[Histopathologic and cytophotometric study of dysplastic and precancerous condyloma acuminata(author's transl)]

Cytologic and histologic manifestations of human papillomavirus infection of the female genital tract and their clinical significance

The historical developments in the recognition of the role of human papillomavirus (HPV) infection in cells and tissues of the female genital tract are briefly summarized. The identification of a specific marker cell, the koilocyte, has led to initial studies of frequency and biologic significance of neoplastic lesions of the uterine cervix associated with HPV. By molecular virology techniques, over 40 types of HPV have been identified and their tissue affinity determined. Types 6, 11, 16, 18, and 31 are most commonly associated with anogenital lesions, among them a broad spectrum of cervical intraepithelial neoplasia (CIN). While current evidence suggests that lesions associated with HPV Types 6 and 11 are potentially less harmful to the patient than lesions associated with HPV Types 16 and 18 (which have been identified also in invasive cervical carcinomas and cell lines derived therefrom), a major long term prospective study may be required to confirm this view. A factor that complicates the issue still further is the recent observation that HPV DNA of all four types has been identified in 11% of women and 5.5% of men free of disease. Infection with multiple viral types (including Types 16 and 18) was common in this apparently healthy population. Although HPV must be considered as a prime candidate for a transforming virus, current evidence suggests that the infection with the virus is per se an insufficient condition for the development of precancerous lesions or cancer of the uterine cervix and that another factor or factors may be necessary for these events to take place. Some of these possible cofactors such as age, repeated infections, and the immune status of the patient are discussed. A great deal of additional work is required before the precise role of HPV virus in the genesis of carcinoma of the uterine cervix, vulva, and vagina is firmly documented.

Laser surgery for vulvar intraepithelial neoplasia: principles and results

Twenty-nine patients with grade 3 vulvar intraepithelial neoplasia were treated with the carbon dioxide laser while they were under anesthesia. Superficial lesions in nonhairy areas were vaporized to less than 1 mm, but lesions extending onto hairy areas were vaporized to 3 mm to destroy disease in skin appendages. Eighty-three percent of lesions involved nonhairy areas alone. Seventy-two percent of cases were cured by one laser application, 25% by two, and one case by three. Two patients had permanent hair loss after healing. The laser is an appropriate modality for lesions in nonhairy areas but scalpel excision is probably better for vulvar intraepithelial neoplasia in hairy areas.

DNA measurements of cervical epithelial cells in combination with scanning electron microscopy

A method is described in which the surface morphology of benign and malignant cervical cells is investigated with a combined light microscope-scanning electron microscope, after the measurement of the DNA content of each individual cell in the same instrument. The suspect cells can thus be identified by an increased aneuploid DNA content (greater than 5C) and not primarily by morphology. The DNA content was measured, after a quantitative acriflavine-Feulgen staining, by using a microphotometer attached to the combined microscope. It was found that the suspect cells show a different surface morphology compared to normal cells from a benign specimen.

Papillomavirus infection of the lower genital tract: detection of viral DNA in gynecological swabs

A total of 311 smears from the lower genital tract were examined by the filter in situ hybridization method to identify human papillomavirus (HPV) DNA. Of these 311 smears, 229 came from clinically and cytologically negative patients and served as a control group. In this group HPV-DNA was detected in 5 cases (2.2%). Of 82 cytologically positive cases (25 confirmed by histology) 56 (68%) contained HPV-DNA. A high prevalence of HPV 6/11 and absence of HPV 16/18 was found in cases with cytological signs of permissive HPV infection. In mild and moderate dysplasia all viruses occurred at almost the same frequency. In severe dysplasia/carcinoma in situ HPV 16/18 was found 5 times more frequently than HPV 6/11. HPV 16/18 was identified in all 4 invasive cancer cases. Cervical irrigation of colposcopically suspect areas was performed in 15 cytologically and HPV-DNA positive cases using the hydrodynamic filtration method. In 12 cases only the cells obtained from the colposcopically positive areas contained HPV-DNA. The sensitivity and reproducibility of the filter in situ hybridization was shown by: comparing the results obtained by HPV-DNA hybridization using Southern blot analysis of tumor biopsies; analysing the correlation of cytologic diagnosis and presence of HPV-DNA in follow-up examinations, and diagnosing presence or absence of HPV-DNA in parallel filters from the same patients.

