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- Volume 6, Issue 1, 2014
Southern African Journal of Gynaecological Oncology - Volume 6, Issue 1, 2014
Volume 6, Issue 1, 2014
Author Greta DreyerSource: Southern African Journal of Gynaecological Oncology 6, pp 3 –4 (2014)More Less
Lower genital tract gynaecological cancers remain classic examples of diseases which are so-called noncommunicable, but which are caused by infective agents; challenging our desire to classify in order to control. The epidemiology of these cancers follows that of several sexually transmitted infections. Interactions between different infective agents are intriguing, and although often studied, remain difficult to prove and understand. Current evidence demonstrates viruses to be by far the most important infective oncogenes, with other infections acting as co-factors in transmission at most. An intact mucosa in cervical pathogenesis may be critical, as has also been demonstrated in human immunodeficiency virus (HIV) transmission trials.
Case of invasive adenocarcinoma of the cervix in a human immunodeficiency virus and schistosome co-infected patient : letter to the editorAuthor Louis Van BogaertSource: Southern African Journal of Gynaecological Oncology 6, pp 5 –6 (2014)More Less
I read with interest the case report on invasive adenocarcinoma of the cervix in a human immunodeficiency virus (HIV) and schistosome co-infected patient. I would like to make some comments. Schistosomiasis is endemic in Limpopo, Mpumalanga and KwaZulu-Natal. Prevention rests on two legs: water sanitation and the screening of schoolchildren. Because of the high cost of water sanitation, the main preventive measure is screening and treatment at school level. Unfortunately, no systematic prevention programme has been implemented in South Africa.
Small biopsy pathology of mass lesions of the endometrial cavity : differential diagnostic considerations : review articleSource: Southern African Journal of Gynaecological Oncology 6, pp 7 –14 (2014)More Less
Sampling for histological examination is usually part of the work-up for further planning with regard to the management of patients presenting with uterine bleeding. This review, utilising the classification of the World Health Organization, aims to discuss some commonly recurring differential diagnostic problems on small biopsy specimens. Diagnostic difficulties generally relate to representativeness of the sample, determining the site of the lesion, and fragmentation and trauma artefact. Reference is made to clinical relevance, and attention drawn to some lesser known diagnostic entities. Morphological features and immunohistochemical markers that are useful in certain differential diagnostic scenarios are highlighted. The level of diagnostic certainty should be indicated in the report, and when the limitations do not permit a definite diagnosis in a small sample, the pathologist should provide the clinician with a differential diagnosis on which further management decisions can be based.
The role of sentinel lymph node biopsy in cervical cancer : an overview of the literature : review articleSource: Southern African Journal of Gynaecological Oncology 6, pp 15 –21 (2014)More Less
Cervical cancer is the second most common cancer in southern African women. Although the FIGO staging does not include lymph node status, lymph node metastasis is an important risk factor for recurrence and death in patients with early cervical cancer. Accurate information about lymph node metastasis is crucial to decide on optimal individualised treatment. Complete pelvic lymphadenectomy is the current standard used to obtain accurate information on lymph node status. Because of the low incidence of nodal metastasis in patients with early cervical cancer, identifying women in whom lymphadenectomy can be safely avoided would result in less morbidity associated with pelvic lymphadenectomy, without compromising overall and disease-free survival. Over the past 15 years, the role of sentinel lymph node (SLN) biopsy has been studied extensively in patients with early-stage cervical cancer. Assessment of the SLN in women with early-stage disease may potentially offer an alternative to complete lymphadenectomy. Data are limited with regard to the role of SLN assessment in patients with cervical cancer in low-resource settings where the prevalence of HIV and other gynaecological infections is high.
HPV L1 capsid protein detection in high-risk human papillomavirus-positive cervical smears : original researchSource: Southern African Journal of Gynaecological Oncology 6, pp 22 –26 (2014)More Less
Background : The L1 capsid protein is a viral nuclear protein that encapsidates the human papillomavirus (HPV) DNA to build new infectious particles. Previous studies in immune-competent patients have shown that detectable L1 protein in lowgrade squamous intraepithelial lesion (LSIL) smears is associated with remission in 60-75% of cases. Thus, the test can reduce interventions by approximately 75%.
Objective : This study was performed to evaluate the use of HPV L1 capsid protein detection on cytology samples in a population with relatively high human immunodeficiency virus (HIV) prevalence and with known high-risk HPV (hrHPV) DNA results.
