Biomedical subjects
Publications and source records attributed to R Barrasso.
Therapeutical circumcision (posthectomy) in nine patients presenting with diffuse penile warts. CO2 laser circumcision resulted in a 100 p. 100 cure rate after a 3-month follow-up in patients with diffuse warts of recent onset, and a 75 p. 100 cure rate in patients with recalcitrant warts.
Genital Papillomavirus infection has now reached epidemic size. Several techniques may be used to treat genital condylomas, but none of them is 100 percent effective. At the first consultation for external genital condylomas, the choice of treatment is determined by the size, location, number and histology of the lesions. Typical condyloma acuminata that are present in small number and have a less than 5 mm base of implantation are treated by cryotherapy or trichloracetic acid. Podophyllin should be reserved for patients with diffuse lesions. When one or several lesions do not regress after 3 to 4 weeks of treatment, surgical procedures (electrocautery, CO2 laser) must preferably be used. Condylomas that have a base of implantation wider than 5 mm are directly destroyed by surgical excision, as are dysplastic lesions. Post-treatment cure of external genital lesions must be confirmed by a negative acetic acid test. Patients should be advised to utilize condoms throughout the duration of treatment.
42 subclinical HPV related vulvar lesions have been studied by Southern Blot Hybridization and histological samplings. 15 women had normal Pap smears. Cervical intraepithelial neoplasia was present in 24 other women, 15 of them had HPV on Southern Blots. Macular or papular areas on the vulva were strongly correlated with HPV infection, since 6 out 9 of them harboured HPV 16, 42 or X. Histologically, flat condyloma was present in 6 cases. However, 33 nonspecific acetowhite reactions of the vulva were free of HPV. It is therefore important to recognize such aspects on colposcopical examination of the vulva to avoid unnecessary treatment.
We have been looking for urethral condylomatous lesions during a screening genital examination of 2,000 male patients who were the partners of women presenting with a condylomatous infection. The use of a small speculum and of a retractor of our own design has allowed the out patient diagnosis and treatment of urethral lesions up to 20 mm deep in 26 (22%) of the 123 patients presenting with lesions of the urethral meatus. A follow-up urethroscopy demonstrated the presence of condylomatous lesions in the retrobalanic portion, up to the vicinity of the striated sphincter in 11 (8%) of these patients. The use of a novel retractor thus allows visualizing all the lesions located up to the great lacuna and treating them with a laser beam, with a healing rate of 93%. Urethroscopy must be reserved for recurrence of meatic condylomas after treatment.
Numerous epidemiological studies have made it possible to isolate groups of women at risk or developing an epidermoid carcinoma of the uterine cervix. Among the factors studied, age at the time of the first sexual intercourse and number of male partners were found to be statistically significant factors. No study has yet proved that smegma facilitates cancer and that circumcision may prevent its occurrence. However, the importance of the "male factor" has been enhanced by many studies suggesting the possibility of an oncogenic factor transmissible by sexual intercourse. Several data suggest that some types of human papillomavirus are the necessary, if not sufficient, factors of cervical oncogenesis. Some types of herpes virus, notably HPV 16, can be identified in the majority of invasive cancers and their direct precursors: intraepithelial neoplasias. The carcinogenic role of papillomaviruses in animals ans in laboratory experiments supports the theory that these sexually transmissible viruses are involved in the origin of epidermoid cervical carcinoma.
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This study includes 28 intraepithelial squamous lesions of the cervix associated with human papillomavirus (HPV) DNA sequences detected by the Southern blot technique. Objective analyses of the histologic features by morphometric parameters and mitotic index have demonstrated that lesions of HPV types 6 and 11 can be distinguished from types 16, 18, and 33 by stepwise discriminant functions. The latter lesions have higher mitotic and cellularity indexes and greater nuclear atypia than the former, supporting a greater degree of epithelial proliferation and abnormality seen in association with HPV types 16/18/33.
