Eduardo Schejter

Observations on the ultrasound diagnosis of ovarian neoplasms

SummaryIn order to determine whether sonography could differentiate between benign and malignant ovarian neoplasms a retrospective analysis of preoperative ultrasound examination was made. The ultrasound images were evaluated for internal consistency, presence of septae, presence of solid nodules, papillary projections and tumor borders. Evidence of ascites and omental involvement were also assessed. Our study showed that benign ovarian serous tumors had a similar appearance to low grade malignant serous tumors, and were undistinguishable from the borderline serous carcinoma. The poorly differentiated serous adenocarcinoma was characterized by the presence of thick papillary projections rather than echogenicity. However, benign or malignant mucinous tumors gave the same pattern. Loss of tumor wall definition, ascites and omental involvement may signal malignancy. The dermoid tumor had a characteristic sonographic appearance.

Is removal of asymptomatic cervical polyps necessary?: histologic findings in asymptomatic Israeli Jewish women.

Objective: The purpose of the present study was to assess the frequency of abnormal histologic findings in polyps of asymptomatic Israeli Jewish women who are known to have a low incidence of cervical neoplasia. Materials and Methods: The medical records of Israeli Jewish women with histologically proven cervical polyps treated during 2005 to 2009 in 2 Maccabi Health Service clinics that specialize in cervical pathology and colposcopy were retrieved from a computerized database. The records of asymptomatic women who underwent polypectomy were reviewed, and demographic information, clinical information, and the presence of abnormal colposcopic patterns, cervical intraepithelial neoplasia (CIN), and malignancy were abstracted. Results: The study included 228 asymptomatic women with cervical polyps who underwent colposcopy. Their median age was 49 ± 10.9 years (range = 21-82 y). The highest percentage of patients was observed in the 40- to 49-year-old age group, was Israeli-born, and was married. The percentage of patients referred because of an abnormal cytology report (29.4%) was considerably higher than the percentage reported in Israeli Jewish women. Abnormal colposcopy patterns were seen in 9 polyps, and CIN was found in 6 of them. Despite the high frequency of abnormal cytologic smears, CIN 3 was detected in only 1 polyp (0.4 %). In none of the polyps was malignancy found. Conclusions: The very low frequency of neoplasia in cervical polyps of asymptomatic patients seems to support the notion that there is no clear indication for polypectomy when cytology is normal.

Impact of quadrivalent human papillomavirus vaccine on genital warts in an opportunistic vaccination structure

OBJECTIVE Genital warts are the most common sexually transmitted disease and have a detrimental impact on quality of life. Genital warts could be prevented by prophylactic HPV vaccination. The objective was to study real-life benefit of opportunistic HPV vaccination on age and gender specific incidence of genital warts. METHODS We performed a register-based population cohort study from publicly funded health-care provider in Israel. The incidence of genital warts was assessed during three time frame intervals: 2006-2008 (pre-vaccination effect period) 2009-2012 (early post-vaccination effect period) and 2013-2015 (late post-vaccination effect period), with an average annual number of members of 1,765,481, 1,906,774 and 2,042,678 in the years 2006-2008, 2009-2012 and 2013-2015, respectively. RESULTS Among females, annual incidence of genital warts per 100,000 women decreased from 210.43 to 161.71 (OR 0.76, 95%CI 0.71-0.82, p<0.001) and to 146.8 (OR 0.69, 95%CI 0.66-0.72, p<0.001) between pre-vaccination period and early and late post-vaccination periods, respectively. Among males, annual incidence of genital warts per 100,000 men decreased from 262.85 to 232.40 (OR 0.88, 95%CI 0.83-0.93, p<0.001) and to 234.01 (OR 0.88, 95%CI 0.86-0.91, p<0.001) between pre-vaccination period and early and late post-vaccination periods, respectively. CONCLUSIONS There is a potential benefit in reducing incidence of genital warts even in opportunistic HPV vaccination structure. This information may be relevant for health-care providers in countries where national immunization programs do not include HPV vaccines.

Prevalence and correlates of human papillomavirus genotypes among patients with cervical cancer and cervical intraepithelial neoplasia 3 in Israel.

Objectives This study aimed to assess the prevalence of human papillomavirus (HPV) in Israeli patients with cervical cancer and cervical intraepithelial neoplasia 3 (CIN3), to describe the distribution of the virus genotypes among positive cases, to characterize patients positive to HPV and, in particular, patients positive to HPV-16 and/or -18, and to evaluate the possible contribution of implementing HPV vaccination in Israel. Methods Samples from 84 patients with cervical cancer and 886 patients with CIN3, archived at the Maccabi Institute of Pathology, were screened for HPV. DNA extraction was performed using DNeasy Blood and Tissue Kit/QIAGEN. HPV detection and typing were performed by multiplex polymerase chain reaction with primers E6/E7, using the f-HPV/Genomed kit. Results Of the samples from 84 patients with cervical cancer, 89.3% were positive for HPV. Among these positive samples, HPV-16 was found in 70.7% and HPV-18 was found in 9.3%. Of the samples from 886 patients with CIN3, 85.0% were positive for HPV. Among these positive samples, HPV-16 was found in 73.8% and HPV-18 was found in 1.1%. In the patients with CIN3, the prevalence of HPV genotypes 16 and/or 18 was higher among young women and decreased across age groups. In addition, age, being born in Israel, being born in Europe, and being born in the former Soviet Union were correlated with a low risk of being infected with genotypes 16 and/or 18. Discussion The prevalence of HPV-16 and -18 in patients with cervical cancer and CIN3 in Israel is high. It is expected that the implementation of routine vaccination against these types of HPV will significantly reduce the burden of these diseases in Israel.

Risk Factors for Cervical Cancer and CIN3 in Jewish Women in Israel - Two Case Control Studies.

PURPOSE The aim of the study was to identify risk and protective factors/markers for cervical cancer and cervical intraepithelial neoplasia 3 (CIN3) in Israeli Jewish women in order to settle the discrepancy of low incidence rate of cervical cancer and relatively high incidence rate of CIN3. MATERIALS AND METHODS We conducted two case control studies, which examined the association between potential risk and protective factors/markers for cervical cancer or CIN3 using self administered detailed questionnaires. RESULTS For studying cervical cancer, 40 cases and 40 matched controls were interviewed. In the univariable and multivariable analyses older age, depression or anxiety and ever smoking seemed to act as independent risk factors/markers, while older age at first intercourse was protective. For studying CIN3, 99 cases and 79 controls were interviewed. Multivariable analysis has demonstrated that being born in Israel, depression or anxiety and ever smoking were independent risk factors/markers for CIN3. CONCLUSIONS The risk factors/markers studied, that were associated with cervical cancer or CIN3 among Jewish women in Israel, are similar to those reported in other parts of the world, and do not explain the observed discrepancy of high in-situ cervical cancer rates and low invasive cervical cancer incidence in Israel.