Invasive Carcinoma Of Cervix Research Articles

Colposcopic Findings for Detecting Pre-invasive Lesion of Cervix Among Visually Inspected Acetic Acid Positive Cases

Background: Cervical cancer-a preventable disease, is the second most commonly diagnosed cancer among women of developing countries. Paps smear is the gold standard screening method worldwide. But a low-cost test, visual inspection of cervix with acetic acid (VIA) has been emerged as an alternative for use in lowresource settings. VIA is simple and easy to perform by auxiliary health professionals. Colposcopy is an essential procedure in the evaluation of screen positive cervix though it requires considerable training and experience. Objective: The objective of this study was to evaluate the VIA positive cases by colposcopy, colposcopy guided biopsy and histopathological examination. Methods: This was a cross sectional observational study conducted among 100 VIA positive cases attended at GOPD of Dhaka Medical College Hospital from July 2014 to December 2014. Colposcopy was performed in all VIA positive cases. Subsequent biopsy and histopathological examinations were done for those with colposcopic abnormal findings. Results: The mean age of the study population was 37.9±9.3 years. Among VIA positive cases 66.0% had complaints of whitish vaginal discharge. Among the study population, colposcopically 46.0% had healthy cervix (normal) and 54.0% had abnormal findings. Colposcopy guided biopsy was taken from those with abnormal findings. Histopathological findings were normal in 38.9% cases, chronic cervicitis in 20.37% cases, squamous cell metaplasia in 3.7% cases, CIN I in 16.7%, CIN II in11.11%, CIN III in 5.6% and 3.7% cases were carcinoma cervix. True positive value was 20, false positive value 34 and positive predictive value of colposcopy was 37.03%. Conclusion: This study concluded that VIA is effective in detection of CIN and invasive carcinoma of cervix. It also suggests the role of colposcopy in the evaluation of CIN and other cervical diseases in screen positive cases. VIA can be used as a screening tool in low and middle income countries like Bangladesh, not only in rural areas and small health centres, but also in hospitals, cancer institutes, and other health facilities with better resources. Bangladesh Med Res Counc Bull 2022; 48(1): 27-32

Morbidity following image-guided brachytherapy for cervical cancer: Patient and treatment related factors

PurposeThis retrospective study aims to assess factors associated with the occurrence of toxicity after brachytherapy (BT), as boost after external beam radiotherapy (EBRT) for treatment of invasive cervix carcinoma. METHODS AND MATERIALSAll consecutive patients diagnosed with cervical carcinoma, and treated with concurrent radiochemotherapy from August 2017 to January 2020 were retrospectively included. An isodose conformation index (ICI) was developed to assess the percentage of the prescription isodose contained within the intermediate risk clinical target volume (IR-CTV). ResultsEighty-one patients with invasive cervix carcinoma from stage IB to stage IVa were included. Thirty-two (40%) and 49 (60%) patients were treated with Pulsed Dose Rate (PDR) and High Dose Rate (HDR) BT, respectively. Median follow-up was 19.6 months (5.6–41.2). The main factors associated with development of gastrointestinal toxicity were: the median volume of the prescription isodose (67.9cm[3] [37.6–92.9] vs. 49.1cm[3] [34.5–53.5], p = 0.05), the value of ICI (59% [51%-83%] vs. 86% [65%-96%], p = 0.01), the median equivalent dose delivered to the sigmoid (D2cc= 58.4 GyEQD2 [53.9–61.1] vs. 55.2 GyEQD2 [52.8–57.5], p = 0.06) and the median equivalent dose delivered to the IR-CTV (D90= 63.9 GyEQD2 [60.6–66.4] vs. 61.2 GyEQD2 [59.4–64.5], p = 0.03). The proportion of patients who received EBRT lymph node boost was higher in patients who developed urinary toxicity than in patients who did not (57.1% vs. 28.6%, p = 0.08). Anticoagulant (p = 0.02) and antiaggregant therapy (p = 0.01) were associated with occurrence of both urinary and gastrointestinal toxicity. ConclusionSOur study confirms the predictive value of irradiated volume in the occurrence of gastrointestinal toxicity, as well as the need for a better conformation to the target volume. Precautions should be considered in patients with vascular comorbidities.

