Increased incidence of cervical atypia in women with systemic lupus erythematosus treated with chemotherapy

Abstract

In a retrospective study we found that 19 of 80 women with systemic lupus erythematosus had atypical cervical smears as compared to only 9 of 80 agematched women without the disease. This increased incidence occurred mainly among women receiving cytotoxic drugs. Cervical atypia in women with lupus was not morphologically different from cervical atypia in general. Possible mechanisms responsible for the increased incidence are discussed. It is concluded that women with lupus who receive chemotherapy should have cervical smears taken regularly.Malignant disease has been reported to be more common in persons with systemic lupus erythematosus (SLE) (1,2). Malignant lymphoma is the malignancy most commonly discussed in relation to SLE. It has been debated whether the lymphomas are related to the immune disorder itself or to the immunosuppressive therapy (3-8). Cancer of the cervix is included among the neoplasms found (1,2), but so far no study has shown a statistically significant increase. The purpose of the present investigation was to reveal any increased incidence of cervical atypia in women suffering from lupus and to evaluate the relationship to chemotherapy. PATIENTS AND METHODSOne hundred and twenty women with strongly suspected or established diagnoses of systemic lupus erythema- Submitted for publication October 29, 1980; accepted in revised form November 19, 1980. tosus were included in the study. They had been seen at the Departments of Medicine, Dermatology, Rheumatology, or Neurology at Sahlgrenska Hospital, Goteborg, or at the Medical Department at the County Hospital in Molndal. No selection was made with regard to the age of the patients (median 42 years; range 20-80), organs affected, degree of activity, or therapy given. Thus, the women included cover a wide spectrum of this disease. Their records were studied, and time of onset of symptoms, year of diagnosis, and duration of any chemotherapy were noted. Most patients were presently or had previously received treatment. No attempt was made to evaluate the extent of this therapy.At the Laboratory of Clinical Cytology at Sahlgrenska Hospital, records of patients are filed in a computer registry according to their birthdate. These records include the results of any previous cytologic and relevant histologic examinations. The registry now contains data from more than 300,000 women.Of the 120 women with SLE, 80 were found to have previous cytologic records.* We used the computer files to choose 80 controls. For each of these 80 SLE patients, the control subject was the woman whose file immediately preceded the file of the SLE patient. In 74 cases, the control was born on the same day as the patient, and, in the remaining 6 cases, the control was one day older.Women with repeated cytologic or histologic examinations were recorded according to their "most malignant" report. In this context, cervical atypia was defined as any epithelial abnormality within the range of slight dysplasia to invasive carcinoma, corresponding to Papanicolaou classes 11-V. T...

Effects of Chemotherapy and Tamoxifen on Cervical and Vaginal Smears in Bone Marrow Transplant Recipients

“…16 The cytologic features of nuclear and cellular enlargement, polychromasia, binucleation and multinucleation, nuclear wrinkling, cytoplasmic fibrils and granules, vacuolization and bizarre forms have been described. 29 Conflicting results regarding the presence or absence of squamous and glandular atypia 5,12,23,25 have been documented. In some cases, the precise degree of squamous atypia is uncertain since the Papanicolaou classification was used.…”

Abnormal Pap Tests in Systemic Lupus Erythematosis: A Cytopathological and Human Papillomavirus Testing Study.

“…This was not in agreement with the results of this study. Another report found that in women currently receiving azathioprine, 50% had cervical atypia compared with 11% of controls (20) .…”

Involvement of the Local Immune Response in a Case of Advanced Cervical Cancer in a Patient with Systemic Lupus Erythematosus

“…4], The median duration of SLE, as measured from onset to the most recent follow-up. was longer in patients who devel oped tumors than in those without malignancies (16.1 vs. 11 years) [1], The incidence of malignancy may be enhanced by the presence of SLE [3], Moreover, the higher incidence of malignancy in patients with SLE reflects the high rate among those treated with immuno suppressive drugs [4], Problems exist in the treatment of patients with ad vanced cervical cancer and SLE. First, patients with SLE usually are in poor general condition, with complications of renal dysfunction and poor wound healing.…”

“…There are many reports of malignancy in patients with systemic lupus erythematosus (SLE) [1,2], Malignant lymphoma is the malignancy most commonly discussed in relation to SLE [3], However, there are a few reports of cervical cancer with SLE, although an increased incidence of cervical atypia has been reported in patients with SLE [4], The present report describes a case with a 20-year his tory of SLE who developed advanced cervical cancer. In addition, clinical course of the rash is discussed in rela tion to the local immune response.…”