A review on the impact of iud in cervical cytology: mardin region data

Abstract

Objective: The aim of the study was to provide an overview to infectious and reactive cytological effects of intrauterine devices, which are one of the most widely used methods of contraception, with the results we obtained in the Mardin region. Material and Method:We evaluated together the pap smears of the 300 intrauterine device (+) and 300 intrauterine device (-) patients sent to the pathology department in the period of 2010-2011. Genital infection rates and frequency of reactive-dysplastic cellular changes were statistically compared between the groups together with the literature data. Results:In the intrauterine device (+) group, 2 (+) and more severe inflammation was observed in 66.3% of cases. Bacterial vaginosis (26%), candida (12%) and trichomonas vaginalis (8%) were recorded as the most common infectious agents, followed by actinomyces (4%). Between the groups of intrauterine device (+) and (-), no significant difference was observed in terms of the incidence of squamous cell abnormalities, except ASC-US (p=0.02). In the intrauterine device (+) group, the presence of atypical glandular cells and reactive findings was significantly higher than the control group. After the removal of the intrauterine device, 61 cases that had control smears showed regression, with a rate of %75.4 (n=46). Conclusion:The local irritative and inflammatory effect of intrauterine devices basically causes reactive and regenerative changes mostly in glandular cells. Intrauterine devices disrupt the genital flora and significantly increase the frequency of genital infection by creating a foreign body reaction. Bulgular: Rahim içi araç (+) hasta grubunda 2 (+) ve üzerinde inflamasyon yoğunluğu gösteren olguların oranı %66 olarak izlenmiştir. En sık enfeksiyon etkeni olarak, bakteriyel vajinozis (%26), candida (%12) ve trikomonas vajinalis (%8) kaydedilmiştir. Aktinomiçes ise %4 oranında izlenmiştir. Rahim içi araç (+) hastalarda, (-) olanlara göre ASC-US ve AGC görülme sıklıkları anlamlı olarak yüksek izlenmiştir (p=0,02, p<0,01). Ayrıca skuamöz metaplazi, tubal metaplazi, sitoplazmik balon vakuollü hücreler, HGSIL'i taklit eden izole hücreler gibi reaktif bulguların izlenme sıklığı rahim içi araç (-) gruba göre anlamlı oranda yüksek izlenmiştir. Rahim içi araç çıkartıldıktan sonra takip smirleri olan 61 olguda %75,4 (n=46) oranında bulgularda gerileme saptanmıştır.Sonuç: Rahim içi araç lokal irritatif ve inflamatuvar etkisi ile temel olarak glandüler hücrelerde belirgin reaktif ve rejeneratif değişikliklere neden olmaktadır. Yabancı cisim ortamı yaratarak genital florayı bozmakta ve genital enfeksiyon sıklığını belirgin ölçüde artırmaktadır. Kendi bölgemizden elde edilen sonuçlar da bu bulguları destekler yöndedir.

Prevalencia de vaginosis bacteriana, Actinomyces spp., Candida spp. y Trichomonas vaginalis en usuarias del dispositivo intrauterino (DIU), Medellín, Colombia, 2011-2013

“…principalmente por su efecto de anaerobiosis debido al material de cobre que liberan radicales libres que reducen las concentraciones de oxígeno en la vagina y generan un ambiente propicio para el crecimiento de Actinomyces spp. y otros microorganismos anaerobios causantes de vaginosis bacteriana [19,32].…”

“…Esto puede ser sustentado en el hecho que, si bien el cuello del útero cumple una función de barrera física y química que inhibe la entrada de bacterias en el útero, la presencia de un cuerpo extraño como el dispositivo intrauterino, que cuenta con una cola que está expuesta en el exocérvix, crea un ambiente adecuado para la transición de microorganismos hacia el útero. Al mismo tiempo, el dispositivo intrauterino produce cambios bioquímicos, histopatológicos y celulares en el endometrio y la cérvix como la formación de prostaglandinas que derivan en una respuesta inflamatoria que podría aumentar la incidencia de la infección bacteriana[19,32].En relación con lo anterior, debe indicarse que algunos microorganismos como Candida albicans tienen la capacidad de adherirse a diferentes partes del dispositivo intrauterino, generando biopelículas que parecen estar implicadas en el desarrollo de la vulvovaginitis y su recurrencia[26,33]. Además, el dispositivo intrauterino de cobre también suele asociarse con infecciones vaginales,…”

The cytopathology of Actinomyces, Nocardia, and their mimickers

“…When fuzzy aggregates or sulfur granules are identified microscopically, care must be taken to confirm the presence of filamentous Actinomyces within these granules because non‐filamentous bacteria are capable of forming similar structures . The non‐filamentous, non‐ Actinomyces bacteria that contribute to the formation of these granules have been described as “dust bunnies.” “Crystalline bodies,” thought to be the cytology preparation analogue to “pseudoactinomycotic radiate granules” (PAMRAG) seen in histology, also serve as sulfur granule mimics. PAMRAGs and “crystalline bodies” are identical radiate, refractile‐appearing structures that consist of irregular, broad, club‐like projections that lack a dense central core.…”

Uso de pessários para tratamento do prolapso genital

“…Um estudo realizado em 2000 avaliou 44 usuárias de pessários comparadas com 176 controles e observou que há um aumento de 3,3 vezes no risco de vaginose bacteriana (VB) nas mulheres usuárias de pessário (32% versus 10% nos controles) (39). Este achado é esperado, pois a presença de corpo estranho já foi relacionada à alteração da flora vaginal e à maior suscetibilidade a infecções genitais em outros estudos, como, por exemplo, em trabalho realizado com usuárias de DIU (40). No entanto, há pouca informação sobre o uso de pessários e a presença de corrimento vaginal.…”