To determine whether neoplastic cervical lesions in women are associated with papillomavirus infections in their sexual partners, we used a colposcope to examine male sexual partners of women with cervical flat condyloma (294 cases) or cervical intraepithelial neoplasia (186 cases), before and after 5 percent acetic acid was applied to the penis and the anogenital area. Condylomata acuminata, papules, and macules were observed in 309 of the 480 men (64.4 percent). In 204 of them (42.5 percent), macules or slightly elevated papules were detected only after application of acetic acid. Condylomata acuminata or lesions showing histologic features of condyloma were found in 121 partners (41.2 percent) of women with condyloma, but in only 10 partners (5.4 percent) of women with cervical intraepithelial neoplasia. Penile lesions showing histologic features of intraepithelial neoplasia were found in 61 partners (32.8 percent) of women with cervical intraepithelial neoplasia, but in only 4 partners (1.4 percent) of women with flat condyloma. Thirty-six (60 percent) of the 60 macules or papules tested contained papillomavirus DNA sequences. Human papillomavirus types 16 and 33 were almost exclusively found in penile intraepithelial neoplasia. Type 6, type 11, and the recently recognized type 42 were found in lesions showing features of condyloma or minimal histologic changes. As yet uncharacterized papillomaviruses were found in 15 percent of the specimens. These data support the concept that cervical carcinomas and precancerous lesions in women may be associated with genital papillomavirus infection in their male sexual partners.
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To evaluate the reliability of colposcopy for distinguishing flat condyloma from cervical intraepithelial neoplasia (CIN), 211 patients with abnormal cytology, colposcopical evidence of an atypical transformation zone (ATZ), and a histological diagnosis of flat condyloma or CIN were studied. Colposcopic evidence of surface abnormalities, the presence of satellite lesions, and an irregular Lugol's uptake were tentatively considered to be features of condyloma. Histologically, koilocytotic lesions with a disorganized cytologically atypical basal/parabasal layer and with atypical mitotic figures (AMFs) were considered to be CIN cases, and designated as CIN with koilocytosis (CIN K). At least two colposcopic features of condyloma found in 98 of 99 flat condylomas, were also found in 89 of 112 CINs. When colposcopic features were matched with histology for every directed biopsy site, they correlated strongly with koilocytosis, regardless of the degree of atypia in the lesion. Moreover, these features often occurred at the periphery of poorly differentiated or undifferentiated, high grade CINs, in areas histologically indistinguishable from flat condyloma. Thus, colposcopic features are not of predictive value in distinguishing flat condyloma from CIN, do not show correspondence to the lesional degree of atypia and cannot be fully related to the biological characteristics of the cervices in which they are found. These findings confirm that colposcopy cannot be considered to be a diagnostic method.
Cervical biopsies from 66 women presenting an abnormal smear, with HPV related features were studied and histologic features were correlated to the HPV type, as determined by molecular hybridisation studies. HPV DNA sequences were evidenced in 13 of 19 lesions corresponding to exophytic or flat condyloma (HPV type 16 in seven cases, HPV type 11 in four cases, as yet uncharacterized HPV types, HPV X, in two cases). Fourty biopsies were histologically interpreted as CIN, on the basis of atypical mitotic figures (AMF) and/or basal-parabasal cell atypia. HPV type 16 was evidenced in 20 cases (3 cases of double infection: HPV types 16 and 18, HPV types 16 and 33, HPV types 16 and X). In 10 other cases, HPV DNA sequences corresponding to HPV type 11 (one case), HPV 18 (one case) and HPV X (8 cases) were evidenced. In this study, potentially oncogenic HPV types (HPV 16, HPV 18, HPV 33) have been found only in CIN lesions defined on the presence of AMFs and/or basal-parabasal cells atypia. These histologic criteria seem to allow a distinction between low and high risk cervical lesions.
