Concurrent cytologic and colposcopic evaluation of symptomatic cervical erosion

Background: Cervical cancer is amongst the leading causes of deaths due to cancer in developing countries. Moreover, preinvasive lesions of the cervix have a long latency period for conversion into malignancy and are also detectable by screening techniques. Hence, colposcopy in addition to cytology should be carried out wherever facility is available to ensure early detection and timely management.Methods: Simultaneous cytology and colposcopy was done for 80 women with symptomatic cervical erosion followed by a colposcopic directed biopsy in women with MRCI >3. Finally, correlation between cytology, colposcopy and histopathological results was done.Results: 65/80 women were biopsied. 12/80 women had MRCI >6 amongst which 10/80 were confirmed to have a high grade lesion on histopathology. 13/80 had lesser abnormalities (ASCUS and LSIL) amongst which 3/80 had CIN1 on histopathology. Only 2/80 had HSIL on cytology as compared to 8/80 on histopathology that had CIN 2/3. Lastly, only 1/80 had SCC on cytology compared to 2/80 on histopathology. The sensitivity, specificity, PPV and NPV of cytology and colposcopy for diagnosing cervical dysplasia was 46.1%, 83.5%, 35.2%, 88.8% and 84.6%, 86.5%, 55%, 96.6% respectively making colposcopy a better screening tool than cytology for evaluating cervical malignancy.Conclusions: Colposcopic examination should ideally be carried out in all women with symptomatic cervical erosion in addition to cytology. Moreover, suspicious areas should be biopsied even if cytology is normal to exclude malignancy.

Evaluation of Dynamic Thiol-Disulfide Balance in Preinvasive Lesions of the Cervix

Purpose: This study aimed to determine the potential clinical use of dynamic thiol disulfide balance in cases with preinvasive lesions of the cervix.Methods: One hundred and sixteen patients with high-grade squamous intraepithelial lesion, one hundred patients with low-grade squamous intraepithelial lesion and one hundred and ten healthy controls were enrolled in the study. A fully automated colorimetric system was used to determine the levels of thiol-disulfide parameters. The ischemia-modified albumin, total oxidant-antioxidant capacity, oxidative stress index of the retrieved cases were further analysed.Results: Native thiol and total thiol levels are significantly lower in the high-grade squamous intraepithelial lesion group according to control group (p:0.004 and p:0.015, respectively). Disulfide level is significantly increased in the high-grade squamous intraepithelial lesion group compared to control group (p:0.004). Oxidative stress index levels in high-grade squamous intraepithelial lesion group were observed as significantly higher according to the control group (p:0.014). Ischemia-modified albumin levels in the high-grade squamous intraepithelial lesion group were observed as significantly higher compared to the control group (p:0.020). Disulfide levels are positively correlated with risk type of Human papillomavirus (r:0.420, p<0.001).Conclusion: The analysis of dynamic thiol disulfide balance revealed considerable oxidative damage in patients with Human papillomavirus -related cervical precursor lesions compared to women with ordinary cytology specimens. Therefore, investigation of thiol disulfide balance with presented method represents a new promising test for early diagnosis and management of women at high risk for cervical cancer.

Immunohistochemical Differences in Squamous Precancerous and Cancerous Lesions of the Oral Cavity and the Larynx: Preliminary Data

The aim of this study is to assess immune cell populations in squamous precancerous (preinvasive) and cancerous lesions of the oral cavity and larynx. Qualitative and quantitative immunohistochemical analyses were performed to determine the expressions of CD4, CD8, CD15, CD57 and CD68. The expressions of programmed death-ligand 1 (PD-L1), p16 and Ki67 were also assessed. Squamous cell lesions from forty-one patients were included in the study. Sixteen samples were categorized as precancerous (preinvasive) lesions and twenty-five as invasive squamous cell carcinoma. Invasive lesions showed a negative correlation with CD57+ cells (ρ = −0.69) and a positive correlation with Ki67 (ρ = 0.61). The amount of CD4+ lymphocytes was higher in invasive lesions. There were no differences in PD-L1 and p16 immunoreactivity. Our analysis showed differences in the immunohistochemical profile between preinvasive and invasive squamous cell lesions. In the near future, this study should be useful in driving treatment strategy in both preinvasive and invasive squamous cell lesions of the oral cavity and larynx. However, studies on larger series of patients focusing on site-specific lesions are required.

