Lee-Wen Huang

Multiple HPV genotypes in cervical carcinomas: improved DNA detection and typing in archival tissues

BACKGROUNDnHuman papillomaviruses (HPV) have been considered to be the necessary and central agents of cervical carcinoma.nnnOBJECTIVEnThe aim of this study was to determine the prevalence and genotypes of HPV in archival cervical carcinomas.nnnSTUDY DESIGNnThe study included 152 paraffin-embedded, formaldehyde-fixed cervical carcinoma specimens. To improve the detection and typing of HPV in archival tissues, we conducted a comprehensive study in which, polymerase chain reaction (PCR)-based methods using E7 type-specific (TS) and L1 modified general primers (MY11/GP6+ and GP5+/GP6+) were employed.nnnRESULTSnOverall HPV prevalence was 98% in the cervical carcinomas. HPV 16 was detected in 66% of the tumors, HPV 18 in 22%, HPV 31 in 13%, HPV 33 in 9%, and HPV 58 in 9%. Notably, multiple HPV types were present in 44 (28.9%) of the 152 cervical carcinomas. The most common co-infections were HPV types 16/18 (12 cases), followed by HPV types 16/31 (7 cases). Additionally, HPV 18 was more frequent in adenocarcinomas and adenosquamous carcinomas (86%) than in squamous cell carcinomas (15.8%) (P = 0.0002).nnnCONCLUSIONSnThe combination of L1 general primers and E7 type-specific primers can be of use in detecting HPV DNA in archival tissues. The present study showed a high frequency of multiple HPV infections in cervical carcinomas. Hence, relevant HPV typing information in cervical carcinoma is very important for further HPV vaccine design and application.

Integration of human papillomavirus type-16 and type-18 is a very early event in cervical carcinogenesis

Aim: Human papillomavirus (HPV) integration is a critical event in cervical carcinogenesis. The aim of this study was to explore the physical status of HPV-16 and HPV-18 during the progression of cervical precancerous lesions. Methods: A series of 101 HPV-16 or HPV-18 positive cervical neoplasms (32 cervical intraepithelial neoplasia (CIN) cases and 69 cervical carcinoma (CC) cases) were evaluated. The physical status of both types of HPV was assessed from paraffin-embedded formaldehyde-fixed surgical specimens by real-time PCR. Results: For HPV-16, integrated DNA was observed in 5 (83.3%) of 6 CIN I cases, 10 (90.9%) of 11 CIN II/III cases, 29 (82.9%) of 35 FIGO (International Federation of Gynecology and Obstetrics) stage I CC cases and 16 (94.1%) of 17 FIGO stages II∼IV CC cases. For HPV-18, integrated DNA was observed in 3 (50%) of 6 CIN I cases, 5 (55.6%) of 9 CIN II/III cases, 9 (64.3%) of 14 FIGO stage I CC cases, and 1 (33.3%) of 3 FIGO stages II∼IV CC cases. The mixed form of HPV DNA was the most prevalent physical state in HPV-16. There was no significant difference between the physical state of HPV-16 and HPV-18 DNA with regard to the various grades of cervical lesions. Conclusions: These data imply that integration of HPV-16 and HPV-18 DNA into the host genome occurs in the very early stage of cervical neoplastic progression. These early events may play an initiating role in the malignant transformation of HPV-16- and HPV-18-related low-grade lesions into high-grade dysplasia and invasive carcinoma.

Reduced Fhit expression in cervical carcinoma: correlation with tumor progression and poor prognosis

