Don't overtreat HPV in adolescents. (Most Cases Transient).

NEW York -- There is no need to be overly aggressive with surgical or medical interventions for adolescent girls and young adults with cervical human papillomavirus infections, Dr. Liane Deligdisch said.

Dr. Deligdisch, professor of pathology at Mount Sinai School of Medicine, New York, conducted a comparative study of cytologic samples from HPV-positive teens as well as women older than 35 years. While the younger patients had very distinct and definitely abnormal cytology because these abnormalities are largely transient, they did not warrant aggressive intervention.

"In adolescence, HPV has a much more benign nature than previously thought. Most cases are transient and do not need to be overtreated," she said at a conference on pediatric, adolescent, and young adult gynecology sponsored by Mount Sinai.

Dr. Deligdisch and her colleagues made exhaustive analyses of specimens taken from 100 HPV-positive patients seen at Mount Sinai's adolescent colposcopy clinic. This included a group of 14- to 20-year-olds with low-grade squamous intraepithelial lesions (LSIL) and a second group of teens with high-grade intraepithelial lesions (HSIL). These were compared with samples taken from women aged 35-64 years, who had LSIL and HSIL.

"HPV infection looks quite different in adolescents versus adult women," Dr. Deligdisch said. In addition to the koilocytes typically seen in condylomata taken from adults with HPV, infected adolescents also have atypical cells with "enormously large nuclei."

The investigators compared the average size of the 50 largest nuclei found in each cytologic sample. The teens with LSIL averaged 90.8 [mu][m.sup.2], and those with HSIL averaged 93.6 [mu][m.sup.2]. In contrast, in the samples taken from older patients, the averages were 67 [mu][m.sup.2] for LSIL, and 74 [mu][m.sup.2] for HSIL.

The huge nuclei seen in the adolescents "definitely look odd and scary." However, she stressed that these cells are not dysplastic, nor should they be seen as cancer precursors. Just the opposite appears to be true.