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Purpose of investigation: To analyze which are the risk factors in developing multicentric lesions of lower genital tract. Materials and Methods: A prospective study of 1,011 patients was conducted at the low genital tract pathology clinic of Sant Joan de Deu Hospital between 2003-2011. A complete assessment of cervix, vagina, and vulva was carried out including HPV-DNA testing, cytology study, colposcopy, and biopsy in case of atypical findings. The statistical analysis was done with SPSS v.19 software. Differences between groups were considered statistically significant at p < 0.05. Results: Twenty-two patients presented multicentric lesions (2.2%). The average age was 43 years. Most of the lesions were bicentric affecting cervix and vagina and cervix and vulva. Only in two cases (9%) there were three sites of genital neoplasia. The authors found four cervical cancer, 17 high grade, and one low grade lesions of the cervix. Eighteen vaginal intraepithelial neoplasia (VAIN), six high grade, 14 low grade, and four vulvar intraepithelial neoplasia (VIN) were found. HPV infection, age > 35 years, multiparity, contraceptive method, immunodeficiency, and level of studies were significantly correlated with multicentric lesions. High percentage of affected margins were found. VIN cases were treated with surgical excision and in two cases microinvasion was found. VAIN III cases were treated with surgical excision or with laser and one case progressed to vaginal cancer. Recurrence after treatment was 27%. Conclusion: Age, multiparity, contraceptive method, immunodeficiency, and level of studies were significantly correlated with multicentric lesion. Multicentric lesions had an increased risk of recurrence and progression to cancer. [ABSTRACT FROM AUTHOR]

Purpose of investigation: To document the relationship between smoking and HPV infection, and the risk of developing preinvasive lesions and cervical carcinoma. Materials and Methods: Prospective, cross-sectional descriptive study. A total of 1,007 patients were recruited among women seen at the cervical pathology clinic of Sant Joan de Déu University Hospital in Barcelona (Spain) between January 2003 and March 2011. Patients were asked specifically about their smoking habits. Statistical analyses were done with SPSS v.19 software. Differences between groups were considered statistically significant at p < 0.05. Results: In patients studied, 48.7% were smokers. The average number of cigarettes per day among smoking patients was 7.07 (1-40). In the of patients with HPV infection, 53% were smokers versus 37% of patients without HPV infection (p < 0.05). The average number of cigarettes per day among patients with HPV infection was 7.64 cigarettes/day versus 5.55 cigarettes/day among patients without HPV infection (p < 0.05). In the patients with high-risk HPV genotypes infection, 54.5% were smokers versus 43.2% of patients without high-risk HPV infection (p < 0.05). Risk of HPV infection increases 1.905 times among smoking patients versus no smoking patients (OR = 1.905, CI 95% (1.426 - 2.545), p < 0.05). Among patients with changes associated to HPV and atypical cells, there were 29.2% and 14.4% of smokers, respectively, versus 45.5%, 55.6%, and 48.6% of smokers among patients with grade 1 cervical intraepithelial neoplasia (CIN 1), CIN 2-3, and carcinoma, respectively (p < 0.05). Risk of CIN 2-3 or cervical carcinoma cervical increases 1.642 times among smoking patients versus no smoking ones (OR = 1.642, CI 95% (1.325 - 1.884), p < 0.05). Conclusions: Smoking interferes in the increase of HPV infection prevalence and in an increased risk of CIN and cervical carcinoma. Risk also increases with more cigars smoked per day. [ABSTRACT FROM AUTHOR]