• Title, Summary, Keyword: Cervical intraepithelial neoplasia

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5 Cases of Regressions of Cervical Intraepithelial Neoplasia with High-risk Human Papilloma Virus Treated with Traditional Korean Medicine (한방치료로 호전된 고위험군 인유두종바이러스(HPV) 및 자궁경부 이형성증 5례 증례 보고)

  • Kang, So-Jung;Bae, Kwang-Rok;Hwang, Deok-Sang;Lee, Jin-Moo;Lee, Chang-Hoon;Jang, Jun-Bock
    • The Journal of Korean Obstetrics and Gynecology
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    • v.32 no.1
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    • pp.94-107
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    • 2019
  • Purpose: To report the effect of Traditional Korean medical treatments on 5 patients with cervical intraepithelial neoplasia with high-risk human papilloma virus (HPV). Methods: The patients were diagnosed with cervical intraepithelial neoplasia with High-Risk human papilloma virus. The patients were treated by Traditional Korean Medicine such as herb medication and fumigation therapy. Results: After 3~6 months treatments, cervical intraepithelial neoplasia grades 1-2 lesions regressed and high-risk HPV infections were not detected. Conclusions: The case report shows that Korean medical treatment can be an effective option for treating lower grade of cervical intraepithelial neoplasia with high-risk human papilloma virus.

4 Cases of Traditional Korean Medicine Treatment for Patients with Surgical Margin Positive after LEEP in Cervical Intraepithelial Neoplasia (LEEP시술 절단면에 병변이 잔존하는 자궁경부상피내종양(CIN) 한의학적 치험 4례)

  • Lee, Eun;Lee, Kyung-yeob;Yu, Byung-kook
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.34 no.3
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    • pp.149-158
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    • 2020
  • The positive margins after LEEP(loop electrosurgical excision procedure) in cervical intraepithelial neoplasia are generally considered to be a risk factor for the recurrence or persistence of CIN currently. When positive margin exists, secondary LEEP or hysterectomy is performed. The aim of this study was to observe effects of Traditional Korean Medicine treatment for patients with surgical margin positive after LEEP. It was conducted retrospective chart review for 4 patients with the surgical margin positive after LEEP, who were scheduled to have secondary LEEP 3 months later. Patients were treated with herbal medicine, pharmacopuncture and herbal liquid vaginal treatment. They were followed up by cytology, colposcopy, human papillomavirus DNA test and punch-biopsy at 1, 3 and 6 months. After 3 month of treatment, three patients did not need secondary LEEP because of normal cytology, negative HPV status and normal colposcopy, while the other patient underwent secondary LEEP because of ASCUS cytology and positive high-risk HPV. After 6 month of treatment, the other patient also had normal cytology, negative HPV status and normal colposcopy and had been in fifth week of pregnancy. This study suggest that Traditional Korean Medicine treatment may be an effective to the patients with surgical margin positive after LEEP in cervical intraepithelial neoplasia.

Integration Sites and Genotype Distributions of Human Papillomavirus in Cervical Intraepithelial Neoplasia

  • Wang, Li;Dai, Shu-Zhen;Chu, Hui-Jun;Cui, Hong-Fei;Xu, Xiao-Yan
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.6
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    • pp.3837-3841
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    • 2013
  • Objectives: To analyse HPV integration prevalence and genotype distributions in cervical intraepithelial neoplasia (CIN) in east part of China, furthermore to assess preferential sites for common HPV integrations and provide baseline information for cervical abnormality screening and prevention. Methods: Integration of HPV in 113 paraffin-embedded cervical intraepithelial neoplasia samples was assessed using Gencap technology in Key Laboratory of Biotechnologies in BGI-Shenzhen. Results: 64 samples were HPV-integrated and as the cervical lesions increased, the integration rate became higher significantly (P=0.002). Fifteen different HPV genotypes were detected, 14 high-risk (16, 18, 31, 33, 51, 52, 56, 58, 66, 68) and 1 low-risk (11). The most common genotypes were HPV-16, 58, 33, 52, 66, and 56. Thirteen patients had co-integration involving mainly HPV-16 and 58. The frequency of HPV gene disruption was higher in L1 and E1 genes than in other regions of the viral genomes. Conclusion: Some 56.6% of CIN lesions in Qingdao had HPV integrations, and 67.2% of HPV-integrated patients were HPV-16 and 58, more prone to be integrated in younger patients below 45 years old. There exist preferential sites for HPV-16 and HPV-58 integration, and they are more likely to be disrupted in the L1 and E1 loci.

