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Pham JP, Allen N, Star P, Cust AE, Stewart C, Guitera P, Marghoob AA, Smith A. Full-body skin examination in screening for cutaneous malignancy: a focus on concealed sites and the practices of Australian dermatologists. Int J Dermatol 2024; 63:467-473. [PMID: 38036942 PMCID: PMC11326497 DOI: 10.1111/ijd.16942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/01/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Full-body skin examination (FSE) is a vital practice in the diagnosis of cutaneous malignancy. Precisely how FSE should be conducted with respect to concealed site inclusion remains poorly elucidated. OBJECTIVE To establish the approach of Australian dermatologists to concealed site examination (CSE). METHODS A cross-sectional study was performed consisting of an online self-administered 11-question survey delivered to fellows of the Australasian College of Dermatologists. RESULTS There were 237 respondents. Anogenitalia was the least often examined concealed site (4.6%), and 59.9, 32.9, and 14.3% reported always examining the scalp, breasts, and oral mucosa, respectively. Patient concern was the most frequently cited factor prompting examination, while many cited low incidence of pathology and limited chaperone availability as the main barriers to routine examination of these sites. CONCLUSION Most Australian dermatologists do not routinely examine breasts, oral mucosal, or anogenital sites as part of an FSE. Emphasis should be made on identifying individual patient risk factors and education regarding self-examination of sensitive sites. A consensus approach to the conduct of the FSE, including concealed sites, is needed to better delineate clinician responsibilities and address medicolegal implications.
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Affiliation(s)
- James P Pham
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Darlinghurst, NSW, Australia
| | - Nicholas Allen
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Phoebe Star
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute of Australia, North Sydney, NSW, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Cameron Stewart
- Sydney Health Law, Sydney Law School, University of Sydney, Sydney, NSW, Australia
| | - Pascale Guitera
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute of Australia, North Sydney, NSW, Australia
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Annika Smith
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute of Australia, North Sydney, NSW, Australia
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Choi S, Ismail A, Pappas-Gogos G, Boussios S. HPV and Cervical Cancer: A Review of Epidemiology and Screening Uptake in the UK. Pathogens 2023; 12:pathogens12020298. [PMID: 36839570 PMCID: PMC9960303 DOI: 10.3390/pathogens12020298] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Cervical cancer is the fourth most common malignancy in females worldwide, and a leading cause of death in the United Kingdom (UK). The human papillomavirus (HPV) is the strongest risk factor for developing cervical intraepithelial neoplasia and cancer. Across the UK, the national HPV immunisation programme, introduced in 2008, has been successful in protecting against HPV-related infections. Furthermore, the National Health Service (NHS) implemented the cytology-based cervical cancer screening service to all females aged 25 to 64, which has observed a decline in cervical cancer incidence. In the UK, there has been an overall decline in age-appropriate coverage since April 2010. In 2019, the COVID-19 pandemic disrupted NHS cancer screening and immunisation programmes, leading to a 6.8% decreased uptake of cervical cancer screening from the previous year. Engagement with screening has also been associated with social deprivation. In England, incidence rates of cervical cancer were reported to be 65% higher in the most deprived areas compared to the least, with lifestyle factors such as cigarette consumption contributing to 21% of cervical cancer cases. In this article, we provide an update on the epidemiology of cervical cancer, and HPV pathogenesis and transmission, along with the current prevention programmes within the NHS.
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Affiliation(s)
- Sunyoung Choi
- GKT School of Medicine, King’s College London, London SE1 9RT, UK
| | - Ayden Ismail
- GKT School of Medicine, King’s College London, London SE1 9RT, UK
| | - George Pappas-Gogos
- Department of General Surgery, University Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, 6th Kilometer, 68100 Alexandroupolis, Greece
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Kent, Gillingham ME7 5NY, UK
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK
- Kent Medway Medical School, University of Kent, Kent, Canterbury CT2 7LX, UK
- AELIA Organization, 9th Km Thessaloniki—Thermi, 57001 Thessaloniki, Greece
- Correspondence: or or or
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Rousset-Jablonski C, Mekki Y, Denis A, Reynaud Q, Nove-Josserand R, Durupt S, Touzet S, Perceval M, Ray-Coquard I, Golfier F, Durieu I. Human papillomavirus prevalence, persistence and cervical dysplasia in females with cystic fibrosis. J Cyst Fibros 2022:S1569-1993(22)01415-1. [DOI: 10.1016/j.jcf.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/14/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022]
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Wielgos A, Pietrzak B, Suchonska B, Sikora M, Rudnicka L, Wielgos M. A Six-Year Gynecological Follow-Up of Immunosuppressed Women with a High-Risk Human Papillomavirus Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3531. [PMID: 35329222 PMCID: PMC8953826 DOI: 10.3390/ijerph19063531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 12/16/2022]
Abstract
Immunocompromised women are at an increased risk of developing malignancies, especially those that are viral-induced, such as invasive cervical cancer caused by the human papillomavirus (HPV). The aim of the study was to describe gynecological follow-up of women undergoing chronic immunosuppressive therapy for various reasons (e.g., kidney/liver transplant, systemic lupus erythematosus), diagnosed with a high-risk HPV (hrHPV) infection based on a self-sampling test. Twenty-six hrHPV-positive women were invited to take part in a gynecological follow-up, including a visual assessment of the anogenital region, two-handed gynecological examination, and cervical cytology as well as a colposcopy and cervical biopsy when necessary. Four women declined taking part in the study. Over six years of observation, low-grade squamous intraepithelial lesions (LSIL) were detected at least once in 7/22 women (31.8%), and a cervical intraepithelial lesion 1 (CIN 1) histopathologic result was obtained five times in 3/22 women. No cases of high-grade squamous intraepithelial lesions, CIN 2/3, or invasive cervical cancers were observed. Loop electrosurgical excision procedure (LEEP) was performed in three patients. As immunocompromised women are prone to persistent hrHPV infections, they should be under strict gynecological supervision because only vigilant surveillance enables fast detection and treatment of early dysplasia and, therefore, provides a chance for the reduction of the cervical cancer burden.
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Affiliation(s)
- Aleksandra Wielgos
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland;
| | - Bronisława Pietrzak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-115 Warsaw, Poland; (B.P.); (B.S.); (M.W.)
| | - Barbara Suchonska
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-115 Warsaw, Poland; (B.P.); (B.S.); (M.W.)
| | - Mariusz Sikora
- National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-006 Warsaw, Poland;
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland;
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-115 Warsaw, Poland; (B.P.); (B.S.); (M.W.)
