-
Medicina (Kaunas, Lithuania) Nov 2022: Cervical squamous cell carcinoma (SCC) usually showed an infiltrative growth pattern into endocervical stroma. In rare cases, SCC spreads superficially as an...
: Cervical squamous cell carcinoma (SCC) usually showed an infiltrative growth pattern into endocervical stroma. In rare cases, SCC spreads superficially as an intraepithelial lesion to proximal uterine segments, and more rarely, involves invasive and more aggressive behavior on secondary sites. : In this study, we present the case of an interesting form of cervical SCC growth and we discuss the possible reasons for that presentation. : After clinical examination and repeated histomorphological analysis, we found remarkable cervical epithelial dysplasia (a high-grade squamous intraepithelial lesion-H-SIL). A histopathology report after conization and hysterectomy showed squamocellular carcinoma with microinvasive focuses. Interestingly, squamocellular carcinoma was found in the proximal uterine and adnexal structure, as well as intraepithelial and microinvasive lesions. : Our study described a rare presentation of primary cervical SCC with unusual adnexal involvement. This pattern of tumor growth should be especially considered for patients who are proposed for sparing surgical procedures. A detailed and multidisciplinary approach for every patient is very important because unpredictable cases are present. However, they are rare.
Topics: Female; Humans; Carcinoma, Squamous Cell; Hysterectomy; Neoplasms, Connective Tissue; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms
PubMed: 36422194
DOI: 10.3390/medicina58111655 -
Inflammatory Bowel Diseases Nov 2023Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal cancer. In cases of invisible or nonendoscopically resectable dysplasia found at...
BACKGROUND
Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal cancer. In cases of invisible or nonendoscopically resectable dysplasia found at colonoscopy, total proctocolectomy with ileal pouch anal anastomosis can be offered with good long-term outcomes; however, little is known regarding cancer-related outcomes when dysplasia is found incidentally after surgery on final pathology.
METHODS
Using our prospectively collected pouch registry, we identified patients who had preoperative colonic dysplasia or dysplasia found only after colectomy. Patients with cancer preoperatively or after colectomy were excluded. Included patients were divided into 3 groups: PRE (+preoperative biopsy, negative final pathology), BOTH (+preoperative biopsy and final pathology), and POST (negative preoperative biopsy, +final pathology). Long-term outcomes in the 3 groups were assessed.
RESULTS
In total, 517 patients were included: PRE = 125, BOTH = 254, POST = 137. After a median follow-up of 12 years (IQR 3-21), there were no differences in overall, disease-free, or pouch survival between groups. Cancer/dysplasia developed in 11 patients: 3 (2%) in the PRE, 5 (2%) in the BOTH, and 3 (2%) in the POST group. Only 1 cancer-related death occurred in the entire cohort (PRE group). Disease-free survival at 10 years was 98% for all groups (P = .97). Pouch survival at 10 years was 96% for PRE, 99% for BOTH, and 97% for POST (P = .24).
CONCLUSIONS
The incidental finding of dysplasia on final pathology after proctocolectomy was not associated with worsened outcomes compared with preoperatively diagnosed dysplasia.
PubMed: 37963567
DOI: 10.1093/ibd/izad263 -
ANZ Journal of Surgery Sep 2022We aimed to determine pouch function and retention rate for restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) in elderly...
AIM
We aimed to determine pouch function and retention rate for restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) in elderly patients.
METHODS
We identified patients over 50 years old subjected to IPAA for confirmed pathological UC from 1980 until 2016. Patients were grouped according to age: 50-59, 60-69 and 70+ years. Short and long-term outcomes and quality of life (QOL) were compared among the groups.
