Purpose Persistent high-risk HPV infection is associated with an elevated risk for prevalent CIN II + despite normal cytology (NILM). Our study aims to evaluate the clinical relevance of a persistent high-risk HPV infection without cytologic changes in women aged ≥ 65 and to determine the role of colposcopy for triage in these cases. Methods 211 patients aged ≥ 65 with persistent HPV infection and normal cytology (NILM) who presented for colposcopy at five certified centers between January 2021 and April 2022 were included in the study. Colposcopic findings, HPV subtypes, when available, histology and p16/Ki67 staining were assessed as well as individual risk factors such as smoking and previous HPV-related surgery. Results 87.7% (185/211) of the included women had a type 3 transformation zone. In 83.4% (176/211), a biopsy was taken [thereof 163 endocervical curettages (ECC)]. In 35/211 women (16.6%), sampling was not possible during colposcopy due to an inaccessible cervix, pain during examination or obliteration of the cervical canal. Out of these, 6 women received a diagnostic excision. CIN II + was detected in 10.6% of all histologies (excisional or biopsy) (20/182). 50% of the women with a CIN II + where HPV 16 positive. Taking only the women diagnosed with CIN III or AIS into account, ( n = 12) 75% were HPV 16 positive. Interestingly, 80% of the women with CIN II + had an abnormal cytology when repeatedly taken during colposcopy, vice versa an endocervical lesion was diagnosed in 53% of women with abnormal repeat cytology (27/51). Conclusion The prevalence of CIN II + in women is ≥ 65 with persistent hr HPV infection but NILM cytology is similar to that in younger women. However, more than 85% of the women have a type 3 transformation zone. Colposcopy is, therefore, not helpful to diagnose the women who need treatment in this age group.

Background In 2020, cervical cancer screening has changed from a solely cytology based to a combined HPV and cytology based strategy for all women aged 35 and older. Within the screening algorithm all women with persisting high risk HPV Infection >12 months undergo a colposcopic evaluation of the cervix. However, in elderly women the transformation zone is often hidden, and colposcopy might not be the ideal diagnostic procedure for these women. Furthermore, little is known about the course of an HPV infection at this age with regard to different subtypes.

PURPOSE:Human papillomavirus (HPV) infection represents the primary cause of anogenital premalignant and malignant disease. Regarding the high prevalence of cervical HPV infection and the increasing incidence of HPV associated oropharyngeal cancer in recent years, a significant viral transmission from the cervical to the oral site, possibly depending on the sexual behavior must be considered. The present study aims to determine the prevalence of oral HPV infection in cervical HPV positive and negative women and their sexual partners.METHODS:Cervical HPV positive and negative women and their sexual partners took part in the study. Cervical smears, oral smears and mouthwashes were taken from women attending gynecological outpatient clinics in two different institutions. Further, oral smears as well as mouthwashes of their sexual partners were obtained whenever possible. HPV genotyping was performed using the Cobas® polymerase chain reaction and nucleic acid hybridization assay for the detection of 14 high-risk HPV types. In addition, all participants were invited to complete a personal questionnaire.RESULTS:144 HPV positive and 77 HPV negative women and altogether 157 sexual partners took part in the study. Age, sexual behaviour, medication, smoking and alcohol consumption were distributed equally in both groups. Cervical HPV positive women had a significantly higher number of sexual partners. One woman with a HPV positive cervical smear and one partner of a woman with a HPV positive cervical smear showed an oral HPV infection. No oral HPV infections were detected in the HPV negative control group. The overall incidence of oral HPV infection was 0.5%, the incidence of oral HPV infection in women with a positive cervical smear was 0.7%.CONCLUSION:The data demonstrate that the overall risk of an oral HPV infection is low. HPV transmission to the oropharynx by autoinoculation or oral-genital contact constitute a rare and unlikely event.

Nicht-operative Behandlung einer seit 3 Jahren persistenten, histologisch gesicherten CIN 2 – 3 durch Applikation von Imiquimod in kurativer Absicht (mit dem Ziel der kompletten Remission).

Zielsetzung: Gemäß nationaler und internationaler Leitlinien wird bei Patientinnen mit einer CIN III eine Konisation durchgeführt. Entsprechend der Definition der LLETZ (large loop excision of the transformation zone) wird bei der Operation zusätzlich zur Läsion die Transformationszone mitentfernt.

Background: Only limited data is available on the impact of a short interval between two pap smears. Most institutions practice a minimal time span of six to eight weeks before obtaining a second smear. A short interval is commonly believed to be associated with an increase of false-negative results in the second smear.

