Diagnostic and prognostic significance of image cytometric DNA ploidy measurement in cytological samples of cervical squamous intraepithelial lesions

D. Demirel, N. Akyürek and I. Ramzy
Diagnostic and prognostic significance of image cytometric DNA ploidy measurement in cytological samples of cervical squamous intraepithelial lesions Objective: To study the DNA ploidy pattern of uterine cervical squamous intraepithelial lesions (SILs) and its diagnostic and prognostic significance. Methods: The study included 31 cases of SIL: 11 low‐grade (LSIL) and 20 high‐grade (HSIL). Feulgen–pararosaniline staining was performed on previously Papanicolaou‐stained smears and a DNA image cytometric study was performed. An internal reference was used to calibrate the samples. Results: All 31 cases of SIL, either LSIL or HSIL, were non‐diploid. Of the 11 cases of LSIL, four were tetraploid and seven were aneuploid, whereas, of the 20 cases of HSIL, four were tetraploid and 16 were aneuploid. Stemline aneuploidy was not a significant discriminator between LSIL and HSIL (P = 0.32). Based on single‐cell analysis, HSIL cases had significantly higher DNA content than LSIL cases (P < 0.01). When a mean of 30% or more was used for the 6c‐exceeding event (6cEE) value, the sensitivity and specificity to indicate HSIL were 83% and 64%, respectively, with a positive predictive value (PPV) of 81% and negative predictive value (NPV) of 65%. All HSIL cases were cervical intraepithelial neoplasia grade 2 or worse (CIN2+) on biopsy. In addition, cases which showed recurrence had more DNA content by single‐cell analysis than those with an indolent clinical behaviour: P = 0.04 and P = 0.03 for LSIL and HSIL, respectively. Conclusions: Image cytometric DNA analysis is a useful technique for diagnostic and prognostic purposes in uterine cervical SIL when appropriate ‘c’ values are used in single‐cell analysis. We propose that a >6c DNA content of 30% is useful as a cut‐off level for predicting cases with CIN2+ in DNA image cytometry of cervical smears.     

子宫颈感染人乳头瘤病毒基因亚型分析

目的 了解深圳地区妇女人群子宫颈感染HPV基因亚型流行特征。方法应用PCR结合反向寡核苷酸探针斑点杂交技术对1455例HPV阳性感染者进行基因亚型检测。结果1455例阳性感染者,单一型感染1277例,占87．8％,混合型感染178例,占12．2％;前5位胛y高危基因亚型分别是HPV16、52、58、18、33;在2006～2008年与2009～2010年两个时间段之间,HPV16、33和52基因亚型构成比明显不同,差异均具有统计学意义。结论子宫颈感染HPV以单一型为主,HPV16、52、58、18、33是感染的主要高危基因亚型;HPV高危基因亚型构成比在不同阶段存在差异。     

PDGF—D和VEGF在宫颈鳞癌中的表达及其意义

目的：检测宫颈鳞癌组织中血小板源性生长因子D（PDGF—D）和血管内皮生长因子（VEGF）的表达,探讨二者在宫颈癌变过程中的作用及意义,为探讨宫颈鳞癌的发病机制和宫颈鳞癌的早期治疗提供理论依据。方法：采用免疫组织化学（sP法）检测40例宫颈鳞癌和10例正常宫颈组织中PDGF—D和VEGF蛋白的表达,分析两者之间的相关性及其与临床病理特征之间的关系。结果：宫颈鳞癌组织中PDGF—D和VEGF蛋白的表达显著高于正常宫颈组织（P〈0．05）;PDGF—D和VEGF的表达与宫颈鳞癌的分化程度及淋巴结转移有关（P〈0．05）;与年龄及临床分期无关（P〉0．05）。Spearman相关分析发现PDGF—D与VEGF表达程度呈正相关（r=0．346,P〈0．05）。结论：1．PDGF—D和VEGF在宫颈鳞癌组织中特异性高表达,可能在宫颈鳞癌的发生、发展与转移中起着重要作用。2．PDGF-D和VEGF表达与宫颈鳞癌的分化程度及淋巴结转移有关,与年龄及临床分期无关,提示它们可能在宫颈鳞癌的浸润和转移及预后方面有重要的监测意义。3．PDGF-D和VEGF在宫颈鳞癌组织中的表达呈正相关,提示两者起着相互促进的作用,对PDGF—D和VEGF的联合检查,为临床实际应用提供了参考。     

Examination for the Certificate in Advanced Practice in Cervical Cytology – the first year''s experience

Following the decision to establish an Advanced Biomedical Scientist Practitioner grade for senior biomedical scientists in the NHS Cervical Screening Programme, a conjoint examination board has been appointed by the Royal College of Pathologists and Institute of Biomedical Science to oversee the Certificate in Advanced Practice in Cervical Cytology examination. The examination consists of a multiple-choice paper, short-answer written questions and practical microscopy sections covering screening of unmarked slides, and more complex discussion cases. In the first year there were 58 entries with 29 successful candidates, a pass rate of 50%. The standard of performance in the examination showed a wide range, and some candidates appear to have underestimated the degree of preparation, knowledge or level of microscopy skill required.     

