Abnormal Smears Research Articles

Endocervical Adenocarcinoma With Skip Lesion in a Fundal Endometrial Polyp Mimicking Endometrioid Adenocarcinoma Arising From Endometrial Polyp

Abstract Human papillomavirus–related adenocarcinomas account for approximately 20% of all cervical cancers. Most of them arise in the transformation zone but may be found exclusively in endocervical canal. Contiguous spread into the lower uterine segment is known to occur, but finding a “skip” lesion in a fundal endometrial polyp poses an interesting pathologic conundrum. We present a case of a 57-year-old woman with a history of postcoital bleeding and abnormal cervical smear. Cervical exam showed a 2-cm exophytic mass on anterior cervix. Biopsy revealed invasive endocervical adenocarcinoma. Patient underwent radical hysterectomy. Gross examination revealed large cervical mass without involvement of low uterine segment and a benign-appearing small uterine fundal polyp. Microscopic examination confirmed the deeply invasive endocervical adenocarcinoma, and the benign-appearing endometrial polyp had similar atypical glands on the polyp surface and admixed with benign endometrial glands. Both cervical tumor and the carcinoma involving endometrial polyp demonstrated identical immunohistochemistry showing diffuse positive p16 and CEA(m) and negative for ER and vimentin. The authors report a rare case of endocervical adenocarcinoma with skip lesion in the endometrial fundal polyp, and rare cases with skip lesion in the fallopian tubes from endocervical adenocarcinoma have been reported in the literature. High clinical suspicion and ancillary immunohistochemistry are necessary to differentiate the lesion from endometrioid or papillary carcinoma arising from endometrial polyp.

Primary peritoneal serous papillary carcinoma: a case series.

To present the clinical and laboratory characteristics, as well as the management, of patients with primary peritoneal serous papillary carcinoma (PPSPC). This is a retrospective study of 19 patients with PPSPC who underwent debulking surgery followed by first line chemotherapy and were managed in Metaxa Memorial Cancer Hospital between January 2002 and December 2017. The median age of the patients was found to be 66years (range 44-76years). Clinical presentation of PPSPC included abdominal distention and pain, constipation, as well as loss of appetite and weight gain. Two of the patients did not mention any symptomatology and the disease was suspected by an abnormal cervical smear and elevated CA125 levels respectively. Biomarkers measurement during the initial management of the patients revealed abnormal values of CA125 for all the participants (median value 565 U/ml). Human epididymis secretory protein 4 (HE4) and ratios of blood count were also measured. Perioperative Peritoneal Cancer Index ranged from 6 to 20. Optimal debulking was achieved in 5 cases. All patients were staged as IIIC and IVA PPSPC and received standard chemotherapy with paclitaxel and carboplatin, whereas bevacizumab was added in the 5 most recent cases. Median overall survival was 29months. PPSPC is a rare malignancy, the management of which should take place in tertiary oncology centers.

High prevalence of human papillomavirus infection in HIV-infected women living in French Antilles and French Guiana

An association between HIV infection and cervical cancer, a major public health issue worldwide, has been reported. The aim of this study was to estimate the prevalence of human papillomavirus (HPV) infection and the distribution of HPV genotypes in HIV-infected women living in French Antilles and Guiana and to determine HIV-related characteristics associated with HPV infection. This cross-sectional study included 439 HIV-infected women who were followed between January 2011 and May 2014. Variables related to HIV infections were collected, and cervical samples were analysed to determine HPV genotypes. The median age of the population was 46 years. Estimated prevalence of HPV and high-risk (HR)-HPV infection were 50.1% IC95 [45.4–54.7] and 42% IC95 [37.3–46.6], respectively. HR-HPV 16, 52, 53 or intermediate risk-HPV-68 were found in 25% to 30% of the HPV-infected patients. Gynaecological screening revealed abnormal cervical smear in 24% and 42% of HR-HPV-negative and HPV-positive women, respectively (p = 0.003). Approximately 90% of women were on antiretroviral therapy (ART). Demographic characteristics associated with a higher prevalence of HPV infection included alcohol consumption. Regarding HIV-related characteristics, current therapy on ART, its duration, and undetectable plasma concentrations of RNA-HIV1 were associated with a lower risk of HPV infection. Infection rate with HR-HPV was higher than what is commonly reported in HIV-negative women worldwide and was more likely in women with incomplete HIV suppression. These results highlight the need for supporting adherence to ART, cervical cytology, HPV testing and HPV vaccination.