Mucin-1, ein ubiquitäres Glykoprotein auf apikalen Epithelzelloberflächen, fungiert in malignen Prozessen als Trägerprotein für onkofetale Kohlenhydrate wie das Thomsen-Friedenreich Antigen und Tumormarker wie CA 15 – 3 und CA 19 – 9.

Fragestellung: Im Jahr 2008 wurde in Frankreich, Spanien und Portugal eine Umfrage der „Women Against Cervical Cancer Foundation“ durchgeführt, um zu erheben, welche Belastungen Patientinnen mit einem auffälligen Pap-Abstrich empfinden und welche Informationsbedürfnisse sie haben. Ziel dieser Studie war es vergleichbare Daten für Deutschland zu erheben.

The carbohydrate molecules Sialyl Lewis X (SLeX), Sialyl Lewis A (SLeA), Lewis Y (LeY) and Thomsen-Friedenreich antigen (TF) are known to mediate the adhesion between tumor cells and endothelium. They are used as serum markers in diagnosis and treatment in a broad spectrum of human carcinomas, but their expression profile and role in the development of cervical cancer remains unclear. The aim of this study was to investigate the expression of SLeX, SLeA, LeY and TF in normal cervical squamous epithelium, cervical dysplasia and cervical cancer. Slides of paraffin-embedded tissue were fixed and incubated with monoclonal antibodies against SLeX, SLeA, LeY and TF. Immunohistochemical staining was evaluated by using a semi-quantitative score (IRS Score). We found a significant difference of SLeA expression in invasive cervical cancer compared to normal epithelium (p=0.006) and all grades of dysplasia (p=0.002). The expression of SLeX in normal epithelium was less intense than in carcinoma in situ (p=0.036). Staining for LeY showed the weakest results of the investigated markers. Significant differences were found when normal epithelium was compared to CIN I (p=0.011), to CIN II (p=0.013) and to invasive cervical cancer (p=0.005). For TF, significant differences were found in normal epithelium compared to CIN I (p=0.011), CIN II (p=0.013) and compared to invasive cervical cancer (p=0.005). This is the first study on the expression of SLeA, SLeX, LeY and TF in normal cervical endothelium, cervical dysplasia, carcinoma in situ and invasive cervical cancer. Further studies and higher numbers are desirable.

Einleitung: Die Kohlenhydratverbindungen Sialyl Lewis A (SLeA), Sialyl Lewis X (SLeX), Lewis Y (LeY) and Thomsen-Friedenreich Antigen (TF) sind bekannt dafür, dass sie die Adhäsion zwischen Tumorzellen und dem Endothel vermitteln. Sie werden als Serummarker in der Diagnose und Behandlung vieler Karzinome eingesetzt, doch ihr Expressionsprofil und ihre Rolle beim Zervixkarzinom sind unklar. Ziel der Studie war es, die Expression von SLeA, SLeX, LeY und TF in normalem Plattenepithel, in Dysplasien Grad 1–3 (CIN I-III), sowie in Carcinoma in situ (Cis) und invasiven Plattenepithelkarzinomen der Zervix uteri zu untersuchen.

Patientinnen mit chronischen Schmerzzuständen im Bereich der Vulva, und/oder Juckreiz gelten als schwierig. Durch rein somatische Betrachtung ihrer Symptomatik, die zu mehrfachen Überweisungen, häufigen Arztwechseln und sogar chirurgischen Interventionen führt, werden die Betroffenen häufig frustriert, die Symptome können chronifizieren. Referiert werden biopsychosoziale Ansätze zur Ätiopathogenese sowie psychoanalytische und -somatische Modelle und Behandlungsansätze. Im Einzelnen dargestellt wird ein verhaltenstherapeutischer Ansatz (u. a. Entspannungsverfahren, Schmerztagebuch, behaviorale Techniken für den Abbau ungünstigen Krankheitsverhaltens, Entwicklung alternativer Coping-Strategien) für somatoforme Störungen am Beispiel einer Patientin mit länger bestehender Vulvodynie und Pruritus vulvae.

Background and Aim: HIV-infected patients show a high rate of anal dysplasia and anal carcinoma but there is no gold standard for early detection. Therefore, the objectives of this prospective study were: a) evaluation of an anal screening using anal/perianal cytology; b) in case of a positive result to investigate its relation to immune status, clinical symptoms of HIV infection and antiretroviral therapy. Patients and Methods: In every HIV-infected woman visiting our gynaecological outpatient clinic, an anal and perianal swab for anal cytology was taken. One experienced cytologist examined all specimens. Relevant details of the HIV-related history such as CDC classification, CD4 count, viral load, actual antiretroviral therapy etc. were documented. Results: Altogether, 104 HIV-infected women were enrolled on this study. The results of 13 (13.5%) anal cytologies were classified as suspicious for low-grade or high-grade anal dysplasia and 6 of these were confirmed in an anal biopsy. A total of 9 out of 13 also had a cervical dysplasia and 12 were positive for high-risk HPV at the cervix. Ten of these women had already experienced clinical symptoms of their HIV infection and 8 showed a nadir of the CD4 count below 200 cells/mu l. All but one took a highly active antiretroviral therapy. Conclusion: In this pilot study, anal screening using anal cytology showed 13.5% suspected anal dysplasia in HIV-infected women. All performed biopsies revealed the presence of a high-grade anal lesion. The majority of these women already had an advanced disease and/or immune defect related to their HIV infection. In summary, we found anal cytology to be a useful tool to early detect anal dysplasia of high-risk patients such as HIV-infected women. How far this screening method contributes to the prevention of anal cancer has to be evaluated in further investigations.

