Ervo Vesterinen

Natural history of vaginal intraepithelial neoplasia

The natural history of vaginal intraepithelial neoplasia (VAIN) was studied in 23 patients followed for at least 3 years with no treatment. The mean age of the patients was 41 years of age. A large proportion of the VAIN lesions (50%) were multifocal, and approximately one half of the lesions were associated with concomitant cervical or vulvar intraepithelial neoplasia. Progression to invasive vaginal carcinoma occurred in two (9%) cases, persistence of VAIN occurred in three (13%) cases, and regression of VAIN occurred in 18 (78%) cases. The risk for progression to invasive carcinoma emphasizes the significance of colposcopic examination of the vagina with directed biopsy specimens obtained from all lesions.

Adenocarcinoma of the uterine cervix

In Finland, the incidence of cervical cancer has shown a decreasing tendency since the 1960s. The same trend, however, has not been noticed in the incidence of cervical adenocarcinoma. The reason for this is not known, although many studies have shown differences in the cause, epidemiology, and biology of the epidermoid and adenocarcinoma of the uterine cervix. A total of 106 new patients with cervical adenocarcinoma were treated at our institution from 1976 to 1980, which represents 20.4% of all cervical carcinomas treated. The mean age of the patients was 58.1 years (range, 29 to 82 years) and the peak incidence was in the group 60 to 69 years of age. Most of the patients were postmenopausal (71.7%) and the main symptom was abnormal vaginal bleeding (78.3%). The proportion of Stage I was 61.3%. Combined operative and radiation therapy was used in 74.5% of the patients. The overall 5‐year survival rate was 65.1% (corrected 74.5%), which did not differ from that of patients with squamous cell carcinoma. The most significant prognostic factors were the size of the tumor, presence of pelvic lymph node metastases, and the stage of the disease.

Increase of cervical adenocarcinoma: A report of 520 cases of cervical carcinoma including 112 tumors with glandular elements

A total of 520 new cases of cervical carcinoma were treated at the Department of Obstetrics and Gynecology, Helsinki University Central Hospital, in 1976 through 1980. Of these carcinomas, 95 (18.3%) were pure adenocarcinomas and 17 (3.3%) represented adenosquamous tumors. The mean age was 58.9 years (range 23-88 years). The age distribution was similar in patients with and without malignant glandular elements and the peak incidence was in the age group 60-69 years. In patients with adenocarcinoma, stage I was overrepresented (62.1%) whereas epidermoid carcinomas were more evenly distributed among various stages. The overall 5-year survival rate was 63.1%, with the corresponding corrected rate being 69.1%. The survival rate for patients with adenocarcinoma did not differ significantly from that for patients with squamous cell tumor. It is concluded that in our population the increasing frequency of cervical adenocarcinoma has not influenced the favorable results of the 5-year study. This disease, however, deserves more attention since its etiology, pathogenesis, and biology are still largely unresolved.

Examination of Men with Nongonococcal Urethritis and Their Sexual Partners for Chlamydia trachomatis and Ureaplasma urealyticum

Chlamydia trachomatis was recovered from 39 (52%) of 75 men who had nongonococcal urethritis and from 28 (37%) of their sexual partners. Of the partners of men with Chlamydia-positive nongonococcal urethritis, 64% excreted Chlamydia, compared with 8% of the partners of men with Chlamydia-negative nongonococcal urethritis. In contrast, an apparently sexual mode of transmission was not observed with Ureaplasma urealyticum. Rates of recovery of U. urealyticum from men with nongonococcal urethritis whose cultures were Chlamydia-positive and those whose cultures were Chlamydia-negatie were the same. Significant seroconversion was detected by the single-antigen immunofluorcscence test in about 50% of patients who had Chlamydia-positive cultures.

Deoxyribonucleic acid flow cytometric analysis of cervical adenocarcinoma: prognostic significance of deoxyribonucleic acid ploidy and S-phase fraction.

Paraffin-embedded tumor samples from 125 patients with cervical adenocarcinoma were analyzed by deoxyribonucleic acid flow cytometry. Thirty-one percent of the tumors were aneuploid. Triploid deoxyribonucleic acid content predominated (51.3%) and one third of the deoxyribonucleic acid aneuploid tumors were tetraploid, whereas near-diploid deoxyribonucleic acid aneuploidy was seen infrequently. Deoxyribonucleic acid aneuploidy was associated with tumor size, histologic grade, clinical stage, and high S-phase fraction. Deoxyribonucleic acid ploidy and S-phase fraction value were independent prognostic parameters, together with the presence of lymph node metastases and tumor size. In conclusion, our results indicate that flow cytometric deoxyribonucleic acid analysis helps to predict the prognosis and may thus influence the choice of treatment.