Mast Cells and Vascular Endothelial Growth Factor Expression in Neoangiogenesis of Cervical Intraepithelial Neoplasia and Invasive Squamous Cell Carcinomas of the Uterine Cervix (자궁경부상피내종양과 침윤성 편평상피암종의 혈관신생에서 비만세포와 혈관내피성장인자의 발현)

  • Jekal, Seung-Joo;Lee, Jung-Ah;Rho, Jong-Sup
    • Korean Journal of Clinical Laboratory Science
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    • v.37 no.3
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    • pp.197-206
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    • 2005
  • To determine the correlation between mast cells(MCs) and neoangiogenesis in the growth and progression of cervical cancer, we investigated mast cell density(MCD), microvessel density(MVD) and the expression of vascular epithelial growth factor(VEGF) in cervical intraepithelial neoplasia and invasive suqamous cell carcinoma of the uterine cervix. Forty-five cervical intraepithelial neoplasia(CIN I, II and III), 15 microinvasive carcinomas, 15 invasive squamous cell carcinomas and 20 normal cervical epithelia were included in this study. MCs were stained with anti-c-Kit antibody and alcian blue, microvessels with anti-factor VIII antibody and VEGF with anti-VEGF antibody. The adjacent fields of both normal and neoplastic epithelium were used for counting MCs and microvessels. Computerized image analysis was used to evaluate MCD and MVD. MCD and MVD were the mean numbers per $1mm^2$ counted in 5-10 high and low power fields respectively. In both c-Kit and alcian blue stained sections, MCD progressively increased along the continuum from CIN I to invasive squamous cell carcinoma(p<0.001). MVD increased significantly with cervical neoplasia progression, from CIN to invasive squamous cell carcinoma (p<0.001). In double c-Kit and Factor VIII-stained sections, MCs were mainly present in the areas adjacent to newly formed blood vessels. However, there were no significant differences in MCD and MVD between normal epithelum and CIN I. A strong correlation was also observed between MCD and MVD. In double VEGF and alcian blue-stained sections, VEGF was expressed in only MCs. Strong VEGF-positive MCs were particularly abundant around the tumorous region. Our results suggest that MCs may upregulate neoangiogenesis by VGEF secretion in the development and progression of cervical neoplasia.

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Long-term Outcomes of a Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia in a High Incidence Country

  • Sangkarat, Suthi;Ruengkhachorn, Irene;Benjapibal, Mongkol;Laiwejpithaya, Somsak;Wongthiraporn, Weerasak;Rattanachaiyanont, Manee
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.2
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    • pp.1035-1039
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    • 2014
  • Aim: To evaluate the operative, oncologic and obstetric outcomes of the loop electrosurgical excision procedure (LEEP) in cases with cervical neoplasia. Materials and Methods: A retrospective cohort study was conducted on patients who were suspected of cervical neoplasia and therefore undergoing LEEP at Siriraj Hospital, Mahidol University, Thailand, during 1995-2000. Outcome measures included operative complications in 407 LEEP patients and long-term outcomes in the 248 patients with cervical intraepithelial neoplasia (CIN) who were treated with only LEEP. Results: There were 407 patients undergoing LEEP; their mean age was $39.7{\pm}10.5$ years. The histopathology of LEEP specimens revealed that 89 patients (21.9%) had lesions ${\leq}CIN$ I, 295 patients (72.5%) had CIN II or III, and 23 patients (5.6%) had invasive lesions. Operative complications were found in 15 patients and included bleeding (n=9), and infection (n=7). After diagnostic LEEP, 133 patients underwent hysterectomy as the definite treatment for cervical neoplasia. Of 248 CIN patients who had LEEP only, seven (2.8%) had suffered recurrence after a median of 16 (range 6-93) months; one had CIN I, one had CIN II, and five had CIN III. All of these recurrent patients achieved remission on surgical treatment with re-LEEP (n=6) or simple hysterectomy (n=1). A significant factor affecting recurrent disease was the LEEP margin involved with the lesion (p=0.05). Kaplan-Meier analysis showed 5-year and 10-year disease-free survival (DFS) estimates of 99.9%. Twelve patients became pregnant a total of 14 times, resulting in 12 term deliveries and two miscarriages - one of which was due to an incompetent cervix. Conclusions: LEEP for patients with cervical neoplasia delivers favorable surgical, oncologic and obstetric outcomes.

