Journal of Lower Genital Tract Disease最新文献

{"title":"The Significance of Extended HPV Genotyping for Detecting Endocervical Glandular Neoplasia for Atypical Glandular Cells.","authors":"Fangfang Zhong, Megan L Zilla, Yihua Sun, Xianxu Zeng, Hao Zhang, Jianan Xiao, Xiang Tao, Chengquan Zhao","doi":"10.1097/LGT.0000000000000886","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000886","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate the risk of cervical glandular neoplasia with extended high-risk human papillomavirus (hrHPV) genotyping, in patients with atypical glandular cells (AGC) cytology.</p><p><strong>Methods: </strong>Cervical AGC cases with concurrent extended HPV genotyping between October 2017 and October 2023 were retrieved from the archives of Department of Pathology, Obstetrics, and Gynecology Hospital of Fudan University (OGHFU).</p><p><strong>Results: </strong>A total of 497 AGC cases with extended hrHPV genotyping showed an hrHPV-positive rate of 32.0%. The top 4 hrHPV types were HPV18, 16, 52, and 59. A total of 304 cases had histological follow-up. A total of 72 cases (23.7%) had cervical adenocarcinoma in situ/cervical intraepithelial neoplasia3 or worse (AIS/CIN3+) lesions with 43 endocervical carcinoma (EC-ADC), 28 AIS, and 1 CIN3. Cervical AIS/CIN3+ lesions were detected in 50.5% (55/109) of the hrHPV-positive group.Women with HPV18/16/45 positivity had 77.6% cumulative risk of cervical AIS/CIN3 + lesions (52/67), accounting for 94.6% (52/55) of the total hrHPV-associated cervical AIS/CIN3+ lesions. For all 15 other hrHPV types, the overall risk of AIS/CIN3+ was 7.1% (3/42 cases). The sensitivity, specificity, PPV, and NPV of the composite HPV18/16/45 group for detecting endocervical glandular neoplasia was 71.8%, 93.1%, 76.1%, and 91.6%, respectively. Endocervical carcinoma was found in 17 of 195 (8.7%) women with negative hrHPV testing, accounting for 39.5% EC-ADC (17/43) cases.</p><p><strong>Conclusions: </strong>Atypical glandular cells was rarely related to CIN3. Atypical glandular cells was strongly related to AIS and EC-ADC. Women aged 30-49 years had highest risk for AIS/CIN3+ lesions. Although HPV test can be helpful, there were still some cases of HPV-negative endocervical adenocarcinomas. Extended HPV genotyping in AGC cases identified certain HPV types associated with a higher risk of cervical glandular lesions, potentially assisting with risk stratification.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Regarding \"A Narrative Review of the Vulvar Disease Literature With Images of Women of Color\".","authors":"Debra S Heller","doi":"10.1097/LGT.0000000000000872","DOIUrl":"10.1097/LGT.0000000000000872","url":null,"abstract":"","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"204"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lichen Sclerosus in Cancer Patients.","authors":"Amaris N Geisler, Shivani Jain, Kara Long Roche, Deborah J Goldfrank, Alina Markova, Mario E Lacouture, Sarah J Noor","doi":"10.1097/LGT.0000000000000870","DOIUrl":"10.1097/LGT.0000000000000870","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the association between cancer therapies and the development of lichen sclerosus (LS) in a case series of patients.</p><p><strong>Methods: </strong>A retrospective chart review was performed to screen for patients who were diagnosed with LS while undergoing cancer therapy at Memorial Sloan Kettering Cancer Center between 2003 and 2019. Patients were excluded if they had been diagnosed with LS prior to starting cancer therapy. Clinical and treatment characteristics were analyzed.</p><p><strong>Results: </strong>The final study sample included 29 female patients who developed LS in the setting of systemic cancer therapy. Median time to LS onset after cancer therapy initiation was 420 days. Primary tumor types included breast (10, 34.5%), gynecologic (8, 27.6%), gastrointestinal (5, 17.2%), cutaneous (2, 6.9%), lung (2, 6.9%), and hematologic (2, 6.9%). Cancer therapy regimens included hormonal therapy (10, 34.5%), chemoradiation (7, 24.1%), cytotoxic chemotherapy (7, 24.1%), PD-1/PD-L1 inhibitors (3, 10.3%), local radiation (1, 3.4%), and allogeneic stem cell transplant (1, 3.4%). Across all patients, the mean number of treatments for LS was 2.8. Twenty-three (79.3%) patients received the first-line therapy of ultrapotent topical steroids, but 16 (69.6%) required additional topical and systemic treatment. Limitations include retrospective design and referral bias.