Maria Paraskevas

Chlamydia trachomatis infection in women with ectopic pregnancy.

Fifty women with ectopic pregnancy and 49 control women with intrauterine pregnancy were interviewed and evaluated for evidence of Chlamydia trachomatis infection. Among women with ectopic pregnancy, 14 women were wearing an intrauterine contraceptive device or had a tubal ligation (group A), and 36 women had no readily identifiable risk factors (group B). Group B women had greater total numbers of sexual partners than did control women with intrauterine pregnancy (P less than .005). Group B women more often had C trachomatis antibody than group A (P = .03) and control women (P = .002). Of 27 C trachomatis cultures from fallopian tube tissue from women with ectopic pregnancy, none were positive. Fallopian tube tissue distant from the site of ectopic implantation was available for histopathology of 41 cases. Nine (22%) had extensive subepithelial plasma cell infiltration. All nine were among group B women (P = .06) and all seven with plasma cell salpingitis who were tested for C trachomatis antibody were seropositive (P = .004). It is concluded that a subset of women with ectopic pregnancy were at increased risk for acquiring a sexually transmitted disease by virtue of their sexual behavior and that women in this subset frequently have serologic evidence of C trachomatis infection and histologic evidence of plasma cell salpingitis. Because few of these women recall having had pelvic infection, the authors speculate that subclinical C trachomatis tubal infection producing plasma cell salpingitis may commonly underly ectopic pregnancy.

The association of sexually transmitted diseases with cervical intraepithelial neoplasia: A case-control study

Thirty-three women with histologically confirmed cervical intraepithelial neoplasia (grades I to III, with one case of microinvasive carcinoma) and 54 women without evidence of the disease were prospectively studied to determine the relationship of genital infection to cervical neoplasia. Demographic and sexual data for patients and control subjects were collected, with standardized clinical and colposcopic evaluation by means of predefined diagnostic categories. Cultures from the cervix were examined for herpes simplex virus, cytomegalovirus, Chlamydia trachomatis, and Neisseria gonorrhoeae. Human papilloma virus infection was identified by characteristic changes of koilocytosis in cytologic or histopathologic specimen. Cultures from the vagina were evaluated for Gardnerella vaginalis, Trichomonas vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Candida albicans, and other yeasts. Separate Gram strains were prepared from endocervical secretions and from vaginal secretions. More lifetime sexual partners, larger area of transformation zone, evidence of human papilloma virus infection, and altered vaginal flora were observed in women with cervical intraepithelial neoplasia. The association of human papilloma virus infection and altered vaginal flora with cervical intraepithelial neoplasia was independent of sexual experience.

Vaginal microbial flora as a cofactor in the pathogenesis of uterine cervical intraepithelial neoplasia

The vaginal microbial flora of 106 women with histopathologically confirmed cervical intraepithelial neoplasia and 79 women without disease, was evaluated for Gardnerella vaginalis, Trichomonas vaginalis, Candida albicans and other yeasts. Flora morphology was assessed by gram staining of secretions. Cervical cultures were examined for Herpes Simplex virus, Cytomegalovirus and Neisseria gonorrhoeae. Chlamydia trachomatis antigens in cervical secretions were detected by enzyme immunoassay. Human Papillomavirus was identified by koilocytosis in cytologic or histopathologic specimens. Human Papillomavirus infection (P < 0.00001), vaginal infection with Mycoplasma hominis (P = 0.012) and abnormal vaginal flora (P = 0.006) were significantly associated with CIN, suggesting that CIN may be promoted by vaginal microorganisms in conjunction with human papillomavirus cervical infection.

Detection of Human Papillomavirus 16 Transcription in Human Prostate Tissue

Previously we demonstrated human papillomavirus type 16 DNA in a high proportion of benign hyperplastic (BPH) and cancerous (CaP) prostate specimens using the polymerase chain reaction (PCR). While these data designate the prostate as a possible reservoir for sexual transmission of HPV, an etiological role for the virus in prostatic neoplasia is uncertain. Since transcription of the E6/E7 genes of HPV 16 is essential for both viral replication and cellular transformation, we sought to assess the transcriptional activity of HPV 16 found in prostate tissues. The E6/E7 viral gene transcripts were identified in 5 of 10 BPH specimens and 3 of 7 CaP specimens known to contain HPV 16 DNA. Expression of the HPV viral genes is not associated preferentially with either BPH or CaP, nor is transcription observed in all samples which contain the viral genome. These findings suggest that the prostate may act as a site for HPV replication, but that HPV is unlikely to be involved in the transformation of prostatic cells.

