Chan Joo Kim

HPV oligonucleotide microarray-based detection of HPV genotypes in cervical neoplastic lesions ☆

BACKGROUND In this study we examined the use of a new-human papillomavirus (HPV) detection method, the HPV oligonucleotide microarray system (Biomedlab Co., Korea), which we compared with the well-established HPV DNA detection system (Hybrid Capture II; HC-II, Digene Co.). This new method prompted us to develop a new HPV genotyping technique, using the oligonucleotide microarray, to detect the generic and type-specific sequence of HPV types. In particular, we undertook the evaluation of the clinical efficacy of the HPV oligonucleotide microarray for detecting HPV in cervical neoplastic lesions. METHODS One hundred forty patients were involved and classified into three groups according to their histopathologic diagnoses: Group I (nonspecific chronic cervicitis; n = 61), Group II (low-grade squamous intraepithelial lesion (SIL); koilocytosis, and mild dysplasia; n = 39), and Group III (high-grade SIL; moderate, severe dysplasia and in situ carcinoma; n = 40). Cytological diagnoses were based on the Bethesda System and cervical samples were analyzed by the two methods. The HPV oligonucleotide microarray detected 15 types of high-risk HPV (HPV-16/-18/-31/-33/-35/-39/-45/-51/-52/-56/-58/-59/-66/-68/-69) and 7 types of low-risk HPV (HPV-6/-11/-34/-40/-42/-43/-44). RESULTS In 105 of the 140 cervical samples (75%), HPV DNAs were examined using the HC-II method. HPV detection rates using the HPV microarray agreed with those of HC-II. One HC-II-positive, but HPV microarray-negative, case occurred in the low-grade SIL (Group II) and was later confirmed negative for HPV. The other HPV microarray-positive but HC-II-negative case was found to be HPV-18 by PCR. Low-risk types of HPV were detected in 3 of 39 low-grade SIL cases (Group II) using the HPV microarray. HPV-16 was the most frequent type (32.1%) in all specimens tested, and was significantly more frequent in low-grade or high-grade intraepithelial lesions (Groups II or III) than in normal controls (Group I) (P < 0.05). HPV-58 was the second most common type (17.5%) in Group III. The HPV microarray was found to have advantages in terms of identifying the HPV genotypes and cases of multiple HPV infection. Double HPV infections were detected in 12 cases and triple HPV infections in 7 cases. Two cases were positive for four types of HPV (HPV-16/18/33/35, HPV-16/18/58/68). The sensitivity of HPV testing (HC-II; 94.9%, HPV microarray; 93.7%) for identifying patients with squamous intraepithelial lesion was significantly better than the sensitivity of cytology (77.1%, P < 0.05). On using multiple logistic regression analysis to estimate the relative risk of SIL versus HPV type, HPV-16-positive cases were found to have a 7.5-fold risk of SIL (95% CI = 3.28-16.51; P < 0.01). HPV-33 and HPV-58 were found to be significantly related to high-grade SILs (P < 0.01). CONCLUSIONS Our results suggest that the HPV oligonucleotide microarray is highly comparable to HC-II for detecting HPV in cervical specimens. The HPV oligonucleotide microarray provides useful information on viral genotype and multiple HPV infections in HPV-related cervical lesions. Genetic information on HPV in cervical specimens might be a particular benefit of the new procedure in the management of cervical neoplastic lesions

Cell-mediated immune response to human papillomavirus 16 E7 peptide pools in patients with cervical neoplasia

Objective. To identify characteristics of the cell‐mediated immune (CMI) response to human papillomavirus‐16 (HPV) E7 viral peptide pools to help the formulation of therapeutic vaccines. Design. Prospective study. Population. Korean women. Setting. University hospital. Methods. From December 2008 to August 2010, 33 HPV‐16‐positive patients, seven patients exhibiting a high‐risk HPV infection other than HPV‐16 with grade 2/3 cervical intraepithelial neoplasm (CIN2/3), and nine healthy control donors were enrolled. Main Outcome Measures. CMI response to synthetic HPV‐16 E7 overlapping peptide pools using the IFN‐γ ELISPOT assay. Results. The E7 sequence comprising amino acids 16–55 was a major immunogenic region. The CMI response to HPV‐16 E7 is highly type‐specific. The follow‐up CMI response may last longer than expected after the lesion is resected. Conclusions. We found that the E7 sequence comprising amino acids 16–55 is a major immunogenic region that is critical for the T‐cell‐mediated immune response with CIN2/3 or cervical cancer. The identification of CMI responses to HPV‐16 E7 peptide pools may provide insight into therapeutic vaccine trials for the control of HPV‐associated diseases.