</p><p><strong>Conclusions: </strong>Breast cancer was the most common primary tumor among patients in this study. The most common cancer therapy regimen was hormonal therapy. Most patients required an escalation in therapy to manage their LS. For patients undergoing cancer treatment, concomitant LS management can present unique challenges due to the biological mechanism of some anticancer therapies and the pathophysiology of LS. There is limited data to guide treatment of LS for this population. Some of the patients included in this analysis had progression of LS and recurrence of cancer while undergoing management of both conditions, necessitating close follow-up.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"186-189"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Collected Vaginal Specimens for HPV Testing: Recommendations From the Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee.","authors":"Nicolas Wentzensen, L Stewart Massad, Megan A Clarke, Francisco Garcia, Robert Smith, Jeanne Murphy, Richard Guido, Ana Reyes, Sarah Phillips, Nancy Berman, Jeffrey Quinlan, Eileen Lind, Rebecca B Perkins","doi":"10.1097/LGT.0000000000000885","DOIUrl":"10.1097/LGT.0000000000000885","url":null,"abstract":"<p><strong>Objective: </strong>The Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee developed recommendations for the use of self-collected vaginal specimens for human papillomavirus (HPV) testing in health care settings.</p><p><strong>Methods: </strong>A comprehensive literature search was performed, external systematic reviews were evaluated, and HPV genotype agreement between self-collected vaginal and clinician-collected cervical specimens was summarized. Recommendations considered available data, public comments, and expert consensus. Recommendations were ratified through a vote by the Consensus Stakeholder Group.</p><p><strong>Results: </strong>Clinician-collected cervical specimens are preferred and self-collected vaginal specimens are acceptable for primary HPV screening of asymptomatic average-risk individuals. Repeat testing in 3 years is recommended following HPV-negative screens using self-collected vaginal specimens. Colposcopy with collection of cytology and biopsies is recommended following positive tests for HPV types 16 and 18. Clinician-collected cytology or dual stain for triage testing is recommended following positive tests for HPV 45, 33/58, 31, 52, 35/39/68, or 51 or for pooled HPV other types but negative for HPV 16 or 18. Repeat HPV testing in 1 year is recommended following a positive test for HPV types 56/59/66 and no other carcinogenic types. Minimal data exist on use of self-collected vaginal specimens for surveillance following abnormal screening test results, colposcopy or treatment, and therefore, clinician-collected cervical specimens are preferred.</p><p><strong>Conclusions: </strong>Human papillomavirus testing of self-collected vaginal specimens expands cervical cancer screening options and has potential to increase access for currently underscreened individuals. Laboratory and clinical workflows will need to be modified to ensure adequate specimen processing and follow-up.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"144-152"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11939108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Benefits of Endocervical Curettage in Women Infected With HPV16/18.","authors":"Yusha Chen, Suyu Li, Jiancui Chen, Huifeng Xue, Xiangqin Zheng, Diling Pan","doi":"10.1097/LGT.0000000000000863","DOIUrl":"10.1097/LGT.0000000000000863","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates the effectiveness of endocervical curettage (ECC) in detecting additional high-grade squamous intraepithelial lesions or worse (HSIL+) in women infected with human papillomavirus (HPV) types 16 and 18, which may be missed by biopsy alone.</p><p><strong>Methods: </strong>A retrospective cohort study analyzed the medical records of 4,811 women referred for colposcopy due to HPV16/18 infection from January 2019 to December 2023. Patients underwent both biopsy and ECC. Statistical comparisons of various clinical factors between HSIL+ and low-grade or normal lesions were performed using χ 2 tests and logistic regression analyses, with stratified analysis to determine ECC's additional detection rate under different clinical conditions.