Distribution of Human Papillomavirus Types in Different Histological Subtypes of Cervical Adenocarcinoma

Little information is available regarding distribution of HPV types in different histological subtypes of adenocarcinoma (AC). Thus, in this study we examined the frequency of high-risk (hr) HPV types in AC, adenocarcinoma in situ (AIS) and adenosquamous carcinoma (ADSQ). A total of 102 cases of primary cervical adenocarcinoma (26 AIS and 76 invasive AC) obtained from pathology files from 1995–2006 were histologically subtyped. Our results demonstrated that endocervical type occupied the major subtype of AC (22/66) followed by ADSQ (17/66) where as in the group of AIS endocervical type (12/23) was followed by intestinal type of AIS (7/23). Successful DNA extraction was obtained in 89 samples; 81 out of 89 (91.0%) tested positive for HPV DNA. The prevalence of HPV DNA in AIS, AC and ADSQ was 91.3% (21/23), 90.9% (60/66) and 94.1% (16/17), respectively. We found HPV 18 type to be the most predominant type in AIS (11/21) and AC (17/60) followed by HPV of undeternmined type in AIS (3/21) and HPV 16 in AC (9/60) as the sole viral type. HPV 18 was most frequently detected type in all histological subtypes of AIS and AC. We have detected HPV DNA in all 5 samples of clear cell carcinoma (CCC), although other studies have reported a highly variable prevalence of HPV DNA in CCC. The most prevalent HPV type in ADSQ was HPV-16 followed by HPV 33 as single type. The observed overall predominance of HPV 18 in AIS ( 2= 6.109, p£ 0.025) and AC ( 2 = 8.927, p£0.01) as well as of HPV 16 in ADSQ ( 2 = 10.164, p £ 0.01) was statistically significant. Our data revealed statistically significant predominance of single hrHPV infections in AIS (16/21; 2 = 11.523, p £ 0.001) and AC (37/60; 2 = 6.533, p £ 0.025) whereas multiple hrHPV infections were more abundant in AC comparing to AIS (23/81and 5/81, respectively; 2 = 13.989, p £ 0.001)

Temeljna načela kirurškog liječenja zloćudnih ginekoloških novotvorina

In the treatment of gynecologic malignancies surgery represents a cornerstone of gynecologic oncology. Surgery is important to establish the definitive diagnosis, to define the extent of disease and to eliminate the tumor according to the type and localization. The most frequent tumors among gynecologic malignancies are cervical, endometrial and ovarian cancer. Actual surgical approach in early cervical cancer with microscopic extension includes conservative techniques, in the first place the use of conisation. In the same group of patients but with fulfilled reproductive activities, hysterectomy is recommended. Radical surgery could be applied in invasive cervical cancer staged IB1 to IIA. Surgical treatment in the advanced stage of cervical cancer could be exerted exclusively in controlled trials as a part of multimodal treatment. Endometrial cancer still remains incompletely defined in the extension of surgical procedures. Namely, lymphadenectomy in patients with endometrial cancer according to the low rate of lymphatic dissemination is not completely accepted in hospital daily practice. Furthermore, the increasing use of minimal invasive surgery transforms our way of thinking, especially in the case of endometrial cancer. Ovarian cancer still remains an unresolved diagnostic problem with negative implication in the treatment efficacy. About two thirds of patients are in advanced stage at the time of their first surgery, primarily for the lack of a high effective screening test as well as unknown pathophysiology in early ovarian cancer development. In early ovarian cancer comprehensive staging should be done, while in patients with advanced disease standard approach should include maximal effort in surgical cytoreduction.Kirurški tretman malignih novotvorina ženskog spolnog sustava predstavlja početak i osnovu svakog onkološkog liječenja. Kirurški je zahvat, naime, od temeljne važnosti pri postavljanju konačne dijagnoze, određivanju stadija bolesti, kao i za uklanjanje tumorske mase tijekom prvog operacijskog zahvata sukladno lokalizaciji i vrsti malignoma. Najčešću pojavnost malignoma ženskih spolnih organa nalazimo na cerviksu, endometriju i ovariju. Suvremeni kirurški pristup liječenju ranog stadija - mikroskoposkog raka vrata maternice uključuje konzervativne zahvate u smislu konizacije. U slučajevima gdje je reprodukcija završena može se posegnuti za histerektomijom. Radikalna kirurgija predstavlja metodu izbora u klinički invazivnom obliku bolesti (stadij IB1 do IIA). Kirurško liječenje viših stadija može se rabiti u kontroliranim studijama u sklopu multimodalnog liječenja. Rak endometrija i dalje ostaje u određenom smislu nedovoljno definiran u smislu opsežnosti samoga kirurškog zahvata. Naime, limfadenektomija kod bolesnica s rakom endometrija s obzirom na relativno nisku stopu limfogenog rasapa i dalje predstavlja kamen spoticanja u kliničkoj praksi. S druge strane, sve opsežnije uvođenje endoskopske kirurgije otvorilo je nepovratni put ka prihvaćanju operativnih zahvata s minimalno invazivnim tehnikama. Rak jajnika još uvijek predstavlja veliki dijagnostički i terapijski problem. Kako ne postoje široko primijenjeni učinkoviti testovi probira, bolest se u dvije trećine bolesnica otkriva tek u uznapredovaloj fazi s posljedičnom visokom stopom smrtnosti koja premašuje zbroj smrtnosti svih preostalih ginekoloških malignoma. U bolesnica s naizgled ranim stadijem bolesti potrebno je učiniti sveobuhvatni kirurški zahvat radi određivanja točnog stadija bolesti, dok u bolesnica s uznapredovalom bolešću standardni pristup uključuje optimalnu kiruršku citoredukciju