A study on expression of p16INK4a by immunohistochemistry in cervical dysplasia and Invasive carcinoma of cervix

Introduction: Cervical cancer is the most common cancer in developing country. Early diagnosis of intraepithelial cervical neoplasia and malignancy is important. Infection with Human Papilloma Virus (HPV) results in precancerous lesions and invasive cervical cancer. Interaction of HPV oncogenic proteins with cellular regulatory proteins leads to upregulation of p16INK4a, a cyclin dependent kinase inhibitor. Therefore, p16INK4a overexpression is a surrogate biomarker of HPV infection making it useful in evaluating HPV associated premalignant and malignant lesions of gynecological tract. In our study we have used p16INK4a IHC staining to find out its correlation with dysplasia grading and cervical carcinoma. Materials and Methods: This retrospective descriptive case series for five years duration (from Jan 2014 to Dec2018) was conducted in the Department of Pathology, IGMC & RI, Puducherry, India. A total of 43 cervical biopsies and hysterectomies were collected out of which 17 cases were of carcinoma cervix and 26 cases were of cervical intraepithelial neoplasia ( CIN). All biopsies were subjected to p16INK4a staining. Results: The Immuno expression of p16INK4a of CIN I was 13.3%, CIN II was 20%, CIN III was 50% and Carcinoma cervix was 100%. In normal (non dysplasia) cervical epithelium it showed, 100% negative association. Conclusion: IHC expression of p16INK4a in cervical biopsy is directly related to degree of histological dysplasia and malignancy, so it may be used as a adjunct with routine histopathological examination in identifying cervical dysplasia and also has prognostic value in the management of cervical lesions. Keywords: Dysplasia, Cervical cancer, p16INK4a CIN

ROLE OF PAP SMEAR AS A SCREENING TEST IN PRECANCEROUS AND CANCEROUS LESIONS OF CERVIX.

Introduction: A pap smear is a simple, co-effective, non invasive screening test in detecting precancerous and cancerous lesion of cervix and also useful for early detection and implementation of appropriative treatment in pre invasive cervical lesions. Early epithelial changes are recognised by pap smear test. Based on pap smear results to educate the women regarding symptoms of cervical cancer. Aim: Based on results of study, to differentiate between pre invasive and invasive carcinoma of cervix. Materials and Methods: The present study was done over a period of three years period (February 2016 - January 2019). The total number of 966 cases was studied in department of pathology, Government medical college, Kadapa. All the cases were categorised based on cyto-morphological features of pap smear. Requirement of materials: Cervical smears, coupling jars, suitable fixative is Isopropyl alcohol, Alcohol fixed slides were taken for Papanicolaou stain. Results: The present study done on total 966 cases, out of these inflammatory lesions were 628 cases (65.01%), ASCUS were 228 cases (23.60%), LSIL were 62 cases (6.41%), HSIL were 28 cases (2.89%) and malignancy seen in 20 cases (2.07%). Predominate age group in ASCUS and LSIL was fourth decade. HSIL was seen in Fifth decade. Depending on clinical data predominant cases 760cases (78.67%) were presented with leucorrhoea.
 Keywords: Cervical smears, Papanicolaou stain, Cervical lesions

Comparative study of expression of keratins 8, 10, 13 and 17 in CIN III and invasive carcinoma of cervix

