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Abstract Background The purpose of this study was to predict the risk factors for residual lesions in patients with high-grade cervical intraepithelial neoplasia who underwent total hysterectomy. Methods This retrospective study included 212 patients with histologically confirmed high-grade cervical intraepithelial neoplasia (CIN2-3) who underwent hysterectomy within 6 months after loop electrosurgical excision procedure (LEEP). Clinical data (e.g., age, menopausal status, HPV type, and Liquid-based cytology test(LCT) type), as well as pathological data affiliated with endocervical curettage (ECC), colposcopy, LEEP and hysterectomy, were retrieved from medical records. A logistic regression model was applied to estimate the relationship between the variables and risk of residual lesions after hysterectomy. Results Overall, 75 (35.4%) patients had residual lesions after hysterectomy. Univariate analyses revealed that positive margin (p = 0.003), glandular involvement (p = 0.017), positive ECC (p

Background: The purpose of this study was to predict the risk factors for residual lesions in patients with high-grade cervical intraepithelial neoplasia who underwent total hysterectomy. Methods: This retrospective study included 212 patients with histologically confirmed high-grade cervical intraepithelial neoplasia (CIN2-3) who underwent hysterectomy within 6 months after loop electrosurgical excision procedure (LEEP). Clinical data (e.g., age, menopausal status, HPV type, and Liquid-based cytology test(LCT) type), as well as pathological data affiliated with endocervical curettage (ECC), colposcopy, LEEP and hysterectomy, were retrieved from medical records. A logistic regression model was applied to estimate the relationship between the variables and risk of residual lesions after hysterectomy. Results: Overall, 75 (35.4%) patients had residual lesions after hysterectomy. Univariate analyses revealed that positive margin (p = 0.003), glandular involvement (p = 0.017), positive ECC (p < 0.01), HPV16/18 infection (p = 0.032) and vaginal intraepithelial neoplasia (VaIN) I-III (p = 0.014) were factors related to the presence of residual lesions after hysterectomy. Conversely, postmenopausal status, age ≥ 50 years, ≤ 30 days from LEEP to hysterectomy, and LCT type were not risk factors for residual lesions. A positive margin (p = 0.025) and positive ECC (HSIL) (p < 0.001) were identified as independent risk factors for residual lesions in multivariate analysis. Conclusions: Our study revealed that positive incisal margins and ECC (≥ CIN2) were risk factors for residual lesions, while glandular involvement and VaIN were protective factors. In later clinical work, colposcopic pathology revealed that glandular involvement was associated with a reduced risk of residual uterine lesions. 60% of the patients with residual uterine lesions were menopausal patients, and all patients with carcinoma in situ in this study were menopausal patients. Therefore, total hysterectomy may be a better choice for treating CIN in menopausal patients with positive margins and positive ECC. Highlights: Positive margins and positive ECC were found to be independent risk factors for residual lesions after hysterectomy for high-grade cervical intraepithelial neoplasia. Glandular involvement should be indicated in colposcopic pathology. Any type of positive margin should be further treated. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of glandular involvement and persistent human papillomavirus（HPV） infection upon the recurrence of high-grade squamous intraepithelial lesion（HSIL） of the cervix， aiming to provide evidence for postoperative clinical management. Methods Clinical data of 596 HSIL patients who underwent cold-knife conization were collected， including 240 cases of glandular involvement（glandular involvement group） and 356 cases of non-glandular involvement（non-glandular involvement group）. The recurrence of HSIL at postoperative 2 years was considered as the end point. The differences between recurrent and non-recurrent patients were compared. According to glandular involvement and HPV-16 infection， patients were divided into the glandular involvement+HPV-16 infection， glandular involvement alone， HPV-16 infection alone and non-glandular involvement+non-HPV-16 infection groups， respectively. The differences in the recurrence rate of HSIL were compared among four groups. Results Among 596 HSIL patients， 75 cases recurred（12.6%）. HPV-16 infection rate in the glandular involvement group was 67.9%， significantly higher than 23.0% in the non-glandular involvement group， and the difference was statistically significant（P < 0.05）. In univariate analysis， the proportion of≥45 years old， glandular involvement and persistent HPV-16 infection were not significantly correlated with the recurrence of HSIL（all P > 0.05）. The recurrence rates of HSIL were 33.8%， 10.9%， 8.5% and 9.7% in the glandular involvement+HPV-16 infection， glandular involvement alone， HPV-16 infection alone and non-glandular involvement+non-HPV-16 infection groups， respectively. The recurrence rate of HSIL in patients with glandular involvement+HPV-16 infection was significantly higher than that in other three groups， and the difference was statistically significant（all P < 0.017）. Conclusions HSIL patients with glandular involvement and persistent HPV-16 infection are prone to relapse after cervical cold-knife conization. For these patients， active surgical regimen should be adopted and postoperative follow-up should be strengthened.