OBJECTIVEnThe fragile histidine triad (FHIT) gene is located at chromosome 3p14.2 and encompasses the common fragile site, FRA3B, which may contribute to chromosome breakage and rearrangement of cancer cells. Aberrant protein expression and inactivation of the FHIT gene have been identified in a variety of precancerous and cancerous lesions. To identify the potential implications of the FHIT gene in the development of cervical carcinoma and explore the clinical importance of change in gene expression, we assessed the level of Fhit protein in precancerous lesions and carcinomas of the cervix.nnnMETHODSnIn our study, 15 low-grade squamous intraepithelial lesions (LSIL), 35 high-grade squamous intraepithelial lesions (HSIL), 12 microinvasive carcinomas, and 103 invasive carcinomas were evaluated. The expression of Fhit was studied by immunohistochemistry using a polyclonal antibody specific for the protein.nnnRESULTSnAll samples of normal epithelium and LSIL exhibited intermediate to strong immunostaining of Fhit. Reduced Fhit protein expression was observed in 30 of 103 (29.1%) invasive carcinomas, 1 of 12 (8.3%) microinvasive carcinomas, and 3 of 35 (8.6%) HISL. Compared with normal epithelium and dysplasia, microinvasive and invasive carcinomas showed significantly lower Fhit expression. Fhit expression was also correlated with clinicopathological status. Reduced Fhit expression was significantly associated with lymph node metastasis (P = 0.005), parametrial invasion (P = 0.023), and vaginal involvement of the tumor (P = 0.016). In univariate analysis, Fhit expression was found to be a significant predictor of survival (relative risk 2.54, P = 0.0091): the patient with reduced Fhit expression had a 154% higher risk of dying from cervical cancer than the patient with opposite values.nnnCONCLUSIONnOur results indicate that immunostaining of Fhit expression has potential as a prognostic marker in the management of cervical cancer. The trend of reduced Fhit expression in microinvasive and invasive carcinomas suggests that down-regulation of Fhit is strongly linked to cancer progression. Moreover, loss of Fhit expression was related to lymph node metastasis, parametrial invasion, and vaginal involvement in cervical carcinoma. These results imply that loss of Fhit protein is associated with highly aggressive phenotypes of cervical carcinoma.

Pyomyoma after a cesarean section

Pyomyoma, or suppurative leiomyoma, is a rare but serious complication of leiomyomas. Since 1945, only 14 cases have been reported, and the mortality was 21% (1). The high mortality probably reflects delayed diagnosis. Most cases occurred related to pregnancy or menopause, and were caused by ascending infection from the lower genital tract. Here we report a woman who developed Escherichia coli bacteremia and wound infection and Candida parapsilosis pyomyoma. This is the first case that pyomyoma was caused by Candida. Magnetic resonance imaging (MRI) of pyomyoma, which has never been reported, is also presented here.

Transvaginal three-dimensional ultrasonography combined with serum CA 125 level for the diagnosis of pelvic adhesions before laparoscopic surgery.

STUDY OBJECTIVEnTo investigate the role of transvaginal three-dimensional ultrasonography combined with serum CA 125 level in diagnosing pelvic adhesions before scheduled laparoscopic surgery.nnnDESIGNnProspective study (Canadian Task Force classification II-1).nnnSETTINGnTertiary care academic hospital.nnnPATIENTSnFifty-nine women with an adnexal mass diagnosed by two-dimensional transvaginal ultrasonography.nnnINTERVENTIONnPreoperative transvaginal three-dimensional ultrasonography and serum CA 125 level, followed by laparoscopy or laparotomy.nnnMEASUREMENTS AND MAIN RESULTSnPelvic adhesions were correctly identified by transvaginal three-dimensional ultrasonography in 26 of 32 women in whom the lesions were confirmed at laparoscopy or laparotomy. Mean serum CA125 level in women with adhesions was 70 +/- 73.7 U/ml, which was significantly higher than that in women without adhesions (24 +/- 16.16 U/ml, p = 0.004). The sensitivity of combined transvaginal three-dimensional ultrasonography and serum CA 125 level was 90%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 89%. The two methods showed strong agreement with surgical results (kappa = 0.889). Eight scheduled laparoscopies (13.6%) were converted to laparotomy due to severe adhesions. One patient (1.7%) experienced colon injury during laparoscopic adhesiolysis.nnnCONCLUSIONnTransvaginal three-dimensional ultrasonography combined with serum CA 125 level is sensitive in detecting pelvic adhesions before laparoscopic surgery. Patients with suspected severe pelvic adhesions should have preoperative bowel preparation to reduce the risk of intraoperative injury.