Introduction: The role of keratin expression patterns as candidate tumour markers continues to be under investigation in human cervix carcinogenesis. Keratin comprise of family of at least 20 intermediate filament proteins that have a specific distribution pattern in epithelial tissue. Objective: The present study was conducted with an aim to identify CINI, II and CINIII in tissue sections with the help of immunohistochemistry of specific diagnostic markers so as to reduce the burden of invasive cervical carcinoma and to evaluate the role of cytokeratin 8,10,13 and 17 for differentiating CINIII from cervical carcinoma along with its correlation with histopathological diagnosis of these lesions. Method: We examined the immunohistochemical staining of CK8, CK10, CK13 and CK17 in 64 cases of reference cervix, CINIII lesions and invasive cervical carcinoma. Results: In present study cytokeratin 8 has sensitivity 40% and specificity 100%, cytokeratin 10 has sensitivity 80% and specificity 40%, cytokeratin 13 has sensitivity 100% and specificity 80% and cytokeratin 17 has sensitivity 40% and specificity 100% in invasive cervical carcinoma. In the CIN III lesions, cytokeratin 8 has sensitivity 56% and specificity 100%, cytokeratin 10 has sensitivity 80% and specificity 79%, cytokeratin 13 has sensitivity 100% and specificity 75% and cytokeratin 17 has sensitivity 72% and specificity 100% in cervical intraepithelial lesion III. Conclusions: We observed that expression of keratins 8 and 17 and loss of keratins 10 and 13 are good markers of malignant transformation in human cervix. Keratin expression patterns, namely expressions of keratin 10 can be useful for studying and grading squamous cell carcinomas of the cervix.

Cytologic and colposcopic evaluation of all symptomatic women at tertiary care centre

Background: Cervical cancer in India ranks as the 2nd most frequent cancer among women and the 2nd most frequent cancer among women between 15 and 44 years of age. Invasive carcinoma of cervix is preventable as it is associated with pre-invasive stage which occurs 10-15 years prior to it, thus permitting early detection by screening and leading to effective treatment and thereby reducing mortality rate with greater impact on lives saved. Objectives were to correlate the findings of Pap smear with colposcopy in evaluation of all symptomatic women; and to assess the utility of colposcopy in detecting the premalignant and malignant lesions of cervix.Methods: This was a prospective observational study of 200 symptomatic women attending the Gynecology OPD of Umaid Hospital Dr. S. N. Medical College Jodhpur, Rajasthan, India from February 2015 to October 2016. Evaluation of all symptomatic women done with Pap smear, colposcopy and biopsy in selected cases and findings were noted.Results: Commonest complaint was white discharge per vaginum in 58.5% followed by pelvic pain in 24% women. 8% women had abnormal pap smear findings with 4% of women had ASCUS, 0.5% had ASC-H, 3% had LSIL and 0.5% had HSIL,73% had inflammatory and 19% with normal smear. 38.5% had abnormal colposcopy with maximum 28% women had acetowhite lesions. Sensitivity of pap smear was 44.44% while sensitivity of colposcopy was 88.88%.Conclusions: Pap smear had poor sensitivity as compared to colposcopy. Hence simultaneous use of colposcopy has shown to increase in the rate of carcinoma cervix detection in symptomatic women.

Role of Colposcopy in the Evaluation of Visual Inspection of Cervix with Acetic Acid-positive Cases of Unhealthy Cervix