Genital warts and cervical neoplasia: an epidemiological study

Cervical carcinoma and cervical intra-epithelial neoplasia (CIN) are likely to be associated with all sexually transmitted diseases (STDs). To help discover which (if any) of the recognised STDs might actually cause these conditions, a key question is whether one particular such association is much stronger than the others. The present study is therefore only of women newly attending an STD clinic, and compares the prevalences of cytological abnormalities of the cervix among 415 women attending with genital warts, 135 with genital herpes, and 458 with trichomoniasis or gonorrhoea. Significantly more genital wart patients (8.1%) than trichomoniasis or gonorrhoea patients (1.9%) showed dyskaryotic changes (adjusted relative risk (RR) = 5.8 with 95% limits 2.5-13.5) at, or a few months before, first attendance, while no excess whatever was seen in women with genital herpes. Moreover, half the women had a subsequent smear (at an average of 3-4 years after first attendance) and, although the diagnosis at first attendance was not related to the onset rate of dyskaryotic changes observed in these subsequent smears, it was related to the onset rate of grade III cervical intra-epithelial neoplasia (CIN III), which was found in 7 previous genital wart patients, in 2 previous trichomonas patients, but in 0 previous genital herpes patients. Thus, our findings suggest that herpes is not directly relevant to dyskaryotic change, but that one or more of the human papilloma viruses that cause genital warts may be.

DNA content of condyloma acuminatum

Female genital condylomata acuminata were examined for DNA content. Diploid and polyploid DNA distributions, including tetraploidy and octaploidy, were found. These findings are in clear counter-distinction to squamous intraepithelial lesions, which have been found to be aneuploid. DNA quantitation, therefore, can be used in difficult cases to distinguish between condylomatous and neoplastic epithelium.

Carcinoma in situ of the vulva: a continuing challenge

The epidemiologic data, clinical features, associated diseases, and histologic characteristics present in 50 cases of carcinoma in situ of the vulva are analyzed. A comparison of follow-up results obtained with various treatment methods is presented. With primary surgery the recurrence rate is dependent on the presence or absence of tumor at the surgical margins. Deoxyribonucleic acid patterns, determined by microspectrophotometry, were aneuploid in 92% of the cases studied. Five patients (10%) with aneuploid lesions, observed without therapy, experienced spontaneous regression of tumor and replacement of abnormal areas by euploid epithelium.

Condylomatous epithelial changes in the uterine cervix and their relationship to cervical carcinogenesis

Two hundred twenty-six (226) women with histologically verified dysplastic or neoplastic epithelial lesions in the uterine cervix were assessed for the presence (CO-series) or absence (N-CO-series) of the three newly established types of condylomatous lesions. Both the CO-series and the N-CO-series comprised 113 patients. Histologic changes fulfilling the previously outlined criteria of the (a) flat, (b) inverted and (c) papillomatous condylomas were found in association with all degrees of epithelial atypia, from mild dysplasia to frankly invasive carcinoma. The flat type was most common, comprising 69% of all condylomas. The inverted and papillomatous types were relatively rare, with frequencies of 18.6% and 12.4%, respectively. The mean age of the patients in the CO-series was 30.9 years, that of the N-CO-series patients was 39.3 years (p less than 0.0001). The causal relationship between the cervical condylomas and cervical carcinoma is discussed. The conclusion is drawn that this possibility needs to be seriously considered when searching for a venereally transmitted agent as an etiologic factor of cervical carcinoma.

Morphologic survey of the condylomatous lesions in dysplastic and neoplastic epithelium of the uterine cervix

One hundred eighty-four women with a histologically verified dysplastic or neoplastic lesion in the uterine cervical epithelium were histologically assessed with special reference to the presence of the various histological types of condyloma in these epithelial specimens. Histological changes fulfilling the previously outlined criteria of the flat, inverted, and papillomatous condylomas were encountered in 91 (49.4%) women. Condylomatous lesions were seen in association with all degrees of epithelial atypia from mild dysplasia to frankly invasive cervical carcinoma, which seemed to develop at significantly earlier age when concomitant condylomatous lesion was present than with its absence (p less than 0.001). The serious consideration of the relationship between the condylomatous lesions and the uterine cervical was emphasized.