MicroRNA-551b expression profile in low and high-grade cervical intraepithelial neoplasia

OBJECTIVE: To evaluate the expression of microRNA (miR)-551b in patients with low and high grade cervical intraepithelial neoplasia (CIN) and to find an association with high-risk Human Papillomavirus (HR-HPV) infection-related prognostic biomarkers. PATIENTS AND METHODS: The expression level of miR-551b was determined in 50 paraffin-embedded cervical specimens (10 normal squamous epithelium, 18 condylomas, 8 CIN1, and 14 CIN2-3) using quantitative Real-time polymerase chain reaction (qRT-PCR). χ2-test compared miR-551b expression in different diagnosis groups. An Ordered Logistic Regression and a Probit correlation were made to correlate miR-551b expression levels with the cervical tissue histological findings. The immunohistochemical distribution of p16 and Ki-67 according to histopathological findings was also assessed. RESULTS: The distribution of the miR-551b expression profile was significantly lower in CIN1-3 samples compared to other histological diagnosis groups (condyloma and negative). The expression levels were inversely correlated to the cervical pathological grade, from negative to CIN2-3. A 1% increase in miR-551b expression level produced an increase of 19% to the probability of a minor histological grade diagnosis in a range from negative to CIN2-3 and an increase of 13% to the probability of a negative histological grade diagnosis. Among the cases with miR-551b expression < 0.02 (considered as cut-off value) a significant statistical correlation was found between p16 and Ki-67 expression and the diagnosis of CIN2-3. CONCLUSIONS: O ur d ata s howed a s ignificant inverse correlation between miR-551b expression and the histological grading of the lesions, suggesting a tumor suppressive function in the different stages of cervical dysplasia

Diagnostic accuracy of sonohysterography vs hysteroscopy in benign uterine endocavitary findings

OBJECTIVE: To compare diagnostic accuracy of sonohysterography vs hysteroscopy in patients with benign uterine endocavitary findings. PATIENTS AND METHODS: This retrospective study evaluated 202 patients submitted to sonohysterography after transvaginal ultrasound examination suspicious for uterine endocavitary findings. Cytological sample was taken and analyzed from the fluid used to distend the uterine cavity. Of 202 patients enrolled for this study, 86 patients underwent gynaecological surgery, of whom 77 were treated with operative hysteroscopy and 9 with other gynaecological surgical techniques. Statistical analysis was performed to evaluate diagnostic agreement between sonohysterography vs hysteroscopy and cytology vs histology. RESULTS: Diagnostic concordance between sonohysterography and hysteroscopy was significant (k value 0.87). The correlation between cytological and histological findings had a moderate level of concordance (k value 0.49).CONCLUSIONS: Sonohysterography provides a diagnostic accuracy as well as hysteroscopy, therefore, it could be considered an alternative procedure in the diagnosis of benign uterine endocavitary findings

HPV vulvare

CDRO

Patologia cervicale nelle adolescenti: come si adeguano le Linee Guida

C

Infezioni da HPV nelle adolescenti

L’età adolescenziale si colloca nella seconda decade della vita al di sotto dei 20 anni. Secondo le stime più recenti, dal 10% al 30% delle quindicenni in Europa è sessualmente attivo, e l’età del primo rapporto sessuale, pur variando nei diversi contesti sociali e nelle diverse aree geografiche, è di circa 17 anni. L’infezione persistente da HPV ad alto rischio oncogeno (HR-HPV) è considerata condizione necessaria per la carcinogenesi cervicale. L’integrazione del DNA di HR-HPV nel genoma della cellula ospite viene ipotizzato come l’evento critico durante la progressione neoplastica, pur rendendosi necessari vari cofattori quali l’uso a lungo termine degli estroprogestinici, il fumo di sigaretta, l’immunosoppressione e le coinfezioni. La maggior parte delle infezioni da HPV viene limitata dalla risposta immunitaria cellulomediata dell’organismo ospite. L’infezione da HPV nelle adolescenti è generalmente transitoria, con una clearance virale nel 70-90% dei casi entro 12-24 mesi dall’infezione. Complessivamente, la regressione dell’infezione da LR HPV è apparsa più rapida e più probabile rispetto a quella da virus ad alto rischio oncogeno: in particolare dopo soli 8 mesi si assiste alla regressione di HPV non oncogeni (LR HPV) in circa l’80% dei casi, ed in più del 90% a 16 mesi. Per quanto riguarda i genotipi ad alto rischio oncogeno (HR HPV) la regressione dell’infezione ad 8 mesi è del 55%, del 75% a 12 mesi e di oltre il 90% a 16 mesi

