11/35. Vaginal and vulvar adenosis. An unsuspected side effect of CO2 laser vaporization. During a 15-month period, September 1984 through January 1986, 10 women who were treated in the Section of Gynecologic Oncology, Department of obstetrics and gynecology, pennsylvania Hospital, philadelphia, pennsylvania, developed vaginal or vulvar adenosis after CO2 laser vaporization. The indications for therapy were condylomata of the cervix, vagina and vulva refractory to conservative management in 3 patients, vulvar intraepithelial neoplasia in 3, lichen sclerosus in 1 and cervical intraepithelial neoplasia with condylomata on the cervix and vagina in 3. All the patients underwent treatment of the vagina. Most underwent treatment of the cervix, and some underwent treatment of the vulva at various degrees of intensity and depth. During the posttreatment colposcopic follow-up examination, all the patients demonstrated lesions colposcopically consistent with adenosis of the vagina or vulva within the area treated with the CO2 laser. Biopsies of the lesions were performed, adenosis was confirmed histologically, and endometriosis was ruled out histologically. This entity has not been previously associated with CO2 laser vaporization, and its clinical significance is undetermined. Further follow-up is indicated. ( info) |
| Bowenoid papulosis (BP) is a cutaneous condition of the external genitalia seen primarily in young adults. Evidence supports an etiologic role of human papillomavirus (HPV), particularly type 16. HPV-16 is also associated with an increased risk for cervical intraepithelial neoplasia (CIN) and invasive carcinoma. A 17-year-old female, referred to the adolescent dysplasia clinic with a diagnosis of condyloma acuminatum, was presented. She had multiple smooth, shiny, brown 3- to 4-mm papules on the external genitalia. biopsy confirmed BP. Colposcopic examination of the cervix and biopsy showed CIN III. The patient's sexual partner was examined colposcopically, and no suspicious lesions were seen. The patient underwent laser vaporization of her external genital and cervical lesions. At the time of treatment, some of the initial BP lesions had spontaneously regressed. This case highlights the need to evaluate females with BP for possible CIN, to examine sexual partners, and to use ablative therapy, as there is the potential of malignant progression in BP. ( info) |
13/35. Development of melanosis of uterine cervix after cryotherapy for epithelial dysplasia. A case report and brief review of the literature on pigmented lesions of the cervix. A case of melanosis of the exocervix, which developed within eight months after cryotherapy for epithelial dysplasia, is reported. The literature on pigmented lesions of the cervix is briefly summarized and the importance of biopsy and histologic examination for diagnosis and classification of these lesions is emphasized. ( info) |
14/35. Post-hysterectomy extra-uterine endometrial stromal sarcoma: a case report. Endometrial stromal sarcoma is a relatively rare form of uterine sarcoma. The present paper reports on a patient who was found to have contracted endometrial stromal sarcoma eight years after a hysterectomy. A postoperative specimen revealed this sarcoma to have originated in extra-uterine endometrium of the rectovaginal septum. ( info) |
15/35. Endocrine cell hyperplasia of the uterine cervix. A precursor of neuroendocrine carcinoma of the cervix? A 33-year-old woman who presented with vaginal bleeding was diagnosed to have neuroendocrine small cell carcinoma based on cervical smear and biopsy. hysterectomy was performed, and a tumor measuring 5.5 X 2 mm was found at the squamocolumnar junction of the uterine cervix. In the immediate vicinity of the tumor, there was proliferation of cytologically benign endocrine cells in the normal endocervical glands and in the glands showing intraepithelial glandular neoplasia. Both the hyperplastic endocrine cells and the invasive tumor cells showed argyrophilia and immunostaining for neuron-specific enolase, neurofilament, and chromogranin. The topographical relationship suggests that endocrine cell hyperplasia may represent a precursor of neuroendocrine carcinoma of the cervix. ( info) |
16/35. Cloning and characterization of the dna of a new human papillomavirus from a woman with dysplasia of the uterine cervix. A previous analysis of 121 female genital tract lesions from the united states and south america had revealed that a large number contained dna sequences that were weakly homologous to a panel of human papillomavirus (HPV) probes. The dna sequences of one of these viruses have been molecularly cloned and shown to be a new type of HPV which is called HPV 31. Among the cloned HPV genomes, HPV 31 is most closely related to HPV 16. Although absent from all genital condylomas studied, HPV 31 was present in approximately 20% of the mild and moderate dysplasias and in 6% of the invasive cervical cancers ( info) |
17/35. Recurrent penile condylomata acuminata in a 17-month-old boy. Penile condyloma acuminatum is a rare pediatric entity. We report on a 17-month-old boy with penile and urethral condyloma acuminatum. The presence of cervical dysplasia in a histological setting suggestive of condyloma in his mother supports congenital acquisition of the disease. Histological and histochemical evidence for a viral etiology of the disease in the mother and patient is presented. ( info) |
18/35. Premalignant and malignant uterine changes in immunosuppressed renal transplant recipients. 29 female immunosuppressed renal transplant recipients were examined gynecologically. In 2 cases the epithelium of the portio was found to be dysplastic, while endometrial carcinoma was present in 1 patient. A review of the literature suggests that immunosuppressed patients are more likely to develop tumors than others. The authors stress the need for gynecological and cytological examinations at short intervals, to identify premalignant and early malignant uterine changes at a time at which these can readily be treated without discontinuation of the immunosuppressive therapy. ( info) |
19/35. conization of the cervix with the CO2 laser as an office procedure. conization of the cervix is usually done under general anesthesia in an operating room. The use of the CO2 laser has been shown to reduce the high morbidity associated with cervical conization, but, like cold-knife conization, laser excisional procedures are still usually done in an operating room under general anesthesia. Forty-one patients underwent conization of the cervix with the CO2 laser in an office setting. The procedure was well tolerated, and intraoperative bleeding was not a problem. Two cases of delayed postoperative bleeding were treated on an outpatient basis. The ability to perform cervical conization in an office setting offers significant advantages. ( info) |
20/35. The significance of atypical vessels and neovascularization in cervical neoplasia. The relationship between atypical vessels seen colposcopically and dysplasia, carcinoma in situ (CIS), microinvasion, and frank invasion was studied quantitatively. No atypical vessels were found with dysplasia, but 2.8% of patients with CIS had atypical vessels. Half of the patients with microinvasion and all of the patients with frank invasion, in whom the entire zone of transformation was viewed, had atypical vessels. Eight-two percent of the patients with atypical vessels had invasion. The conclusions are: (1) Atypical vessels are not present with dysplasia and rarely present with CIS. (2) Atypical vessels may be associated with microinvasion, but are required for frank invasion to occur. (3) Because atypical vessels are usually associated with invasion, which can be in or near the field of atypical vessels, diagnosis cone biopsy should be performed if atypical vessels are seen and colposcopic biopsies do not show frank invasion. (4) Microinvasion without atypical vessels may be a localized disease. ( info) |