FEMALE GENITAL SCHISTOSOMIASIS (FGS) - RELATIONSHIP BETWEEN GYNECOLOGICAL AND HISTOPATHOLOGICAL FINDINGS

Schistosomiasis of the lower female reproductive tract manifests itsel f in a broad spectrum of clinical features. However, clinical and hist opathological findings have never been studied in a synoptic manner. B ased on the assumption that any type of pathology present in the femal e 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 comprehensi ve manner. Thirty-three women in Malawi with urinary and genital schis tosomiasis were examined parasitologically and gynecologically. A thor ough 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 colp oscopic findings were sandy patches on the cervical surface similar to those seen in the bladder and polypous/papillomatous tumors with irre gular surface on the vaginal wall and in the vulvar area. The histopat hological sections of sandy-patch-like lesions demonstrated only a sma ll cellular reaction around S. haematobium eggs in various stages of d isintegration. In contrast, in the case of polyps the histology reveal ed a more pronounced immunological reaction characterized by a heavy c ellular infiltrate. One case of invasive squamous cell carcinoma of th e cervix was diagnosed. We conclude that colposcopy is a useful tool i n the detection of FGS related pathology in the lower female reproduct ive tract and that the synoptic assessment of surface and of correspon ding histological sections helped to understand the pathophysiology of S. haematobium associated disease in genital tissue.