[Cytological examination of urine in the differential diagnosis of recurrent lower urinary tract infection]

INTRODUCTION

A diagnosis and treatment of recurrent lower urinary tract infection (UTI) in women is still one of the unresolved problems of urology. The proper identification of the etiological factor determines the treatment tactics. Therefore, the most urgent issue of recurrent lower UTI is the differential diagnosis of the causative pathogens.

MATERIALS AND METHODS

A cytological study of urine was performed in 151 patients with recurrent lower UTI, who, according to the results of bacteriological and PCR studies of urine, were divided into three groups, depending on the etiological factor. The group 1 (n=70) included women with recurrent lower UTI of bacterial etiology, while in group 2 (n= 70) papillomavirus etiology was found, and in group 3 (n=11) candida species were the causative pathogens. The age of the patients ranged from 20 to 45 years (32.3+/-7.8).

RESULTS

In the majority of patients with recurrent lower UTI of bacterial etiology, the cytological features were represented by leukocytes, plasma, epithelial cells and bacteria in combination with actively phagocytic macrophages. In group 3, in addition to a large number of leukocytes (neutrophils) and epithelial cells, Candida mycelium was found. In group 2, signs of bacterial inflammation were minimal, while a predominance of lymphocytes, epithelial cells, and the presence of single neutrophils was seen. With papillomavirus lesions of the bladder, urothelial cell dystrophy with the presence of koilocytes developed.

CONCLUSIONS

A cytological examination of urine can confirm the etiology of the recurrent lower UTI and be an evidence-based criterion in the differential diagnosis of bacterial, candidiasis, and papillomavirus infection. Total transformation of the urothelium and vacuolization of urothelial cells, as well as an excess of lymphocytes in the urine in the absence of neutrophils, are the characteristic features of viral recurrent lower UTI.

Human papillomavirus infection in the oromaxillofacial area: Clinical anatomy and histological considerations

Clinical manifestations of human papillomavirus (HPV) infection in the head and neck can range from benign lesions, which are the most frequent, to malignant lesions. The prevalence of head and neck cancer is increasing, despite currently decreasing trends in known risk factors such as smoking and alcohol use. A new patient profile has appeared in recent practice: most frequently a middle-aged male patient who does not smoke or drink alcohol, is sexually active (possibly having multiple partners), and presents with oral or cervicofacial lesions requiring diagnosis and treatment. Another risk factor that should be considered in these patients is HPV infection. The association of oral potentially malignant disorders (OPMD) with HPV is a challenge for the medical practitioner. The gold standard for diagnosis is histopathological examination, which can also yield evidence suggesting HPV infection. Determination of the viral genotype provides additional data for assessing the oncological risk of an HPV infection. Treatment of these patients is aimed at removing the lesions, in association or not with antiviral treatment and recurrence control.

Squamous cell papilloma of the conjunctiva due to human papillomavirus (HPV): presentation of two cases and review of literature

Purpose

We describe two patients with squamous cell papilloma of the conjunctiva due to human papilloma virus (HPV) and review the literature.

Patients and methods

Two patients with conjunctival tumors were examined and treated in the University Eye Clinic and diagnosed in the University Pathology Department, University Hospital of Ioannina, Greece. The first patient was a 48-year-old man presenting with an extended papillomatous lesion in bulbar conjunctiva covering part of the cornea of his right eye. The second patient was a 24-year-old man presenting with a polypoidal papillomatous lesion on the caruncle of his right eye. The two lesions were removed surgically, cryotherapy was applied to the adjacent conjunctiva, and topical mitomycin-C was used. The amniotic membrane was used to restore the conjunctival defect in the first patient. The two removed lesions were sent to the Pathology Department for histopathological examination. Immunohistochemistry, DNA in situ hybridization, and polymerase chain reaction (PCR) analysis were performed.

Results

In the first patient, histopathology showed the presence of a benign squamous papilloma with koilocytosis. DNA in situ hybridization with broad-spectrum probes showed that this patient was positive for HPV DNA. In the second patient, histopathology showed the presence of a squamous papilloma with mild dysplasia and koilocytosis. Immunohistochemical analysis was positive for HPV protein and p16 protein. DNA in situ hybridization with broad-spectrum probes showed that the patient was positive for HPV DNA. PCR analysis showed the presence of HPV 6. According to morphological and molecular findings, both patients were diagnosed with squamous cell papilloma due to HPV.

Conclusion

HPV can infect the ocular surface. According to clinical results, the ophthalmologist in cooperation with the pathologist can recommend appropriate laboratory examinations to confirm the diagnosis and successfully treat conjunctival papillomas.

Koilocytes indicate a role for human papilloma virus in breast cancer

BACKGROUND

High-risk human papilloma viruses (HPVs) are candidates as causal viruses in breast cancer. The scientific challenge is to determine whether HPVs are causal and not merely passengers or parasites. Studies of HPV-related koilocytes in breast cancer offer an opportunity to address this crucial issue. Koilocytes are epithelial cells characterised by perinuclear haloes surrounding condensed nuclei and are commonly present in cervical intraepithelial neoplasia. Koilocytosis is accepted as pathognomonic (characteristic of a particular disease) of HPV infection. The aim of this investigation is to determine whether putative koilocytes in normal and malignant breast tissues are because of HPV infection.

METHODS

Archival formalin-fixed normal and malignant breast specimens were investigated by histology, in situ PCR with confirmation of the findings by standard PCR and sequencing of the products, plus immunohistochemistry to identify HPV E6 oncoproteins.

RESULTS

human papilloma virus-associated koilocytes were present in normal breast skin and lobules and in the breast skin and cancer tissue of patients with ductal carcinoma in situ (DCIS) and invasive ductal carcinomas (IDCs).

INTERPRETATION

As koilocytes are known to be the precursors of some HPV-associated cervical cancer, it follows that HPVs may be causally associated with breast cancer.