The development and standardization of cytologic screening of the uterine cervix has dramatically decreased the prevalence of squamous cell carcinoma of the uterine cervix. Advances in the understanding of biology of human papillomavirus have contributed to upgrading the histologic diagnosis of the uterine cervix; however, cytologic screening that should triage those that need further management still poses several difficulties in interpretation. Cytologic features of high grade intraepithelial squamous lesion (HSIL) mimics including atrophy, immature metaplasia, and transitional metaplasia, and glandular lesion masquerades including tubal metaplasia and HSIL with glandular involvement are described with accentuation mainly on the differential points. When the cytologic features lie in a gray zone between the differentials, the most important key to the more accurate interpretation is sticking to the very basics of cytology; screening the background and cellular architecture, and then scrutinizing the nuclear and cytoplasmic details.

Objective To evaluate the effect of glandular involvement and persistent human papillomavirus (HPV) infection upon the recurrence of high-grade squamous intraepithelial lesion (HSIL) of the cervix, aiming to provide evidence for postoperative clinical management. Methods Clinical data of 596 HSIL patients who underwent cold-knife conization were collected, including 240 cases of glandular involvement (glandular involvement group) and 356 cases of non-glandular involvement (nonglandular involvement group). The recurrence of HSIL at postoperative 2 years was considered as the end point. The differences between recurrent and non-recurrent patients were compared. According to glandular involvement and HPV-16 infection, patients were divided into the glandular involvement+ HPV-16 infection, glandular involvement alone, HPV-16 infection alone and non-glandular involvement+non-HPV-16 infection groups, respectively. The differences in the recurrence rate of HSIL were compared among four groups. Results Among 596 HSIL patients, 75 cases recurred (12.6%). HPV-16 infection rate in the glandular involvement group was 67.9%, significantly higher than 23.0% in the non-glandular involvement group, and the difference was statistically significant (P < 0.05). In univariate analysis, the proportion of~45 years old, glandular involvement and persistent HPV-16 infection were not significantly correlated with the recurrence of HSIL (all P > 0.05). The recurrence rates of HSIL were 33.8%, 10.9%, 8.5% and 9.7% in the glandular involvement+HPV-16 infection, glandular involvement alone, HPV-16 infection alone and non-glandular involvement+non-HPV-16 infection groups, respectively. The recurrence rate of HSIL in patients with glandular involvement+HPV-16 infection was significantly higher than that in other three groups, and the difference was statistically significant (all P < 0.017). Conclusions HSIL patients with glandular involvement and persistent HPV-16 infection are prone to relapse after cervical cold-knife conization. For these patients, active surgical regimen should be adopted and postoperative follow-up should be strengthened. [ABSTRACT FROM AUTHOR]

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The development and standardization of cytologic screening of the uterine cervix has dramatically decreased the prevalence of squamous cell carcinoma of the uterine cervix. Advances in the understanding of biology of human papillomavirus have contributed to upgrading the histologic diagnosis of the uterine cervix; however, cytologic screening that should triage those that need further management still poses several difficulties in interpretation. Cytologic features of high grade intraepithelial squamous lesion (HSIL) mimics including atrophy, immature metaplasia, and transitional metaplasia, and glandular lesion masquerades including tubal metaplasia and HSIL with glandular involvement are described with accentuation mainly on the differential points. When the cytologic features lie in a gray zone between the differentials, the most important key to the more accurate interpretation is sticking to the very basics of cytology; screening the background and cellular architecture, and then scrutinizing the nuclear and cytoplasmic details.