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Thornton C, Somayaji R, Chu A, Parkins MD. Human papillomavirus (HPV) and cervical dysplasia in adult female cystic fibrosis (CF) lung transplant recipients. Thorax 2022; 77:625-627. [PMID: 35121654 DOI: 10.1136/thoraxjnl-2021-218461] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/10/2022] [Indexed: 11/03/2022]
Abstract
Human papillomavirus (HPV) is the principal risk factor for cervical cancer. Transplant recipients are at a disproportionate risk of HPV complications. We conducted a single-centre, retrospective study of adult female cystic fibrosis (CF) lung transplant recipients between 2008 and 2021. We observed 12 of 34 (35.3%) with ≥1 abnormal pap smear (median age: 26.7 years). Complications included refractory anogenital warts (n=3), vulvectomy (n=2) and cervical cancer (n=4), with two deaths from metastatic disease. None with HPV morbidity was vaccinated. Lung transplant recipients had greater odds of cervical dysplasia relative to controls (OR, 3.98; 95% CI 1.17 to 11.82). CF care providers must prioritise HPV vaccination to attenuate potential future morbidity and mortality.
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Affiliation(s)
- Christina Thornton
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ranjani Somayaji
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Angel Chu
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Michael D Parkins
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada .,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
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Rousset-Jablonski C, Haesebaert J, Denis A, Reix P, Llerena C, Perceval M, Touzet S, Durieu I. Human Papilloma Virus Vaccination Among Female Patients Attending French Pediatric Cystic Fibrosis Centers. J Pediatr Adolesc Gynecol 2021; 34:317-323. [PMID: 33338628 DOI: 10.1016/j.jpag.2020.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/06/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To describe human papilloma virus (HPV) vaccination practice among adolescent girls with cystic fibrosis (CF) and to identify reasons for non-vaccination. DESIGN Cross-sectional multicentric study. SETTING AND PARTICIPANTS Girls aged 9-17 years, attending 7 French pediatric CF centers, and their accompanying adult. INTERVENTIONS Administration of a self-report questionnaire. MAIN OUTCOME MEASURES The proportion of girls having received or receiving HPV vaccination, compliance with the vaccination schedule, factors associated with vaccination, and reasons for vaccination and for non-vaccination. RESULTS A total of 113 girls and 104 accompanying adults participated. The mean age was 13.6 years (standard deviation 2.5; range 9-17). A total of 34 (30.9%) patients reported having received HPV vaccination. Among the 34 girls aged 15 years or older, 15 (44.1%) were vaccinated. Most patients (58.8%) started vaccination between 11 and 14 years of age (mean age 13.9). Most vaccine prescriptions (67.6%) were made by a CF center health care provider. Factors associated with vaccination were older age (odds ratio [OR] = 1.27, 95% confidence interval [CI] = 1.01-1.6, P = .037 for each year older), previous vaccination by the accompanying parent of one of their children for hepatitis B (OR = 8.01, 95% CI = 0.96-67.02), P = .055), and parental influence on decision-making (OR = 2.77, 95% CI = 0.97-7.95, P = .058). Health care providers' positive advice and fear of HPV-related disease were the main reasons given to justify vaccination decisions. Insufficient knowledge and concerns about potential side effects were the main barriers. CONCLUSION HPV vaccination remains insufficient among girls with CF. CF health care providers may play a crucial role in HPV vaccination acceptance, and their sensitization to cervical cancer prevention is mandatory.
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Affiliation(s)
- Christine Rousset-Jablonski
- Department of Internal medicine, Cystic Fibrosis Adult Reference Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Pierre Benite, France; Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Groupe Hospitalier Sud, Pierre Benite, France; Department of Surgical Oncology, Leon Berard Cancer Center, Centre Léon Bérard, Lyon, France; EA 7425 HESPER-Health Services and Performance Research-Lyon 1 Claude Bernard University, Lyon, France.
| | - Julie Haesebaert
- EA 7425 HESPER-Health Services and Performance Research-Lyon 1 Claude Bernard University, Lyon, France; Pôle de Santé Publique-Service de Recherche et d'Epidémiologie Cliniques, Hospices civils de Lyon, Groupement hospitalier Est, Bron, France
| | - Angélique Denis
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - Philippe Reix
- Service de Pneumologie Pédiatrique et CRCM enfant, Hospices civils de Lyon, Hôpital Femme Mère Enfant, Bron, France; UMR 5558 (EMET), CNRS, LBBE, Université de Lyon, Villeurbanne, France
| | - Cathy Llerena
- Pneumologie Pédiatrique, Antenne Pédiatrique du CIC, Center Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
| | - Marie Perceval
- Department of Internal medicine, Cystic Fibrosis Adult Reference Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Pierre Benite, France
| | - Sandrine Touzet
- EA 7425 HESPER-Health Services and Performance Research-Lyon 1 Claude Bernard University, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - Isabelle Durieu
- Department of Internal medicine, Cystic Fibrosis Adult Reference Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Pierre Benite, France; EA 7425 HESPER-Health Services and Performance Research-Lyon 1 Claude Bernard University, Lyon, France
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7
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Klitzke S, Wender IO, Salcedo MP, Pessini SA. Cervical cancer screening abnormalities in immunosuppressed renal transplant women: case-control study in Southern Brazil. Arch Gynecol Obstet 2020; 302:649-655. [PMID: 32488400 DOI: 10.1007/s00404-020-05621-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the prevalence of cervical pre-malignancies in the cervical cytology of female renal transplant recipients (RTR) and compare to immunocompetent patients. METHODS A prospective case-control study of 165 RTR (cases) and 372 immunocompetent women (controls) was carried out from May 2015 to August 2016. The participants completed a questionnaire with demographic characteristics, habits, reproductive history, and information about the renal transplant. Cervical cytology samples were collected at their visit for cervical cancer screening. Relevant medical history was obtained from medical records and previous cervical cytology results were retrieved: from the time of kidney transplantation to the beginning of this study for RTR and all collected throughout life for controls. RESULTS The mean age was similar between groups (42.6 ± 11.4 vs. 41.8.2 ± 11.1 years, p = 0.447). Considering cervical cytology collected since the kidney transplant, RTR had three times higher rates of abnormal cervical cytology test (24.8% of RTR vs. 6.3% for controls), and the abnormalities were more frequent (p < 0.001) for low squamous intraepithelial lesion (LSIL) (n = 23, 13.9%) and high squamous intraepithelial lesion (HSIL) (n = 9, 5.5%). Cervical cytology collected during the study had normal results in 152 RTR (92.1%) vs. 326 controls (93.9%) (p > 0.05). When the altered results were broken down, a higher frequency of LSIL could be seen in RTR (3.6% vs 0.0%, p = 0.008). CONCLUSION RTR had significantly higher rates of cervical cytology abnormalities comparing to the control group and most of it was composed of LSIL.