ABSTRACT Introduction Cervical cancer is the second most common cancer in women worldwide, and it is the principal cancer of women in most developing countries, where 80% of cases occur. This disease is preventable by screening and treatment of preinvasive condition. All sexually active women are at risk of acquiring a human papillomavirus (HPV) infection that may lead to cervical cancer in the future. Cervical cancer is a preventable disease as the different screening, diagnostic, and therapeutic procedures are effective. The screening procedures are visual inspection of cervix with acetic acid (VIA), Pap smear, colposcopy, and HPV deoxyribonucleic acid test. Among them, colposcopy is effective in screening, taking colposcopy-directed biopsy as well as treatment of cervical intraepithelial neoplasia (CIN), such as cold coagulation, cryotherapy, and loop electro-surgical excision procedure. Hence, there is an obvious need to subject the women with VIA-positive report to colposcopy and directed biopsy. This study is done to evaluate the role of colposcopy in evaluation of VIA-positive cases. Objective Colposcopic evaluation of VIA-positive cases and detection of precancerous lesion of cervix for early management. Materials and methods This was a cross-sectional study done among married female patient aged 22 to 65 years, who had VIA-positive report, and attending the colposcopy clinic in the Department of Obstetrics and Gynecology of Sir Salimullah Medical College and Mitford Hospital from January 2014 to December 2016. Colposcopy-directed punch biopsy was taken from the abnormal colposcopic appearance and specimen sent for histopathological examination. Results Out of 97 cases, all had VIA-positive acetowhite areas. But colposcopy revealed that 76.29% had CIN and invasive lesions, while 23.71% had either normal or inflammatory lesions. Colposcopy-directed punch biopsy revealed that 59.79% cases had positive lesions like CIN or invasive carcinoma and 40.21% had neither CIN nor invasive lesions. Among positive lesions, about 34.02% had CIN I, 3.09% had CIN II, 0% had CIN III, and 22.68% had invasive carcinoma. In this study, sensitivity and specificity of colposcopy examination were found 94.83 and 51.28% respectively. Conclusion Cervical cancer presents as major cause of morbidity and mortality, especially in developing countries like Bangladesh. In developing countries, the various screening programs are implemented for its early detection and treatment. It is evident that colposcopy plays a very important role in early diagnosis and treatment of preinvasive and early invasive carcinoma of cervix. So wide use of colposcopy in screening program of Bangladesh can reduce many young women's morbidity and mortality. How to cite this article Kasem SB, Razzaque SA, Adiba R, Anika S, Begum F. Role of Colposcopy in the Evaluation of Visual Inspection of Cervix with Acetic Acid-positive Cases of Unhealthy Cervix. J South Asian Feder Menopause Soc 2017;5(2):102-106.

Relationship between cervical intraepithelial neoplasia and high-risk human papillomavirus in areas with dense floating population

Objective To investigate the relevant factors and relationship between cervical intraepithelial neoplasia and high-risk human papillomavirus happened in the areas with dense floating population.Methods The basic data of the patients infected by HPV16,HPV18,and HPV31 subgroups from the gynecological clinic were collected,and the relevant data were completed reviewing their electronic medical records or through telephone follow-up.Results The HPV infection frequency was 217 in the 198 patients.Among them,61.75％ were infected by HPV16,25.35％ by HPV18,and 12.90％ by HPV31.In the 198 patients,16.16％ had sex life in too young age or had more than one sex mate,32.83％ had been pregnant,delivered,or aborted more than once,90.40％ got vaginal infection,81.82％ had chronic cervicitis,and 26 patients (13.13％),including 22 cases infected by HPV16 and having higher malignancy degree,had cervical intraepithelial neoplasia and cervical carcinoma.Conclusions Cervical intraepithelial neoplasia closely relates to high-risk HPV16 infection in the areas with dense floating population.Low immunity caused by chronic cervicitis and cervical and vaginal infections,was the main factors for high risk HPV infection. Key words: Invasive carcinoma of cervix; Cervical intraepithelial neoplasia; Human papillomavirus; High risk factors

Clinical profile and treatment protocol of invasive carcinoma of cervix

Cervical cancer is the most common prevalent cancer that continues to be a major health care problem world wide. It is still an important cause of mortality and morbidity in the developing countries. An estimated 500,000 new cases of cancer cervix and 233.000 deaths occurred in the year 2000 and almost 80% of these cases happen in the developing countries. Hospital based statistics indicated cervical cancer constitutes 22-35% of the female cancer in different areas of Bangladesh and India. A retrospective study was done in Gynaecology and Obstetric department in KMCH between January 2004 to January 2009 to see the incidence, correlation of age, parity, socioeconomic condition and clinical staging, treatment and other risks factors of carcinoma cervix. Out of total 120 diagnosed cases of cervical cancer were evaluated regarding their clinio-demographic profile, appearance of growth, clinical staging and types of treatment done . The results showed 49% of patient were in the age group of 31-40 years, 26% were in the 41-50 years group, early age at first coitus (70%), most of the patients (82%) presented with advanced stage and referred for radiotherapy or chemo radiation. One in ten female cancers diagnosed world wide are cancers of the cervix and there is seven fold variation in the incidence of cervical cancer between the different regions of the world. The Incidence of invasive cervical carcinoma can be reduced by development of health education and promotion of national screening programme such as Visual Inspection of cervix (VIA), Colposcopy and vaccination against Human Pappiloma Virus (HPV). DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13623 Bang Med J (Khulna) 2012; 45 : 11-14