Setting : Samples were obtained during a cervical cancer screening study at primary healthcare clinics in the Tshwane district, Gauteng. The HIV prevalence of the target group was estimated to be between 20% and 30%.
Method : Conventional cervical cytology smears of 575 women were microscopically assessed and diagnosed. In addition, women were tested for the presence of HPV DNA on a cervical or vaginal sample. Immunocytochemical analysis was performed on morphologically abnormal smears and on a 52 control group smears reported to be negative for HPV DNA and morphological abnormalities. The detection of L1 capsid protein was carried out with the Cytoactiv® HPV L1 screening set, an antibody-based immunocytochemical stain.
Results : A cytological diagnosis of LSIL was made in 19 women (3.3%), high-grade squamous intraepithelial lesions (HSILs) in 42 (7.5%) and malignancy in 1 (0.2%). Of the LSIL cases, 10 of 19 (52.6%) stained positive for the presence of the L1 protein, while only one of 42 HSIL (2.4%) cases stained positive. Three hundred and four cases (52.9%) tested positive for hrHPV DNA, including women with LSIL, HSIL and malignancy. All of the control cases stained negative for the L1 capsid protein.
Conclusion : hrHPV was not a useful triage test for women with abnormal cellular morphology in this population. Promising results were reported for Cytoactiv® immunostaining as a triage test for patients with LSIL, but it added no value to samples known to be HPV-negative or reported to be morphologically negative. The immunostaining of smears reported to be HSIL or worse were almost universally negative, supporting the diagnostic accuracy of cytology and the expectation of persistence or progression of these lesions.
Source: Southern African Journal of Gynaecological Oncology 6, pp 27 –29 (2014)More Less
Rosai-Dorfman disease, also termed sinus histiocytosis with massive lymphadenopathy (SHML), represents a rare proliferative disorder of histiocytes, that commonly affects the cervical lymph nodes. It was first described as a unique clinicopathological entity by Rosai and Dorfman in 1969. Extranodal disease is encountered in almost half of all cases, presenting within the skin, soft tissue, salivary glands, bone or central nervous system. We describe a case of a young female who presented with an iliac fossa mass. Radiological imaging failed to demonstrate abnormalities within the uterus or the adnexae. A biopsy of the mass revealed sinus histiocytosis with emperipolesis, consistent with a diagnosis of Rosai-Dorfman disease. The patient was treated with conventional chemotherapy, followed by surgical intervention in the form of complete pelvic lymph node clearance. The patient has remained disease free to date.
Fertility-sparing treatment in a young patient with complex atypical hyperplasia of the endometrium : case studyAuthor G.C. Du ToitSource: Southern African Journal of Gynaecological Oncology 6, pp 30 –32 (2014)More Less
Endometrial carcinoma is a common gynaecologicalmalignancy in developed countries. It affects postmenopausal women predominantly, but 25% of cases occur in premenopausal women, 5% of whom are younger than 40 years of age. Complex atypical hyperplasia (CAH) of the endometrium is a precursor to endometrial carcinoma, with a progression rate to carcinoma of 10%. Women with stage I, grade 1 endometrial carcinoma treated by hysterectomy, have a 99.2% five-year survival. The high cure rate of the disease shifts the treatment focus to issues of quality of life subsequent to successful treatment. Young nulliparous women with CAH raise the possibility of fertility-sparing treatment. The treatment approach to CAH is viewed in the same light as that pertaining to early-stage endometrial carcinoma. In both scenarios, fertility-sparing treatment (with subsequent successful pregnancies) has been described. The conservative management of CAH poses several challenges with regard to adequate sampling of the endometrium, as well as optimal treatment and follow-up monitoring. The current case illustrates successful conservative management of CAH.
Case of a locally advanced carcinoma cervix presenting with protrusio acetabuli : pre-screening era presentation rarely seen in modern times : case studySource: Southern African Journal of Gynaecological Oncology 6, pp 33 –35 (2014)More Less
Cervical cancer is the third most commonly diagnosed cancer, and the fourth leading cause of cancer deaths in women worldwide. In 2008, there were an estimated 529 000 new cases of cervical cancer, and 275 000 cervical cancer-related deaths. Cancer of the cervix has been the most common cancer in women in India for the past two decades.