Evaluation of the HPV L1 Capsid Protein in Prognosis of Mild and Moderate Dysplasia of the Cervix Uteri

Cervical intraepithelial neoplasia (CIN) can be detected in the cytologic smears years before invasive squamous cancer arises, but no reproducible morphologic criteria exist to predict behavior of cervical lesions. The possibility of predicting the clinical course of cervical lesions could be of high value in clinical practice and some women will spare of unnecessary treatment. HPV L1 capsid protein represents about 90% of the total protein on the surface of the virus and can be detected in mild to moderate dysplasia and rarely in severe dysplasia. The purpose of the study was to evaluate the use of immunodetection of HPV L1 protein on archival Pap smears with findings of mild and moderate dysplasia in predicting its clinical course. Immunochemical analyses with L1 antibody revealed positively stained nuclei of squamous epithelial cells in 56 of 114 smears (49.1%). The staining results were correlated with follow-up smears or with histologic verification. Regression (negativisation of the Pap smear for 24 months or longer) was noticed in 31 of 56 (55.4%) L1-positive cases and in 20 of 58 (34.5%) L1-negative cases. Persistent disease occured in 13 (23.2%) L1-positive cases and in 14 (24.1%) L1-negative cases. Progressive disease occured in 12 (21.4%) L1-positive cases and in 24 (41.4%) L1-negative cases. The difference in the clinical course between the L1-positive and L1-negative patients was statistically significant (p=0.025). Also, the difference in the clinical course of the L1-negative staining in the under-30 and over-30 years age group was statistically significant (p=0.04). For conclusion, our data confirm that immunostaining for HPV L1 capsid protein could offer prognostic information about mild and moderate intraepithelial cervical squamous lesions

Evaluation of the HPV L1 Capsid Protein in Prognosis of Mild and Moderate Dysplasia of the Cervix Uteri

Cervical intraepithelial neoplasia (CIN) can be detected in the cytologic smears years before invasive squamous cancer arises, but no reproducible morphologic criteria exist to predict behavior of cervical lesions. The possibility of predicting the clinical course of cervical lesions could be of high value in clinical practice and some women will spare of unnecessary treatment. HPV L1 capsid protein represents about 90% of the total protein on the surface of the virus and can be detected in mild to moderate dysplasia and rarely in severe dysplasia. The purpose of the study was to evaluate the use of immunodetection of HPV L1 protein on archival Pap smears with findings of mild and moderate dysplasia in predicting its clinical course. Immunochemical analyses with L1 antibody revealed positively stained nuclei of squamous epithelial cells in 56 of 114 smears (49.1%). The staining results were correlated with follow-up smears or with histologic verification. Regression (negativisation of the Pap smear for 24 months or longer) was noticed in 31 of 56 (55.4%) L1-positive cases and in 20 of 58 (34.5%) L1-negative cases. Persistent disease occured in 13 (23.2%) L1-positive cases and in 14 (24.1%) L1-negative cases. Progressive disease occured in 12 (21.4%) L1-positive cases and in 24 (41.4%) L1-negative cases. The difference in the clinical course between the L1-positive and L1-negative patients was statistically significant (p=0.025). Also, the difference in the clinical course of the L1-negative staining in the under-30 and over-30 years age group was statistically significant (p=0.04). For conclusion, our data confirm that immunostaining for HPV L1 capsid protein could offer prognostic information about mild and moderate intraepithelial cervical squamous lesions

Genes for anti-Müllerian hormone and androgen receptor are underexpressed in human cumulus cells surrounding morphologically highly graded oocytes

