Studies of cervical conization in patient; with CIN lesions have generally focused on the frequency of complications and outcome of follow-up. Factors associated with presurgical assessment in order to avoid improper treatment have been inadequately investigated. The present study of 1000 patients undergoing Cone-equivalent Electrosurgical Procedure (C.E.P) was aimed at evaluating (1) the determinants of presurgical assessment of cervical lesion and (2) the role of colposcopy as "diagnostic key point" in cervical pathology before treatment In our study pap smear failed to detect HG Lesions in 20% of the patients, histology on punch biopsy hid 7% of CIN2-3 and cancer. In over 70% of High Grade Lesions or cancer on cone specimen, colposcopy was rot satisfactory. Therefore, no diagnostic procedure currently available should be regarded as "gold standard" in cervical pathology. It is only by integrating the different tools that the lesion limits on be sufficiently defined and the appropriate therapeutic approach can be selected, reducing the rate of margins involvement as well as that of under/over treatment.

The patterns of parametrial spread and the impact on survival of cervical squamous carcinoma have been evaluated in surgical specimens from 125 consecutive women with squamous cervical carcinoma FIGO stage in and stage IIA treated by radical hysterectomy plus pelvic lymphadenectomy and followed for at least 5 years. The microscopic involvement of the parametria was found in 15% in stage in and 39% in stage 11A. Anterior and posterior spread were never observed alone, but in association with the lateral extension of the tumor. Lymph nodes were involved in 50% of the cases with tumor extension beyond the cervix, and only 15% of the patients without parametria involvement (p< 0,001). Paracervical cancer extension was related to the depth of stromal invasion, LVS involvement and lymph node metastases (p<0,001). Five year survival figure was 90% in patients with parametria and nodes metastases, while it dropped to 50% and 46% in women with paracervical involvement and negative or positive nodes, respectively.

OBJECTIVE: To investigate epidemiologic, clinical and pathologic aspects of various grades of vulvar intraepithelial neoplasia (VIN).STUDY DESIGN: A retrospective, multicenter study of 370 cases of vulvar intraepithelial neoplasia (VIN) wits performed by the Italian Study Group on Vulvar Disease.RESULTS: Of the 370 cases, 148 were VIN 1 (40.0%), 53 were VIN 2 (14.3%), and 169 were VIN 3 (45.7%). The mean age of the patients was 52.6 years. During the study period an increase in the rate of human papillomavirus-associated VIN was observed. In addition, while VIN 1 and 2 were associated mostly with squamous cell hyperplasia, VIN 3 was almost equally associated with lichen sclerosus and squamous cell hyperplasia; the difference was statistically significant. Intraepithelial or invasive squamous neoplasia of the lower genital tract was associated in 22% of the cases (82/370).CONCLUSION The results of the investigation, although not allowing firm conclusions due to the retrospective and multicentered nature of the study, demonstrate the extreme heterogeneity of VIN lesions.

To elucidate some of the recently arisen issues related to the bimodal disease pattern of vulvar intraepithelial lesions (VIN) and vulvar cancer, a series of 27 consecutive women with vulvar symptoms was analyzed for human papillomavirus (HPV) involvement by colposcopy, light microscopy and in situ hybridization (ISH) for HPV types 6, 11, 16, 18, 31, 33 and 42. Altogether, HPV DNA was discovered in 13/27 (48.1%) of the lesions by ISH; the rest were HPV DNA negative for the seven HPV types tested. HPV DNA was present in both of two exophytic lesions (HPV 6 in condyloma and HPV 16 in verrucous cancer). Of the flat lesions, 7/13 (53.8%) were HPV DNA positive. HPV 6 was confined to low grade lesions (HPV/non-VIN and VIN 1), whereas HPV 11 was found in a case of VIN 3 as well. Of the invasive carcinomas, three of four were HPV DNA positive (2 HPV 16 and 1 HPV 31). Dystrophic changes were detected in three of four invasive carcinomas and in all three HPV 16-positive lesions. Dystrophic changes were absent in 9 of 14 (64.3%) of HPV DNA-negative lesions. Fifty percent (7/14) of vulvar warty lesions (without concomitant VIN) were found in women younger than 60. Three of four invasive carcinomas occurred in women older than 60. This small series provided additional evidence of HPV involvement in the pathogenesis of VIN lesions, and the findings support the hypothesis of a multifactorial etiology in vulvar carcinogenesis in which HPV, dystrophic changes and chronic inflammatory disease play a synergistic role.

