Classification Of Precancerous Lesions Research Articles

Treatment with laser CO2 cordectomy and clinical implications in management of mild and moderate laryngeal precancerosis

All the classification of precancerous lesions are based on the progression of specific histopathological characteristics, which in turn considers the grade of epithelial hyperplasia and dysplasia, nevertheless the transformation of laryngeal keratosis into carcinoma occurs through progressive modifications of normal epithelium in keratosis without dysplasia, to the point of degenerating into carcinoma in situ. The treatment of laringeal precancerosis has not yet defined a gold standard: according to some authors, a simple excision biopsy may be sufficient, others, instead, perform the stripping of the involved vocal cord, while others yet perform vaporization by means of CO2 laser. The aim of this paper is to evaluate and possibly validate the treatment of mild and moderate laryngeal dysplasia (LIN1-2) by CO2 laser, with particular attention to oncological and functional results. Fifty-eight patients (44 males and 14 females, mean age 54.3 years) affected by mild and moderate dysplasia (32 LIN I and 26 LIN II) diagnosed by a bioptic exam, were treated by performing a CO2 laser cordectomy (following the European Society of Laryngology's criteria). Before surgery to the patients was given a questionnaire to identify primary risk factors such as smoking, alcohol use and gastroesophageal reflux, were also handed a Vocal Performance Questionnaire. In all patients was performed a pH measurement over a 24-h period, a voice evaluation using a Kay digital Strobe 920. 84% of patients were smokers; the presence of reflux was reported in 11 patients (19%). The 32 LIN1 cases treated with type I cordectomy determined four recurrences (12.4%), of which two LIN1, one LIN2 and one carcinoma in situ. Of the 26 LIN2 cases examined, the 12 treated with type 1 cordectomy generated 1 recurrence alone with the presence of an invasive carcinoma (T1a) (8.3%), while no recurrences were reported in the group of 14 LIN2 cases treated with type II cordectomy. 93.1% (54/58) of cases showed a complete closing of the glottal plane over time. Considering the results in terms of disease control, and functional outcomes, our experience suggests subepithelial cordectomy (ELS I) for LIN 1 and subligament cordectomy (ELS II) for LIN 1 recurrences; therefore we suggest subligament cordectomy (ELS II) in LIN 2 cases.

New Classification of Precancerous Lesions of the Uterine Cervix with Reference to Human Papillomavirus

New Classification of Precancerous Lesions of the Uterine Cervix with Reference to Human Papillomavirus

Precancerous lesions of the endometrium

The existence of precancerous lesions of the endometrium is well established, but differences in terminology and difficulties in the interpretation of published studies have complicated quantitation of the malignant potential of the described subtypes. Clinical investigations, cellular studies, chromosome and DNA analyses, and animal experiments suggest that the malignant potential of cystic hyperplasia is low in contrast to that of the more complex types of hyperplasia. The significance of atypical secretory hyperplasia, squamous metaplasia, and endometrial polyps in the evolution of endometrial cancer has not been investigated adequately. Artifactual crowding of glands due to fragmentation and benign processes such as the epithelial regeneration in late menstrual endometrium and the Arias-Stella reaction should not be confused with precancerous changes. A classification of precancerous lesions is presented and the need for adoption of a uniform terminology for future investigations and communication with gynecologists is emphasized.