Persistent Dysplasia Research Articles

Discrepancy of cervical cytology and colposcopic biopsy: Is cervical conization necessary?

The purpose of this study was to determine whether diagnostic cervical conization is necessary in the patient with a discrepancy between the Papanicolaou smear and the colposcopically directed biopsy(s). Patients eligible for the study had at least a two-degree discrepancy, eg, CIN III cytology and CIN I or less on colposcopic biopsies, or CIN II cytology with biopsies showing no dysplasia. Of the 786 records reviewed, 87 (11.1%) had such a discrepancy. Twelve of 87 patients (13.8%) were pregnant and ten of 87 (11.5%) failed to return after their initial colposcopic evaluation, leaving 65 patients in the study group. Of these, 20 of 65 (30.8%) were treated medically, nine (13.8%) had cryotherapy, and 36 (55.4%) underwent diagnostic cervical conization. Of patients undergoing cervical conization, three had microinvasive carcinoma of the cervix. Following medical therapy, only two of 20 patients (10%) had negative cytology, two (10%) had CIN I, five (25%) received additional therapy, and 11 (55%) were lost to follow-up. Seven patients did not return for follow-up Papanicolaou smear after medical treatment, and four did not return after their initial posttreatment Papanicolaou smear revealed persistent dysplasia. Of the nine patients treated with cryotherapy, six (66.7%) had a negative Papanicolaou smear at the time of their initial follow-up. The results of this study emphasize the importance of proceeding with diagnostic or therapeutic conization if a two-stage or greater discrepancy exists between the colposcopically directed biopsies and the cervical cytology. The risk of not diagnosing a microinvasive or invasive cervical carcinoma far outweighs the risk of conization.

Persistent uterine cervical dysplasia

Persistent uterine cervical dysplasia

Varus derotation osteotomy and treatment of persistent dysplasia and congenital dislocation of the hip: J.R. Kasser, J.R. Bowen, and G.D. MacEwen. J Bone Joint Surg 67A:195–202, (February), 1985

Varus derotation osteotomy and treatment of persistent dysplasia and congenital dislocation of the hip: J.R. Kasser, J.R. Bowen, and G.D. MacEwen. J Bone Joint Surg 67A:195–202, (February), 1985

VARUS DEROTATION OSTEOTOMY IN THE TREATMENT OF PERSISTENT DYSPLASIA IN CONGENITAL DISLOCATION OF THE HIP

We have attempted to define the indications for and limitations of varus derotation osteotomy in the treatment of persistent dysplasia in congenital dislocation of the hip. We studied the cases of thirty-four patients (forty-four hips) who were divided into three groups according to age at operation, and evaluated the influence of femoral remodeling, age, acetabular response, instability, and pre-existing avascular necrosis with respect to the final results. The length of follow-up ranged from five to twenty-two years. Rapid return to a valgus femoral neck-shaft angle by remodeling was not a cause of failure in any age group. There were consistently good results in the patients who were less than four years old at the time of operation. Acetabular correction by remodeling occurred through the age of eight years, but four of thirteen hips in patients who were between the ages of four and eight showed persistent dysplasia despite the operative procedure. The results were less predictable as the patients approached the age of eight years. There was no benefit from isolated femoral osteotomy in ten of eleven hips in patients who were older than eight. Pre-existing avascular necrosis appeared to compromise the results of the procedure in all age groups.

Varus derotation osteotomy in the treatment of persistent dysplasia in congenital dislocation of the hip.

We have attempted to define the indications for and limitations of varus derotation osteotomy in the treatment of persistent dysplasia in congenital dislocation of the hip. We studied the cases of thirty-four patients (forty-four hips) who were divided into three groups according to age at operation, and evaluated the influence of femoral remodeling, age, acetabular response, instability, and pre-existing avascular necrosis with respect to the final results. The length of follow-up ranged from five to twenty-two years. Rapid return to a valgus femoral neck-shaft angle by remodeling was not a cause of failure in any age group. There were consistently good results in the patients who were less than four years old at the time of operation. Acetabular correction by remodeling occurred through the age of eight years, but four of thirteen hips in patients who were between the ages of four and eight showed persistent dysplasia despite the operative procedure. The results were less predictable as the patients approached the age of eight years. There was no benefit from isolated femoral osteotomy in ten of eleven hips in patients who were older than eight. Pre-existing avascular necrosis appeared to compromise the results of the procedure in all age groups.