Association of Abnormal Pap Smear with Occult Cervical Stromal Invasion in Patients with Endometrial Cancer.

Objective:The purpose of this study was to determine the association between abnormal preoperative Pap smear results and occult cervical stromal invasion in endometrial cancer patients. Methods:Medical records were reviewed of patients with endometrial cancer who had undergone surgical staging at Srinagarind Hospital. Patients with gross cervical involvement, with an unsatisfactory Pap smear, without available Pap smear results, with no cervical intraepithelial lesion/invasive cervical cancer, or who had previously undergone pelvic radiation therapy were excluded. The patients were assigned to one of two groups according their Pap smear results (negative and epithelial cell abnormalities). Logistic regression was used to determine the independent association between an abnormal Pap smear and the risk of cervical stromal invasion. Results:All cervical smears in this study were performed as conventional Pap smears. Smears were abnormal in 50 (21.0%) of the 238 patients enrolled and normal in the remaining 188 (79.0%). The types of Pap smear abnormalities included adenocarcinoma (n=22); atypical endometrial cells (n=2); atypical glandular cells (n=17); high-grade squamous intraepithelial lesions (n=4); atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (n=2); and atypical squamous cells of undetermined significance (n=3). After controlling for type of endometrial cancer, abnormal Pap smear results were found to be a significant independent factor that indicated cervical stromal invasion (adjusted OR 2.65; 95% CI 1.35 to 5.21). Conclusion:Endometrial cancer patients with abnormal Pap smears were strongly and independently associated with histopathologically diagnosed cervical stromal invasion.

Evaluation of erythrocyte morphology and prevalence of poikilocytes in peripheral blood of sick domestic ferrets (Mustela putorius furo)

ABSTRACT To evaluate the prevalence of poikilocytes on peripheral blood smears of sick domestic ferrets and to determine if any erythrocyte morphologic anomalies are associated with a specific diagnosis. Peripheral blood smears from ferrets that presented to the Centre Hospitalier Universitaire Veterinaire between August 2010 and January 2015. Red blood cell morphologic changes were scored by each reviewer and the presence of keratocytes, acanthocytes, schizocytes, and codocytes was compared to the final diagnosis assigned to each patient, as determined by evaluation of their medical records. A total of 83 ferrets met the inclusion criteria. Clinical diagnoses included adrenal disease (n = 27), lymphoma (n = 14), insulinoma (n = 5), gastrointestinal disease (n = 25), liver disease (n = 9), and other (n = 22). No ferrets had eccentrocytes or basophilic stippling and the most frequently observed red blood cells morphologies were echinocytes (86.7%), polychromatophils (66.2%), and Howell-Jolly bodies (14.4%). The presence of poikilocytes that are often considered to be of pathologic significance was noted 12 times in 9 ferrets: schizocytes (n = 7), codocytes (n = 3), acanthocytes (n = 1), and keratocytes (n = 1). Significantly higher numbers of acanthocytes and schizocytes were observed in ferrets with lymphoma. However, schizocytes were also observed with gastrointestinal disease. The results suggest that ferrets with lymphoma may be more likely to have schizocytes and acanthocytes in their peripheral blood. However, the sensitivity and specificity of these changes need to be more comprehensively evaluated. Studies using larger numbers of ferrets with lymphoma and gastrointestinal diseases and studies evaluating blood smear abnormalities in healthy ferrets are warranted.

The influence of probiotics on genital high-risk human papilloma virus clearance and quality of cervical smear: a randomized placebo-controlled trial

BackgroundProbiotics has been shown to be effective in reducing vaginal colonization of pathogenic organisms. The aim of this study was to investigate the influence of probiotic strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on genital high-risk human papilloma virus (HR-HPV) clearance and quality of cervical smear.MethodsThis was a randomized, double-blinded, placebo-controlled trial. Women with genital HR-HPV infection were randomized into study and control groups. A probiotic or placebo preparation was administered orally (one capsule daily) until negative HR-HPV testing. A cervical smear and HR-HPV tests were performed at the beginning of the study and every 3 months thereafter until a negative result was obtained.ResultsA total of 121 women with genital HR-HPV infection were enrolled (62 in the study group and 59 in the control group). There was no significant difference in HR-HPV clearance rate between the two groups (58.1% vs. 54.2%). The only factor predicting HR-HPV clearance was a lower initial viral load (HR 3.214; 95% CI: 1.398, 7.392; p = 0.006). Twenty-two women had a mildly abnormal initial cervical smear and nine had an unsatisfactory smear. At 6 months follow-up, both mildly abnormal cervical smear and unsatisfactory smear rates had decreased significantly in the study group compared to the control group (p = 0.017 and 0.027).ConclusionsThe application of probiotic strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 did not influence genital HR-HPV clearance, but may have decreased the rates of mildly abnormal and unsatisfactory cervical smears.Trial registrationClinicaltrials.gov NCT01599416, May, 2012. Retrospectively registered.

