Importance of Cuff Cytology and Human Papillomavirus Screening, Especially in Patients with Autoimmune Disorders

Canan ÜNAL, Hanife Güler DÖNMEZ, Erdem FADILOĞLU, Atakan TANAÇAN, M. Sinan BEKSAÇ
2019 Journal of Clinical Obstetrics & Gynecology  
fter total hysterectomy, except that in women with a history of cervical cancer or Cervical Intraepithelial Neoplasia (CIN) II/CIN III/High-grade Squamous Intraepithelial Lesion (HSIL), routine vaginal cuff cytology screening is not recommended, if the hysterectomy was performed for benign uterine conditions like uterine fibroids, endometriosis/adenomyosis, uterine prolapse or urinary incontinence. 1,2 However, different studies report various percentages of high-risk HPV and premalignant
more » ... premalignant changes in a cuff smear, which range from 4.5-9.5%. 1 Vaginal intraepithelial neoplasia was found to develop in nearly 7.4% of the patients in a study wherein a hysterectomy was performed for HSIL/CIN III. 3 Vaginal cancer is rare, comprising only about 1-4% of the lower genital tract cancers; the rate of progression of vaginal intraepithelial neoplasia into invasive vaginal cancer ranges from 0-9%. [4] [5] [6] [7] Cuff smear cytology is often ignored due to the rarity of vaginal cancer and the fact that its progression rate is lower than that of cervical cancer. There is no clear conformity on the matter of cuff smear cytology following total hysterectomy, especially in benign cases. Therefore, the authors aim to report the results of four female patients with HPV positivity and abnormal cuff smear in whom total hysterectomy was performed. CASE REPORTS This case series reports the results of four patients with HPV positivity after they underwent routine gynecologic follow-up after a hysterectomy. The A AB BS S T TR RA AC CT T This article aims to report the results of four cases of human papillomavirus (HPV) positivity and abnormal cuff smear. A hysterectomy was performed in this study to eliminate precancerous cervical lesion in one patient and uterine myoma in another. Subsequent follow-up of the patients revealed HPV DNA positivity in cuff cytology, even though both the patients tested negative for HPV prior to hysterectomy. Cuff cytology and HPV DNA screening, therefore, seem to be important in dicey and benign cases, especially occurring together with autoimmune disorders. HPV type 16 was found to be the most frequent subtype (75%) in this study. K Ke ey yw wo or rd ds s: : Cytology; human papilloma virus 16; human papilloma virus DNA test; autoimmune disorders
doi:10.5336/jcog.2019-65338 fatcat:lp4ilraddfgevmkbmz2hjpec3a