Temeljna načela kirurškog liječenja zloćudnih ginekoloških novotvorina

In the treatment of gynecologic malignancies surgery represents a cornerstone of gynecologic oncology. Surgery is important to establish the definitive diagnosis, to define the extent of disease and to eliminate the tumor according to the type and localization. The most frequent tumors among gynecologic malignancies are cervical, endometrial and ovarian cancer. Actual surgical approach in early cervical cancer with microscopic extension includes conservative techniques, in the first place the use of conisation. In the same group of patients but with fulfilled reproductive activities, hysterectomy is recommended. Radical surgery could be applied in invasive cervical cancer staged IB1 to IIA. Surgical treatment in the advanced stage of cervical cancer could be exerted exclusively in controlled trials as a part of multimodal treatment. Endometrial cancer still remains incompletely defined in the extension of surgical procedures. Namely, lymphadenectomy in patients with endometrial cancer according to the low rate of lymphatic dissemination is not completely accepted in hospital daily practice. Furthermore, the increasing use of minimal invasive surgery transforms our way of thinking, especially in the case of endometrial cancer. Ovarian cancer still remains an unresolved diagnostic problem with negative implication in the treatment efficacy. About two thirds of patients are in advanced stage at the time of their first surgery, primarily for the lack of a high effective screening test as well as unknown pathophysiology in early ovarian cancer development. In early ovarian cancer comprehensive staging should be done, while in patients with advanced disease standard approach should include maximal effort in surgical cytoreduction.Kirurški tretman malignih novotvorina ženskog spolnog sustava predstavlja početak i osnovu svakog onkološkog liječenja. Kirurški je zahvat, naime, od temeljne važnosti pri postavljanju konačne dijagnoze, određivanju stadija bolesti, kao i za uklanjanje tumorske mase tijekom prvog operacijskog zahvata sukladno lokalizaciji i vrsti malignoma. Najčešću pojavnost malignoma ženskih spolnih organa nalazimo na cerviksu, endometriju i ovariju. Suvremeni kirurški pristup liječenju ranog stadija - mikroskoposkog raka vrata maternice uključuje konzervativne zahvate u smislu konizacije. U slučajevima gdje je reprodukcija završena može se posegnuti za histerektomijom. Radikalna kirurgija predstavlja metodu izbora u klinički invazivnom obliku bolesti (stadij IB1 do IIA). Kirurško liječenje viših stadija može se rabiti u kontroliranim studijama u sklopu multimodalnog liječenja. Rak endometrija i dalje ostaje u određenom smislu nedovoljno definiran u smislu opsežnosti samoga kirurškog zahvata. Naime, limfadenektomija kod bolesnica s rakom endometrija s obzirom na relativno nisku stopu limfogenog rasapa i dalje predstavlja kamen spoticanja u kliničkoj praksi. S druge strane, sve opsežnije uvođenje endoskopske kirurgije otvorilo je nepovratni put ka prihvaćanju operativnih zahvata s minimalno invazivnim tehnikama. Rak jajnika još uvijek predstavlja veliki dijagnostički i terapijski problem. Kako ne postoje široko primijenjeni učinkoviti testovi probira, bolest se u dvije trećine bolesnica otkriva tek u uznapredovaloj fazi s posljedičnom visokom stopom smrtnosti koja premašuje zbroj smrtnosti svih preostalih ginekoloških malignoma. U bolesnica s naizgled ranim stadijem bolesti potrebno je učiniti sveobuhvatni kirurški zahvat radi određivanja točnog stadija bolesti, dok u bolesnica s uznapredovalom bolešću standardni pristup uključuje optimalnu kiruršku citoredukciju

Treatment of Invasive Cervical Cancer: Rijeka Experience

The aim of this retrospective analysis was to evaluate the survival rate in 661 patients with cervical cancer regarding two time periods 1990–1996 and 1997–2003 and the specific stage related risk factors. The respective five-year survival was 71.7% and 80.0%. Analyzing the risk factors in the univariate and multivariate regression modalities ultimately only two parameters, the two time periods and FIGO staging were found to be independent prognostic factors. The observed total improvement in the survival rate of the second time period is followed by an increase in conservative surgery in stage T1A1, a reduction in the use of adjuvant radiotherapy among operable stages T1b1, T1b2 and T2A, while the treatment of locally advanced cervical cancer did not differ significantly