Reliability and validity of the Center for Epidemiologic Studies Depression (CES-D) scale in Serbian women with abnormal Papanicolaou smear results

ObjectivesCervical cancer ranks as the second most frequent cancer among women in Serbia. Organized screening for detection of cervical cancer was introduced in Serbia in 2013 and provided free of...

Detection of acute lymphoblastic leukemia using image segmentation and data mining algorithms.

Blood is composed of white blood cells, red blood cells, and platelets. Segmentation of the blood smear cells and extraction of features of the cells is essential in the field of medicine. Acute lymphoblastic leukemia is a form of blood cancer caused due to the abnormal increase in the production of immature white blood cells in the bone marrow. It mostly affects the children below 5years and adults above 50years of age. Due to the late diagnosis and cost of the devices used for the determination, the mortality rate has increased drastically. Flow cytometry technique that performs automated counting fails to identify the abnormal cells. Manual recount performed using hemocytometer are prone to errors and are imprecise. The proposed work aims to survey different computer-aided system techniques used to segment the blood smear image. The primary objective here is to derive knowledge from the different methodologies used for extracting features from white blood cells and develop a system that would accurately segment the blood smear image by overcoming the drawbacks of the previous works. The objective mentioned above is achieved in two ways. Firstly, a novel algorithm is developed to segment the nucleus and cytoplasm of white blood cell. Secondly, a model is built to extract the features and train the model. The different supervised classifiers are compared, and the one with the highest accuracy is used for the classification. Six hundred images are used in the experimentation. InfoGainAttributeEval and the Ranker Search method are used to achieve the feature selection which in turn helps in improvising the classifier performance. The result shows the classification of the acute lymphoblastic leukemia into its three respective categories namely: ALL-L1, ALL-L2, ALL-L3. The model can differentiate between a normal peripheral blood smear and an abnormal blood smear. The extracted feature values of a cancerous cell and a normal cell are also shown. The performance of the model is evaluated using the test images stained with various stains. The proposed algorithm achieved an overall accuracy of 98.6%. The promising results show that it can be used as a diagnostic tool by the pathologists. Graphical abstract.

Cytomorphological patterns of cervical Papanicolaou smear abnormalities based on 2014 Bethesda System in North Karnataka region

Introduction: Cervical PAP smears are a cost effective, out-patient procedure to screen patients for cervical pathology. Objectives: To utilize cervical PAP smear examination in categorizing lesions according to the 2014 Bethesda System for cervical cytology, to analyse the spectrum of lesions andto evaluate its effectiveness as a screening procedure for detection of epithelial abnormalities in a teaching hospital in North Karnataka. Methods: A prospective one year study was carried on all conventional PAP smears received in the Department of Pathology, Navodaya Medical College, Raichur. Reporting was done in accordance with the 2014 Bethesda System for reporting cervical cytology. Correlation was done with the clinical findings. Results: A total of 578 cases were included in the study. The most common presenting complaint was abdominal pain (28.5%). The most frequent examination finding was white discharge per vaginum, WDPV (38.9%). 90.8% of PAP smears were categorized as ‘Negative for intraepithelial Lesion or Malignancy’. Specific infections were seen in 8.1%, squamous metaplasia in 15.5% and atrophic changes in 3.2%. Epithelial cell abnormalities comprised 9.2% of cases, of which Atypical Squamous Cells of Undetermined Significance (ASC-US) was 3.2%, Low grade Squamous Intraepithelial Lesion (LSIL) was 3.6%, High grade Squamous Intraepithelial Lesion (HSIL) was 1.9%, Squamous Cell Carcinoma (SCC) was 0.2% and Atypical Glandular Cells– Not Otherwise Specified (AGC-NOS) was 0.9%. Conclusion: The overall prevalence of epithelial cell abnormalities concurred with studies done in other parts of India and constituted9.2% of the total smears screened, LSIL being the most common lesion.

