Degrees Of Cervical Intraepithelial Neoplasia Research Articles

Pharmacological correction of immunological disorders in perimenopausal women with recurrent epithelial cervical dysplasia associated with human papillomavirus infection

Despite the successes achieved in implementing screening programs and treating diseases caused by human papillomavirus (HPV) infection, the frequency of cervical intraepithelial neoplasia (CIN) of moderate and high grades associated with high-risk human papillomavirus (HR-HPV) remains between 9% to 21%. Vaginal dysbiosis and the development of immunodeficient states due to persistent HR-HPV infection require effective immunomodulatory and antiviral therapy before cervical surgery in perimenopausal women with recurrent CIN II.The objective: to evaluate the effectiveness of antiviral and immunomodulatory therapy by determining the state of vaginal biocenosis, immunological status and papillomavirus load of the cervical mucosa before surgical treatment in perimenopausal women with recurrent CIN II.Materials and methods. A prospective study was conducted on 98 women aged 40 to 55 years old, including 60 patients with morphologically verified recurrent CIN II associated with high-risk HPV, forming the main group. The control group comprised 38 women with negative HPV test results and without significant gynecological or somatic pathology. In the main group, a complex consisting of a blend of plant extracts of sod pike grass (Deschampsia caespitosa), ground cinquefoil grass (Calamagrostis epigeios), and echinacea purpurea grass (Echinaceae purpureae) was administered orally.Vaginal microbiota was assessed using Hey-Іson criteria, and immunological status was examined in patients using solid-phase enzyme-linked immunosorbent assay to determine IgG, IgM, IgA antibodies in serum and cervical mucus, levels of interleukin-1β (IL-1β), interferons alpha (IFN-α), gamma (IFN-γ), tumor necrosis factor alpha (TNF-α). Additionally, the DNA of high-risk HPV in cervical mucosa was quantitatively assessed using real-time PCR. The investigations were conducted before and after the applied therapy.Results. The investigation of vaginal content revealed the presence of bacterial vaginosis in 65.0% of patients in the main group, the frequency of which decreased by 2 times after treatment, with the number of women with an intermediate type of vaginal content increasing by 2.8 times (51.7%) and those with normal microbiota increasing by 2.5 times. Disruptions in cellular and humoral immunity systems were identified. After treatment, there was an increase in viral load in the significant «threshold» category (3–5 lg) by 1.25 times and in the «above threshold for progression» category (>5 lg) by 2.3 times, reflecting natural HPV clearance. No direct correlation was found between viral load activity and the degree of CIN or positive morphological changes regarding regression of cervical intraepithelial lesions.Conclusions. The use of a complex containing a blend of plant extracts of sod pike grass (Deschampsia caespitosa), ground cinquefoil grass (Calamagrostis epigeios), and echinacea purpurea grass (Echinacea purpureae) improves the state of vaginal biocenosis, indicators of cellular and humoral immunity, and promotes HPV elimination, it has adequate safety and tolerability, which determines the feasibility of its use in the complex treatment of cervical intraepithelial neoplasia at the preparatory stage before surgery and in the postoperative period to prevent complications and relapses.

Pathways of IFN-alpha Activation in Patients with Cervical Intraepithelial Neoplasia (CIN).