One hundred and seventy five CIN cases diagnosed during the years 1958-60 have been reviewed and histologic slides as well as colpographies have been reevaluated for the presence of Papillomavirus-related features. Histo-colposcopic features of HPV infection have been found in 70% of CIN cases, incidence comparable to the one actually observed. Thus, the relationship between HPVs and cervical cancer doesn't seem to be changed.
Ten years after the description of cervical flat condyloma, it is now admitted that Human Papillomaviruses (HPVs) type 6 and 11 are responsible for condylomata acuminata and typical flat condyloma of the uterine cervix. HPV DNA type 16 and, less frequently, 18, 33 and other as yet uncharacterized HPV types (G. Orth, personal communication), are found in the majority of Cervical Intraepithelial Neoplasia (CIN), Vulvar Intraepithelial Neoplasia (VIN) and cervical and vulvar invasive cancers. Since HPVs are sexually transmissible, recent interest has focused on the "male factor". Clinically detectable lesions of male genitalia are condylomata acuminata, bowenoid papulosis and flat condyloma-like papules. The aim of our study was the colposcopical screening, recently suggested, of different groups of male patients in order to detect HPV-related lesions and the description of the colposcopical features of subclinical HPV-related lesions, since most of them have never been reported, to our knowledge, in the literature. A total of 114 men were examined. Among them, 18 presented clinically detected recalcitrant condylomata acuminata, 28 had been treated for the same pathology 1 to 5 days earlier and were clinically free of lesions, 46 were sexual partners of women with cervical atypia (flat condyloma and/or CIN) and 22 had a clinical diagnosis of genital infection without HPV-related lesions. A careful examination of external genitalia was performed. Then all patients underwent penile colposcopy before and after application of 5 p. 100 acetic acid. Selected biopsies were performed in all lesions which were clinically and colposcopically different from classic warts. Colpophotographs were taken in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)
Sera taken from pregnant patients and their newborns at delivery were examined for evidence of primary or reactivated Epstein-Barr virus infection. Of 102 women, 37 showed serological signs of reactivated and two signs of primary infection. A mild congenital defect was observed in association with one of the two cases of maternal primary infection. Infants of mothers with reactivated infections remained healthy during the one year follow-up after birth.
A series of 111 cervical conization specimens from patients with carcinoma in situ (CIS) have been examined by the authors in order to point out the real incidence of condylomatous lesions and their different aspects. The histological criteria of condyloma and cervical intra-epithelial neoplasia (dysplasia and CIS) are recalled, and relationships between them are discussed. Koïlocytes have been observed in 77.5% of CIS examined. Different localisations of condylomatous aspects as regards dysplastic and neoplastic lesions are described and discussed. The histological pattern defined as CIN III with incomplete signs of condylomatous lesion, is significantly associated to flat condyloma (72.7% of cases). Morphological and biological border between condyloma and CIN seems to be not clean; therefore the authors stress on the careful screening, treatment and follow-up of this patients.
At the Institute of Pathology and Applied Cytology, 619 cases of conization or hysterectomies for CIS had been reviewed, through the study of 6,439 slides: 263 cases from the years 1957-1968, 287 cases from the years 1981-1983, have been studied. In the 1957-1968 group, a condylomatous lesion was associated with CINIII/CIS in 60% and in 79% in the 1981-1983 group. The relationship between the condylomatous lesions and the CIS, the grade of these lesions and the mean age of the patients had been examined. In the both groups, the HPV signs had been more frequently discovered in the younger women. But a difference of 4 years was found between the patients with CINIII without any sign of HPV infection and those with a CINIII/CIS associated with a condyloma. These data support the hypothesis of a lessening and a later disappearance of the HPV signs when the neoplasias become more severe. In both groups, the relationship between the signs of HPV infection and the grade of the cervical epithelial atypias are exactly the same. These lesions, more often extended, with a transitional passage between CIN with HPV cytopathological effects and CIS, comfort the hypothesis of a straight relationship between HPV infection and carcinoma of the cervix.
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