Association of Bacterial Vaginosis and Human Papilloma Virus Infection With Cervical Squamous Intraepithelial Lesions.

Human papillomavirus (HPV) is known to be associated with squamous intraepithelial lesions (SILs). However, there is limited and conflicting literature on the relationship between bacterial vaginosis (BV) and SIL. The aim of this study is to determine the prevalence of BV and evaluate the association between BV and SIL. A retrospective study was performed on 10,546 cases between 2012 and 2017. HPV results were available in 7,081 cases. BV was present in 17.6% of cases. There was significant association between BV, positive HPV infection, and high-grade SIL. BV patients with negative HPV infection showed more squamous abnormalities than BV-negative HPV-negative patients. We found there is a significant association between BV and SIL. BV is more common among patients with HPV infection and is independently associated with squamous abnormalities in cervical smears and surgical follow-up.

Histopathological Patterns and Characteristics of Abnormal Cervical Smear in Madinah Region of Saudi Arabia

Cervical cancer is a major public health problem that continues to be one of the leading female genital cancers worldwide. In the kingdom of Saudi Arabia (KSA), cervical cancer ranks the fifteenth most frequent cancer among females. This study is the first published research study addressing the screening of cervical cancer in Madinah region of KSA.Aim:To evaluate the abnormal cytological entities detected by cervical Pap smear in Madinah region of KSA and to compare the results with other national and international studies.Methods:This retrospective case-control study was conducted in the Departments of Obstetrics and Gynecology, and Histopathology at the Maternity and Children Hospital (MCH), Madinah, KSA from January 2013 to December 2015.Results:Of the 1594 cases reviewed, only 38 cases (2.4%) had epithelial cell abnormalities. High grade squamous intraepithelial lesions (HSIL) and low grade squamous intraepithelial lesions (LSIL) were the most common diagnosis categories, and cervical cancer accounted for 36.8% of the total cases for each, followed by atypical squamous cells of uncertain significance (ASCUS) found in (15.9%). Squamous cell carcinoma (SCC ) was found in (5.3%) of the cases. Patients with abnormal epithelial changes had higher parity (P=0.021) and presented more with a complaint of postcoital bleeding (P<0.0001), tend to have abnormal cervical appearance (P=0.004), more likely bleeding on touch (P=0.001) and associated with cervical erosion (P=0.014).Conclusion:The study showed a relatively low prevalence of epithelial cell lesions. These lesions were mainly squamous cell lesions harbored by females who have an abnormal cervical appearance, and those with high parity who were lacking cervical screening program.

A study of clinicopathological profile and treatment outcomes in patients with autoimmune hemolytic anaemia

Background: Autoimmune haemolytic anaemia (AIHA) is relatively uncommon condition with grave consequences, if not diagnosed and treated early. The literature on the clinical outcome and response to treatment is relatively scarce. Aim was to study the clinic-pathological profile and the treatment outcomes in patients with AIHA.Methods: Around 25 patients with AIHA attending a tertiary care hospital over a period of one year were included in the study. The patients were divided based on severity of anaemia and etiology. All the patients data were analysed for the demographic data, clinico -pathological findings and the response to treatment. All the patients data were analysed using SPSS software (version 22).Results: Out of 25 patients, 76% were females and 24% were males. Based on severity of anaemia, 60%, 28% and 8% had severe, moderate and mild anaemia. Around 48% of the patients had thrombocytopenia along with anaemia. 8 (32%) and 17 (68%) patients have primary and secondary AIHAs respectively. In our study the commonest cause for the secondary AIHA was Systemic Lupus Erythematosus (SLE) followed by haematological malignancy, primary Sjogrens, Anti-phospholipid antibody (APLA) syndrome, carcinoma colon and Wilsons disease. Hepatosplenomegaly and lymphadenopathy were present in 36% and 4% respectively. Out of 22 (88%) patients on corticosteroid therapy, 15 (60%) patients responded to corticosteroids alone and 6(24%) patients required corticosteroid plus immunosuppressive therapy.Conclusions: AIHA has to be ruled out in all anaemia patients with indirect hyperbilirubinemia and abnormal peripheral smear. Secondary AIHA is more common than primary. Corticosteroids and immunosuppressive agents are the mainstay of treatment of AIHA.

