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1/8. Special problems in cervical cancer management.

    Cervical cancer is easily recognized when it presents as a visible lesion, but a problem arises when it adopts unusual presentations. Cervical cancer can develop high in the endocervical canal, beyond the reach of cone biopsy. Copious vaginal discharge from cervical adenocarcinoma may lead to a false-negative Papanicolaou (Pap) smear. Treatment of cervicitis can result in a delay in diagnosis. Successful and timely diagnosis and treatment of cervical cancer requires experience and vigilance. Careful intraoperative palpation of the cervix and uterus can help determine the location and extent of the lesion. Flexibility during surgery is required to utilize intraoperative findings and thus optimize treatment. Pitfalls of cervical cancer diagnosis and treatment with actual case presentations are presented along with other special problems in cervical cancer management such as incidental findings of cervical cancer in hysterectomy specimens, treatment of cervical stump cancers, and unusual cervical cancer cell types.
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ranking = 1
keywords = cervicitis
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2/8. lymphoma-like lesion of the uterine cervix.

    lymphoma-like lesion of the uterine cervix is a benign reactive lymphoid hyperplasia associated with chronic cervicitis that may pose a problem in differential diagnosis from malignant lymphoma. It is a rare entity and only about 20 cases have been reported in the world literature. Two cases of cervical lymphoma-like lesion are described. In both patients, the diagnosis was based on microscopic examination of biopsies taken from the uterine cervix. One patient subsequently had a cervical conization that confirmed the diagnosis of lymphoma-like lesion. Both patients are well, alive and with no evidence of malignant lymphoma. It is concluded that the diagnosis of lymphoma-like lesion is based on the well-established characteristic microscopic features of this lesion. Immunohistochemical staining is usually not helpful in distinguishing this lesion from malignant lymphoma. No specific treatment is necessary for this condition.
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ranking = 1
keywords = cervicitis
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3/8. Abnormal cervicovaginal smears due to endometriosis: a continuing problem.

    endometriosis may be challenging when identified on cervicovaginal smears (CVS), leading to an incorrect interpretation of high-grade squamous intraepithelial lesion (HSIL), or atypical glandular cells of undetermined significance (AGUS) including adenocarcinoma in situ (AIS). awareness of cervical endometriosis, particularly in predisposed patients, is crucial for a correct diagnosis. While cervical endometriosis has been reported to be a diagnostic pitfall of glandular abnormalities, its characteristic features are still not well-established. This may partially be attributed to the varied cytomorphologic features endometriosis shows, depending on menstrual cycle hormonal changes. We describe our experience with three examples where CVS were interpreted as either AGUS or HSIL, which led to a hysterectomy in 2 of 3 patients. Cervical endometriosis needs to be considered with other well-known benign conditions that mimic glandular abnormalities, including cervicitis, tubal metaplasia, lower uterine segment sampling, and microglandular hyperplasia. Published series and our own experience lead us to suggest that these smears will continue to present diagnostic difficulties.
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ranking = 1
keywords = cervicitis
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4/8. Squamous cell carcinoma associated with amoebic cervicitis. Report of a case.

    A case of squamous cell carcinoma associated with amebiasis is presented. Protozoa identified as entamoeba histolytica were found in a routine Papanicolaou smear and in the cervical biopsy of a young woman following the initial diagnosis of cervical cancer and the institution of a radiation therapy regimen. No amoebae were found in repeated stool specimens. The late detection and diagnosis of amebiasis precluded any possible changes in the management of the case. Initial follow-up for the carcinoma demonstrated that the patient was not responding well to therapy; her failure to return to the clinic precluded long-term follow-up and treatment for the amebiasis.
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ranking = 4
keywords = cervicitis
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5/8. Syphilitic cervicitis. A report of a case.

    A case report of a young female who had a biopsy of a cervical lesion suspicious for malignancy is presented. After further evaluation, an initial diagnosis of Stage III sarcoma of the cervix was considered. The patient was eventually appropriately treated for a syphilitic chancre of the cervix. The pitfalls of diagnosis in this patient and other patients in the literature who have leutic cervicitis are stressed in order to alert the practicing gynecologist to this unusual location of a common veneral disease.
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ranking = 5
keywords = cervicitis
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6/8. Detection of human papillomavirus type 16 in plasma cells.

    Chronic benign plasma cell tumor of the cervix, also called chronic plasma cell cervicitis, is a rare disease of unknown etiology, characterized by a heavy infiltration of plasma cells forming granulation tissue. To identify infectious agents associated with this disease, we extracted and analyzed dna from the 17-year-old paraffin section of the original case report and from granulation tissue surgically removed from a patient at our institution with a chronic benign plasma cell tumor. The dna from both patients was shown by a polymerase chain reaction (PCR) technique to contain a human papillomavirus 16 (HPV 16) sequence. Genomic Southern analysis of the fresh-frozen tissue confirmed the initial PCR finding. in situ hybridization further demonstrated that the HPV 16 was present in the plasma cells and not a contaminant from the surrounding epithelial tissue. The etiological role of HPV 16, an oncogenic virus associated with cervical carcinoma, in this disease is not yet clear. Our results, however, suggest that the types of cells that are infected by HPV may include cells of lymphoid origin, and that HPV may be associated with chronic benign plasma cell tumors of the cervix.
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ranking = 1
keywords = cervicitis
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7/8. Chronic plasma cell cervicitis simulating a cervical malignancy: a case report.

    BACKGROUND: Only one case of plasma cell cervicitis, a rare variant of chronic cervicitis, has been reported. We report a second case and present data supporting the detection of human papillomavirus (HPV) outside of epithelial tissues. CASE: A 67-year-old woman was found to have a large cervical tumor. Extensive diagnostic evaluation failed to reveal a suspected cervical cancer; subsequently, a hysterectomy was performed. light microscopic studies confirmed plasma cell cervicitis. Standard virologic tests were used to confirm the presence of HPV 16 in cervical sections. Retrospective study of the first reported case also demonstrated HPV. CONCLUSION: Fulminant cases of chronic cervicitis, presenting with clinical features similar to cervical cancer, are unusual. Even more interesting is the detection of HPV outside of the epithelium; this is the first case that clearly demonstrates HPV in plasma cells.
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ranking = 8
keywords = cervicitis
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8/8. Syphilitic cervicitis simulating stage II cervical cancer. Report of two cases with cytologic findings.

    Two women, ages 42 and 46, each had a cervical mass that clinically was grossly compatible with invasive carcinoma. colposcopy supported the clinical impression. Weeks after the women were examined, it was determined that the masses represented syphilitic cervicitis. This entity has received almost no attention in the cytology literature, and is not discussed in major cytopathology texts. Accordingly, the cervicovaginal smears that were obtained in these cases are of interest. The smear pattern, which included lymphocytes, plasma cells, histiocytes, and debris, is described. Although in contrast, the histopathology of syphilitic cervicitis is well-characterized, diagnostic evidence of syphilis was missed in the initial interpretation of several of the biopsies. syphilis recently has reemerged as a public health problem. Although the cases reported here represent rare events, pathologists should be aware that syphilitic cervicitis may clinically and colposcopically simulate a primary advanced cervical cancer. When interpreting cervical biopsies and cervicovaginal smears, they should be alert to patterns that suggest that syphilis is present.
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ranking = 7
keywords = cervicitis
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