Saccucci P, Mastrone M, Are P, Pisani G, Provenza C
II Department of Obstetrics and Gynecology, San Camillo Hospital, Rome, Italy.
Eur J Gynaecol Oncol. 1996;17(4):306-8.
Recent evidence suggests an association between cervical condyloma, dysplasia and HIV infection. However, the course of cervical cancer in immunodeficient patients has not yet been thoroughly researched. Cervical cancer presently amounts to 1% of the causes of death in AIDS patients. This percentage is bound to increase not only because an improved life expectancy has been obtained, but mainly because the virus is widely spreading among the female population. A 28 year-old AIDS patient, parity 1/0/1/1, underwent gynecological examination and colposcopy following an episode of vaginal bleeding. Biopsy revealed an invasive cervical carcinoma. The last gynecologic investigation, which included a Pap smear and colposcopy, was performed 14 months earlier and resulted negative. Cytologic reexamination of the specimen confirmed the previous Pap smear result. Proctoscopy and cystoscopy showed no mucose involvement. Urography was negative. The cat scan indicated minor spleen and liver enlargement but no signs of malignant abdominal spread were found. The neoplasia was classified as a stage IIB cervical carcinoma (according to the FIGO classification) due to the spread to the left cardinal ligament. In spite of radiation therapy, the disease rapidly progressed leading to a monolateral ureteral involvement which created a juxtavescical stenosis. The patient died three months later. Necroscopic examination revealed lung metastasis. Such a rapidly progressive form of cervical cancer could be related to the acquired immunodeficiency condition. Recurrent cytological and colposcopic examinations are to be considered mandatory in HIV patients.
近期证据表明宫颈湿疣、发育异常与HIV感染之间存在关联。然而，免疫缺陷患者宫颈癌的病程尚未得到充分研究。宫颈癌目前占艾滋病患者死因的1%。这一比例必然会上升，不仅是因为患者预期寿命延长，主要还因为该病毒在女性人群中广泛传播。一名28岁、孕产史为1/0/1/1的艾滋病患者，在一次阴道出血后接受了妇科检查和阴道镜检查。活检显示为浸润性宫颈癌。上一次妇科检查（包括巴氏涂片和阴道镜检查）在14个月前进行，结果为阴性。对标本进行的细胞学复查证实了之前巴氏涂片的结果。直肠镜检查和膀胱镜检查未发现黏膜受累。静脉肾盂造影结果为阴性。计算机断层扫描显示脾脏和肝脏轻度肿大，但未发现腹部恶性扩散迹象。由于肿瘤扩散至左侧主韧带，该肿瘤被分类为IIB期宫颈癌（根据国际妇产科联盟分类）。尽管进行了放射治疗，但病情迅速进展，导致单侧输尿管受累，形成膀胱旁狭窄。患者三个月后死亡。尸检显示有肺转移。这种宫颈癌快速进展的形式可能与获得性免疫缺陷状况有关。对于HIV患者，应考虑定期进行细胞学和阴道镜复查。