Cervical cancer screening: hTERC gene amplification detection by FISH in comparison with conventional methods

Aim: To assess the clinical significance of hTERC amplification for cervical cancer screening detected by fluorescence in situ hybridization (FISH) and compare it with that of current screening methods within the same group. Methods: A total of one hundred and nine women were recruited in this study. All of them had liquid-based thin-prep cytologic test (TCT), human papillomavirus (HPV) DNA testing and hTERC gene amplification analysis using interphase two-color FISH. In addition, colposcopically directed biopsy and/or cone biopsy were conducted for definite histopathologic diagnosis for each case. The optimal threashold of hTERC gene amplification by fluorescence in situ hybridization (FISH) were assecced by receiver operating characteristic (ROC) curve. The results of hTERC gene amplification analysis were compared with the cytological analysis, HPV DNA testing and those of subsequent biopsies. Results: Among the 109 patients, 18 were benign lesion, 17 were LSIL, 66 were HSIL and 8 were invasive carcinoma of cervix (ICC). Of them, hTERC-positive cases were found in 0.0% (0/18) of normal specimens, 11.8% (2/17) of LSIL, 72.7% (48/66) of HSIL and 100.0% (8/8) of ICC, respectively. The positive rate of hTERC gene amplification was significantly higher in HSIL and ICC compared with normal and LSIL (all P < 0.01).The optimal cut-off point of percentages of cells with hTERC amplification was determined as 5.5%. Using this threshold the hTERC test reached a much higher specificity(94.3%, 33/35) and a relatively lower sensitivity(77.0%, 57/74) to distinguish benign lesion and LSIL from HSIL and ICC in comparison with HR-HPV test (51.4%; 91.9%) and TCT (74.3%; 81.1%). Area Under the Curve revealed that hTERC amplification test performed more accurately (area under the curve = 0.857) compared to HPV test (area under the curve = 0.717) and cytology(area under the curve = 0.777) to discriminate HSIL or higher from LSIL or lower. This study also found a significant positive correlation between positive hTERC gain and HR-HPV infection, abnormal cytological or histopathologic lesions (all P < 0.01) in patients with cervical diseases. Conclusion: hTERC amplification testing may be a promising adjunct to screen women for cervical precancer or cancer with high specificity and accuracy.

Long-Term Follow-up of Patients with HIV-Related Diffuse Large B-Cell Lymphoma (DLBCL) Treated in the Phase II Study with Rituximab and CHOP (R-CHOP)

