Helling-Giese G, Sjaastad A, Poggensee G, Kjetland E F, Richter J, Chitsulo L, Kumwenda N, Racz P, Roald B, Gundersen S G, Krantz I, Feldmeier H
Department of Gynecology and Obstetrics, Frauenklinik Finkenau, Hamburg, Germany.
Acta Trop. 1996 Dec 30;62(4):257-67. doi: 10.1016/s0001-706x(96)00027-7.
Schistosomiasis of the lower female reproductive tract manifests itself in a broad spectrum of clinical features. However, clinical and histopathological findings have never been studied in a synoptic manner. Based on the assumption that any type of pathology present in the female reproductive tract is the expression of a complex pathophysiological reaction towards eggs sequestered in the genital tissues, we decided to analyze colposcopic and histopathological findings in a comprehensive manner. Thirty-three women in Malawi with urinary and genital schistosomiasis were examined parasitologically and gynecologically. A thorough colposcopic examination with photodocumentation was performed and biopsies were taken from the cervix, the vagina and/or the vulva for histological sectioning and immunohistochemistry. The predominant colposcopic findings were sandy patches on the cervical surface similar to those seen in the bladder and polypous/papillomatous tumors with irregular surface on the vaginal wall and in the vulvar area. The histopathological sections of sandy-patch-like lesions demonstrated only a small cellular reaction around S. haematobium eggs in various stages of disintegration. In contrast, in the case of polyps the histology revealed a more pronounced immunological reaction characterized by a heavy cellular infiltrate. One case of invasive squamous cell carcinoma of the cervix was diagnosed. We conclude that colposcopy is a useful tool in the detection of FGS related pathology in the lower female reproductive tract and that the synoptic assessment of surface and of corresponding histological sections helped to understand the pathophysiology of S. haematobium associated disease in genital tissue.
女性下生殖道血吸虫病表现出广泛的临床特征。然而，临床和组织病理学发现从未以综合的方式进行研究。基于女性生殖道中存在的任何类型的病理变化都是对滞留在生殖组织中的虫卵的复杂病理生理反应的表达这一假设，我们决定全面分析阴道镜检查和组织病理学发现。对马拉维33名患有泌尿生殖系统血吸虫病的女性进行了寄生虫学和妇科检查。进行了全面的阴道镜检查并拍照记录，并从宫颈、阴道和/或外阴取活检组织进行组织切片和免疫组织化学检查。阴道镜检查的主要发现是宫颈表面有类似于膀胱所见的沙斑，以及阴道壁和外阴区域有表面不规则的息肉样/乳头状肿瘤。沙斑样病变的组织病理学切片显示，在处于不同崩解阶段的埃及血吸虫卵周围仅有轻微的细胞反应。相比之下，息肉的组织学显示免疫反应更为明显，其特征是大量细胞浸润。诊断出1例宫颈浸润性鳞状细胞癌。我们得出结论，阴道镜检查是检测女性下生殖道与血吸虫病相关病理变化的有用工具，对表面和相应组织切片的综合评估有助于理解生殖组织中埃及血吸虫相关疾病的病理生理学。