Progression to invasive cancer after snare polypectomy of intracholecystic papillary neoplasms during gallbladder stone removal by percutaneous transhepatic choledochoscopy: a case report

Background Intracholecystic papillary neoplasms (ICPNs) of the gallbladder are rare, preinvasive lesions characterized by an intracholecystic papillary growth that may be associated with invasive adenocarcinoma. The natural history of ICPN is unknown. Here, we report a case of ICPN, highlighting its natural course. Case presentation A 79-year-old woman presented to the emergency department with perforated cholecystitis. After percutaneous transhepatic gallbladder drainage, due to the presence of surgical risk factors, we opted to perform gallstone removal through percutaneous transhepatic cholangioscopy instead of cholecystectomy. ICPN, which was accidentally detected after the removal of the gallbladder stones, was also endoscopically removed. After 4 years, the patient came back to the hospital with a large gallbladder mass. After cholecystectomy, pathological examination revealed ICPN with invasive adenocarcinoma. Conclusion The current case showed endoscopic findings of ICPN and its natural progression, particularly its clinicopathological features and outcomes.

Single-cell transcriptomes of pancreatic preinvasive lesions and cancer reveal acinar metaplastic cells’ heterogeneity

Acinar metaplasia is an initial step in a series of events that can lead to pancreatic cancer. Here we perform single-cell RNA-sequencing of mouse pancreas during the progression from preinvasive stages to tumor formation. Using a reporter gene, we identify metaplastic cells that originated from acinar cells and express two transcription factors, Onecut2 and Foxq1. Further analyses of metaplastic acinar cell heterogeneity define six acinar metaplastic cell types and states, including stomach-specific cell types. Localization of metaplastic cell types and mixture of different metaplastic cell types in the same pre-malignant lesion is shown. Finally, single-cell transcriptome analyses of tumor-associated stromal, immune, endothelial and fibroblast cells identify signals that may support tumor development, as well as the recruitment and education of immune cells. Our findings are consistent with the early, premalignant formation of an immunosuppressive environment mediated by interactions between acinar metaplastic cells and other cells in the microenvironment.

Artificial intelligence-assisted CT characterizations and quantitative analysis for differentiating pre-invasive lesions from invasive adenocarcinomas in pulmonary subsolid nodules ≤ 2cm.

e21614 Background: The use of artificial intelligence (AI) in medical imaging has dramatically improved the quality of segmentation including accuracy, efficiency and reproducibility. This study sought to determine whether AI-assisted computed tomography (CT) features and quantitative analysis of pulmonary subsolid nodules (SSNs) under 2cm could be used to differentiate preinvasive lesions from invasive adenocarcinomas. Methods: Clinical data and CT images of 297 preinvasive lesions and early invasive lung adenocarcinomas confirmed by surgery pathology with CT manifestations of SSNs under 2cm were retrospectively analysed. The nodules were divided into two groups: the preinvasive lesions (PILs, N = 115) including 7 cases of atypical adenomatous hyperplasia (AAH), 30 cases of adenocarcinoma in situ (AIS) and 78 cases of minimally invasive adenocarcinoma (MIA), and the invasive adenocarcinomas (IACs, N = 182). All CTs were processed by AI and the volume, mean CT value, consolidation-to-tumor ratio (CTR), mass and maximum diameter of each SSN were obtained. Results: The volume, mean CT value, CTR, maximum diameter and mass of nodules showed significant difference between the two groups (Table). Multivariate analysis was determined by logistic regression. The regression model between the two groups was logit(p) = -1.439-2.927Volume +0.0005(mean CT value)-0.463(CTR > 0.5) +0.238(maximum diameter)+6.298(mass).The receiver operating characteristic curve (ROC) showed that the mass can do the best prediction among all the independent factors with the areas under the curve(AUC) 0.748 at a cut-off value of 0.154, with the sensitivity of 70.9% and specificity of 70.4% .The AUC of the ROC using the regression probabilities of regression model was 0.769. Conclusions: AI-assisted CT characterizations may be promising tools to predict if SSNs under 2 cm have invaded. [Table: see text]