The aim of the present study was to compare the local and systemic expression of the factors linked to the interferon alpha (IFN-α) activation pathway in different degrees of cervical intraepithelial neoplasia (CIN) and cervical cancer. A total of 128 patients with CIN I, CIN II, CIN III and cervical cancer was evaluated. The real-time polymerase chain reaction (RT-PCR) technique was used to evaluate the gene expression of IFNR1, IFNR2, IFN-α, oligoadenylate synthase (2'5'OAS), cytokine signal suppressor 1 (SOCS) 1, SOCS3, signal transducer and transcription activator 1 (STAT1), and IRF9 from 128 biopsies. A total of 46 out of 128 samples were evaluated by flow cytometry for IFNAR1, IFNAR2, STAT1, IRF7 and IFN-α in peripheral blood cells. Patients with CIN II and III (63 samples) had a low local expression of IFNR1, but not IFNR2. Patients with some degree of injury showed high expression of SOCS1 and SOCS3. Systemically, patients with CIN II and III (20 samples) had a significant increase in IFNR1, IFNR2, STAT1, IRF7, and IFN-α in helper, cytotoxic T lymphocytes, and in monocytes. Patients with high-grade lesions have increased systemic expression of IFN-α and its activation pathways in helper and cytotoxic T lymphocytes, as well as in monocytes due to an exacerbation of the immune response in these patients. This phenomenon is not accompanied by resolution of the lesion due to a defect in the IFN-α activation pathway that revealed by low local IFNAR1 expression and high local expression of SOCS1 and SOCS3.

The correlation of HPV16 and HPV18 with local vaginal immunity after the treatment of cervical intraepithelial neoplasia

BackgroundThis study aimed to investigate the correlation between the level of HPV16 and HPV18 in patients with cervical lesions and the local vaginal immunity after receiving treatment with different degrees of cervical intraepithelial neoplasia (CIN) and cervical squamous cell carcinoma (CSCC).MethodsOne hundred and thirty-six patients with LSIL (grade 1 CIN or CIN 1), 263 patients with HSIL (grade 2 and 3 CIN or CIN 2 and 3), and 33 patients with CSCC pathologically confirmed between November 2012 and September 2016 were assigned to the test group and 100 healthy women in the same period were assigned to the control group. ELISA was used to determine the levels of SIgA, IgG, IL-2, and IL-10 and the IL-2/IL-10 ratio in vaginal lavage fluid in the test group (before treatment and 3, 6, and 12 months after treatment) and the control group, respectively. Gene chip technology was adopted to test the HPV infection in the test group (before treatment and 3, 6, and 12 months after treatment) and the control group, respectively.ResultsThe results showed that the levels of SIgA, IgG, and IL-10 were positively correlated with the degree of cervical lesions and IL-2/IL-10 was negatively correlated with the degree in all patients before treatment. The levels of SIgA, IgG, and IL-10 were positively correlated with the degree of cervical lesions and IL-2/IL-10 was negatively correlated with the degree in HPV16 and HPV18-infected patients before receiving the treatment.ConclusionsThe recovery after the treatment of HPV infection is time-dependent and the immune system of patients with CIN starts to recover in the 6th month after treatment, early intervention is not recommended. However, the immune system is approximately in a normal sate at 12 months after treatment, at which time the efficacy can be evaluated, and clinical intervention can be initiated if necessary. The level of local immune factors in the vagina can be monitored to determine the progression and prognosis of patients’ cervical lesions.

Influence of immune-checkpoint inhibitor and HLA-G in patients with Cervical Cancer

Abstract A better understanding of the role of Immune checkpoint inhibitors (ICI) and immunoregulatory genes HLA-G is essential for the development of immunotherapeutic strategies in cancer. This study aims to evaluate the influence of CTLA-4, PD-1 and polymorphisms of HLA-G and soluble HLA-G (sHLA-G) in patients with cervical cancer (CC), different degrees of Cervical Intraepithelial Neoplasia (CIN), and healthy control (HC). One hundred and seventy-four (174) non-pregnant Brazilian women, sexually active, older than 18 years, were evaluated. These patients were stratified according to the results of the anatomopathological examination in: CC group n=24, Low-grade squamous intraepithelial lesions (LSIL) n=66, High-grade squamous intraepithelial lesions (HSIL) n=84. HC group consisted of 47 women without cytological and/or colposcopic abnormalities detected. The peripheral blood of these patients was collected for analysis of CTLA-4, PD-1 and HLA-G polymorphisms using real-time PCR. The analysis indicated a significantly higher 14bpDel allele frequency in CC when compared to HC group (P=0.030, OR=1.71, 95%CI 1.01–2.74). Moreover, the 14bpDel/Del genotype frequency was also significantly higher in patients with CC group (P = 0.035, OR=2.23, 95%CI 1.05–4.97). Qualitative analysis revealed that the production of sHLA-G is detectable in 52.03% (n=77) of all patients groups and 34.29 %(n=12) in HC groups. This analysis revealed a trend of significance (P= 0.063; OR=2.08, 95%CI=0.96–4.48) in CC group. The polymorphisms of CTLA-4 and 14 bp HLA-G are associated with a significantly increased risk of CC. HLA-G 14bp Del/Del polymorphism, and the serum sHLA-G can act as a promising biomarker for might be a genetic risk factor for CC.