</p><p><strong>Results: </strong>Endocervical curettage detected an additional 6.46% of HSIL+ lesions missed by biopsy alone, with the highest rates in women with normal colposcopic impressions (23.1%), those aged 50 or older (12%), type 3 transformation zones (9.5%), and postmenopausal women (11.9%). In contrast, younger women under 30 and those with type 1 or 2 transformation zones had significantly lower detection rates (2.9%). Logistic regression indicated that older age, type 3 transformation zone, higher grade cytological results, and abnormal colposcopic impressions are significant risk factors for HSIL+ detection via ECC ( p < .001).</p><p><strong>Conclusions: </strong>Data from this study indicate that ECC would be beneficial for women over 30 with HPV16/18 infections, particularly those with type 3 transformation zones or normal colposcopy, as it enhances HSIL+ detection. However, it offers minimal benefit for younger women or those with type 1 or 2 transformation zones.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"111-117"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutaneous Intertriginous Langerhans Cell Histiocytosis in Adults: A Case Report and Systematic Review.","authors":"Patricia K Mansfield, Daniel Tinker, Emily Smith, Nicole M Burkemper, Kristin Smith, Aibing Mary Guo","doi":"10.1097/LGT.0000000000000871","DOIUrl":"10.1097/LGT.0000000000000871","url":null,"abstract":"<p><strong>Objective: </strong>Authors characterized all published adult cases of cutaneous, intertriginous Langerhans cell histiocytosis (LCH) to bring this clinical presentation to the attention of clinicians. The authors emphasize the morphology, histopathology, immunohistochemical profiles, and genetic mutations associated with these cases.</p><p><strong>Materials and methods: </strong>A systematic review of the National Center for Biotechnology Information's PubMed was conducted, utilizing the following specific key words to identify all adult LCH patients with cutaneous intertriginous involvement: \"Intertriginous Langerhans,\" \"Vulvar Langerhans,\" \"Genital Langerhans,\" \"Perineal Langerhans,\" \"Perianal Langerhans,\" \"Intergluteal Langerhans,\" \"Inguinal Langerhans,\" \"Axillary Langerhans,\" and \"Inframammary Langerhans.\" Reports were subjected to strict inclusion criteria: case reports, case series, or meta-analyses documenting case(s) of biopsy-proven LCH with cutaneous, intertriginous involvement in adult patients (>18 years of age at the time of diagnosis).</p><p><strong>Results: </strong>This systematic review identified 1 original and 121 published cases of biopsy-proven, cutaneous, intertriginous LCH in adult patients. Morphology commonly included eroded, ulcerated papules and plaques, and rare presentations demonstrated potential mimickers (hidradenitis suppurativa, deep fungal mycosis, condyloma accuminata).</p><p><strong>Conclusions: </strong>This systematic review encompasses the largest compilation of adult cutaneous intertriginous LCH cases in the medical literature to the authors' knowledge to date. This study identifies an important clinical presentation of this rare, commonly pediatric diagnosis; highlights trends among these cases and important clinical mimickers; and serves as a reminder to clinicians to maintain suspicion for LCH in adult populations, particularly in the setting of intertriginous cutaneous involvement.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"195-200"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updated Review for Guidelines for Cervical Cancer Screening in Immunosuppressed Women Without HIV Infection.","authors":"Anna-Barbara Moscicki, Lisa Flowers, Megan J Huchko, Margaret E Long, Kathy L MacLaughlin, Jeanne Murphy, Lisa Beth Spiryda, Caleb J Scheckel, Michael A Gold","doi":"10.1097/LGT.0000000000000866","DOIUrl":"10.1097/LGT.0000000000000866","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The purpose of this review was to examine new evidence since the authors' 2019 guidelines for cervical cancer (CC) screening in non-HIV immunocompromised persons and to provide updated recommendations based on literature review and expert opinion. In addition, human papillomavirus (HPV) vaccine efficacy in these populations was reviewed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A literature search was performed similar to the authors' previous publication but was conducted through March 2023. Risk of CC, squamous