Objectives: The aim of this study was to investigate the expression of genes crucial for the quality of the oocyte and whether expression levels of these genes in cumulus cells can be biological markers for the quality of the oocyte, zygote or embryo, or even for achievement of pregnancy after the assisted reproductive technology procedure. We examined the expression profile of the anti-Müllerian hormone (AMH) gene and its respective receptors: anti-Müllerian hormone receptor type 2 (AMHR2), follicle-stimulating hormone receptor (FSHR) and androgen receptor (AR) in cumulus cells (CCs) surrounding the oocyte, as well as AMH concentrations in follicular fluid of the associated follicle. The obtained gene expression levels were correlated with the morphological quality of the associated oocyte, zygote and embryo as well as with assisted reproductive technology outcome following the intracytoplasmic sperm injection procedure. Results: The results yielded suggest a relationship between AMH, AR and oocyte morphology: AMH and AR gene expression levels in CCs surrounding morphologically optimal oocytes were significantly lower than in CCs surrounding oocytes with suboptimal morphology (p = 0.011 and p = 0.008, respectively). Statistically significant positive correlation was found between mRNA expression levels of AMH and FSHR (p < 0.001), AMH and AR (p = 0.001), AMHR2 and FSHR (p < 0.001), AMHR2 and AR (p < 0.001), as well as between FSHR and AR (p < 0.001). Conclusion: Assessed results point to AMH and AR relation with oocyte maturity, but not with its fertilization potential, or with embryo quality

ANALYSIS OF PROGNOSTIC FACTORS AND OF TYPE OF TREATMENT IN PATIENTS WITH ENDOMETRIAL CANCER IN THE FIRST FIGO STAGE

Cilj rada. Ispitati važnost histopatoloških čimbenika rizika i svrsishodnost načina liječenja u bolesnica s rakom endometrija u kirurškom – FIGO stadiju I. Metode. Retrospektivno je izdvojeno 219 bolesnica s rakom endometrija u kojih je učinjen sveobuhvatni staging (lavat negativan, limfne žlijezde negativne). Srednja dob bolesnica iznosila je 59 godina (SD 8, min. 39, maks. 75 godina). Vrijeme promatranja iznosilo je od 1 do 180 mjeseci, medijana 68 mjeseci. Analizirani su u odnosu na petogodišnje preživljenje sljedeći prognostički čimbenici: dob bolesnice, dubina invazije miometrija, histologija i diferenciranost tumora, vrsta histerektomije i primjena adjuvantne radioterapije. U 85 bolesnica učinjena je radikalna histerektomija, dok je njih 55 primilo adjuvantnu radioterapiju. Rezultati. Ukupno preživljenje promatrane skupine bolesnica iznosi 92,8%. Analizom svih prognostičkih parametara nije nađena značajnost u razlici preživljenja. Od 219 bolesnica njih 82 (37,4%) imale su kumulativne negativne prognostičke čimbenike, slabo diferencirani tumor ili neendometrioidni histološki nalaz ili invaziju miometrija preko polovice, a preživljenje između visoko rizične i nisko rizične skupine se bitno ne razlikuje (93,9% odnosno 91,2%). Primjena radikalne histerektomije uz adjuvantnu radioterapiju ne daje bolje rezultate preživljenja od radikalne histerektomije. Zaključak. Prema našoj retrospektivnoj analizi čimbenika rizika u bolesnica s rakom endometrija prvog FIGO stadija, analizirani čimbenici rizika nemaju prognostičko obilježje. Primjena radikalne histerektomije s ili bez adjuvantne radioterapije zdjelice ne pruža bolje rezultate u smislu preživljenja, i daljnju primjenu treba temeljito preispitati.Objective. To analyze the effect of histopathologic characteristics and usefullness of therapy mode in FIGO stage I endometrial cancer patients. Methods. Retrospectively were analyzed 219 endometrial cancer patients with hysterectomy, salpingoophorectomy and pelvic lymphadenectomy (peritoneal cytology and nodes negative). Patients characteristics include age, myometrial invasion, FIGO substages, histologic type, tumor grade, type of hysterectomy and adjuvant radio¬therapy. The mean age was 59 years (SD 8, Min. 39, Max. 75 years). Follow up ranges from 1 to 180 months (median 68). In 85 patients radical hysterectomies were performed and 45 patients received adjuvant radiotherapy. Results. Five year disease related survival was 92,8%. There is no significant difference among analyzed histopathologic patient’s characteristics related to five years survival. In 82 (37.3%) patients out of 219 were found cumulative negative prognostic factors (high risk patients) including non-endometrioid histology, poor tumor differentiation and/or outer half of miometrial invasion. There is no difference in survival between low (91,2%) and high risk patients (93,9%). Radical hysterectomy as well as adjuvant radiotherapy has no advantage in five year survival. Conclusion. This retrospective study has not identified histopathologic prognostic significant characteristics in FIGO stage I endometrial cancer patients. The use of radical hysterectomy and/or adjuvant radiotherapy has not better five years survival and should be reevaluated