A series of 199 male regular sexual partners of women attending an STD clinic for the examination and treatment of HPV-associated diseases was examined by peniscopy, surgical biopsy and nucleic acid hybridization for the presence of clinical, histological and molecular markers pathognomic of HPV infection. There was a 100% correlation between condylomata acuminata and detection of HPV type 6 or 11 DNA. Papillary lesions displayed neither histological signs of HPV infection, nor did they harbor HPV DNA (viral types 6, 11, 16, 18, 33) while 44.9% (22/49) of acetowhite epithelia showed HPV-suggestive histological changes. Of the 19 analysed for HPV DNA, 15.8% (3/19) harbored HPV 6/11 and 16 DNA. Regular male and female sexual partners did not always harbor the same HPV types, showing that latent or occult infection and the sexual habits of each individual play an important role in the clinical manifestations of HPV infection observed in sexual couples. The present data show that: i) the likelihood of developing a clinical HPV lesion was affected, to a large extent, by the previous sexual history and habits in the partners of women with flat condylomata, while partners of women with condylomata acuminata or CINs displayed a higher correlation with the current state of infection in their regular partner; ii) despite the assessed infective state of their consorts, men with a low lifetime number of sexual partners seldom displayed HPV-associated acetowhitening. Prevalence of such lesions, however, increased significantly with an increase in the total number of sexual partners; iii) clinical assessment and evaluation of HPV-risk for inconspicuous penile lesions in the male partner should be carried out not only on the basis of clinical and peniscopic appearance, but also considering the current state of infection in the regular partner and the sexual history and habits of each individual.

A series of 65 male sexual partners of 65 women attending an STD clinic in Bologna, Italy for examination and treatment of genital human papillomavirus (HPV)-infections during 1990–1991, were examined using peniscopy and surgical biopsy, the latter being analysed by light microscopy, in situ hybridization (ISH) and polymerase chain reaction (PCR) for HPV DNA. A detailed medical and sexual history was recorded from all men. Of the 65 men, 17 (26.2%) gave a history of a previous STD. The male partners with previous genital condylomata (14, 21.5% of men) were significantly associated with the detection of HPV DNA in the current lesions; 21.4% (3 of 14) and 10.2% (5 of 51) in those with and without previously treated condyloma, respectively. On colposcopy, 63 (96.9%) men presented with an abnormal pattern, the vast majority (49 of 65, 75.4%) showing an acetowhite lesion, and only 12 (18.5%) lesions being classified as condyloma acuminatum. HPV DNA was found, however, in only 4 of 12 (33.3%) condylomas by ISH and PCR, and in 4 of 49 (8.2%) and 6 of 49 (12.2%) acetowhite lesions by ISH and PCR, respectively. In a total of 41 (63%) patients, the biopsy was classified as non-HPV on light microscopy. HPV DNA detection rate was significantly higher in all morphologically HPV-suggestive lesions, compared with the non-HPV where ISH was invariably negative. PCR, however, disclosed HPV DNA in 4 of 41 (9.8%) cases. PIN (I or II) was present in 6 of 65 (9.2%) men. HPV DNA detection rate increased in parallel with the increasing grade of lesion, both HPV 16-positive cases containing a PIN lesion. Altogether, HPV DNA was found by ISH in 8 of 65 (12.3%) biopsies, and PCR amplification increased the detection rate by only two cases. HPV DNA was never present in men with only a single sexual partner, but increased significantly when the number of partners was increased, being highest (27.3%, 3 of 11) in those reporting 11–20 partners. HPV detection rate was lowest in those men whose partner had a flat condyloma, but significantly higher in those who presented with condyloma acuminatum (40%, 2 of 5), or HPV-CINI and II lesions. Of interest was the finding that HPV DNA was never demonstrated in the men whose partner had only vaginal HPV lesions. Peniscopy is an applicable means of finding the abnormal patterns remaining undetectable by the naked eye, but because of its limited resolution, it is not a conclusive diagnostic tool capable of differentiating HPV- from non-HPV-lesions.