Correlation of Abnormal Pap Smears with Histopathologic Results: Philippine General Hospital Experience (2014-2017)

Objectives. To evaluate abnormal Papanicolau smear results at the Philippine General Hospital (PGH) for the past four years by comparing abnormal smear cytology with histologic interpretations. Possible causes of discrepant results were also determined.&#x0D; Methods. All Pap smears released as abnormal from January 2014 to December 2017 and the corresponding available biopsies were retrieved. Discrepancy between cytologic and histology diagnosis was assessed and pairs with major discordance were reviewed.&#x0D; Results. There were a total of 30,237 conventional pap smears signed out of which 239 (0.79%) were abnormal and only 56 (23%) had a subsequent tissue biopsy. The overall concordance rate is 75% while strict or absolute concordance rate is 32%. The overall discordance rate is 25%. Positive predictive value is highest for pap smears signed out as atypical glandular cells favor neoplastic (AGC-NEO) (100%), followed by malignant (93%), high grade squamous intraepithelial lesion (HSIL) (83%), and then atypical squamous cells cannot exclude an HSIL (ASC-H) and atypical squamous cell of undetermined significance (ASCUS), both at 67%.&#x0D; Conclusions. Considering that the Philippine General Hospital is a referral and academic center, we have a low percentage of abnormal pap smears compared to other developing countries and even a lower percentage of patients who had subsequent biopsies. Cytohistologic correlation detected interpretative as well as sampling errors, and the aim is to work on these deficiencies by improving quality assurance protocols and modifying current local practices of both pathologists and clinicians.

A Study of Pap Smears in HIV-Positive and HIV-Negative Women from a Tertiary Care Center in South India

Objectives: The aim of this work was to study the spectrum of epithelial abnormalities on Pap smears of HIV-positive women categorized as per the Bethesda System of Reporting Cervical Cytology, to correlate them with CD4 lymphocyte counts, and to compare them with the spectrum of abnormalities seen in a HIV-negative control group. Study Design and Methodology: The present study was a 6-year retrospective study conducted in the Department of Pathology at Kasturba Medical College, Mangalore, which included 150 Pap smears from HIV-positive and HIV-negative women, respectively. The Pap-stained slides of the cases were retrieved and studied. The data collected were tabulated and analyzed. A statistical study was performed using SPSS software. The χ² test was used to analyze the data and a p value < 0.05 was considered to be significant. Results: Pap smear abnormalities were twice as high in HIV-infected women (12%) as compared with HIV-negative women (6%; p = 0.006, RR = 2). Negative for intraepithelial lesion/malignancy was the most common finding (88%), which was further subdivided into inflammatory, atrophic smear, non-specific, candidiasis, and bacterial vaginitis groups. The percentage of epithelial abnormalities was 12%, including: atypical squamous cells of undetermined significance, 5.55%; atypical squamous cells, cannot exclude HSIL, 16.66%; low-grade squamous intraepithelial lesion, 5.55%; high-grade squamous intraepithelial lesion (HSIL), 61.11%, and squamous cell carcinoma, 11.11%. The highest incidence of intraepithelial lesions in HIV-positive females was in the age group of 34–49 years. CD4 cell counts fell in the range of 200–500 cells/mm³ in most of the HIV-positive patients (68.75%), but was not found to be statistically significant. Conclusion: Routine Pap smear examination is advocated in women with HIV as the prevalence of epithelial cell abnormalities was found to be 12%, which was twice as high as compared to the HIV-negative control group. Although there was no correlation of epithelial cell abnormalities with CD4 counts, a higher rate of the cases with epithelial abnormalities were observed to have CD4 cell counts of 200–500 cells/mm³.

A survey of infectious diseases and vaccination uptake in long-term hematopoietic stem cell transplant survivors in Australia.