RESULTS
Six hundred and one patients were identified (399 (66.4%) between 50-59 181 (30.1%) between 60-69, and 21 (3.5%) over 70 years of age). More males were in the 70+ arm, and more two-stage procedures were performed in this group. Wound infection increased with age (P = 0.023). There was a trend of more fistula and pouchitis in the 70+ patients (P = 0.052 and P = 0.055, respectively). Pouch failure rate increased with age, and it was statistically significant in the 70+ cohort (P = 0.015). Multivariate stepwise logistic regression showed that pelvic sepsis (HR 4.8 (95% CI 1.5-15.4), P = 0.009), fistula (HR 6.0 (95% CI 1.7-21.5), and mucosectomy with handsewn anastomosis (HR 4.5 (95% CI 1.4-14.7)), were independently associated with pouch failure. No difference was observed in the QOL among the groups, but pouch function was better for patients younger than 60 years.
CONCLUSION
In elderly patients with UC, IPAA may be offered with reasonable functional outcomes, and ileal pouch retention rates, as an alternative to the permanent stoma. Stapled anastomosis increases the chance of pouch retention and should be recommended as long as the distal rectum does not carry dysplasia.
Topics: Aged; Aged, 80 and over; Anastomosis, Surgical; Colitis, Ulcerative; Colonic Pouches; Contraindications; Humans; Male; Middle Aged; Proctocolectomy, Restorative; Quality of Life; Treatment Outcome
PubMed: 35434821
DOI: 10.1111/ans.17728 -
Gastroenterology Report Oct 2019This cross-sectional study investigated the prevalence and risk factors of high-risk human papilloma virus (HPV) infection, especially types 16 and 18, and cervical...
BACKGROUND AND AIM
This cross-sectional study investigated the prevalence and risk factors of high-risk human papilloma virus (HPV) infection, especially types 16 and 18, and cervical neoplasia in female Inflammatory bowel disease (IBD) patients.
METHODS
From July 2014 to January 2017, sexually active, female, Chinese IBD patients (21-60 years) and age-matched controls underwent cervical ThinPrep cytology testing (TCT) and high-risk HPV-DNA detection, and completed questionnaires about awareness of cervical cancer and HPV. Cervical dysplasia was categorized as cervical intraepithelial neoplasia (CIN) 1, 2 and 3.
RESULTS
Of 124 IBD patients (30 ulcerative colitis and 94 Crohn's disease), 17 (13.7%) had high-risk HPV among whom 9 (7.3%) had HPV 16/18 infection and 4 (3.2%) had cervical CIN (3 CIN 3, 1 CIN 1) by pathology. Among 372 controls, 33 (8.9%) had high-risk HPV and only 1 (0.3%) had HPV 16 infection. Cervical TCT detected atypical squamous cells of unknown significance in one control; no control had CIN. The HPV 16/18 infection rate and CIN prevalence were significantly higher in IBD patients than controls (both < 0.001). The HPV-infection rate was higher in patients administered methotrexate [ = 0.005, odds ratio (95% confidence interval) 4.76 (1.471-15.402)] or more than two immunosuppressants [ = 0.013, odds ratio (95% confidence interval) 3.64 (1.255-10.562)]. Thiopurine, steroid, infliximab and disease behavior/location were not associated with HPV infection. Only 29.3% of patients had undergone cervical-cancer screening. Awareness of HPV infection and HPV-related cervical cancer was poor (28.2%).
CONCLUSIONS
Female IBD patients are at increased risk of high-risk HPV infection and cervical neoplasia, which may be associated with immunosuppressants. Education and routine follow-up with HPV-DNA testing and TCT are recommended, especially in female Chinese IBD patients.
PubMed: 31687153
DOI: 10.1093/gastro/goy053 -
La Tunisie Medicale Oct 2016Cervical cancer is the second gynecological cancer Tunisian women after breast. This is a sexually transmitted disease including the role of HPV has been proven....
PROBLEM
Cervical cancer is the second gynecological cancer Tunisian women after breast. This is a sexually transmitted disease including the role of HPV has been proven. Cervical cancer screening is possible due to the accessibility of the cervix with a speculum examination and implementation of cervical smear.
AIM OF THE WORK
To study the epidemiological and clinical data of patients, analyze the results of the Pap test, colposcopy and cervical biopsy staging are the lesions observed in colposcopy, compare the results of smears, colposcopy and cervical biopsy.