Small cell neuroendocrine carcinoma of the uterine cervix presenting with syndrome of inappropriate antidiuretic hormone secretion

Small cell carcinoma of the uterine cervix is rare. It is estimated that 10% of patients with small-cell lung cancer have syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and hyponatremia has been reported to be significantly associated with a poor prognosis. A proportion of small cell carcinoma of the uterine cervix exhibit neuroendocrine characteristics as revealed by immunohistochemistry, However, cases presenting typical symptoms due to SIADH are extremely rare. This report of the SIADH of the uterine cervix is a rare case in the small cell carcinoma of the cervix presenting with tumor-associated paraneoplastic syndrome.

Factors associated with participation in cervical cancer screening among young Koreans: a nationwide cross-sectional study

Objectives Despite the possibility of early detection of cervical cancer, participation in screening programmes among young Koreans is low. We sought to identify associations between risk factors and participation in screening for cervical cancer among young Koreans. Design Nationwide cross-sectional study. Setting Republic of Korea. Participants 3734. Main outcome measures The Korea National Health and Nutrition Examination Survey (KNHANES V: 2010–2012) was used to evaluate factors associated with attendance for cervical cancer screening among women aged 15–39. After excluding those who were previously diagnosed with cervical cancer and those with incomplete responses to questionnaires, a total of 3734 subjects were eligible. Multi-dimensional covariates as potential predictors of cervical cancer screening were adjusted in multiple logistic regression analysis. Results The participation rate for cervical cancer screening was 46% among women aged 40 or younger. The logistic analyses showed that age, education, total household income, smoking and job status among women aged 15–39 were associated with participation in cervical cancer screening (p<0.05). After age stratification, the associated factors differed by age groups. Moreover, a dose–response between participation in cervical cancer screening and high total household income in the 30–39 age group was seen. Conclusions Predictive factors differed among young women (aged 15–29 vs 30–39). Thus, age-specific tailored interventions and policies are needed to increase the participation rate in screening for cervical cancer.

Does the type of hysterectomy affect the prognosis in clinical stage I endometrial cancer

Aim:  To determine whether clinical outcomes show a benefit from extended hysterectomy in patients with early endometrial cancer.

Persistent low-level elevation of serum human chorionic gonadotropin after termination of pregnancy: a rare case of peritoneal trophoblastic implant

Peritoneal trophoblastic implant can occur after treatment of ectopic pregnancy. Similarly, after termination of intrauterine pregnancy, trophoblastic implants are rare but can be a complication of perforation during dilatation and curettage. We report an extremely rare case of trophoblastic implant on the myometrium, ovarian surface, and peritoneal wall 4 months after uncomplicated dilatation and curettage. To the best of our knowledge, this is the first case of peritoneal trophoblastic implant following dilatation and curettage without uterine perforation. Knowledge of this case is useful for the management of patients with persistent low-level elevation of serum human chorionic gonadotropin after termination of pregnancy.

Toll-like receptor 2 gene polymorphisms in Korean women with human papillomavirus-related cervical neoplasia.

The aim of this study was to investigate the association between Toll‐like receptor 2 (TLR2) gene polymorphisms and human papillomavirus (HPV)‐related cervical neoplasia in Korean women.

A Case of Hemoperitoneum from A Spontaneous Venous Rupture Overlying Uterine Leiomyoma

자궁근종은 가임기 여성에서 매우 흔하게 발생되는 종양이지만 자궁근종 표면을 주행하는 혈관의 파열은 매우 드문 합병증이다. 본 저자들은 급성 복통을 호소하는 여성에서 3 × 4 cm 크기의 장막하 자궁근종의 표면혈관이 자연 파열되어 혈복강이 발생한 증례 한 건을 경험하여 문헌고찰과 함께 보고하는 바이다. 자궁근종의 혈관 파열은 매우 드문 합병증이지만 급성 혈복강을 일으킬 수 있기 때문에, 자궁근종의 높은 유병률을 고려한다면 혈복강을 보이는 환자의 감별 진단 과정에서 자궁근종 파열도 염두에 두어야 한다.