Abstract 4980 Background and objective.In the highly active antiretroviral treatment (HAART) era R-CHOP based chemotherapy has proven to be feasible and effective in HIV-related DLBCL. However, the available information on long-term follow-up of patients in remission of lymphoma is scarce. In addition, solid tumors constitute an emerging cause of cancer in HIV-infected patients under HAART. The follow-up of patients in complete response (CR) included in a phase II clinical trial of R-CHOP every 21 days conducted by the Spanish PETHEMA, GESIDA, GELTAMO and GELCAB groups (Ribera JM et al. Br J Haematol 2007; 140: 411–419) has been analyzed. Patients and methods.Out of 81 patients included in the trial 55 patients were in CR. The following data were recorded in these patients: NHL relapse, opportunistic infections (OI) and other cancers. Cumulative probabilities of OI and second cancers, as well as overall survival (OS) and event-free survival (EFS) were calculated. Results.Median follow-up of alive patients was 6.4 yr (range: 4.6–9.5). One patient was lost of follow-up in CR, 8 relapsed, 5 had OI (meningoencephalitis [2], Pneumocystis jiroveci pneumonia [1], varicella pneumonia [1], pneumoccal pneumonia [1], esophageal candidiasis [1], and CMV colitis [1]; 2 patients suffered 2 OI during their evolution) and 5 developed a second cancer (invasive carcinoma of cervix [1], squamous lung cancer [1], lung adenocarcinoma [1], pancreatic adenocarcinoma [1], and metastatic sarcoma of unknown origin [1]). Eight-year cumulative probability for OI was 15% (95%CI: 7%-23%) and for second cancer was 12% (95%CI: 2%-22%). Fourteen patients have died: 5 due to lymphoma relapse, 3 due to OI, 4 due to second cancer and 2 due to other reasons (sudden death and assassinate). Eight-year OS probability for the 55 patients in first CR of the lymphoma was 67% (95%CI: 48%-86%) and EFS probability was 59% (95%CI: 42%-76%). Conclusions.HIV-infected patients with DLBCL treated with R-CHOP and HAART followed for long-time have a significant frequency of OI and second cancers, with impact on their survival probability.Supported in part with grants RD06/0020/1056 from RTICC, Instituto Carlos III, 36606/06 from FIPSE and P-EF/10 from FJC. Disclosures:No relevant conflicts of interest to declare.

Simple trachelectomy of early invasive cervix carcinoma in the second trimester

Although cervical carcinoma is among the most frequently encountered malignancies during pregnancy only a small number of cases during pregnancy have been reported. Usually, the patients have been treated by radical trachelectomy with or without chemotherapy during the pregnancy. Laparoscopic pelvic lymph node dissection with frozen section, simple trachelectomy and cerclage were performed in the 22(nd) week of pregnancy. The histologic examination confirmed a squamous cell carcinoma of the cervix of 35mm diameter, lymphangioinvasion (L1), low grade, clear surgical margin, negative pelvic lymph nodes according to stage Figo IB. Adjuvant chemotherapy with three cycles of cisplatin was performed after surgery. Delivery was performed by cesarean section followed by radical hysterectomy in the the 32(nd) week of pregnancy. Recurrent adjuvant chemotherapy with three cycles of cisplatin and local vaginal iridium radiation were performed after surgery. Patient had no surgery related complications. No relapse of cancer has been diagnosed during the following 16 months. Simple trachelectomy may be alternative treatment option to radical trachelectomy for pregnant women with early stage cervical cancer without lymph node metastasis.

Expression of VEGF and its correlation with clinicopathological factors of cervical carcinoma ABSTRACT

Objective This study was designed to examine the expression of VEGF and its correlation with clinicopathological factors of cervical carcinoma. Methods mmunohistochemistry S-P method was used to detect the expression of VEGF in 10 cases of nomal cevical epithelium( NCE), 18 cases of cervical intraepithelial neoplasm (CIN) and 77 cases of early invasive carcinoma of cervix (ICC). Results The positive rate of VEGF protein in NCE,CIN,ICC was 10% (1/10) ,44.4% (8/18) ,74. 0% (57/77), respectively. The defference was significant (P ＜0. 05). Expresson of VEGF was not related with tumor stage, histologic types and stroma infiltration, but related with cell differentiation and intravascular involvement、lymph node metastasis. Conclusion VEGF protein had a positive correlation with cell differentiation and intravascular involvement 、 lymph node metastasis. the expression of VEGF gene result in the occurrence and development of cervical carcinoma by inducing the angiogenesis. Key words: Cervical carcinoma; Hypoxia-inducible factor-1α; Immunohistochemistry

Ultrastructural changes in premalignant and malignant lesions of the uterine cervix with papillomavirus infection

