THE INCIDENTAL FINDING OF ABNORMAL CERVICAL HISTOLOGY IN POSTMENOPAUSAL PATIENTS

A report is supplied on 216 samples of cervical tissue incidentally fo und in 684 endometrial specimens collected during hysteroscopic examin ation of postmenopausal women with uterine bleeding and a recent negat ive Pap smear. We found 43 (19.9%) specimens including cervical tissue with some histologic sign of pathology. Twenty-five (11.6%) had histo logic features suggestive for human papillomavirus (HPV) infection, wh ile 18 (8.3%) had cervical intraepithelial neoplasia (CIN). Of the 18 CIN cases, 9 were CIN I, 6 CIN II and 3 CIN III. Altogether, the preva lence of dysplasia in postmenopausal women with recently referred norm al cervical cytology was impressive, A significant number of dysplasti c lesions (14 out of 18, 77.7%) did not present any histologic sign of HPV. Also, none of the histologic diagnoses of sub-clinical HPV infec tion was confirmed: by the in situ hybridization. Considering the sign ificant prevalence of high grade lesions (9 CIN II and III, 4.2% of th e analysed samples) found in this randomly selected patient population , our data strongly suggest the need for a regular follow-up of the tr ansformation zone in all postmenopausal women. Although in women of po stmenopausal age some low grade lesions seem to have only a reactive-r eparative significance, a more accurate screening procedure, taking in to account the peculiar modifications of the menopausal uterine cervix , is advisable.