Studies on maturation of genitalia in murrah buffalo-heifers

Studies on the growth of uterine horns and cervix were conducted on 161 prepuberal, puberal and postpuberal (non-gravid) farm-reared buffalo heifers. Age of the buffalo heifers varied between 17 and 37 months, while body weight range was 180–500 kg. The approximate diameters of the mid-cervix and uterine cornua (at the point of pseudobifurcation) were visualized mentally by palpating the organs per rectum with fingers of the left hand while focusing the adjudged diameters between the jaws of a vernier caliper held in the other hand. Both uterus and cervix increased progessively with the advancing age and body weight of heifers, however, the growth of the cervix was more consistent compared to that of the uterus. A marked enlargement in uterine cornua was noted at the time of puberty, however, the rate of cornual growth declined with subsequent estrous cycles.     

常州地区妇女HPV感染状况调查

目的：研究骶州地区普通妇女人群中HPV感染状况,为宫颈癌的预防及治疗提供理论依据。方法：采用PCR与基因芯片技术,对常州地区参加J妇科体检的744名妇女进行HPV分型检查,并对不同分型感染情况进行统计学分析。结果：744名妇女中共检出HPV阳性者157例,感染率为21．10％。在高危型HPV感染妇女中,共计83．64％的妇女感染了以下六种亚型,依次是16型46例,58型28例,33型24例,18型18例,31型11例以及52型11例。结论：鉴于高危型HPV与宫颈癌发生的密切关系,对普通妇女人群展开HPV检测具有预防与治疗意义。     

评估宫颈微浸润腺癌不同外科治疗的结果

目的:通过大样本的病例回顾,明确宫颈微浸润腺癌需要彻底外科治疗的病变范围。方法:46例因患宫颈微浸润腺癌(浸润深度小于或等于5mm)行外科手术治疗的病人,来自中国人民解放军总医院妇产科,同一位病理专家确定组织学类型、肿瘤分级、浸润深度、肿瘤宽度、有无淋巴管间的浸润、肿瘤边缘状况、宫旁状况以及是否有结节状的转移。病变分级参照FIGO(2009)的标准。结果:46例患者按照现行的FIGO分期标准,34例ⅠA1期,12例ⅠA2期。治疗方式主要有宫颈锥切、单纯全子宫切除、全子宫切除加淋巴结清扫、广泛子宫切除加淋巴结清扫。31例广泛全子宫切除的患者没有发现宫旁浸润。34例行淋巴结清扫的病人没有发现淋巴结转移。平均随访80个月未见复发。结论:关于微浸润腺癌的处理仍旧有争议,相对于微浸润宫颈鳞状细胞癌而言,传统的治疗宫颈微浸润腺癌彻底外科治疗更多一些。通过本次研究,我们认为宫颈为浸润癌基质浸润深度小于3mm或者FIGOIA1期的患者,简单的全子宫切除足够,不需要淋巴结清扫、广泛的子宫切除和卵巢切除。     

Exposure to the dioxin 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) induces squamous metaplasia in the endocervix of cynomolgus macaques

Female cynomolgus macaques (n = 11) were treated orally with graded doses of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Cervical tissue was recovered at necropsy 1.2-2.7 years later and examined using routine histopathology. Results were compared histologically with cervical tissue from untreated, age- and parity-matched controls. Significant squamous epithelial metaplasia was observed in the endocervix of 9 of 11 TCDD-treated animals, and the degree of severity was dose dependent. In contrast, minimal or no pathological changes were observed in eight of nine control animals and one animal had only mild squamous metaplasia. These results suggest that TCDD exposure induces epithelial transdifferentiation in the primate cervix. Consequently, the TCDD-treated macaque may serve as a predictable animal model for the study of cervical epithelial transdifferentiation and for examining the relationship between squamous metaplasia and cervical oncogenesis both at the cellular and at the molecular level.     

Changes in elastin-binding protein in fibroblasts derived from cardinal ligaments of patients with prolapsus uteri

Prolapsus uteri in pelvic supportive disorders are common in elderly women, and their etiology remains unclear. We examined elastin-binding proteins (EBPs) and binding sites in cultured cardinal ligament fibroblasts derived from elderly patients with prolapsus uteri (HPLiF) and compared them with those from age-matched control subjects (HCLiF). Cell attachment to alpha-elastin was significantly lower in HPLiF than in HCLiF. Elastin suppressed the higher proliferative activity at near confluency in HPLiF. The 67-kDa EBP was detectable in HCLiF, whereas HPLiF expressed a 59-kDa EBP. The expression of EBP was significantly lower in HPLiF. The synthetic peptide Val-Gly-Val-Ala-Pro-Gly (VGVAPG), which contains a recognition sequence for the elastin receptor, inhibited the adhesion of HCLiF to alpha-elastin at 10(-5)-10(-4) M, but showed no inhibitory activity on the adhesion of HPLiF at 10(-5) M. These results suggest that fibroblasts derived from elderly women with prolapsus uteri can recognize alpha-elastin through interactions with the low-molecular-size (59-kDa) EBP for the sequence VGVAPG with low affinity and may contribute to the loss of supportive function in uterine connective tissues.