The main purpose of this study was intended to determine the possible ultrastructural relations among the human papilloma virus infection, angiogenesis and cellular infiltrate in premalignant and malignant lesions of uterine cervix. 58 samples of cervix were obtained from patients of the ambulatory “Maria Teresa Toro” Aragua, Venezuela, with cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) infection. For the ultrastructural study routine transmission electron microscopy techniques were used as well as detection and type definition of HPV by PCR. At the ultrastructural level in CIN I samples vessels reduplication of basement membrane was founded. In this case, type 6 was detected in all CIN samples. In CIN II samples, with a positive report of HPV 16 numerous mast cells were observed. A sample with diagnosis of CIN III with HPV16 exhibited mast cell invaginating toward capillary lumen. In a sample of invasive cervix carcinoma, HPV11 was detected, endothelial cytoplasm prolongations into the lumen were found, and widening of endothelial wall. Changes of microvasculature tissue in premalignant lesions and an increase of thickness of the endothelial wall of capillaries in malignant lesions of uterine cervix indicated the activation of the angiogenesis. Mast cells in the vascular periphery, not only in malignant lesions, but also in premalignant lesions indicate its relationship with angiogenic processes. Key words: Cellular infiltrate, endothelial vascular, cervical cancer, HVP, ultrastructure.

Expressions of bFGF and PTEN in cervical carcinoma and their clinical significance

To investigate the expressions of bFGF and PTEN in cervical carcinoma and their clinical significance. Tissue microarray technique and immunohistochemistry SP method were used to detect the expressions of bFGF and PTEN in 143 cases of invasive carcinoma of cervix (ICC) and 20 cases of normal cervical epithelium remote from tumor (NCE). The relationship between the expressions of bFGF and PTEN in ICC and some factors relating to clinical pathology of cervical carcinoma such as histopathological grading, lymph node metastasis, stroma involvement and FIGO staging were analyzed. The rate of the positive expression of bFGF in ICC was significantly higher than that in NCE 88.8% (127/143) vs. 25.0% (5/20, P = 0.000). The rate of positive expression of PTEN in ICC was significantly lower than that in NCE 67.1% (96/143) vs. 100.0% (20/20, P = 0.000). The expression of bFGF was positively correlated with lymph node metastasis and histopathological grading (r = 0.239, P = 0.004 and r = 0.369, P = 0.000, respectively). The expression of PTEN was negatively correlated with FIGO staging, histopathological grading and lymph node metastasis (r = -0.189, P = 0.024; r = -0.211, P = 0.011; r = -0.321, P = 0.000, respectively). The expression of bFGF was negatively correlated with the expression of PTEN in ICC (r = -0.261, P = 0.002). The overexpression of bFGF and underexpression of PTEN are closely related to the invasion and growth of cervical carcinoma. Detection of the expression of both bFGF and PTEN may be of value in further understanding the biological behavior and predicting the prognosis of cervical carcinoma.

P52 Prognostic factors for recurrence in elderly patients with cervical carcinoma

Cervix carcinoma is an important health problem world-wide, being the second most common cancer among women, ranking first in many developing countries. A number of important epidemiological risk factors have been identified as contributing to the development of CIN and invasive cervix carcinoma. Of key importance is infection with human papillomavirus (HPV), which is the primary risk factor. There are evolving primary and secondary preventive strategies that could further reduce the burden from cervical carcinoma. The possible primary preventive strategies include risk reduction, diet or dietary supplements, HPV vaccines, and other chemopreventive agents. The possible advances in secondary preventive strategies include new technologies for Pap smears, HPV typing triage, and other adjuvant screening procedures. The impact of these strategies will depend upon evidence to support their use along with the characteristics of the population and environment in which they are used.

Acute myelogenous leukemia following treatment of invasive cervix carcinoma: A case report and a review of the literature

Second malignancy is one of the late complications of long-term cancer survivors, treated with radiation or chemotherapy. Here is a case report on acute myelogenous leukemia, which developed after 63 months following the completion of treatment with surgery and platinum-based chemoradiation in a patient of carcinoma cervix IB. The above-mentioned second malignancy is one of the late sequelae of platinum-based chemoradiation. This case is reported here for documentation because of its rarity.