Treatment of genital HPV infection with carbon dioxide laser and systemic interferon alpha-2b.

Background and Objectives Treatment of genital warts is problematic. Numerous treatment modalities are available, but response to any therapy often is unsatisfactory. Recently, studies have suggested that interferons would be effective in the treatment of some genital warts. Goal of this Study To compare carbon dioxide laser with or without adjuvant subcutaneously administered interferon alpha-2b in the treatment of genital human papillomavirus infection. Study Design One hundred randomized women with genital HPV infection were treated with carbon dioxide laser and adjuvant systemic interferon alpha-2b or carbon dioxide laser and placebo. Patients were followed colposcopically, cytologically, and by HPV DNA testing for 6 months. Results Complete response was seen in 62% patients who received adjuvant interferon, and in 68% patients who received placebo. However, recurrence was less common in patients treated with interferon who were infected with HPV 16/18. Conclusion Only a subgroup of patients, women infected with HPV DNA 16/18, benefited from adjuvant systemic interferon treatment.

Endometrial adenocarcinoma: Clinical outcome in 881 patients and analysis of 146 patients whose deaths were due to endometrial cancer

Throughout 1970-1975, 881 patients were treated at Departments I and II of Obstetrics and Gynecology, Helsinki University Central Hospital. They were treated mainly by using surgery and/or radiotherapy combined with adjuvant progestin therapy. The over-all uncorrected 5-year survival rate was 72.2% and corrected rate was 82.1%. In 146 out of 245 cases death was due to endometrial cancer, and this group was analyzed separately.

Condyloma and cervical epithelial atypias in young women

One hundred and three adolescent women with cervical cytology suggestive of mild to moderate dysplasia were studied for the presence of condylomatous lesion. The analysis of smears revealed cells suggestive of condyloma in 81% of the cases. In histopathologic studies cervical lesions typical of condyloma were observed in 59 preparations. Of these 16 were papillary and 35 were flat condylomas, and in 8 cervices both papillary and flat condylomatous lesions were present. Colposcopic examination showed an atypical transformation zone in 57 cases. Papillary condylomas were present in 24 cervices in 7 cases combined with an atypical transformation zone. In addition to the cervical epithelial atypias there were 18 cases in which colposcopic and histologic examination of vagina revealed papillary warts, 13 of them combined with cervical condylomas. In four patients vaginal leucoplakia was seen and all were histologically flat condylomas. Thus, in 68 cases or in 66% of adolescent women having abnormal cervical cytology, histological investigation revealed condylomatous changes.

Carcinoma of the uterine cervix stage III: A report of 311 cases

Abstract A series of 311 cases of carcinoma of the uterine cervix stage III treated during 1964–1973 and followed up at least for 5 years is presented. In 1964–1969 (period I), local applications of radium were first given, followed by X-ray treatment of parametria with Mullers apparatus. This therapy was replaced in 1970–1973 (period II) by external megavoltage treatment followed by radium applications. A total of 169 patients were treated in period I and 142 in period II. The 5-year observed survival rate was 28% in the former and 36% in the latter period. The higher survival rate of the latter period was, however, statistically significant only in the first 2 years after treatment. The relative survival rates for the older age groups of patients were better than those for the younger groups, a trend which was statistically highly significant. Megavoltage therapy increased the frequency of transient complications. Severe complications, however, were equally represented in both periods. Fistulas were observed in 12.5% of the patients. In 13% of the series a surgical operation was performed for correction of a complication.

Cervical human papillomavirus deoxyribonucleic acid and cytologic evaluations in gynecologic outpatients

We studied the prevalence and cytologic manifestations of human papillomavirus deoxyribonucleic acid among 2668 gynecologic outpatients. The study population consisted of 1573 women who came into the emergency room, 623 women from an abortion clinic who were seen because of induced first-trimester abortion, and 472 women who had been referred to a colposcopy clinic because of an abnormal Papanicolaou smear finding. A dot blot technique was used for the detection of human papillomavirus types 6/11, 16/18, and 31/33/35. The prevalence of human papillomavirus deoxyribonucleic acid was 4.4% in the emergency room population, 8.8% in the abortion clinic population, and 31.4% in the colposcopy clinic population. Human papillomavirus type 16/18 was most prevalent (3.5%), followed by human papillomavirus type 31/33/35 (3.1%), and human papillomavirus type 6/11 was least prevalent (2.1%). Of all unselected human papillomavirus deoxyribonucleic acid-positive women who were enrolled from the emergency room or from the abortion clinic, 73% had normal cytologic evaluations. Twenty-five percent had benign atypia, and 2% had dyskaryotic changes. No human papillomavirus deoxyribonucleic acid type-specific differences were detected in the distribution of cytologic atypias.