This cross-sectional survey aimed to establish the prevalence of infectious diseases and vaccination uptake in long-term allogeneic hematopoietic stem cell transplants (HSCT) survivors in New South Wales, in order to reduce long-term post-HSCT morbidity and mortality and enhance long-term care. Hematopoietic stem cell transplants survivors aged over 18years and transplanted between 2000-2012 in New South Wales (NSW) were eligible to participate. Survivors self-completed the Sydney Post BMT Study survey, FACT-BMT (V4), Chronic Graft versus Host Disease (cGVHD) Activity Assessment Self Report, Lee Chronic GvHD Symptom Scale, DASS21, Post Traumatic Growth Inventory, and the Fear of Recurrence Scale. Of the 583 HSCT survivors contacted, 441 (78%) completed the survey. Respondents included 250 (57%) males and median age was 54years (range 19-79years). The median age at the time of transplant was 49years (Range: 17-71), the median time since HSCT was 5years (Range: 1-14) and 69% had cGVHD. Collectively, 41.7% of survivors reported a vaccine preventable disease (VPD) with the most common being influenza-like-illness (38.4%), varicella zoster/shingles (27.9%), pap smear abnormalities (9.8%), pneumococcal disease (5.1%), and varicella zoster (chicken pox) (4.6%). Only 31.8% had received the full post-HSCT vaccination schedule, and the majority (69.8%) of these had received the vaccines via their General Practitioner. cGVHD was not found to be a significant factor on multivariate analysis for those who were vaccinated. There was a trend toward lower vaccination rates in patients in a lower income strata. Vaccinating post-HSCT survivors to prevent infections and their consequences have an established role in post-HSCT care. Improving rates of post-HSCT vaccination should be a major priority for BMT units.

The effect of an animation video on consultation time, anxiety and satisfaction in women with abnormal cervical cytology: Animation video reduces colposcopy time.

The objective was to assess whether supplementing hospital-dependent standard information with a hospital-independent animation video might reduce consultation time, pre-colposcopy anxiety levels and increase post-colposcopy satisfaction.Between November 2016 and May 2018, women were included if they were referred to the department of Obstetrics and Gynaecology in one of the three participating hospitals in the Netherlands due to an abnormal cervical smear. Exclusion criteria were colposcopy in the medical history or inability to understand, speak or read Dutch. Two consecutive cohorts were created: a control group that received standard information and an intervention group that received the same plus the animation video. Outcome measures were consultation time, pre-colposcopy anxiety level and post-colposcopy satisfaction. Consultation time was measured using stopwatch. Anxiety was measured using the State-Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale (HADS). Satisfaction was measured with the Patient's Experience and Attitude Colposcopy Eindhoven questionnaire (PEACE-q).In total, 122 women were included, 61 in each group. Baseline characteristics were similar between the two groups. Pre-colposcopy consultation time was significantly reduced in the intervention group (median 140 s) compared to the control group (median 269 s). However, overall consultation time was not reduced. The outcome measures anxiety and satisfaction were not significantly different.A hospital-independent animation video did significantly reduced pre-colposcopy consultation time but did not reduce anxiety or increase satisfaction in women with abnormal cervical cytology. Further research should focus on the effects of animation video in a primary care setting.

Correlation of Cervical Squamous Intraepithelial Lesions with Human Papillomavirus in Women Infected with the Human Immunodeficiency Virus

The human papillomavirus (HPV) is the major etiologic agent in the development of cervical cancer with known risk factors like immunosuppression. The natural history of HPV infection is altered in persons infected with the human immunodeficiency virus (HIV). The persistent HPV infection increases their risk of having cervical squamous intraepithelial lesions (SILs). This study emphasizes on prevalence of high-risk human papillomavirus (HR-HPV) and correlation with cervical smears cytology in HIV-positive women regardless of treatment. A cross-sectional observational study was conducted at a tertiary care hospital over a period of 2 years. The study group is comprised of HIV seropositive women attending antiretroviral treatment center. CD4 cell counts were taken from the records available, and cervical samples were taken for cytological analysis and HR-HPV testing. Statistical analysis was done using the software Epi 6 Info, and p value was calculated by Chi-square test and Fisher’s exact 2-tailed test for associations of abnormal cytology and to determine risk factors for abnormal cytology. The median age of the 100 participants was 33.34 years. Low-grade squamous intraepithelial neoplasms (LSILs), high-grade squamous intraepithelial neoplasms, atypical squamous cells of uncertain significance and atypical glandular cells were the precancerous lesions found. Prevalence of HR-HPV in HIV-positive women was found to be 35% among women with abnormal smears. A strong correlation between SILs and HR-HPV with p value of < 0.05 was found. A strong statistical correlation was also seen in between low CD4 count to that of detection of HR-HPV along with LSIL. A strong correlation between cervical SILs and HR-HPV in our study suggests that routine screening of cervical cytology by PAP smear should include HPV subtype identification in HIV-positive women to pick up cases which are likely to progress to invasive carcinoma.

