Robbert Soeters

Acetic acid visualization of the cervix: an alternative to cytologic screening.

Objective To investigate the value of acetic acid visualization of the cervix as an alternative to cytologic screening. Methods A prospective study was conducted in a squatter area in Cape Town, South Africa, on 2426 women who underwent speculum examination, naked-eye inspection of the cervix after application of acetic acid, and cytologic smear. The smears were stained and processed at the screening site. Patients with a positive reading after acetic acid or a smear indicating a high-grade squamous intraepithelial lesion (SIL) were referred for immediate colposcopy, biopsy, and when indicated, treatment by large loop excision of the transformation zone. Therefore, histology was obtained on all patients with a positive acetic acid test or a positive cytology. Results Seventy-six women with positive reactions to acetic acid. Among the 2350 women with negative reactions, 254 had positive cervical smears; only 11 of these had histologic high-grade SIL. In contrast, 20 of the 61 women with positive cytology and positive acetic acid test had high-grade SIL on histology. Therefore, the acetic acid reaction enabled the observer to detect 20 of the 31 women (64%) who exhibited a high-grade SIL both on cytology and histology. Conclusion In locations where access to cytopathology is limited, naked-eye visualization of the cervix after application of diluted acetic acid warrants consideration as an alternative in the detection of cervical premalignant lesions.

Seroresponses to human papillomavirus types 16, 18, 31, 33, and 45 virus-like particles in South African women with cervical cancer and cervical intraepithelial neoplasia.

The aim of the study was to determine the prevalence of antibodies to human papillomavirus (HPV) types 16, 18, 31, 33, and 45 in woman in Cape Town with cervical intraepithelial neoplasia (CIN) (n = 95), cervical cancer (n = 40), female blood donors (n = 95) and children (n = 110). The enzyme‐linked immunosorbent assay (ELISA) made use of baculovirus synthesised HPV virus like particles (VLPs) as antigen. Antibodies to at least one HPV type were detected in sera from 75% of cancer patients, 71.6% of CIN patients, 44.2% of blood donors and 27.3% of children. Sera from 95 women with CIN were compared with age‐matched female blood donors. There was a significant association of seropositivity to VLP‐16 (P = 0.006) and VLP‐45 (P = 0.008) with CIN compared with the blood donors. There was also a significant difference in the seropositivity of women with CIN to any of the five virus‐like particle (VLP) types compared to the blood donors (P = 0.0002: OR = 3.2). Thirty‐nine of sixty‐nine (56.5%) women with CIN were found to be HPV‐16 DNA positive. The average age of women in this group that were VLP‐16 seropositive was 34 years and those found to be VLP‐16 seronegative was 52 years of age. Antibodies to all five VLP types were detected in these populations, thus an ideal vaccine should induce protection from infection by a wide range of HPV types. J. Med. Virol. 60:403–410, 2000.

Peutz‐Jeghers syndrome in association with adenoma malignum (minimal deviation adenocarcinoma) of the cervix. Case report

A 44-year-old woman was admitted to the Gynaecological Oncology and Radiotherapy unit of the Groote Schuur Hospital in Cape Town for persistent dysuria and a vaginal tumour. At the age of 16 the diagnosis of PeutzJeghers syndrome (PJS) had been made after she had presented with rectal bleeding and was found to have melanin pigmentation around the mouth and on her fingers. At the time she underwent surgery twice to relicvc intestinal obstruction due to duodenal intussusception. Two ycars later she had a bowel resection at which time duodenal hamartomatous polyps were found confirming the diagnosis of PJS. At the agc of 19 several anal polyps were removed. At the age of 40 she underwent a total abdominal. hysterectomy with bilateral salpingooophorectomy for menorrhagia. Histological examination of the cervix was thought to show adenosis. Three years later she presented to her gynaecologist with persistent dysuria, when the

Combined chemotherapy and radiotherapy in patients with advanced squamous carcinoma of the cervix (cis-platinum-bleomycin-vinblastine)

In a pilot study, nine patients with advanced carcinoma of the cervix were treated with combination chemotherapy including cis-platinum, vinblastine, and bleomycin repeated at 3-week intervals for three courses followed by radiotherapy. Only one patient showed a partial response (reduction of tumor size more than 50%). There were no complete responses. Five of the nine patients have died from the disease with a median survival time of 20 months. These findings suggest that this particular combination of chemotherapy with radiotherapy does not have a significant effect in patients with advanced stage carcinoma of the cervix.

Ultrasonography of pelvic masses

29 Romero R, Avila C, Brekus C et al. The role of systemic and intrauterine infection in preterm parturition in uterine contractility. In: Garfield R, editor. Mechanism of Control. Norwell, Massachusetts: Serono Symposia, 1990: 319-353. 30 Romero R, Quintero R, Nores J et al. Amniotic fluid white blood count: a rapid and simple test to diagnose microbial invasion of the amniotic cavity and predict preterm delivery. Am J Obstet Gynecol

A rare case of a synchronous endometrioid adenocarcinoma of the ovary and of eutopic endometrium in a patient with endometriosis

Malignant transformation of endometriosis is a rare, documented complication of endometriosis. Endometriosis shares characteristics with malignancy and has biological systems central to its progression and malignant transformation. Evidence has emerged on the role of the fallopian tube in endometriosis and ovarian cancer. This has led to a paradigm shift in how the fallopian tube is viewed. This is a case of endometrioid adenocarcinoma of the ovary arising from endometriosis, occurring synchronously in eutopic endometrium. There is agreement on the risk factors of malignant transformation of endometriosis which should assist in clinical vigilance and screening of ovarian cancer associated with endometriosis. Although most ovarian malignancies require aggressive therapy, endometriosis-associated ovarian cancer appears to be less aggressive, is diagnosed early and has a better prognosis and overall survival.

A clinical appraisal of stage 1 mucinous carcinoma of the ovary

Thirty patients with stage I mucinous carcinoma of the ovary are reviewed with special reference to possible prognostic factors. The role of adjuvant therapy is discussed. Adjuvant therapy is recommended only for patients with poorly differentiated tumours and with stage Ic disease.