METHODS
A retrospective analytical study about 120 observations of patients who underwent colposcopy and biopsy of the cervix over a seven year period from January 2006 to December 2012.
RESULTS
The mean age of patients was 46.6 years. The mean gravidity was 4.99. The mean parity was 4.07. The average age of first sexual intercourse was 24 years. 95.83% of the patients were married. Four patients had multiple partners, 3, 33%. Eighty-one patients 67.5% were genital activity. Two patients had a history of pelvic infection is 1.66%. A history of repeated low genital infection were found in 20 patients, or 16.66%. HPV testing was requested for two patients. The genotypes found were 16, 35 and 53. The most common reasons were essentially pathological smears, pelvic pain and exploration of bleeding. The FCU was performed in 98 patients either in 81.66% of cases. The smear was pathological in 83 patients or 84.69% of smears. He showed: a persistent inflammatory smears in 64 women, or 65.30% of the cases, 6 ASCUS or 6.12% of cases, 13 cervical dysplasia or 13.26% of cases: 8 CIN1 or 8.16% of event; 1 CIN2 or 1.02% and 4 CIN 3, or 4.08% of cases. Colposcopy was indicated before an abnormal smear: In 83 patients either in 69.16% of cases. Colposcopy was performed in front of an abnormal appearance of the cervix in 37 patients. Colposcopy has concluded that: normal cervix in 28 patients or 23.33% of the cases, cervicitis appearance in 15 patients or 12.5% of cases, ectropion in 23 patients or 19.2% of cases, with TAGI 47 patients or 39.2% of cases, a TAG2 in 6 patients either 5% of cases, ulceration in a patient or 0.83% of cases. Cervical biopsy objectified normal mucosa in 19 patients, or 15.8% of cases. She objectified cervical metaplasia in 11 patients, or 9.2% of cases, ectropion in a patient, or 0.8% of cases, cervicitis in 56 patients, or 46.7% of cases, condyloma in 2 patients, 1.7% of cases, CIN 1 in 6 patients, 5% of cases, CIN2 in 4 patients, soit3,3% of CIN3 and in 3 patients, 2.5% of cases. FCU had a sensitivity of 60%, a specificity of 95.18%, positive predictive value of 69% and a negative predictive value of 93%. The sensitivity of colposcopy was 66% and specificity of59%. Positive predictive value of 18% and a negative predictive value of 92%. For high-grade dysplasia, colposcopy had a sensitivity of 85%, specificity 58%, positive predictive value of 11.3% and a negative predictive value of 98%. Cervical biopsy finds carcinoma in situ in two cases and squamous micro-invasive carcinoma in one case. The treatments were performed essentially a cervical electrocoagulation in 8 patients, a cone biopsy in 7 patients and post conization hysterectomy in 2 patients.
CONCLUSION
Colposcopy is a harmless and reliable examination to guide the cervical biopsy. Tracks smear, colposcopy and directed biopsy confirmed.
Topics: Adult; Aged; Colposcopy; Female; Humans; Middle Aged; Papanicolaou Test; Papillomaviridae; Papillomavirus Infections; Pregnancy; Retrospective Studies; Sensitivity and Specificity; Uterine Cervical Neoplasms; Vaginal Smears; Young Adult; Uterine Cervical Dysplasia
PubMed: 28972254
DOI: No ID Found -
La Tunisie Medicale Oct 2016Cervical cancer is the second gynecological cancer Tunisian women after breast. This is a sexually transmitted disease including the role of HPV has been proven....
PROBLEM
Cervical cancer is the second gynecological cancer Tunisian women after breast. This is a sexually transmitted disease including the role of HPV has been proven. Cervical cancer screening is possible due to the accessibility of the cervix with a speculum examination and implementation of cervical smear.
AIM OF THE WORK
To study the epidemiological and clinical data of patients, analyze the results of the Pap test, colposcopy and cervical biopsy staging are the lesions observed in colposcopy, compare the results of smears, colposcopy and cervical biopsy.
METHODS
A retrospective analytical study about 120 observations of patients who underwent colposcopy and biopsy of the cervix over a seven year period from January 2006 to December 2012.