Urothelial abnormalities in the obstructed bladder.

Bladder mucosa from patients undergoing prostatectomy was examined histologically for evidence of pre-malignant change. The mucosal appearances were compared with tissue taken from control patients without bladder outlet obstruction. The appearances in patients with uncomplicated obstruction and in control patients were found to be similar and dysplastic change was uncommon. However, dysplasia was found relatively frequently in patients with bladder outlet obstruction complicated by the presence of infection, catheters or stones. In all, 10 out of 74 patients were found to have dysplasia and 7 of these agreed to have a further cystoscopy and biopsy taken at an interval of between 10 and 28 months after the first examination. Persistent dysplasia was found in all 7 cases and in 3 of these it had progressed from mild to moderate in severity. The significance of these findings is discussed.

The problem of so-called conservative treatment of the atypical cervical epithelium (author's transl)

There is an increasing tendency of a so-called conservative treatment of intraepithelial atypia. The new term of cervical intraepithelial neoplasia (CIN) supposedly called for a new concept of treatment. However, the term CIN replaces only the ambiguous terms of Carcinoma in situ and Dysplasia. The term CIN expresses the latter two being principally identical changes that are distinguishable only by differentiation. Persistent dysplasia is nothing but a highly differentiated Carcinoma in situ and must be treated as such. - For final diagnosis of CIN not only the histological pattern must be known but above all the relationship to the stroma and the extent of changes. NEither cytology nor colposcopy and directed biopsy or a combination of these can define the lesions with such accuracy as is necessary as a basis for a really adequate treatment. It could be proved that treatment results of Carcinoma in situ depended on the quality of primary diagnosis. Out of 390 cases that were treated after limited biopsy, eight died of cancer. After treatment of 1012 cases with conization alone there was not one fatal case. The danger of so-called conservative treatment lies not only in unrecognized invasive lesions but above all in preinvasive lesions remaining in deeply situated glands. Their discovery may fail in spite of regular follow-ups. They will reappear possibly only after a long latency period as invasive cancer.

Precancerous lesions in the cervix

Atypical intraepithelial lesions arise in clearly defined fields. These develop mostly via the process of atypical squamous metaplasia, which in turn arise in sharply demarcated areas. Spread of atypical epithelium into neighbouring epithelia cannot take place. A lesion originating in the cervical mucosa therefore will not transgress the site of the last cervical gland in the direction of native squamous epithelium. At the latter site epithelia transformation takes place via the process of basal hyperplasia. Since surface spread has been ruled out, and the localization of carcinoma in situ is not identical with that of dysplasia, dysplasia cannot be regarded as a precursor of carcinoma in situ. Rather, persistent dysplasia should be considered as highly differentiated forms of carcinoma in situ. Extension of epithelial changes is brought about by apposition of new fields of sharply demarcated epithelia. The sharp demarcation of atypical epithelia is an important criterion in endoscopic diagnosis.

The treatment of cervical dysplasias

Of 111 patients with untreated persistent dysplasia of the cervix, followed longer than 5 yr, 17 progressed to carcinoma in situ, one to in situ carcinoma with questionable invasion, and one to microinvasive carcinoma (17% progression). Sharp cold-knife conization of the cervix was used to treat 62 other patients with dysplasias of the cervix, proved by biopsy and with persistent dysplastic smears. Six had residual or recurrent lesions up to 9 yr later. Cryosurgery was used to treat 66 patients with dysplasia of the cervix. Fifty of these followed for 3–12 mo had ablation of the lesions, although six required two or three treatments. But 16 had persistent dysplasias as proved by cytology, although seven of the 16 had been retreated (four persisted after two freezes, and three after three freezes). Mild and moderate dysplasias may be observed as they infrequently progress. Severe dysplasias require tissue studies and conservative treatment. Sharp cold-knife conization appears to give a better cure rate than cryosurgery, although cryosurgery is simpler to carry out. All cases with dysplasia must have continuous follow-up examinations.