Human papillomavirus infection-associated markers of the occurrence and progression of cervical intraepithelial neoplasias: from research developments to clinical practice

Cervical intraepithelial neoplasias (CIN), the stages of development in cancer of the cervix uteri (CCU) during persisting infections caused by human papillomavirus (HPV), are a disease frequently occurring in young women. The carcinogenic process lasts 3-5 to 10-30 years during which timely detection and organ-saving treatment for the lesion are possible. The development of markers for the persis- tence of HPV infection and the transition of a productive to transforming phase of infection (from mild to severe CIN) is a basis for the current approach to screening for CIN and BC and to a patient follow-up. The review paper presents the main areas of studies developing markers that are directly associated with HPV infection (HC2 viral load), virus typing, viral physical status, E6 and E7 mRNA, E2/E6 ratio) and its mediated action on host cells (p16INK4a, hTERT). The pathogenetic effect of HPV early genes and their association with the expression of basic surrogate markers are considered in detail. The majority of the presented markers are being actively put into clinical practice in foreign countries

Abnormal cervical smears in the unchanged uterine cervix: difficulties in the screening, diagnosis, and treatment of cervical intraepithelial neoplasias and microinvasive cancer

The author analyzes an algorithm for identifying and treating w omen with cervical intraepithelial neoplasias (CIN) and microinv asive cancer of the cervix uteri in cases of the hidden area of transformation and in the absence of visible cervical changes. There are excep- tional difficulties of making the diagnosis of epithelial damages due to the incomplete reproducibility of cytological abnormal ities and the low informative value of a histological study of scrapes from the cervical canal. To avoid hypodiagnosis, it is justifiable to prefer human papillomavirus testing (Hybrid Capture 2 (HC2)) to repeat smears for the choice of a management tactic. Conization is recommend ed as a diagnostic and/or therapeutic procedure when the viral load is high in over 35-year-old patients with abnormal smears anda hidden transformation area

Neuroendocrine tumors of the vagina

The paper covers the most important topographic-anatomic and histological characteristics of the vagina, gives general information on the epidemiology of primary vaginal cancer (VC), on the rules of its staging, describes the frequently encountered morphological types of this tumor, and indicates the properties and features of the course of neuroendocrine tumors (NETs), including the most common manifestations of carcinoid syndrome and the symptoms of tumor hypersecretion of a number of biologically active substances. It also indicates the most common sites of NETs, the rules of their classification according to the grade and mitotic activity of tumor cells, as well as major methods for biochemical and radiological diagnosis. The immunohistochemical NET markers that can diagnose VC, their physiological role, sensitivity, and specificity, as well as the possibility of determining them in the body’s biological environments in order to increase physicians’ awareness are described in detail and the main aspects of tumor immunohistochemical staining are denoted. The role of circulating tumor cells as a promising method to specify the extent of NETs is defined. The paper gives epidemiological information on the development of vaginal NET and summarizes the available data by their clinical course and treatment results. It provides current guidelines on the required treatment volume and specifies the role of surgical intervention and the necessary volume if the intervention is expedient. It sets forth the up-to-date guidelines for chemotherapy for small cell tumors, as well as VC, which includes the specific features of managing patients with tumor recurrences depending on the time of their development