RESULTS
The mean age of patients was 46.6 years. The mean gravidity was 4.99. The mean parity was 4.07. The average age of first sexual intercourse was 24 years. 95.83% of the patients were married. Four patients had multiple partners, 3, 33%. Eighty-one patients 67.5% were genital activity. Two patients had a history of pelvic infection is 1.66%. A history of repeated low genital infection were found in 20 patients, or 16.66%. HPV testing was requested for two patients. The genotypes found were 16, 35 and 53. The most common reasons were essentially pathological smears, pelvic pain and exploration of bleeding. The FCU was performed in 98 patients either in 81.66% of cases. The smear was pathological in 83 patients or 84.69% of smears. He showed: a persistent inflammatory smears in 64 women, or 65.30% of the cases, 6 ASCUS or 6.12% of cases, 13 cervical dysplasia or 13.26% of cases: 8 CIN1 or 8.16% of event; 1 CIN2 or 1.02% and 4 CIN 3, or 4.08% of cases. Colposcopy was indicated before an abnormal smear: In 83 patients either in 69.16% of cases. Colposcopy was performed in front of an abnormal appearance of the cervix in 37 patients. Colposcopy has concluded that: normal cervix in 28 patients or 23.33% of the cases, cervicitis appearance in 15 patients or 12.5% of cases, ectropion in 23 patients or 19.2% of cases, with TAGI 47 patients or 39.2% of cases, a TAG2 in 6 patients either 5% of cases, ulceration in a patient or 0.83% of cases. Cervical biopsy objectified normal mucosa in 19 patients, or 15.8% of cases. She objectified cervical metaplasia in 11 patients, or 9.2% of cases, ectropion in a patient, or 0.8% of cases, cervicitis in 56 patients, or 46.7% of cases, condyloma in 2 patients, 1.7% of cases, CIN 1 in 6 patients, 5% of cases, CIN2 in 4 patients, soit3,3% of CIN3 and in 3 patients, 2.5% of cases. FCU had a sensitivity of 60%, a specificity of 95.18%, positive predictive value of 69% and a negative predictive value of 93%. The sensitivity of colposcopy was 66% and specificity of59%. Positive predictive value of 18% and a negative predictive value of 92%. For high-grade dysplasia, colposcopy had a sensitivity of 85%, specificity 58%, positive predictive value of 11.3% and a negative predictive value of 98%. Cervical biopsy finds carcinoma in situ in two cases and squamous micro-invasive carcinoma in one case. The treatments were performed essentially a cervical electrocoagulation in 8 patients, a cone biopsy in 7 patients and post conization hysterectomy in 2 patients.
CONCLUSION
Colposcopy is a harmless and reliable examination to guide the cervical biopsy. Tracks smear, colposcopy and directed biopsy confirmed.
Topics: Biopsy; Cervix Uteri; Colposcopy; Female; Humans; Middle Aged; Papanicolaou Test; Papillomaviridae; Papillomavirus Infections; Pregnancy; Retrospective Studies; Sensitivity and Specificity; Tunisia; Uterine Cervical Neoplasms; Vaginal Smears; Uterine Cervical Dysplasia
PubMed: 28685798
DOI: No ID Found -
BMC Gastroenterology Apr 2022Emphysematous cystitis (EC) is characterized by the presence of air within the bladder wall, often a complication of urinary tract infection (UTI) by gas-producing...
BACKGROUND
Emphysematous cystitis (EC) is characterized by the presence of air within the bladder wall, often a complication of urinary tract infection (UTI) by gas-producing organisms. However, EC has also been reported in the setting of infectious colitis suggesting an alternate etiology. We report a rare case of EC in the setting of severe Crohn's colitis with no clinical evidence of UTI.