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Affiliation(s)
- Sibele Klitzke
- Graduate Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Isabella Osorio Wender
- School of Medicine, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Mila Pontremoli Salcedo
- Graduate Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal de Ciências da Saúde de Porto Alegre/Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - Suzana Arenhart Pessini
- Graduate Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil. .,Department of Obstetrics and Gynecology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
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Vinkenes E, Nielsen MA, Blaakaer J. Is there evidence for efficacy of human papillomavirus vaccination in solid organ transplant recipients? Eur J Obstet Gynecol Reprod Biol X 2019; 4:100015. [PMID: 31673683 PMCID: PMC6817653 DOI: 10.1016/j.eurox.2019.100015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/20/2019] [Accepted: 03/23/2019] [Indexed: 11/25/2022] Open
Abstract
Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide and is associated with precancerous lesions and cancers of the cervix, vulva, vagina, penis, anus, tonsils and base of the tongue. Several studies show an increased risk of HPV-associated cancers in solid organ transplant recipients (SOTR). The aims of this review are to investigate the evidence of efficacy for the HPV vaccination in transplant recipients and to discuss the known national guidelines. A systematic literature search has been conducted to identify studies where SOTR received the HPV vaccination to evaluate the efficacy of the HPV vaccine on this population. The primary outcome was antibody response against the HPV genotypes included in the vaccines and the secondary outcome was national guidelines recommending HPV vaccination of SOTR. Three cohort studies evaluated immunogenicity. Two studies found suboptimal effect of the HPV vaccine, while an early terminated study detected 100% seropositivity. We have identified four national guidelines in the following countries; United States of America, Canada, Australia and Ireland, along with a recommendation from the World Health Organization (WHO). The results from the three studies were inconclusive due to the small sample sizes and the diverging results. Recommendations of HPV vaccination of SOTR is based on the knowledge about safety and efficiency in the general population and the safety of other inactivated (not live) vaccines in SOTR. Theoretically, the nonavalent vaccine should be recommended as the first choice in SOTR without age- or sex restrictions.
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Affiliation(s)
- Emeline Vinkenes
- Odense University Hospital, Dept. of Obstetrics. & Gyn, Sdr. Boulevard 29, Odense 5000 C, Denmark
| | - Martine A Nielsen
- Odense University Hospital, Dept. of Obstetrics. & Gyn, Sdr. Boulevard 29, Odense 5000 C, Denmark
| | - Jan Blaakaer
- Odense University Hospital, Dept. of Obstetrics. & Gyn, Sdr. Boulevard 29, Odense 5000 C, Denmark
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Reinholdt K, Thomsen LT, Dehlendorff C, Larsen HK, Sørensen SS, Hædersdal M, Kjær SK. Human papillomavirus‐related anogenital premalignancies and cancer in renal transplant recipients: A Danish nationwide, registry‐based cohort study. Int J Cancer 2019; 146:2413-2422. [DOI: 10.1002/ijc.32565] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/21/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Kristian Reinholdt
- Unit of Virus, Lifestyle and Genes Danish Cancer Society Research Center Copenhagen Denmark
| | - Louise T. Thomsen
- Unit of Virus, Lifestyle and Genes Danish Cancer Society Research Center Copenhagen Denmark
| | - Christian Dehlendorff
- Unit of Statistics and Pharmacoepidemiology Danish Cancer Society Research Center Copenhagen Denmark
| | - Helle K. Larsen
- Unit of Virus, Lifestyle and Genes Danish Cancer Society Research Center Copenhagen Denmark
- Department of Dermato‐Venerology Bispebjerg Hospital, Copenhagen University Hospital Copenhagen Denmark
| | - Søren S. Sørensen
- Department of Nephrology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Merete Hædersdal
- Department of Dermato‐Venerology Bispebjerg Hospital, Copenhagen University Hospital Copenhagen Denmark
| | - Susanne K. Kjær
- Unit of Virus, Lifestyle and Genes Danish Cancer Society Research Center Copenhagen Denmark
- Department of Gynecology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
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Guidelines for Cervical Cancer Screening in Immunosuppressed Women Without HIV Infection. J Low Genit Tract Dis 2019; 23:87-101. [DOI: 10.1097/lgt.0000000000000468] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Eleutério J, Cavalcante LR, Gonçalves AKS, Eleutério RMN, Giraldo PC. Prevalence of high‐risk HPV and atypia in liquid‐based cytology of cervical and intra‐anal specimens from kidney‐transplanted women. Diagn Cytopathol 2019; 47:783-787. [PMID: 30897299 DOI: 10.1002/dc.24180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/23/2019] [Accepted: 03/07/2019] [Indexed: 11/10/2022]
Affiliation(s)
- José Eleutério
- Department of Maternal and Child Health, Faculty of MedicineFederal University of Ceará Fortaleza Brazil
- Division of Molecular BiologyProf. Eleuterio Laboratory Fortaleza Brazil
| | - Liana R. Cavalcante
- Department of Maternal and Child Health, Faculty of MedicineFederal University of Ceará Fortaleza Brazil
| | - Ana K. S. Gonçalves
- Gynecology and Obstetrics DepartmentFederal University of Rio Grande do Norte Natal Brazil
| | | | - Paulo C. Giraldo
- Gynecology and Obstetrics DepartmentState University of Campinas Campinas Brazil
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Martínez-Gómez X, Curran A, Campins M, Alemany L, Rodrigo-Pendás JÁ, Borruel N, Castellsagué X, Díaz-de-Heredia C, Moraga-Llop FA, Del Pino M, Torné A. Multidisciplinary, evidence-based consensus guidelines for human papillomavirus (HPV) vaccination in high-risk populations, Spain, 2016. Euro Surveill 2019; 24:1700857. [PMID: 30782268 PMCID: PMC6381660 DOI: 10.2807/1560-7917.es.2019.24.7.1700857] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 10/15/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Although human papillomavirus (HPV) routine vaccination programmes have been implemented around the world and recommendations have been expanded to include other high-risk individuals, current recommendations often differ between countries in Europe, as well as worldwide. AIM To find and summarise the best available evidence of HPV vaccination in high-risk patients aiding clinicians and public health workers in the day-to-day vaccine decisions relating to HPV in Spain. METHODS We conducted a systematic review of the immunogenicity, safety and efficacy/effectiveness of HPV vaccination in high-risk populations between January 2006 and June 2016. HPV vaccination recommendations were established with levels of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS A strong recommendation about HPV vaccination was made in the following groups: HIV infected patients aged 9-26 years; men who have sex with men aged 9-26 years; women with precancerous cervical lesions; patients with congenital bone marrow failure syndrome; women who have received a solid organ transplant or hematopoietic stem cell transplantation aged 9-26 years; and patients diagnosed with recurrent respiratory papillomatosis. CONCLUSIONS Data concerning non-routine HPV vaccination in populations with a high risk of HPV infection and associated lesions were scarce. We have developed a document to evaluate and establish evidence-based guidelines on HPV vaccination in high-risk populations in Spain, based on best available scientific evidence.
