The aim of this study was to assess the safety, effectiveness and advantages of a new surgical technique for the extraction of endometrial polyps after in-office hysteroscopic polipectomy. Between November 2009 and September 2013, 140 pre- and post-menopausal women with a sonographic diagnosis of endometrial polyps underwent polypectomy in-office hysteroscopy, followed by lesion removal using classical surgical instruments or the new REP-b technique. A total of 70 women underwent endometrial polyp removal using the new surgical technique REP-b (GROUP A), and 70 women received endometrial polyp removal using classical surgical instruments (GROUP B). The extraction time Tr, calculated as the time from the introduction of the basket into the operative hysteroscopic sheath to the complete removal of the previously sectioned polyp, in GROUP A (REP-b technique) was significantly lower compared with GROUP B (control group). The median Tr for GROUP A was 29.50 s versus the median Tr for GROUP B of 54.00 s (P < 0.01). The use of the REP-b technique improves the outcome of the operation and reduces the extraction time for the removal of endocavitary uterine lesions.

The oral transmission of HPV and, consequently, the risk of oral cancer has increased in the last years. Oral sex has often been implicated among the risk factors for oral HPV infections, however, there is still no consensus on these topics, nor on the relationship between genital and oral HPV infections. The present study aimed to evaluate the coexistence of papilloma virus, at the levels of the oral and genital mucosa, in women with a histologically confirmed HPV lesions (and a positive HPV test) at the genital level and a negative HPV control group. We also evaluated how some risk factors, such as smoking, the number of partners, age, and sexual habits can influence the possible presence of the virus itself in the oropharynx of the same women. In total, 117 unvaccinated women aged between 18 and 52 were enrolled. We found that the prevalence of oral HPV infection was high among the women with concomitant genital HPV infection (22%) compared to the HPV-negative women (0%), and the estimated odds ratio was 17.36 (95% CI: 1.02, 297.04). In none of the women with oral HPV did we find any relevant clinical lesions. The potential risk factors for HPV infections in the oropharynx and genitals were analyzed based on questionnaire responses. A multivariate analysis showed that genital HPV infections were significantly associated with a number of sexual partners > 10 (OR 138.60, 95% CI: 6.04–3181.30, p < 0.001), but the data also referred to having between 3–5 or 6–10 partners as being significant, as were a high level of education (OR 6.24, 95% CI: 1.67–4.23.26 p = 0.003), a frequency of sexual intercourse >10 (OR 91.67 95% CI: 3.20–2623.52, p = 0.004), oral sex (OR 6.16, 95% CI: 1.22–31.19, p = 0.014), and >20 cigarettes/day (OR 6.09 95% CI: 1.21–30.61, p = 0.014). Furthermore, being “separate” and having multiple sexually transmitted diseases were also significantly associated with genital HPV infection. In contrast, oral HPV infections were significantly associated with women aged 36 to 50 years (OR 27.38, 95% CI: 4.37–171.37; p = 0.000202) and oral sex (OR 95.5, 95% CI: 5.13–1782.75, p = 0.001126).Additionally, being separate, being cohabitant, lifetime sexual partners of >10, 3–5 lifetime sexual partners, <20 years of age, >10 sexual intercourse per month, occasional and regular anal sex, >20 cigarettes per day, a history of sexually transmitted disease (herpes and multiple), and having a history of genital warts were significant. Screening and early diagnosis are considered to be practically unfeasible for this category of cancer, given the lack of visible lesions; the 9-valent HPV vaccine remains the only means that could help to successfully counter the growing incidence of oral squamous cell carcinoma.

HighlightsPelvic mass and hemoperitoneum.

SummaryIntroduction: placental mesenchymal dysplasia (PMD) is a rare placental anomaly characterized by placentomegaly and grapelike vesicles which resemble molar pregnancy. Case: we report the case of 33-year-old woman (1-gravid) who visited our clinic at 11 weeks of gestation due to a suspected molar pregnancy. Ultrasound examination showed an enlarged placenta with multiple vesicular lesions. Maternal human chorionic gonadotropin level was normal and chorionic villus sampling showed a normal male karyotype (46 XY). The fetus exhibited no specific anomalies and fetal growth was normal during pregnancy with no signs of fetal suffering. At 31 weeks, the pregnancy ended owing to intrauterine fetal death (IUFD). The patient delivered a normal-sized male fetus (1800 g) with no definite anomalies. A pathological examination led to a diagnosis of placental mesenchymal dysplasia. Conclusion: in the presence of placental ultrasound anomalies with no other sign of fetal suffering, the pregnancy should be considered at risk and, therefore, should be monitored carefully including the option of hospitalization.

Background: The p16/Ki67 technique has been poorly studied in postmenopausal women with ASC-US cytology. The objective of this study was to compare the accuracy of p16/Ki67 staining, HPV testing and HPV 16 genotyping for the identification of CIN2 + lesions in postmenopausal women with ASC-US cytology. Method: A total of 324 postmenopausal women with positive ASC-US were included. The women underwent HPV test, colposcopy, and biopsy. The slides were discolored and then stained with the CINtec Plus Kit for p16/Ki67. The HPV test results were classified as HPV16 +, hrHPV+ (other hrHPV genotypes), or HPV negative. Results: The p16/Ki67 sensitivity for CIN2+ was 94.5%, the specificity 86.6%, PPV of 59% and NPV of 95.9%. The HPV test showed a sensitivity of 96.4% for CIN2+, a specificity of 62.8%, a PPV of 35% and a NPV of 98.8%. In postmenopausal women, the prevalence of genotype 16 decreases in favor of the other high-risk genotypes. Conclusion: Given the low sensitivity of cytology and the low percentage of HPV16-positive cancers among elderly women, triage via cytology and genotyping is not the best strategy; double staining cytology shows high profiles of sensibility and specificity for CIN2+ in ASCUS postmenopausal women.