Роль иммуногистохимического исследования при диагностике опухолевых поражений шейки матки

The analysis of literature data about the use of immunohistochemical markers for the diagnosis and differential diagnosis of cervical lesions. The most significant assistance in identifying and determining the degree of cervical intraepithelial neoplasia has immunohistochemical detection of Ki-67 and p16. Shows the changes of p63, topoisomerase, C-erbB-2, cyclin D1 at the cervical intraepithelial neoplasia of different degrees of severity and cervical cancer. It is concluded that the immunohistochemical research is legitimate considered as an effective method for histopathological studies. It allows to carry out an objective diagnosis of neoplastic lesions of the cervix, to carry out their differential diagnosis with reactive and tumor-like changes, as well as to determine the prognosis of the disease.

Comparison of p16INK4a Immunocytochemistry with the HPV Polymerase Chain Reaction in Predicting High Grade Cervical Squamous Intraepithelial Lesions

To compare p16INK4a immunocytochemistry with the HPV polymerase chain reaction in predicting high grade cervical squamous intraepithelial lesions. This diagnostic case-control study was conducted from January 2010 until December 2010. We obtained 30 samples, classified according to the degree of cervical intraepithelial neoplasia (CIN): 11 samples for CIN 1, 9 samples for CIN 2, and 10 samples for CIN 3. HPV PCR, p16INK4a immunocytochemistry, and histopathological examination were performed on all samples. Statistical analysis was conducted using SPSS 20.0. In predicting CIN 2-3, we found p16INK4a to have similar specificity and positive predictive value as HPV PCR (95%, 97.2% vs 96.7%), but better sensitivity (87.5% vs 72.5%) and negative predictive value (82.1% vs 67.6%). The most prevalent types of high-risk HPV in our study were HPV 33, 35, 58, 52, and 16. p16INK4a has better diagnostic values than HPV PCR and may be incorporated in the triage of ASCUS and LSIL to replace HPV PCR. Genotype distribution of HPV differs in each region, providing a challenge to develop HPV vaccines based on the epidemiology of HPV in that particular region.

Lidocaine Spray Compared With Submucosal Injection for Reducing Pain During Loop Electrosurgical Excision Procedure

To examine the effectiveness of lidocaine spray compared with conventional lidocaine submucosal injection during a loop electrosurgical excision procedure (LEEP). Women undergoing LEEP for any degrees of cervical intraepithelial neoplasia were invited to participate. The participants were randomly assigned into two groups. In group 1 (injection), the participants were anesthetized with 1.8 mL (36 mg) of 2% lidocaine with 1:100,000 epinephrine injected submucosally using a pressure syringe injector with a 27-gauge needle tip at 3, 6, 9, and 12 o'clock locations of the ectocervix. For group 2 (spray), the patients were locally anesthetized with four puffs (40 mg) of 10% lidocaine spray applied thoroughly to the ectocervix. The patients rated their pain according to a 10-cm visual analog scale at different points during the procedure including baseline, postanesthesia, excision, and 30 minutes postexcision. Primary outcomes were the excision pain score and its difference from the baseline. One hundred one patients (51 in the injection group and 50 in the spray group) participated in the study. The baseline pain scores, the excision pain scores, the difference between the excision and the baseline pain scores, and the postexcision pain scores were comparable between the study groups. The median postanesthesia pain score and the median difference of the postanesthesia score from baseline were significantly higher in the injection group, 3.4 compared with 0.6 and 1.9 compared with 0.0, respectively (P<.01). Lidocaine spray is an effective and practical alternative measure for reducing pain associated with electrical excision of the cervix during LEEP. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01505920. I.

