Roland P. Matthews

Cervical cancer as an AIDS-defining illness.

Objective To evaluate the importance of cervical cancer in the spectrum of human immunodeficiency virus (HIV)-related diseases at a single high-risk institution and to compare disease characteristics in HIV-infected women with cervical cancer and those with other AIDS-related malignancies. Methods We retrospectively reviewed data on cervical cancer and AIDS in women registered through the New York City Department of Health and institutional tumor registries from 1987 through 1995. Results During the study period, cervical cancer was diagnosed in 28 HIV-positive women. In 26, cervical cancer was the initial AIDS-defining illness, representing 4% (26 of 725) of the subjects, and it was the sixth most common initial AIDS-defining illness in women. Cervical cancer was the most common AIDS-related malignancy among women, representing 55% of the cases, followed by lymphoma (29%) and Kaposi sarcoma (16%). In 71% of the women with cervical cancer, HIV infection was diagnosed at the time of cancer presentation by routine testing, whereas in women with other malignancies, HIV diagnosis preceded cancer diagnosis (70%) by a mean of 2.7 years. Patients with other malignancies had greater immunosuppression (mean CD4 count 153/μL) than those with cervical cancer (mean CD4 count 312/μL). The recurrence rate for women with cervical cancer was 88%. Although the interval from cancer diagnosis to death was similar in all three groups (9.1–12.4 months), cancer was the cause of death in 95% of HIV-infected women with cervical cancer, compared with 60% of those with other AIDS-related malignancies. Conclusion In urban populations at increased risk for both diseases, cervical cancer is an important AIDS-defining illness and may be the most common AIDS-related malignancy in women.

Is HIV infection a risk factor for advanced cervical cancer

OBJECTIVES To compare HIV-infected and HIV-negative women with invasive cervical cancer with respect to predictors of advanced disease. METHODS A retrospective analysis of 28 HIV-positive and 132 HIV-negative women with invasive cervical carcinoma was conducted and the two groups were compared with regard to stage of disease, demographic and behavioral variables, and risk factors for advanced disease. RESULTS Overall, HIV-infected women were more likely to have advanced disease, because 78% of HIV-positive women had Stage II to IV compared with 55% of HIV-negative women (odds ratio [OR] = 3.1; p = .03). Substance abuse was strongly associated with HIV infection, as were high-risk sexual variables. Although HIV infection was associated with a threefold increase in advance stage cervical cancer in a univariate analysis, only symptom duration and lack of a recent Papanicolaou smear were significant predictors of advanced disease in a multiple logistic regression analysis. CONCLUSIONS The major predictors of advanced cervical cancer are similar in HIV-positive and HIV-negative women, although the reasons for these predictors may be very different. It is likely that a large proportion of HIV-positive patients with cervical cancer acquire HIV infection after initiation of the neoplastic process.

Cone biopsy and pathologic findings at radical hysterectomy in stage I cervical carcinoma

OBJECTIVE To examine the association between cone biopsy and pathologic findings at radical hysterectomy in stage I cervical carcinoma. METHODS Fifty‐four patients diagnosed by cone biopsy with stage I cervical carcinoma and treated with radical hysterectomy comprised the study group. The association between the depth of invasion on conization, lymph‐vascular invasion, positive cone margins, positive endocervical curettage (ECC), and the depth of residual invasion in the radical hysterectomy specimen was examined using Pearson r and point biserial correlation. Independent predictors of the depth of residual invasion were determined by multiple regression. RESULTS The depth of residual invasion correlated significantly with the depth of invasion (r = .374) and presence of lymph‐vascular invasion (rpb = .372) in the conization specimen, post‐cone ECC status (rpb = .669), and age at diagnosis (r = .347). The same factors were jointly assessed using multiple regression (R2 = .636, P < .001). Depth of invasion on conization, lymph‐vascular invasion, and ECC status were identified as independent predictors of the depth of residual invasion. Patients with deep (5 mm or greater) stromal invasion and lymph‐vascular invasion on conization had significantly higher rates of positive parametrial margins (22% compared with zero, P = .001) and adjuvant radiation (66.7% compared with 20%, P = .004) compared with all other patients. CONCLUSION Depth of invasion, presence of lymph‐vascular invasion, and age at diagnosis were independent predictors of the depth of residual invasion in the subsequent hysterectomy specimen. These factors should be considered in treatment planning. Patients with a combination of these factors may have increased risk for deep residual invasion, positive hysterectomy margins, and adjuvant radiation.

Magnetic resonance imaging in the preoperative determination of tumor resectability in previously irradiated groin tumor

We present an unusual case in which magnetic resonance (MR) imaging was utilized in the preoperative determination of resectability of a large inguinal tumor. The patient had previously presented with a large fungating, surgically nonresectable mass, which impinged upon the anterior ramus of the pubic bone. Following chemotherapy and radiation, the mass appeared more mobile and surgically resectable. Due to fibrosis and induration, the relationship of the tumor and underlying femoral vascular bundle were unclear. MR imaging clearly depicted that the tumor was sufficiently distant from the vessels, to allow safe resection with an adequate surgical margin. Resection was performed with clear lateral and deep margins. Histopathology demonstrated squamous cell carcinoma of the inguinal skin replacing subcutaneous tissue.