BackgroundCervical cancer ranks second among all cancers reported in Sri Lankan women. This study assessed the prevalence and type-distribution of human papillomavirus (HPV) among Sri Lankan women with invasive cervical cancer (ICC) and pre-cancerous lesions.Methods114 women aged 21 years and above, hospitalized in the National Cancer Institute, Sri Lanka with a diagnosis of ICC or cervical intraepithelial neoplasia (CIN) 2/3 were prospectively enrolled between October 2009 and September 2010 (110430/NCT01221987). The cervical biopsy or excision specimens collected during routine clinical procedures were subjected to histopathological review. DNA was extracted from samples with a confirmed histological diagnosis and was amplified using polymerase chain reaction and HPV DNA was detected using Enzyme Immuno Assay. HPV positive samples were typed using reverse hybridization Line Probe Assay.ResultsOf the cervical samples collected, 93.0% (106/114) had a histologically confirmed diagnosis of either ICC (98/106) or CIN 2/3 (8/106). Among all ICC cases, squamous cell carcinoma was diagnosed in the majority of women (81.6% [80/98]). HPV prevalence among ICC cases was 84.7% (83/98). The HPV types most commonly detected in ICC cases with single HPV infection (98.8% [82/83]) were HPV-16 (67.3%) and HPV-18 (9.2%). Infection with multiple HPV types was recorded in a single case (co-infection of HPV-16 and HPV-59).ConclusionsHPV was prevalent in most women with ICC in Sri Lanka; HPV-16 and HPV-18 were the predominantly detected HPV types. An effective prophylactic vaccine against the most prevalent HPV types may help to reduce the burden of ICC disease.
This is a case of a 64 year old woman, presented with extensive recurrent vulvar squamous cell carcinoma. She had a unilateral wide local excision of vulva followed by radiotherapy, 30 months prior to this presentation with 18 months of defaulted follow up at outpatient department. During this presentation she had extensive localized disease involving bilateral labial, clitoral and peri-anal regions, which was confirmed by a biopsy. There was no clinical or radiological evidence of lymph node or distant metastasis. As she was medically fit, reconstruction surgery was performed with a vertical rectus myocutaneous flap along with primary closure of clitoral and right labial defects. She had a very good post-operative recovery with minimal morbidity and she was disease free for 40 months after the vulvar reconstruction.
A 52-year-old postmenopausal female of Filipino heritage presented with a three-day history of increasing abdominal bloating, vomiting, and fever. A CT scan revealed a 22 cm ovarian mass and ascites. Her laboratory results were unremarkable except for CA-125 and CA-19.9 which were slightly elevated. Due to suspicion of ovarian neoplasm, she underwent a laparotomy where multiple inflammatory deposits were observed throughout the pelvis. Histology confirmed florid granulomatous inflammation with caseous necrosis, and peritoneal fluid culture was positive for tuberculosis. She was treated with standard antimycobacterial therapy and made an uneventful recovery.
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