Scoring System and Management Algorithm Assessing the Role of Survivin Expression in Predicting Progressivity of HPV Infections in Precancerous Cervical Lesions

To identify the risk factors and assess the role of survivin in predicting progessivity precancerous cervical lesions. This case-control study was conducted from October 2009 until May 2010. We obtained 74 samples, classified according to the degree of cervical intraepithelial neoplasia (CIN): 19 samples for CIN 1, 18 samples for CIN 2, 18 samples for CIN 3, and 19 samples as controls. Demographic profiles and risk factors assesment, histopathologic examination, HPV DNA tests, immunocytochemistry (ICC) and immunohistochemistry (IHC) staining for survivin expression were performed on all samples. Data was analyzed with bivariate and multivariate analysis. Multivariate analysis revealed significant risk factors for developing precancerous cervical lesions are age <41 years, women with ≥2 sexual partners, course of education ≥13 years, use of oral contraceptives, positive high-risk HPV DNA, and high survivin expression by ICC or IHC staining. These factors were fit to a prediction model and we obtained a scoring system to predict the progressivity of CIN lesions. Determination of survivin expression by immunocytochemistry staining, along with other significant risk factors, can be used in a scoring system to predict the progressivity of CIN lesions. Application of this scoring system may be beneficial in determining the action of therapy towards the patient.

Diagnostic accuracy of guided cervical biopsies: a prospective multicenter study comparing the histopathology of simultaneous biopsy and cone specimen

We sought to determine the validity of colposcopically directed cervical biopsies as a diagnostic test to define the degree of cervical intraepithelial neoplasia (CIN). In a prospective multicenter trial, patients undergoing excisional procedures of the transformation zone additionally had colposcopy and up to 3 guided cervical biopsies in a single procedure. Cervical biopsies were regarded as a diagnostic test to detect high-grade lesions (CIN 2,3), with the cone specimen as reference standard. In all, 488 biopsies were performed in 244 cases, with 2 biopsies done in 192 cases. Cervical biopsies underestimated the severity of lesions in 46.7% of cases. Sensitivity, specificity, and positive and negative predictive values were 66.2% (95% confidence interval [CI], 59.4-72.3), 95.0% (95% CI, 83.5-98.6), 98.5% (95% CI, 94.8-99.6), and 35.5% (95% CI, 27.1-44.9), respectively. Our data suggest that cytologically suspected high-grade lesions (CIN 2,3) can be confirmed by biopsy in many cases, but they cannot be excluded.

135 PHYSIOLOGICAL MONITORING OF THE CONDITION OF PATIENTS WHO ARE RECEIVING COMBINED MAGNETIC LASER THERAPY

This report presents a learning experience in the use of colposcopy in the management of 254 patients consecutively and personally studied in whom one or more Papanicolaou smears suggested a cervical intraepithelial neoplasia or early invasive carcinoma. The accuracy of cytology in predicting the degree of cervical intraepithelial neoplasia and early invasive carcinoma, within the limits of confidence of the laboratory, was 84.5 per cent. The accuracy of the colposcopic impression, within the limits of confidence, was 83.5 per cent. When only those lesions that could be satisfactorily examined were considered, the accuracy of the colposcopic interpretation within the limits of confidence was found to be 96.4 per cent. Neoplastic lesions limited to the ectocervix, and lesions that extended from the ectocervix into the lower portion of the endocervical canal and lesions limited to the canal were significantly related to the age of the patient. Of the total group of 254 patients examined, 45 patients (17.7 per cent) were subjected to a diagnostic cone biopsy.