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Affiliation(s)
- Xavier Martínez-Gómez
- Servei de Medicina Preventiva i Epidemiologia, Hospital Universitari Vall d'Hebron - Universitat Autònoma de Barcelona, Barcelona, España
| | - Adrian Curran
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron - Universitat Autònoma de Barcelona, Barcelona, España
| | - Magda Campins
- Servei de Medicina Preventiva i Epidemiologia, Hospital Universitari Vall d'Hebron - Universitat Autònoma de Barcelona, Barcelona, España
| | - Laia Alemany
- Programa de Recerca en Epidemiologia del Càncer, Institut Català d'Oncologia - IDIBELL CIBER Epidemiología y Salud Pública, Barcelona, España
| | - José Ángel Rodrigo-Pendás
- Servei de Medicina Preventiva i Epidemiologia, Hospital Universitari Vall d'Hebron - Universitat Autònoma de Barcelona, Barcelona, España
| | - Natalia Borruel
- Unitat d'Atenció Crohn-Colitis, Servei d'Aparell Digestiu; Hospital Universitari Vall d'Hebron - Universitat Autònoma de Barcelona, Barcelona, España
| | - Xavier Castellsagué
- Programa de Recerca en Epidemiologia del Càncer, Institut Català d'Oncologia - IDIBELL CIBER Epidemiología y Salud Pública, Barcelona, España
| | - Cristina Díaz-de-Heredia
- Servei d'Oncologia i Hematologia Pediàtrica, Hospital Universitari Vall d'Hebron - Universitat Autònoma de Barcelona, Barcelona, España
| | | | - Marta Del Pino
- Unidad de Ginecología Oncológica, Instituto Clínico de Ginecología y Obstetricia y Neonatología (ICGON), Hospital Clínic de Barcelona, Barcelona, España
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - Aureli Torné
- Unidad de Ginecología Oncológica, Instituto Clínico de Ginecología y Obstetricia y Neonatología (ICGON), Hospital Clínic de Barcelona, Barcelona, España
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Facultad de Medicina, Universidad de Barcelona, Barcelona, España
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Nissen LHC, Derikx LAAP, Jacobs AME, van Herpen CM, Kievit W, Verhoeven R, van den Broek E, Bekers E, van den Heuvel T, Pierik M, Rahamat-Langendoen J, Takes RP, Melchers WJG, Nagtegaal ID, Hoentjen F, Peutz-Kootstra C, Roelofs JJTH, Willems SM, Willig AP, van Bodegraven AA, Tan ACITL, Meeuse JJ, van der Meulen–de Jong AE, Oldenburg B, Loffeld BCAJ, Durfeld BM, van der Woude CJ, Cahen DL, D’Haens G, Janik D, Mares WGM, Gilissen LPL, Wolters FL, Dijkstra G, Erkelens GW, Tang TJ, Breumelhof R, Smalbraak HJT, Thijs JC, Voskuil JH, Kuyvenhoven JP, Vecht J, Rijk MCM, Janssen JM, Sarneel JT, Tjhie-Wensing JWM, Lai JYL, Vlasveld LT, Oostenbrug LE, Gerretsen M, Van Herwaarden MA, Mahmmod N, Russel MGVM, Grubben MJAL, Vu MK, Verhulst ML, Dewint P, Stokkers PCF, Bus PJ, Wismans PJ, van der Haeck PWE, Stuyt RJL, Zeijen RNM, Dahlmans RPM, Vandebosch S, Romkens TEH, Moolenaar W, ten Hove WR, Boot H, van der Linde K, Wahab P, de Boer SY, Thurnau K, Thijs WJ, Josemanders DFGM, West RL, Pierik MJ, Depla ACTM, Keulen ETP, de Boer WA, Naber AHJ, Vermeijden JR, Mallant-Hent RC, Beukers R, Ter Borg PCJ, Halet ECR, Bruin KF, Linskens RK, Bruins Slot W. Risk Factors and Clinical Outcomes of Head and Neck Cancer in Inflammatory Bowel Disease: A Nationwide Cohort Study. Inflamm Bowel Dis 2018; 24:2015-2026. [PMID: 30759216 DOI: 10.1093/ibd/izy096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Immunosuppressed inflammatory bowel disease (IBD) patients are at increased risk to develop extra-intestinal malignancies. Immunosuppressed transplant patients show increased incidence of head and neck cancer with impaired survival. This study aims to identify risk factors for oral cavity (OCC) and pharyngeal carcinoma (PC) development in IBD, to compare clinical characteristics in IBD with the general population, and to assess the influence of immunosuppressive medication on survival. METHODS We retrospectively searched the Dutch Pathology Database to identify all IBD patients with OCC and PC between 1993 and 2011. Two case-control studies were performed: We compared cases with the general IBD population to identify risk factors, and we compared cases with non-IBD cancer patients for outcome analyses. RESULTS We included 66 IBD patients and 2141 controls with OCC, 31 IBD patients and 1552 controls with PC, and 1800 IBD controls. Age at IBD diagnosis was a risk factor for OCC development, Crohn's disease (CD; odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.07), and ulcerative colitis (UC; OR, 1.03; 95% CI, 1.01-1.06). For PC, this applied to UC (OR, 1.05; 95% CI, 1.01-1.06). IBD OCC cases showed impaired survival (P = 0.018); in PC, survival was similar. There was no effect of immunosuppression on survival. Human papillomavirus (HPV) testing of IBD cases revealed 52.2% (12/23) HPV-positive oropharyngeal carcinomas (OPCs). CONCLUSION This study shows that IBD is associated with impaired OCC survival. Higher age at IBD diagnosis is a risk factor for OCC development. We found no influence of immunosuppression on survival; 52.2% of OPC in IBD contained HPV.