The Cytological Diagnosis of Prostatic Carcinoma by Transrectal Fine Needle Aspiration

During a 2-year period a prospective study was conducted, comparing the accuracy of transrectal fine needle aspiration with that of transperineal needle biopsy in the diagnosis of prostatic carcinoma. With increasing experience the accuracy of aspiration was found to be at least equal to that of biopsy. Blood cultures 1 hour postoperatively in 1 group and 5 minutes postoperatively in another revealed a low incidence of bacteremia. Our findings suggest that prostatic aspiration should be used more widely as the initial diagnostic procedure for suspected prostatic cancer.

Angiosarcoma of the uterus: A case report

We are reporting a case of angiosarcoma of the uterus in which the diagnosis was confirmed ultrastructurally by demonstration of Weibel-Palade bodies in the tumor cells. Only 10 cases of this entity have been previously documented in the literature.

Human papillomavirus infection and the size and grade of cervical intraepithelial neoplastic lesions associated with failure of therapy

OBJECTIVE: This investigation was designed to identify specific risk factors associated with treatment failure for cervical intraepithelial neoplasia. METHOD: A cohort of 436 women was assessed for the presence of co‐factors associated with therapy failure. The risk factors included the HP V infection status of the patient, a previous history of genital condyloma and the size of cervical lesions. RESULT: The treatment outcome was not related to the treatment modality (P = 0.058). Thirteen (8.1%) women failed laser therapy while 15 (5.4%) women failed cryotherapy. While treatment failure occurred only in the presence of HP V infection (P = 0.036), failure was not related to infection by a specific genotype. Therapy failure was associated with treatment for CIN II (RR 4.157) and CIN III (RR 2.053) relative to CIN I and treatment of large lesions (P = 0.014). CONCLUSION: The determination of the relative area occupied by cervical lesions may have prognostic value in identifying women who are at risk for treatment failure.

Premalignant cervical lesions are characterized by dihydrofolate reductase gene amplification and c-Myc overexpression: possible biomarkers.

Objective. The c-Myc oncoprotein deregulation is associated with overall genomic instability and locus-specific genomic instability involving the dihydrofolate reductase (DHFR) locus. This study analyzes c-Myc protein levels and the stability of the DHFR gene in cervical tissue biopsies. Materials and Methods. The stability of the DHFR gene was examined by fluorescence in situ hybridization (FISH). c-Myc protein levels were evaluated using quantitative fluorescent immunohistochemistry. Forty-four cervical tissue biopsies were analyzed and included 33 preinvasive cervical lesions identified by histology, 14 samples were cervical intraepithelial neoplasia (CIN) 1; 7 were CIN 2; and 12 were CIN 3. Eleven biopsies had negative histology. Results and Conclusion. c-Myc protein levels were elevated in CIN 1, 2, and 3 (p = .02) biopsies. Concomitantly, DHFR gene amplification was detected in CIN 1, 2, and 3 (p = .0001). The degrees of DHFR gene amplification and of c-Myc protein levels were a measure of the progressive degree of the lesion.

Effect of the menstrual cycle on detection and typing of human papillomavirus in uterine cervical cells

We observe fluctuations in human papillomavirus detection and variation in genotyping between sequential cervical cell specimens analyzed by filter in situ hybridization. Furthermore, specimen adequacy for analysis varies. To determine whether these phenomena are correlated with menstrual cycle stage at the time of sampling, we analyzed cervical cell specimens from women with cervical intraepithelial neoplasia. Specimens were categorized on the basis of a 28-day menstrual cycle and were analyzed by hybridization to combined probes for virus types 6 and 11 or types 16 and 18. Specimen adequacy was determined by hybridization to a human Alu I repetitive deoxyribonucleic acid probe. Analysis of data with chi 2 revealed that fluctuations in virus detection and type variation are unrelated to menstrual cycle stage. Specimen adequacy is stage-dependent for women who take oral contraceptives. Whereas specimens can be collected at any time other than the first week of the menstrual cycle, accurate determination of infection status requires multiple assessments.

Laboratory diagnosis of latent human papillomavirus infection.

The etiologic association of human papillomavirus (HPV) with uterine cervical cancer has prompted the need for improved laboratory diagnosis of this virus. The application of conventional hybridization technology, including filter in situ hybridization (FISH) and Southern-blot analysis, has revealed that the detection and typing of the virus is inconsistent between sequential specimens from the same individual. To determine whether the polymerase chain reaction (PCR) can be used to provide a more accurate assessment of infection status, two exfoliated cervical cell specimens obtained sequentially from a cohort of 30 women without clinical evidence of cervical abnormalities were analyzed in parallel by FISH and PCR at 6-month intervals. Neither of the procedures provided consistent findings with two sequential specimens suggesting that multiple analyses are necessary to assess infection accurately. However, PCR was less subjective in interpretation and demonstrated greater specificity than did FISH. With the increased sensitivity inherent to PCR, our findings indicated that PCR is more likely to identify latent HPV infection with a single specimen.