Gene Expression Profiling of Women with Varying Degrees of Cervical Intraepithelial Neoplasia

A pilot study to determine genomic microarray differences in patients with normal cervical tissue and cervical intraepithelial neoplasia (CIN) 3. After institutional review board approval, patients referred to the University of Alabama at Birmingham Colposcopy Clinic for a loop electrosurgical excisional procedure were identified. Tissue biopsies of both normal tissue and CIN 3 from fresh loop electrosurgical excisional procedure specimens were obtained and sent to pathology for histological confirmation. Procurement of these 2 types of tissue from the same patient controls for different types of human papillomavirus infection, smoking and nutritional status, age, immunocompetency, and other microenvironment factors (i.e., the patient serves as their own control). Standard RNA extraction techniques (Qiagen, Inc., Valencia, CA) were used to prepare the tissue specimens for microarray analysis with the Affymetrix GeneChip U133A expression array (Affymetrix, Inc., Santa Clara, CA). Paired samples were eligible for microarray analysis only when both normal tissue and CIN 3 were confirmed by pathology. The data were then subsequently subjected to a log-like transformation and analyzed with a t test. For this study, p<.001 was determined to be statistically significant. Twenty-one pairs of both normal and CIN tissues were obtained and underwent histological evaluation followed by RNA extraction. Within the normal group, 86% were confirmed as true normals and 14% as CIN. Within the CIN group, 28.5% were found to have CIN 2, 62% were found to have CIN 3, and 9.5% had no evidence of CIN. Mean RNA content of normal samples was 2.0 microg, whereas the mean RNA content of CIN samples was significantly higher at 7.4 microg (p=006). Ultimately, 5 pairs of normal and neoplastic tissues were subjected to microarray analysis. Using a cutoff of p<.001, 24 candidate genes were identified from more than 18,000 genes. In the CIN 3 group, 14 genes were overexpressed and 10 genes were underexpressed. Of the 14 overexpressed genes, 9 were noted to have identities listed in the National Center for Biotechnology Information public domain. Five (56%) of these 9 genes were directly related to immunity-related pathways, and 3 (33%) of the 9 genes were found to be involved in cell cycle function/control. One overexpressed gene was identified as p53. The presence of CIN is marked by increased transcriptional activity, evident by an almost 4-fold increase in mean RNA content obtained from our CIN samples versus normal cervical tissue. Furthermore, a number of statistically significant overexpressed genes of interest related to immune function/response and cell cycle control were identified in our pilot microarray study. This data have the ability to direct future research endeavors in cervical neoplasia. Future endeavors include the use of laser capture microdissection to evaluate genomic changes strictly at the epithelial level and, as such, exclude stromal response contributions.

Expression of p16 INK4a in relation to histopathology and viral load of ‘high-risk’ HPV types in cervical neoplastic lesions

A total of 91 cervical archival biopsy series were analysed for the presence and viral load of ‘high-risk’ types of human papillomavirus (HR-HPV), and p16 INK4a expression. The women had various degrees of CIN (cervical intraepithelial neoplasia). HPV 16 was the most prevalent type found, at 47% frequency. The frequency of HPV 16 increased with increasing immunoreactivity to p16 INK4a, from 39% to 44% at cases scored low to medium, to 65% at high reactivity. Thirty (33%) of the samples had negative p16 INK4a analysis results, but were positive for HR-HPV. There was no significant correlation between viral load and the level of p16 INK4a expression, while the grade of CIN correlated to such expressions. Thus, p16 INK4a expression analysis yielded information which is consistent with results from the histopathology and might complement the HPV analysis in a clinical prognostic procedure in order to find women at risk for cervical cancer.