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Affiliation(s)
- Loes H C Nissen
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology.,Department of Gastroenterology and Hepatology, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands
| | | | - Anouk M E Jacobs
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology
| | - Carla M van Herpen
- Department of Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rob Verhoeven
- Netherlands Cancer Registry/Netherlands Comprehensive Cancer Organization
| | | | - Elise Bekers
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Tim van den Heuvel
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marieke Pierik
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Robert P Takes
- Department of Otorhinolaryngology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank Hoentjen
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology
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Tosti G, Iacobone AD, Preti EP, Vaccari S, Barisani A, Pennacchioli E, Cantisani C. The Role of Photodynamic Therapy in the Treatment of Vulvar Intraepithelial Neoplasia. Biomedicines 2018; 6:biomedicines6010013. [PMID: 29393881 PMCID: PMC5874670 DOI: 10.3390/biomedicines6010013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 01/25/2018] [Accepted: 01/30/2018] [Indexed: 01/30/2023] Open
Abstract
Background: vulvar intraepithelial neoplasia is a non-invasive precursor lesion found in 50–70% of patients affected by vulvar squamous cell carcinoma. In the past, radical surgery was the standard treatment for vulvar intraepithelial neoplasia, however, considering the psychological and physical morbidities related to extensive surgery, several less aggressive treatment modalities have been proposed since the late 1970s. Photodynamic therapy is an effective and safe treatment for cutaneous non-melanoma skin cancer, with favorable cosmetic outcomes. Methods: in the present paper, the results of selected studies on photodynamic therapy in the treatment of vulvar intraepithelial neoplasia are reported and discussed. Results: Overall, complete histological response rates ranged between 20% and 67% and symptom response rates ranged between 52% and 89% according to different studies and case series. Conclusions: the real benefit of photodynamic therapy in the setting of vulvar intraepithelial neoplasia lies in its ability to treat multi-focal disease with minimal tissue destruction, preservation of vulvar anatomy and excellent cosmetic outcomes. These properties explain why photodynamic therapy is an attractive option for vulvar intraepithelial neoplasia treatment.
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Affiliation(s)
- Giulio Tosti
- Division of Melanoma, Soft Tissue Sarcomas and Rare Tumors, Istituto Europeo di Oncologia, Via G. Ripamonti 437, 20141 Milano, Italy.
| | | | | | - Sabina Vaccari
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Policlinico Sant'Orsola-Malpighi, 40138 Bologna, Italy.
| | - Alessia Barisani
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Policlinico Sant'Orsola-Malpighi, 40138 Bologna, Italy.
| | - Elisabetta Pennacchioli
- Division of Melanoma, Soft Tissue Sarcomas and Rare Tumors, Istituto Europeo di Oncologia, Via G. Ripamonti 437, 20141 Milano, Italy.
| | - Carmen Cantisani
- Department of Dermatology, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy.
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Human Immunodeficiency Virus (HIV)- and Non-HIV-Associated Immunosuppression and Risk of Cervical Neoplasia. Obstet Gynecol 2018; 131:47-55. [PMID: 29215531 DOI: 10.1097/aog.0000000000002371] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate the risk of cervical intraepithelial neoplasia grade 2, 2-3, 3, adenocarcinoma in situ, or cancer (CIN 2 or worse) among women with human immunodeficiency virus (HIV)- and non-HIV-associated immunosuppression. METHODS We performed a case-control study of 20,146 women with incident CIN 2 or worse and 5:1 age-matched, incidence-density selected women in a control group (n=100,144) enrolled in an integrated health care system from 1996 to 2014. Adjusted rate ratios (RRs) from conditional logistic regression were obtained for HIV status (stratified by CD4 T-cells), solid organ transplant history, and immunosuppressive medication use. RESULTS Risk of CIN 2 or worse was increased among women with HIV (n=36 women in the case group and 79 women in the control group; adjusted RR 2.0, 95% CI 1.3-3.0) compared with those without HIV and in solid organ transplant recipients (n=51 women in the case group and 68 women in the control group; RR 3.3, 95% CI 2.3-4.8) compared with women without a prior transplant. The highest risks were among women with HIV and less than 200 CD4 T-cells/microliter (n=9 women in the case group and eight women in the control group; RR 5.6, 95% CI 2.1-14.7) compared with those without HIV and in solid organ transplant recipients prescribed three or greater immunosuppressive medication classes (n=32 women in the case group and 33 women in the control group; RR 4.1, 95% CI 2.5-6.8) compared with women without a prior transplant and zero medication classes. No increased risks were observed for women with HIV and 500 or greater CD4 T-cells/microliter (n=9 women in the case group and 43 women in the control group; RR 0.8, 95% CI 0.4-1.7) compared with those without HIV or women without prior solid organ transplantation prescribed two or fewer immunosuppressive medication classes (n=1,262 women in the case group and 6,100 women in the control group; RR 0.95, 95% CI 0.89-1.01) compared with women without and a prior transplant and zero medication classes. CONCLUSION Risk of CIN 2 or worse is increased in women with a prior solid organ transplant or who have HIV and CD4 cells/microliter less than 500 but not in women with HIV and higher CD4 levels or in women without a prior solid organ transplant but who are prescribed only one or two immunosuppressive medication classes.
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Risk Factors for De Novo Malignancies in Women After Kidney Transplantation: A Multicenter Transversal Study. Int J Gynecol Cancer 2017; 26:967-70. [PMID: 27206219 DOI: 10.1097/igc.0000000000000710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Transplantation results in a 5-time elevated risk for a variety of malignancies (Kaposi sarcoma, skin, liver, lung, gastrointestinal cancer). A patient's risk for malignancies could be of particular interest for the follow-up programs of patients and risk adaption after kidney transplantation. The aim of this study was to identify independent risk factors for de novo malignancies in women after renal transplantation. METHODS AND MATERIALS This is a multicenter transversal study, conducted at the Medical University of Vienna and Hospital Rudolfstiftung, Vienna, Austria. We included female kidney graft recipients who were transplanted between 1980 and 2012 and followed-up at our institutions (N = 280). Clinical data of patients were extracted from hospital charts and electronic patient files. Patients were interviewed using a standardized questionnaire regarding their medical history, history of transplantation, and malignant diseases. Detailed information about present and past immunosuppressive regimens, rejection episodes and therapies, renal graft function, and information about primary disease was obtained. Diagnostic work-up and/or surgical exploration was performed if any presence of malignancy was suspected during routine follow-up. Histological specimens were obtained from all patients. MAIN OUTCOME MEASURES the presence of de novo malignancy after kidney transplantation. RESULTS Two hundred sixty-two women were included for statistical analysis. Median (interquartile range) follow-up period after transplantation was 101.1 (27.3-190.7) months. Thirty-two patients (12.2%) developed a malignancy: dermatologic malignancies (5.7%), breast cancer (3.4%), cervical cancer (0.8%), lung cancer (0.4%), gastrointestinal malignancies (1.5%), vulvar cancer (0.4%), and unclassified malignancies (1.9%). Median (interquartile range) time to malignancy after transplantation was 185.9 (92.0-257.6) months. Cumulative cancer rates were 4.9% (1 year), 14.4% (3 years), 16.4% (5 years), and 21.8% (10 years). Second transplantations were identified as independent risk factor for development of malignancy after transplantation. CONCLUSIONS Long-term risk of developing a malignancy after kidney transplantation is high, which might justify a follow-up of more than 10 years.
