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Cancer: Cervical & Ovarian Message Board

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Hello all:

:confused: I need help interpreting my colpo path report. Before I begin, I will note there is an error in the report. My history of ASCUS paps began in June 07, I've rec'd 3 paps (June 07, Sept 07 and March 08) with HPV testing and all were ASCUS pap w/ HPV negative. However, the dr's office when sending my "history" with my colpo specimen apparently noted I was HPV positive . That was an error which has since been corrected in my record and was confirmed by the nurse/dr's office by specifically re-looking at each hpv test . So the specimen went to the lab with this history and you will note HPV positve history is noted by the pathologist which is based on the history the office sent. That said, here's the report (long):

Prev abnormal Pap smear (Atypical Squamous Cells); High Risk HPV Positive

A) Cervix @ 4:0 spirabrush; B) Cervix @ 7:0 spirabrush; C) Cervix @ 12:00 D) Endocervix- Spirabrush

A) The specimen consists of a spirabrush containing approximately .8 cm aggregate of minute tan brown soft tissue fragments and blood tinged mucoid material. TS
B, C and D read the same but with .9 cm, .4 cm and .6 cm respectively

Sections of Part A of Spirabrush material demonstrate fragments of squamous epithelium with no dysplasia or HPV changes identified. Some mild metaplastic atypia is present.

Sections of Part B and C of Spirabrush material demonstrate fragments of squamous epithelium with focal atypia of squamous cells.

Sections of Part D of Spirabrush material demonstrate squamous epithelium with atypia characterized by nuclear enlargement, nuclear pleomorphism, nuclear crowding and pernuclear clearing.

Cervix at 4:00 Spirabrush biopsy (A): Mild metaplastic atypia; No HPV change or dysplasia identified
Cervix at 7:00 and 12:00 (B,C): Changes suspicious for, but not completely diagnostic of cytopathic effect of HPV; SEE NOTE
Endocervical tissue (D): No HPV change or dysplasia identified

The patient's previous abnormal pap smear find of atypical squamous cells is noted. The very atypical metaplastic epithelium seen in the spirabrush material here probably accounts for those findings. THese foci are highly suspicious for cytopathic effect of HPV. THe patient's postive HPV status is noted. Closed continued follow up is suggested as clinically indicated

Dr's notes: Atypia- repat 6 months
The pathology findings confirm your hrHPV positive status. The path saw nuclear changes, always indicative of HPV, but no dysplasia. When there is active HPV, the nuclei of cervical cells enlarge, crowd, and generally look atypical (hence, the finding of "atypia," also called "koilocytic atypia"). If you're going to have HPV (which most of us do just being human and engaging in human activity!), this is actually very good news because it's too low to grade (although the new 2001 Bethesda classification system would group this under "LSIL" or low grade squamous epithelial lesion), and because there is nothing in the endocervical canal. Yours however is not even a lesion--merely HPV cytopathic (cellular) effect.

Take good care of yourself and you should be fine. Next time you will probably get a normal pap and possibly a negative HPV test (although I question the accuracy and usefulness of the latter).
WOW...thank you so much for a quick reply. I posted this half way thinking it would be days if ever that I would receive a response so thanks again. I do a couple of follow up questions though.

The note of the HPV positive in the "HISTORY" section is NOT accurate. THe 4 HPV tests I've had have all indicated "NOT DETECTED". When my Dr's office sent my history w/ the specimen to the lab, they incorrectly indicated HPV positive. They have since corrected that. Unfortunately the path read the biopsies thinking I had history of positive HPV when in fact all tests to date for high risk are NEGATIVE. If that is in fact true and I am HPV NEGATIVE then howwould that affect his reading? Now, my DR did say that the testing thus far has only been for HR HPV and those have been Neg. HOWEVER she said it's possible that I'm positive for low risk and low risk can also cause cellular changes but usually does not lead to dysplasia/cancer etc. Could that explain these changes.

Again, thanks so much for taking time on your weekend to field questions like this. This ordeal has been a mentally & emotionally draining experience me. Thank you
My mistake, I thought I'd read that your history reported hrHPV negative when it was really positive. So it's actually the other way around. That changes my impression. My guess is if you were to take a lrHPV test, it would read positive. You don't necessarily have to have overtly visible warts in order to be lrHPV positive. So, ask for that test if it'll put your mind at ease. If it comes up positive then you have lr, not hr, and can basically forget this episode (if you live a good lifestyle) because by the time your next pap comes around it will almost certainly be gone.

Your doctor is correct on both counts, that it is probably lr, and that lr types almost never cause cancer (unless you are a chain smoker or otherwise immunodepressed) so there is generally no need to monitor them as you would for hr. Which brings me to another point that I assumed in my initial reply: don't smoke (not sure if you do, it's just something I say to everyone). It's the single worst thing you can do for this problem.

If your path saw the nuclear changes that he did, and he was very specific and detailed about his findings (way more so than my path!) then it's HPV, whether low or high risk. Nothing else causes those changes. They used to think hormonal changes caused some cells to go atypical, and while hormones DO influence dysplasia a lot, they will not cause the nuclear enlargement and crowding noted on your report.

Finally, I wrote a pretty detailed reply to "magnj" in her thread about the circumstances under which you can test negative for hrHPV yet be positive. I think this is less the case with you but even if it does turn out to be your situation, there are ways to fight it off/keep it at bay. Most people DO fight it off you know, doing absolutely nothing!

Also, I read that presence of koilocytes statistically gives better prognosis, it's when koilocytes disappear and dysplasia takes over that's a bit less favorable but in rare cases even women with CIN 3 have auto-regressed. I guess this is more reply than you asked for! Good luck.
Thank you so much for this info! Off topic your experience because this is your profession or is this a personal experience that you have researched greatly? You seem to be very knowledgable ! Whatever the case, it's appreciated. While I have family and friends, this is still a "lonely" experience because no one wants to sit and talk about PAPS all day plus they don't really understand it all. Thanks again:)
Unfortunately, the reason for my knowledge is personal experience. Since November of last year when I first learned I had this (although I'd been experiencing problems since beginning of last year, delaying a much-needed gyn appointment way too long...) I've scoured the internet and read probably every HPV-related scientific study out there. I even corresponded with an HPV researcher for awhile. I always loved reading scientific articles. One of my biggest regrets is not pursuing a career in pharmacy or medicine, but that's another story! Well, let us know if you get a lrHPV test done and what happens. I really think you will be fine (if you aren't already).

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