Comparative study of MMP-2 (matrix metalloproteinase 2) immune expression in normal uterine cervix, intraepithelial neoplasias, and squamous cells cervical carcinoma

Objective This study was undertaken to evaluate the levels of matrix metalloproteinase 2 (MMP-2) in the precursors lesions and in the invasive cervical carcinoma and to quantify the immune reactive expression of MMP-2, using MMP-2 immunohistochemistry, in intraepithelial cervical neoplasias and in the invading cervical carcinoma. Study design We evaluated 60 samples of cervical tissues using immunohistochemistry for MMP-2 in 5 distinct groups. The groups were divided in control, cervical intraepithelial neoplasia I (CIN I), CIN II, CIN III, and cervical invading carcinoma. Results MMP-2 expression was found gradually increased according to the degree of cervical intraepithelial neoplasia and cervical carcinoma. (Control<CIN I<CIN II<CIN III<Carcinoma) Conclusion Our results suggest that the expression of MMP-2 can distinguish CIN I, II, and III grades and the invading carcinoma.

Comparative study of MMP-2 (matrix metalloproteinase 2) immune expression in normal uterine cervix, intraepithelial neoplasias, and squamous cells cervical carcinoma*1

Objective This study was undertaken to evaluate the levels of matrix metalloproteinase 2 (MMP-2) in the precursors lesions and in the invasive cervical carcinoma and to quantify the immune reactive expression of MMP-2, using MMP-2 immunohistochemistry, in intraepithelial cervical neoplasias and in the invading cervical carcinoma. Study design We evaluated 60 samples of cervical tissues using immunohistochemistry for MMP-2 in 5 distinct groups. The groups were divided in control, cervical intraepithelial neoplasia I (CIN I), CIN II, CIN III, and cervical invading carcinoma. Results MMP-2 expression was found gradually increased according to the degree of cervical intraepithelial neoplasia and cervical carcinoma. (Control<CIN I<CIN II<CIN III<Carcinoma) Conclusion Our results suggest that the expression of MMP-2 can distinguish CIN I, II, and III grades and the invading carcinoma.

Sexual attitudes and their relation to cervical intraepithelial neoplasia in Maiduguri, Nigeria

Five hundred randomly selected sexually active women attending antenatal, postnatal, family planning and gynaecological clinics in the Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, had questionnaires administered on their sexual attitudes/ behaviour and their 'pap'smears taken for cytological assessment. The aim was to identify any significant association between sexual attitudes/behaviour and cervical intraepithelial neoplasia (CIN) for the purpose of targeting the population most at risk. Ninety-one women had varying degrees of CIN, a prevalence rate of 18.2%. However, multiple sexual partners was the only factor incriminated to significantly increase the risk of occurrence of CIN. Targeting women with multiple sexual partners may help in directing limited screening resources to those more likely to be positive.

Monoclonal antibody MIB1 in the assessment of cervical squamous intraepithelial lesions.

The aims of the study were to assess patterns of cell proliferation, using the monoclonal antibody MIB1, in a variety of non-neoplastic and neoplastic cervical squamous intraepithelial lesions. We also wished to determine whether this antibody is of value in the discrimination of different grades of cervical intraepithelial neoplasia (CIN) and in the distinction of CIN from non-neoplastic lesions that may histologically mimic CIN. Tissue sections of formalin-fixed, paraffin-embedded cervical colposcopic biopsies were stained immunohistochemically with MIB1 after microwave heating. Normal ectocervix and cervical specimens exhibiting immature squamous metaplasia, koilocytosis, CIN grades I, II, and III, and atrophic squamous epithelium were studied. In normal ectocervix, MIB1-positive cells were confined almost exclusively to the parabasal cell layer. Increased expression was seen in cases of koilocytosis and CIN, positive staining being present in progressively higher layers of epithelium in accordance with the degree of CIN. In immature squamous metaplasia, positive staining was generally confined to the parabasal layer with occasional scattered positive cells in higher layers of epithelium. There was little or no staining of atrophic squamous epithelium. The study confirms that proliferating cells, as demonstrated by MIB1 immunostaining, are found at progressively higher levels in cervical squamous epithelia from normal to koilocytosis to CIN grades I, II and III. Immunostaining with MIB1, which can be easily performed on routinely processed tissues, is of potential value as an adjunct to histology in the grading of CIN and the distinction of CIN from non-neoplastic lesions that may mimic CIN.