CASE PRESENTATION
A 43-year old female presented with a 2-month history of bloody diarrhea consisting of 8-12 bowel movements a day, weight loss of 10 kg and peripheral edema. She also had multiple ulcerated lesions on her abdominal wall and in the perianal region. Initial CT scan was significant for pancolitis, anasarca and EC. The follow-up CT cystogram, flexible cystoscopy and pelvic MRI confirmed the diagnosis of EC and ruled out any fistulous tracts in the pelvis including enterovesical/colovesical fistula. The patient did not report any urinary symptoms and the urinalysis was within normal limits. An extensive infectious workup was negative. Despite the paucity of infectious findings, the EC was empirically treated with an intravenous third-generation cephalosporin. Colonoscopy was significant for multiple ulcerated and hyperemic areas with pseudopolyps all throughout the right, transverse and left colon. Biopsies confirmed Crohn's colitis with no evidence of granulomata or dysplasia. Immunohistochemistry was negative for CMV. The perianal and abdominal wall lesions were suspected to be pyoderma gangrenosum although biopsies were equivocal. The colitis was initially treated with intravenous steroids followed by biologic therapy with Infliximab. Despite appropriate escalation of therapies, the patient developed colonic perforation requiring subtotal colectomy.
CONCLUSION
This is a rare case of EC in a patient with severe Crohn's colitis. There was no evidence of urinary tract infection or fistulising disease. According to our review, this is the first reported incident of EC in a patient with inflammatory bowel disease without any prior intra-abdominal surgeries. While active Crohn's disease alone is a critical illness, we conclude that concomitant EC may be a poor prognostic factor.
Topics: Adult; Colitis; Crohn Disease; Cystitis; Female; Humans; Infliximab; Intestinal Fistula
PubMed: 35410166
DOI: 10.1186/s12876-022-02253-6 -
Gastroenterology Report Feb 2019This study sought to evaluate the risk factors for the development of colitis-associated neoplasia (CAN) in Chinese patients with inflammatory bowel disease (IBD).
BACKGROUND
This study sought to evaluate the risk factors for the development of colitis-associated neoplasia (CAN) in Chinese patients with inflammatory bowel disease (IBD).
METHODS
IBD patients who developed CAN between 1999 and 2016 were identified from eight medical centers. In addition to initial pathology evaluation, a CAN diagnosis was confirmed by two expert pathologists. Patients with CAN ( = 29) were compared with non-CAN controls ( = 87). Matching was performed for gender and IBD type with a ratio of three controls to one subject.
RESULTS
Of the 29 patients with CAN, 8 (27.6%) had colorectal cancer (CRC), 20 (69.0%) had a final diagnosis of low-grade dysplasia and 1 (3.4%) had high-grade dysplasia. Multivariate analysis revealed that an older age at the time of IBD diagnosis and a longer IBD duration were independent risk factors for the development of CAN, with odds ratios of 1.09 [95% confidence interval (CI): 1.04-1.14, <0.001] and 1.14 (95% CI: 1.03-1.27, =0.013), respectively. Comparison between IBD patients with CRC and those with dysplasia indicated that the former were older at the time of IBD diagnosis (=0.012) and had longer IBD durations (=0.019).
CONCLUSIONS
Older age at the time of IBD diagnosis and longer IBD duration were found to be associated with the development of CAN in IBD patients.
PubMed: 30792868
DOI: 10.1093/gastro/goy039 -
GE Portuguese Journal of... Jul 2022-lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) and an uncommon cause of proctitis. The diagnosis requires a high index of clinical suspicion,...
BACKGROUND
-lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) and an uncommon cause of proctitis. The diagnosis requires a high index of clinical suspicion, since the clinical, imaging, endoscopic, and histological findings can mimic multiple benign or malignant conditions like inflammatory bowel disease and rectal neoplasms.