Intracholecystic papillary neoplasms of the gallbladder (ICPN) and intraductal papillary neoplasms of the bile duct (IPNB) show intramural neoplastic growths in addition to intraluminal papillary or polypoid neoplastic growth. Such intramural growths include intraepithelial involvement of non-neoplastic glands by preinvasive neoplastic epithelia (glandular involvement) as well as stromal invasive carcinoma. A total of 29 ICPN cases and 84 IPNB cases were pathologically examined for their glandular involvement. Glandular involvement was characterized by intramural neoplastic glands (1) showing cytological and phenotypical similarities to intraluminal preinvasive papillary neoplasms and (2) showing reminiscent configurations of non-neoplastic glands, such as (i) a mixture of preinvasive neoplastic epithelia and non-neoplastic epithelia within the same glands, (ii) neoplastic glands close to or within clustered non-neoplastic glands, or (iii) continuous growth of intraluminal preinvasive neoplastic glands into the walls. Such glandular involvement was found in 16 of 29 ICPN and 48 of 84 IPNB, and 15 of the former and 28 of the latter were not associated with invasive carcinoma. Non-invasive ICPN and IPNB with glandular involvement showed a favorable postoperative overall survival (OS). Glandular involvement by preinvasive neoplastic epithelia was frequently found in ICPN and IPNB. Such lesions may be diagnostic pitfalls in ICPN and IPNB referring to invasion. Glandular involvement without invasive carcinoma was not associated with an unfavorable postoperative OS in ICPN and IPNB. Recognition of glandular involvement may thus prevent overestimation of invasive carcinoma in ICPN and IPNB., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the recurrence rates of cervical intraepithelial neoplasia (CIN) in a cohort of HIV-infected and noninfected women who underwent the loop electrosurgical excision procedure (LEEP).Methods: A prospective cohort study of 94 HIV-positive and 107 HIV-negative women, both with CIN, treated with LEEP. The diagnosis of recurrence was established after biopsy. The Kaplan-Meier method was used for survival analysis and multivariate analyses were carried out using the Cox proportional hazards regression model.Results: There was a predominance of low-grade lesions in HIV-positive compared with HIV-negative women (P<0.01). Recurrence was more frequent with compromised margins and glandular involvement (P<0.01). A multivariate analysis showed that HIV-infection, glandular involvement, and positive margins were independently associated with recurrence of lesions.Conclusions: Recurrence rate of CIN in HIV-positive women was higher than in HIV-negative women. The factors associated with recurrence were HIV infection, glandular involvement, and positive margins. [ABSTRACT FROM AUTHOR]

Objectives: Experimental models of Graves hyperthyroid disease accompanied by Graves orbitopathy (GO) can be efficiently induced in susceptible inbred strains of mice by immunization by electroporation of heterologous human TSH receptor (TSHR) A-subunit plasmid. The interrelated pathological findings in the thyroid glands of Graves disease (GD) that explain the core changes classically include diffuse follicular hyperplasia and multifocal mild lymphocytic infiltrate. However, the relative contributions of different thyroid tissue components (colloid, follicular cells, and stroma) have not been previously evaluated. In this study, we characterize the thyroid gland of an experimental mouse model of autoimmune GD. Our objective was to define the relative contribution of the different thyroid tissue components to the pathology of glands in the experimental model., Methods: Mice were immunized with human TSHR A-subunit plasmid. Antibodies induced to human TSHR were pathogenic in vivo due to their cross-reactivity to mouse TSHR., Results: Autoimmune thyroid disease in the model was characterized by histopathology of hyperplastic glands with large follicular cells. Further examination of thyroid glands of immunized animals revealed a significantly increased follicular area and follicle/stroma ratio, morphometrically correlated with a noninflammatory follicular hyperplasia/hypertrophy. The increased follicle/stroma ratio was the most relevant morphometrically variable summarizing the pathological changes for screening purposes., Conclusion: GD thyroid glands are enlarged and characterized by a noninflammatory diffuse follicular cell hyperplasia/hypertrophy and a significant increase in the follicles with an increased follicle/stroma ratio. Overall, this mouse model is a faithful model of an early hyperthyroid status of GD (diffuse glandular involvement and follicular expansion).