Does the loop electrosurgical excision procedure adversely affect the histopathological interpretation of cervical conization specimens?

To assess the suitability of conized specimens obtained by loop electrosurgical excision procedure for histopathological interpretation. We evaluated the histological pictures of 215 tissue sections obtained by loop electrosurgical excision procedure. These sections came from 32 cases of patients with various degrees of cervical intraepithelial neoplasia. All women included in our study had a satisfactory colposcopy and no cytological or colposcopic evidence of invasive cancer. We quantified the thickness of thermal damage in the tissue sections using a stage-mounted, calibrated grid microscope. At its greatest extent, thermal damage occurring next to incision lines ranged from 160 to 520 mu (mean 262, SE 14 mu). Two different zones of thermal damage were produced by LEEP: the carbonization and coagulation zones. The carbonization zone was located at the outermost layer and was very thin, measuring from 10 to 30 mu in depth. The coagulation zone was adjacent to the carbonization zone, was eosinophilic, and was significantly deeper than the carbonization zone at its points of greatest thickness (150 to 500 mu; p < 0.0001, Student's t-test). The depth of the coagulation zone correlated significantly with the depth of the carbonization zone (p = 0.041, least linear correlation). Tissue distortion was present in 53% (17/32) of the cases, and appeared only in the coagulation zone. Tissue structure from the diseased portions of the conized specimens was generally well preserved. The area of thermal damage was limited and thus did not result in diagnostic problems. We conclude that LEEP is a reliable method for obtaining tissue samples for histopathological examination.

Screening for Cervical Neoplasia in an African Population

In many countries cytologic screening for cervical cancer has become firmly established and accepted. This has not been the case in some developing countries because of limited financial and manpower resources. In a series of 1564 patients, simultaneous colposcopy and cytology revealed 31 women with varying degrees of cervical intraepithelial neoplasia. We feel that an initial combination of colposcopy and cytology provides a more reliable diagnosis of cervical lesions and a case is made for the establishment of mass cytologic screening in Nigeria.

Screening for cervical neoplasia in an African population: Simultaneous use of cytology and colposcopy

In many countries cytologic screening for cervical cancer has become firmly established and accepted. This has not been the case in some developing countries because of limited financial and manpower resources. In a series of 1564 patients, simultaneous colposcopy and cytology revealed 31 women with varying degrees of cervical intraepithelial neoplasia. We feel that an initial combination of colposcopy and cytology provides a more reliable diagnosis of cervical lesions and a case is made for the establishment of mass cytologic screening in Nigeria.

Lokale Immunreaktionen bei CIN und Zervixkarzinom - Eine histologische und immunhistochemische Studie*

50 conisation or hysterectomy specimens with different degrees of cervical intraepithelial neoplasia (CIN), carcinoma in situ (CiS) or invasive carcinoma, as well as controls, were studied by conventional histological methods as well as by immunohistochemistry. In CIN I and II there is a significant reduction of T lymphocytes, macrophages and T accessory cells, whereby CIN III, CiS and invasive carcinoma show a noticeable increase in the number of immunocompetent cells. The depletion of immunocompetent cells in CIN probably represent a local immunodeficiency state which permits progression of HPV-associated CIN, whilst the marked increase of accessory and effector cells in the stroma of high grade CIN and invasive carcinoma does not appear to exert control over the neoplastic cells, due to an ineffective tumour-specific activation.