CASE PRESENTATION
We present the case of a 48-year-old Caucasian male with no significant previous medical history who was admitted due to the suspicion of a rectal neoplasia. He underwent an abdominopelvic computed tomography (CT) scan and pelvic magnetic resonance imaging (MRI) before admission due to complaints of anorectal pain, hematochezia, and constipation over the previous 2 weeks. The examination revealed a circumferential rectal wall thickening, infiltration of the perirectal fat and invasion of the mesorectal fascia, associated with perirectal fat lymphadenopathy. A radiological diagnosis of a rectal malignant neoplasia staged as T4N2MX was stated. Digital rectal examination identified a circumferential rectal tumor. Rectosigmoidoscopy showed an extensive and circumferential ulceration of the rectal mucosa, with elevated geographical borders, exudate, and aphthoid erosions at the proximal limit of the endoscopic mucosal ulceration. Biopsy specimens revealed acute ulcerative proctitis with lymphoplasmocytic inflammatory infiltrate but no evidence of dysplasia or malignancy. A STI screening was positive for HIV-1 (CD4+ 251/mm; = 700-1,100) and , with an elevated IgA-specific antibody titer (52.000; < 5.0), suggesting LGV disease. The diagnosis was confirmed by the identification of DNA on rectal swab. Other infectious causes of acute proctitis were excluded. When faced with these results, the patient ended up mentioning that he had unprotected anal sex with men. He started treatment with doxycycline 100 mg twice a day for 21 days, with a drastic improvement. Rectosigmoidoscopy was repeated and showed clear signs of progressive resolution of the ulcerative proctitis.
DISCUSSION
LGV-associated proctitis, often undervalued, is a reemerging disease which should always be considered a benign cause of rectal mass, in order to avoid delay in diagnosis and development of complications. Diagnosis becomes more challenging in patients with unknown HIV status. A detailed clinical history, including sexual behaviors, is a vital step to achieve the final diagnosis.
PubMed: 35979244
DOI: 10.1159/000516011 -
Obstetrics and Gynecology Nov 2021To compare maternal and neonatal outcomes after preterm prelabor rupture of membranes (PROM) from 23 to 34 weeks of gestation in twin compared with singleton gestations.
OBJECTIVE
To compare maternal and neonatal outcomes after preterm prelabor rupture of membranes (PROM) from 23 to 34 weeks of gestation in twin compared with singleton gestations.
METHODS
We conducted a secondary analysis of an obstetric cohort of 115,502 individuals and their singleton or twin neonates born in 25 hospitals nationwide (2008-2011). Those with preterm PROM from 23 0/7 through 33 6/7 weeks of gestation were included; neonates with major fetal anomalies were excluded. The coprimary outcomes for this analysis were composite maternal morbidity (chorioamnionitis, blood transfusion, postpartum endometritis, wound infection, sepsis, venous thromboembolism, intensive care unit admission, or death) and composite major neonatal morbidity (persistent pulmonary hypertension, intraventricular hemorrhage grade III or IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II or III, bronchopulmonary dysplasia, stillbirth subsequent to admission, or neonatal death before discharge). Logistic regression was used to estimate unadjusted and adjusted odds ratios (ORs) with 95% CIs for twin compared with singleton gestations.
RESULTS
Of 1,531 (1.3%) individuals who met eligibility criteria for this analysis, 218 (14.2%) had twin gestations. The median gestational age at preterm PROM was similar between those with twins and singletons (31.2 weeks [interquartile range 27.4-32.9] vs 30.6 weeks [interquartile range 26.9-32.7], P=.23); however, those with twin gestations had a shorter median latency period (2.0 days [interquartile range 1.0-5.0] vs 3.0 days [interquartile range 2.0-8.0], P<.001). After adjustment for potential confounders, odds of experiencing composite maternal morbidity (17.9% vs 19.3%, adjusted OR 0.97, 95% CI 0.66-1.42) or composite neonatal morbidity (20.4% vs 20.5%, OR 0.97, 95% CI 0.72-1.31) did not differ between groups.
CONCLUSION
In a large, diverse cohort, the likelihood of composite maternal or neonatal morbidity per fetus after preterm PROM was similar for twin and singleton gestations.
Topics: Adult; Chorioamnionitis; Cohort Studies; Endometritis; Enterocolitis, Necrotizing; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Outcome Assessment, Health Care; Perinatal Mortality; Pregnancy; Pregnancy Outcome; Pregnancy, Twin; Premature Birth; Sepsis; Venous Thromboembolism; Wound Infection; Young Adult
PubMed: 34619719
DOI: 10.1097/AOG.0000000000004561