Down-regulation of miR-34a Expression in Cervical Intraepithelial Neoplasia with Human Papillomavirus Infection and Its Relationship with p53 Expression

  • Lee, Kyung Eun
    • Biomedical Science Letters
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    • v.19 no.4
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    • pp.348-352
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    • 2013
  • microRNAs (miRNAs) play pivotal roles in controlling cell proliferation and differentiation. miRNA expression in human is becoming recognized as a new molecular mechanism of carcinogenesis. microRNA-34a (miR-34a), a member of the p53 network, was found to be regulated in multiple types of tumor. The purpose of this study was to define roles of miR-34a expression in cervical intraepithelial neoplasia with human papillomavirus infection, and its relationship with p53 protein expression. This study was performed to analyze expression of miR-34a by using qRT-PCR, and to evaluate p53 protein expression by using immunohistochemistry in 40 cases. Down-regulation of miR-34a expression was detected in 27 (67.5%) out of 40 cases and Immunoreactivity for p53 was found in 17 (42.5%) out of 40 cases. Nineteen (82.6%) of the 23 cases with a negative p53 expression showed a down-regulation miR-34a expression, there was a significant associations between miR-34a and p53 protein expression (P=0.04). These results suggest that miRNA-34a expression tend to be reduced depending on the advanced histologic grade, and down-regulation of miR-34a expression might be associated with inactivation of p53 protein expression by human papillomavirus infection.

Frequency and Type-distribution of Human Papillomavirus from Paraffin-embedded Blocks of High Grade Cervical Intraepithelial Neoplasia Lesions in Thailand

  • Swangvaree, Sukumarn Sanersak;Kongkaew, Phon;Ngamkham, Jarunya
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.2
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    • pp.1023-1026
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    • 2013
  • Cervical cancer is the most important female gynecological cancer, the second leading cause of cancer mortality in women worldwide and the second most common cancer in Thai women. The major cause of cervical cancer is persistent infection of human papillomavirus (HPV), leading to abnormal epithelial lesions, with progression to precancerous and invasive cancer. This study was conducted to investigate the frequency and type distribution of HPV in Thai women who had abnormal cytology. HPV detection from FFPE confirmed abnormal of high grade cervical intraepithelial lesions were for SPF-10-Innogenic Line Probe Assay. HPV-positivity was detected in 320/355 cases (90.14%) and HPV-negativity in 35/355 (9.86%). HPV-positive was found 147/320 cases (41.4%) of single infection, whereas 173/320 cases (48.7%) showed the multiple HPV infection. The most common seven types were HPV-16, -52, -18, -11, -51, -31 and -33, in that order. HPV 16 and 18, the important oncogenic HPV type, were observed in 64.8% of HSIL cases. Interestingly, a high proportion of multiple infections was found in this study and more than ten types could be detected in one case. Therefore, HPV infection screening program in women is essential, particularly in Thailand. Effective primary and secondary prevention campaigns that reinforce HPV screening for HPV detection and typing may be decrease the incidence and mortality of cervical cancer in the future and may lead to significantly improve the quality of life in Thai women.

Long Term Outcomes of Laser Conization for High Grade Cervical Intraepithelial Neoplasia in Thai Women

  • Wongtiraporn, Weerasak;Laiwejpithaya, Somsak;Sangkarat, Suthi;Benjapibal, Mongkol;Rattanachaiyanont, Manee;Ruengkhachorn, Irene;Chaopotong, Pattama;Laiwejpithaya, Sujera
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.18
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    • pp.7757-7761
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    • 2014
  • Aim: To report long term outcomes of laser conization for high grade cervical intraepithelial neoplasia (CIN) in Thai women. Materials and Methods: A retrospective cohort study was conducted in patients undergoing laser conization due to abnormal cervical cytology suggesting neoplasia during 1989 to 1994 and having follow-up data until December 2010. Conization was performed under colposcopy using a 0.5-mm $CO_2$ laser beam with power density of $18,000-20,000watts/cm^2$, and the surgical base was vaporized using a low power defocused beam. The follow-up protocol included cervical cytology and colposcopy. Long term outcome measures were failure rate (persistence and recurrence), post-conization status of transformation zone, and obstetric outcomes. Results: Of 104 patients undergoing conization, 71 had therapeutic conization for high grade CIN and were followed up for a median time of 115 (range 12-260) months. There was one case of persistent and one of recurrent disease comprising a failure rate of 2.8%. The post treatment transformation zone was well visualized in 68.3% of 63 patients with an intact uterus. Sixteen patients achieved 25 pregnancies; none had second trimester miscarriage. The obstetric outcomes were unremarkable. Conclusions: Laser conization under colposcopic visualization for the treatment of high grade CIN in Thai women has a low failure rate of 2.8%. The post-conization transformation zone could not be evaluated completely in approximately 30% of cases; therefore the follow-up protocol should include both cytology and colposcopy. Obstetric outcomes are not adversely affected by this therapeutic procedure.

