Unusual histologic finding in tissue obtained from voluntary pregnancy termination: a case report

Background: An unusual histologic finding in tissue obtained from voluntary pregnancy termination (VPT) is reported to demonstrate the utility of pathologic examination of this specimen. Methods: A 30-year-old woman with a history of depression was referred to the gynecology clinic for VPT in the eighth week of gestation. Material obtained from uterine cavity curettage was macroscopically and histologically examined. Based on the histological findings, a molecular study by polymerase chain reaction amplification (PCR) was performed to evaluate the presence of human papilloma virus (HPV) DNA. For DNA extraction, 4-mu m-thick histological sections were stained with hematoxylin and examined under a stereomicroscope. The PCR amplification was performed with the L1 consensus primers Gp5+/Gp6+, giving an expected PCR product size of 150 bp: these primers have been developed to allow the detection of a broad spectrum of mucosotropic HPV genotypes. Results: Histological examination of tissue obtained from the VPT showed immature villi with post-abortive hydropic degeneration and the presence of a small fragment of cervical mucosa with a squamous intraepithelial lesion characterized by mild to moderate nuclear atypia (SIL). PCR revealed that this lesion was related to HPV. Subsequently, the pap smear and cervical biopsy revealed a high-risk squamous intraepithelial lesion due to high-risk HPV Conclusions: This report demonstrates that tissue obtained from VPT cannot be considered normal "a priori" and that a histological study can be useful to provide new information regarding a woman's gynecological health.

bcl-2; Voluntary pregnancy termination (VPT); Histological examination; Polymerase chain reaction amplification (PCR)

[1] Bennet M.J.. Abortion: “Essentials of Obstetrics Gynecology, 3rd edition, Philadelphia, WB Saunders, 1998, 477.

[2] Sloane R.B.: “The unwanted pregnancy”. N. Engl. J. Med., 1969, 280, 1206.

[3] Freidl W., Greimel E., Polanz A., Egger J., Mayer H.O.: “Induced abortion. A critical life change event”. Zentrabl. Gynakol., 1991, 113, 869.

[4] Fulcheri E., di Capua E., Ragni N.: “Histologic examination of products of conception at the time of pregnancy termination”. Int. J. Gynaecol. Obstet., 2003, 80, 315.

[5] de Roda Husman A.M., Walboomers J.M., van den Brule A.J., Meijer C.J., Snijders P.J.: “The use of general primers GP5 and GP6 elongated at their 3’ ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR”. J. Gen. Virol., 1995, 76, 1057.

[6] Sano T., Oyama T., Kashiwabara K., Fukuda T., Nakajima T.: “Expression status of p16 protein is associated with human papillomavirus oncogenic potential in cervical and genital lesions”. Am. J. Pathol., 1998, 153, 1741.