性人乳头瘤病毒（HPV）感染、宫颈癌前病变、宫颈癌等的发生密切相关,发病率较低。阴道上皮内瘤变多无明显临床症状,肉眼观察阴道黏膜基本正常,诊断主要依据辅助检查。与宫颈上皮内瘤变诊断的三阶梯诊断程序一致,常在宫颈癌筛查的第二阶段阴道镜检查时偶然发现,常合并宫颈上皮内瘤变。近年来随着阴道镜应用的普及和提高,阴道上皮内瘤变的检出率明显增加。阴道上皮内瘤变的治疗主要依据病变级别,阴道上皮内瘤变Ⅰ级病变可自行消退,不需要治疗,密切随访即可,但对于高危型HPV感染的患者应重视随访。阴道上皮内瘤变Ⅱ～Ⅲ级公认为癌前病变,一旦确诊需积极治疗,临床上的治疗方法有手术治疗、药物治疗、物理治疗及放疗。但至今尚无统一的临床诊疗标准方案,每种方法都有其利弊,根据患者自身情况选择治疗方案非常重要。     

A Case of Polymyositis and Invasive Squamous Cell Carcinoma of the Uterine Cervix

Summary: To our knowledge, this is the fifth reported case of invasive cervical neoplasia associated with idiopathic inflammatory myopathy and illustrates the importance of cervical examination in women with polymyositis.     

Current Practices in the Management of Cervical Intraepithelial Neoplasia in Australia

Summary: Responses from 181 returned questionnaires (from members of the Australian Society for Colposcopy and Cervical Pathology) regarding the management of cervical intraepithelial neoplasia (CIN) were analysed. The preferred methods of ablation of CIN were laser treatment and electrocoagulation diathermy. Diathermy of lesions was more commonly used by older respondents and those in provincial centres. Fifty-percent of those surveyed used a combination of local and general anaesthesia for ablation of CIN; 30% used either local or general anaesthesia but 15% reported no use of anaesthesia.     

The Significance of Histology and Morphometry in Predicting Lymph Node Metastases in Patients with Squamous Cell Carcinoma of the Vulva

The material consists of a series of 73 patients with squamous cell carcinoma of the vulva. The site and the size of the primary tumor and the histological status of the lymph nodes of the groin were known. Two pathologists evaluated nuclear hyperchromatism, nuclear polymorphism, histological differentiation, number of mitoses, inflammatory response, and vascular invasion and graded these parameters from one to three. The reliability of the histopathological grades evaluated by the κ coefficient showed considerable interobserver variation. Despite this a model which included the subjective parameter nuclear hyperchromatism could predict patients without lymph node metastases. The model consisted of patients with tumors which were not situated on the clitoris, were less than 40 mm in diameter, and exhibited only slight hyperchromatism. The model fitted 19 (26%) and 14 (19%) of the patients with two different pathologists evaluating the nuclear hyperchromatism and none of these patients had lymph node metastases. The quantitative parameter—mean nuclear volume—determined by morphometry was of no diagnostic value for the prediction of patients without groin node metastases at the time of operation.     

High-Dose-Rate Brachytherapy in the Management of High-Grade Intraepithelial Neoplasia of the Vagina

The majority of women with high-grade intraepithelial neoplasia (VAIN 3) are over 60 years of age and have a history of premalignant or malignant disease of the cervix. Although the natural history of VAIN is not well defined, high-grade lesions are premalignant. Ablative treatment with laser or 5-fluorouracil cream is commonly unsatisfactory. Several series have reported a low rate of recurrence and complications if VAIN 3 is treated with low-dose-rate brachytherapy. This retrospective review reports the outcome of 14 patients treated with high-dose-rate brachytherapy, with a dose of 34 to 45 Gy in 4.5- to 8.5-Gy fractions. Treatment was well tolerated with no severe early or late toxicity observed. At a median follow-up of 46 months 1 patient progressed to invasive carcinoma of the vagina; in another patient VAIN 3 persisted.     

宫颈环形电切术治疗宫颈上皮内瘤变的临床研究

目的:探讨宫颈环形电切术(LEEP)在诊治不同级别宫颈上皮内瘤变(CIN)的效果.方法:回顾性分析898例行LEEP手术的宫颈上皮内瘤变患者,观察手术时间、出血量、手术前后组织病理诊断结果变化及高危型人乳头瘤病毒变化,评价LEEP诊断情况及治疗效果.结果:LEEP平均手术时间5.1分钟.术中平均出血量5.6ml,术前电子阴道镜下活检结果与IEEP术后病理结果诊断一致率为77.73%(698/898).LEEP术后病理结果级别升高96例(10.69%),手术前后HPV-DNA负荷量下降明显,差异有统计学意义(P<0.01).结论:LEEP手术对于宫颈病变具有较电子阴道镜下宫颈多点活检更高的宫颈浸润癌检出率,LEEP在切除病变的同时可以有效消除高危型HPV感染,是一种诊断、治疗CIN的非常理想的手段.