Expression of Toll-like Receptor 9 Increases with Progression of Cervical Neoplasia in Tunisian Women - A Comparative Analysis of Condyloma, Cervical Intraepithelial Neoplasia and Invasive Carcinoma

  • Fehri, Emna;Ennaifer, Emna;Ardhaoui, Monia;Ouerhani, Kaouther;Laassili, Thalja;Rhouma, Rahima Bel Haj;Guizani, Ikram;Boubaker, Samir
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.15
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    • pp.6145-6150
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    • 2014
  • Toll-like receptors (TLRs) are expressed in immune and tumor cells and recognize pathogen-associated molecular patterns. Cervical cancer (CC) is directly linked to a persistent infection with high risk human papillomaviruses (HR-HPVs) and could be associated with alteration of TLRs expression. TLR9 plays a key role in the recognition of DNA viruses and better understanding of this signaling pathway in CC could lead to the development of novel immunotherapeutic approaches. The present study was undertaken to determine the level of TLR9 expression in cervical neoplasias from Tunisian women with 53 formalin-fixed and paraffin-embedded specimens, including 22 samples of invasive cervical carcinoma (ICC), 18 of cervical intraepithelial neoplasia (CIN), 7 of condyloma and 6 normal cervical tissues as control cases. Quantification of TLR9 expression was based on scoring four degrees of extent and intensity of immunostaining in squamous epithelial cells. TLR9 expression gradually increased from CIN1 (80% weak intensity) to CIN2 (83.3% moderate), CIN3 (57.1% strong) and ICC (100% very strong). It was absent in normal cervical tissue and weak in 71.4% of condyloma. The mean scores of TLR9 expression were compared using the Kruskall-Wallis test and there was a statistical significance between normal tissue and condyloma as well as between condyloma, CINs and ICC. These results suggest that TLR9 may play a role in progression of cervical neoplasia in Tunisian patients and could represent a useful biomarker for malignant transformation of cervical squamous cells.

Human Telomerase Gene and High-Risk Human Papillomavirus Infection are Related to Cervical Intraepithelial Neoplasia

  • Zhao, Xu-Ye;Cui, Yongm;Jiang, Shu-Fang;Liu, Ke-Jun;Han, Hai-Qiong;Liu, Xiao-Su;Li, Yali
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.2
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    • pp.693-697
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    • 2015
  • Our aims were to evaluate the clinical performance of human telomerase RNA gene component (hTERC gene) amplification assay with high-risk human papillomavirus (HR-HPV) DNA test of Hybrid Capture 2 DNA test (HC2), for the detection of high grade cervical precancerous lesions and cancer (CIN 2+). In addition, the association shown between hTERC gene amplification and HPV DNA test positive in women with and without cervical neoplasia was assessed. There were 92 women who underwent cytology, HR-HPV DNA test, hTERC gene amplification test, colposcopy and biopsy. We compared the clinical performance of hTERC gene test along with HR-HPV DNA test of women with colposcopy and routine screening. The samples were histology-confirmed high-grade cervical intraepithelial neoplasia (CIN 2) or worse (CIN2+) as the positive criterion. The test of hTERC gene showed the hTERC gene amplification positivity increased with the severity of histological abnormality and cytological abnormality. The test of hTERC gene showed higher specificity than HR-HPV DNA test for high-grade lesions (84.4% versus 50%) and also higher positive predictive value (90.4% versus 76.5%). Our results predicted that hTERC gene amplification demonstrated more specific performance for predicting the risk of progression and offer a strong potential as a tool for triage in cervical cancer screening, with the limited sensitive as HR-HPV DNA test.