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Abstract
Human papillomavirus (HPV) is involved in one of the at least 2 pathways leading to vulvar squamous cell carcinoma (VSCC). Inactivation of p53 and retinoblastoma by the viral products E6 and E7 is involved in malignant transformation. The percentage of HPV-positive VSCCs ranges from 18% to 75%, depending on the geographical area. HPV-associated tumors affect relatively young women and arise from high-grade intraepithelial lesions, identical to other HPV-associated premalignant lesions of the anogenital tract. HPV-independent tumors tend to affect older women and usually arise in a background of inflammatory skin disorders and a subtle variant of in situ lesion called differentiated vulvar intraepithelial neoplasia. HPV-positive tumors tend to be of basaloid or warty types, whereas HPV-independent tumors tend to be of keratinizing type, but there is frequent overlap between histologic types. There is no conclusive evidence yet on the best strategy in terms of determining HPV attribution. HPV DNA detection is generally considered the gold standard although there is some concern about misclassification when using this technique alone. p16 immunostaining has shown to be an excellent surrogate marker of HPV infection. Positive results for both techniques are considered the best evidence for HPV-association. The prognostic role of HPV in VSCC is still contradictory, but increasing evidence suggests that HPV-associated tumors are less aggressive. Currently, there are no differences in treatment between HPV-associated and HPV-independent VSCC, but novel immunological strategies based on anti-HPV antigens are being evaluated in clinical trials.
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Hinten F, Hilbrands LB, Meeuwis KAP, IntHout J, Quint WGV, Hoitsma AJ, Massuger LFAG, Melchers WJG, de Hullu JA. Reactivation of Latent HPV Infections After Renal Transplantation. Am J Transplant 2017; 17:1563-1573. [PMID: 28009475 DOI: 10.1111/ajt.14181] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 01/25/2023]
Abstract
Female renal transplant recipients (RTRs) have an increased risk for developing human papillomavirus (HPV)-related (pre)malignant lesions of the genital tract. This study aims to assess the genital prevalence of HPV before and after renal transplantation (RT). In female patients who were counseled for RT at the Radboud University Medical Center Nijmegen, the Netherlands, gynecological examination was performed at first visit, and 1 and 2 years later. HPV self-sampling and questionnaires on sexual behavior were performed every 3 months. In 65 patients who underwent RT, the high-risk human papillomavirus (hrHPV) prevalence as assessed with the highly sensitive SPF10 -LiPA25 test increased significantly from 19% before to 31% after RT (p = 0.045). Based upon the clinically validated Cobas 4800 HPV test, the hrHPV prevalence increased from 10% before to 14% after RT (p = 0.31). During follow-up, no changes in sexual behavior were reported. Thirty-three patients who did not undergo RT showed a hrHPV prevalence of 21% at study entry and of 27% after 12 months with the sensitive test, and a stable prevalence of 16% with the clinically validated test. The results of this study indicate that activation of latent HPV infections may contribute to the increased risk of HPV-related (pre)malignant lesions in female RTRs.
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Affiliation(s)
- F Hinten
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - K A P Meeuwis
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J IntHout
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - W G V Quint
- Delft Diagnostic Laboratory, Rijswijk, the Netherlands
| | - A J Hoitsma
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L F A G Massuger
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - W J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J A de Hullu
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
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Improvement of Gynecological Screening of Female Renal Transplant Recipients by Self-Sampling for Human Papillomavirus Detection. J Low Genit Tract Dis 2017; 21:33-36. [DOI: 10.1097/lgt.0000000000000270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Mazanowska N, Rajski D, Pietrzak B, Kaminski P, Wielgos M. Should We Be Concerned About Asymptomatic Adnexal Masses in Female Kidney and Liver Graft Recipients? Transplant Proc 2016; 48:1532-4. [PMID: 27496441 DOI: 10.1016/j.transproceed.2016.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/11/2016] [Accepted: 02/24/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pathological changes of uterine adnexa are frequently encountered in patients after solid-organ transplantation. The aim of the study was to evaluate the incidence of malignancies among recipients operated with the diagnosis of adnexal tumor with or without clinical symptoms. METHODS We retrospectively analyzed data from 146 solid-organ recipients who underwent surgery in the First Department of Obstetrics and Gynecology, Medical University of Warsaw, in the years 2000 to 2014. Among them, we identified 80 patients of mean age 40.9 ± 11.1 years with suspected adnexal tumor. Data on symptoms reported by patients were compared with the results of histopathological examination after surgical treatment. RESULTS Kidney recipients were 76.2% of the group studied (including 5 women after kidney and pancreas transplantation); the remaining 23.75% of patients were liver recipients (including 1 kidney and liver). The majority of patients (71.25%) reported no clinical symptoms. The remaining 28.75% of patients had clinical complaints, with the most common symptom being abdominal pain (in 60% of patients). Analysis of the results of histopathological examination revealed that in both groups, the most often encountered pathological findings were serous cystadenoma (33.3% and 47% of patients, respectively), endometrial cysts (24.6% and 21.7%, respectively), and functional cysts (22.8% and 17.3%, respectively). None of the asymptomatic patients were diagnosed as malignant, whereas 2 cases (both ovarian and fallopian tube cancer) were diagnosed among women who reported clinical symptoms. CONCLUSIONS Observations of patients after organ transplantation indicate a recurring nature of adnexal changes, resulting in qualification for surgical treatment. The survey results suggest that solid-organ recipients with pathology in the uterine adnexa, with non-suspicious ultrasound image and not reporting clinical symptoms, could safely be subjected to clinical observation providing strict supervision.