intraepithelial lesions, and HPV infection in those living with solid organ transplant (SOT), end-stage renal disease (ESRD), hematopoietic stem cell transplant (HSCT), and autoimmune diseases (AID), specifically systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and inflammatory bowel disease (IBD) with addition of multiple sclerosis (MS) were researched. This update also summarizes data available on newer disease-modifying therapies (DMTs) including monoclonal antibodies (MABs). The authors then made recommendations for HPV vaccine administration, and screening using either general population guidelines or increased surveillance, the latter based on following current recommendations for women living with HIV. Additionally, the literature search included antibody response to HPV vaccines and recommendations for their administration for these same conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Based on the reviewed risks, evidence continued to support those persons living with SOT, ESRD, HSCT, and SLE, whether on immunosuppressant therapy or not, had an increased risk of HPV, squamous intraepithelial lesions, and CC whereas there was weak evidence that those persons with IBD, RA, and MS not on immunosuppressants were at risk. Data on persons using DMT/MAB were conflicting. Data showed that patients on certain immunosuppressants had lower antibody titers following HPV vaccination. There were no studies on HPV vaccine efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Following US Center for Disease Control and Prevention HIV Cervical cancer screening (CCS) guidelines is recommended for the following: SOT, ESRD, HSCT, and SLE whether on immunosuppressants or not, and IBD, RA, and MS on immunosuppressants. Shared decision-making about increased surveillance for IBD and RA not on immunosuppressants and persons on any DMT or MAB is reasonable based on conflicting data. Human papillomavirus vaccination should not change the recommendations for increased CC surveillance. A 3-dose series of the HPV vaccine is recommended for all age-eligible patients starting at 9 years of age, with catch-up to 26 years of age. Vaccination from age 27 up to age 45 years per Advisory Committee on Immunization Practices guidelines should be considered in shared decision-making. When possible, HPV vaccine series should be initiated and completed before SOT or initiation of DMT/MAB. For HSCT, the vaccine series should be readministered alon","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"168-179"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11939099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of LEEP in Treating CIN 2-3 During Pregnancy.","authors":"Yoav Siegler, Jacob Bornstein, Ofer Lavie, Zvi Vaknin, Nir Kugelman, Efraim Siegler","doi":"10.1097/LGT.0000000000000868","DOIUrl":"10.1097/LGT.0000000000000868","url":null,"abstract":"<p><strong>Abstract: </strong>Cervical intraepithelial neoplasia (CIN) 2-3, a premalignant lesion usually treated by Loop Electrosurgical Excision Procedure (LEEP) in nonpregnant women, is addressed differently in pregnant women. Data from 2006 to 2023 on 178 pregnant women with CIN 2-3 were provided by the Israeli Society of Colposcopy. Sixty-seven underwent LEEP within 15 weeks of gestation with only minor complications. Of the 57 continuing pregnancies, 53 (93%) delivered at term, 2 (3.5%) at 34-37 weeks, and 2 (3.5%) experienced missed abortions. One hundred eleven women were followed through pregnancy without LEEP. Of that group, 5 women were lost to follow-up. From 173 women on whom the authors have follow-up data, 9 (5.2%) were finally diagnosed with cervical cancer, 132 women (76.3%) remained CIN 2-3, and 32 women (18.5%) were CIN 1 or normal. Loop Electrosurgical Excision Procedure (LEEP) performed within the first 15 weeks of pregnancy in 67 women was safe. In 5.2% of pregnant women with CIN 2-3, the final diagnosis was invasive cancer.