Background . Although tuberculosis (TB) is a major health problem worldwide, primary extrapulmonary tuberculosis (EPTB), and in particular female genital tract infection, remains a rare event. Case Report . A 35-year-old human immunodeficiency virus (HIV) seropositive woman of African descent with lower abdominal pain and fever of two days duration underwent surgery due to left adnexal mass suggesting pelvic inflammatory disease. The surgical situs showed a four quadrant peritonitis, consistent with the clinical symptoms of the patient, provoked by a tuboovarian abscess (TOA) on the left side. All routine diagnostic procedures failed to determine the causative organism/pathogen of the infection. Histopathological evaluation identified a necrotic granulomatous salpingitis and specific PCR analysis corroborated Mycobacterium tuberculosis (M. Tb). Consequently, antituberculotic therapy was provided. Conclusion . In the differential diagnosis of pelvic inflammatory disease, internal genital tuberculosis should be considered. Moreover, physicians should consider tuberculous infections early in the work-up of patients when immunosuppressive conditions are present.

Fragestellung: Ist die Exfoliativzytologie der Analregion geeignet auswertbare Präparate zu generieren? Wie ist die Prävalenz der Analdyplasie in den untersuchten Kohorten (HIV positive Männer und Frauen; Frauen mit Cervixdysplasien)? Wie korreliert der zytologische Befund mit dem histologischen Befund? Methodik: Es wurden Patientinnen und Patienten in den Immundefektsprechstunden und der Dysplasiesprechstunde (Frauenklinik/Dermatologische Klinik) untersucht. Die Abstriche wurden mit angefeuchtetem Wattetupfer aus dem Analkanal und unmittelbar perianal entnommen, sofort fixiert und nach Papanicolaou gefärbt. Die Auswertung erfolgte durch einen erfahrenen Zytologen; Befunddokumentation erfolgte in der Münchener (II) und Bethesda Nomenklatur. Ergebnisse: Bis dato wurden 359 Fälle evaluiert. Alle Präparate waren auswertbar.

Fragestellung: Das Zervixkarzinom sowie dessen Vorstufen ist als AIDS-assoziiertes Malignom seit langem in die CDC-Klassifikation der HIV-Infektion eingegangen. HPV-assoziierte anale Dysplasien erweisen sich jedoch ebenfalls als gehäuft bei HIV-Infizierten. Ein entsprechendes standardisiertes Screening existiert bisher jedoch nicht. Ziel dieser Pilotstudie ist, langfristig ein solches für ein Hochrisikokollektiv zu entwickeln. Methodik: prospektive Untersuchung HIV-infizierter Patientinnen mittels analer Zytologie, HPV-Abstrich, Anoskopie, ggf. Histologie. Gleichzeitige Dokumentation des Immunstatus, HI-Viruslast, antiretrovirale Therapie (ART), relevante Vorgeschichte. Ergebnisse: 50 HIV-infizierte Patientinnen aus der Sprechstunde wurden konsekutiv in die Studie eingeschlossen. Bei 15 von 50 Probandinnen (30%) zeigte sich ein anal positiver HPV high-risk Befund. Von diesen 15 Frauen hatten 6 auch zytologisch eine Dysplasie (5x Pap IIID, 1x Pap IVa). 11/15 Patientinnen hatten gleichzeitig zervikal eine HPV high-risk, davon bei 8 zytologisch eine Dysplasie (7x Pap IIID, 1x Pap IVa). Mithilfe der Anoskopie wurden bisher bei einer dieser Patientin anale Biopsien mit dem Ergebnis AIN vorgenommen. Alle 15 Pat. nehmen aktuell eine ART mit einer gut kontrollierten Viruslast, nur 3 waren mit ihrer CD4Zellzahl <200/µl.

Ist die Exfoliativzytologie perianal/anal geeignet ausreichend beurteilbare Proben zu generieren (beurteilt nach der II. Münchner Nomenklatur)?