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Introduction: The mortality due to uterine cervical cancer has been gradually increasing in women under 40 years of age (U40) in Japan. We investigated the effect of high-risk human papillomavirus (HR-HPV) on U40 subjects without any overt cytological abnormalities. Materials and Methods: We retrospectively examined the clinical data, including the findings of a cobas 4800 HPV test that was approved in Japan in 2013 to triage women with atypical squamous cells of undetermined significance (ASC-US) and a histological examination in 589 Japanese women. Results: The overall prevalence rate of HR-HPV was 34.5%. Biopsy-confirmed cervical intraepithelial neoplasia (CIN) 2, or worse (CIN2+) was identified in 45.1% (23/51) of HR-HPV-positive women with ASC-US, who underwent colposcopy immediately. The mean period from the HPV test to the diagnosis of CIN2+ was 3.7 months. CIN2+ was more common (69.6%) in U40 patients. The rates of single or multiple infections of HPV-16, HPV-18, and 12 other HR-HPV (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) in CIN2+ U40 patients were 31.3%, 0%, and 81.3%, respectively. The relative risk for CIN 2+ among U40 women with HPV-16 was not significantly different from that of the patients with infection of any of the 12 other HR-HPVs. Conclusion: The results of this study suggest that the 12 other HR-HPVs have a potential to generate high-grade cervical lesions among young women, and the examination rate of colposcopy should be increased.

Introduction: The mortality due to uterine cervical cancer has been gradually increasing in women under 40 years of age (U40) in Japan. We investigated the effect of high-risk human papillomavirus (HR-HPV) on U40 subjects without any overt cytological abnormalities. Materials and Methods: We retrospectively examined the clinical data, including the findings of a cobas 4800 HPV test that was approved in Japan in 2013 to triage women with atypical squamous cells of undetermined significance (ASC-US) and a histological examination in 589 Japanese women. Results: The overall prevalence rate of HR-HPV was 34.5%. Biopsy-confirmed cervical intraepithelial neoplasia (CIN) 2, or worse (CIN2+) was identified in 45.1% (23/51) of HR-HPV-positive women with ASC-US, who underwent colposcopy immediately. The mean period from the HPV test to the diagnosis of CIN2+ was 3.7 months. CIN2+ was more common (69.6%) in U40 patients. The rates of single or multiple infections of HPV-16, HPV-18, and 12 other HR-HPV (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) in CIN2+ U40 patients were 31.3%, 0%, and 81.3%, respectively. The relative risk for CIN 2+ among U40 women with HPV-16 was not significantly different from that of the patients with infection of any of the 12 other HR-HPVs. Conclusion: The results of this study suggest that the 12 other HR-HPVs have a potential to generate high-grade cervical lesions among young women, and the examination rate of colposcopy should be increased.

Objective: Considered to be a cause of unexplained chronic pelvic pain, appendiceal endometriosis is relatively rare, accounting for only 3% of all pathologic lesions of this disorder. In this study, we analyzed the clinicopathologic findings of resected appendices with an abnormal appearance discovered during laparoscopic surgery for endometriosis.Patients and Methods: We performed laparoscopic surgery on 309 patients with endometriosis between January 2006 and December 2008 in Hokkaido University Hospital and its affiliated hospitals. Nineteen patients underwent laparoscopic appendectomy after careful pathologic inspection of their appendices.Results: An abnormal appendiceal appearance was found in 17 of 19 patients; the remaining 2 patients possessed no superficial appendiceal abnormalities but had chronic pelvic pein. Of 17 cases with abnormal appendiceal appearance, 16 (94.1%) had pathological abnormalities: appendiceal endometriosis was found in 12 cases and appendicitis in 4 cases. Two patients affected by chronic pelvic pain with normal appendiceal appearances had appendices with no pathological abnormalities. The prevalence of appendiceal endometriosis in this study was 3.9% (12/309). All patients with appendiceal endometriosis had endometriomas. Neither conversion to open surgery nor treatment for surgical complication was necessary.Conclusion: Laparoscopic appendectomy is an appropriate procedure for patients with endometriosis if they have abnormal appendiceal appearances. During laparoscopic surgery for endometriosis, especially in the case of endometrioma, close observation of the appendix may allow surgeons to remove endometriotic lesions more thoroughly.

Objective: To evaluated the utility and safety of the Cavitron ultrasonic surgical aspirator (CUSA) for laparoscopic paraaortic lymphadenectomy in gynecologic malignancies.Methods: Between January 2007 and January 2008, we performed laparoscopic treatment of gynecologic cancer in 22 patients. In all patients, laparoscopic lymphadenectomy was included in the surgical procedures. In 10 of 22 patients, CUSA was used for the dissection of the left-sided para-aortic lymph nodes. The range of lymphadenectomy was up to the renal vein for patients with endometrial and ovarian cancers, and up to the inframesentric artery for patients with cervical cancer. We analyzed the number of removed lymph nodes and the time needed for the procedure. The results in the group with CUSA and those without CUSA were compared.Result: The number of lymph nodes removed was equivalent between the groups, irrespective of the range of lymphadenectomy. However, the operative time was shortened in the group with CUSA. We had no particular complications in either group.Conclusion: We safely performed laparoscopic lymphadenectomy using CUSA. There is a possibility that by using CUSA, the time required for laparoscopic lymphadenectomy may be shortened.

2020