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"131-133"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adalimumab Use in Severe Recalcitrant Vulval Lichen Sclerosus and Vulval Lichen Planus.","authors":"Ashling Courtney, Sarah Rose Adamson, Emma Veysey","doi":"10.1097/LGT.0000000000000862","DOIUrl":"10.1097/LGT.0000000000000862","url":null,"abstract":"<p><strong>Objectives: </strong>This case series aims to evaluate the demographic features, disease characteristics, and treatment outcomes of 8 patients receiving subcutaneous (SC) adalimumab for severe, refractory vulval lichen sclerosus (VLS) and/or vulval lichen planus (VLP). Both conditions are chronic inflammatory dermatoses that significantly impair quality of life, and although first-line treatment typically involves potent to ultrapotent topical corticosteroids, managing severe cases is challenging due to a lack of FDA-approved systemic therapies. Adalimumab, a TNF-α inhibitor, may offer a promising alternative by targeting the inflammatory cytokine implicated in the pathogenesis of both conditions.</p><p><strong>Methods: </strong>Eight patients received SC adalimumab for VLS and/or VLP at a tertiary referral vulvar disorders clinic from September 2020 to June 2024. Among the 8 patients, 4 had VLS/VLP clinical overlap, 2 had VLP, and 2 had VLS. Evaluation included patient-reported outcome measures (PROMs) namely the vulval life quality index (VLQI) and numerical rating scales for itch and pain, and objective clinical severity was assessed by a vulvar dermatologist based on cutaneous signs and architectural features.</p><p><strong>Results: </strong>Adalimumab was well tolerated by 6 of 8 patients who received treatment for at least 9 months. Varying degrees of clinical improvement were observed in cutaneous signs and PROMs, including significant reductions in vulval life quality index scores for 6 patients. Architectural changes remained stable throughout treatment for all patients.</p><p><strong>Conclusion: </strong>This case series indicates that SC adalimumab may be a treatment option for patients with severe, refractory VLS and VLP, as demonstrated by significant improvements in PROMs. The observed clinical benefits suggest that adalimumab targets key inflammatory pathways in these conditions. Controlled trials are necessary to further validate these findings and define adalimumab's role in managing severe refractory VLS and VLP. Future research should also investigate long-term efficacy and safety, as well as potential predictors of treatment response, to optimize care for this challenging patient population.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"190-194"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Risk of HPV-Related Preneoplastic and Neoplastic Vulvar Lesions in Women Living With HIV.","authors":"Alberto Agarossi, Valeria Savasi, Chiara Frangipane, Francesca Parisi, Andrea Agarossi, Mattia Dominoni, Barbara Gardella","doi":"10.1097/LGT.0000000000000864","DOIUrl":"10.1097/LGT.0000000000000864","url":null,"abstract":"<p><strong>Objective: </strong>The authors aimed to investigate the epidemiology of human papilloma virus (HPV)-related preneoplastic and neoplastic vulvar lesions in a large cohort of women living with HIV (WLWH).</p><p><strong>Materials and methods: </strong>The authors retrospectively selected 1,796 WLWH who had a gynecological examination, cervical cytology, high-risk (HR-) HPV test, vulvoscopy, and colposcopy with targeted biopsies when necessary between 1987 and 2020 at 2 Italian institutions. Univariable and multivariable regression analyses were carried out to test the association of the anamnestic and clinical data with the development of precancerous and cancerous lesions.</p><p><strong>Results: </strong>At baseline, 348 (19.4%) of 1,796 WLWH had genital warts, 30 (1.7%) had vulvar high-grade intraepithelial neoplasia (VHSIL), and 2 (0.1%) had squamous cell carcinoma of the vulva. Among 895 WLWH who had more than 1 year of follow-up, the authors found 40 (4.5%) new cases of VHSIL and 7 (0.8%) cases of vulvar cancer. The cumulative incidence of VHSIL and vulvar cancer was respectively 0.56 and 0.10 per 100 person-years. Risk factors independently associated with the development of vulvar HSIL and cancer included history of injection drug use ( p < .01), genital warts at baseline ( p < .001), HR-HPV test positivity at diagnosis ( p < .001), and severe immunodepression (CD4 cell count <200 cells/mL) at diagnosis ( p < .01).</p><p><strong>Conclusions: </strong>WLWH are at high risk of vulvar high-grade intraepithelial neoplasia and cancer, especially those with severe immunodepression. A careful inspection of vulva, perineum and anus, possibly with the aid of colposcopy, should become part of the surveillance protocol of HIV-infected women.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"118-122"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}