THE EFFECT OF EARLY CERVICAL CANCER DIAGNOSIS

Background: Treatment effectiveness and clinical outcome of patients with cervical carcinoma FIGO stage IA1 and IA2 are analyzed in three different time period at the Department of Obstetrics and Gynecology Rijeka, Croatia. Method: Retrospective analysis of the hospital chart of all cervical cancer patients between 1991 and 2005 was conducted with five-year follow up. Results: Data on cervical cancer distribution by stage and five-year survival are presented. Separately analyzed age, histology type and treatment modalities in stage FIGO IA1 and IA2 during three consecutive five-year periods are presented. Conclusions: Conservative surgical approach – conization alone in stage IA1 of the squamous cell car- cinoma is reasonable and safe treatment option for reproductive active women. During observed periods conization became the most used surgical technique applied in almost two third of FIGO IA1 cervical cancer patients. Lymph vascular space invasion in stage IA1 lead to adjunct pelvic lymphadenectomy with unclear clinical benefit. In cervical cancer patients stage IA2 simple hysterectomy and pelvic lymphadenectomy could be accepted as a standard treatment. In these patients further studies are recommended to evaluate other less radical surgical techniques – simple and radical trachelectomy with or without pelvic lymphadenectomy. Radical hysterectomy in both stages IA1 and IA2, based on personal experience and literature data represents a surgical overtreatment and should be abandoned

Učinak zgodnje detekcije cervikalnega karcinoma

Background Treatment effectiveness and clinical outcome of patients with cervical carcinoma FIGO stage IA1 and IA2 are analyzed in three different time period at the Department of Obstetrics and Gynecology Rijeka, Croatia. Methods Retrospective analysis of the hospital chart of all cervical cancer patients between 1991 and 2005 was conducted with five-year follow up. Results Data on cervical cancer distribution by stage and five-year survival are presented. Separately analyzed age, histology type and treatment modalities in stage FIGO IA1 and IA2 during three consecutive five-year periods are presented. Conclusions Conservative surgical approach – conization alone in stage IA1 of the squamous cell carcinoma is reasonable and safe treatment option for reproductive active women. During observed periods conization became the most used surgical technique applied in almost two third of FIGO IA1 cervical cancer patients. Lymph vascular space invasion in stage IA1 lead to adjunct pelvic lymphadenectomy with unclear clinical benefit. In cervical cancer patients stage IA2 simple hysterectomy and pelvic lymphadenectomy could be accepted as a standard treatment. In these patients further studies are recommended to evaluate other less radical surgical techniques – simple and radical trachelectomy with or without pelvic lymphadenectomy. Radical hysterectomy in both stages IA1 and IA2, based on personal experience and literature data represents a surgical overtreatment and should be abandoned

Učinak zgodnje detekcije cervikalnega karcinoma

Background Treatment effectiveness and clinical outcome of patients with cervical carcinoma FIGO stage IA1 and IA2 are analyzed in three different time period at the Department of Obstetrics and Gynecology Rijeka, Croatia. Methods Retrospective analysis of the hospital chart of all cervical cancer patients between 1991 and 2005 was conducted with five-year follow up. Results Data on cervical cancer distribution by stage and five-year survival are presented. Separately analyzed age, histology type and treatment modalities in stage FIGO IA1 and IA2 during three consecutive five-year periods are presented. Conclusions Conservative surgical approach – conization alone in stage IA1 of the squamous cell carcinoma is reasonable and safe treatment option for reproductive active women. During observed periods conization became the most used surgical technique applied in almost two third of FIGO IA1 cervical cancer patients. Lymph vascular space invasion in stage IA1 lead to adjunct pelvic lymphadenectomy with unclear clinical benefit. In cervical cancer patients stage IA2 simple hysterectomy and pelvic lymphadenectomy could be accepted as a standard treatment. In these patients further studies are recommended to evaluate other less radical surgical techniques – simple and radical trachelectomy with or without pelvic lymphadenectomy. Radical hysterectomy in both stages IA1 and IA2, based on personal experience and literature data represents a surgical overtreatment and should be abandoned