Pathological discrepancy between colposcopic directed cervical biopsy and conisation results: A five years experience of a single center in Turkey.

Objective:To analyze the clinical outcomes and treatment strategies of patients who underwent conisation in a tertiary hospital clinicMethods:The study was designed as a retrospective cohort study. Retrospective data’s of 176 patients who underwent conisation due to detection of dysplasia via colposcopic biopsy or cytology-histology discrepancy between 2012 and 2017 were collected. Colposcopy guided biopsies were performed according to HPV positivity and/or abnormal smear results in Izmir Katip Celebi University Ataturk Research and Training Hospital.Results:Indications for colposcopic biopsies were HPV positivity in 51 patients (29.1%), abnormal smear results in 125 patients (70.9 %). Distribution of abnormal smear results were ASCUS, ASC-H, LSIL, HSIL in 6 (4.8 %), 21 (16.8 %), 24 (19.2%), 74 (59.2%) patients respectively. According to biopsy results, 8 patients (4.4 %) showed no dysplasia where two (1.1%) and 162 (91.5 %) patients were with LSIL and HSIL respectively. Only two were diagnosed with in situ carcinoma. Among 162 patients with HSIL in colposcopic biopsy, 45 showed no dysplasia where four were diagnosed with invasive carcinoma.Conclusions:To detect high grade cervical lesions colposcopy guided biopsy is gold standard. Although cone biopsy should be performed related to severity of dysplasia in order to sustain the diagnosis and treatment. Contradictory results between colposcopic and cone biopsies should be considered during decision-making process.

2274. Assessment of Anal Papanicolaou Smear Screening and Follow-up Rates in Eastern North Carolina for HIV-Positive Patients Who Are Men Who Have Sex With Men

The purpose of this research is to show the prevalence of anal Pap smear abnormalities and follow-up activities among MSM patients receiving HIV care at the ECU Infectious Diseases and International Travel Health Clinic (ECU ID).BackgroundSquamous cell carcinoma of the anus (i.e. anal cancer), represents 0.5% of all new cancer cases in the United States in 2017 according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Literature shows that the HIV-infected men who have sex with men (MSM) population is 52 times more likely to develop anal cancer compared with the non-HIV-infected population. Anal Pap screenings have the potential to detect the presence of anal cancer earlier, but no national guidelines exist for performing anal Papanicolaou (Pap) screens among MSM.MethodsA retrospective chart review was performed on 505 qualifying patients. Baseline data about anal Pap screening and follow-up rates were gathered. Data were collected from January 1st, 2016 to May 31st, 2017.ResultsAnal Pap smear abnormality findings: Atypical Squamous cells of Undetermined Significance (ASCUS), Low Grade Squamous Intraepithelial Lesion (LGSIL), High Grade Squamous Intraepithelial Lesion (HGSIL). ConclusionOur results indicate variation in practice among providers at ECU ID Clinic regarding the screening, the need for a follow-up, and the type of follow-up provided. Additionally, research shows that anal cancer is one of the non-defining AIDS cancers whose incidence increases as the patient ages. However, based on the data, anal cancer screening decreases as the patient ages at the ECU ID clinic. Therefore, a standardized clinic protocol is needed, which may help improve the screening and follow-up rates. Also, a higher percentage of patients with an ASCUS result do not receive follow-up when compared with patients with an LGSIL and HGSIL result. Future research to determine the significance of follow-up for patients with an ASCUS result should be explored.Disclosures All authors: No reported disclosures.

Vaginitis Emphysematosa in 80 years old woman

Introduction: Vaginitis Emphysematosa is a very rare condition, self limited cystic disorder of the vagina. It is caused by Trichomonos vaginilis and it is very common in pregnant or immunocomprimised patients. It can present with a pressure symptoms, abnormal cervical smear or vaginal discharge. In this paper, we present a case of this rare condition in an elderly lady. Case report: An 80 years old woman presented to us with vaginal mass. She has had occasional smelly vaginal discharge, sensation of lump inside her vagina, with a sensation of not being able to completely emptying her bowels of 6 months duration. Local examination revealed a well circumscribed mid line cystic mass in the lower third of her vagina, measuring 2cm in diameter (size of a small lemon). Histological assessment of the biopsy revealed overall appearances are those of vaginitis emphysematosa. Conclusion: This rare case would help clinicians and pathologists to be aware about the recognition of this unusual condition, which is a benign self limiting condition.