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Affiliation(s)
- N Mazanowska
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - D Rajski
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.
| | - B Pietrzak
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - P Kaminski
- Military Institute of Medicine, Warsaw, Poland
| | - M Wielgos
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
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Marschalek J, Helmy S, Schmidt A, Polterauer S, Sobulska M, Gyoeri GP, Grimm C. Prevalence of genital dysplasia after kidney transplantation - a retrospective, non-interventional study from two centers. Acta Obstet Gynecol Scand 2015; 94:891-7. [DOI: 10.1111/aogs.12663] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/21/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Julian Marschalek
- Department of Gynecology and Gynecological Oncology; Gynecological Cancer Unit; Comprehensive Cancer Center; Medical University of Vienna; Vienna Austria
| | - Samir Helmy
- Department of Gynecology and Gynecological Oncology; Gynecological Cancer Unit; Comprehensive Cancer Center; Medical University of Vienna; Vienna Austria
| | - Alice Schmidt
- Division of Nephrology and Dialysis; Department of Medicine Ill; Medical University of Vienna; Vienna Austria
| | - Stephan Polterauer
- Department of Gynecology and Gynecological Oncology; Gynecological Cancer Unit; Comprehensive Cancer Center; Medical University of Vienna; Vienna Austria
| | - Martha Sobulska
- Department of Gynecology and Gynecological Oncology; Gynecological Cancer Unit; Comprehensive Cancer Center; Medical University of Vienna; Vienna Austria
| | - Georg P. Gyoeri
- Division of Transplantation; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Christoph Grimm
- Department of Gynecology and Gynecological Oncology; Gynecological Cancer Unit; Comprehensive Cancer Center; Medical University of Vienna; Vienna Austria
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Preti M, Igidbashian S, Costa S, Cristoforoni P, Mariani L, Origoni M, Sandri MT, Boveri S, Spolti N, Spinaci L, Sanvito F, Preti EP, Falasca A, Radici G, Micheletti L. VIN usual type-from the past to the future. Ecancermedicalscience 2015; 9:531. [PMID: 25987900 PMCID: PMC4431399 DOI: 10.3332/ecancer.2015.531] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Indexed: 12/27/2022] Open
Abstract
Usual vulvar intraepithelial neoplasia (uVIN) is the most common VIN type, generally related to a human papillomavirus (HPV) infection, predominantly type 16. The incidence of uVIN has been increasing over the last decades, and a bimodal peak is observed at the age of 40–44 and over 55 years. Almost 40% of patients with uVIN have a past, concomitant or future HPV-associated lesion of the lower genital tract. HPV-related malignancies are associated with a persistent HPV infection. The host immune response is of crucial importance in determining clearance or persistence of both HPV infections and HPV-related VIN. About 60% of the patients present with symptoms. Clinical features of uVIN vary in site, number, size, shape, colour, and thickness of lesions. Multicentric disease is often present. Most uVIN lesions are positive at immunohistochemistry to p16ink4a and p14arf, but negative to p53. Irrespective of surgical treatment used, uVIN recurrence rates are high. Positive margins do not predict the development of invasive disease and the need to re-excide the tissue around the scare remains to be demonstrated. Therefore, considering the low progression rate of uVIN and psycosexual sequelae, treatments should be as conservative as possible. Medical treatments available are mainly based on immunotherapy to induce normalisation of immune cell count in uVIN. None are approved by the food and drug administration (FDA) for the treatment of uVIN. If medical treatment is performed, adequate biopsies are required to reduce the risk of unrecognised invasive disease. Some studies suggest that failure to respond to immunotherapy might be related to a local immunosuppressive microenvironment, but knowledge of the uVIN microenvironment is limited. Moreover, our knowledge of the potential mechanisms involved in the escape of HPV-induced lesions from the immune system has many gaps. HPV vaccines have been demonstrated to be effective in preventing uVIN, with 94.9% efficacy in the HPV-naive population, while studies on therapeutic vaccines are limited. The low incidence of VIN requires large multicentre studies to determine the best way to manage affected patients and to investigate the immunological characteristics of the ‘vulvar microenviroment’ which leads to the persistence of HPV.
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Affiliation(s)
- Mario Preti
- Preventive Gynecology Unit, European Institute of Oncology, Milano 20100, Italy ; The Italian HPV Study Group (IHSG)
| | - Sarah Igidbashian
- Preventive Gynecology Unit, European Institute of Oncology, Milano 20100, Italy
| | - Silvano Costa
- M.F. Toniolo Hospital, Bologna 40100, Italy ; The Italian HPV Study Group (IHSG)
| | - Paolo Cristoforoni
- Villa Montallegro, Genova 16100, Italy ; The Italian HPV Study Group (IHSG)
| | - Luciano Mariani
- HPV-Unit Gynecologic Oncology, Regina Elena National Cancer Institute of Rome, Rome 00100, Italy ; The Italian HPV Study Group (IHSG)
| | - Massimo Origoni
- Department of Obstetrics and Gynecology, Vita Salute San Raffaele University School of Medicine, Milano 20100, Italy ; The Italian HPV Study Group (IHSG)
| | - Maria T Sandri
- Division of Laboratory Medicine, European Institute of Oncology, Milano 20100, Italy ; The Italian HPV Study Group (IHSG)
| | - Sara Boveri
- Preventive Gynecology Unit, European Institute of Oncology, Milano 20100, Italy
| | - Noemi Spolti
- Preventive Gynecology Unit, European Institute of Oncology, Milano 20100, Italy
| | - Laura Spinaci
- Preventive Gynecology Unit, European Institute of Oncology, Milano 20100, Italy
| | - Francesca Sanvito
- Preventive Gynecology Unit, European Institute of Oncology, Milano 20100, Italy
| | - Eleonora P Preti
- Preventive Gynecology Unit, European Institute of Oncology, Milano 20100, Italy
| | - Adriana Falasca
- Preventive Gynecology Unit, European Institute of Oncology, Milano 20100, Italy
| | - Gianluigi Radici
- Preventive Gynecology Unit, European Institute of Oncology, Milano 20100, Italy
| | - Leonardo Micheletti
- Department of Obstetrics and Gynecology, University of Torino, Torino 10100, Italy
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Meeuwis KAP, Hilbrands LB, IntHout J, Slangen BFM, Hendriks IMP, Hinten F, Christiaans MHL, Quint WGV, van de Kerkhof PCM, Massuger LFAG, Hoitsma AJ, van Rossum MM, Melchers WJG, de Hullu JA. Cervicovaginal HPV infection in female renal transplant recipients: an observational, self-sampling based, cohort study. Am J Transplant 2015; 15:723-33. [PMID: 25675976 DOI: 10.1111/ajt.13053] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 09/21/2014] [Accepted: 10/04/2014] [Indexed: 01/25/2023]
Abstract
Immunosuppressive treatment of organ transplant recipients is associated with an increase in the occurrence of human papillomavirus (HPV) related anogenital (pre)malignancies. This cohort study investigated the genotype-specific prevalence of HPV infections in a large cohort of female renal transplant recipients (RTRs). Participants self-collected a cervicovaginal sample for detection and genotyping of HPV. Besides, they completed a questionnaire regarding sociodemographic variables, medical data and sexual behavior. Anogenital screening was offered to all HPV-positive participants. A total number of 218 female RTRs was included. The prevalence of mucosal HPV infections was 27.1% and 17.4% for high risk HPV in particular. The studied cohort showed a broad range of HPV genotypes and multiple HPV genotypes were found in 27.1% of HPV-positive patients. Seven participants were identified with occult premalignant anogenital lesions. In conclusion, this study shows a high point-prevalence of HPV in female RTRs (age-matched West-European general population: 9-10%) with a shift in the distribution of genotypes as compared with the general population. Moreover, a substantial number of patients with occult premalignancies was identified. The introduction of self-sampling for HPV positivity can help in early detection of (pre)malignant anogenital lesions in this vulnerable population.
