Ok Atılgan Alev, Tepeoğlu Merih, Haberal A Nihan, Durukan Elif, Kuşcu Esra, Haberal Mehmet
From the Department of Pathology, Baskent University Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2015 Apr;13 Suppl 1:219-22.
Solid-organ transplant recipients are at increased risk of developing cancer including cervical cancer compared with woman in the general population, mostly due to long-term immunosuppressive therapy. The Papanicolaou smear remains the primary method of screening cervical pathology including preinvasive and invasive lesions. The objective of this study was to evaluate Pap smear findings in solid-organ transplant recipients, determine the prevalence of abnormal smears, and compare these patients with the general population.
We retrospectively examined 111 women patients who received liver or kidney transplant between January 1990 to December 2012 at Başkent University Ankara Hospital. Pap smear findings were compared with normal control patients matched for same age and technical procedure of cervical cytology. To selection of control patients, propensity score matching program was performed. All Pap smears were re-examined according to Bethesda 2001 criteria.
In 111 transplant patients, 2 patients (1.8%) had atypical squamous cells of undetermined significance, 8 patients (7.2%) had low-grade squamous intraepithelial lesion, 15 patients (13.5%) had Candida infection, 2 patients (1.8%) had Trichomonas vaginalis, 1 patient (0.9%) had herpes simplex infection, 13 patients (11.7%) had bacterial vaginosis, 15 patients (13.5%) had reactive changes due to inflammation, and 18 patients (16.2%) had atrophy. When we compared our results with the control group, there were statistically significant differences (P ≤ .05) between the 2 groups in epithelial cell abnormalities (low-grade squamous intraepithelial lesion), Candida infection, bacterial vaginosis, and atrophy.
Pap smear screening potentially may help recognize cervical preinvasive and invasive lesions. The risk of developing cervical intraepithelial neoplasia is greater in transplant recipients because of immunosuppressive therapy. The incidence of low-grade squamous intraepithelial lesion was significantly greater in transplant recipients than the general population. Intensive follow-up with Pap smear in transplant recipients is important in the early detection of these lesions.
与普通人群中的女性相比，实体器官移植受者患包括宫颈癌在内的癌症的风险增加，这主要归因于长期免疫抑制治疗。巴氏涂片检查仍然是筛查宫颈病变（包括癌前病变和浸润性病变）的主要方法。本研究的目的是评估实体器官移植受者的巴氏涂片检查结果，确定异常涂片的患病率，并将这些患者与普通人群进行比较。
我们回顾性研究了1990年1月至2012年12月期间在安卡拉巴斯肯特大学医院接受肝或肾移植的111例女性患者。将巴氏涂片检查结果与年龄和宫颈细胞学检查技术程序相匹配的正常对照患者进行比较。为了选择对照患者，进行了倾向评分匹配程序。所有巴氏涂片均根据2001年贝塞斯达标准重新检查。
在111例移植患者中，2例（1.8%）有意义不明确的非典型鳞状细胞；8例（7.2%）有低度鳞状上皮内病变；15例（13.5%）有念珠菌感染；2例（1.8%）有滴虫感染；1例（0.9%）有单纯疱疹感染；13例（11.7%）有细菌性阴道病；15例（13.5%）有炎症反应性改变；18例（16.2%）有萎缩。当我们将结果与对照组进行比较时，两组在上皮细胞异常（低度鳞状上皮内病变）、念珠菌感染、细菌性阴道病和萎缩方面存在统计学显著差异（P≤0.05）。
巴氏涂片筛查可能有助于识别宫颈的癌前病变和浸润性病变。由于免疫抑制治疗，移植受者发生宫颈上皮内瘤变的风险更大。移植受者中低度鳞状上皮内病变的发生率明显高于普通人群。对移植受者进行巴氏涂片的强化随访对于早期发现这些病变很重要。