Microcolposcopy in the diagnostic evaluation of abnormal cervical cytology: when and why to do it

Microcolposcopy is an in vivo cytological examination of the uterine cervix allowing the localization of exoendocervical precancerous lesions. The aim of this study was to assess the diagnostic reliability of microcolposcopy by means of correlation with histology, colposcopy and Pap test results. For the study, 256 patients with abnormal Pap test results were selected and subjected to colposcopy and microcolposcopy with the aim of evaluating the presence of any intraepithelial lesions. One hundred and nine of these patients were subjected to a biopsy. Colposcopy, histology and cytology results were compared with those obtained by microcolposcopy. In low-grade squamous intraepithelial lesion (LSIL) cytology cases, the percentage agreement on lesion grade between Pap test and microcolposcopy results was 74%, while in high-grade squamous intraepithelial lesion (HSIL) cytology cases, it was equal to 80%. The comparison between colposcopy and microcolposcopy showed a level of agreement of 72% for lower grades and 68% for higher grades. Finally, histology was in agreement with microcolposcopy in 73% of cervical intraepithelial grade 1 neoplasia (CIN 1) cases and reached 71% for CIN 2-3. Microcolposcopy proved to be accurate with regard to the diagnosis of lesion grade, and showed to be definitive in patients where cytology was positive for HPV infection and colposcopy was not able to identify any lesions

Vaginal bacterial and fungal flora in pregnant diabetic and non-diabetic women: a multi center observational case-control study

Objective: We evaluated the prevalence of cervicovaginal Bacteria, group B Streptococcus (GBS), Gardnerella vaginalis (GV), Candida spp., Chlamydia trachomatis (CT), Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU) in pregnant women with and without diabetes mellitus (DM). Materials and method: Cervicovaginal swabs were gathered from 473 pregnant patients divided into 127 diabetic and 346 non-diabetic. The results were correlated to gestational age, parity and glycemic control. Results: A higher prevalence of MH/UU (P=0.012) was found in the diabetic patients. After the 28th weeks of pregnancy the prevalence for all investigated microorganisms appeared similar except for MH/UU (P=0.014). In multigravida were there statistically differences between two groups in testing for Bacteria (P=0.015) and for MH/UU (P=0.037). The diabetic condition correlated to the state of multigravida in cases positive for Candida spp (P=0.049) and in those testing positive for at least one microorganism (P=0.043). Pregnant with a blood glucose > 92 have twice the risk of being positive to a single microbiological test than those with better glycemic control. Conclusions: The higher prevalence of MH/UU after the 28 th weeks can be explained with the physiological reduced insulin tolerance characteristic of this gestational period. Among the diabetic testing positive to Candida spp the statistically significant association was observed only in multigravida condition. These data suggest that diabetic multigravida are at increased risk for Candida spp infection in relation to the improper glycemic control

Cervicovaginal bacteria and fungi in pregnant diabetic and non-diabetic women. a multicenter observational cohort study

Abstract. – OBJECTIVE: We evaluated the prevalence of cervicovaginal Bacteria, group B Streptococcus (GBS), Gardnerella vaginalis (GV), Candida spp., Chlamydia trachomatis (CT), Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU) in pregnant women with and without diabetes mellitus (DM). PATIENTS AND METHODS: Cervicovaginal swabs were gathered from 473 pregnant patients divided into 127 diabetic and 346 non-diabetic. The results were correlated to gestational age, parity and glycemic control. RESULTS: A higher prevalence of MH/UU (p=0.012) was found in the diabetic patients. After the 28th week of pregnancy, the prevalence for all investigated microorganisms appeared similar except for MH/UU (p=0.014). In multigravida, there were statistical differences between two groups in testing for Bacteria (p=0.015) and for MH/UU (p=0.037). The diabetic condition correlated to the state of multigravida in cases positive for Candida spp. (p=0.049) and in those testing positive for at least one microorganism (p=0.043). Pregnant with a blood glucose > 92 have twice the risk of being positive to a single microbiological test than those with better glycemic control. CONCLUSIONS: The higher prevalence of MH/ UU after the 28th weeks can be explained with the physiologically reduced insulin tolerance characteristic of this gestational period. Among the diabetic testing positive to Candida spp. the statistically significant association was observed only in multigravida condition. These data suggest that diabetic multigravida women are at increased risk for Candida spp. infection in relation to the improper glycemic control