Expressions of receptor-binding cancer antigen expressed on SiSo cells, vascular endothelial growth factor, and matrix metalloproteinase-9 in cervical carcinoma and correlation thereof with the invasion and metastasis of the cancerous tissues

To investigate the expression of receptor-binding cancer antigen expressed on SiSo cells (RCAS1), vascular endothelial growth factor (VEGF), and matrix metalloproteinase-9 (MMP-9) in early invasive cervical carcinoma and their relationship with the invasion and metastasis of the cervical cancerous tissues. Samples of cervical tissues were obtained from 95 cases of early invasive carcinoma of cervix (ICC) and 82 cases of cervical intraepithelial neoplasm (CIN) during operation. 24 samples of normal cervical epithelium (NCE) were obtained during resection of hysteromyomas. Immunohistochemistry (S-P method) was used to detect the expression of RCAS1, VEGF, and MMP-9 in these samples. The relationship between those indexes and the factors related to clinical pathology of cervical carcinoma were analyzed statistically. The positive protein expression rates of RCAS1, VEGF, and MMP-9 in different samples all increased in the sequence of NCE, CIN, and ICC (0, 39.0%, and 72.6% respectively for RCAS1, 16.7%, 41.5%, and 67.4% respectively for VEGF, and 18.2%, 53.7%, and 78.9% respectively for MMP-9), with a significant difference between any 2 groups (all P < 0.001). The expression of RCAS1 protein was correlated with pelvic lymph node metastasis, intravascular and stromal infiltration, and histological grading (P = 0.001 or 0.000); but not correlated with patient's age, clinical stage, and histological types (all P > 0.05). The expression of VEGF and MMP-9 was correlated with pelvic lymph node metastasis, intravascular and stromal infiltration, and clinical stage (all P < 0.05); but not correlated with patient's age, histological grading, and histological types (all P > 0.05). There was an obviously positive correlation between the RCAS1 expression and VEGF expression (r = 0.882, P < 0.01), between the RCAS1 expression and MMP-9 expression (r = 0.868, P < 0.01), as well as between the VEGF and MMP-9 expression (r = 0.765, P < 0.01) in the cervical cancer. The positive expression of RCAS1, VEGF, and MMP-9 in invasive cervical carcinoma may play an important role in the development, lymph node metastasis, intravascular and stromal involvement of cancer cells. The expression of some metastasis related genes can be used to estimate the metastasis potentiality and is helpful for the treatment.

Synchronous invasive squamous cell carcinoma and clear cell adenocarcinoma of the uterine cervix: A different human papillomavirus status

Background A multiple primary invasive carcinoma of the cervix is a rare condition and is seldom composed of squamous cell carcinoma and clear cell adenocarcinoma. Case A 47-year-old woman presented with contact bleeding. The anterior lip of the cervix revealed a 2.0-cm protruded mass. Preoperative pathological and imaging studies demonstrated the squamous cell carcinoma of the exocervix alone. Radical hysterectomy was performed on the diagnosis of stage 1B cervical cancer. Histological examination of the specimen manifested a coexisting invasive clear cell adenocarcinoma in the endocervix. Human papillomavirus (HPV) 18 was detected in the squamous cell carcinoma; however, no HPV was detected in the clear cell adenocarcinoma. Conclusion This finding suggests that there was an obvious difference in association of HPV with the two neoplasms.

Prevention of cervix cancer

Cervix carcinoma is an important health problem world-wide, being the second most common cancer among women, ranking first in many developing countries. A number of important epidemiological risk factors have been identified as contributing to the development of CIN and invasive cervix carcinoma. Of key importance is infection with human papillomavirus (HPV), which is the primary risk factor. There are evolving primary and secondary preventive strategies that could further reduce the burden from cervical carcinoma. The possible primary preventive strategies include risk reduction, diet or dietary supplements, HPV vaccines, and other chemopreventive agents. The possible advances in secondary preventive strategies include new technologies for Pap smears, HPV typing triage, and other adjuvant screening procedures. The impact of these strategies will depend upon evidence to support their use along with the characteristics of the population and environment in which they are used.