Oocyte donation using immature oocytes from a normal ovulatory woman

Oocyte donation is a well-established treatment for some infertile patients. The main problem with an oocyte donation program is the limited source of donors. The discomfort and risks associated with ovarian stimulation and oocyte retrieval limit the availability of donors. Recovery of immature oocytes followed by in vitro maturation (IVM) is a potential alternative of infertility treatment. This technique saves tedious ovarian stimulation and may greatly improve a woman’s willingness to be an oocyte donor. Pregnancies resulting from immature oocyte donation of Cesarean section or PCOS women have been reported (1), although the pregnancy rates were very low. Recent reports by Chian et al. proposed that by giving human chorionic gonadotropin (HCG) before immature oocyte recovery from polycystic ovary syndrome (PCOS) women, the pregnancy rate could be significantly improved (2). We reported here the first case of pregnancy resulting from immature oocyte donation, after priming with HCG, from a normal ovulatory woman with polycystic appearing ovaries. Unfortunately, this pregnancy ended up as an ectopic pregnancy.

Prenatal three-dimensional ultrasound diagnosis of a camptomelic dysplasia.

Abstract.nWe describe a case of camptomelic dysplasia identified prenatally with the assistance of three-dimensional ultrasonography. The typical skeletal dysplasia of camptomelic dysplasia – including anterior bowing of the tibia, with skin dimpling over a convex surface at the point of maximal deformity, and talipes equinovarus – was successfully identified using the techniques of surface-rendering, multiplanar displays and rotated volume data. Three-dimensional ultrasonography allows the diagnosis of camptomelic dysplasia , which has a poor prognosis as it is accompanied by respiratory insufficiency and spinal deformities, to be made without delay and provides information supplementary to that provided by two-dimensional ultrasound for early diagnosis of skeletal dysplasia.

Ovarian pregnancy torsion.

IntroductionOvarian-cyst torsion is often seen in early pregnancy due to progesterone stimulation. It is the fifth-most-common gynecological emergency, with a reported incidence of 3%. An ectopic pregnancy implanted in the ovary is rare, occurring in only 0.5–1% of such pregnancies.Case reportWe presented a case of ovarian pregnancy with concomitant ipsilateral side tubal torsion managed by laparoscopy.Discussion and conclusionsVarying density distribution in the ovary can predispose to ovarian torsion. Emergency surgery may offer the possibility of avoiding the ablation of functional ovarian tissue. Early detection and prompt management can preserve fertility and ovarian function. The etiology, presenting syndrome and management are discussed.

Comparison of the outcomes of primary twin pregnancies and twin pregnancies following fetal reduction

High-order multifetal pregnancy is an inevitable consequence of assisted reproduction; and is associated with an increase in perinatal morbidity and mortality. Fetal reduction appears to be a safe and efficacious method for improving obstetric outcome. We made a retrospective study of study population 54 high multiple pregnancy following assisted reproduction that were reduced to twins at Shin Kong Memorial Hospital, Taipei,Taiwan from September 1992 to March 2000. Our study compares the outcome of multifetal pregnancy reduced to twins with the outcome of primary twin pregnancy. Maternal age, birth weight, gestational age at delivery and the incidence of preterm contractions were the only statistically significant differences between the two groups.

Complete hydatidiform mole with a coexisting fetus resulting from in vitro fertilization

Complete hydatidiform mole with a coexisting fetus (CMCF) is a rare entity, with an incidence of 1 in 22,000—100,000 pregnancies. It is associated with many complications, including vaginal bleeding, hyperemesis gravidarum, preeclampsia, and persistent trophoblastic disease (PTD). Delivery of a viable infant from CMCF is even rarer. We report here the seventh case of CMCF following assisted reproductive technologies (ART). It is also the third with a live birth. A 39-year-old woman came to Shin-Kong Wu HoSu Memorial Hospital for ART. Twenty oocytes were obtained after ovarian stimulation, and were