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Affiliation(s)
- K A P Meeuwis
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, The Netherlands; Department of Dermatology, Radboud university medical center, Nijmegen, The Netherlands
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Clinical Characteristics Associated With Development of Recurrence and Progression in Usual-Type Vulvar Intraepithelial Neoplasia. Int J Gynecol Cancer 2013; 23:1476-83. [DOI: 10.1097/igc.0b013e3182a57fd6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Prevalence of high-risk human papillomavirus cervical infection in female kidney graft recipients: an observational study. Virol J 2012; 9:117. [PMID: 22709394 PMCID: PMC3489881 DOI: 10.1186/1743-422x-9-117] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 05/31/2012] [Indexed: 11/30/2022] Open
Abstract
Background Immunosuppressive therapy protects the transplanted organ but predisposes the recipient to chronic infections and malignancies. Transplant patients are at risk of cervical intraepithelial neoplasia (CIN) and cervical cancer resulting from an impaired immune response in the case of primary infection or of reactivation of a latent infection with human papillomavirus of high oncogenic potential (HR-HPV). Methods The aim of this study was to assess the prevalence of HR-HPV cervical infections and CIN in 60 female kidney graft recipients of reproductive age in comparison to that in healthy controls. Cervical swabs were analyzed for the presence of HR-HPV DNA. HR-HPV-positive women remained under strict observation and were re-examined after 24 months for the presence of transforming HR-HPV infection by testing for HR-HPV E6/E7 mRNA. All the HR-HPV-positive patients were scheduled for further diagnostic tests including exfoliative cytology, colposcopy and cervical biopsy. Results The prevalence of HR-HPV did not differ significantly between the study group and the healthy controls (18% vs 25%, p = 0.37). There was no correlation between HR-HPV presence and the immunosuppresive regimen, underlying disease, graft function or time interval from transplantation. A higher prevalence of HR-HPV was observed in females who had had ≥2 sexual partners in the past. Among HR-HPV-positive patients, two cases of CIN2+ were diagnosed in each group. In the course of follow-up, transforming HR-HPV infections were detected in two kidney recipients and in one healthy female. Histologic examination confirmed another two cases of CIN2+ developing in the cervical canal. Conclusions Female kidney graft recipients of reproductive age are as exposed to HR-HPV infection as are healthy individuals. Tests detecting the presence of HR-HPV E6/E7 mRNA offer a novel diagnostic opportunity in those patients, especially in those cases where lesions have developed in the cervical canal.
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Anogenital Malignancies in Women After Renal Transplantation Over 40 Years in a Single Center. Transplantation 2012; 93:914-22. [DOI: 10.1097/tp.0b013e318249b13d] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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HPV-related (pre)malignancies of the female anogenital tract in renal transplant recipients. Crit Rev Oncol Hematol 2012; 84:161-80. [PMID: 22425015 DOI: 10.1016/j.critrevonc.2012.02.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 02/03/2012] [Accepted: 02/22/2012] [Indexed: 01/13/2023] Open
Abstract
Renal transplantations (RTs) are performed routinely in many countries. After RT, the administration of lifelong immunosuppressive therapy is required. As a consequence, renal transplant recipients (RTRs) have a high risk to develop virus-associated (pre)malignancies, such as Human papillomavirus (HPV) related anogenital (pre)malignancies. It is known that the majority of the RTRs are infected with HPV and that these women have a 14-fold increased risk of cervical cancer, up to 50-fold of vulvar cancer and up to 100-fold of anal cancer. Often, treatment of these lesions requires concessions and may be suboptimal as radiation therapy and extensive surgery may damage the renal transplant. Therefore, prognosis may be compromised due to inadequately treated malignancies. Especially for these immunocompromised patients prevention is of utmost importance. Yearly cervical cancer screening for RTRs is advised, but appears to be executed poorly. For the future, optimizing screening and prevention of anogenital (pre)malignancies is an important issue for women after RT. This review gives a broad overview of all aspects regarding HPV-related (pre)malignancies of the female anogenital tract in RTRs.
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Gadducci A, Barsotti C, Cosio S, Domenici L, Riccardo Genazzani A. Smoking habit, immune suppression, oral contraceptive use, and hormone replacement therapy use and cervical carcinogenesis: a review of the literature. Gynecol Endocrinol 2011; 27:597-604. [PMID: 21438669 DOI: 10.3109/09513590.2011.558953] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
High-risk human papillomaviruses (HPVs) are involved in the etiopathogenesis of cervical intraepithelial neoplasia (CIN) and cervical cancer. After taking HPV into account, smoking habit appears to be the most significant environmental risk factor, and the risk of this malignancy increases significantly with intensity and duration of smoking. Women with human immunodeficiency virus (HIV) infection experience a higher incidence of CIN and invasive cervical cancer. Among HIV+ women, the highly active antiretroviral therapy increases the regression rate of CIN, but the majority of these lesions do not regress to normal. As far as oral contraceptives (OCs), a systematic review of 28 studies found that, compared with never pill users, the relative risk (RR) of cervical cancer increased with increasing duration of OC use. The results were similar for squamous cell carcinoma and adenocarcinoma, and the RRs decreased after pill discontinuation. However, by weighing risks and benefits, the World Health Organization does not recommend any change in OC practice. There is no correlation between hormone replacement therapy and cervical cancer. Experimental data have shown that estradiol and progesterone can modulate the host immune response to HPV16. Prophylactic vaccination in conjunction with cervical screening is the best prevention strategy for cervical cancer.
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Affiliation(s)
- Angiolo Gadducci
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.
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Abstract
This mini review describes human papillomavirus-related (pre)malignancies of the lower anogenital tract, for which female renal transplant recipients (RTRs) have a markedly increased risk. Until now, the implementation of intensified cervical cancer screening in RTRs is disappointing. We emphasize the need for improvement of cervical screening programs, combined with close inspection of the vulva and perianal area for potential lethal malignancies in RTRs.
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